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Sample records for clinical anaphylaxis treatment

  1. Methylene blue for clinical anaphylaxis treatment: a case report

    Directory of Open Access Journals (Sweden)

    Janine Moreira Rodrigues

    Full Text Available CONTEXT AND OBJECTIVE: Nitric oxide has a pathophysiological role in modulating systemic changes associated with anaphylaxis. Nitric oxide synthase inhibitors may exacerbate bronchospasm in anaphylaxis and worsen clinical conditions, with limited roles in anaphylactic shock treatment. The aim here was to report an anaphylaxis case (not anaphylactic shock, reversed by methylene blue (MB, a guanylyl cyclase inhibitor. CASE REPORT: A 23-year-old female suddenly presented urticaria and pruritus, initially on her face and arms, then over her whole body. Oral antihistamine was administered initially, but without improvement in symptoms and signs until intravenous methylprednisolone 500 mg. Recurrence occurred after two hours, plus vomiting. Associated upper respiratory distress, pulmonary sibilance, laryngeal stridor and facial angioedema (including erythema and lip edema marked the evolution. At sites with severe pruritus, petechial lesions were observed. The clinical situation worsened, with dyspnea, tachypnea, peroral cyanosis, laryngeal edema with severe expiratory dyspnea and deepening unconsciousness. Conventional treatment was ineffective. Intubation and ventilatory support were then considered, because of severe hypoventilation. But, before doing that, based on our previous experience, 1.5 mg/kg (120 mg bolus of 4% MB was infused, followed by one hour of continuous infusion of another 120 mg diluted in dextrose 5% in water. Following the initial intravenous MB dose, the clinical situation reversed completely in less than 20 minutes, thereby avoiding tracheal intubation. CONCLUSION: Although the nitric oxide hypothesis for MB effectiveness discussed here remains unproven, our intention was to share our accumulated cohort experience, which strongly suggests MB is a lifesaving treatment for anaphylactic shock and/or anaphylaxis and other vasoplegic conditions.

  2. Optimal treatment of anaphylaxis: antihistamines versus epinephrine.

    Science.gov (United States)

    Fineman, Stanley M

    2014-07-01

    Anaphylaxis is a rapid, systemic, often unanticipated, and potentially life-threatening immune reaction occurring after exposure to certain foreign substances. The main immunologic triggers include food, insect venom, and medications. Multiple immunologic pathways underlie anaphylaxis, but most involve immune activation and release of immunomodulators. Anaphylaxis can be difficult to recognize clinically, making differential diagnosis key. The incidence of anaphylaxis has at least doubled during the past few decades, and in the United States alone, an estimated 1500 fatalities are attributed to anaphylaxis annually. The increasing incidence and potentially life-threatening nature of anaphylaxis coupled with diagnostic challenges make appropriate and timely treatment critical. Epinephrine is universally recommended as the first-line therapy for anaphylaxis, and early treatment is critical to prevent a potentially fatal outcome. Despite the evidence and guideline recommendations supporting its use for anaphylaxis, epinephrine remains underused. Data indicate that antihistamines are more commonly used to treat patients with anaphylaxis. Although histamine is involved in anaphylaxis, treatment with antihistamines does not relieve or prevent all of the pathophysiological symptoms of anaphylaxis, including the more serious complications such as airway obstruction, hypotension, and shock. Additionally, antihistamines do not act as rapidly as epinephrine; maximal plasma concentrations are reached between 1 and 3 hours for antihistamines compared with < 10 minutes for intramuscular epinephrine injection. This demonstrates the need for improved approaches to educate physicians and patients regarding the appropriate treatment of anaphylaxis.

  3. Anaphylaxis

    Directory of Open Access Journals (Sweden)

    Kim Harold

    2011-11-01

    Full Text Available Abstract Anaphylaxis is an acute, potentially fatal systemic reaction with varied mechanisms and clinical presentations. Although prompt recognition and treatment of anaphylaxis are imperative, both patients and healthcare professionals often fail to recognize and diagnose early signs and symptoms of the condition. Clinical manifestations vary widely, however, the most common signs are cutaneous symptoms, including angioedema, urticaria, erythema and pruritus. Immediate intramuscular administration of epinephrine into the lateral thigh is first-line therapy, even if the diagnosis is uncertain. The mainstays of long-term management include specialist assessment, avoidance measures, and the provision of an epinephrine auto-injector and an individualized anaphylaxis action plan. This article provides an overview of the causes, clinical features, diagnosis and acute and long-term management of this serious allergic reaction.

  4. Anaphylaxis.

    Science.gov (United States)

    Hernandez, Lorenzo; Papalia, Sarah; Pujalte, George G A

    2016-09-01

    Anaphylaxis is an acute, systemic reaction mediated by immunoglobulin E hypersensitivity. Release of bioactive factors causes vasodilation and bronchiole constriction that can lead to hypotensive shock and asphyxiation. Differential diagnosis includes acute asthma, localized angioedema, syncope, and anxiety/panic attacks. Diagnostic tests lack specificity. Clinical diagnosis is based on demonstration of specific airway or cardiovascular compromise within proximity of allergen exposure. Treatment includes epinephrine, antihistamines, fluid resuscitation, and airway management. Prevention focuses on awareness/avoidance of triggers, implementation of personalized action plans, as well as immune modulation by desensitization in a closely controlled setting where available.

  5. Treatment of food anaphylaxis with traditional Chinese herbal remedies – from mouse model to human clinical trials

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    Wang, Julie

    2014-01-01

    Purpose of review To describe the development of a novel treatment for food allergy, named the food allergy herbal formula-2 (FAHF-2), that is based on Traditional Chinese Medicine. Recent findings FAHF-2 has proven to be safe and effective for the treatment of food allergies in murine models of peanut and multiple food allergies. These results are accompanied by evidence of favorable immune modulation, and the effects are persistent after discontinuation of treatment. Early clinical trials demonstrate the safety and tolerability of this formula in subjects with food allergies. An on-going Phase II clinical trial will evaluate the efficacy of FAHF-2 in protecting individuals from allergen-induced allergic reactions during oral food challenges. Summary FAHF-2 is an herbal formula that has a high safety profile and has shown to prevent anaphylaxis in murine models of food allergy. Similar findings in clinical trials could bring a novel treatment for food allergies. PMID:23799334

  6. Anaphylaxis

    DEFF Research Database (Denmark)

    Muraro, A; Roberts, G; Worm, M

    2014-01-01

    features. First-line treatment for anaphylaxis is intramuscular adrenaline. Useful second-line interventions may include removing the trigger where possible, calling for help, correct positioning of the patient, high-flow oxygen, intravenous fluids, inhaled short-acting bronchodilators, and nebulized...... adrenaline. Discharge arrangements should involve an assessment of the risk of further reactions, a management plan with an anaphylaxis emergency action plan, and, where appropriate, prescribing an adrenaline auto-injector. If an adrenaline auto-injector is prescribed, education on when and how to use...

  7. Anaphylaxis

    Institute of Scientific and Technical Information of China (English)

    Aziz Sheikh; Samantha Walker

    2006-01-01

    @@ A 60 year old man attends to discuss his recent allergic reaction to an insect sting. He presents you with the casualty letter which reads: "Treated for anaphylaxis after bee sting-see GP for follow-up."

  8. Anaphylaxis and urticaria.

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    Williams, Kelli W; Sharma, Hemant P

    2015-02-01

    Anaphylaxis and urticaria are common presenting allergic complaints. Affecting up to 2% of the population, anaphylaxis is a serious, life-threatening allergic reaction. Although not life-threatening, urticaria is a rash of transient, erythematous, pruritic wheals that can be bothersome and affects up to 25% of the population. All cases of anaphylaxis warrant thorough clinical evaluation by the allergist-immunologist, although most cases of urticaria are self-limited and do not require specialist referral. This article offers an overview of our current knowledge on the epidemiology, pathogenesis, triggers, diagnosis, and treatment of anaphylaxis and urticaria.

  9. Perioperative anaphylaxis

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    Marta Inés Berrío Valencia

    2015-08-01

    Full Text Available BACKGROUND AND OBJECTIVE: Anaphylaxis remains one of the potential causes of perioperative death, being generally unanticipated and quickly progress to a life threatening situation. A narrative review of perioperative anaphylaxis is performed.CONTENT: The diagnostic tests are primarily to avoid further major events. The mainstays of treatment are adrenaline and intravenous fluids.CONCLUSION: The anesthesiologist should be familiar with the proper diagnosis, management and monitoring of perioperative anaphylaxis.

  10. Treatment with Epinephrine (Adrenaline) in Suspected Anaphylaxis during Anesthesia in Denmark

    DEFF Research Database (Denmark)

    Garvey, Lene H; Belhage, Bo; Krøigaard, Mogens

    2011-01-01

    BACKGROUND:: Literature on the use of epinephrine in the treatment of anaphylaxis during anesthesia is very limited. The objective of this study was to investigate how often epinephrine is used in the treatment of suspected anaphylaxis during anesthesia in Denmark and whether timing of treatment ...

  11. Why Do People Die of Anaphylaxis?—A Clinical Review

    Directory of Open Access Journals (Sweden)

    M. Eric Gershwin

    2005-01-01

    Full Text Available Anaphylaxis is a source of anxiety for patients and healthcare providers. It is a medical emergency that presents with a broad array of symptoms and signs, many of which can be deceptively similar to other diseases such as myocardial infarction, asthma, or panic attacks. In addition to these diagnostic challenges, anaphylaxis presents management difficulties due to rapid onset and progression, lack of appropriate self-treatment education and implementation by patients, severity of the allergic response, exacerbating medications or concurrent disease, and unpredictability. The most common causes of anaphylaxis are food allergies, stinging insects and immunotherapy (allergy shots but idiopathic anaphylaxis, latex allergy and drug hypersensitive all contribute to the epidemiology. Reactions to IVP and other dyes are coined anaphylactoid reactions but have identical pathophysiology and treatment, once the mast cell has been degranulated. As many antigens can be the trigger for fatal anaphylaxis, it is useful to examine the features of each etiology individually, highlighting factors common to all fatal anaphylaxis and some specific to certain etiologies. Generally what distinguishes a fatal from non fatal reaction is often just the rapidity to apply correct therapy. Prevention is clearly the key and should identify high-risk patients in an attempt to minimize the likely of a severe reaction. Although fatal anaphylaxis is rare, it is likely underreported.

  12. Anaphylaxis in referred pediatric patients: demographic and clinical features, triggers, and therapeutic approach.

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    De Swert, Liliane F A; Bullens, Dominique; Raes, Marc; Dermaux, Anna-Maria

    2008-11-01

    Anaphylaxis remains under-diagnosed and under-treated. A better knowledge of patterns and triggers of anaphylaxis might contribute to a better management. In this study we evaluated the demographic and clinical features of anaphylaxis in pediatric patients, as well as its triggers and therapeutic approach. From May 1st 2004 until April 30th 2006 we prospectively collected data on all patients referred for investigation of anaphylaxis to the pediatric department of the University Hospital Gasthuisberg Leuven and to two private pediatric practices. Data were stored in a MYSQL database by use of an online encrypted web form. Sixty-four cases of anaphylaxis occurred in 48 children, aged 6 months to 14.8 years. Twenty-seven episodes (42.2%) occurred at home. The symptoms were dermatologic in 62 (96.9%) episodes, respiratory in 57 (89.1%), gastrointestinal in 19 (29.7%), cardiovascular in 14 (21.8%), and neurological or behavioural in 19 (29.7%). Antihistamines were administered in 41/57 (71.9%) cases, corticosteroids in 26/57 (45.6%), beta-2-mimetics in 14/57 (24.6%), and adrenaline in 11/57 (19.3%). Out of nine cases where Epipen was available at the moment of anaphylaxis, it was administered in one case only. Food was the cause of anaphylaxis in 42/55 (76.4%) cases with identified trigger, while medication, insect stings, latex, and birch pollen triggered 5 (9.1%), 4 (7.3%), 3 (5.5%), and 1 (1.8%) case(s), respectively. Allergy to the trigger was known prior to anaphylaxis in 19/55 (34.5%) cases. In conclusion, anaphylaxis in pediatric patients generally presents with dermatologic and respiratory symptoms, while in 1/5 episodes cardiovascular symptoms occur. Food is by far the most frequent trigger. Allergy to the trigger is known in 1/3 cases only. Anaphylaxis is under-treated, even when appropriate medication is available.

  13. Perioperative anaphylaxis.

    LENUS (Irish Health Repository)

    Mertes, P M

    2010-07-01

    The incidence of immune-mediated anaphylaxis during anesthesia ranges from 1 in 10,000 to 1 in 20,000. Neuromuscular blocking agents are most frequently incriminated, followed by latex and antibiotics, although any drug or substance used may be a culprit. Diagnosis relies on tryptase measurements at the time of the reaction and skin tests, specific immunoglobulin E, or basophil activation assays. Treatment consists of rapid volume expansion and epinephrine administration titrated to symptom severity.

  14. Successful treatment of acute systemic anaphylaxis in a western lowland gorilla (Gorilla gorilla gorilla).

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    Hayman, David T S; King, Tony; Cameron, Kenneth

    2010-09-01

    This brief communication describes the successful treatment of acute systemic anaphylaxis in a wild-born but captive infant western lowland gorilla (Gorilla gorilla gorilla) in the Republic of Congo. The infant demonstrated signs of acute respiratory distress, lingual swelling, and reaction to intradermal tuberculin, given 55 hr earlier. Details of the treatment with steroids, anesthetic induction, and i.v. epinephrine are all reported, and potential antigens that may have initiated the anaphylactic shock are discussed.

  15. Anafilaxia Anaphylaxis

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    C. Rubio

    2003-01-01

    Full Text Available La anafilaxia es un cuadro clínico potencialmente mortal, infradiagnosticado. Los agentes desencadenantes más frecuentes son los fármacos y los alimentos. El tratamiento inmediato correcto con adrenalina, aunque se sabe que está claramente indicado, no se realiza con la frecuencia deseada debido fundamentalmente al elevado número de casos de anafilaxia que no se diagnostican como tales. En los pacientes que ya han sufrido un primer episodio de anafilaxia, el diagnóstico etiológico posterior es crucial para evitar la aparición de nuevos episodios. La única situación de anafilaxia en la que hay que valorar inmunoterapia con el alergeno, es aquella en la que el agente causal es el veneno de himenópteros.Anaphlaxis is a potentially mortal, underdiagnosed clinical picture. The most frequent triggering agents are drugs and foodstuffs. The first therapeutic option, adrenaline, although clearly indicated, is not carried out with the desired frequency due basically to the high number of cases of anaphylaxis that are not diagnosed as such. In patients with a first episode of anaphylaxis, posterior aetiological diagnosis is crucial to avoid the appearance of new episodes. The only case of anaphylaxis in which immunotherapy with the allergen must be evaluated, is that in which the causal agent is the poison of hymenopters.

  16. [Approach and Registry of Anaphylaxis in Portugal].

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    Mota, Inês; Pereira, Ana Margarida; Pereira, Celso; Tomaz, Elza; Ferreira, Manuel Branco; Sabino, Filipa; Coelho, Anabela; Santos, Anabela; Martins, Henrique; Morais-Almeida, Mário

    2015-01-01

    Anaphylaxis has a growing incidence, especially in children. It represents a medical emergency and its successful therapy depends on early and proper intervention. Intramuscular epinephrine, with dose adjustment according to weight and age, is the drug of choice for anaphylaxis treatment. After resolution of the acute reaction, the patient should be kept under clinical surveillance for 6 to 24 hours, due to possible biphasic reactions. Prescription of an epinephrine auto injectable device should be considered in all patients with diagnosed or suspected anaphylaxis; additionally these patients should always be referred to an Immunoallergy consultation, to perform adequate investigation and management in order to reduce future risk. All anaphylaxis episodes must be recorded in The Portuguese Catalogue of Allergies and other Adverse Reactions (Catálogo Português de Alergias e outras Reações Adversas, CPARA), which represents a fundamental tool to share clinical information within the Health System. The present manuscript intends to disclose the most recent Portuguese guidelines for the diagnosis and treatment of anaphylaxis, making its clinical approach more effective and homogeneous, and to promote the use of The Portuguese Catalogue of Allergies and other Adverse Reactions as an essential tool to register and share information on anaphylaxis in Portugal.

  17. Epinephrine (adrenaline) in the first-aid, out-of-hospital treatment of anaphylaxis.

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    Simons, F Estelle R

    2004-01-01

    Epinephrine (adrenaline), the initial treatment of choice for systemic anaphylaxis, is an alpha- and beta-adrenergic agonist with bidirectional, cyclic adenosine monophosphate-mediated pharmacological effects on target organs, and a narrow therapeutic index. In a recent study, 0.95% of a geographically-defined population was found to have had epinephrine dispensed for out-of-hospital use; dispensing rates within this population varied from 1.44% for individuals under age 17 years to 0.32% for those older than 65 years. Although epinephrine is widely available in the community, it is not necessarily given in a timely manner when anaphylaxis occurs. Individuals with anaphylaxis may fail to respond to first-aid treatment with epinephrine for a variety of reasons. These include: (1) delay in treatment (in an animal model, epinephrine injection at the nadir of shock fails to provide sustained haemodynamic recovery); (2) administration of epinephrine by sub-optimal routes such as subcutaneous injection or inhalation from a pressurized metered-dose inhaler instead of intramuscular injection; (3) administration of an inappropriately low epinephrine dose due to the limitations currently imposed by the availability of only two fixed-dose auto-injectors: EpiPen Jr 0.15 mg or EpiPen 0.3 mg; and (4) injection of 'outdated' epinephrine, with inadvertent administration of an inadequate dose. Additional fixed-dose formulations of epinephrine are needed to facilitate optimal first-aid dosing in patients of all ages and sizes.

  18. Fatal asthma or anaphylaxis?

    OpenAIRE

    Rainbow, J; Browne, G

    2002-01-01

    The incidence of anaphylaxis is under-reported. Children with asthma are frequently atopic and prone to allergic reactions. Parents and clinicians may attribute wheeze of rapid onset to acute severe asthma, rather than recognising an anaphylactic event. Two cases of fatal anaphylaxis are reported who were initially diagnosed as acute severe asthma, and responded poorly to bronchodilator treatment. Survivors of "acute asphyxic asthma" should be screened for reactions to common allergens that p...

  19. Management of anaphylaxis

    DEFF Research Database (Denmark)

    Dhami, S; Panesar, S S; Roberts, G

    2014-01-01

    time series and - only in relation to adrenaline - case series investigating the effectiveness of interventions in managing anaphylaxis. Fifty-five studies satisfied the inclusion criteria. We found no robust studies investigating the effectiveness of adrenaline (epinephrine), H1-antihistamines......, systemic glucocorticosteroids or methylxanthines to manage anaphylaxis. There was evidence regarding the optimum route, site and dose of administration of adrenaline from trials studying people with a history of anaphylaxis. This suggested that administration of intramuscular adrenaline into the middle...... of vastus lateralis muscle is the optimum treatment. Furthermore, fatality register studies have suggested that a failure or delay in administration of adrenaline may increase the risk of death. The main long-term management interventions studied were anaphylaxis management plans and allergen...

  20. Anaphylaxis Conundrum: A Trojan Horse Phenomenon.

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    Esquivel, Ann; Busse, William W

    2016-10-17

    Anaphylaxis is a serious and potentially life-threatening allergic reaction that may follow the ingestion of foods. Although these reactions usually follow a common clinical pattern and often demonstrate IgE sensitization to the antigen in question, both the clinical presentation and causative allergen may be atypical, surprising, and difficult to identify. Failure to identify the actual cause of the reaction can compromise treatment and complicate long-term care. Here, we present a patient who had symptoms of anaphylaxis after eating salmon, but confirmation of the causative allergen was not readily apparent. This particular case serves as an insightful lesson for patients undergoing evaluation for anaphylaxis and also provides a framework for navigating through a case involving identification of an underlying allergen.

  1. [Anaphylaxis caused by human seminal fluid].

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    Rubira, N; Roger, A; Nogueiras, C; Server, T; Guspi, R; Cadahia, A

    1995-01-01

    Anaphylaxis to human seminal fluid (HSF) is rare. We present an atopic woman with postcoital cutaneous and respiratory symptoms. Prick by prick to HSF was positive. CAP to FSH was also positive (4 KU/l). The clinical findings, differential diagnosis and different treatments are discussed.

  2. Anaphylaxis related to fentanyl citrate

    Directory of Open Access Journals (Sweden)

    Gaurav Singh Tomar

    2012-01-01

    Full Text Available Anaphylaxis is a fulminant, unexpected, immunoglobulin E-mediated allergic reaction that can be triggered by multiple agents. Common causative agents include neuromuscular blocking drugs, latex, antibiotics, colloids, hypnotics, and opioids. Fentanyl citrate, however, is an extremely unusual cause of anaphylaxis. Pulmonary edema, although uncommon in anaphylaxis, can be a prominent feature, as was in one of the patient. An adverse drug reaction is a noxious or unintended reaction to a drug that is administered in standard doses by the proper route for the purpose of prophylaxis, diagnosis, or treatment. Reactions are classified into two major subtypes: type A, which are dose dependent and predictable; and type B, which are not dose dependent and unpredictable. Unpredictable reactions include immune (allergic or no immune drug hypersensitivity reactions and are related to genetic susceptibilities or undefined mechanisms (formally called idiosyncratic and intolerance reactions. A drug allergy is always associated with an immune mechanism for which evidence of drug-specific antibodies or activated T lymphocytes can be shown. In the last few years, many novel drugs have entered clinical practice (i.e., biologic agents generating novel patterns of drug hypersensitivity reactions. As old drugs continue to be used, new clinical and biologic techniques enable improvement in the diagnosis of these reactions.

  3. Precision medicine in allergic disease-food allergy, drug allergy, and anaphylaxis-PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology.

    Science.gov (United States)

    Muraro, A; Lemanske, R F; Castells, M; Torres, M J; Khan, D; Simon, H-U; Bindslev-Jensen, C; Burks, W; Poulsen, L K; Sampson, H A; Worm, M; Nadeau, K C

    2017-01-25

    This consensus document summarizes the current knowledge on the potential for precision medicine in food allergy, drug allergy, and anaphylaxis under the auspices of the PRACTALL collaboration platform. PRACTALL is a joint effort of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology, which aims to synchronize the European and American approaches to allergy care. Precision medicine is an emerging approach for disease treatment based on disease endotypes, which are phenotypic subclasses associated with specific mechanisms underlying the disease. Although significant progress has been made in defining endotypes for asthma, definitions of endotypes for food and drug allergy or for anaphylaxis lag behind. Progress has been made in discovery of biomarkers to guide a precision medicine approach to treatment of food and drug allergy, but further validation and quantification of these biomarkers are needed to allow their translation into practice in the clinical management of allergic disease.

  4. Navigating the Updated Anaphylaxis Parameters

    Directory of Open Access Journals (Sweden)

    Kemp Stephen F

    2007-06-01

    Full Text Available Anaphylaxis, an acute and potentially lethal multi-system clinical syndrome resulting from the sudden, systemic degranulation of mast cells and basophils, occurs in a variety of clinical scenarios and is almost unavoidable inmedical practice. Healthcare professionalsmust be able to recognize its features, treat an episode promptly and appropriately, and be able to provide recommendations to prevent future episodes. Epinephrine, administered immediately, is the drug of choice for acute anaphylaxis. The discussion provides an overview of one set of evidence-based and consensus parameters for the diagnosis and management of anaphylaxis.

  5. Anaphylaxis in Israel: experience with 92 hospitalized children.

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    Hoffer, V; Scheuerman, O; Marcus, N; Levy, Y; Segal, N; Lagovsky, I; Monselise, Y; Garty, B Z

    2011-03-01

    Little is known about the courses, causes, and clinical features of anaphylaxis in children outside the USA and Europe. Our objective was to evaluate the events of anaphylaxis in children admitted to the Schneider Children's Medical Center of Israel, a major tertiary facility, over a 12-year period. Ninety-two children with anaphylaxis (50 boys, 42 girls) aged 14 days to 18 yr (mean, 7.4 yr) were hospitalized during the study period. The event occurred at home in 52 children (56%), in a medical institution in 24 (26%), outdoors in 13 (15%), at school in 2 (2%), and in an unspecified location in 1 (1%). The main causes were foods (43%), mainly milk and nuts, medications (22%), and hymenoptera venom (11%); in five children, anaphylaxis occurred during general anesthesia, and in 5, the causative agent could not be determined. Food-induced anaphylaxis tended to occur in younger children. Forty-eight children (52%) had a history of atopy (mainly asthma). Hospital treatment consisted of corticosteroids (85%), antihistamines (75%), epinephrine (72%), and β2 agonists (42%). Seven patients were admitted to intensive care units. There were no fatalities. EpiPen was used by only one of the 16 patients with more than one episode of anaphylaxis, indicating that patient and parent education in the application of the EpiPen needs to be improved.

  6. Precision Medicine in Allergic Disease - Food Allergy, Drug Allergy, and Anaphylaxis-PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma & Immunology

    DEFF Research Database (Denmark)

    Muraro, Antonella; Lemanske, Robert F; Castells, Mariana

    2017-01-01

    This consensus document summarizes the current knowledge on the potential for precision medicine in food allergy, drug allergy and anaphylaxis under the auspices of the PRACTALL collaboration platform. PRACTALL is a joint effort of the European Academy of Allergy and Clinical Immunology (EAACI...... underlying the disease. Although significant progress has been made in defining endotypes for asthma, definitions of endotypes for food and drug allergy or for anaphylaxis lag behind. Progress has been made in discovery of biomarkers to guide a precision medicine approach to treatment of food and drug......) and the American Academy of Allergy, Asthma and Immunology (AAAAI), which aims to synchronize the European and American approaches to allergy care. Precision medicine is an emerging approach for disease treatment based on disease endotypes, which are phenotypic subclasses associated with specific mechanisms...

  7. Training and administration of epinephrine auto-injectors for anaphylaxis treatment in US schools: results from the EpiPen4Schools® pilot survey

    Directory of Open Access Journals (Sweden)

    Hogue SL

    2016-06-01

    Full Text Available Susan L Hogue,1 Diana Goss,1 Kelly Hollis,1 Suyapa Silvia,2 Martha V White3 1Health Solutions, RTI International, Research Triangle Park, NC, 2Education and Workforce Development, RTI International, Research Triangle Park, NC, 3Institute for Asthma and Allergy, Wheaton, MD, USA Background: Anaphylaxis is a serious, potentially life-threatening condition. Adequate preparation for anaphylaxis management is imperative for school personnel. This descriptive pilot study assessed preparedness of US schools to manage anaphylactic reactions. Methods: An exploratory, cross-sectional, web-based, pilot survey assessed the occurrence and characteristics of anaphylactic events, as well as training provided to school personnel for the recognition and treatment of anaphylaxis. Eligible US schools were participants in the EpiPen4Schools® program during the 2013–2014 school year. EpiPen4Schools provides EpiPen® (epinephrine injection Auto-Injectors and training materials to qualifying US schools. Survey data were parsed by US Census Bureau region and state and were evaluated using descriptive statistics. Results: Schools from all 50 states and the District of Columbia participated in the survey (N=6,019. Among schools that provided information on anaphylactic events, 11% (607/5,683 reported the occurrence of one or more events, with significant variability in incidence across census regions and among states. A total of 5,613 schools provided information regarding which staff members were trained to recognize the signs and symptoms of anaphylaxis. Thirty-six percent of schools (2,022/5,613 indicated that only the school nurse and select staff were trained in anaphylaxis recognition. The proportion of schools in which most or all school staff received such training differed by region/state (range, 13%–100%. A total of 5,578 schools provided information on which staff were permitted to administer epinephrine. The majority of schools (54%; 3

  8. Training and administration of epinephrine auto-injectors for anaphylaxis treatment in US schools: results from the EpiPen4Schools® pilot survey

    Science.gov (United States)

    Hogue, Susan L; Goss, Diana; Hollis, Kelly; Silvia, Suyapa; White, Martha V

    2016-01-01

    Background Anaphylaxis is a serious, potentially life-threatening condition. Adequate preparation for anaphylaxis management is imperative for school personnel. This descriptive pilot study assessed preparedness of US schools to manage anaphylactic reactions. Methods An exploratory, cross-sectional, web-based, pilot survey assessed the occurrence and characteristics of anaphylactic events, as well as training provided to school personnel for the recognition and treatment of anaphylaxis. Eligible US schools were participants in the EpiPen4Schools® program during the 2013–2014 school year. EpiPen4Schools provides EpiPen® (epinephrine injection) Auto-Injectors and training materials to qualifying US schools. Survey data were parsed by US Census Bureau region and state and were evaluated using descriptive statistics. Results Schools from all 50 states and the District of Columbia participated in the survey (N=6,019). Among schools that provided information on anaphylactic events, 11% (607/5,683) reported the occurrence of one or more events, with significant variability in incidence across census regions and among states. A total of 5,613 schools provided information regarding which staff members were trained to recognize the signs and symptoms of anaphylaxis. Thirty-six percent of schools (2,022/5,613) indicated that only the school nurse and select staff were trained in anaphylaxis recognition. The proportion of schools in which most or all school staff received such training differed by region/state (range, 13%–100%). A total of 5,578 schools provided information on which staff were permitted to administer epinephrine. The majority of schools (54%; 3,024/5,578) permitted only the school nurse and select staff to administer epinephrine, although percentages varied by region/state (range, 4%–100%). Conclusion Schools differed substantially in their preparedness to manage anaphylaxis, with significant disparities in staff training and permission to treat. Given

  9. Human IgE-independent systemic anaphylaxis.

    Science.gov (United States)

    Finkelman, Fred D; Khodoun, Marat V; Strait, Richard

    2016-06-01

    Anaphylaxis is a rapidly developing, life-threatening, generalized or systemic allergic reaction that is classically elicited by antigen crosslinking of antigen-specific IgE bound to the high-affinity IgE receptor FcεRI on mast cells and basophils. This initiates signals that induce cellular degranulation with release and secretion of vasoactive mediators, enzymes, and cytokines. However, IgE-independent mechanisms of anaphylaxis have been clearly demonstrated in experimental animals. These include IgG-dependent anaphylaxis, which involves the triggering of mediator release by IgG/antigen complex crosslinking of FcγRs on macrophages, basophils, and neutrophils; anaphylaxis mediated by binding of the complement-derived peptides C3a and C5a to their receptors on mast cells, basophils, and other myeloid cells; and direct activation of mast cells by drugs that interact with receptors on these cells. Here we review the mechanisms involved in these IgE-independent forms of anaphylaxis and the clinical evidence for their human relevance. We conclude that this evidence supports the existence of all 3 IgE-independent mechanisms as important causes of human disease, although practical and ethical considerations preclude their demonstration to the degree of certainty possible with animal models. Furthermore, we cite evidence that different clinical situations can suggest different mechanisms as having a primal role in anaphylaxis and that IgE-dependent and distinct IgE-independent mechanisms can act together to increase anaphylaxis severity. As specific agents become available that can interfere with mechanisms involved in the different types of anaphylaxis, recognition of specific types of anaphylaxis is likely to become important for optimal prophylaxis and therapy.

  10. Prevention of anaphylaxis in healthcare settings.

    Science.gov (United States)

    Worth, Allison; Sheikh, Aziz

    2013-09-01

    In this paper, we review recent evidence on preventing anaphylaxis in healthcare settings and contexts where the risk of developing anaphylaxis is known to be increased. These include investigation units in which patients are undergoing challenge testing, outpatient clinics undertaking immunotherapy and vaccination, inpatient settings in which patients receive antibiotics, non-steroidal anti-inflammatory drugs, opiates and biological agents and operating theatres in which patients receive general anesthetics. Anaphylaxis may however develop unpredictably in any patient exposed to a wide range of drugs, food and other triggers (e.g., latex, iodinated contrast media and exercise), so it is important that all healthcare professionals and systems have effective, well-rehearsed protocols for risk assessment and management of this allergic emergency. Where available, we consider evidence for the effectiveness of interventions aiming to reduce the risk of developing anaphylaxis.

  11. Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow-up of anaphylaxis during anaesthesia

    DEFF Research Database (Denmark)

    Kroigaard, M; Garvey, L H; Gillberg, L;

    2007-01-01

    titration of adrenaline (epinephrine) and fluid therapy as first-line treatment. Recommendations for primary and secondary follow-up are given, bearing in mind that there are variations in geography and resources in the different countries. A list of National Centres from which anaesthesiologists can seek....... It is hoped that increased focus on the subject will lead to prompt diagnosis, rapid and correct treatment, and standardised management of patients with anaphylactic reactions during anaesthesia across Scandinavia. The recommendations are based on the best available evidence in the literature, which, owing...

  12. Implementation of anaphylaxis management guidelines: a register-based study.

    Directory of Open Access Journals (Sweden)

    Linus Grabenhenrich

    Full Text Available BACKGROUND: Anaphylaxis management guidelines recommend the use of intramuscular adrenaline in severe reactions, complemented by antihistamines and corticoids; secondary prevention includes allergen avoidance and provision of self-applicable first aid drugs. Gaps between recommendations and their implementation have been reported, but only in confined settings. Hence, we analysed nation-wide data on the management of anaphylaxis, evaluating the implementation of guidelines. METHODS: Within the anaphylaxis registry, allergy referral centres across Germany, Austria and Switzerland provided data on severe anaphylaxis cases. Based on patient records, details on reaction circumstances, diagnostic workup and treatment were collected via online questionnaire. Report of anaphylaxis through emergency physicians allowed for validation of registry data. RESULTS: 2114 severe anaphylaxis patients from 58 centres were included. 8% received adrenaline intravenously, 4% intramuscularly; 50% antihistamines, and 51% corticoids. Validation data indicated moderate underreporting of first aid drugs in the Registry. 20% received specific instructions at the time of the reaction; 81% were provided with prophylactic first aid drugs at any time. CONCLUSION: There is a distinct discrepancy between current anaphylaxis management guidelines and their implementation. To improve patient care, a revised approach for medical education and training on the management of severe anaphylaxis is warranted.

  13. Managing nut-induced anaphylaxis: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Lomas JM

    2015-10-01

    Full Text Available Jeanne M Lomas, Kirsi M Järvinen Division of Pediatric Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA Abstract: The prevalence of peanut and tree nut allergy in the USA has increased, especially in the pediatric population. Nut allergy remains the leading cause of fatal anaphylactic reactions. Management of anaphylaxis includes not only treatment of symptoms during a reaction, but strict dietary avoidance and education on potential situations, which may place the patient at high risk for accidental exposure. Cross-reactivity between various nuts along with various cross-contamination sources should be discussed with all nut-allergic individuals. Exciting research continues to emerge on other potential treatments for patients allergic to nuts, including allergen immunotherapy. Results of such interventions have been encouraging, though further studies are needed regarding safety and long-term outcomes before these can be applied to clinical practice. Keywords: peanut, tree nut, anaphylaxis, cross-reactivity, avoidance, immunotherapy

  14. Antigen-induced bronchial anaphylaxis in actively sensitized guinea-pigs: effect of long-term treatment with sodium cromoglycate and aminophylline.

    Science.gov (United States)

    Andersson, P.; Bergstrand, H.

    1981-01-01

    1 The effects of long-term treatment with sodium cromoglycate (SCG) and aminophylline on antigen-induced bronchoconstriction have been studied in guinea-pigs actively sensitized according to two different regimens (one producing IgE- and IgG-like antibodies and the other producing exclusively IgG-like antibodies). 2 Treatment for three weeks with SCG (10 mg/kg) and aminophylline (10, 30 or 60 mg/kg) led to a decreased bronchial response capacity which persisted even three days after treatment ceased. In this respect SCG was effective only in guinea-pigs sensitized to produce at least partly IgE-like antibodies; aminophylline was effective in guinea-pigs sensitized to produce both IgE and/or IgG antibodies. 3 The results in vivo with SCG were reflected in vitro by a reduced capacity of chopped lung tissue to release histamine at antigen challenge; lungs from animals treated with aminophylline did not show reduced histamine releasing capacity. 4 Acute treatment with atropine was shown to reduce significantly the antigen-induced bronchial contraction in guinea-pigs sensitized to produce both IgE- and IgG-antibodies. No effect of atropine was seen on an IgG-mediated anaphylaxis. 5 Increased reactivity to methacholine but not to histamine was seen in guinea-pigs sensitized to produce both IgG- and IgE-antibodies. Long-term treatment with SCG did not affect this hyperreactivity to methacholine. 6 Decreased reactivity to isoprenaline was found in isolated tracheae taken from guinea-pigs sensitized to produce both IgE- and IgG-like antibodies compared to unsensitized guinea-pigs. Long-term treatment with SCG, but not with aminophylline, reversed this decreased reactivity. PMID:6170376

  15. Autoimmune Progesterone Anaphylaxis

    Directory of Open Access Journals (Sweden)

    Mohammad Hassan Bemanian

    2007-06-01

    Full Text Available Progesterone induced dermatitis is a rare disorder. It typically occurs in females due to anautoimmune phenomenon to endogenous progesterone production, but can also be caused byexogenous intake of a synthetic progestin. Here in, we present a case of autoimmune progesterone anaphylaxis (AIPA observed in an adolescent female.The patient is an 18-year-old Caucasian female with no significant past medical history and noprior exogenous hormone use, who presented to her primary care physician complaining of cyclic skin eruptions with dyspnea, cough and respiratory distress. She noted that her symptoms occurred monthly, just prior to her menses. An intradermal skin test using 0.1 cml of progesterone was performed. The patient developed a 15mm wheal after 15 minutes, confirming the diagnosis of AIPA.The patient was started on a continuous regimen of an oral conjugated estrogen (0.625mg. The skin eruptions and respiratory symptoms have not returned since the initiation of this therapy.Autoimmune progesterone dermatitis manifests via the occurrence of cyclic skin eruptions.Women with the disorder commonly present with dermatologic lesions in the luteal phase of themenstrual cycle, if there are any other organ involvement in addition to skin (e.g. lung, GI thereaction should be called as autoimmune progesterone anaphylaxis. Diagnosis of AIPA is confirmed by performing a skin allergen test using progesterone.

  16. Anaphylaxis Due to Head Injury

    Directory of Open Access Journals (Sweden)

    Bruner, Heather C.

    2015-05-01

    Full Text Available Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury. [West J Emerg Med. 2015;16(3:435–437.

  17. Perioperative Anaphylaxis to Chlorhexidine during Surgery and Septoplasty

    Science.gov (United States)

    Teixeira de Abreu, Ana Paula; Ribeiro de Oliveira, Leonardo Ramos; Teixeira de Abreu, Ana Flavia; Ribeiro de Oliveira, Evandro; Santos de Melo Ireno, Michele; Aarestrup, Matheus Fonseca; Aarestrup, Paula Fonseca

    2017-01-01

    Chlorhexidine is an antiseptic and disinfectant used in surgical and clinical practice since 1954 and is available in aqueous or alcoholic solutions 0.5%–4.0% and has a broad-spectrum activity. Despite their widespread use, allergic reactions with chlorhexidine are rarely reported. We describe a case of anaphylaxis with chlorhexidine during a septoplasty, turbinectomy, and maxillary sinusectomy. The patient presented with periorbital edema, hives, hypotension, and wheezing. Immediately after the diagnosis of anaphylaxis promethazine, hydrocortisone, and epinephrine were administered with immediate clinical improvement. This case highlights the importance of assessing whether there is a previous clinical history of hypersensitivity to chlorhexidine in patients who will undergo surgical procedures.

  18. Clinical Characteristics of Anaphylaxis Induced by Honeybee Venom%蜜蜂蜂毒致严重过敏反应临床特征

    Institute of Scientific and Technical Information of China (English)

    关凯; 李丽莎; 王瑞琦; 尹佳

    2016-01-01

    目的:探讨蜜蜂蜂毒致严重过敏反应的临床特点。方法回顾性分析2010年至2016年在北京协和医院确诊为蜜蜂蜂毒致严重过敏反应的患者临床资料,根据蜇刺后各系统症状和体征分为Ⅰ~Ⅳ级严重过敏反应,分析患者生活地域、暴露类型等特点,初步探索变应原组分对鉴别蜜蜂蜂毒和胡蜂蜂毒交叉反应、双重过敏的临床意义。结果30例蜜蜂蜂毒致严重过敏反应患者的男女之比为12∶18(2∶3),平均年龄35(27,38)岁。70.0%(21/30)来自京津冀地区,23.3%(7/30)生活在市区,76.7%(23/30)生活在郊区。各级严重过敏反应构成:Ⅰ级20.0%(6/30),Ⅱ级26.7%(8/30),Ⅲ级40.0%(12/30),Ⅳ级13.3%(4/30)。蜜蜂蜂毒暴露类型:自然性6.7%(2/30),职业性86.7%(26/30),医源性6.7%(2/30),其中养蜂者高达86.7%。30例患者 i1(蜜蜂蜂毒) sIgE 检测结果为12.80(2.80,33.50) kUA/L,其中19例患者完成了蜜蜂蜂毒变应原组分i208(磷脂酶A2) sIgE检测;在8例i1和i3(胡蜂蜂毒) sIgE均为阳性的患者中,7例胡蜂蜂毒变应原组分 i209(抗原 V5) sIgE <0.10 kUA/L,仅1例 i209 sIgE 为8.03 kUA/L,证实为双重过敏。33%(10/30)的患者在首次蜜蜂蜇刺后表现为大局部反应,3个月至1年后再次蜜蜂蜇刺后出现严重过敏反应。结论职业性暴露是蜜蜂蜂毒致严重过敏反应最常见的暴露类型,使用变应原组分检测有助于确诊蜜蜂蜂毒和胡蜂蜂毒双重过敏。%Objective To investigate the clinical characteristics of honeybee venom induced anaphylaxis. Methods Cases of anaphylaxis induced by honeybee sting were collected and analyzed retrospectively since 2011 to 2016 in Peking Union Medical College Hospital.The severity was classified into GradesⅠtoⅣbased on the systemic manifestations after

  19. THE RARE CAUSE OF THE ANAPHYLAXIS: EXERCISE

    Directory of Open Access Journals (Sweden)

    Sami OZTURK

    2005-02-01

    Full Text Available Introduction: Exercise-induced anaphylaxis (EIA is a rare syndrome. We described two patients experienced anaphylaxis after exercise. Case 1: A 24 -year-old male patient, recruited to army as a private 6 months ago. The medical history was suggestive of an anaphylactic reaction which was developed about 30 minute after a vigorous exercise. Case 2: A 42-year old female, was referred to our clinic because of the recurrent episodes of generalized pruritus, nausea, vomiting, swelling on extremities and breathing difficultly. She was experienced with symptoms after moderate exercises which were performed to losing weight. Evaluation: The complete diagnostic procedures including skin tests with foods and inhalant allergens were performed. In Case 2, positive skin test results were detected in food allergens (apricot, tomato, vanilla and inhalant allergens (house-dust mites and cockroach. Management: In Case 1, he was first experienced EIA symptoms with the military training. For this reason, he exempted from vigorous exercises during his remaining compulsory military service and self-injectable epinephrine kit and antihistamine were prescribed him. In Case 2, she advised to avoid from vigorous exercises. Conclusion: EIA should be considered in cases of anaphylaxis with uncertain etiology. [TAF Prev Med Bull 2005; 4(1.000: 46-49

  20. Glafenine-associated anaphylaxis as a cause of hospital admission in The Netherlands

    NARCIS (Netherlands)

    B.H.Ch. Stricker (Bruno); R. de Groot (Ronald); J.H.P. Wilson (Paul)

    1991-01-01

    markdownabstractSummary. In 1981 generalized anaphylaxis was registered on 166 occasions in Dutch general and academic hospitals. Clinical details of 120 of those patients revealed that in 107 anaphylaxis was either probable (n=90) or possible (n = 17), whereas in 13 cases some other reaction tha

  1. Doxycycline exerts multiple anti-allergy effects to attenuate murine allergic conjunctivitis and systemic anaphylaxis.

    Science.gov (United States)

    Su, Wenru; Wan, Qian; Han, Longhui; Huang, Jingwen; Chen, Xiaoqing; Chen, Guihua; Zheng, Song Guo; Liang, Dan

    2014-10-01

    Allergic diseases, which affect up to 20-30% of the world population, are still therapeutic challenge for allergists. Tetracyclines, which belong to an antibiotic drug family that possesses a striking variety of non-antibiotic properties, have been successfully applied to a wide range of diseases. However, their roles in allergic conjunctivitis and anaphylaxis and their underlying anti-allergy mechanisms remain elusive. Here, we reported that treatment with doxycycline significantly reduced IgE release from mouse B cells and the degranulation and inflammatory cytokines production of mouse mast cells (MCs) activated by IgE-dependent way. Furthermore, doxycycline treatment significantly inhibited histamine-induced vascular hyperpermeability in vitro. Mechanistically, the doxycycline-mediated inhibition of B cells, MCs and histamine may occur via modulation of the PI3K/Akt pathway. In vivo, our results demonstrated that treatment with doxycycline significantly attenuated clinical symptoms of mouse models of experimental allergic conjunctivitis (EAC) with a significant decrease in inflammatory cell frequency, IgE production, histamine release, and a decrease in TNF-α and IL-4 production. Using mouse models of MCs-dependent passive systemic anaphylaxis (PSA), we further confirmed anti-allergy effects of doxycycline and doxycycline-mediated inhibitory effects on MCs. Furthermore, our results showed that doxycycline significantly attenuate histamine-induced systemic anaphylaxis-like reaction (HISA) with a significantly downregulation of PI3K/Akt/eNOS/VE-cadherin pathway. The doxycycline-mediated anti-allergy effects during EAC, PSA and HISA were abrogated when an Akt activator, SC79, was administered. These findings suggest that doxycycline inhibits B cell, MC and histamine function and attenuates experimental allergic conjunctivitis and systemic anaphylaxis by possible modulating the PI3K/Akt pathway.

  2. Types of Treatment: Clinical Trials

    Science.gov (United States)

    ... Disease Information Treatment Types of Treatment Clinical Trials Clinical Trials Clinical Trials SHARE: Print Glossary Taking part in a clinical ... for cancer are based on previous clinical trials. Clinical Trial Service: LLS provides personalized clinical trial navigation when ...

  3. Acute symptoms of drug hypersensitivity (urticaria, angioedema, anaphylaxis, anaphylactic shock).

    Science.gov (United States)

    Limsuwan, Ticha; Demoly, Pascal

    2010-07-01

    Drug hypersensitivity reactions (HSRs) are the adverse effects of drugs which, when taken at doses generally tolerated by normal subjects, clinically resemble allergy. Immediate-reaction of drug HSRs are those that occur less than 1 hour after the last drug intake, usually in the form of urticaria, angioedema, rhinitis, conjunctivitis, bronchospasm, and anaphylaxis or anaphylactic shock. Acute urticarial and angioedema reactions are common clinical problems frequently encountered by internists and general practitioners. They are not specific to drug allergic reaction, and can be caused by various pathogenic mechanisms. Despite the benign course of urticaria and angioedema, a mucocutaneous swelling of the upper respiratory tract could be life-threatening by itself or a feature of anaphylaxis. This article reviews acute symptoms of drug HSR-related urticaria, angioedema, anaphylaxis, and anaphylactic shock, and how clinicians should approach these problems.

  4. Analysis of the burden of treatment in patients receiving an EpiPen for yellow jacket anaphylaxis

    NARCIS (Netherlands)

    Elberink, Joanne N. G. Oude; van der Heide, S.; Guyatt, Gordon H.; Dubois, Anthony E. J.

    2006-01-01

    Background: Venom immunotherapy (VIT) is a treatment with established efficacy for the prevention of repeated anaphylactic reactions in patients with Hymenoptera allergy, which also allows patients to discontinue carrying an EpiPen. Despite their merits, both treatments can have negative aspects pot

  5. Anaphylaxis across two Canadian pediatric centers: evaluating management disparities

    Directory of Open Access Journals (Sweden)

    Lee AYM

    2016-12-01

    Full Text Available Alison YM Lee,1 Paul Enarson,2 Ann E Clarke,3 Sébastien La Vieille,4 Harley Eisman,5,6 Edmond S Chan,7 Christopher Mill,7 Lawrence Joseph,8 Moshe Ben-Shoshan9 1Pediatric Residency Program, Department of Pediatrics, University of British Columbia, BC Children’s Hospital, 2Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, 3Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, 4Food Directorate, Health Canada, Ottawa, ON, 5Emergency Department, 6Department of Pediatrics, Montreal Children’s Hospital, Montreal, QC, 7Division of Allergy and Immunology, Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, BC, 8Department of Epidemiology and Biostatistics, McGill University, 9Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children’s Hospital, Montreal, QC, Canada Background: There are no data on the percentage of visits due to anaphylaxis in the emergency department (ED, triggers, and management of anaphylaxis across different provinces in Canada. Objective: To compare the percentage of anaphylaxis cases among all ED visits, as well as the triggers and management of anaphylaxis between two Canadian pediatric EDs (PEDs. Methods: As part of the Cross-Canada Anaphylaxis Registry (C-CARE, children presenting to the British Columbia Children’s Hospital (BCCH and Montreal Children’s Hospital (MCH EDs with anaphylaxis were recruited. Characteristics, triggers, and management of anaphylaxis were documented using a standardized data entry form. Differences in demographics, triggers, and management were determined by comparing the difference of proportions and 95% confidence interval. Results: Between June 2014 and June 2016, there were 346 visits due to anaphylaxis among 93,730 PED visits at the BCCH ED and 631 anaphylaxis visits among 164,669 pediatric visits at

  6. Anaphylaxis to Insect Venom Allergens

    DEFF Research Database (Denmark)

    Ollert, Markus; Blank, Simon

    2015-01-01

    Anaphylaxis due to Hymenoptera stings is one of the most severe consequences of IgE-mediated hypersensitivity reactions. Although allergic reactions to Hymenoptera stings are often considered as a general model for the underlying principles of allergic disease, diagnostic tests are still hampered......, and to contribute to the understanding of the immunological mechanisms elicited by insect venoms....

  7. Omalizumab: Practical considerations regarding the risk of anaphylaxis

    Directory of Open Access Journals (Sweden)

    Kim Harold L

    2010-12-01

    Full Text Available Abstract Omalizumab has demonstrated efficacy among patients with moderate to severe persistent allergic asthma, whose symptoms are inadequately controlled with other controller agents. This therapy is generally well tolerated, but there are some safety considerations, the most important of which is the rare, but potentially life-threatening, occurrence of omalizumab-associated anaphylaxis. In Canada, data from the manufacturer of omalizumab indicate that the frequency of anaphylaxis attributed to Xolair in post-marketing use is approximately 0.2%. Other researchers, including the American Omalizumab Joint Task Force (OJTF, have suggested a lower overall frequency of 0.09%. This paper provides a summary of the epidemiologic research carried out to date and presents a concise, practical set of recommendations for the prevention, monitoring and management of omalizumab-associated anaphylaxis. Prevention tips include advice on patient education measures, concomitant medications and optimal administration. For the first three injections, the recommendation is to monitor in clinic for two hours after the omalizumab injection; for subsequent injections, the monitoring period should be 30 minutes or an appropriate time agreed upon by the individual patient and healthcare professional. In the event that a patient does experience omalizumab-associated anaphylaxis, the paper provides recommendations for handling the situation in-clinic and recommendations on how to counsel patients to recognize the potential signs and symptoms in the community and react appropriately.

  8. Anaphylaxis challenges on the front line: perspectives from community medicine.

    Science.gov (United States)

    Bennett, John R; Fromer, Leonard; Hayden, Mary Lou

    2014-01-01

    This report reflects a discussion from the multidisciplinary Partnership for Anaphylaxis Round Table meeting, held in November 2012, in Dallas, Texas. Community medicine participants included John R. Bennett, MD, an internist who practiced in Cumming, Georgia, and whose patients were adults; Leonard Fromer, MD, a family practitioner in Los Angeles, California, who was the medical director of a network of 600 medical groups, including pediatricians, internists, and family physicians, and who in his previous practice treated children and adults, many of them with severe allergies; and Mary Lou Hayden, MS, RN, FNP-BC, AE-C, a nurse practitioner who treated adults in a university employee health clinic and in an allergy clinic in Charlottesville, Virginia, and whose prior practice focused on allergy and immunology in children and adults. This discussion was moderated by Dr Bennett. Participants provided their perspectives as primary care providers (PCPs) concerning anaphylaxis, which has become a major public health concern. The rising prevalence of severe allergies and incidence of anaphylaxis and other severe allergic reactions among children and adults is shifting more care to PCPs. This discussion provides insights into challenges faced by PCPs in treating patients at risk for anaphylaxis in the community setting and provides potential solutions to those challenges.

  9. Clinical Case Study on Anaphylaxis Induced by Red Meat Ingestion%红肉诱发严重过敏反应的临床病例研究

    Institute of Scientific and Technical Information of China (English)

    利平; 周俊雄; 尹佳; 李宏; 孙毅; 孙劲旅; 王瑞琦

    2015-01-01

    pork,innards were performed,based on western blotting by using sera from case 1 and a healthy control to observe the features ofspecificbindingcharacteristics.Results Thetwocases(case1female/57yrs,case2male/44yrs)are both farmers who live in the suburb of Beijing,manifested with anaphylactic reactions three to six hours after red meat ingestion. Serum specific IgE and skin test results to multiple mammalian proteins were positive. Specific IgE to galactose-α-1 ,3-galactose were positive in the two patients (>100 kU/L in case 1 and 6. 00 kU/L in case 2 ).Case 1 reported a history of tick biting with large regional reactions 2-3 weeks before anaphylaxis. The ticks on her dog were captured and authenticated as hematophagous ixodidae. Case 2 did not report history of tick bites. The increased concentration of IgE reactive epitopes in mammalian organs wasconfirmedbyusingwesternblottingwithserumofcase1.Conclusions Ingestionofredmeatcan induce severe and sometimes life-threatening clinical manifestations,which might be induced by tick bite. This issue should arouse concerns both in public and doctors. Patients with red meat allergy should avoid intake of meat as well as innards of non-primate mammalian.

  10. Autoinjectors Preferred for Intramuscular Epinephrine in Anaphylaxis and Allergic Reactions

    Directory of Open Access Journals (Sweden)

    Ronna L. Campbell

    2016-11-01

    Full Text Available Introduction: Epinephrine is the treatment of choice for anaphylaxis. We surveyed emergency department (ED healthcare providers regarding two methods of intramuscular (IM epinephrine administration (autoinjector and manual injection for the management of anaphylaxis and allergic reactions and identified provider perceptions and preferred method of medication delivery. Methods: This observational study adhered to survey reporting guidelines. It was performed through a Web-based survey completed by healthcare providers at an academic ED. The primary outcomes were assessment of provider perceptions and identification of the preferred IM epinephrine administration method by ED healthcare providers. Results: Of 217 ED healthcare providers invited to participate, 172 (79% completed the survey. Overall, 82% of respondents preferred the autoinjector method of epinephrine administration. Providers rated the autoinjector method more favorably for time required for training, ease of use, convenience, satisfaction with weight-based dosing, risk of dosing errors, and speed of administration (p<0.001 for all comparisons. However, manual injection use was rated more favorably for risk of provider self-injury and patient cost (p<0.001 for both comparisons. Three participants (2% reported a finger stick injury from an epinephrine autoinjector. Conclusion: ED healthcare providers preferred the autoinjector method of IM epinephrine administration for the management of anaphylaxis or allergic reactions. Epinephrine autoinjector use may reduce barriers to epinephrine administration for the management of anaphylaxis in the ED.

  11. Anaphylaxis from atracurium without skin manifestation

    Directory of Open Access Journals (Sweden)

    Souvik Maitra

    2014-01-01

    Full Text Available Anaphylaxis is an acute, potentially fatal allergic reaction involving multi organ system that is triggered by a wide range of antigens with a subsequent release of chemical mediators from mast cells and basophils. Diagnosis is primarily clinical though laboratory studies are helpful in further confirmation. Anaphylactic reactions during anesthesia are rare, but can be fatal if not promptly recognized and treated. Among all drugs commonly used in anesthesia, muscle relaxants are the most notorious to trigger anaphylactic reactions and benzylisoquinolinium group of drugs are known to be less common an offender than the steroidal compounds. We report severe anaphylactic reaction after administration of atracurium that was promptly diagnosed and managed without any further morbidity.

  12. EAACI Food Allergy and Anaphylaxis Guidelines

    DEFF Research Database (Denmark)

    Muraro, A; Werfel, T; Hoffmann-Sommergruber, K

    2014-01-01

    Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building...... on previous EAACI position papers on adverse reaction to foods and three recent systematic reviews on the epidemiology, diagnosis, and management of food allergy, and provide evidence-based recommendations for the diagnosis and management of food allergy. While the primary audience is allergists......, this document is relevant for all other healthcare professionals, including primary care physicians, and pediatric and adult specialists, dieticians, pharmacists and paramedics. Our current understanding of the manifestations of food allergy, the role of diagnostic tests, and the effective management...

  13. The management of anaphylaxis in childhood

    DEFF Research Database (Denmark)

    Muraro, A; Roberts, G; Clark, A

    2007-01-01

    to provide practical guidelines for managing anaphylaxis in childhood based on the limited evidence available. Intramuscular adrenaline is the acknowledged first-line therapy for anaphylaxis, in hospital and in the community, and should be given as soon as the condition is recognized. Additional therapies...... such as volume support, nebulized bronchodilators, antihistamines or corticosteroids are supplementary to adrenaline. There are no absolute contraindications to administering adrenaline in children. Allergy assessment is mandatory in all children with a history of anaphylaxis because it is essential to identify......, involving school staff, healthcare professionals and patients' organizations. Absolute indications for prescribing self-injectable adrenaline are prior cardiorespiratory reactions, exercise-induced anaphylaxis, idiopathic anaphylaxis and persistent asthma with food allergy. Relative indications include...

  14. Anaphylaxis

    Science.gov (United States)

    ... Education Center Fellows-in-Training Grants & Awards Program Directors Practice Resources ASTHMA IQ Consultation and Referral Guidelines Practice Financial Survey Practice Tools Running a Practice Statements and Practice Parameters About AAAAI Advocacy Allergist / Immunologists: ...

  15. Anaphylaxis to hyperallergenic functional foods

    Directory of Open Access Journals (Sweden)

    Ameratunga Rohan

    2010-12-01

    Full Text Available Abstract Background Food allergy can cause life threatening reactions. Currently, patients with severe food allergy are advised to avoid foods which provoke allergic reactions. This has become increasingly difficult as food proteins are being added to a broader range of consumer products. Patients and methods Here we describe our investigations into the allergenicity of a new drink when two cow's milk allergic children suffered anaphylaxis after consuming Wh2ole®. Results Our studies have shown that in comparison with cow's milk, Wh2ole® contains at least three times the concentration of β-lactoglobulin. β-lactoglobulin is one of the dominant allergens in bovine milk. Conclusions These studies have shown that modern technology allows the creation of "hyperallergenic" foods. These products have the potential to cause severe reactions in milk allergic persons. Avoiding inadvertent exposure is the shared responsibility of allergic consumers, regulatory authorities and the food industry.

  16. Late Onset Anaphylaxis in a Hydatid Cyst Case Presenting with Chronic Urticaria

    Directory of Open Access Journals (Sweden)

    Insu Yilmaz

    2013-01-01

    Full Text Available Hydatid cyst is still endemic in various regions of the world. It is the most frequent cause of liver cysts worldwide. Urticaria is sometimes the first manifestation of the disease. However anaphylactic reaction and urticaria have been very rarely reported in the literature. Traditionally, surgery has been the only accepted mode of treatment; however, percutaneous treatment has recently been proposed as an alternative. Cases of anaphylaxis have been reported after percutaneous drainage of hydatid cyst. However, anaphylaxis usually develops within a few hours. Herein, we describe the case of a patient who presented with hydatid cyst causing chronic urticaria and late anaphylactic reaction following percutaneous aspiration of a liver hydatid cyst. We emphasize that physicians should be aware of hydatid cyst as a possible etiology for seemingly chronic spontaneous urticaria, especially in endemic regions. Patients should be kept under observation for at least one day due to the risk of early and late anaphylaxis after percutaneous aspiration treatment.

  17. Aspirin-Exacerbated Diseases: Advances in Asthma with Nasal Polyposis, Urticaria, Angioedema, and Anaphylaxis.

    Science.gov (United States)

    Stevens, Whitney; Buchheit, Kathleen; Cahill, Katherine N

    2015-12-01

    Aspirin-exacerbated diseases are important examples of drug hypersensitivities and include aspirin-exacerbated respiratory disease (AERD), aspirin- or non-steroidal anti-inflammatory drug (NSAID)-induced urticaria/angioedema, and aspirin- or NSAID-induced anaphylaxis. While each disease subtype may be distinguished by unique clinical features, the underlying mechanisms that contribute to these phenotypes are not fully understood. However, the inhibition of the cyclooxygenase-1 enzyme is thought to play a significant role. Additionally, eosinophils, mast cells, and their products, prostaglandins and leukotrienes, have been identified in the pathogenesis of AERD. Current diagnostic and treatment strategies for aspirin-exacerbated diseases remain limited, and continued research focusing on each of the unique hypersensitivity reactions to aspirin is essential. This will not only advance the understanding of these disease processes, but also lead to the subsequent development of novel therapeutics that patients who suffer from aspirin-induced reactions desperately need.

  18. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy

    DEFF Research Database (Denmark)

    Muraro, A; Halken, S; Arshad, S H

    2014-01-01

    by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Prevention and is part of the EAACI Guidelines for Food Allergy and Anaphylaxis. It aims to provide evidence-based recommendations for primary prevention of food allergy. A wide range of antenatal, perinatal, neonatal, and childhood......Food allergy can have significant effects on morbidity and quality of life and can be costly in terms of medical visits and treatments. There is therefore considerable interest in generating efficient approaches that may reduce the risk of developing food allergy. This guideline has been prepared...... strategies were identified and their effectiveness assessed and synthesized in a systematic review. Based on this evidence, families can be provided with evidence-based advice about preventing food allergy, particularly for infants at high risk for development of allergic disease. The advice for all mothers...

  19. [Anaphylaxis caused by royal jelly].

    Science.gov (United States)

    Roger, A; Rubira, N; Nogueiras, C; Guspi, R; Baltasar, M; Cadahia, A

    1995-01-01

    Royal jelly is the food on which are fed and which causes them to develop into queen bees. It is claimed to have rejuvenating virtues for human beings. This report describes a 15-year-old atopic woman who presented, 15 minutes after the intake of royal jelly, local angioedema, generalised urticaria, dysphonia and bronchospasm. She was given antihistaminics and corticoesteroids and responded well. The ingested product contains royal jelly, lactose and potassium sorbate. No anaphylactic reactions to lactose and sorbates have been described previously. Prick test to common food allergens hymenoptera venoms and pollens were negative. RAST to meletin was also negative. Blood eosinophils were 600 and total IgE 465. Non-commercial prepared specific IgE to royal jelly was positive (0.8 KU/l). Prick by prick was positive to 1/10 dilution, being negative in controls (undiluted). No oral provocation test was performed due to the risk of anaphylaxis. No reported cases of royal jelly allergy were founded in a review of the medical literature. Concluding, it is the first described case of IgE anaphylactic reaction due to royal jelly.

  20. Vaccination and anaphylaxis: a forensic perspective

    Science.gov (United States)

    Palmiere, Cristian; Tettamanti, Camilla; Scarpelli, Maria Pia

    2017-01-01

    Aim To review the available literature pertaining to fatalities following vaccine administration and, in particular, cases of vaccine-related fatal anaphylaxis. Method The MEDLINE database was systematically searched up to March 2016 to identify all relevant articles pertaining to fatal cases of anaphylaxis following vaccine administration. Results Six papers pertaining to fatal anaphylaxis following vaccination were found relevant. Mast cell tryptase and total IgE concentration was assessed exclusively in one case. Laryngeal edema was not detected in any of these cases, whereas eosinophil or mast cell infiltration was observed in lymphoid organs. In one case, immunohistochemical investigations using anti-tryptase antibodies allowed pulmonary mast cells and degranulating mast cells with tryptase-positive material outside to be identified. Conclusion In any suspected IgE-mediated fatal anaphylactic cases, biochemical investigations should be systematically performed for forensic purposes. Splenic tissue should be routinely sampled for immunohistochemical investigations in all suspected anaphylaxis-related deaths and mast cell/eosinophil infiltrations should be systematically sought out in the spleen, myocardium, and coronary artery wall. The hypothesis of fatal anaphylaxis following vaccination should be formulated exclusively when circumstantial data, available medical records, laboratory investigations, and autopsy or histology findings converge in a consistent pattern. The reasonable exclusion of alternative causes of death after all postmortem investigations is also imperative in order to establish or rule out a cause-and-effect relationship between vaccine administration and any presumptive temporarily-related death. PMID:28252871

  1. First case report of anaphylaxis caused by Rajgira seed flour (Amaranthus paniculatus) from India: a clinico-immunologic evaluation.

    Science.gov (United States)

    Kasera, Ramkrashan; Niphadkar, P V; Saran, Aditya; Mathur, Chandni; Singh, A B

    2013-03-01

    The prevalence of food allergy is reported to be 3-4% in adults and about 6% in children. However food allergy across different countries accounts for 35-50 % all cases of anaphylaxis to foods. In the present study, we have reported a case of anaphylaxis to Amaranth grain (Amaranthus paniculatus) commonly known as Rajgira (Ramdana) in India. A 60 year old female suffered anaphylaxis after consuming Rajgira seed flour generally consumed during fasting. Food allergy to Amaranth seeds is not reported so far. The patient reported to hospital with complaints of itching in mouth, choking throat, redness and swelling of face and burning abdomen within 5 min of consuming Rajgira flour. Clinical and immunological investigations revealed SPT and oral challenge positivity beside high allergen specific IgE in the serum of the patient. Three IgE binding protein fractions were detected in roasted Rajgira seed flour extract which could be considered to be allergenically important for triggering anaphylaxis.

  2. Level of knowledge about anaphylaxis and its management among health care providers

    Directory of Open Access Journals (Sweden)

    H S Drupad

    2015-01-01

    Full Text Available Objectives: This study was conducted to assess the level of knowledge of health care providers regarding anaphylaxis and its management at a tertiary care teaching hospital. Materials and Methods: A pretested structured questionnaire was administered to interns, MBBS Phase II students, and nursing students. The subjects were asked to answer the questionnaire, which included questions regarding anaphylaxis and its management. Results: Of 265 subjects, 151 (56.9% of subjects answered correctly that adrenaline is the first line of drug for the treatment of anaphylaxis. Among 151 subjects, 40 (26.4% answered the correct dose of adrenaline, of which 25 (16.5% subjects selected intramuscular injection as the most appropriate route of administration. Medical students′ performance was better than interns and nursing students on questions regarding dose, route, and site of adrenaline administration. Conclusion: Knowledge regarding the management of anaphylaxis was inadequate in almost all the health care providers who were included in the study. Improved education and training of health care providers are necessary for better management of anaphylaxis.

  3. [Anaphylaxis secondary to prick-to-prick tests to foods and its risk factors].

    Science.gov (United States)

    Galindo-Pacheco, Lucy Vania; O'Farrill-Romanillos, Patricia María; Amaya-Mejía, Adela Sisy; Almeraya-García, Priscilla; López-Rocha, Eunice

    2014-01-01

    The diagnosis of food allergy requires a proper anamnesis and diagnostic testing with skin prick tests with fresh foods and/or standardized allergen, or specific IgE tests. The risk of systemic reactions is of 15-23 per 100,000 skin tests performed by prick method, specifically anaphylaxis at 0.02%. This paper reports the case of four patients, who while performing prick to prick test with fresh food presented anaphylactic reaction. Implicated foods were fruits of the Rosaceae, Anacardiaceae and Caricaceae families. The severity of anaphylaxis was: two patients with grade 4, one patient grade 2 and one grade 3, all with appropriate response to drug treatment. The risk factors identified were: female sex, personal history of atopy, previous systemic reaction to Hymenoptera venom, prior anaphylaxis to prick tests to aeroallergens. We found that a history of positive skin test for Betulla v, can be a risk factor for anaphylaxis in patients with oral syndrome. During testing prick to prick with food anaphylaxis can occur, so it should be made with aerial red team on hand. The history of positivity Betulla v is an additional risk factor in these patients.

  4. Anaphylaxis induced by pine nuts in two young girls.

    Science.gov (United States)

    Ibáñez, M Dolores; Lombardero, Manuel; San Ireneo, Mercedes Martinez; Muñoz, M Carmen

    2003-08-01

    Pine nuts are the seeds of Pinus pinea. There are few reported cases of allergy to pine nut. We describe two young girls with anaphylaxis caused by small amounts of pine nuts. Specific IgE to pine nut was demonstrated by skin prick tests and RAST but no IgE to other nuts and pine pollen was detected. The patients had IgE against a pine nut protein band with apparent molecular weights of approximately 17 kDa that could be considered as the main allergen. Our patients were monosensitized to pine nut and the 17-kDa protein could be correlated with the severe clinical symptoms.

  5. Endurance exercise after orange ingestion anaphylaxis

    Directory of Open Access Journals (Sweden)

    Manu Gupta

    2016-01-01

    Full Text Available Endurance exercise after orange ingestion cause anaphylaxis which is food-dependent exercise-induced anaphylaxis (FDEIA which is a form of exercise-induced anaphylaxis. In this article, an individual develops symptoms such as flushing, itching, urticaria, angioedema, and wheezing after eating a food allergen and proceeds to exercise. Neither the food alone nor exercise alone is sufficient to induce a reaction. This case report describes a 36-year-old asthmatic male athlete who experienced nausea, vomiting, flushing, urticaria, and facial swelling while exercising in a gymnasium after eating oranges. Neither oranges alone nor exercise alone induced the reaction. Total avoidance of suspected food allergens would be ideal. Persons with FDEIA should keep at hand an emergency kit with antihistamines, injectable rapid action corticoids, and adrenaline.

  6. Jackfruit anaphylaxis in a latex allergic patient.

    Science.gov (United States)

    Wongrakpanich, Supakanya; Klaewsongkram, Jettanong; Chantaphakul, Hiroshi; Ruxrungtham, Kiat

    2015-03-01

    Several fruits have been reported to crossreact with latex antigen in latex allergy patients but little is known regarding tropical fruits in particular. Here we report the case of a 34-year old nurse who developed anaphylaxis following the ingestion of dried jackfruit (Artocarpus heterophyllus). The patient had a history of chronic eczema on both hands resulting from a regular wear of latex gloves. She and her family also had a history of atopy (allergic rhinitis and/or atopic dermatitis). The results of skin prick tests were positive for jackfruit, latex glove, kiwi and papaya, but the test was negative for banana. While we are reporting the first case of jackfruit anaphylaxis, further research needs to be conducted to identify the mechanisms underlying it. In particular, in-vitro studies need to be designed to understand if the anaphylaxis we describe is due to a cross reactivity between latex and jackfruit or a coincidence of allergy to these 2 antigens.

  7. Mast cell activation syndromes presenting as anaphylaxis.

    Science.gov (United States)

    Akin, Cem

    2015-05-01

    Anaphylaxis results from severe systemic mast cell activation. In addition to IgE-mediated and physical triggers, it may occur with a clonal mast cell disease and in an idiopathic fashion without clear provoking factors. Disorders of mast cell activation are classified into primary (clonal), secondary, and idiopathic. Mast cell activation syndrome (MCAS) is a multisystem disorder characterized by objective documentation of elevated mast cell mediators during attacks and a favorable response to antimediator therapy. It should be considered in the differential diagnosis of patients presenting with recurrent anaphylaxis without a clear cause. This article discusses the diagnosis of MCAS.

  8. Serious shortcomings in the management of children with anaphylaxis in Scottish schools.

    Directory of Open Access Journals (Sweden)

    Kirsty E Rankin

    2006-08-01

    Full Text Available BACKGROUND: The United Kingdom incidence of anaphylaxis has increased very sharply over the last decade, with the highest rates of hospital admissions occurring in school-aged children. This raises concerns about the extent to which schools are aware of approaches to the prevention and treatment of anaphylaxis. METHODS AND FINDINGS: We undertook a national postal survey of 250 Scottish schools enquiring about approaches to managing children considered to be at risk of anaphylaxis. We obtained responses from 148 (60% schools, 90 (61% of which reported having at least one at risk child. Most (80% schools with children considered to be at risk reported having personalised care plans and invariably reported having at least one member of staff trained in the emergency treatment of anaphylaxis. Access to adrenaline was available on-site in 97% of these schools. However, significantly fewer schools without children considered to be at risk reported having a trained member of staff (48%, p < 0.001, with access to adrenaline being very poor (12%, p < 0.001. Overall, 59% of respondents did not feel confident in their school's ability to respond in an emergency situation. CONCLUSIONS: Most schools with children considered to be at risk of anaphylaxis report using personal care plans and having a member of staff trained in the use of, and with access to, adrenaline. The picture is, however, less encouraging in schools without known at risk children, both in relation to staff training and access to adrenaline. The majority of schools with at risk children have poorly developed strategies for preventing food-triggered anaphylaxis reactions. There is a need for detailed national guidelines for all schools, which the Scottish Executive must now ensure are developed and implemented.

  9. Bee sting anaphylaxis in an urban population of South Australia.

    Science.gov (United States)

    Roberts-Thomson, P J; Harvey, P; Sperber, S; Kupa, A; Heddle, R J

    1985-12-01

    The clinical manifestations and circumstances of bee sting anaphylaxis have been studied retrospectively in 98 subjects. Most reactions occurred in children but the most severe reactions were seen in adult males, of whom 7 lost consciousness and 2 required cardiopulmonary resuscitation. Most stings causing anaphylaxis occurred on the unprotected feet whilst the subject was on lawn in the afternoons in December, January and February when the maximum daily temperature was between 20 and 30 degrees C. This is the temperature range when bees are particularly active in gathering pollen. However, a significantly greater frequency of anaphylactic reactions occurred at higher temperatures when bees are less active, suggesting that high environmental temperature may predispose the individual to greater exposure to bees or possibly to anaphylactic reactions per se. The presence of atopy did not appear to predispose subjects to bee venom hypersensitivity. Considerable anxiety and lifestyle alteration were identified in some subjects. The alleviation of this anxiety is considered an appropriate indication for bee venom immunotherapy.

  10. Specific Oral Tolerance Induction Using IFN-Gamma in 2 Cases of Food-Dependent Exercise-Induced Anaphylaxis

    Directory of Open Access Journals (Sweden)

    Geunwoong Noh

    2013-01-01

    Full Text Available Anaphylaxis induced by exercise after the intake of certain foods is referred to as food-dependent exercise-induced anaphylaxis (FDEIA. Only the preventive medication such as oral sodium cromoglycate and oral combined cetirizine-montelukast was tried in FDEIA. Specific oral tolerance induction (SOTI using IFN-gamma was tried in 2 cases of FDEIA for wheat. Merely, exercise accompanied every treatment just after the intake of allergenic foods during treatment. Patients acquired tolerance for wheat in both cases successfully. After treatment, two patients take wheat in their food living freely. Conclusively, SOTI using IFN-gamma was effective as the causative treatment for allergenic foods in FDEIA.

  11. Spontaneous Intraperitoneal Rupture of a Hepatic Hydatid Cyst with Subsequent Anaphylaxis: A Case Report

    Directory of Open Access Journals (Sweden)

    Benjamin Tinsley

    2013-01-01

    Full Text Available Hydatid cyst rupture into the abdomen is a serious complication of cystic hydatid disease of the liver (Cystic Echinococcosis with an incidence of up to 16% in some series and can result in anaphylaxis or anaphylactoid reactions in up to 12.5% of cases. At presentation, 36–40% of hydatid cysts have ruptured or become secondarily infected. Rupture can be microscopic or macroscopic and can be fatal without surgery. Hydatid disease of the liver is primarily caused by the tapeworm Echinococcus granulosus and occurs worldwide, with incidence of up to 200 per 100,000 in endemic areas. Our case describes a 24-year-old Bulgarian woman presenting with epigastric pain and evidence of anaphylaxis. Abdominal CT demonstrated a ruptured hydatid cyst in the left lobe of the liver. A partial left lobe hepatectomy, cholecystectomy, and peritoneal washout was performed with good effect. She was treated for anaphylaxis and received antihelminthic treatment with Albendazole and Praziquantel. She made a good recovery following surgery and medical treatment and was well on follow-up. Intraperitoneal rupture with anaphylaxis is a rare occurrence, and there do not seem to be any reported cases from UK centres prior to this.

  12. Anaphylaxis related to avocado ingestion: a case and review

    Science.gov (United States)

    2011-01-01

    Anaphylaxis to avocado, independent of latex sensitization, has been rarely reported in the literature. This case report describes a 15 year old male who experienced anaphylaxis within half an hour after eating avocado-containing food. Avocado consumption is common in both North America and South America. It is important to consider avocado as a cause of anaphylaxis, even in patients not sensitized to latex. PMID:21663642

  13. Anaphylaxis related to avocado ingestion: a case and review

    OpenAIRE

    Abrams Elissa M; Becker Allan B; Gerstner Thomas V

    2011-01-01

    Abstract Anaphylaxis to avocado, independent of latex sensitization, has been rarely reported in the literature. This case report describes a 15 year old male who experienced anaphylaxis within half an hour after eating avocado-containing food. Avocado consumption is common in both North America and South America. It is important to consider avocado as a cause of anaphylaxis, even in patients not sensitized to latex.

  14. Anaphylaxis caused by honey: a case report

    Science.gov (United States)

    Duarte, Fátima Cabral; Mendes, Ana; Bartolomé, Borja; Barbosa, Manuel Pereira

    2017-01-01

    Honey allergy is a very rare, but serious health condition. In this study, we presented 1 patient who had anaphylaxis after the honey allergological investigation with skin prick-prick test with honey. Honey as a food has been associated to allergic reactions and as the increased consumption of honey in health food may increase the incidence of honey-related allergic reactions. PMID:28154806

  15. 血小板活化因子在药源性严重过敏反应中的研究现状%Advance of platelet activating factor in drug-induced anaphylaxis

    Institute of Scientific and Technical Information of China (English)

    马翔; 李潇潇; 刘维; 翟所迪

    2015-01-01

    药源性严重过敏反应有难以预测、发作突然和致命性等特点,从而成为困扰临床药物使用的重要安全性因素。由于目前尚无严格的随机对照试验支持抢救药物的推荐,医生常根据临床经验用肾上腺素、抗组胺药和/或糖皮质激素应对突发的药源性严重过敏反应。血小板活化因子( PAF)信号通路可为研究药源性严重过敏反应提供崭新的视角。本文将就药源性严重过敏反应的临床和流行病学特点、PAF通路、抗PAF通路的药物等进行概述。%The acute unpredictably life -threatening characteristic of drug-induced anaphylaxis hinders the safe use of clinical medication.In the absence of rigid randomized controlled trials supporting the recommen-dations for the treatment of immediate onset, doctors often treat drug-induced anaphylaxis with epinephrine, antihistamines and/or glucocorticoids.The researches in platelet activating factor signaling path-way could provide a novel perspective for drug-induced anaphylaxis.This review will briefly introduce the clinical and epidemiological characteristics of drug-induced anaphylaxis, platelet activating factor pathway and drugs targeting at this pathway.

  16. Anaphylaxis Imaging: Non-Invasive Measurement of Surface Body Temperature and Physical Activity in Small Animals.

    Directory of Open Access Journals (Sweden)

    Krisztina Manzano-Szalai

    Full Text Available In highly sensitized patients, the encounter with a specific allergen from food, insect stings or medications may rapidly induce systemic anaphylaxis with potentially lethal symptoms. Countless animal models of anaphylaxis, most often in BALB/c mice, were established to understand the pathophysiology and to prove the safety of different treatments. The most common symptoms during anaphylactic shock are drop of body temperature and reduced physical activity. To refine, improve and objectify the currently applied manual monitoring methods, we developed an imaging method for the automated, non-invasive measurement of the whole-body surface temperature and, at the same time, of the horizontal and vertical movement activity of small animals. We tested the anaphylaxis imaging in three in vivo allergy mouse models for i milk allergy, ii peanut allergy and iii egg allergy. These proof-of-principle experiments suggest that the imaging technology represents a reliable non-invasive method for the objective monitoring of small animals during anaphylaxis over time. We propose that the method will be useful for monitoring diseases associated with both, changes in body temperature and in physical behaviour.

  17. Food-dependent exercise-induced anaphylaxis: a case related to chickpea ingestion and review.

    Science.gov (United States)

    Wong, Chet G; Mace, Sean R

    2007-12-15

    : Food-dependent exercise-induced anaphylaxis (FDEIA) is recognized as a distinct category of exercise-induced anaphylaxis (EIA) but is very likely underdiagnosed. This report describes a 41-year-old Indian woman who experienced two separate episodes of anaphylaxis while dancing after she had eaten chickpea-containing foods. The chickpea, a small legume, is a staple ingredient in culinary traditions from around the world, especially in India, the Middle East, and North Africa. Chickpea-containing dishes are also becoming more widespread in the Western world with the growing popularity of South Asian, Middle Eastern, and African cuisines. It is important to consider FDEIA in cases of unexplained anaphylaxis as reactions can occur several hours after ingesting the culprit food(s). Furthermore, no reaction occurs if a sensitized individual eats the culprit food(s) without exercising afterward; therefore, triggering foods can easily be overlooked. Current ideas on the pathophysiology, predisposing factors, workup, and treatment of FDEIA are also summarized here.

  18. Food-Dependent Exercise-Induced Anaphylaxis: A Case Related to Chickpea Ingestion and Review

    Directory of Open Access Journals (Sweden)

    Wong Chet G

    2007-12-01

    Full Text Available Food-dependent exercise-induced anaphylaxis (FDEIA is recognized as a distinct category of exercise-induced anaphylaxis (EIA but is very likely underdiagnosed. This report describes a 41-year-old Indian woman who experienced two separate episodes of anaphylaxis while dancing after she had eaten chickpea-containing foods. The chickpea, a small legume, is a staple ingredient in culinary traditions from around the world, especially in India, the Middle East, and North Africa. Chickpea-containing dishes are also becoming more widespread in the Western world with the growing popularity of South Asian, Middle Eastern, and African cuisines. It is important to consider FDEIA in cases of unexplained anaphylaxis as reactions can occur several hours after ingesting the culprit food(s. Furthermore, no reaction occurs if a sensitized individual eats the culprit food(s without exercising afterward; therefore, triggering foods can easily be overlooked. Current ideas on the pathophysiology, predisposing factors, workup, and treatment of FDEIA are also summarized here.

  19. The epidemiology of anaphylaxis in Europe

    DEFF Research Database (Denmark)

    Panesar, S S; Javad, S; de Silva, D;

    2013-01-01

    BACKGROUND: Anaphylaxis is an acute, potentially fatal, multi-organ system, allergic reaction caused by the release of chemical mediators from mast cells and basophils. Uncertainty exists around epidemiological measures of incidence and prevalence, risk factors, risk of recurrence, and death due...... and analytical epidemiological investigations, and studies involving analysis of routine data. RESULTS: Our searches identified a total of 5,843 potentially eligible studies, of which 49 satisfied our inclusion criteria. Of these, three were suitable for pooled estimates of prevalence. The incidence rates...

  20. Anaphylaxis after accidental ingestion of kiwi fruit.

    Science.gov (United States)

    Gawrońska-Ukleja, Ewa; Różalska, Anna; Ukleja-Sokołowska, Natalia; Zbikowska-Gotz, Magdalena; Bartuzi, Zbigniew

    2013-06-01

    Numerous cases of anaphylaxis after ingestion of kiwi fruit, after the skin tests and during oral immunotherapy were described. The article describes the case of severe anaphylactic reaction that occurred in a 55-year-old patient after accidental ingestion of kiwi. Allergy to kiwi fruit was confirmed by a native test with fresh kiwi fruit. After the test, the patient experienced generalized organ response in the form of headache, general weakness and rashes on the neck and breast, and dyspnea. The patient had significantly elevated levels of total IgE and IgE specific to kiwi fruit.

  1. Inhibitory effects on passive cutaneous anaphylaxis of gamma-irradiated natural herbal extracts

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Bo Ram; Gwon, Hui Jeong; Kim, Yong Soo; Lim, Youn Mook; Nho, Young Chang [Korea Atomic Energy Research Institute, Jeongeup (Korea, Republic of)

    2009-12-15

    The allergenicity of natural herbal extracts (NHE) was evaluated by a passive cutaneous anaphylaxis (PCA) test. Compound 48/80 has been used as a convenient reagent to study a mast cell-mediated non-specific anaphylactic reaction. The NHE treated group has significantly lower Evans blue dye concentration than the control group. These results suggest that the NHE may be useful for the prevention and treatment of allergy-related disease.

  2. Anaphylaxis to scorpion antivenin and its management following envenomation by Indian red scorpion, Mesobuthus tamulus

    OpenAIRE

    Rahul Ramesh Bhoite; Girija Ramesh Bhoite; Dayanand N Bagdure; Himmatrao S Bawaskar

    2015-01-01

    Mesobuthus tamulus is an Indian red scorpion that is responsible for numerous cases of scorpion stings in the Indian subcontinent. Antivenin, vasodilators, and benzodiazepines are medications of choice in the treatment of scorpion bites. Adverse reactions such as anaphylaxis to antivenin have been infrequently described in the literature. We, herein, present a case of a 42-year-old man stung by Indian red scorpion while gardening at home in India, who presented with extreme pain at the sting ...

  3. Cow’s Milk Anaphylaxis in Children First Report of Iranian Food Allergy Registry

    Directory of Open Access Journals (Sweden)

    Pegah Teymourpour

    2012-03-01

    Full Text Available Cow’s  milk  anaphylaxis is  the  most  common  food-induced  anaphylaxis in  Iranian children. The clinical and laboratory findings of cow’s milk anaphylaxis are evaluated in this study. All children who had experienced cow’s  milk anaphylaxis and had been referred to Immunology, asthma and allergy research center during a 5-year period were considered. After fulfilling a questionnaire, patients underwent measurement of total IgE and cow’s milk- specific IgE by Immunocap test and Skin prick test (SPT with cow’s milk extract. Patients with a convincing history and one positive cow’s milk-specific IgE test (SPT or Immunocap test and patients with both positive tests were enrolled, in this study.Out of 49 patients, 59.2% were male. Patients’ mean age was 5 years old and their mean age at the  time of  first attack was 5.7 months  (SD =  4.3. Most  of  the  patients  have experienced more than one episode of anaphylaxis (79.5% and in 85.7% of all cases, first attack occurred during the first year of life. Severity grading 1-5 were 2%, 6.1%, 18.4%,69.4%, 4.1% respectively. Most common manifestations were cutaneous 98%, Respiratory91.8%, Gastrointestinal  55.1%, Cardiovascular 46.9% and  neurologic  46.9%  signs  and symptoms  respectively. Twenty four  patients showed positive SPT. Mean total IgE  was 239.6±3.3  (IU/mL  and  mean  cow’s  milk-specific IgE  was 19.28±27.2  (IU/mL.  Most patients showed reactions only after ingestion of cow’s milk or after dairy foods (81.6%.It  is concluded  that  cow’s milk anaphylaxis may happen  early in life. Regarding the severity of attacks and remarkable number of patients with several attacks, poor knowledge about this disorder is evident.

  4. HYDATID CYST LIVER EXCISION: THE TWIN PROBLEMS OF ANAPHYLAXIS AND HYPERNATREMIA

    Directory of Open Access Journals (Sweden)

    Anand Rampure Vittal

    2015-05-01

    Full Text Available Hydatid cyst infestation is most commonly encountered in liver. Though several procedures have been described in the treatment of hepatic echinococcal cysts ranging from simple puncture to liver resection , radical surgery ( T otal pericystectomy or partial hepatectomy is indicated for liver cyst. Prevention of spillage into the peritoneal cavity and wound edges by injecting a scolicidal agent into the unopened cyst and walling off the operative field with sponges soaked in a scolicidal agent are the two most commonly employed measures. 20% hypertonic saline is one of the recommended scolicidal agent , but can be associated with hypernatremia. Anaphylaxis during hydatid cyst resection is one of the rare occurrences. We hereby de scribe the twin problem of Anaphylaxis intraoperatively and hypernatremia postoperatively and its management.

  5. Galactose-α-1,3-galactose and Delayed Anaphylaxis, Angioedema, and Urticaria in Children

    Science.gov (United States)

    Kennedy, Joshua L.; Stallings, Amy P.; Platts-Mills, Thomas A.E.; Oliveira, Walter M.; Workman, Lisa; James, Haley R.; Tripathi, Anubha; Lane, Charles J.; Matos, Luis; Heymann, Peter W.

    2013-01-01

    BACKGROUND AND OBJECTIVE: Despite a thorough history and comprehensive testing, many children who present with recurrent symptoms consistent with allergic reactions elude diagnosis. Recent research has identified a novel cause for “idiopathic” allergic reactions; immunoglobulin E (IgE) antibody specific for the carbohydrate galactose-α-1,3-galactose (α-Gal) has been associated with delayed urticaria and anaphylaxis that occurs 3 to 6 hours after eating beef, pork, or lamb. We sought to determine whether IgE antibody to α-Gal was present in sera of pediatric patients who reported idiopathic anaphylaxis or urticaria. METHODS: Patients aged 4 to 17 were enrolled in an institutional review board–approved protocol at the University of Virginia and private practice allergy offices in Lynchburg, VA. Sera was obtained and analyzed by ImmunoCAP for total IgE and specific IgE to α-Gal, beef, pork, cat epithelium and dander, Fel d 1, dog dander, and milk. RESULTS: Forty-five pediatric patients were identified who had both clinical histories supporting delayed anaphylaxis or urticaria to mammalian meat and IgE antibody specific for α-Gal. In addition, most of these cases had a history of tick bites within the past year, which itched and persisted. CONCLUSIONS: A novel form of anaphylaxis and urticaria that occurs 3 to 6 hours after eating mammalian meat is not uncommon among children in our area. Identification of these cases may not be straightforward and diagnosis is best confirmed by specific testing, which should certainly be considered for children living in the area where the Lone Star tick is common. PMID:23569097

  6. Distinct transcriptome profiles differentiate NSAID-dependent from NSAID-independent food anaphylaxis

    Science.gov (United States)

    Muñoz-Cano, Rosa; Pascal, Mariona; Bartra, Joan; Picado, Cesar; Valero, Antonio; Kim, Do-Kyun; Brooks, Stephen; Ombrello, Michael; Metcalfe, Dean D.; Rivera, Juan; Olivera, Ana

    2015-01-01

    Background Lipid transfer protein (LTP), an abundant protein in fruits, vegetables and nuts, is a common food allergen in Mediterranean areas causing diverse allergic reactions. Approximately 40% of food anaphylaxis induced by LTP require non-steroidal anti-inflammatory drugs (NSAIDs) as a triggering cofactor. Objective To better understand the determinants of NSAID-dependent (NSAID-LTP-A) and NSAID-independent LTP-anaphylaxis (LTP-A) Methods Selection of patients was based on a proven clinical history of NSAID-dependent or -independent anaphylaxis to LTP, positive skin prick test to LTP and serum LTP-IgE. Whole transcriptome (RNA-Seq) analysis of blood cells from 14 individuals with NSAID-LTP-A, 7 with LTP-A and 13 healthy controls was performed to identify distinct gene expression signatures. Results Expression of genes regulating gastrointestinal epithelium renewal was altered in both patient sets, particularly in LTP-A, who also presented gene expression profiles characteristic of an inflammatory syndrome. These included altered B cell pathways, increased neutrophil activation markers and elevated levels of reactive oxygen species. Increased expression of the IgG receptor (CD64) in LTP-A patients was mirrored by the presence of LTP-specific IgG1 and 3. Conversely, NSAID-LTP-A patients were characterized by reduced expression of IFN-γ-regulated genes and IFN-γ levels as well as up-regulated adenosine receptor 3 (ADORA3) expression and genes related to adenosine metabolism. Conclusions Gene ontology analysis suggests disturbances in gut epithelium homeostasis in both LTP-related anaphylaxis groups with potential integrity breaches in LTP-A that may explain their distinct inflammatory signature. Differential regulation in LTP-A and NSAID-LTP-A of the IFN-γ pathway, IgG receptors and ADORA3 may provide the pathogenic basis of their distinct responses. PMID:26194548

  7. Elevated exhaled nitric oxide in anaphylaxis with respiratory symptoms

    Directory of Open Access Journals (Sweden)

    Yoichi Nakamura

    2015-10-01

    Conclusions: Elevation of FeNO was related to respiratory symptoms observed in anaphylactic patients without asthma. Although the mechanism of increased FeNO level is unclear, its usefulness for diagnosis of anaphylaxis must be examined in prospective studies.

  8. Anaphylaxis across two Canadian pediatric centers: evaluating management disparities

    Science.gov (United States)

    Lee, Alison YM; Enarson, Paul; Clarke, Ann E; La Vieille, Sébastien; Eisman, Harley; Chan, Edmond S; Mill, Christopher; Joseph, Lawrence; Ben-Shoshan, Moshe

    2017-01-01

    Background There are no data on the percentage of visits due to anaphylaxis in the emergency department (ED), triggers, and management of anaphylaxis across different provinces in Canada. Objective To compare the percentage of anaphylaxis cases among all ED visits, as well as the triggers and management of anaphylaxis between two Canadian pediatric EDs (PEDs). Methods As part of the Cross-Canada Anaphylaxis Registry (C-CARE), children presenting to the British Columbia Children’s Hospital (BCCH) and Montreal Children’s Hospital (MCH) EDs with anaphylaxis were recruited. Characteristics, triggers, and management of anaphylaxis were documented using a standardized data entry form. Differences in demographics, triggers, and management were determined by comparing the difference of proportions and 95% confidence interval. Results Between June 2014 and June 2016, there were 346 visits due to anaphylaxis among 93,730 PED visits at the BCCH ED and 631 anaphylaxis visits among 164,669 pediatric visits at the MCH ED. In both centers, the majority of cases were triggered by food (BCCH 91.3% [88.7, 94.0], MCH 82.4% [79.7, 85.3]), of which peanuts were the most common culprit (24.7% [20.9, 29.9] and 19.0% [15.8, 22.7], respectively). Pre-hospital administration of epinephrine (BCCH 27.7% [23.2, 32.8], MCH 33.1% [29.5, 37.0]) and antihistamines (BCCH 50.6% [45.2, 56.0], MCH 47.1% [43.1, 51.0]) was similar. In-hospital management differed in terms of increased epinephrine, antihistamine, and steroid use at the BCCH (59.2% [53.9, 64.4], 59.8% [54.4, 65.0], and 60.1% [54.7, 65.3], respectively) compared to the MCH (42.2% [38.3, 46.2], 36.2% [32.5, 40.1], and 11.9% [9.5, 14.8], respectively). Despite differences in management, percentage of cases admitted to the intensive care unit was similar between the two centers. Conclusion Compared to previous European and North American reports, there is a high percentage of anaphylaxis cases in two PEDs across Canada with substantial

  9. Anaphylaxis Complicated by Acute Respiratory Distress and Fatal Outcome in A Nigerian Family

    Science.gov (United States)

    Agelebe, Efeturi; Musa, Tawakalit Lily; Ajayi, Idowu Adebowale

    2017-01-01

    Reports on hypersensitivity diseases in Nigerians are rare. We report the incidence of anaphylaxis in three siblings following fatal outcome in their mother. Urticarial rashes were noticed in three siblings’ resident in a South Western Nigerian town, one week before presentation at our facility. All the three siblings developed respiratory distress four days after the rash was noticed. Onset of respiratory distress made the family seek care at a private hospital, where they were admitted and treated with intravenous aminophylline and ceftriaxone. The mother of the children had experienced the same symptoms earlier also. She took treatment and died in the same private hospital, where her children received care. Death of the mother and worsening respiratory distress in the children made the father effect transfer of the children to the paediatric emergency unit of Ladoke Akintola University of Technology Teaching Hospital, Osogbo. The three children made a slow but uneventful recovery after instituting appropriate management for anaphylaxis and acute respiratory distress syndrome. The cases are discussed with a view to create awareness amongst health practitioners about the occurrence of anaphylaxis in our society. The need for prompt recognition and appropriate management, when confronted with this disease is also underscored.

  10. Atracurium-induced anaphylaxis and angioedema: a case report

    Directory of Open Access Journals (Sweden)

    Jyoti Sharma

    2015-08-01

    Full Text Available Drug-induced anaphylaxis has increased in frequency with the more widespread use of pharmaceutical agents. Neuromuscular blocking agents (NMBAs are one of the most common causes of anaphylaxis during general anesthesia. However, the incidence of anaphylaxis due to atracurium is very rare (<1/10,000 according to UK Summary of Product Characteristics. NMBAs can induce two types of reactions: one is immune mediated - immunoglobulin E dependent and the second one is associated with non-specific stimulation of mast cells. Systemic manifestations of anaphylaxis can be in the form of hypotension, difficulty in breathing. Rarely, it can be associated with cutaneous manifestations such as urticaria, angioedema, and flushing. If it is not promptly diagnosed and treated, it can be fatal. In the present case, the patient was posted for submandibular gland surgery. She was well-stabilized after general anesthesia and within the seconds of giving injection atracurium; she had difficulty in breathing and marked decrease in blood pressure that was soon followed by periorbital swelling and swelling of lips. The patient was diagnosed with anaphylaxis with angioedema due to atracurium and was promptly managed in operation theater. She was kept under observation for 2 days. Anaphylaxis along with angioedema with atracurium is a very rare event, and hence it is being reported here. [Int J Basic Clin Pharmacol 2015; 4(4.000: 802-804

  11. Clinical Records for Acupuncture Treatment of Migraine

    Institute of Scientific and Technical Information of China (English)

    陶莎

    2005-01-01

    @@ Migraine, characterized by periodic attacks that hampers the quality of the daily life, is an obstinate symptom complex commonly seen in the clinic. In contrast with the poor effects obtained in Western medicine, acupuncture is a safe and effective treatment for migraine. The following are the clinical records for acupuncture treatment of migraine in the recent 5 years.

  12. Clinical Practice Guidelines for Cerebral Abscess Treatment

    Directory of Open Access Journals (Sweden)

    Danny Barrueta Reyes

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Cerebral Abscess Treatment. It has been defined as a festering process caused by any germ and placed inside the cerebral parenchyma; this is a diagnostic and therapeutic challenge for surgeons and general doctors since the clinical and radiological manifestations are often imprecise. This document describes its etiological agents, clinical presentation, diagnosis and treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  13. [Hypertensive crisis: pathogenesis, clinic, treatment].

    Science.gov (United States)

    Vertkin, A L; Topolianskiĭ, A V; Abdullaeva, A U; Alekseev, M A; Shakhmanaev, Kh A

    2013-01-01

    Contemporary data on mechanisms of development, types, and clinical picture of hypertensive crisis (HC) are presented. Algorithms of rational therapy of uncomplicated and complicated HC are considered. Appropriateness of the use in HC of antihypertensive drugs with multifactorial action is stressed. These drugs include urapidil - an antihypertensive agent with complex mechanism of action. Blocking mainly the postsynaptic 1-adrenoreceptors urapidil attenuates vasoconstrictor effect of catecholamines and decreases total peripheral resistance. Stimulation of 5HT1-receptors of medullary vasculomotor center promotes lowering of elevated vascular tone and prevents development of reflex tachycardia.

  14. Clinical Practice Guidelines Infective Endocarditis Treatment.

    Directory of Open Access Journals (Sweden)

    Lázaro de la Cruz Avilés

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Infective Endocarditis Treatment. Infectious disease affecting the endocardium produces vegetations and could also affect the septum, the chordae tendinae or mural endocardium. It includes concept, risk factors, classification (and special groups and an update and review of the main clinical aspects, complications and treatment stressing the antibiotic therapy. It includes assessment guidelines focused on the most important aspects to be accomplished.

  15. EAACI food allergy and anaphylaxis guidelines. Primary prevention of food allergy.

    Science.gov (United States)

    Muraro, A; Halken, S; Arshad, S H; Beyer, K; Dubois, A E J; Du Toit, G; Eigenmann, P A; Grimshaw, K E C; Hoest, A; Lack, G; O'Mahony, L; Papadopoulos, N G; Panesar, S; Prescott, S; Roberts, G; de Silva, D; Venter, C; Verhasselt, V; Akdis, A C; Sheikh, A

    2014-05-01

    Food allergy can have significant effects on morbidity and quality of life and can be costly in terms of medical visits and treatments. There is therefore considerable interest in generating efficient approaches that may reduce the risk of developing food allergy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Prevention and is part of the EAACI Guidelines for Food Allergy and Anaphylaxis. It aims to provide evidence-based recommendations for primary prevention of food allergy. A wide range of antenatal, perinatal, neonatal, and childhood strategies were identified and their effectiveness assessed and synthesized in a systematic review. Based on this evidence, families can be provided with evidence-based advice about preventing food allergy, particularly for infants at high risk for development of allergic disease. The advice for all mothers includes a normal diet without restrictions during pregnancy and lactation. For all infants, exclusive breastfeeding is recommended for at least first 4-6 months of life. If breastfeeding is insufficient or not possible, infants at high-risk can be recommended a hypoallergenic formula with a documented preventive effect for the first 4 months. There is no need to avoid introducing complementary foods beyond 4 months, and currently, the evidence does not justify recommendations about either withholding or encouraging exposure to potentially allergenic foods after 4 months once weaning has commenced, irrespective of atopic heredity. There is no evidence to support the use of prebiotics or probiotics for food allergy prevention.

  16. Patients with anaphylaxis to pea can have peanut allergy caused by cross-reactive lgE to vicilin (Ara h 1)

    NARCIS (Netherlands)

    Wensing, M.; Knulst, A.C.; Piersma, S.; O'Kane, F.; Knol, E.F.; Koppelman, S.J.

    2003-01-01

    Background: Serologic cross-reactivity among legumes has been described; however, it is rarely clinically significant. In this study 3 patients with a history of anaphylaxis to pea are described who subsequently had symptoms after ingestion of peanut. Objective: We investigated whether the peanut-re

  17. Patients with anaphylaxis to pea can have peanut allergy caused by cross-reactive IgE to vicilin (Ara h 1)

    NARCIS (Netherlands)

    Wensing, M.; Knulst, A.C.; Piersma, S.R.; O'Kane, F.E.; Knol, E.F.; Koppelman, S.J.

    2003-01-01

    Background: Serologic cross-reactivity among legumes has been described; however, it is rarely clinically significant. In this study 3 patients with a history of anaphylaxis to pea are described who subsequently had symptoms after ingestion of peanut. Objective: We investigated whether the peanut-re

  18. The Nobel Prize laureate - father of anaphylaxis Charles-Robert Richet (1850-1935) and his anticancerous serum.

    Science.gov (United States)

    Androutsos, G; Karamanou, M; Stamboulis, E; Liappas, I; Lykouras, E; Papadimitriou, G N

    2011-01-01

    Professor of physiology Charles-Robert Richet, winner of the Nobel Prize in 1913, is best known for his work on anaphylaxis. However, with his collaborator Jules Héricourt studied the effects of antibody treatment and made the very first attempts to fight cancer with serotherapy. Being versatile, Richet contributed in neurology, psychology and was also a poet, playwrighter, pacifist and pioneer in aviation.

  19. Spinal lipomas: clinical spectrum, embryology, and treatment.

    Science.gov (United States)

    Finn, Michael A; Walker, Marion L

    2007-01-01

    Spinal lipomas, particularly lipomas of the conus medullaris and terminal filum, are the most common form of occult spinal dysraphism and represent a wide spectrum of disease with regard to anatomy, clinical presentation, and treatment options. These lesions, however, are united by a similar embryology and pathological mechanism by which symptoms arise. Recently, the treatment of these lesions has generated much controversy, with some physicians advocating surgical treatment for all patients regardless of symptoms and others proposing that surgery be withheld until symptoms develop. The authors discuss lumbosacral spinal lipomas, with particular attention to the theories of their origin, anatomical and pathological features, and treatment options, including a review of current controversies.

  20. Neuromyelitis optica: clinical features, immunopathogenesis and treatment

    Science.gov (United States)

    Jarius, S; Wildemann, B; Paul, F

    2014-01-01

    The term ‘neuromyelitis optica’ (‘Devic's syndrome’, NMO) refers to a syndrome characterized by optic neuritis and myelitis. In recent years, the condition has raised enormous interest among scientists and clinical neurologists, fuelled by the detection of a specific serum immunoglobulin (Ig)G reactivity (NMO-IgG) in up to 80% of patients with NMO. These autoantibodies were later shown to target aquaporin-4 (AQP4), the most abundant water channel in the central nervous system (CNS). Here we give an up-to-date overview of the clinical and paraclinical features, immunopathogenesis and treatment of NMO. We discuss the widening clinical spectrum of AQP4-related autoimmunity, the role of magnetic resonance imaging (MRI) and new diagnostic means such as optical coherence tomography in the diagnosis of NMO, the role of NMO-IgG, T cells and granulocytes in the pathophysiology of NMO, and outline prospects for new and emerging therapies for this rare, but often devastating condition. Other Articles published in this series Paraneoplastic neurological syndromes. Clinical and Experimental Immunology 2014, 175: 336–48. Disease-modifying therapy in multiple sclerosis and chronic inflammatory demyelinating polyradiculoneuropathy: common and divergent current and future strategies. Clinical and Experimental Immunology 2014, 175: 359–72. Monoclonal antibodies in treatment of multiple sclerosis. Clinical and Experimental Immunology 2014, 175: 373–84. CLIPPERS: chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. Review of an increasingly recognized entity within the spectrum of inflammatory central nervous system disorders. Clinical and Experimental Immunology 2014, 175: 385–96. Requirement for safety monitoring for approved multiple sclerosis therapies: an overview. Clinical and Experimental Immunology 2014, 175: 397–407. Myasthenia gravis: an update for the clinician. Clinical and Experimental Immunology 2014, 175: 408

  1. 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.

  2. [Clinical laboratory approaches to parodontitis treatment optimization].

    Science.gov (United States)

    Soboleva, L A; Shul'diakov, A A; Oseeva, A O; Aleksandrova, E A

    2010-01-01

    In order to determine cycloferon liniment clinical-pathogenetic efficacy in comprehensive parodontitis therapy examination and treatment of 80 patients was done. It was determined that the cycloferon liniment use in comprehensive treatment of patients with parodontitis let to reduce infectious load in parodontal pockets and local inflammation intensity, to normalize the secretory immunoglobulin level and immune status indices that provided speed up of healing process and reduction relapse frequency.

  3. [Hemolytic uremic syndrome. Clinical manifestations. Treatment].

    Science.gov (United States)

    Exeni, Ramón A

    2006-01-01

    Clinical manifestation are described in children with epidemic HUS. The intestinal involvement in the prodromic period, is outlined and the most common disturbances such acute renal failure, thrombocytopenia, hemolytic anemia, leucocitosis hypertension, neurological, pancreatic and cardiac manifestations are described. We discuss the acid-base and electrolyte disturbances, metabolic acidosis, hyponatremia, hyperkalemia. The etiopathogenic treatment and the control of renal sequelae are also discussed.

  4. Clinical symptoms, diagnosis, and treatment of neurocysticercosis.

    Science.gov (United States)

    Garcia, Hector H; Nash, Theodore E; Del Brutto, Oscar H

    2014-12-01

    The infection of the nervous system by the cystic larvae of Taenia solium (neurocysticercosis) is a frequent cause of seizure disorders. Neurocysticercosis is endemic or presumed to be endemic in many low-income countries. The lifecycle of the worm and the clinical manifestations of neurocysticercosis are well established, and CT and MRI have substantially improved knowledge of the disease course. Improvements in immunodiagnosis have further advanced comprehension of the pathophysiology of this disease. This knowledge has led to individualised treatment approaches that account for the involvement of parenchymal or extraparenchymal spaces, the number and form of parasites, and the extent of degeneration and associated inflammation. Clinical investigations are focused on development of effective treatments and reduction of side-effects induced by treatment, such as seizures, hydrocephalus, infarcts, and neuroinjury.

  5. Fullerene carbon-70 derivatives dampen anaphylaxis and allergic asthma pathogenesis in mice

    Science.gov (United States)

    Norton, Sarah Brooke

    Fullerenes are carbon nanospheres that can be solublized by the addition of polar chemical groups to the carbon cage, forming fullerene derivatives. One specifically derivatized fullerene compound, termed C 70-Tetragylocolate (C70-TGA), has been shown to stabilize mast cell responses in vitro thus we hypothesized it may have an effect on mast cell-driven diseases such as asthma and systemic anaphylaxis. To observe the effects of C70-TGA on systemic anaphylaxis, mice were subjected to a model of passive systemic anaphylaxis. In this model, mice were injected with DNP-specific IgE 16 hours prior to challenge, then treated with C 70-TGA. Immediately prior to DNP challenge, mice were subjected to a second injection of C70-TGA. Following DNP challenge, body temperature was recorded and blood was collected for quantitation of histamine levels. Treatment with C70-TGA significantly reduced body temperature drop associated with systemic anaphylaxis and serum histamine levels. To observe the effects of C70-TGA on chronic features of asthma in vivo, we utilized a heavily MC influenced model of asthma pathogenesis. Mice were sensitized by intraperitoneal (i.p.) injection of ovalbumin (OVA) in saline, challenged intranasally (i.n.) with OVA, and one of two treatment strategies was pursued. In one, C70-TGA was given i.n. throughout disease development. In the other, C70-TGA was given following an initial set of challenges to allow disease to develop prior to treatment; mice were then re-challenged with OVA to assess the effect on established disease. We found that C70-TGA treatment significantly reduced airway inflammation and eosinophilia and dramatically reduced bronchoconstriction in either model. Cytokines IL-4 and IL-5 and serum IgE levels are significantly reduced in C70-TGA treated animals. Interestingly, we also saw an increase in the anti-inflammatory eicosanoid 11, 12-epoxyeicosatreinoic acid (11,12-EET) in the BAL fluid, suggesting the involvement of this mediator in

  6. Pediatric insomnia: clinical, diagnosis, and treatment.

    Science.gov (United States)

    Miano, Silvia; Peraita-Adrados, Rosa

    2014-01-01

    Pediatric insomnia is an extrinsic sleep disorder subdivided into two categories: behavioral insomnia and insomnia related to medical, neurological, and psychiatric diseases. This review will cover several types of insomnia, comorbidities and specific pediatric therapies according to clinical characteristics and age. Behavioral insomnia should be differentiated from pediatric insomnia due to medical conditions, mostly occurring during the first year of life. Multiple night awakenings and diurnal hypersomnolence are strong indicators of insomnia due to medical conditions. Insomnia during adolescence and pediatric insomnia associated with psychiatric comorbidity, cognitive disabilities and epilepsy, will be discussed in terms of diagnosis, clinical features and implications for treatment.

  7. Anti-anaphylactic effects of Trichilia monadelpha (Thonn.) J. J. De Wilde extracts on rodent models of anaphylaxis

    Science.gov (United States)

    Ben, Inemesit Okon; Woode, Eric; Koffuor, George Asumeng; Asiamah, Emmanuel Akomanin

    2016-01-01

    Effects of petroleum ether and ethanolic extracts of Trichilia monadelpha stem bark (PEE and EAE) on compound 48/80-induced systemic and passive anaphylaxis were determined. Survival rate, extravasation, degranulation of mast cells, and secretion of tumour necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were measured after pre-treatment with extracts (10-100 mg/kg) and disodium chromoglycate (2.5-250 μg/kg) and induction of anaphylaxis in C57BL/6 mice or Sprague-Dawley rats with compound 48/80. Histopathological assessments were made from skin biopsies of rats. Data was analyzed by Kaplan-Meier Survival Log-Rank Analysis, or One-way ANOVA and Holm-Sidak’s post hoc test. PEE and EAE inhibited (P ≤ 0.0001) tremors in systemic anaphylaxis passive cutaneous anaphylactic reactions and extravasation, stabilized or prevented (P ≤ 0.001-0.0001) mast cell degranulation, and inhibited (P ≤ 0.001-0.0001) TNF-α and IL-6 secretion. Per the findings, PEE and EAE of T. monadelpha have exhibited substantial anti-anaphylactic and anti-inflammatory property (with PEE performing better) which substantiates its use traditionally in management of allergies and other inflammatory disorders. PMID:27920822

  8. Clinical Practice Guidelines for Severe Asthma Treatment.

    Directory of Open Access Journals (Sweden)

    Eddy Pereira Valdes

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Severe Asthma Treatment. This disease is characterized by an overreaction of the tracheobronchial tree with hyperactivity after certain stimulus consisting of a diffuse narrowing of the respiratory ways related with an excessive contraction of the bronchial smooth muscle, hyper-secretion of mucus and mucosa edema. It is spontaneously reversible or reversible after treatment. We include a review of its definition, classification and development, stressing those elements related with ventilation. It includes assessment guidelines focused on the most important aspects to be accomplished.

  9. Pericoronitis: treatment and a clinical dilemma.

    LENUS (Irish Health Repository)

    Moloney, Justin

    2009-06-01

    Pericoronitis is an infection associated with impacted lower third molars that can necessitate the removal of these teeth. The clinical features of this condition are described and its treatment outlined, emphasising local measures. A case of pericoronitis in a 52-year-old patient is discussed, which illustrates the risks and benefits of removal of wisdom teeth; removal can lead to nerve damage, retention can precipitate serious, even life-threatening infection.

  10. Pericoronitis: treatment and a clinical dilemma.

    LENUS (Irish Health Repository)

    Moloney, Justin

    2009-08-01

    Pericoronitis is an infection associated with impacted lower third molars that can necessitate the removal of these teeth. The clinical features of this condition are described and its treatment outlined, emphasising local measures. A case of pericoronitis in a 52-year-old patient is discussed, which illustrates the risks and benefits of removal of wisdom teeth; removal can lead to nerve damage, retention can precipitate serious, even life-threatening infection.

  11. Pericoronitis: treatment and a clinical dilemma.

    Science.gov (United States)

    Moloney, Justin; Stassen, Leo F A

    2009-01-01

    Pericoronitis is an infection associated with impacted lower third molars that can necessitate the removal of these teeth. The clinical features of this condition are described and its treatment outlined, emphasising local measures. A case of pericoronitis in a 52-year-old patient is discussed, which illustrates the risks and benefits of removal of wisdom teeth; removal can lead to nerve damage, retention can precipitate serious, even life-threatening infection.

  12. Neuromyelitis optica: clinical features, immunopathogenesis and treatment.

    Science.gov (United States)

    Jarius, S; Wildemann, B; Paul, F

    2014-05-01

    The term 'neuromyelitis optica' ('Devic's syndrome', NMO) refers to a syndrome characterized by optic neuritis and myelitis. In recent years, the condition has raised enormous interest among scientists and clinical neurologists, fuelled by the detection of a specific serum immunoglobulin (Ig)G reactivity (NMO-IgG) in up to 80% of patients with NMO. These autoantibodies were later shown to target aquaporin-4 (AQP4), the most abundant water channel in the central nervous system (CNS). Here we give an up-to-date overview of the clinical and paraclinical features, immunopathogenesis and treatment of NMO. We discuss the widening clinical spectrum of AQP4-related autoimmunity, the role of magnetic resonance imaging (MRI) and new diagnostic means such as optical coherence tomography in the diagnosis of NMO, the role of NMO-IgG, T cells and granulocytes in the pathophysiology of NMO, and outline prospects for new and emerging therapies for this rare, but often devastating condition.

  13. EAACI Food Allergy and Anaphylaxis Guidelines. Food allergy health-related quality of life measures.

    Science.gov (United States)

    Muraro, A; Dubois, A E J; DunnGalvin, A; Hourihane, J O'B; de Jong, N W; Meyer, R; Panesar, S S; Roberts, G; Salvilla, S; Sheikh, A; Worth, A; Flokstra-de Blok, B M J

    2014-07-01

    Instruments have been developed and validated for the measurement of health-related quality of life in patients with food allergy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Guidelines for Food Allergy and Anaphylaxis Group. It draws on a systematic review of the literature on quality of life instruments for food allergy and the Appraisal of Guidelines for Research & Evaluation (AGREE II) guideline development process. Guidance is provided on the use of such instruments in research, and the current limitations of their use in clinical practice are described. Gaps in current knowledge as well as areas of future interest are also discussed. This document is relevant to healthcare workers dealing with food-allergic patients, scientists engaging in food allergy research and policy makers involved in regulatory aspects concerning food allergy and safety.

  14. Gynecomastia induced by H1-antihistamine (ebastine) in a patient with idiopathic anaphylaxis

    OpenAIRE

    Jung, Hwa Sik; Park, Chan-Ho; Park, Young Tae; Bae, Mi Ae; Lee, Youn Im; Kang, Byung Ju; Jegal, Yangjin; Ahn, Jong Joon; Lee, Taehoon

    2015-01-01

    H1-antihistamine is generally a well-tolerated and safe drug. However, in resemblance with all other drugs, H1-antihistamines can also prompt adverse drug reactions (ADRs). We recently encountered the very unusual ADR of H1-antihistamine-induced gynecomastia. A 21-year-old man with idiopathic anaphylaxis was treated with ebastine (Ebastel), a second-generation H1-antihistamine, for the prevention of anaphylaxis. Three months later, the patient remained well without anaphylaxis, but had newly ...

  15. A case of severe anaphylaxis following coronary angiography

    Directory of Open Access Journals (Sweden)

    Anil Kumar

    2016-01-01

    Full Text Available Anaphylaxis reactions are not uncommon in routine practice and involve multiple systems usually. Cardiovascular collapse is the severest form of reaction. We present a case of severe anaphylactic reaction with cardiovascular collapse without other systems involvement which had to treat with intravenous adrenaline for a prolonged duration (successfully. The case is presented because of the rarity of presentation (single system involvement and requirement of prolonged use of adrenaline for more than 24 h.

  16. Anaphylaxis from intravascular rupture of Hydatid disease following liver trauma

    Directory of Open Access Journals (Sweden)

    Paul J Marriott

    2010-09-01

    Full Text Available Cystic Echinococcosis also known as cystic hydatid disease is a parasitic infection endemic in many parts of the world. Humans are accidental intermediate hosts with cysts most commonly developing in the liver. This case describes a rare presentation of hydatid disease following trauma to the liver. Intraparenchymal cyst rupture led to haemodynamic instability with release of the parasites protoscolices into hepatic venules producing severe life threatening anaphylaxis.

  17. Anaphylaxis at image-guided epidural pain block secondary to corticosteroid compound.

    LENUS (Irish Health Repository)

    Moran, Deirdre E

    2012-09-01

    Anaphylaxis during image-guided interventional procedures is a rare but potentially fatal event. Anaphylaxis to iodinated contrast is an established and well-recognized adverse effect. However, anaphylaxis to some of the other frequently administered medications given during interventional procedures, such as corticosteroids, is not common knowledge. During caudal epidural injection, iodinated contrast is used to confirm needle placement in the epidural space at the level of the sacral hiatus. A combination of corticosteroid, local anesthetic, and saline is subsequently injected. We describe a very rare case of anaphylaxis to a component of the steroid medication instilled in the caudal epidural space.

  18. Clinical Progress on Moxibustion Treatment of Asthma

    Institute of Scientific and Technical Information of China (English)

    WU Yao-chi; SHI Yin; HUANG Guo-qi

    2004-01-01

    In the treatment of asthma, there are the commonly-used external therapies of scarring moxibustion, ginger-insulated moxibustion and acupoint herb-applying method, etc, with better clinical effects. But, strict recruitment standard was lacked and the designs of clinical studies were not complete in some reports. Therefore, the design of clinical study on moxibustion therapy and acupoint herb-applying method in the treatment of asthma needs to be strict and complete in the future studies.%治疗哮喘的常用外治法有化脓灸,隔姜灸和穴位贴敷等,均有较好的临床效果,但部分报道缺乏严格的纳入标准,而且临床研究设计不完善,有待于在以后的研究中严格与完善灸法和穴位贴敷防治哮喘的临床研究设计.

  19. Neurosarcoidosis: Clinical manifestations, diagnosis and treatment.

    Science.gov (United States)

    Nozaki, Kenkichi; Judson, Marc A

    2012-06-01

    Sarcoidosis is an idiopathic granulomatous disease affecting multiple organs. Neurosarcoidosis, involving the central and/or peripheral nervous systems, is a relatively rare form of sarcoidosis. Its clinical manifestations include cranial neuropathies, meningitis, neuroendocrinological dysfunction, hydrocephalus, seizures, neuropsychiatric symptoms, myelopathy and neuropathies. The diagnosis is problematic, especially when occurring as an isolated form without other organ involvement. Distinguishing neurosarcoidosis from other granulomatous diseases and multiple sclerosis is especially important. Although biopsy of neural tissue is the gold standard for the diagnosis of neurosarcoidosis, this is often not practical and the diagnosis must be inferred though other tests, often coupled with biopsy of extraneural organs. Corticosteroids and other immuno-suppressants are frequently used for the treatment of neurosarcoidosis. This article reviews the epidemiology, pathogenesis, pathology, clinical features, diagnosis, diagnostic tests, diagnostic criteria, and therapy of neurosarcoidosis.

  20. Clinical characteristics and current treatment of glaucoma.

    Science.gov (United States)

    Cohen, Laura P; Pasquale, Louis R

    2014-06-02

    Glaucoma is a neurodegenerative disorder in which degenerating retinal ganglion cells (RGC) produce significant visual disability. Clinically, glaucoma refers to an array of conditions associated with variably elevated intraocular pressure (IOP) that contributes to RGC loss via mechanical stress, vascular abnormalities, and other mechanisms, such as immune phenomena. The clinical diagnosis of glaucoma requires assessment of the ocular anterior segment with slit lamp biomicroscopy, which allows the clinician to recognize signs of conditions that can produce elevated IOP. After measurement of IOP, a specialized prismatic lens called a gonioscope is used to determine whether the angle is physically open or closed. The structural manifestation of RGC loss is optic nerve head atrophy and excavation of the neuroretinal rim tissue. Treatment is guided by addressing secondary causes for elevated IOP (such as inflammation, infection, and ischemia) whenever possible. Subsequently, a variety of medical, laser, and surgical options are used to achieve a target IOP.

  1. PSORIATIC ARTHRITIS: CLASSIFICATION, CLINICAL PRESENTATION, DIAGNOSIS, TREATMENT

    Directory of Open Access Journals (Sweden)

    T. V. Korotaeva

    2014-01-01

    Full Text Available The lecture gives basic information about psoriatic arthritis (PsA, a chronic inflammatory disease of the joints, spine, and enthesises from a group of spondyloarthritis. It describes the epidemiology of the disease and considers current ideas on its pathogenesis and factors influencing the development of PsA in psoriatic patients. The classification and clinical forms of PsA are presented. The major clinical manifestations of the disease are indicated to include peripheral arthritis, enthesitis, dactylitis, and spondylitis. The diagnosis of the disease is noted to be established on the basis of its detected typical clinical and radiological signs, by applying the CASPAR criteria. A dermatologist, rheumatologist, and general practitioner screen PsA, by actively detecting complaints, characteristic clinical and radiological signs of damage to the joints, and/or spine, and/or enthesises and by using screening questionnaires. There are data that patients with PsA are observed to be at higher risk for a number of diseases type 2 diabetes mellitus hypertension, coronary heart disease, obesity, metabolic syndrome, inflammatory bowel diseases, etc. The aim of current pharmacotherapy for PsA is to achieve remission or minimal activity of clinical manifestations of the disease, to delay or prevent its X-ray progression, to increase survival, to improve quality of life in patients, and to reduce the risk of comorbidities. The paper considers groups of medicines used to treat the disease, among other issues, information about biological agents (BA registered in the Russian Federation for the treatment of PsA. Most patients are mentioned to show a good response to this therapy option just 3–6 months after treatment initiation; however, some of them develop primary inefficiency. In this case, switching one BA to another is recommended. Some patients using a BA develop secondary treatment inefficiency, which is firstly due to the appearance of

  2. [Polymyositis/dermatomyositis--clinical picture and treatment].

    Science.gov (United States)

    Anić, Branimir; Cerovec, Mislav

    2012-01-01

    The clinical presentation ofmyositis ranges from a painless muscle weakness to significant myalgia with muscle weakness and constitutional symptoms. Along with muscle and skin affection and constitutional symptoms, the disease can affect lungs, joints, heart and gastrointestinal system. It is important to note that the clinical presentation ofmyositis syndrome may overlap with symptoms of other connective tissue disease in overlap syndromes (SLE, SSCL, RA, SSjö). Common manifestations of the disease are weakness and muscle fatigue, which is the result of skeletal muscles inflammation (usually the proximal group of muscles, bilaterally and symmetrical). Severe forms of the disease with affection of the throat and respiratory muscles can vitally endan- ger patients. Among constitutional (general) symptoms, fever, malaise and weight loss are usually expressed. Skin affection in dermatomyositis can be localized or generalized like vesiculobullous erythroderma. Pathognomonic cutaneous manifestations of dermatomyositis are Gottron's papules and heliotrope erythema. Lungs are most commonly affected organs (with exception of muscles and skin) in polymyositis and dermatomyositis. The affection of lung can sometimes result in fatal outcome (interstitial lung disease, secondary pulmonary hypertension). Cardiac affection is usually subclinical, but can also be expressed as heart failure, acute coronary syndrome or conduction disturbances. Infrequent manifestations of the disease are gastroesophageal reflux, malabsorption, gastrointestinal mucosal ulceration, soft tissue calcification, Raynaud's syndrome, arthralgia/arthritis and some other less common clinical manifestations of the disease. Treatment of polymyositis/dermatomyositis includes immunosuppressive/immunomodulatory therapy and supportive, symptomatic treatment. The basis for myositis treatment are glucocorticoids, which are applied orally in a daily dosage regimen of 0.75 to 1 mg/kg/day, and in severe forms of the

  3. [Infantile dermatomyositis. Clinical aspects and prospective treatments].

    Science.gov (United States)

    Cordone, G; Buoncompagni, A; Ciccone, O; Minetti, C; Fasce, L; Scribanis, R; De Langlade, E

    1991-10-01

    Juvenile dermatomyositis (DMI) is a rare illness of multisystem inflammatory disease of unknown etiology. It is usually considered as a part of the spectrum of polymyositis/dermatomyositis (PM/DM), and is distinguished from the adult form in having a number of different clinical features as well as distinctive pathologic findings. Although the clinical findings and course of the disease, laboratory evaluation and therapy have been reviewed, many of these studies are old and may not accurately reflect the current status of the disease as it is now defined and treated. Generally it is first diagnosed by the appearance of typical signs in both the skin and muscles. The clinical picture shows early signs of heterogeneity and is confirmed by these latter developments. Its classification falls into three groups: acute single cycle, chronic polycycle and continued chronic; this sickness invariably evolves into one or another of these three. Our current work involves 15 cases of DMI; 8 have acute monocycle, 4 chronic polycycle and 3 continued chronic. This illustrates the clinical and biological heterogenousness of this illness which in itself presents extreme difficulties when considering possible treatment. From our experience, high dose of corticosteroida intraveins have had the best result. Where cases have been acute at the beginning of the sickness and where there has been complications, particularly those of a bronco-pulmonary nature (we treated 3 such cases) it has proven to be beneficial to use corticosteroid together with the immunosuppresant: ciclofosfamide. The use of ciclosporina in one case who had resisted other forms of therapy has appeared to be effective, though this has yet to be verified.

  4. [Diverticular disease - clinical patterns and treatment].

    Science.gov (United States)

    Lembcke, Bernhard; Kruis, Wolfgang

    2015-09-01

    Diverticulosis, diverticular disease and diverticulitis have come into focus again because new aspects concerning diagnosis, risk factors and treatment arose only recently which prompted a new Guideline released by the DGVS and DGAV summarising the current evidence. Along with the guideline's essentials for medical practice a diagnosis of diverticulitis is considered unsatisfactory unless a cross-sectional imaging method (either ultrasonography [US] or computed tomography [CT] ) has proven that the clinical findings and inflammation (CRP considered superior to WBC and temperature) are due to diverticular inflammation. For reasons of practicability and considering relevant legislation for radiation exposure protection, US is the primary - and usually effectual - diagnostic method of choice as it is equipotent to CT. While US offers better resolution and enables precise imaging exactly at the location of pain as well as reiterative application, the latter implies advantages in the case of a deep abscess or diverticulitis in difficult locations (e. g. the small pelvis). Clinical evidence and laboratory and imaging findings allow for distinguishing a large number of differential diagnoses and also form the basis of a new classification (classification of diverticular disease, CDD) which comprises all forms of diverticular disease, from diverticulosis to bleeding and to the different facettes of diverticulitis. This classification -which should be applied in any patient with the diagnosis of diverticular disease- is independent of specific diagnostic preferences and applicable both to conservative and operative treatment options. While the number of recurrent episodes is no longer a significant indicator for surgery in diverticulitis, severity and / or complications determine treatment options along with the patients preferences. According to first data, conservative treatment may waive antibiotics under certain circumstances, however they are indispensible in

  5. Evidence on conservative clinical treatments for haemorrhoids

    Directory of Open Access Journals (Sweden)

    Fernanda da Silva Barbosa

    2013-12-01

    Full Text Available Objective: The objective of this health technology assessment was to analyse the evidence on conservative clinical treatments for haemorrhoids usable in Primary Health Care. Methods: We searched in Embase, LILACS and MEDLINE through Pubmed for meta-analyses, systematic reviews and randomized controlled trials published until December 2012, without limits of language. Studies should evaluate the effects of conservative medical treatments (fibres or laxatives, flavonoids, analgesics, corticosteroids, sitz baths or nitro-glycerine ointments compared to placebo or each other. The outcomes considered were overall symptom improvement, bleeding, itching, pain, prolapse and adverse effects. Results: One meta-analysis showed that fibres promote overall improvement of symptoms and bleeding; and decrease recurrence after outpatient procedures. Three meta-analyses showed efficacy of flavonoids for acute and postoperative bleeding, overall symptom improvement, perianal discharge and recurrence after acute episode. There was no statistical difference for itching, pain, prolapse, or adverse effects in both cases. Rutosides, a type of flavonoid, reduced symptoms in pregnant women, despite the insufficiency of data to prove its safety. No studies were found on other types of treatment that met the selection criteria. Conclusions: In Primary Health Care, oral fibres or flavonoids can be used to improve overall symptoms and bleeding in haemorrhoid patients at grades I and II; to patient grade III who does not wish to undergo outpatient procedure; and postoperatively. Randomized controlled trials with adequate methodological quality are needed to confirm these results.

  6. Anaphylaxis Preparedness among Preschool Staff before and after an Educational Intervention

    Directory of Open Access Journals (Sweden)

    Ashley A. Foster

    2015-01-01

    Full Text Available Introduction. Children with severe food allergies may spend many hours in the preschool setting. Little is known about anaphylaxis recognition and management preparedness among preschool staff. The objective of this study was to assess anaphylaxis preparedness among preschool staff. Methods. Anonymous questionnaires were administered before and after a 40-minute educational seminar on anaphylaxis recognition and management. Results. In total, 181 individuals participated in the preintervention survey and 171 participated in the postintervention survey. The comfort level with recognizing anaphylaxis and administering an epinephrine autoinjector significantly increased after the intervention (P<.001 for both. Of the 5 steps needed to administer an epinephrine autoinjector, staff named a mean (SD of 3 (1.3 steps in the correct order compared with 4.2 (1.1 steps after the educational intervention (P<.001. Conclusion. This study shows that a brief education intervention can significantly increase caregiver comfort regarding identifying anaphylaxis and administering an epinephrine autoinjector.

  7. Anaphylaxis, Intra-Abdominal Infections, Skin Lacerations, and Behavioral Emergencies: A Literature Review of Austere Analogs for a near Earth Asteroid Mission

    Science.gov (United States)

    Chough, Natacha G.; Watkins, Sharmi; Menon, Anil S.

    2012-01-01

    As space exploration is directed towards destinations beyond low-Earth orbit, the consequent new set of medical risks will drive requirements for new capabilities and more resources to ensure crew health. The Space Medicine Exploration Medical Conditions List (SMEMCL), developed by the Exploration Medical Capability element of the Human Research Program, addresses the risk of "unacceptable health and mission outcomes due to limitations of in-flight medical capabilities". It itemizes 85 evidence-based clinical requirements for eight different mission profiles and identifies conditions warranting further research and technology development. Each condition is given a clinical priority for each mission profile. Four conditions -- intra-abdominal infections, skin lacerations, anaphylaxis, and behavioral emergencies -- were selected as a starting point for analysis. A systematic literature review was performed to understand how these conditions are treated in austere, limited-resource, space-analog environments (i.e., high-altitude and mountain environments, submarines, military deployments, Antarctica, isolated wilderness environments, in-flight environments, and remote, resource-poor, rural environments). These environments serve as analogs to spaceflight because of their shared characteristics (limited medical resources, delay in communication, confined living quarters, difficulty with resupply, variable time to evacuation). Treatment of these four medical conditions in austere environments provides insight into medical equipment and training requirements for exploration-class missions.

  8. Treatment of intracerebral hemorrhage: the clinical evidences.

    Science.gov (United States)

    Sterzi, R; Vidale, S

    2004-03-01

    Of all strokes 10% to 15% are intracerebral hemorrhage, primary ICH accounting for more than 75% of cases. A correct evaluation and management must start in the emergency room, in particular for patients who rapidly deteriorate. The diffusion of organized care for stroke patients and the availability of the stroke units in Italian hospitals, may represent a further opportunity to improve the outcome of patients with ICH. Despite the bulk of evidences coming from the randomized clinical therapeutic trials for acute ischemic stroke, the available data for randomized surgical trials are scanty. In these small randomized studies, neither surgical nor medical treatment has conclusively been shown to benefit patients with ICH. Surgical techniques are improving but it is important to find out the time window during which surgical evacuation is most effective with respect to the long-term outcome. The use of thrombolytic therapy to promote the resolution of ventricular blood clots appears to be promising.

  9. School Refusal: Clinical Features, Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Kayhan Bahali

    2010-12-01

    Full Text Available Children regularly and voluntarily go to school in order to fulfill the expectations of society from them to continue their education or schooling. School continuation has been made compulsory by laws. Nonetheless, contrary to popular belief, for some children it is distressing to go to school. These children have difficulty continuing school and/or refuse to go to school. Today school refusal is defined as a child’s inability to continue school for reasons, such as anxiety and depression. The prevalence of school refusal has been reported to be approximately 1% in school-age children and 5% in child psychiatry samples. The prevalence of school refusal is similar among boys and girls. School refusal can occur at any time throughout the child’s academic life and at all socio-economic levels. School refusal is considered a symptom rather than a clinical diagnosis and can manifest itself as a sign of many psychiatric disorders, with anxiety disorders predominant. Separation anxiety disorder, generalized anxiety disorder, social phobia, specific phobia, and adjustment disorder with anxiety symptoms are the most common disorders co-occurring with school refusal. While separation anxiety disorder is associated with school refusal in younger children, other anxiety disorders, especially phobias, are associated with school refusal in adolescents. Children who have parents with psychiatric disorders have a higher incidence of school refusal, and psychiatric disorders are more frequently seen in adult relatives of children with school refusal, which supports a significant role of genetic and environmental factors in th etiology of school refusal. School refusal is a emergency state for child mental health. As it leads to detrimental effects in the short term and the long term, it should be regarded as a serious problem. The long-lasting follow-up studies of school refusing children have revealed that these children have a higher incidence of

  10. Chloramine-induced anaphylaxis while showering: a case report

    Directory of Open Access Journals (Sweden)

    D’Alò Simona

    2012-09-01

    Full Text Available Abstract Introduction Sodium-N-chlorine-p-toluene sulfonamide, commonly known as chloramine-T, is a derivative of chlorine which is widely used as a disinfectant. For many years, chloramine-T has been described as a cause of immediate-type hypersensitivity, especially with regard to asthma and rhinitis, and as a cause of occupational dermatoses in cleaning personnel in hospitals, although no anaphylactic reaction has yet been reported. Hence, to the best of our knowledge we present the first case of anaphylaxis to chloramine-T with evidence of specific immunoglobulin E antibodies. Case presentation We describe the case of a 25-year-old Caucasian woman who was in good health and with a negative history for atopy, including no respiratory symptoms of rhinitis or asthma, and with no professional exposure to chloramine-T. She, while showering, applied a chloramine-T solution to a skin area with folliculitis on her leg, and within a few minutes developed generalized urticaria and angioedema, followed by vomiting and collapse with loss of consciousness. A skin prick test with a chloramine-T solution at 10mg/mL concentration was positive, and specific immunoglobulin E to chloramine-T was quantified at a value of 2.9 optical density as measured by the enzyme allergosorbent test technique. Conclusion The strict cause-effect relationship and the results of the skin test and the in vitro test make certain the causative role of chloramine-T in this case of anaphylaxis. This suggests that chloramine-T, based on its wide use as a disinfectant, should be considered a possible cause in anaphylaxis of unknown origin.

  11. [Hyperandrogenism: clinical aspects, investigation and treatment].

    Science.gov (United States)

    Beckers, A; Parotte, M C; Gaspard, U; Khalife, A

    1999-04-01

    Androgen excess (AE) is one of the most common endocrine disorders, affecting 10% of adult women before the menopause. The clinical picture varies widely depending on the etiology of AE. Most of these women are suffering from hirsutism, acne, menstrual disturbances, anovulation and obesity. Virilization is unusual, except in patients with ovary or adrenal cancer. Polycystic ovary syndrome (PCOS) and idiopathic hirsutism (IH) are the most frequent causes of androgen excess, accounting for more than 90% of the cases. The pathogenesis of PCOS is still an unresolved problem. A hereditary predisposition has been suggested. Enzymatic deficiency is a less frequent cause of AE, the most common deficiency being the non classic 21-OH deficiency (NCAH). AE has been implicated as a side effect of many drugs. Ovary and adrenal tumours are unusual, however, they must be considered especially in case of severe hirsutism or virilization. Complementary investigations are selected based on the result of clinical examination. Pharmacologic therapy, usually with anti-androgens, is the most widely used treatment for PCOS, IH and NCAH. Surgical therapy should be considered only when there is a particular indication such as Cushing's syndrome, ovary or adrenal tumours.

  12. [Lyme disease--clinical manifestations and treatment].

    Science.gov (United States)

    Stock, Ingo

    2016-05-01

    Lyme disease (Lyme borreliosis) is a systemic infectious disease that can present in a variety of clinical manifestations. The disease is caused by a group of spirochaetes--Borrelia burgdorferi sensu lato or Lyme borrelia--that are transmitted to humans by the bite of Ixodes ticks. Lyme disease is the most common arthropode-borne infectious disease in many European countries including Germany. Early localized infection is typically manifested by an erythema migrans skin lesion, in rarer cases as a borrelial lymphocytoma. The most common early disseminated manifestation is (early) neuroborreliosis. In adults, neuroborreliosis appears typically as meningoradiculoneuritis. Neuroborreliosis in children, however, is typically manifested by meningitis. In addition, multiple erythema migrans lesions and Lyme carditis occur relatively frequently. The most common manifestation oflate Lyme disease is Lyme arthritis. Early manifestations (and usually also late manifestations) of Lyme disease can be treated successfully by application of suitable antibacterial agents. For the treatment of Lyme disease, doxycycline, certain penicillins such as amoxicillin and some cephalosporins (ceftriaxone, cefotaxime, cefuroxime axetil) are recommended in current guidelines. A major challenge is the treatment of chronic, non-specific disorders, i. e., posttreatment Lyme disease syndrome and "chronic Lyme disease". Prevention of Lyme disease is mainly accomplished by protecting against tick bites. Prophylactic administration of doxycycline after tick bites is generally not recommended in Germany. There is no vaccine available for human beings.

  13. The Pholcodine Case. Cough Medicines, IgE-Sensitization, and Anaphylaxis: A Devious Connection.

    Science.gov (United States)

    Florvaag, E; Johansson, S G O

    2012-07-01

    : The Scandinavian data on pholcodine (PHO) strongly indicates that there is a biological chain from PHO exposure through IgE-sensitization to IgE-mediated anaphylaxis to neuromuscular blocking agents (NMBA). PHO is probably one of the strongest inducer of an IgE antibody response known. Of individuals taking PHO in cough medicines, over-the-counter accessibility to large populations, as many as 20 to 25% may become IgE sensitized. Once sensitized, PHO re-exposure will booster IgE antibody levels and IgE by around 100-fold. PHO is monovalent for 2 non-cross-reacting epitopes the quaternary ammonium ion (QAI), the main allergenic epitope of NMBA, and a non-QAI epitope. Thus, PHO most unlikely would initiate an allergic inflammatory response. Consequently, IgE sensitization is not revealed by obvious clinical signs, neither through tests based on IgE-sensitized effector cells. Therefore, it will escape detection if not assayed serologically. However, when subjected to general anesthesia, and thus the IgE-sensitized individual is administered a bivalent NMBA intravenously, the unrecognized presence of serum IgE antibodies to QAI may increase the risk of anaphylaxis 200- to 300-fold. Severe damages to patient's health can result, and mortality rates of 3 to 10% are reported. The Scandinavian experience indicates that the chain of events can efficiently be avoided by stopping PHO exposure: Within 1 year, the prevalence of IgE sensitization to PHO and QAI decreases significantly, and after 2 to 3 years, the numbers of reported anaphylactic reactions decreases equally so.

  14. Anaphylaxis to chemotherapy and monoclonal antibodies.

    Science.gov (United States)

    Castells, Mariana C

    2015-05-01

    Hypersensitivity reactions are increasingly prevalent, although underrecognized and underreported. Platins induce immunoglobulin E-mediated sensitization; taxenes and some monoclonal antibodies can induce reactions at first exposure. Severe hypersensitivity can preclude first-line therapy. Tryptase level at the time of a reaction is a useful diagnostic tool. Skin testing provides a specific diagnosis. Newer tests are promising diagnostic tools to help identify patients at risk before first exposure. Safe management includes rapid drug desensitization. This review provides information regarding the scope of hypersensitivity and anaphylactic reactions induced by chemotherapy and biological drugs, as well as diagnosis, management, and treatment options.

  15. A Multicenter Retrospective Case Study of Anaphylaxis Triggers by Age in Korean Children

    Science.gov (United States)

    Lee, So-Yeon; Ahn, Kangmo; Kim, Jihyun; Jang, Gwang Cheon; Min, Taek Ki; Yang, Hyeon-Jong; Pyun, Bok Yang; Kwon, Ji-Won; Sohn, Myung Hyun; Kim, Kyung Won; Kim, Kyu-Earn; Yu, Jinho; Hong, Soo-Jong; Kwon, Jung Hyun; Kim, Sung-Won; Song, Tae Won; Kim, Woo Kyung; Kim, Hyung Young; Jeon, You Hoon; Lee, Yong Ju; Lee, Hae Ran; Kim, Hye-Young; Ahn, Youngmin; Yum, Hye Yung; Suh, Dong In; Kim, Hyun Hee; Kim, Jin-Tack; Kim, Jeong Hee; Park, Yong Mean

    2016-01-01

    Purpose Although anaphylaxis is recognized as an important, life-threatening condition, data are limited regarding its triggers in different age groups. We aimed to identify anaphylaxis triggers by age in Korean children. Methods We performed a retrospective review of medical records for children diagnosed with anaphylaxis between 2009 and 2013 in 23 secondary or tertiary hospitals in South Korea. Results A total of 991 cases (mean age=5.89±5.24) were reported, with 63.9% involving patients younger than 6 years of age and 66% involving male children. Food was the most common anaphylaxis trigger (74.7%), followed by drugs and radiocontrast media (10.7%), idiopathic factors (9.2%), and exercise (3.6%). The most common food allergen was milk (28.4%), followed by egg white (13.6%), walnut (8.0%), wheat (7.2%), buckwheat (6.5%), and peanut (6.2%). Milk and seafood were the most common anaphylaxis triggers in young and older children, respectively. Drug-triggered anaphylaxis was observed more frequently with increasing age, with antibiotics (34.9%) and nonsteroidal anti-inflammatory drugs (17.9%) being the most common causes. Conclusions The most common anaphylaxis trigger in Korean children was food. Data on these triggers show that their relative frequency may vary by age. PMID:27582405

  16. Clinical effects and treatment of envenoming by Hoplocephalus spp. snakes in Australia: Australian Snakebite Project (ASP-12).

    Science.gov (United States)

    Isbister, G K; White, J; Currie, B J; O'Leary, M A; Brown, S G A

    2011-12-01

    There is limited information on envenoming by snakes of the genus Hoplocephalus from Eastern Australia. We investigated the clinical and laboratory features of patients with definite Hoplocephalus spp. bites including antivenom treatment, recruited to the Australian Snakebite Project. There were 15 definite Hoplocephalus spp. bites based on expert identification including eight by Hoplocephalus stephensi (Stephen's banded snakes), four by Hoplocephalus bungaroides (broad-headed snake) and three by H. bitorquatus (pale-headed snake). Envenoming occurred in 13 patients and was similar for the three species with venom induced consumption coagulopathy (VICC) in all envenomings. Seven patients had an INR >12 and partial VICC, with only incomplete fibrinogen consumption, occurred in three patients. Systemic symptoms occurred in eight patients. Myotoxicity and neurotoxicity did not occur. H. stephensi venom was detected in all three H. stephensi envenomings (1.1, 44 and 81 ng/mL) for whom pre-antivenom blood samples were available, and not detected in one without envenoming. In two cases with post-antivenom blood samples, venom was not detected after tiger snake antivenom (TSAV) was given. In vitro binding studies demonstrated that TSAV concentrations of 50mU/mL are sufficient to bind the majority of free H. stephensi venom components at concentrations above those detected in envenomed patients (100 ng/mL). Eleven patients received antivenom, median dose 2 vials (Range: 1 to 5 vials), which was TSAV in all but one case, where polyvalent antivenom was used. Immediate hypersensitivity reactions occurred in six cases including one case of anaphylaxis. Envenoming by Hoplocephalus spp. causes VICC and systemic symptoms, making it clinically similar to brown snake (Pseudonaja spp.) envenoming. Based on in vitro studies reported here, patients may be treated with one vial of TSAV, although one vial of brown snake antivenom may also be sufficient.

  17. Infectious myocarditis (Clinic, diagnostics, principles of treatment

    Directory of Open Access Journals (Sweden)

    Yu. P. Finogeev

    2016-01-01

    Full Text Available Infective myocarditis can be considered as a case of myocardial damage caused by different infectious agents. Traditionally discusses the questions of diagnostics and treatment infectious myocarditis. The paper has repeatedly stressed the difficulty of clinical diagnosis, and the laboriousness and economic costs of laboratory tests and additional researches. Endomyocardial biopsy findings remain the gold standard for unequivocally establishing the diagnosis. However, it is technically extremely invasive test and can be performed only in specialized cardiology centers. The paper analyzes in detail not only own materials, but also results of researches published in numerous domestic and foreign sources of literature. Publication of «Infectious myocarditis» is necessary due to the fact that patients with a diagnosis of «Myocarditis » account for 11% of all cardiovascular disease in the world. Article is timely and necessary for many professionals, senior students of medical universities.

  18. Narcolepsy: etiology, clinical features, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Jolanta B. Zawilska

    2012-10-01

    Full Text Available [u][/u] Narcolepsy is a chronic hypersomnia characterized by excessive daytime sleepiness (EDS and manifestations of disrupted rapid eye movement sleep stage (cataplexy, sleep paralysis, and hypnagogic/hypnopompic hallucinations. Mechanisms underlying narcolepsy are not fully understood. Experimental data indicate that the disease is caused by a loss of hypocretin neurons in the hypothalamus, likely due to an autoimmune process triggered by environmental factors in susceptible individuals. Most patients with narcolepsy and cataplexy have very low hypocretin-1 levels in the cerebrospinal fluid. An appropriate clinical history, polysomnogram, and multiple sleep latency test are necessary for diagnosis of the disease. Additionally, two biological markers, i.e., cerebrospinal fluid hypocretin-1 levels and expression of the DQB1*0602 gene, are used. The treatment of narcolepsy is aimed at the different symptoms that the patient manifests. Excessive daytime sleepiness is treated with psychostimulants (amphetamine-like, modafinil and armodafinil. Cataplexy is treated with sodium oxybate (GHB, tricyclic antidepressants, or selective serotonin and noradrenaline reuptake inhibitors. Sleep paralysis, hallucinations, and fragmented sleep may be treated with sodium oxybate. Patients with narcolepsy should follow proper sleep hygiene and avoid strong emotions.

  19. Clinical outcomes in clinical trials of anti-HIV treatment

    DEFF Research Database (Denmark)

    Reekie, J; Mocroft, A; J, Neaton;

    2007-01-01

    Since the introduction of combination antiretroviral therapy, there has been a decrease in both AIDS-defining illnesses and deaths. This decrease meant that performing clinical trials with clinical outcomes in HIV infection became more time consuming and hence costly. Improved understanding...

  20. Clinical outcomes in clinical trials of anti-HIV treatment

    DEFF Research Database (Denmark)

    Reekie, J; Mocroft, A; J, Neaton;

    2007-01-01

    Since the introduction of combination antiretroviral therapy, there has been a decrease in both AIDS-defining illnesses and deaths. This decrease meant that performing clinical trials with clinical outcomes in HIV infection became more time consuming and hence costly. Improved understanding and k...

  1. Should the host reaction to anisakiasis influence the treatment?: Different clinical presentations in two cases

    Directory of Open Access Journals (Sweden)

    Stefano Pontone

    Full Text Available Gastrointestinal anisakiasis is a parasitic infection occurring in people that consume raw or inadequately cooked fish or squid. It is frequently characterized by severe epigastric pain, nausea and vomiting caused by the penetration of the larvae into the gastric wall. Acute gastric anisakiasis with severe chest discomfort is rarely reported in Italy. On the other hand, gastro-allergic anisakiasis with rash, urticaria and isolated angioedema or anaphylaxis is a clinical entity that has been described only recently. Also, if patients usually develop symptoms within 12 hours after raw seafood ingestion, not always endoscopic exploration can promptly identify the Anisakis larvae. Moreover, some authors consider the prevailing allergic reaction as a natural and effective defense against the parasitic attack. We report two cases of peculiar manifestations of anisakiasis in both acute and chronic forms (severe chest discomfort and anaphylactoid reaction.

  2. Clinical Characteristics and Treatment of Malignant Granuloma

    Institute of Scientific and Technical Information of China (English)

    Chongjin Feng; Junbing Guo; Yong Chen

    2005-01-01

    OBJECTIVE To analyse the clinical characteristics of malignant granuloma(MG) and evaluate its treatment.METHODS From March 1985 to May 1998, 101 cases of malignant granuloma were treated with radiation (RT) alone or radiotherapy followed by chemotherapy or chemotherapy followed by radiotherapy. For chemotherapy, a CCNU, COMP (CTX, VCR, MTX, PDN) or CHOP (CTX,ADM, VCR, PDN) regimen was given. Radiation was directed through the anterior field of the nose mainly for nasal and paranasal sinus malignant granuloma, and through the faciocervical field for malignant granuloma of Walderyer's ring or for patients with cervical lymphadenectasis. Total dose was 45-65 Gy over 5-6 weeks.RESULTS The overall 3-year, 5-year and 10-year survival rates were 78.2%, 56.1% and 39.7% respectively. The 5-year survival rate was: RT group 60.3%, RT + CHOP or CHOP + RT group 64.7% (P >0.05), RT +CCNU group 40%, and RT + COMP group 33.3%. The 5-year survival rates of patients with one involved focus and more than 2 involved foci were 75.6%(34/45) and 39.3% (22/56) (P<0.001). The 5-year survival rates of patients with or without body symptoms were 39.6% (18/48) and 67.9%(36/53) (P<0.05). The 5-year survival rate of the 50-60 Gy group and the <50Gy group were 60.1% (40/66) and 20% (1/5)(P <0.05). The local and regional recurrence rate was 20.8 % (21/101 ).CONCLUSION Radiotherapy alone should be the treatment of choice for patients with one site involvement and without body symptoms. Radiation fields should be large enough to include the potentially involved sites. The recommended dose is 50-60 Gy over 5-6 weeks. It is suggested that patients with more than 2 foci involvement and those with body symptoms should receive the combination therapy.

  3. Differentiated thyroid carcinoma : treatment and clinical consequences of therapy

    NARCIS (Netherlands)

    Hoftijzer, Hendrieke Catherijn

    2011-01-01

    The first chapters of this thesis describe the treatment of radioiodine non-avid thyroid carcinoma with the tyrosine kinase inhibitor sorafenib. The remainder of the thesis describes the clinical consequences of the treatment of thyroid carcinoma.

  4. TREATMENT OF HYPERTENSION IN PREGNANCY: GUIDELINES AND CLINICAL EXPERIENCE

    Directory of Open Access Journals (Sweden)

    O. V. Gaisenok

    2014-01-01

    Full Text Available Topical issues of the treatment of hypertension in pregnancy are presented. Examples from clinical practice are discussed as well as possible medical treatment of hypertension in pregnant women taking into account actual recommendations.

  5. TREATMENT OF HYPERTENSION IN PREGNANCY: GUIDELINES AND CLINICAL EXPERIENCE

    OpenAIRE

    O. V. Gaisenok; O. A. Zamyatina; N. Yu. Denisova; A. S. Leonov

    2015-01-01

    Topical issues of the treatment of hypertension in pregnancy are presented. Examples from clinical practice are discussed as well as possible medical treatment of hypertension in pregnant women taking into account actual recommendations.

  6. TREATMENT OF HYPERTENSION IN PREGNANCY: GUIDELINES AND CLINICAL EXPERIENCE

    OpenAIRE

    O. V. Gaisenok; O. A. Zamyatina; N. Yu. Denisova; A. S. Leonov

    2014-01-01

    Topical issues of the treatment of hypertension in pregnancy are presented. Examples from clinical practice are discussed as well as possible medical treatment of hypertension in pregnant women taking into account actual recommendations.

  7. TREATMENT OF HYPERTENSION IN PREGNANCY: GUIDELINES AND CLINICAL EXPERIENCE

    Directory of Open Access Journals (Sweden)

    O. V. Gaisenok

    2015-09-01

    Full Text Available Topical issues of the treatment of hypertension in pregnancy are presented. Examples from clinical practice are discussed as well as possible medical treatment of hypertension in pregnant women taking into account actual recommendations.

  8. Adoption of the children's obesity clinic's treatment (TCOCT) protocol into another Danish pediatric obesity treatment clinic

    DEFF Research Database (Denmark)

    Most, Sebastian W; Højgaard, Birgitte; Teilmann, Grete Katrine;

    2015-01-01

    was developed in collaboration with the patient and the family. Patients' height and weight were measured at subsequent visits. There were no exclusion criteria. RESULTS: Three-hundred-thirteen (141 boys) were seen in the clinic in the period of February 2010 to March 2013. At inclusion, the median age......, the mean BMI SDS difference was -0.40 (95% CI: -0.56; -0.25, p intervention 120 patients stopped treatment. Retention rates were 0.76 (95% CI: 0.71; 0.81) after one year and 0.57 (95% CI: 0.51; 0.63) after two years...

  9. Anaphylaxis with Latrodectus antivenin resulting in cardiac arrest.

    Science.gov (United States)

    Murphy, Christine M; Hong, Jeannie J; Beuhler, Michael C

    2011-12-01

    Latrodectus mactans antivenin is a safe and effective therapy for severe black widow spider envenomations when given to most patients. We report a case of a 37-year-old male with a history of asthma that was given L. mactans antivenin for symptoms related to a black widow envenomation and developed a severe anaphylactic reaction resulting in cardiac arrest. When traditional therapies failed, the patient was given methylene blue for anaphylactic shock resulting in a 30-h period of hemodynamic stability. Despite initial resuscitation, the patient ultimately died 40 h after presentation. Under the right circumstances, L. mactans antivenin remains a safe and effective therapy for severe black widow envenomations. However, anaphylaxis is a risk for those receiving this therapy, even when the antivenin is diluted and given as an infusion. We report the first death related to diluted L. mactans antivenin given as an infusion.

  10. A case of taurine-containing drink induced anaphylaxis.

    Science.gov (United States)

    Lee, Seung-Eun; Lee, Suh-Young; Jo, Eun-Jung; Kim, Mi-Young; Yang, Min-Suk; Chang, Yoon-Seok; Kim, Sae-Hoon

    2013-01-01

    Taurine is one of most abundant free amino acids in mammalian tissue. It has been used for various health functional foods as a main ingredient in food industry. A 33-year-old female patient repeatedly experienced generalized itching, urticaria, dyspnea and dizziness after drinking taurine-containing drinks. The patient showed positive response to oral challenge tests with taurine-containing drinks. The patient also showed positive response with synthetic taurine but not with natural taurine. Skin prick test and basophil activation test with the synthetic taurine were negative. To our knowledge, there has been no report of taurine-induced hypersensitivity reactions. We herein report the first case of taurine-containing drink induced anaphylaxis, especially by synthetic taurine.

  11. Anaphylaxis to muscle relaxants: rational for skin tests.

    Science.gov (United States)

    Moneret-Vautrin, D A; Kanny, G

    2002-09-01

    IgE-dependent allergy to muscle relaxants (MR) has an estimated prevalence of 1 out of 6500 General Anesthesias (GA). 62% of anaphylaxis during surgery are due to MR anaphylaxis. All the molecules are divalent, carrying two NH4+ epitopes (quaternary ammonium ions), either structurally or after rapid in vivo protonization (vecuronium). The excellent overall performance of skin test makes them the golden standard for the diagnosis of anaphylactoid reactions. Techniques include intradermal tests and prick-tests. The current localizations are the forearm and the back. Positivity criteria are 3 mm for prick-tests. For IDTs, the criterium is the doubling of the size of the injection papula, when 0.02 to 0.04 ml is injected: 8 mm. The recommended concentrations are not falsely negative. Commercial concentrations can be tested by prick tests, except for mivacurium and atracurium tested of 1:10 dilution. A scale of concentrations is advised for IDT starting with 1:10,000, up to a normally non reactive concentration that is: 100 micrograms/ml (succinylcholine), 200 micrograms/ml (gallamine), 10 micrograms/ml (atracurium), 2 micrograms/ml (mivacurium), 200 micrograms/ml (pancuronium), 400 micrograms/ml (vecuronium), 1,000 micrograms/ml (rocuronium), 200 micrograms/ml (cis atracurium). The specificity and sensitivity of the skin tests to MRs are greater than 95%. The reproducibility over years is 88%. The overall concordance of PT and IDR is 97%. Both types of tests can be used for the diagnosis. IDT have to be carried out for the search of the cross sensitization. 84% of patients do have cross sensitization to MRs but only 16% react to all MRs. The further use of MRs selected by negative IDTs has been proved to be safe.

  12. Differences in hospital attendance for anaphylaxis between immigrants and non-immigrants

    DEFF Research Database (Denmark)

    Norredam, M; Sheikh, A; Svendsen, K Dynnes;

    2016-01-01

    BACKGROUND: The impact of migration on the risk of anaphylaxis is unknown. We hypothesized that non-Western immigrants have a lower incidence of anaphylaxis compared to Danish-born. We investigated variations in hospital attendance for anaphylaxis between immigrants and Danish-born including time......- and age- trends. METHODS: A register-based, historical prospective cohort design. Refugees or family reunified immigrants (n=127,250) who, between January 1,1994 and December 31, 2010, obtained residency permits in Denmark were included and matched in a 1:6 ratio on age and sex with Danish...... for age using a Cox regression model including the influence of duration of residence and age when residence was obtained. RESULTS: In total 1,053 hospital attendances for anaphylaxis were identified: 89 among non-Western immigrants, 9 among Western immigrants and 955 among Danish-born patients. Both male...

  13. Gynecomastia induced by H1-antihistamine (ebastine) in a patient with idiopathic anaphylaxis.

    Science.gov (United States)

    Jung, Hwa Sik; Park, Chan-Ho; Park, Young Tae; Bae, Mi Ae; Lee, Youn Im; Kang, Byung Ju; Jegal, Yangjin; Ahn, Jong Joon; Lee, Taehoon

    2015-07-01

    H1-antihistamine is generally a well-tolerated and safe drug. However, in resemblance with all other drugs, H1-antihistamines can also prompt adverse drug reactions (ADRs). We recently encountered the very unusual ADR of H1-antihistamine-induced gynecomastia. A 21-year-old man with idiopathic anaphylaxis was treated with ebastine (Ebastel), a second-generation H1-antihistamine, for the prevention of anaphylaxis. Three months later, the patient remained well without anaphylaxis, but had newly developed gynecomastia. Because anaphylaxis recurred after the cessation of H1-antihistamine, the preventive medication was changed to omalizumab. A few months later, his gynecomastia had entirely disappeared. Physicians should be aware of this exceptional ADR of H1-antihistamine.

  14. Review on clinical trials of targeted treatments in malignant mesothelioma

    DEFF Research Database (Denmark)

    Jakobsen, Jan Nyrop; Sørensen, Jens Benn

    2011-01-01

    Malignant mesothelioma (MM) is an aggressive tumor of the serosal surfaces with a poor prognosis. Advances in the understanding of tumor biology have led to the development of several targeted treatments, which have been evaluated in clinical trials. This article is a comprehensive review of all...... clinical trials evaluating the effect of targeted treatments in MM....

  15. Clinical characteristics and treatment outcomes of severe ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    詹翔

    2014-01-01

    Objective To explore the clinical characteristics and medicine treatment of patients with severe ulcerative colitis(UC),the efficacy of rescue treatment in patients with glucocorticoid(GCS)resistant severe UC,and the clinical risk factors in patients with GCS-refractory severe UC.Methods From January 2001 to December 2012,

  16. Pharmacists’ response to anaphylaxis in the community (PRAC): a randomised, simulated patient study of pharmacist practice

    Science.gov (United States)

    Salter, Sandra M; Delfante, Brock; de Klerk, Sarah; Sanfilippo, Frank M; Clifford, Rhonda M

    2014-01-01

    Objective To evaluate how community pharmacists manage patients with anaphylaxis. Design A randomised, cross-sectional, simulated patient study of community pharmacist practice. Setting 300 metropolitan pharmacies located in Perth Australia, randomised to three groups of 100 pharmacies. Each group corresponded to a different epinephrine autoinjector: original EpiPen, new-look EpiPen or Anapen. Participants 300 pharmacies were visited with 271 simulated patient visits included in the final analysis (88=original EpiPen, 92=new-look EpiPen, 91=Anapen). Outcome measures Primary anaphylaxis preparedness (readiness to treat acute anaphylaxis). Secondary anaphylaxis engagement (willingness to engage the patient in a discussion about their anaphylaxis). Methods Simulated patients approached pharmacists, using a standardised scenario, for assistance with epinephrine autoinjector use and advice about the use of antihistamines in anaphylaxis. Scores for each outcome were obtained based on the number of predefined statements addressed by the pharmacist during the consultation (maximum score=5 for preparedness and 8 for engagement). Results The mean anaphylaxis preparedness score was 2.39 points (SD 1.17). Scores for new-look EpiPen were significantly higher than for original EpiPen and Anapen (2.75 vs 2.38 points, p=0.027; 2.75 vs 2.03 points, pEpiPen were similar to original EpiPen and Anapen (3.11 vs 3.32 points; 3.11 vs 2.90 points, both p=0.42). Engagement was associated with preparedness. For each additional engagement point, preparedness increased by 7% (0.357 points; 95% CI 0.291 to 0.424; p<0.001). Conclusions Pharmacists demonstrated reasonable knowledge of anaphylaxis symptoms and emergency care, but had poor epinephrine autoinjector technique and rarely discussed anaphylaxis action plans. Pharmacists who had a more comprehensive discussion about anaphylaxis with patients, were more prepared for anaphylaxis emergencies. Future research should evaluate the nature and

  17. LPS promotes Th2 dependent sensitisation leading to anaphylaxis in a Pru p 3 mouse model

    OpenAIRE

    Rodriguez, Maria J.; Aranda, Ana; Fernandez, Tahia D.; Cubells-Baeza, Nuria; Torres, Maria J.; Gomez, Francisca; Palomares, Francisca; Perkins, James R; Rojo, Javier; Diaz-Perales, Araceli; Mayorga, Cristobalina

    2017-01-01

    Pru p 3 is the major peach allergen in the Mediterranean area. It frequently elicits severe reactions, limiting its study in humans, raising the need for animal models to investigate the immunological mechanisms involved. However, no anaphylaxis model exists for Pru p 3. We aimed to develop a model of peach anaphylaxis by sensitising mice with Pru p 3 in combination with lipopolysaccharide (LPS) as an adjuvant. Four groups of mice were sensitised intranasally: untreated; treated with Pru p 3;...

  18. LPS promotes Th2 dependent sensitisation leading to anaphylaxis in a Pru p 3 mouse model

    OpenAIRE

    Rodríguez, María J.; Aranda, Ana; Fernández, Tahia; Cubells-Baeza, Nuria; Torres, María José; Gómez, Francisca; Palomares, Francisca; Perkins, James R; Rojo, Javier; Díaz-Perales, Araceli; Mayorga, Cristobalina

    2017-01-01

    Pru p 3 is the major peach allergen in the Mediterranean area. It frequently elicits severe reactions, limiting its study in humans, raising the need for animal models to investigate the immunological mechanisms involved. However, no anaphylaxis model exists for Pru p 3. We aimed to develop a model of peach anaphylaxis by sensitising mice with Pru p 3 in combination with lipopolysaccharide (LPS) as an adjuvant. Four groups of mice were sensitised intranasally: untreated; treated w...

  19. Clinical Practice Guidelines for Vascular Catheter Infections Treatment.

    Directory of Open Access Journals (Sweden)

    Belkys Rodríguez Llerena

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Vascular Catheter Infections Treatment. It has been defined as the presence of local or systemic signs without other obvious infection site, plus the microbiologic evidence involving the catheter. This document includes a review and update of concepts, main clinical aspects, and treatment and stresses the importance of prophylactic treatment. It includes assessment guidelines focused on the most important aspects to be accomplished.

  20. TARDIVE DYSKINESIA : CLINICAL PRESENTATION AND TREATMENT

    NARCIS (Netherlands)

    van Harten, Peter N.; Tenback, Diederik E.; Brotchie, J; Bezard, E; Jenner, P

    2011-01-01

    Tardive dyskinesia (TD) is a common and potentially irreversible side effect of dopamine blocking agents, most often antipsychotics. It is often socially and sometimes also physically disabling. The clinical picture can be divided into orofacial, limb-truncal, and respiratory dyskinesia. The clinica

  1. Clinical guide to periodontology: reconstructive periodontal treatment.

    Science.gov (United States)

    Floyd, P D; Ide, M; Palmer, R M

    2014-05-01

    Regeneration of the lost tissues of the periodontium is an ideal therapeutic goal and has been the subject of much research and ingenious clinical techniques. Reconstructive or regenerative techniques are used either singly or in combination for three main purposes: (1) to regain lost periodontal ligament attachment, (2) to provide a wider zone of attached gingiva, and (3) to cover previously exposed root surfaces.

  2. [Periocular aging: physiopathogenesis, clinical aspect, and treatment].

    Science.gov (United States)

    Galatoire, O; Morax, S

    2009-05-01

    Aging around the eyes plays a considerable role in facial aging. The demand for periocular rejuvenation is increasingly frequent. Until the past few years, eyelid esthetics was synonymous with blepharoplasty: surgery that consisted in resecting the myocutaneous excesses and reducing fatty deposits. The contribution of new medical and surgical treatments combined with new and more rigorous analysis of the esthetic disorders makes it possible to respond more precisely to patient demand and individualize surgical and/or medical treatment that is not highly aggressive and only uses products that are well tolerated, biocompatible, or resorbable.

  3. Nephrogenic systemic fibrosis: clinical picture and treatment

    DEFF Research Database (Denmark)

    Marckmann, Peter; Skov, Lone

    2009-01-01

    The classic hallmark symptoms of advanced nephrogenic systemic fibrosis (NSF) (skin thickening, hardening and hyperpigmentation, and disabling contractures in renal failure patients) in temporal association with Gd-based contrast agent (GBCA) exposure are almost pathognomonic of NSF. Less obvious......, and the histology of deep skin biopsies. Symptomatic treatment with intensive physiotherapy and painkillers is important, but there is no known curative medical treatment. Spontaneous remission of NSF symptoms may occur with recovery of renal function after an episode of acute renal failure, or with kidney...

  4. Clinical Features and Treatments of Odontogenic Sinusitis

    OpenAIRE

    Lee, Kyung Chul; Lee, Sung Jin

    2010-01-01

    Purpose The aim of this study was to investigate how clinical features such as sex, age, etiologic factors, and presenting symptoms of odontogenic sinusitis are differentiated from other types of sinusitis. Also, this study was designed to find methods for reducing the incidence of odontogenic sinusitis. Materials and Methods A retrospective chart analysis was completed on twenty-seven patients with odontogenic sinusitis. They were all treated at Kangbuk Samsung Hospital between February 2006...

  5. Clinical implications and treatment of dengue

    Institute of Scientific and Technical Information of China (English)

    Chawla Pooja; Yadav Amrita; Chawla Viney

    2014-01-01

    Dengue is a common pathogenic disease often proving fatal, more commonly affecting the tropics. Aedes mosquito is the vector for this disease, and outbreaks of dengue often cause mass damage to life.The current review is an effort to present an insight into the causes, etiology, symptoms, transmission, diagnosis, major organs affected, mitigation and line of treatment of this disease with special emphasis on drugs of natural origin.The disease has a potential to spread as an endemic, often claiming several lives and thus requires concerted efforts to work out better treatment options. Traditional medicine offers an alternative solution and could be explored as a safer treatment option. Development of a successful vaccine and immunization technique largely remains a challenge and a better antiviral approach needs to be worked out to complement the supportive therapy.No single synthetic molecule has found to be wholly effective enough to offer curative control and the line of treatment mostly utilizes a combination of fluid replacement and antipyretics-analgesics like molecules to provide symptomatic relief.

  6. Anxious depression: clinical features and treatment.

    Science.gov (United States)

    Rao, Sanjai; Zisook, Sidney

    2009-12-01

    Anxious depression has been conceptualized in at least two related but separate ways: 1) major depressive disorder with at least one comorbid Axis I anxiety disorder and 2) major depressive disorder with a high level of anxiety with or without one or more comorbid Axis I anxiety disorders. Using either definition, patients with anxious depression seem to have a more chronic course of illness, an increased incidence of suicidal thoughts and behavior, greater functional and occupational impairment, and poorer response to treatment. Multiple classes of medications are used to treat anxious depression, most commonly first- and second-generation antidepressants, atypical antipsychotics, and benzodiazepines. Certain patients with anxious depression may require lower starting doses, more gradual dose escalations, higher end point doses, longer duration of treatment, and/or early augmentation with other agents. Nonpharmacologic treatments such as targeted psychotherapy and preventative stepped-care approaches also may be effective. Well-conceived, randomized controlled treatment trials are necessary to make further gains in the management of patients with anxious depression.

  7. Honeybee propolis extract in periodontal treatment: A clinical and microbiological study of propolis in periodontal treatment

    Directory of Open Access Journals (Sweden)

    Amita Coutinho

    2012-01-01

    Conclusion: Subgingival irrigation with propolis extract as an adjuvant to periodontal treatment was more effective than scaling and root planing as assessed by clinical and microbiological parameters.

  8. Randomised clinical trials with clinician-preferred treatment.

    Science.gov (United States)

    Korn, E L; Baumrind, S

    1991-01-19

    The standard design for randomised clinical trials may be inappropriate when the clinician believes that one of the treatments being tested is superior for the patient, or when the clinician has a preference for one of the treatments. For such instances the suggestion is that the patient is randomly allocated to treatment only when there is clinical disagreement about treatment of choice for that patient, and then the patient is assigned to a clinician who had thought that the regimen allocated is the one most appropriate for that patient.

  9. Pedophilia: Clinical Features, Etiology and Treatment

    Directory of Open Access Journals (Sweden)

    Ayten Erdogan

    2010-08-01

    Full Text Available There is a growing recognition that child sexual abuse is a critical public health problem. Child sexual abusement is not a medical diagnosis and is not necessarily a term synonymous with pedophilia. According to DSM-IV, a pedophile is an individual who fantasizes about, is sexually aroused by, or experiences sexual urges toward prepubescent children (generally <13 years for a period of at least 6 months. It is difficult to estimate the true prevalence of pedophilia because few pedophiles voluntarily seek treatment. Most of the available data are based on individuals who have become involved with the legal system. Most individuals who engage in pedophilia are male. When compared with other sex offenders, pedophiles are in the older adult age range (age, 40-70 years. Pedophiles may engage in a wide range of sexual acts with children. These activities includes exposing themselves to children, looking at naked children, masturbating in the presence of children, physical contact, rubbing, fondling a child, engaging in oral sex, or penetration of the mouth, anus, and/or vagina. Generally, pedophiles do not use force to have children engage in these activities but instead rely on various forms of psychic manipulation and desensitization. People with pedophilia use internet to be a vehicle capable of meeting their needs: obtaining information, monitoring and contacting victims, developing fantasy, overcoming inhibitions, avoiding apprehension, and communicating with other offenders. The compulsive-aggressive trait is more pronounced in people with pedophilia. Generally they plan the sexual offending with the intention of relieving internal pressures or urges. Pedophiles generally experience feelings of inferiority, isolation or loneliness, low self-esteem, internal dysphoria, and emotional immaturity. There are likely multiple factors and multiple pathways involved in the development of pedophilia. Since there has been no treatment method that can

  10. [Paraffinomas: history, clinical features and treatment. A case report].

    Science.gov (United States)

    Mounios-Perchenet, A S; Le Fourn, B; Hepner-Lavergne, D; Pannier, M

    1997-02-01

    One case of paraffinoma is reported on a 60 years old man following injections of paraffin fourty years ago. The authors recalled with this observation history of paraffin, clinical aspect and surgical treatment of the paraffinoma.

  11. Behavioral treatment of rumination: Research and clinical applications.

    Science.gov (United States)

    Luiselli, James K

    2015-09-01

    This brief review describes research on rumination treatment that emphasizes functional analysis, recent intervention methods (supplemental feeding, fixed-time stimulus presentation, continuous access to preferred stimulation), clinical implications, and procedural recommendations.

  12. [Optic neuritis: diagnosis, treatment and clinical implications].

    Science.gov (United States)

    Steffen, Heimo; Tabibian, David

    2015-12-16

    Optic neuritis is one of the most important causes of visual loss in young and middle aged adults. The prognosis in terms of functional outcome is good. The diagnosis of optic neuritis is a clinical one. Steroids can shorten the recovery time but do not change the long term functional outcome. The MRI is the most important investiga- tion to assess an associated risk of multiple sclerosis. Optic cohe- rence tomography (OCT) contribute additional details to course and functional outcome of optic neuritis. In the future the OCT may additionally contribute to the relationship between optic neuritis and possible associated multiple sclerosis.

  13. Candidiasis: pathogenesis, clinical characteristics, and treatment.

    Science.gov (United States)

    Appleton, S S

    2000-12-01

    Candida organisms live on the skin and mucous membranes of up to 75 percent of the population. They can live commensally without causing harm or can change to an aggressive form and invade tissue, causing both acute and chronic disease in the host. Oropharyngeal candidiasis manifests clinically as acute pseudomembranous, acute atrophic, chronic atrophic, chronic hypertrophic/hyperplastic, and angular cheilitis. Systemic infection leading to candidemia can be devastating and cause up to a 60 percent mortality rate in medical or post-surgical intensive care wards. Oral nystatin, clotrimazole, and fluconazole usually provide appropriate therapy; although resistance to medications is increasing, particularly in immunocompromised hosts.

  14. Clinical Practice Guidelines for Pre-eclampsia and Eclampsia Treatment.

    Directory of Open Access Journals (Sweden)

    Frank Carlos Alvarez Li

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Pre-eclampsia and Eclampsia Treatment. This disease is part of a group of conditions known as hypertensive disease in pregnancy that have in common the existence of high blood pressure. This document includes a review and update of the main clinical aspects, concepts, classification and treatment stressing the use of drugs that cause hypotension and magnesium sulphate. It includes assessment guidelines focused on the most important aspects to be accomplished.

  15. Hypertonicity: Clinical entities, manifestations and treatment

    Science.gov (United States)

    Rondon-Berrios, Helbert; Argyropoulos, Christos; Ing, Todd S; Raj, Dominic S; Malhotra, Deepak; Agaba, Emmanuel I; Rohrscheib, Mark; Khitan, Zeid J; Murata, Glen H; Shapiro, Joseph I; Tzamaloukas, Antonios H

    2017-01-01

    Hypertonicity causes severe clinical manifestations and is associated with mortality and severe short-term and long-term neurological sequelae. The main clinical syndromes of hypertonicity are hypernatremia and hyperglycemia. Hypernatremia results from relative excess of body sodium over body water. Loss of water in excess of intake, gain of sodium salts in excess of losses or a combination of the two are the main mechanisms of hypernatremia. Hypernatremia can be hypervolemic, euvolemic or hypovolemic. The management of hypernatremia addresses both a quantitative replacement of water and, if present, sodium deficit, and correction of the underlying pathophysiologic process that led to hypernatremia. Hypertonicity in hyperglycemia has two components, solute gain secondary to glucose accumulation in the extracellular compartment and water loss through hyperglycemic osmotic diuresis in excess of the losses of sodium and potassium. Differentiating between these two components of hypertonicity has major therapeutic implications because the first component will be reversed simply by normalization of serum glucose concentration while the second component will require hypotonic fluid replacement. An estimate of the magnitude of the relative water deficit secondary to osmotic diuresis is obtained by the corrected sodium concentration, which represents a calculated value of the serum sodium concentration that would result from reduction of the serum glucose concentration to a normal level. PMID:28101446

  16. Clinical pharmacology in leishmaniasis: treatment optimization of a neglected disease

    NARCIS (Netherlands)

    Dorlo, T.P.C.

    2013-01-01

    This thesis presents various novel applications of clinical pharmacokinetics and pharmacodynamics in the treatment of leishmaniasis, by which diverse clinically relevant issues, mainly related to the efficacy and safety of miltefosine, could be elucidated. Throughout this thesis, the added value of

  17. Childhood obesity treatment and prevention. Psychological perspectives of clinical approaches

    OpenAIRE

    Maria Catena Quattropani; Teresa Buccheri

    2013-01-01

    Objective: This work focuses on clinical psychologist’ presence within childhood obesity prevention programmes in several countries. Method: The Authors collected articles considering psychological, biological and social aspects linked to childhood obesity. Results: Studies reveal that childhood obesity prevention programmes are based on biological, medical and educational aspects; clinical psychologists up until now have been engaged almost exclusively in the treatment of obesity. Conclusion...

  18. Efficacy of extended cefquinome treatment of clinical Staphylococcus aureus mastitis

    NARCIS (Netherlands)

    Swinkels, J. M.; Cox, P.; Schukken, Y. H.; Lam, T. J G M

    2013-01-01

    Clinical Staphylococcus aureus mastitis is difficult to cure. Extended antimicrobial treatment is often advocated as a practical approach to improve cure rates; however, scientific evidence of this hypothesis is lacking. A multi-centered, nonblinded, randomized, positive-controlled clinical trial wa

  19. Short clinical crowns (SCC) – treatment considerations and techniques

    OpenAIRE

    Sharma, Ashu; G. R. Rahul; Poduval, Soorya T.; Shetty, Karunakar

    2012-01-01

    When the clinical crowns of teeth are dimensionally inadequate, esthetically and biologically acceptable restoration of these dental units is difficult. Often an acceptable restoration cannot be accomplished without first surgically increasing the length of the existing clinical crowns; therefore, successful management requires an understanding of both the dental and periodontal parameters of treatment. The complications presented by teeth with short clinical crowns demand a comprehensive tre...

  20. Clinical Experience in TCM Treatment of Insomnia

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ Insomnia is a sleeping disorder that affects 1 in 10 Americans and around 50% of the seniors. It is often more prevalent in women. Since September 11, 2005 these estimations have increased. Insomnia can affect not only your energy level and mood, but your health as well because sleep helps bolster your immune system. Insomnia is characterized by: 1) difficulty in falling asleep; 2) waking up frequently during the night with difficulty of returning to sleep; 3) waking up too early in the morning; and 4) with unrefreshing sleep, the patient has a low spirit, palpation, poor memory, viscera function disorder. All these seriously affect the patient's life and work. The following is an account of the authors' clinical TCM experience in treating insomnia.

  1. Clinical manifestations, diagnosis, and treatment of neurocysticercosis.

    Science.gov (United States)

    Sotelo, Julio

    2011-12-01

    Neurocysticercosis (NCC) is the most frequent parasitic disease of the human brain. Modern imaging studies, CT and MRI, have defined the diagnosis and characterization of the disease. Through these studies the therapeutic approach for each case may be individualized with the aid of antihelmintics, steroids, symptomatic medicines, or surgery. The use of one or various therapeutic measures largely depends on the peculiar combination of number, location, and biological stage of lesions as well as the degree of inflammatory response to the parasites. Although there is not a typical clinical picture of NCC, epilepsy is the most frequent manifestation of parenchymal NCC, whereas hydrocephalus is the most frequent manifestation of meningeal NCC. Eradication of cysticercosis is an attainable goal by public education and sanitary improvement in endemic areas.

  2. Anaphylaxis and generalized urticaria from eating Chinese bayberry fruit

    Institute of Scientific and Technical Information of China (English)

    Hui-ying WANG; Zhong-shan GAO; Zhao-wei YANG; Jing-xin SHAO; Xiu-zhen ZHAO; Yu DAI; Ronald VAN REE

    2012-01-01

    Chinese bayberry Myrica rubra is a very popular fruit in southeastern China.In spite of its wide consumption,no allergies to this fruit have been reported previously.Here we report on a 40-year-old woman suffering from anaphylaxis to Chinese bayberry fruit.Prick-prick skin tests revealed strong reactions to fresh Chinese bayberry fruits as well as to peach,and weaker reactions to some other fruits including apple,melon,and banana.ImmunoCAP analysis revealed identical titers of specific IgE (4.3 kUA/L) to peach extract and its lipid transfer protein (LTP,rPru p 3),which was confirmed by detection of a 9 kD band following immunoblotting.Immunoblot analysis with Chinese bayberry extract gave bands of 22,45,and 90 kD,but no 9 kD band was recognized.There was also no evidence of LTP recognition for Ioquat (36 kD) or melon (24 kD).This first report of a severe allergic reaction to Chinese bayberry fruit in a patient with LTP-mediated peach allergy indicates that other as yet unidentified non-pollen related fruit allergens are involved in this new severe fruit allergy.

  3. Palonosetron-Induced Anaphylaxis During General Anesthesia: A Case Report

    Science.gov (United States)

    Park, Hyungjun; Oh, Kyunghwan; Lee, Hoonhee; Lee, Ji-Hyang; Kang, Sun-myoung; Park, So-Young; Kwon, Hyouk-Soo; Cho, You Sook; Moon, Hee-Bom

    2017-01-01

    Palonosetron is a 5-hydroxytryptamine-3 (5-HT-3) receptor antagonist used for preventing postoperative nausea and vomiting. Compared with ondansetron and granisetron, it is a better drug because of prolonged action and minimal side effects. Some adverse effects of palonosetron have been reported. In this report, we describe a 37-year-old male who developed severe hypersensitivity reactions to palonosetron during surgery for kidney donation. His medical history was unremarkable, except for inguinal hernia with herniorrhaphy 8 years ago. The surgery was uneventful until 2 hours 20 minutes. After palonosetron injection, his blood pressure dropped to 80/50 mm Hg, and facial edema, rash, conjunctival swelling, and wheezing developed. The patient was resuscitated by administration of ephedrine, hydrocortisone, and peniramine. Following the surgery, the patient was monitored for 3 days, and there were no subsequent anaphylactic reactions or other complications. The skin test on postoperative day 54 was positive for hypersensitivity to palonosetron. Although palonosetron is known for its safety, other hypersensitivity events have been reported. Ondansetron is another widely used 5-HT-3 antagonist, which has been reported to cause anaphylaxis. Therefore, clinicians should be aware of the possibility of patients experiencing severe adverse reactions to palonosetron. PMID:27826967

  4. Anaphylaxis to pine nut: cross-reactivity to Artemisia vulgaris?

    Science.gov (United States)

    Rodrigues-Alves, R; Pregal, A; Pereira-Santos, M C; Branco-Ferreira, M; Lundberg, M; Oman, H; Pereira-Barbosa, M

    2008-01-01

    The use of pine nuts, the seeds of Pinus pinea, is on the increasing in the modern Mediterranean diet. Little more than 20 cases of allergy to this tree nut have been published, and cross-reactivity with pine pollen, peanut and almond has already been reported. We describe the case of a young boy with several episodes of anaphylaxis after pine nut ingestion. Specific IgE to pine nut and Artemisia vulgaris was demonstrated by skin prick tests and in vitro determination of specific IgE, although no IgE to pine pollen or other nuts was detected. Immunoblotting of Artemisia vulgaris and pine nut revealed two matching diffuse bands, just below 14 kDa and 30 kDa. The ImmunoCAP inhibition assays showed complete inhibition of pine nut specific IgE after serum incubation with Artemisia vulgaris extract. As far as we know, this is the first reported case of documented cross-reactivity between pine nut and Artemisia vulgaris.

  5. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations

    DEFF Research Database (Denmark)

    Dworkin, R.H.; Turk, D.C.; Wyrwich, K.W.;

    2008-01-01

    . Provisional benchmarks for identifying clinically important changes in specific outcome measures that can be used for outcome studies of treatments for chronic pain are proposed. PERSPECTIVE: Systematically collecting and reporting the recommended information needed to evaluate the clinical importance......A consensus meeting was convened by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to provide recommendations for interpreting clinical importance of treatment outcomes in clinical trials of the efficacy and effectiveness of chronic pain treatments. A group...... of 40 participants from universities, governmental agencies, a patient self-help organization, and the pharmaceutical industry considered methodologic issues and research results relevant to determining the clinical importance of changes in the specific outcome measures previously recommended by IMMPACT...

  6. Childhood obesity treatment and prevention. Psychological perspectives of clinical approaches

    Directory of Open Access Journals (Sweden)

    Maria Catena Quattropani

    2013-05-01

    Full Text Available Objective: This work focuses on clinical psychologist’ presence within childhood obesity prevention programmes in several countries. Method: The Authors collected articles considering psychological, biological and social aspects linked to childhood obesity. Results: Studies reveal that childhood obesity prevention programmes are based on biological, medical and educational aspects; clinical psychologists up until now have been engaged almost exclusively in the treatment of obesity. Conclusions: There is a clear need to consider psychological aspects (emotional, cognitive and relational related to the childhood obesity’s causes and involve psychologists in its prevention projects. Keywords: childhood obesity, overweight, multidisciplinary approach, clinical psychology, prevention, treatment

  7. Clinical efficacy of cyclophosphamide in treatment of primary sclerosing cholangitis

    Institute of Scientific and Technical Information of China (English)

    程鹏

    2014-01-01

    Objective To investigate the clinical efficacy of cy-clophosphamide in the treatment of primary sclerosing cholangitis(PSC).Methods Twenty-four patients with PSC who received treatment in the department of gastroenterology in our hospital from January 2004 to December2012 were selected as subjects and divided into observation group(n=13)and control

  8. Clinical treatment strategies and experimental studies in polytrauma

    NARCIS (Netherlands)

    van Wessem, K.J.P.

    2013-01-01

    This thesis describes the clinical treatment of polytrauma patients and the underlying pathophysiological mechanisms causing injury-induced inflammatory response. Even though the treatment of polytrauma patients has improved over the years, trauma is still the leading cause of death worldwide.Classi

  9. Clinical Progress on Acupuncture Treatment of Prostatic Hyperplasia

    Institute of Scientific and Technical Information of China (English)

    李丽会; 张淑静; 徐名一; 黄国琪

    2009-01-01

    @@ Prostatic hyperplasia, also termed benign prostatic hyperplasia (BPH), is a commonly encountered disease in middle-aged and old males. This condition is known as "Retention of Urine" and "Urination Syndrome" in Chinese medicine. Now, the literature from 1998 to 2008 on acupuncture treatment of prostatic hyperplasia are abstracted and reviewed, in order to understand the clinical status of acupuncture treatment for this disease.

  10. Clinical Study on Treatment of Infantile Rotaviral

    Institute of Scientific and Technical Information of China (English)

    魏连波; 李智军; 陈宝田; 栾图; 高云飞; 李吉来; 孙升云

    2001-01-01

    Objective: To observe the clinical effect of guava leaf (GL) in treating infantile rotaviral enteritis.Methods: Sixty-two patients of rotaviral enteritis were randomly divided into the treated group treated with GL and the control group treated with Gegen Qinlian Decoction. The time for ceasing diarrhea, content of Na+ in blood, content of Na+ and glucose in stool, and the rate of negative conversion of human rotavirus antigen (HRVA) were observed.Results: The 3-day recovery rate in the treated group (87.1%) was significantly higher than that in the control group (58.1%, P<0.05). The time of ceasing diarrhea in the treated group (25.1±9.5 hrs) was significantly shorter than that in the control group (38.7±15.2 hrs, P<0.01). Moreover, content of Na+ and glucose in stool were reduced obviously in the treated group but not in the control group; and negative conversion rate of HRVA in the former group also got better than that in the latter group (87.1% vs 58.1%, P<0.05). Consequently, the effect of GL was superior to that of the control significantly.Conclusion: GL has good curative effect on infantile rotaviral enteritis.

  11. Implementation of a clinical pathway may improve alcohol treatment outcome

    DEFF Research Database (Denmark)

    Nielsen, Anette Søgaard; Nielsen, Bent

    2015-01-01

    or drinking no more than 21 standard drinks per week). Patients with harmful alcohol use or dependence as their primary problem who were seeking psychosocial treatment at one of four alcohol clinics in Denmark participated in the study. After implementation of the clinical pathway system, which incorporated...... a structured intake, a referral and independent follow-up system, checklists, audit, and feedback, there was no change in length of stay, but significantly more patients had a good clinical outcome (stopped or moderated their consumption) at the end of treatment (OR = 1.9; 1.2–3.1). The study documents...... the feasibility of using a clinical pathway framework, incorporating a local monitoring system, checklists, audit, and feedback to enhance treatment quality and improve outcomes for alcohol use disorders...

  12. Porcelain veneers as an alternative for esthetic treatment: clinical report.

    Science.gov (United States)

    Rotoli, B T; Lima, D A N L; Pini, N P; Aguiar, F H B; Pereira, G D S; Paulillo, L A M S

    2013-01-01

    This case report describes the restoration of the anterior dentition with porcelain laminate veneers. The advances in bonding of porcelain to tooth structure make this treatment a feasible alternative to restore teeth with alteration in shape and position in cases in which the esthetic demand is high. The rationale for various choices in this treatment protocol is detailed with reference to the pertinent literature. Thus, the clinical success of the technique depends on the correct identification of a case for which this treatment is appropriate and the successful execution of the clinical steps involved.

  13. Anti-histamine effect of Rubia tibetica, used to treat anaphylaxis caused by tick bites in the Pamir Mountains, Afghanistan

    DEFF Research Database (Denmark)

    Jeppesen, Anne S.; Kristiansen, Uffe; Soelberg, Jens;

    2012-01-01

    The roots of Rubia tibetica are chewed as an antidote to anaphylaxis caused by bites of the tick Ornithodoros lahorensis by the Wakhi people in Afghanistan.......The roots of Rubia tibetica are chewed as an antidote to anaphylaxis caused by bites of the tick Ornithodoros lahorensis by the Wakhi people in Afghanistan....

  14. When treatment meets research: clinical perspectives from the CSAT Methamphetamine Treatment Project.

    Science.gov (United States)

    Obert, Jeanne L; Brown, Alison Hamilton; Zweben, Joan; Christian, Darrell; Delmhorst, Jenn; Minsky, Sam; Morrisey, Patrick; Vandersloot, Denna; Weiner, Ahndrea

    2005-04-01

    Integrating research-based treatments into clinical settings has become a priority in the substance abuse treatment field. This article examines the introduction of research, via manualized treatment (i.e., the Matrix Model), into community treatment settings that participated in the Center for Substance Abuse Treatment Methamphetamine Treatment Project, a multi-site randomized controlled trial (RCT) that provided free treatment to 1016 methamphetamine-dependent individuals. With both empirical (qualitative) and anecdotal data from those involved clinically in the project, the article utilizes the framework of practitioner concerns set forth by Addis, Wade, and Hatgis (1999) to assess the issues realized during the implementation of this manualized treatment. Despite fairly smooth implementation of the model, the authors conclude that introducing manualized treatment in the context of an RCT may not be the best way to bring research-based treatment into the practice world.

  15. Combining clinical variables to optimize prediction of antidepressant treatment outcomes.

    Science.gov (United States)

    Iniesta, Raquel; Malki, Karim; Maier, Wolfgang; Rietschel, Marcella; Mors, Ole; Hauser, Joanna; Henigsberg, Neven; Dernovsek, Mojca Zvezdana; Souery, Daniel; Stahl, Daniel; Dobson, Richard; Aitchison, Katherine J; Farmer, Anne; Lewis, Cathryn M; McGuffin, Peter; Uher, Rudolf

    2016-07-01

    The outcome of treatment with antidepressants varies markedly across people with the same diagnosis. A clinically significant prediction of outcomes could spare the frustration of trial and error approach and improve the outcomes of major depressive disorder through individualized treatment selection. It is likely that a combination of multiple predictors is needed to achieve such prediction. We used elastic net regularized regression to optimize prediction of symptom improvement and remission during treatment with escitalopram or nortriptyline and to identify contributing predictors from a range of demographic and clinical variables in 793 adults with major depressive disorder. A combination of demographic and clinical variables, with strong contributions from symptoms of depressed mood, reduced interest, decreased activity, indecisiveness, pessimism and anxiety significantly predicted treatment outcomes, explaining 5-10% of variance in symptom improvement with escitalopram. Similar combinations of variables predicted remission with area under the curve 0.72, explaining approximately 15% of variance (pseudo R(2)) in who achieves remission, with strong contributions from body mass index, appetite, interest-activity symptom dimension and anxious-somatizing depression subtype. Escitalopram-specific outcome prediction was more accurate than generic outcome prediction, and reached effect sizes that were near or above a previously established benchmark for clinical significance. Outcome prediction on the nortriptyline arm did not significantly differ from chance. These results suggest that easily obtained demographic and clinical variables can predict therapeutic response to escitalopram with clinically meaningful accuracy, suggesting a potential for individualized prescription of this antidepressant drug.

  16. [Root resorption associated to orthodontic treatment: a clinical case].

    Science.gov (United States)

    Houb-Dine, Afaf; Rerhrhaye, Mariam; Ismaili, Zouheir; Rerhrhaye, Wiam

    2011-12-01

    Root resorption associated to orthodontic treatment is of multiple etiologies and a non intentional iatrogenic side effect which exists in almost all the orthodontic treatment. This clinical case of an apparently healthy patient illustrates the occurrence during the orthodontic treatment of a root resorption interesting the left central incisor, victims of previous traumatism and presenting a moderate periodontal attachment loss. The orthodontic treatment was carried out with light and continuous forces and a per-orthodontic periodontal maintenance in respect of periodontal requirements. As soon as the root resorption on the left central incisive was diagnosed, the active orthodontic treatment was interrupted in order to stabilize the lesion and a regular clinical and radiological monitoring was established.

  17. THORACOLUMBAR BURST FRACTURE: STRUCTURAL CHANGES AND CLINICAL OUTCOME OF TREATMENT

    Directory of Open Access Journals (Sweden)

    Rodrigo Arnold Tisot

    2016-03-01

    Full Text Available ABSTRACT Objective: To evaluate the correlation between structural changes in burst fractures of thoracic and lumbar spine with clinical outcome of the treatment. Methods: A retrospective study in 25 patients with fractures of thoracic and lumbar spine burst fractures without neurological deficit. Eleven patients underwent conservative treatment and for the remaining the treatment was surgical. All patients were followed up for at least 24 months. The cases were evaluated by a protocol that included: posttraumatic measurement of kyphosis, vertebral body collapse and narrowing of the spinal canal, the visual analog scale of pain, and the quality of life questionnaire SF-36 at the follow-up. For statistical analysis, the significance level was 5% and the software SPSS 18.0 was used. Results: No statistically significant difference was observed when comparing the clinical outcomes of one treatment over another. Similarly, there was no statistically significant correlation between kyphosis and post-traumatic narrowing of the spinal canal with clinical worsening in the follow-up, regardless of the treatment used. We found a positive correlation (p<0.05 between initial collapse and SF-36 domains in both groups (operated and non-operated. Conclusion: There was no significant superiority of one treatment over the other, and no correlation was found between kyphosis and spinal canal narrowing in burst fractures of the thoracic and lumbar spine without neurological deficit. However, there was correlation between initial collapse and clinical outcome in some domains of the SF-36 questionnaire.

  18. [Anaphylaxis after injection of corticosteroid preparations--carboxymethylcellulose as a hidden allergen].

    Science.gov (United States)

    Oppliger, Roland; Hauser, Conrad

    2004-11-01

    Two patients developed anaphylaxis after injection of a corticosteroid preparation containing carboxymethylcellulose (E466). In both cases skin tests yielded positive immediate type reactions to pure carboxymethylcellulose. This hydrophilic derivative of cellulose has found wide application in the pharmaceutical, cosmetics and food industry. The diagnosis is based on skin testing as 9% of the normal population was found to have serum IgE antibodies to this compound. In case of anaphylaxis after injection of corticosteroids, carboxymethylcellulose in addition to corticosteroids should be included for skin testing.

  19. Hypersensitivity to biological agents-updated diagnosis, management, and treatment.

    Science.gov (United States)

    Galvão, Violeta Régnier; Castells, Mariana C

    2015-01-01

    Biological agents are used in the treatment of neoplastic, autoimmune, and inflammatory diseases and their clinical applications are becoming broader. Following their increased utilization, hypersensitivity reactions linked to these drugs have become more frequent, sometimes preventing the use of first-line therapies. The clinical presentation of hypersensitivity reactions to biological agents ranges from mild cutaneous manifestations to life-threatening reactions. In this scenario, rapid desensitization is a groundbreaking procedure that enables selected patients to receive the full treatment dose in a safe way, in spite of their immediate hypersensitivity reaction to the drug, and protects them against anaphylaxis. The aim of this review is to update and discuss some of the main biological agents used in clinical practice (rituximab, trastuzumab, cetuximab, ofatumumab, tocilizumab, brentuximab, omalizumab, and tumor necrosis factor alpha inhibitor agents) and their associated hypersensitivity reactions, including clinical presentations, diagnosis, and treatment in the acute setting. In addition, novel management options with rapid desensitization are presented.

  20. CLINICAL ANALYSIS AND TREATMENT OF 14 CASESOF EXTRAMAMMARY PAGET'S DISEASE

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective To diffrentiate extramammary Paget' s disease ( EPD ) clinically and histologically from other skin diseases. Methods Clinical analysis and excisional treatment of 14 patients with EPD were reviewed from 1987 to 1997. Results Of 14 patients, 12 involved scrotum and penis, one in the groin and the other one in the perianal region. All were positive for cytokeratin and negative for S-100 protein. Follow-up showed 3 recurrences who had positive surgical margin biopsy. One died of other disease. Conclusion Surgery is the first choice for treatment of EPD. Negative margin must be achieved to prevent local recurrence.

  1. Chromoblastomycosis: an overview of clinical manifestations, diagnosis and treatment.

    Science.gov (United States)

    Queiroz-Telles, Flavio; Esterre, Phillippe; Perez-Blanco, Maigualida; Vitale, Roxana G; Salgado, Claudio Guedes; Bonifaz, Alexandro

    2009-02-01

    Chromoblastomycosis is one of the most frequent infections caused by melanized fungi. It is a subcutaneous fungal infection, usually an occupational related disease, mainly affecting individuals in tropical and temperate regions. Although several species are etiologic agents, Fonsecaea pedrosoi and Cladophialophora carrionii are prevalent in the endemic areas. Chromoblastomycosis lesions are polymorphic and must be differentiated from those associated with many clinical conditions. Diagnosis is confirmed by the observation of muriform cells in tissue and the isolation and the identification of the causal agent in culture. Chromoblastomycosis still is a therapeutic challenge for clinicians due to the recalcitrant nature of the disease, especially in the severe clinical forms. There are three treatment modalities, i.e., physical treatment, chemotherapy and combination therapy but their success is related to the causative agent, the clinical form and severity of the chromoblastomycosis lesions. There is no treatment of choice for this neglected mycosis, but rather several treatment options. Most of the patients can be treated with itraconazole, terbinafine or a combination of both. It is also important to evaluate the patient's individual tolerance of the drugs and whether the antifungal will be provided for free or purchased, since antifungal therapy must be maintained in long-term regimens. In general, treatment should be guided according to clinical, mycological and histopathological criteria.

  2. Cutaneous malignant melanoma: clinical aspects, imaging modalities and treatment

    Energy Technology Data Exchange (ETDEWEB)

    Ak, I.; Stokkel, M.P.M.; Pauwels, E.K.J. [Leiden University Medical Centre, Department of Radiology, Division of Nuclear Medicine, Leiden (Netherlands); Bergman, W. [Department of Dermatology, Leiden University Medical Centre, Leiden (Netherlands)

    2000-04-01

    Cutaneous melanoma is a highly malignant tumour of the melanocytes presenting characteristic metabolic and biological features. Early detection decreases mortality and morbidity and provides the best chance for optimal clinical management. Imaging techniques, including scintigraphy, have assumed an important role in detection strategies. As a functional modality, nuclear medicine offers a variety of possibilities to assist in the clinical management of malignant melanoma. This review discusses the clinical aspects and treatment of melanoma, and the imaging techniques used for its diagnosis, staging and follow-up. A survey of currently available techniques is presented. (orig.)

  3. [Lactose intolerance: pathophysiology, clinical symptoms, diagnosis and treatment].

    Science.gov (United States)

    Hutyra, Tomasz; Iwańczak, Barbara

    2009-02-01

    Lactose malabsorption and milk products intolerance symptoms are the most common alimentary tract disorders. Lactose intolerance is a result of lactase deficiency or lack of lactase and lactose malabsorption. Three types of lactase deficiency were distinguished: congenital, late-onset lactase deficiency and secondary lactase deficiency. Lactose intolerance means the appearance of clinical gastrointestinal symptoms after ingestion of lactose. To the clinical symptoms of lactose intolerance belongs: nausea, vomiting, abdominal distension, cramps, flatulence, flatus, diarrhea and abdominal pain. The diagnosis of lactose intolerance is based on the breath hydrogen test and analysis of lactase activity in the small intestine mucosa. Dietary treatment eliminates clinical symptoms.

  4. Combining clinical variables to optimize prediction of antidepressant treatment outcomes

    OpenAIRE

    Iniesta, R.; Malki, K.; Maier, W; Rietschel, M.; Mors, O; Hauser, J; Henigsberg, N.; Dernovsek, M. Z.; Souery, D.; Stahl, D.; Dobson, R.; Aitchison, K. J.; Farmer, A; Lewis, C.M.; McGuffin, P.

    2016-01-01

    The outcome of treatment with antidepressants varies markedly across people with the same diagnosis. A clinically significant prediction of outcomes could spare the frustration of trial and error approach and improve the outcomes of major depressive disorder through individualized treatment selection. It is likely that a combination of multiple predictors is needed to achieve such prediction. We used elastic net regularized regression to optimize prediction of symptom improvement and remissio...

  5. Targeting Opioid-Induced Hyperalgesia in Clinical Treatment: Neurobiological Considerations.

    Science.gov (United States)

    Arout, Caroline A; Edens, Ellen; Petrakis, Ismene L; Sofuoglu, Mehmet

    2015-06-01

    Opioid analgesics have become a cornerstone in the treatment of moderate to severe pain, resulting in a steady rise of opioid prescriptions. Subsequently, there has been a striking increase in the number of opioid-dependent individuals, opioid-related overdoses, and fatalities. Clinical use of opioids is further complicated by an increasingly deleterious profile of side effects beyond addiction, including tolerance and opioid-induced hyperalgesia (OIH), where OIH is defined as an increased sensitivity to already painful stimuli. This paradoxical state of increased nociception results from acute and long-term exposure to opioids, and appears to develop in a substantial subset of patients using opioids. Recently, there has been considerable interest in developing an efficacious treatment regimen for acute and chronic pain. However, there are currently no well-established treatments for OIH. Several substrates have emerged as potential modulators of OIH, including the N-methyl-D-aspartate and γ-aminobutyric acid receptors, and most notably, the innate neuroimmune system. This review summarizes the neurobiology of OIH in the context of clinical treatment; specifically, we review evidence for several pathways that show promise for the treatment of pain going forward, as prospective adjuvants to opioid analgesics. Overall, we suggest that this paradoxical state be considered an additional target of clinical treatment for chronic pain.

  6. Uses of coercion in addiction treatment: clinical aspects.

    Science.gov (United States)

    Sullivan, Maria A; Birkmayer, Florian; Boyarsky, Beth K; Frances, Richard J; Fromson, John A; Galanter, Marc; Levin, Frances R; Lewis, Collins; Nace, Edgar P; Suchinsky, Richard T; Tamerin, John S; Tolliver, Bryan; Westermeyer, Joseph

    2008-01-01

    Coerced or involuntary treatment comprises an integral, often positive component of treatment for addictive disorders. By the same token, coercion in health care raises numerous ethical, clinical, legal, political, cultural, and philosophical issues. In order to apply coerced care effectively, health care professionals should appreciate the indications, methods, advantages, and liabilities associated with this important clinical modality. An expert panel, consisting of the Addiction Committee of the Group for the Advancement of Psychiatry, listed the issues to be considered by clinicians in considering coerced treatment. In undertaking this task, they searched the literature using Pubmed from 1985 to 2005 using the following search terms: addiction, alcohol, coercion, compulsory, involuntary, substance, and treatment. In addition, they utilized relevant literature from published reports. In the treatment of addictions, coercive techniques can be effective and may be warranted in some circumstances. Various dimensions of coercive treatment are reviewed, including interventions to initiate treatment; contingency contracting and urine testing in the context of psychotherapy; and pharmacological methods of coercion such as disulfiram, naltrexone, and the use of a cocaine vaccine. The philosophical, historical, and societal aspects of coerced treatment are considered.

  7. Treatment intensification in a hypertension telemanagement trial: clinical inertia or good clinical judgment?

    Science.gov (United States)

    Crowley, Matthew J; Smith, Valerie A; Olsen, Maren K; Danus, Susanne; Oddone, Eugene Z; Bosworth, Hayden B; Powers, Benjamin J

    2011-10-01

    Clinical inertia represents a barrier to hypertension management. As part of a hypertension telemanagement trial designed to overcome clinical inertia, we evaluated study physician reactions to elevated home blood pressures. We studied 296 patients from the Hypertension Intervention Nurse Telemedicine Study who received telemonitoring and study physician medication management. When a patient's 2-week mean home blood pressure was elevated, an "intervention alert" prompted study physicians to consider treatment intensification. We examined treatment intensification rates and subsequent blood pressure control. Patients generated 1216 intervention alerts during the 18-month intervention. Of 922 eligible intervention alerts, study physicians intensified treatment in 374 (40.6%). Study physician perception that home blood pressure was acceptable was the most common rationale for nonintensification (53.7%). When "blood pressure acceptable" was the reason for not intensifying treatment, the mean blood pressure was lower than for intervention alerts where treatment intensification occurred (135.3/76.7 versus 143.2/80.6 mm Hg; PBlood pressure acceptable intervention alerts were associated with the lowest incidence of repeat alerts (hazard ratio: 0.69 [95% CI: 0.58 to 0.83]), meaning that the patient home blood pressure was less likely to subsequently rise above goal, despite apparent clinical inertia. This telemedicine intervention targeting clinical inertia did not guarantee treatment intensification in response to elevated home blood pressures. However, when physicians did not intensify treatment, it was because blood pressure was closer to an acceptable threshold, and repeat blood pressure elevations occurred less frequently. Failure to intensify treatment when home blood pressure is elevated may, at times, represent good clinical judgment, not clinical inertia.

  8. IL-7Rα and L-selectin, but not CD103 or CD34, are required for murine peanut-induced anaphylaxis

    Directory of Open Access Journals (Sweden)

    Maltby Steven

    2012-08-01

    Full Text Available Abstract Background Allergy to peanuts results in severe anaphylactic responses in affected individuals, and has dramatic effects on society and public policy. Despite the health impacts of peanut-induced anaphylaxis (PIA, relatively little is known about immune mechanisms underlying the disease. Using a mouse model of PIA, we evaluated mice with deletions in four distinct immune molecules (IL7Rα, L-selectin, CD34, CD103, for perturbed responses. Methods PIA was induced by intragastric sensitization with peanut antigen and cholera toxin adjuvant, followed by intraperitoneal challenge with crude peanut extract (CPE. Disease outcome was assessed by monitoring body temperature, clinical symptoms, and serum histamine levels. Resistant mice were evaluated for total and antigen specific serum IgE, as well as susceptibility to passive systemic anaphylaxis. Results PIA responses were dramatically reduced in IL7Rα−/− and L-selectin−/− mice, despite normal peanut-specific IgE production and susceptibility to passive systemic anaphylaxis. In contrast, CD34−/− and CD103−/− mice exhibited robust PIA responses, indistinguishable from wild type controls. Conclusions Loss of L-selectin or IL7Rα function is sufficient to impair PIA, while CD34 or CD103 ablation has no effect on disease severity. More broadly, our findings suggest that future food allergy interventions should focus on disrupting sensitization to food allergens and limiting antigen-specific late-phase responses. Conversely, therapies targeting immune cell migration following antigen challenge are unlikely to have significant benefits, particularly considering the rapid kinetics of PIA.

  9. Clinical Practice Guidelines for Valvular Prostheses Dysfunction Treatment

    Directory of Open Access Journals (Sweden)

    Lázaro De la Cruz Avilés

    2009-03-01

    Full Text Available Clinical Practice Guidelines for Valve Prostheses Dysfunction Treatment. The introduction of an artificial valve allows improving life quality and expectancy of an important number of patients and can be considered a common treatment within advanced heart valve disease. However, persons with this kind of prosthesis usually present another disease caused by the potential complications associated with the uses of anti-clotting medications. This document includes the different classifications of artificial heart valves and different kinds of dysfunctions, and updates those aspects related with treatment stressing the appropriate behaviour when valve or prosthesis thrombosis occurs. It includes assessment guidelines focused on the most important aspects to be accomplished.

  10. Hip osteoarthrosis: clinical presentation, diagnosis, approaches to treatment

    Directory of Open Access Journals (Sweden)

    Marina Stanislavovna Svetlova

    2013-01-01

    Full Text Available The paper characterizes the specific features of the anatomy and physiology of the hip joint, the clinical presentation of coxarthrosis and presents current methods for the diagnosis and treatment of the disease. It gives the results of a trial evaluating the impact of long-term (one-year theraflex therapy on the symptoms of hip osteoarthrosis.

  11. Occult hepatitis B virus infection: clinical implications in tuberculosis treatment.

    Science.gov (United States)

    Trigo, C; do Brasil, P E A A; Costa, M J M; de Castro, L

    2016-12-01

    Occult hepatitis B virus infection (OBI) is characterized by the absence of HBsAg and persistence of the virus genome (HBV-DNA) in liver tissue and/or blood. OBI has been reported in several clinical contexts. However, the clinical significance of OBI in tuberculosis (TB) treatment is unknown. We investigated the OBI prevalence and its impact on the risk of drug-induced liver injury (DILI) during TB treatment. This was a prospective cohort study with one hundred patients who were treated for TB from 2008 to 2015. Laboratory, clinical and demographic data of TB patients were extracted from medical records. Based on HBV-DNA testing of serum samples, an OBI prevalence of 12% was established; almost half of these patients had both anti-HBc and anti-HBs serological markers. Low CD4(+) cell counts have been shown to be a risk factor for OBI among TB patients co-infected with HIV (P=.036). High DILI incidence was observed in this study. A multivariable Cox proportional hazard model was conducted and identified OBI (HR 2.98, 95% CI 1.30-6.86) as the strongest predictor for DILI when adjusted to CD4(+) cell count (HR 0.38, 95% CI 0.17-0.90), ALT before TB treatment (HR 1.37, 95% CI 0.81-2.32) and TB extrapulmonary clinical form (HR 2.91, 95% CI 1.75-7.21). The main aim of this study was to highlight DILI as a clinical outcome during treatment of TB patients with OBI. Therefore, HBV-DNA testing should be considered routinely in monitoring DILI, and also in other clinical implications associated with OBI, reduce morbidity and mortality.

  12. Adoption of the children's obesity clinic's treatment (TCOCT) protocol into another Danish pediatric obesity treatment clinic

    DEFF Research Database (Denmark)

    Most, Sebastian W; Højgaard, Birgitte; Teilmann, Grete Katrine

    2015-01-01

    BACKGROUND: Treating severe childhood obesity has proven difficult with inconsistent treatment results. This study reports the results of the implementation of a childhood obesity chronic care treatment protocol. METHODS: Patients aged 5 to 18 years with a body mass index (BMI) above the 99th......, but independent of baseline BMI SDS, age, co-morbidity, SES, pubertal stage, place of referral, hours of treatment per year, and mean visit interval time. CONCLUSIONS: The systematic use of the TCOCT protocol reduced the degree of childhood obesity with acceptable retention rates with a modest time...

  13. Allergy/Anaphylaxis Management in the School Setting. Position Statement. Revised

    Science.gov (United States)

    Zacharski, Susan; DeSisto, Marie; Pontius, Deborah; Sheets, Jodi; Richesin, Cynthia

    2012-01-01

    It is the position of the National Association of School Nurses (NASN) that the safe and effective management of allergies and anaphylaxis in schools requires a collaborative, multidisciplinary team approach. The registered professional school nurse (hereinafter referred to as the school nurse), is the leader in a comprehensive management approach…

  14. Plasma contact system activation drives anaphylaxis in severe mast cell-mediated allergic reactions

    NARCIS (Netherlands)

    Sala-Cunill, Anna; Björkqvist, Jenny; Senter, Riccardo; Guilarte, Mar; Cardona, Victoria; Labrador, Moises; Nickel, Katrin F; Butler, Lynn; Luengo, Olga; Kumar, Parvin; Labberton, Linda; Long, Andy; Di Gennaro, Antonio; Kenne, Ellinor; Jämsä, Anne; Krieger, Thorsten; Schlüter, Hartmut; Fuchs, Tobias; Flohr, Stefanie; Hassiepen, Ulrich; Cumin, Frederic; McCrae, Keith; Maas, Coen; Stavrou, Evi; Renné, Thomas

    2015-01-01

    BACKGROUND: Anaphylaxis is an acute, potentially lethal, multisystem syndrome resulting from the sudden release of mast cell-derived mediators into the circulation. OBJECTIVES AND METHODS: We report here that a plasma protease cascade, the factor XII-driven contact system, critically contributes to

  15. c-fos expression in specific rat brain nuclei after intestinal anaphylaxis: involvement of 5-HT3 receptors and vagal afferent fibers.

    Science.gov (United States)

    Castex, N; Fioramonti, J; Fargeas, M J; Bueno, L

    1995-08-07

    The c-fos immediate-early gene is acutely induced in brain after various stimuli from the digestive tract. 5-HT3 receptors and vagal afferents have been found involved in intestinal motor disturbances induced by intestinal anaphylaxis. Our aim was to determine whether intestinal anaphylaxis activates brain structures, using c-fos expression, and to evaluate the modulation of c-fos induction by 5-HT3 receptors and vagal afferents. The effects of antigen challenge on intestinal motility were evaluated in ovalbumin-sensitized Hooded Lister rats chronically fitted with NiCr electrodes in the jejunal wall. Intestinal motility was assessed in conscious rats pretreated or not by perivagal capsaicin or a 5-HT3 antagonist (ondansetron). In sensitized rats, ovalbumin disrupted for 62.4 +/- 9.5 min the jejunal migrating motor complexes (MMC) and an important c-fos expression was detected in the nucleus tractus solitarius (NTS), lateral parabrachial nucleus (LPB) and paraventricular nucleus of the hypothalamus (PVN). Intraperitoneal administration of ondansetron or perivagal capsaicin treatment significantly reduced the duration of MMC disruption and attenuated markedly c-fos staining in the 3 brain sites. In contrast, intracerebroventricular administration of ondansetron significantly reduced jejunal motor alterations but did not diminish the c-fos expression, suggesting a role of central 5-HT3 receptors in the efferent control of the intestinal disturbances. Blockade of both c-fos expression and MMC disruption by systemic ondansetron and by perivagal capsaicin indicates that some brainstem nuclei are involved in digestive disturbances after intestinal anaphylaxis, and reflects an involvement of peripheral 5-HT3 receptors on vagal afferents. The reduction of c-fos staining in NTS as well as in LPB and PVN after perivagal capsaicin suggests that the NTS is the primary relay in the activation of the central nervous system during intestinal allergic challenge.

  16. Polydatin (PD) inhibits IgE-mediated passive cutaneous anaphylaxis in mice by stabilizing mast cells through modulating Ca{sup 2+} mobilization

    Energy Technology Data Exchange (ETDEWEB)

    Yuan, Meichun [Department of Pathophysiology, School of Medicine, Shenzhen University, Shenzhen 518060 (China); Department of Physiology, Hubei University of Medicine, Shiyan (China); Li, Jianjie [State Key Laboratory of Respiratory Disease for Allergy at Shengzhen University, Shenzhen 518060 (China); Lv, Jingzhang [Shenzhen Entry-Exit Inspection and Quarantine Bureau, Shenzhen 518045 (China); Mo, Xucheng; Yang, Chengbin [State Key Laboratory of Respiratory Disease for Allergy at Shengzhen University, Shenzhen 518060 (China); Chen, Xiangdong [Department of Pathophysiology, School of Medicine, Shenzhen University, Shenzhen 518060 (China); Liu, Zhigang [State Key Laboratory of Respiratory Disease for Allergy at Shengzhen University, Shenzhen 518060 (China); Liu, Jie, E-mail: ljljz@yahoo.com [Department of Pathophysiology, School of Medicine, Shenzhen University, Shenzhen 518060 (China)

    2012-11-01

    Mast cells play a key role in the pathogenesis of asthma and are a promising target for therapeutic intervention in asthma. This study investigated the effects of polydatin (PD), a resveratrol glucoside, on mast cell degranulation upon cross-linking of the high-affinity IgE receptors (FcεRI), as well as the anti-allergic activity of PD in vivo. Herein, we demonstrated that PD treatment for 30 min suppressed FcεRI-mediated mast cell degranulation in a dose-dependent manner. Concomitantly, PD significantly decreased FcεRI-mediated Ca{sup 2+} increase in mast cells. The suppressive effects of PD on FcεRI-mediated Ca{sup 2+} increase were largely inhibited by using LaCl{sub 3} to block the Ca{sup 2+} release-activated Ca{sup 2+} channels (CRACs). Furthermore, PD significantly inhibited Ca{sup 2+} entry through CRACs evoked by thapsigargin (TG). Knocking down protein expression of Orai1, the pore-forming subunit of CRACs, significantly decreased PD suppression of FcεRI-induced intracellular Ca{sup 2+} influx and mast cell degranulation. In a mouse model of mast cell-dependent passive cutaneous anaphylaxis (PCA), in vivo PD administration suppressed mast cell degranulation and inhibited anaphylaxis. Taken together, our data indicate that PD stabilizes mast cells by suppressing FcεRI-induced Ca{sup 2+} mobilization mainly through inhibiting Ca{sup 2+} entry via CRACs, thus exerting a protective effect against PCA. -- Highlights: ► Polydatin can prevent the pathogenesis of passive cutaneous anaphylaxis in mice. ► Polydatin stabilizes mast cells by decreasing FcεRI-mediated degranulation. ► Polydatin suppresses Ca{sup 2+} entry through CRAC channels in mast cells.

  17. Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes

    Directory of Open Access Journals (Sweden)

    Barbara Campos Abreu Marino

    2015-05-01

    Full Text Available Background: Clinical in-stent restenosis (CISR is the main limitation of coronary angioplasty with stent implantation. Objective: Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment. Methods: We analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI] and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization during a minimal follow-up of one year. Results: Mean age was 61 ± 11 years (68.2% males. Clinical presentations included acute coronary syndrome (ACS in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES in 36.4%, Bare Metal Stent (BMS in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5% deaths and 13 (11.8% AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44–12.85]; p = 0.009 and clinical treatment for CISR (HR = 10.66 [2.53–44.87]; p = 0.001. Treatment of CISR with BMS (HR = 4.08 [1.75–9.48]; p = 0.001 and clinical therapy (HR = 6.29 [1.35–29.38]; p = 0.019 emerged as predictors of a secondary outcome. Conclusion: Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.

  18. Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes

    Science.gov (United States)

    Marino, Barbara Campos Abreu; Nascimento, Guilherme Abreu; Rabelo, Walter; Marino, Marcos Antônio; Marino, Roberto Luiz; Ribeiro, Antonio Luiz Pinho

    2015-01-01

    Background Clinical in-stent restenosis (CISR) is the main limitation of coronary angioplasty with stent implantation. Objective Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment. Methods We analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI]) and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization) during a minimal follow-up of one year. Results Mean age was 61 ± 11 years (68.2% males). Clinical presentations included acute coronary syndrome (ACS) in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES) in 36.4%, Bare Metal Stent (BMS) in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5%) deaths and 13 (11.8%) AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44–12.85]; p = 0.009) and clinical treatment for CISR (HR = 10.66 [2.53–44.87]; p = 0.001). Treatment of CISR with BMS (HR = 4.08 [1.75–9.48]; p = 0.001) and clinical therapy (HR = 6.29 [1.35–29.38]; p = 0.019) emerged as predictors of a secondary outcome. Conclusion Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up. PMID:25651344

  19. Evaluation of the clinical usefulness of modulated Arc treatment

    CERN Document Server

    Lee, Young Kyu; Kim, Yeon Sil; Choi, Byung Ock; Nam, Sang Hee; Park, Hyeong Wook; Kim, Shin Wook; Shin, Hun Joo; Lee, Jae Choon; Kim, Ji Na; Park, Sung Kwang; Kim, Jin Young; Kang, Young-Nam

    2015-01-01

    The purpose of this study is to evaluate the clinical usefulness of modulated arc (mARC) treatment techniques. The mARC treatment plans of the non-small cell lung cancer (NSCLC) patients were performed in order to verify the clinical usefulness of mARC. A pre study was conducted to find the most competent plan condition of mARC treatment and the usefulness of mARC treatment plan was evaluated by comparing it with the other Arc treatment plans such as Tomotherapy and RapidArc. In the case of mARC, the optimal condition for the mARC plan was determined by comparing the dosimetric performance of the mARC plans with the use of various parameters. The various parameters includes the photon energies (6 MV, 10 MV), optimization point angle (6{\\deg}-10{\\deg} intervals), and total segment number (36-59 segment). The best dosimetric performance of mARC was observed at 10 MV photon energy and the point angle 6 degree, and 59 segments. The each treatment plans of three different techniques were compared with the followin...

  20. DEVELOPMENT OF ACUPUNCTURE TREATMENT AND CLINICAL RESEARCH OF THREATENED ABORTION

    Institute of Scientific and Technical Information of China (English)

    LI Jing-xia; XIE Gan-gong

    2005-01-01

    In the present paper, the authors review recent development of acupuncture treatment of threatened abortion from 1) clinical application of "Linggui Bafa"(灵龟八法Eight Methods of Intelligent Turtle), 2) body acupoints, and 3) acupuncture combined with Chinese materia medica, and clinical study from 1) effect of acupuncture on the blood flow of uterus, and 2) effect of acupuncture on plasma progesterone level. In addition, acupuncture therapy is also used to help women in gestation and can effectively raise the pregnant rate. "Linggui Bafa" is rather effective in preventing threatened abortion and should be studied further.

  1. COPD, stage and treatment in a large outpatient clinic

    Science.gov (United States)

    Holm, Claire Præst; Holm, Jakob; Nørgaard, Annette; Godtfredsen, Nina

    2017-01-01

    ABSTRACT Some COPD patients suffer from frequent exacerbations despite triple inhalation treatment. These frequent exacerbators should be identified, as exacerbations often lead to decreasing lung function and increasing mortality. Roflumilast reduces exacerbations in patients with a previous history of exacerbations. Our aim was to describe COPD patient characteristics and compare roflumilast treatment eligible to non-eligible patients. An observational cross-section study was conducted. Patients were included from a large COPD outpatient clinic. Information regarding COPD patient characteristics was registered on a standardized form and lung function was measured. Patients were categorized according to the GOLD classification. Eligibility for roflumilast treatment was assessed and patient characteristics compared between groups. 547 patients were included. Most patients (54%) were in GOLD group D. 62 patients (11.3%) met the criteria for treatment with roflumilast. Among the patients eligible for roflumilast treatment, only 14 patients (22.6%) were receiving treatment. There were no significant differences in FEV1, number of exacerbations, hospitalization due to exacerbation, MRC grade, age, smoking status and medication use between patients receiving roflumilast and not treated eligible patients. Our study documents low use of roflumilast treatment. In view of the established effect of roflumilast we think that this treatment should be considered more consistently as an option among COPD patients fulfilling the criteria for this therapy. PMID:28326174

  2. KIT D816V mutation burden does not correlate to clinical manifestations of indolent systemic mastocytosis

    DEFF Research Database (Denmark)

    Broesby-Olsen, Sigurd; Kielsgaard Kristensen, Thomas; Vestergaard, Hanne

    2013-01-01

    Clinical manifestations of indolent systemic mastocytosis (ISM) comprise mediator-related symptoms, anaphylaxis, and osteoporosis. A new sensitive method for KIT D816V mutation detection allows quantification of the level of mutation-positive cells.......Clinical manifestations of indolent systemic mastocytosis (ISM) comprise mediator-related symptoms, anaphylaxis, and osteoporosis. A new sensitive method for KIT D816V mutation detection allows quantification of the level of mutation-positive cells....

  3. Clinical evaluation of amitraz for treatment of canine scabies.

    Science.gov (United States)

    Folz, S D; Kakuk, T J; Henke, C L; Rector, D L; Tesar, F B

    1984-08-01

    A liquid concentrate formulation of amitraz (Mitaban: Upjohn) was used to topically treat 181 dogs with scabies, at an active drug level of 250 ppm, or 10.6 ml of concentrate in 2 gal water. After the dogs were clipped and bathed, the diluted medication was applied and allowed to dry on the animal. All treated dogs were clinically improved and 97.8% cured after a single treatment; 3 dogs required 2 treatments and 1 dog 3 treatments. Otodectes cynotis and Cheyletiella yasguri in several dogs were also cleared after 1 treatment. Mild, transient sedation occurred in 12.4% of treated dogs, with transient vomiting, increased appetite and diarrhea in less than 1%.

  4. Late-onset hypogonadism: etiology, clinical features, diagnostics, treatment

    Directory of Open Access Journals (Sweden)

    E. Yu. Pashkova

    2015-01-01

    Full Text Available In a critical review of the literature current data concerning etiology, clinical features, diagnostics, treatment of late-onset hypogonadism (LOH are given. LOH is a multidisciplinary problem, because a patient with LOH can have osteoporosis, anemia, depression, obesity, diabetes mellitus, erectile dysfunction. Sometimes it is hard to realize that all this complaints are symptoms of LOH. LOH has a negative impact on a patient,s quality of life and it,s impossible to help without androgen replacement therapy. Furthermore doctors often have doubts about testosterone replacement therapy safety because of lack of accurate information. In a convenient for medical practitioners form clinical and laboratory diagnostic criteria of LOH are presented together with formulas for conversion from one measurement unit of main sex hormones into another. Based on latest ISSAM guidelines (International Society for the Study of the Aging Male modern treatment options of LOH are summarized, full information about available testosterone preparations (oral, transdermal, injectable with comparative analysis of advantages and disadvantages of each is given. A full description of indications and contraindications for androgen replacement treatment is presented, also treatment regimen and medical supervision algorithm during treatment are described. 

  5. Late-onset hypogonadism: etiology, clinical features, diagnostics, treatment

    Directory of Open Access Journals (Sweden)

    E. Yu. Pashkova

    2015-04-01

    Full Text Available In a critical review of the literature current data concerning etiology, clinical features, diagnostics, treatment of late-onset hypogonadism (LOH are given. LOH is a multidisciplinary problem, because a patient with LOH can have osteoporosis, anemia, depression, obesity, diabetes mellitus, erectile dysfunction. Sometimes it is hard to realize that all this complaints are symptoms of LOH. LOH has a negative impact on a patient,s quality of life and it,s impossible to help without androgen replacement therapy. Furthermore doctors often have doubts about testosterone replacement therapy safety because of lack of accurate information. In a convenient for medical practitioners form clinical and laboratory diagnostic criteria of LOH are presented together with formulas for conversion from one measurement unit of main sex hormones into another. Based on latest ISSAM guidelines (International Society for the Study of the Aging Male modern treatment options of LOH are summarized, full information about available testosterone preparations (oral, transdermal, injectable with comparative analysis of advantages and disadvantages of each is given. A full description of indications and contraindications for androgen replacement treatment is presented, also treatment regimen and medical supervision algorithm during treatment are described. 

  6. Clinical Neuroprotective Drugs for Treatment and Prevention of Stroke

    Directory of Open Access Journals (Sweden)

    Eiichiro Tanaka

    2012-06-01

    Full Text Available Stroke is an enormous public health problem with an imperative need for more effective therapies. In therapies for ischemic stroke, tissue plasminogen activators, antiplatelet agents and anticoagulants are used mainly for their antithrombotic effects. However, free radical scavengers, minocycline and growth factors have shown neuroprotective effects in the treatment of stroke, while antihypertensive drugs, lipid-lowering drugs and hypoglycemic drugs have shown beneficial effects for the prevention of stroke. In the present review, we evaluate the treatment and prevention of stroke in light of clinical studies and discuss new anti-stroke effects other than the main effects of drugs, focusing on optimal pharmacotherapy.

  7. Clinical Application of Neuroplastic Brain Research in Eating Disorder Treatment

    Directory of Open Access Journals (Sweden)

    Abigail H. Natenshon

    2016-12-01

    Neurophysiological and psychophysiological treatment interventions, by carving new neuronal pathways and creating connectivity that augments brain circuitry, carry the potential to remediate body image and self-image distortions, reintegrating the fragmented eating disordered core self. To date, intentional partnering between therapist, ED patient, and neuroplastic brain has been rarely applied in the clinical milieu and minimally referenced in the treatment literature. By bringing current neuroplasticity research into frontline practice, ED practitioners not only bridge the research/practice gap, but redefine new directions for future ED research.

  8. [Clinical manifestation and surgical treatment of superior lumbar disc herniation].

    Science.gov (United States)

    Klishin, D N; Dreval', O N; Gorozhanin, A V

    2011-01-01

    On the basis of analysis of presentation and surgical treatment of 103 patients with lumbar disc herniation the authors performed comparative assessment of symptoms and therapeutic techniques in patients with higher and lower lumbar disc disease. Short-term and long-term results were evaluated using visual analogue scale and Oswestry disability index (ODI). Statistically significant differences in dynamics of pain and ODI were not present. In spite of differences in clinical presentation, the results of surgical treatment in both groups were similar. They depended on severity of preoperative neurological deficit regardless of level of lesion. Specific features of surgical procedure in superior lumbar disk herniation are described.

  9. Esthesioneuroblastoma: clinical course, long-term results of treatment

    Directory of Open Access Journals (Sweden)

    T. D. Tabolinovskaya

    2016-01-01

    Full Text Available This rare tumor from a group of neuroendocrine neoplasms was studied. The material for the study was the data of 78 patients with esthesioneuroblastoma who had been treated and followed up at the N.N. Blokhin Russian Cancer Research Center in the period 1965 to 2014. Information on hospital statistics, clinical features, methods, and treatment results were presented. The possibilities of using the TNM classification for the nasal cavity, ethmoidal sinuses, and nasopharynx were assessed to determine the anatomic extent of primary tumor. The findings contribute to the solution of problems in the diagnosis and treatment of esthesioneuroblastoma at the present stage. 

  10. Antiarrhythmic treatment with flecainide (Tambocor). Clinical experience from 107 patients

    DEFF Research Database (Denmark)

    Frandsen, F; Pless, P; Mickley, H;

    1990-01-01

    The long-term clinical effect of oral flecainide treatment was evaluated in 107 pts (10-82 yrs). Indications for treatment were: atrial fibrillation 38%, atrial flutter 16%, ventricular tachycardia 24%, ventricular ectopic beats 10% and supraventricular tachycardia 12%. Daily flecainide dosage...... pts due to: insufficient effect in 28, side effects in 17 and for other reasons in 5. The side effects indicating flecainide withdrawal (pts) were: cerebral symptoms (4), gastrointestinal complaints (2), bradyarrhythmias (2), heart failure (3) and suspected pro-arrhythmia (4). (Ventricular tachycardia...

  11. DEVELOPMENT ON CLINICAL TREATMENT OF CONSTIPATION WITH ACUPUNCTURE AND MOXIBUSTION

    Institute of Scientific and Technical Information of China (English)

    YAN Xing-ke; CHUI Jian-mei; YANG Yong-qing

    2005-01-01

    In the present paper, the authors review recent development of clinical treatment of constipation with acupuncture and moxibustion from ① body acupuncture therapy including special needling manipulations, as Ziwu Daojiu Needling, etc. and acupoint combination, ② electroacupuncture therapy, ③ scalp-acupuncture therapy, ④ auricular acupuncture therapy, ⑤ needle-embedding and acupoint-catgut-embedding therapies, ⑥ acupoint-application therapy, ⑦ combined acupuncture and medication therapy, ⑧ other therapies such as cupping therapy and holo-therapy, and ⑨ considerations about the action of acupuncture in the treatment of constipation and its prospect. Up to now, researches on the effect of acupuncture in treating constipation are seldom seen, thus, much attention should be paid about this by clinical and experimental researchers.

  12. Food-dependent exercise-induced anaphylaxis: case report and review of literature%食物依赖运动诱发性过敏反应一例并文献复习

    Institute of Scientific and Technical Information of China (English)

    穆新林; 余洁; 高占成

    2009-01-01

    Objective Food-dependent exercise-induced anaphylaxis (FDEIA) is a kind of food allergic disorder induced by physical exercise. Some FDEIA patients presented severe symptoms which were threat to life. The aim of the article was to improve the recognition of FDEIA among physicians. Methods The clinical data of a patient with FDEIA in our hospital was collected and analyzed, and current related literatures were reviewed. Results An eighteen year-old male was admitted to our hospital because of repeated episodes of urticaria, dyspnea and loss of consciousness for eight months. Each episode was induced by exercise after ingestion of wheat-made food. Symptoms were relieved rapidly by treatment with adrenaline, antihistamines, and/or dexamethasone. Assay of food-specific IgE in serum of the patient showed positive result for shrimp and crab. However, no anaphylaxis was related to the suspected food. Wheat-exercise challenge test showed positive result in the patient, which confirmed the diagnosis of FDEIA. Since then, the patient had avoided wheat food for more than one year, during which period no episode of anaphylaxis was observed, until one day the patient exercised after a diet of wheat food. Conclusions The incidence of FDEIA was rare. Wheat is the common causative food. Food-exercise challenge test is a reliable method for diagnosis of FDEIA. Avoidance of exercise for 4h after eating causative food might be helpful to prevent the occurrence of symptoms in many FDEIA cases. Dietary elimination of causative food ingredients was a reliable method for prophylaxis of FDEIA.%目的 提高临床医师对食物依赖运动诱发性过敏反应(FDEIA)的认识.方法 2007年12月至2009年10月通过对1例FDEIA患者的诊断、治疗经过以及随访结果的分析,结合文献复习,详细阐述该病的病冈、临床表现、诊断方法、治疗及预防方法.结果 患者男,18岁,反复出现荨麻疹、呼吸困难及意识障碍8个月,每次发作均是在进

  13. Evaluation of medication treatment for Alzheimer's disease on clinical evidence

    Directory of Open Access Journals (Sweden)

    Meng-qiu LI

    2014-03-01

    Full Text Available Objective To formulate the best treatment plan for Alzheimer's disease patients by evaluating the therapeutic efficacy and side effect of various evidence-based programs. Methods Alzheimer's disease, donepezil, rivastigmine, galantamine, memantine, rosiglitazone, etc. were defined as retrieval words. PubMed, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure (CNKI databases were used with applying of manual searching. Systematic reviews, randomized controlled trials (RCT, controlled clinical trials and case-observation studies were collected and evaluated by Jadad Scale. Results After screening, 33 selected resources included 14 systematic reviews, 14 randomized controlled trials, 4 controlled clinical trials and 1 case-observation study. According to Jadad Scale, total 28 articles were evaluated to be high quality (12 with score 4, 10 score 5, 6 score 7, and 5 were low quality with score 3. It was summarized as follows: 1 Alzheimer's disease is a progressive neurodegenerative disease for which no cure exists. To date, only symptomatic treatments with cholinesterase inhibitors (donepezil, rivastigmine, galantamine and an N-methyl-D-aspartate (NMDA receptor noncompetitive antagonist (memantine, are effective and well tolerated to counterbalance the neurotransmitter disturbance, but cannot limit or impact on disease progression. 2 Disease modifying drug is an potential agent, with persistent effect on slowing the progression of structural damage, and can be detected even after withdrawing the treatment. Many types of disease modifying drugs are undergoing clinical trials. Conclusions Using evidence-based medicine methods can provide best clinical evidence on Alzheimer's disease treatment. doi: 10.3969/j.issn.1672-6731.2014.03.009

  14. Clinical Observation of Irbesartan in Treatment of Vasovagal Syncope

    Institute of Scientific and Technical Information of China (English)

    Yang Han; Xue-ying L(u); Wei-li Jiang; Yun-mei Yang; Tian-zhi Chen

    2005-01-01

    @@ Vasovagal syncope (VVS), a clinical problem with highmorbidity, seriously affects patients' life style, therefore ap-propriate prophylaxis and treatment of VVS are imperative.Though β-blockers, theophylline, and scopolamine have sh-own curative effects on WS, their use are limited due to sideeffects. We hypothesize that irbesartan, an angiotensin Ⅱ rece-ptor antagonist, can be used to treat VVS with no limitationespecially in small dosage.

  15. Severe anorexia nervosa in males: clinical presentations and medical treatment.

    Science.gov (United States)

    Sabel, Allison L; Rosen, Elissa; Mehler, Philip S

    2014-01-01

    The clinical presentation and medical complications of severe anorexia nervosa among males were examined to further the understanding of this increasingly prevalent condition. Fourteen males were admitted to a medical stabilization unit over the study period. Males with severe anorexia nervosa were found to have a multitude of significant medical and laboratory abnormalities, which are in need of treatment via judicious, nutritional rehabilitation and weight restoration to prevent additional morbidity and to facilitate transfer and admission to traditional eating disorder programs.

  16. Clinical outcomes assessment in clinical trials to assess treatment of femoroacetabular impingement

    DEFF Research Database (Denmark)

    Harris-Hayes, Marcie; McDonough, Christine M; Leunig, Michael

    2013-01-01

    Patient-reported outcome measures are an important component of outcomes assessment in clinical trials to assess the treatment of femoroacetabular impingement (FAI). This review of disease-specific measures and instruments used to assess the generic quality of life and physical activity levels...

  17. Improving clinical trial design for hepatocellular carcinoma treatments

    Directory of Open Access Journals (Sweden)

    Garrett Hisatake

    2011-12-01

    Full Text Available Despite its place as the third leading cause of cancer deaths worldwide, there are currently no approved chemotherapeutic agents, devices or techniques to treat hepatocellular carcinoma. Importantly, there have been no phase III studies demonstrating survival benefit, nor any randomized studies of treatment except for transarterial chemoembolization and most recently sorafenib. The importance of well-designed clinical trials of agents to treat HCC has never been greater. However, general clinical study design issues, combined with HCC-specific issues pose significant challenges in structuring such studies. HCC-related challenges include the heterogeneity of this cancer and the fact that it is frequently accompanied by significant comorbidities at diagnosis, such as active hepatitis B or C virus replication, substantial past or on-going alcohol use, and cirrhosis, itself often a fatal disease. The recently published comparison of a newer treatment, nolatrexed to doxorubicin, and comments about this study’s initial HCC diagnostic criteria, staging system, comparator therapy and choice of endpoints have provided a platform to discuss the challenges unique to the design of HCC clinical trials. The difficulty in accurately framing study results obtained from the constantly changing HCC clinical landscape and approaches to meet these challenges will be reviewed.

  18. Clinical features and treatment of endophthalmitis after cataract surgery.

    Science.gov (United States)

    Zhu, J; Li, Z H

    2015-06-18

    The aim of this study was to investigate the clinical features and treatment results of endophthalmitis after cataract surgery. Five patients with endophthalmitis after phacoemulsification with intraocular lens implantation were enrolled in this study. The pathogenesis, clinical manifestation, and surgical outcomes of 5 patients were compared. Three patients were surgically treated with anterior chamber irrigation and vitrectomy with intravitreal injection. The remaining two patients were medically treated with an intravitreal injection of vancomycin and ceftazidime. Treatment results of the five patients were analyzed. Four patients had positive cultures for bacteria (two cases Staphylococcus epidermidis, one case Enterococcus faecalis, and one case head-like Staphylococcus). The culture of the fifth patient did not have bacterial growth. One year following treatment, four patients had restored visual acuity and a clear vitreous cavity. Retinal detachment and other complications were not observed. The remaining patient had a visual acuity of index at 30 cm one year following treatment. For patients with endophthalmitis after cataract surgery, a biochemical laboratory examination should be promptly performed and should include a bacterial culture and drug sensitivity test. When necessary, vitrectomy combined with an intravitreal injection of vancomycin should be performed to treat the infection early and to help retain useful vision.

  19. Uncaria tomentosa-Adjuvant Treatment for Breast Cancer: Clinical Trial.

    Science.gov (United States)

    Santos Araújo, Maria do Carmo; Farias, Iria Luiza; Gutierres, Jessie; Dalmora, Sergio L; Flores, Nélia; Farias, Julia; de Cruz, Ivana; Chiesa, Juarez; Morsch, Vera Maria; Chitolina Schetinger, Maria Rosa

    2012-01-01

    Breast cancer is the most frequent neoplasm affecting women worldwide. Some of the recommended treatments involve chemotherapy whose toxic effects include leukopenia and neutropenia. This study assessed the effectiveness of Uncaria tomentosa (Ut) in reducing the adverse effects of chemotherapy through a randomized clinical trial. Patients with Invasive Ductal Carcinoma-Stage II, who underwent a treatment regimen known as FAC (Fluorouracil, Doxorubicin, Cyclophosphamide), were divided into two groups: the UtCa received chemotherapy plus 300 mg dry Ut extract per day and the Ca group that only received chemotherapy and served as the control experiment. Blood samples were collected before each one of the six chemotherapy cycles and blood counts, immunological parameters, antioxidant enzymes, and oxidative stress were analyzed. Uncaria tomentosa reduced the neutropenia caused by chemotherapy and was also able to restore cellular DNA damage. We concluded that Ut is an effective adjuvant treatment for breast cancer.

  20. Uncaria tomentosa—Adjuvant Treatment for Breast Cancer: Clinical Trial

    Science.gov (United States)

    Santos Araújo, Maria do Carmo; Farias, Iria Luiza; Gutierres, Jessie; Dalmora, Sergio L.; Flores, Nélia; Farias, Julia; de Cruz, Ivana; Chiesa, Juarez; Morsch, Vera Maria; Chitolina Schetinger, Maria Rosa

    2012-01-01

    Breast cancer is the most frequent neoplasm affecting women worldwide. Some of the recommended treatments involve chemotherapy whose toxic effects include leukopenia and neutropenia. This study assessed the effectiveness of Uncaria tomentosa (Ut) in reducing the adverse effects of chemotherapy through a randomized clinical trial. Patients with Invasive Ductal Carcinoma—Stage II, who underwent a treatment regimen known as FAC (Fluorouracil, Doxorubicin, Cyclophosphamide), were divided into two groups: the UtCa received chemotherapy plus 300 mg dry Ut extract per day and the Ca group that only received chemotherapy and served as the control experiment. Blood samples were collected before each one of the six chemotherapy cycles and blood counts, immunological parameters, antioxidant enzymes, and oxidative stress were analyzed. Uncaria tomentosa reduced the neutropenia caused by chemotherapy and was also able to restore cellular DNA damage. We concluded that Ut is an effective adjuvant treatment for breast cancer. PMID:22811748

  1. Uncaria tomentosa—Adjuvant Treatment for Breast Cancer: Clinical Trial

    Directory of Open Access Journals (Sweden)

    Maria do Carmo Santos Araújo

    2012-01-01

    Full Text Available Breast cancer is the most frequent neoplasm affecting women worldwide. Some of the recommended treatments involve chemotherapy whose toxic effects include leukopenia and neutropenia. This study assessed the effectiveness of Uncaria tomentosa (Ut in reducing the adverse effects of chemotherapy through a randomized clinical trial. Patients with Invasive Ductal Carcinoma—Stage II, who underwent a treatment regimen known as FAC (Fluorouracil, Doxorubicin, Cyclophosphamide, were divided into two groups: the UtCa received chemotherapy plus 300 mg dry Ut extract per day and the Ca group that only received chemotherapy and served as the control experiment. Blood samples were collected before each one of the six chemotherapy cycles and blood counts, immunological parameters, antioxidant enzymes, and oxidative stress were analyzed. Uncaria tomentosa reduced the neutropenia caused by chemotherapy and was also able to restore cellular DNA damage. We concluded that Ut is an effective adjuvant treatment for breast cancer.

  2. Radiofrequency Ablation Treatment for Renal Cell Carcinoma: Early Clinical Experience

    Energy Technology Data Exchange (ETDEWEB)

    Park, Seong Hoon; Yoon, Seong Kuk; Cho, Jin Han; Oh, Jong Young; Nam, Kyung Jin; Kwon, Hee Jin; Kim, Su Yeon; Kang, Myong Jin; Choi, Sun Seob; Sung, Gyung Tak [Dong-A University College of Medicine, Busan (Korea, Republic of)

    2008-08-15

    To evaluate the early clinical experience associated with radiofrequency (RF) ablation in patients with renal cell carcinoma (RCC). The RF ablation treatment was performed on 17 tumors from 16 patients (mean age, 60.5 years; range, 43 73 years) with RCC. The treatment indications were localized, solid renal mass, comorbidities, high operation risk, and refusal to perform surgery. All tumors were treated by a percutaneous CT (n = 10), followed by an US-guided (n = 2), laparoscopy-assisted US (n = 2), and an open (n = 2) RF ablation. Furthermore, patients underwent a follow- up CT at one day, one week, one month, three and six months, and then every six months from the onset of treatment. We evaluated the technical success, technical effectiveness, ablation zone, benign periablation enhancement, irregular peripheral enhancement, and complications. All 17 exophytic tumors (mean size, 2.2 cm; range, 1.1 5.0 cm) were completely ablated. Technical success and effectiveness was achieved in all cases and the mean follow-up period was 23.8 months (range, 17 33 months). A local recurrence was not detected in any of the cases; however, five patients developed complications as a result of treatment, including hematuria (n = 2), mild thermal injury of the psoas muscle (n = 1), mild hydronephrosis (n = 1), and fistula formation (n = 1). The RF ablation is an alternative treatment for exophytic RCCs and represents a promising treatment for some patients with small RCCs.

  3. Magnesium treatment in alcoholics: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Poikolainen Kari

    2008-01-01

    Full Text Available Abstract Background Magnesium (Mg deficiency is common among alcoholics. Earlier research suggests that Mg treatment may help to normalize elevated enzyme activities and some other clinically relevant parameters among alcoholics but the evidence is weak. Methods The effect of Mg was studied in a randomized, parallel group, double-blind trial. The patients were first treated for alcohol withdrawal symptoms and then received for 8 weeks either 500 mg of Mg divided into two tablets or matching placebo. Measurements were made at the beginning and in the end of the Mg treatment period. The primary outcome was serum gamma-glutamyltransferase (S-GGT activity; secondary outcomes included aspartate-aminotransferase (S-AST and alanine-aminotransferase (S-ALT activity. Results The number of randomized patients (completers was 64 (27 in the treatment and 54 (31 in the control group. In intention-to-treat-analyses and in most analyses of study completers, there were no significant differences between the Mg-treated and placebo groups in the outcome variables. When baseline serum Mg level, coffee intake, and the number of unused Mg tablets were controlled for in a multivariate regression model, after-treatment serum Mg levels were found to be higher among the Mg-treated group than in the placebo group (t-test 3.334, df = 53, p = 0.002. After controlling for age, body weight, baseline alcohol intake, subsequent change in alcohol intake and baseline S-AST, the after-treatment S-AST levels were found to be lower among the Mg-treated group than in the placebo group (t-test 2.061, df = 49, p = 0.045. Conclusion Mg treatment may speed up the S-AST decrease in compliant patients. This might decrease the risk of death from alcoholic liver disease. Trial Registration ClinicalTrials.gov ID NCT00325299

  4. Upper cervical injuries: Clinical results using a new treatment algorithm

    Directory of Open Access Journals (Sweden)

    Andrei F Joaquim

    2015-01-01

    Full Text Available Introduction: Upper cervical injuries (UCI have a wide range of radiological and clinical presentation due to the unique complex bony, ligamentous and vascular anatomy. We recently proposed a rational approach in an attempt to unify prior classification system and guide treatment. In this paper, we evaluate the clinical results of our algorithm for UCI treatment. Materials and Methods: A prospective cohort series of patients with UCI was performed. The primary outcome was the AIS. Surgical treatment was proposed based on our protocol: Ligamentous injuries (abnormal misalignment, facet perched or locked, increase atlanto-dens interval were treated surgically. Bone fractures without ligamentous injuries were treated with a rigid cervical orthosis, with exception of fractures in the dens base with risk factors for non-union. Results: Twenty-three patients treated initially conservatively had some follow-up (mean of 171 days, range from 60 to 436 days. All of them were neurologically intact. None of the patients developed a new neurological deficit. Fifteen patients were initially surgically treated (mean of 140 days of follow-up, ranging from 60 to 270 days. In the surgical group, preoperatively, 11 (73.3% patients were AIS E, 2 (13.3% AIS C and 2 (13.3% AIS D. At the final follow-up, the American Spine Injury Association (ASIA score was: 13 (86.6% AIS E and 2 (13.3% AIS D. None of the patients had neurological worsening during the follow-up. Conclusions: This prospective cohort suggested that our UCI treatment algorithm can be safely used. Further prospective studies with longer follow-up are necessary to further establish its clinical validity and safety.

  5. Eosinophilic Esophagitis: Clinical Features, Endoscopic Findings and Response to Treatment

    Directory of Open Access Journals (Sweden)

    Robert Enns

    2010-01-01

    Full Text Available Eosinophilic esophagitis (EE is a motility disorder of the esophagus that typically presents with dysphagia. The objective of the present study was to explore patient characteristics, clinical and endoscopic features, and response to treatment of patients with EE. Patients were selected retrospectively based on a review of biopsy results from previous endoscopies performed between 2004 and 2008. A total of 54 patients (41 men and 13 women with biopsy-proven EE were included in the study. Further information regarding the patients’ clinical and endoscopic features, and response to treatment were obtained through chart reviews and patient telephone interviews. The mean age of the patients at symptom onset was 30 years. All patients complained of dysphagia, 81% had a history of bolus obstruction, 43% had a history of asthma and 70% had a history of environmental allergies. Thirty-three per cent had a family history of asthma, while 52% had a family history of food or seasonal allergies. The most common endoscopic findings were rings and/or corrugations, which were found in 63% of patients. Swallowed fluticasone therapy resulted in symptom resolution in 74% of patients; however, 79% of these patients relapsed after discontinuing fluticasone therapy and required repeat treatments. Esophageal dilation was complication free and resulted in improvement in 80% of patients. However, 83% of those reporting improvement relapsed within one year. The clinical and endoscopic findings were similar to those found in the literature, with most patients requiring ongoing, repeated therapies. Further studies are needed to assess the safety and efficacy of treatment modalities ideally suited to patients with EE.

  6. Clinical classification and treatment of leukokeratosis of the vocal cords

    Institute of Scientific and Technical Information of China (English)

    MA Li-jing; WANG Jun; XIAO Yang; YE Jing-ying; XU Wen; YANG Qing-wen

    2013-01-01

    Background Leukokeretosis of the vocal cords is a clinical descriptive diagnosis,which includes a group of squamous intraepithelial lesions of the vocal cord mucosa.We investigated the clinical classification and treatment efficacy of leukokeratosis of the vocal cords.Methods We conducted a retrospective analysis of the medical history,laryngoscopic examinations,morphological features under a surgical microscope,and pathology results of 360 cases of leukokeratosis of the vocal cords to examine correlations among treatment modalities,therapeutic effects,and clinical features.Results All cases were divided into four types based on symptoms,examination results,and treatment efficacies as follows:21 patients had type Ⅰ inflammatory leukoplakia and their vocal cord morphology and voice quality recovered after conservative therapies; 76 patients had type Ⅱ frictional polyps and received CO2 laser submucosal cordectomy;68 patients had type Ⅲ sulcus vocalis and received mucosal slicing with dredging; and 195 cases had type Ⅳ simple leukokeratosis and received partial subligamental cordectomy with CO2 lasers or transmuscular cordectomy.Our treatment achieved a surgical cure rate of 90.9% (308/339),with a recurrence rate of 9.1% (31/339) and malignant transformation rate of 6.5% (22/339).All cancerous transformations occurred in type Ⅳ patients.Conclusion Choosing conservative or CO2 laser surgery based on the morphological characteristics of squamous epithelial lesions of keratinized vocal cord mucosa can maximally protect voice quality,reduce complications,and improve the cure rate.

  7. Treatment programs in the National Drug Abuse Treatment Clinical Trials Network.

    Science.gov (United States)

    McCarty, Dennis; Fuller, Bret; Kaskutas, Lee Ann; Wendt, William W; Nunes, Edward V; Miller, Michael; Forman, Robert; Magruder, Kathryn M; Arfken, Cynthia; Copersino, Marc; Floyd, Anthony; Sindelar, Jody; Edmundson, Eldon

    2008-01-01

    Drug abuse treatment programs and university-based research centers collaborate to test emerging therapies for alcohol and drug disorders in the National Drug Abuse Treatment Clinical Trials Network (CTN). Programs participating in the CTN completed Organizational Surveys (n=106 of 112; 95% response rate) and Treatment Unit Surveys (n=348 of 384; 91% response rate) to describe the levels of care, ancillary services, patient demographics, patient drug use and co-occurring conditions. Analyses describe the corporations participating in the CTN and provide an exploratory assessment of variation in treatment philosophies. A diversity of treatment centers participate in the CTN; not for profit organizations with a primary mission of treating alcohol and drug disorders dominate. Compared to National Survey of Substance Abuse Treatment Services (N-SSATS), programs located in medical settings are over-represented and centers that are mental health clinics are under-represented. Outpatient, methadone, long-term residential and inpatient treatment units differed on patients served and services provided. Larger programs with higher counselor caseloads in residential settings reported more social model characteristics. Programs with higher social model scores were more likely to offer self-help meetings, vocational services and specialized services for women. Conversely, programs with accreditation had less social model influence. The CTN is an ambitious effort to engage community-based treatment organizations into research and more fully integrate research and practice.

  8. Treatment Programs in the National Drug Abuse Treatment Clinical Trials Network

    Science.gov (United States)

    McCarty, Dennis; Fuller, Bret; Kaskutas, Lee Ann; Wendt, William W.; Nunes, Edward V.; Miller, Michael; Forman, Robert; Magruder, Kathryn M.; Arfken, Cynthia; Copersino, Marc; Floyd, Anthony; Sindelar, Jody; Edmundson, Eldon

    2008-01-01

    Drug abuse treatment programs and university-based research centers collaborate to test emerging therapies for alcohol and drug disorders in the National Drug Abuse Treatment Clinical Trials Network (CTN). Programs participating in the CTN completed organizational (n = 106 of 112; 95% response rate) and treatment unit surveys (n = 348 of 384; 91% response rate) to describe the levels of care, ancillary services, patient demographics, patient drug use and co-occurring conditions. Analyses describe the corporations participating in the CTN and provide an exploratory assessment of variation in treatment philosophies. A diversity of treatment centers participate in the CTN; not for profit organizations with a primary mission of treating alcohol and drug disorders dominate. Compared to N-SSATS (National Survey of Substance Abuse Treatment Services), programs located in medical settings are over-represented and centers that are mental health clinics are under-represented. Outpatient, methadone, long-term residential and inpatient treatment units differed on patients served and services proved. Larger programs with higher counselor caseloads in residential settings reported more social model characteristics. Programs with higher social model scores were more likely to offer self-help meetings, vocational services and specialized services for women. Conversely, programs with accreditation had less social model influence. The CTN is an ambitious effort to engage community-based treatment organizations into research and more fully integrate research and practice. PMID:17875368

  9. [Melasma : An update on the clinical picture, treatment, and prevention].

    Science.gov (United States)

    Becker, S; Schiekofer, C; Vogt, T; Reichrath, J

    2017-02-01

    Melasma, also known as chloasma or mask of pregnancy, presents clinically as hyperpigmented skin areas, which develop mostly in the face as a consequence of increased synthesis of melanin. The established treatment options, including topically applied agents and the use of various laser systems, mostly result in improvement but not in complete remission of the lesions. Because of its significant impact on quality of life and the limited effectivity of available treatment options, the management of melasma is challenging for the treating physician. Although many risk factors, including pregnancy and UV exposure, have been identified, the pathogenesis is not yet fully understood. Avoiding solar or artificial UV exposure is of high importance both for the prevention of melasma and for the clinical outcome of existing lesions. In order to avoid vitamin D deficiency, oral vitamin D supplementation should be recommended. In this review, we give an update on clinical aspects, epidemiology, pathogenesis and therapy of melasma and give an outlook on future developments.

  10. Clinical evaluation of desensitizing treatments for cervical dentin hypersensitivity

    Directory of Open Access Journals (Sweden)

    Ana Cecilia Corrêa Aranha

    2009-09-01

    Full Text Available The aim of this study was to compare different treatments for dentin hypersensitivity in a 6-month follow-up. One hundred and one teeth exhibiting non carious cervical lesions were selected. The assessment method used to quantify sensitivity was the cold air syringe, recorded by the visual analogue scale (VAS, prior to treatment (baseline, immediately after topical treatment, after 1 week, 1, 3 and 6 months. Teeth were randomly assigned to five groups (n = 20: G1: Gluma Desensitizer (GD; G2: Seal&Protect (SP; G3: Oxa-gel (OG; G4: Fluoride (F; G5: Low intensity laser-LILT (660 nm/3.8 J/cm²/15 mW. Analysis was based on the non-parametric Kruskal-Wallis test that demonstrated statistical differences immediately after the treatment (p = 0.0165. To observe the individual effects of each treatment, data was submitted to Friedman test. It was observed that GD and SP showed immediate effect after application. Reduction in the pain level throughout the six-month follow-up was also observed. In contrast, LILT presented a gradual reduction of hypersensitivity. OG and F showed effects as of the first and third month respectively. It can be concluded that, after the 6-month clinical evaluation, all therapies showed lower VAS sensitivity values compared with baseline, independently of their different modes of action.

  11. Risk of solid cancer, cardiovascular disease, anaphylaxis, osteoporosis and fractures in patients with systemic mastocytosis

    DEFF Research Database (Denmark)

    Broesby-Olsen, Sigurd; Farkas, Dóra Körmendiné; Vestergaard, Hanne

    2016-01-01

    In patients with systemic mastocytosis (SM), several aspects of morbidity remain poorly understood. We assessed the risk of solid cancers, cardiovascular disease, anaphylaxis, osteoporosis, and fractures in SM patients. Using Danish medical registries, we conducted a nationwide population......-based cohort study including 687 adult (≥15 years) SM patients diagnosed during 1997-2012. A comparison cohort of 68,700 subjects from the general Danish population who were alive and without SM at the given SM subject's diagnosis were age- and gender-matched. Outcomes were a new diagnosis of solid cancer......, venous thromboembolism (VTE), myocardial infarction (MI), stroke, anaphylaxis, osteoporosis, or fracture. For solid cancers the hazard ratio (HR) was 2.4 (95% confidence interval [CI] 1.9-2.8) with a 10-year absolute risk (AR) in the SM-cohort of 12.6% (95% CI 9.4-16.3). Specifically, we found a HR of 7...

  12. AB129. Osteogenesis imperfecta: clinical features and bisphosphonate treatment outcome

    Science.gov (United States)

    Can, Ngoc Thi Bich; Vu, Dung Chi; Bui, Thao Phuong; Nguyen, Khanh Ngoc

    2015-01-01

    Background and objective Osteogenesis imperfecta (OI) comprises a group of disorders principally affecting type I collagen which result in increased bone fragility. Children with severe OI suffer recurrent fractures, resulting in severe deformity and growth stunting in many cases, with loss of independent ambulation by the teenage years in over 50% of cases. Recently, cyclical intravenous treatment with pamidronate has proven of benefit to children with severe forms of OI. This article aims to describle clinical features and laboratory manifestations of patient with OI and evaluate outcome of bisphosphonate management. Methods Clinical features, biochemical finding, and management outcome of 104 cases were study. The patients were classified into four major subtypes of Sillience et al. 1979. Patients with severe types were treatment with pamidronate (Aredia) used Rauch protocol 2003. Results Now we have 196 patients (87 females and 109 males) but we studied focus on 104 patients from 98 families (60 males, 44 females) onset at 2.1±3.0 years (median 0.35) with the average fracture bone of 5.9±4.4 times. In there, 17% type I, 8% type II, 63% type III, and 12% type IV. Clinical features include of intrauterine fracture visible on ultrasound 35%, bone deformation after birth 68%, triangle face 76%, long bone deformation 91%, chest deformation 46%, scoliosis 27%, short status 90%, blue sclera 83%, dentinogenesis imperfecta 20%, hearing loss 6%. Thirty patients have been treated with pamidronate at 3.2±3.7 years (4 months to 8 years) during 13±0.8 months (6-30 months). Fourteen patients had fracture bone after 6 months of treatment but no patients had fracture bone after 12 months. Seven patients had been treatment after 1.6±0.5 years, BMD increase from 0.39±0.311 to 0.79±0.105 g/cm2 (P<0.05). One patient had fever reaction after first pamidronate infusion but controlled with standard antipyretic therapy, and do not recur in later treatments. Conclusions OI has

  13. A clinical review of the treatment of catatonia

    Directory of Open Access Journals (Sweden)

    Pascal eSienaert

    2014-12-01

    Full Text Available Catatonia is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. A screening instrument, such as the Bush-Francis Catatonia Rating Scale, can guide the clinician through the neuropsychiatric examination. Although severe and life-threatening, catatonia has a good prognosis. Research on the treatment of catatonia is scarce, but there is overwhelming clinical evidence of the efficacy of benzodiazepines, such as lorazepam, and electroconvulsive therapy.

  14. A clinical review of the treatment of catatonia.

    Science.gov (United States)

    Sienaert, Pascal; Dhossche, Dirk M; Vancampfort, Davy; De Hert, Marc; Gazdag, Gábor

    2014-01-01

    Catatonia is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. A screening instrument, such as the Bush-Francis Catatonia Rating Scale, can guide the clinician through the neuropsychiatric examination. Although severe and life-threatening, catatonia has a good prognosis. Research on the treatment of catatonia is scarce, but there is overwhelming clinical evidence of the efficacy of benzodiazepines, such as lorazepam, and electroconvulsive therapy.

  15. CADASIL: pathogenesis, clinical and radiological findings and treatment

    Energy Technology Data Exchange (ETDEWEB)

    Andre, Charles [Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ (Brazil). School of Medicine

    2010-04-15

    Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common genetic cause of ischemic strokes and a most important model for the study of subcortical vascular dementia. This unrelentlessly progressive disease affects many hundreds of families all over the world but is not well studied in Brazil. This manuscript reviews pathogenetic, clinical, radiological and therapeutic features of CADASIL. The causal mutations are now very well known, but the same can not be said about its intimate pathogenetic mechanisms. The variable clinical presentation should lead physicians to actively pursue the diagnosis in many settings and to more thoroughly investigate family history in first degree relatives. A rational approach to genetic testing is however needed. Treatment of CADASIL is still largely empiric. High-quality therapeutic studies involving medications and cognitive interventions are strongly needed in CADASIL. (author)

  16. Food Allergy and Anaphylaxis in Infants and Preschool-Age Children

    OpenAIRE

    Gaspar-Marques, J; Carreiro-Martins, P.; Papoila, AL; Caires, I; Pedro, C; Araújo-Martins, J; Virella, D; Rosado-Pinto, J.; Leiria-Pinto, P; Neuparth, N.

    2014-01-01

    Food allergy (FA) prevalence data in infants and preschool-age children are sparse, and proposed risk factors lack confirmation. In this study, 19 children’s day care centers (DCC) from 2 main Portuguese cities were selected after stratification and cluster analysis. An ISAAC’s (International Study of Asthma and Allergies in Childhood) derived health questionnaire was applied to a sample of children attending DCCs. Outcomes were FA parental report and anaphylaxis. Logistic regression wa...

  17. Anaphylaxis and food allergy: the result of an intervention in the community

    Directory of Open Access Journals (Sweden)

    Helena Ferreira

    2015-09-01

    caring for children with anaphylaxis could not properly recognize or treat an anaphylactic reaction. The educational workshop was apparently effective in the awareness of this condition. In spite of the study limitations (the size of the sample, our results point out the effectiveness of this kind of intervention to disseminate knowledge on a potentially fatal condition, as well as the need of a regular educational program in the community.

  18. A Model of Intestinal Anaphylaxis in Whey Sensitized Balb/c Mice

    OpenAIRE

    Kheroua Omar; Kaddouri Hanane; Negaoui Hanane; Saidi Djamel

    2009-01-01

    Problem statement: Cow’s Milk Allergy (CMA) is a common disease in childhood. Pathophysiological mechanisms involved in gastrointestinal symptoms are relatively poorly understood. Approach: Therefore, an experimental model of intestinal anaphylaxis was needed to approach the problem. The aim of this study was to examine the effect of the parenteral sensitization to whey proteins through immune response and local intestine inflammation using a murine m...

  19. Weightbath hydrotraction treatment: application, biomechanics, and clinical effects

    Directory of Open Access Journals (Sweden)

    Márta Kurutz

    2010-04-01

    Full Text Available Márta Kurutz1, Tamás Bender21Department of Structural Mechanics, Budapest University of Technology and Economics, Hungary; 2Department of Physical Medicine, Polyclinic and Hospital of the Hospitaller Brothers of St. John of God, Budapest, Medical University of Szeged, HungaryBackground and purpose: Weightbath hydrotraction treatment (WHT is a simple noninvasive effective method of hydro- or balneotherapy to stretch the spine or lower limbs, applied successfully in hospitals and health resort sanitaria in Hungary for more than fifty years. This study aims to introduce WHT with its biomechanical and clinical effects. History, development, equipment, modes of application, biomechanics, spinal traction forces and elongations, indications and contraindications of WHT are precented.Subjects and methods: The calculation of traction forces acting along the spinal column during the treatment is described together with the mode of suspension and the position of extra weight loads applied. The biomechanics of the treatment are completed by in vivo measured elongations of lumbar segments using a special underwater ultrasound measuring method. The clinical effects, indications, and contraindications of the treatment are also presented.Results: In the underwater cervical suspension of a human body, approximately 25 N stretching load occurs in the cervical spine, and about 11 N occurs in the lumbar spine. By applying extra weights, the above tensile forces along the spinal column can be increased. Thus, the traction effect can be controlled by applying such loads during the treatment. Elongations of segments L3–L4, L4–L5, and L5–S1 were measured during the usual WHT of patients suspended cervically in water for 20 minutes, loaded by 20–20 N lead weights on the ankles. The mean initial elastic elongations of spinal segments were about 0.8 mm for patients aged under 40 years, 0.5 mm between 40–60 years, and 0.2 mm for patients over 60 years. The mean

  20. Surgical treatment for progressive prostate cancer: A clinical case

    Directory of Open Access Journals (Sweden)

    E. I. Veliev

    2014-01-01

    Full Text Available In spite of its existing standards, the treatment of patients with progressive prostate cancer (PC remains a matter of debate. Ensuring that the patients have good quality of life is also relevant. The paper describes a clinical case of a patient with progressive PC after hormone therapy, brachytherapy, salvage prostatectomy, enucleation of the testicular parenchyma, and salvage lymphadenectomy. A phallic prosthesis and an artificial urinary sphincter have been implanted to improve quality of life. The results of preoperative examination and the technological features of surgical interventions are given.

  1. Clinical Study on Treatment of Chronic Renal Failure with Shenshuailing

    Institute of Scientific and Technical Information of China (English)

    鞠建伟; 郭亚玲; 梁延平; 孙世宁; 杨建华; 杨素云

    2001-01-01

    The therapeutic effects of Shenshuailing Kou Fu Ye (SKFY肾衰灵口服液, the Oral Liquid for Renal Failure) and Shenshuailing Guan Chang Ye (SGCY肾衰灵灌肠液, the Enema for Renal Failure) were evaluated in treatment of chronic renal failure, with coateg aldehyde oxystarch as the controls. The changes in the clinical symptoms, serum creatinine, blood urea nitrogen and creatinine clearance rate were observed. The total effective rate in the former was 90.46%, and the latter 60.43%.

  2. The Clinical Application of Hydrogen as a Medical Treatment.

    Science.gov (United States)

    Iida, Atsuyoshi; Nosaka, Nobuyuki; Yumoto, Tetsuya; Knaup, Emily; Naito, Hiromichi; Nishiyama, Chihiro; Yamakawa, Yasuaki; Tsukahara, Kohei; Terado, Michihisa; Sato, Keiji; Ugawa, Toyomu; Nakao, Atsunori

    2016-10-01

    In recent years, it has become evident that molecular hydrogen is a particularyl effective treatment for various disease models such as ischemia-reperfusion injury; as a result, research on hydrogen has progressed rapidly. Hydrogen has been shown to be effective not only through intake as a gas, but also as a liquid medication taken orally, intravenously, or locally. Hydrogen's effectiveness is thus multifaceted. Herein we review the recent research on hydrogen-rich water, and we examine the possibilities for its clinical application. Now that hydrogen is in the limelight as a gaseous signaling molecule due to its potential ability to inhibit oxidative stress signaling, new research developments are highly anticipated.

  3. Vulvar and Vaginal Atrophy: Physiology, Clinical Presentation, and Treatment Considerations.

    Science.gov (United States)

    Lev-Sagie, Ahinoam

    2015-09-01

    Vulvovaginal atrophy is a common condition associated with decreased estrogenization of the vaginal tissue. Symptoms include vaginal dryness, irritation, itching, soreness, burning, dyspareunia, discharge, urinary frequency, and urgency. It can occur at any time in a woman's life cycle, although more commonly in the postmenopausal phase, during which the prevalence is approximately 50%. Despite the high prevalence and the substantial effect on quality of life, vulvovaginal atrophy often remains underreported and undertreated. This article aims to review the physiology, clinical presentation, assessment, and current recommendations for treatment, including aspects of effectiveness and safety of local vaginal estrogen therapies.

  4. Anaphylaxis to Polyethylene Glycol (Colyte®) in a Patient with Diverticulitis.

    Science.gov (United States)

    Lee, So Hee; Hwang, Sun Hyuk; Park, Jin Soo; Park, Hae Sim; Shin, Yoo Seob

    2016-10-01

    Polyethylene glycols (PEGs) are believed to be chemically inert agents, but larger PEG polymers could have immunogenicity. A 39-year-old man was referred to emergency room for loss of consciousness and dyspnea after taking of PEG-3350 (Colyte®). In laboratory findings, the initial serum tryptase level was increased to 91.9 mg/L (normal range: 0.00-11.40 mg/L) without any other laboratory abnormalities. The intradermal test with 10 mg/mL Colyte® showed a 5 × 5 mm wheal, but basophil activation and histamine releasability tests were negative. PEG-3350 is widely used as an osmotic laxative due to its lack of absorption from the gastrointestinal tract. However, the loss of mucosal integrity at gastrointestinal membrane such as diverticulitis may be a predisposing factor for anaphylaxis to Colyte®. We report a case of anaphylaxis induced by the ingestion of PEG-3350 in a patient with diverticulitis which might be a risk factor of anaphylaxis.

  5. Immunoglobulin E anaphylaxis in rabbits: mechanisms of pulmonary resistance and compliance changes.

    Science.gov (United States)

    Habib, M P; Dunn, A M; Sobonya, R E; Baumgartener, C C; Newell, J D; Halonen, M

    1988-03-01

    Factors causing changes in pulmonary resistance and dynamic compliance with immunoglobulin (Ig) E anaphylaxis in spontaneously breathing rabbits were assessed in ventilated rabbits using tantalum bronchography and wet-to-dry wt ratios. Ventilated rabbits demonstrated changes in resistance and compliance similar to spontaneously breathing rabbits. Chlorpheniramine pretreatment prevented increases in resistance but not decreases in compliance. Anaphylaxis constricted small (less than 1 mm) airways 20.9 +/- 16.0% (mean +/- SD) and intermediate (between 1 and 3 mm) airways 21.8 +/- 19.8%. Chlorpheniramine (10 mg/kg) prevented small airway changes and attenuated those in intermediate airways. Chlorpheniramine prevented histamine-induced constriction of small (23.6 +/- 15.7%) and intermediate (17.6 +/- 15.0%) airways. Lung wet-to-dry wt ratios were unchanged. Changes in resistance and compliance during rabbit IgE anaphylaxis are not due to changes in tidal volume or frequency. Histamine, via H1 receptors, is the principal mediator of pulmonary resistance increases but not dynamic compliance reductions. Chlorpheniramine-sensitive increases in resistance are caused by constrictions of intermediate and small airways, whereas the chlorpheniramine-resistant decrease in compliance is not caused directly by constriction of the smallest measurable airways (0.25 mm) or changes in lung water.

  6. Clinical Experience in Acupuncture Treatment of Allergic Rhinitis

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yan-qiu

    2009-01-01

    Objective:To observe the clinical effects of acupuncture for allergic rhinitis.Methods:The body acupuncture, auricular seed-embedding and microwave irradiation were adopted for treatment of allergic rhinitis due to various causative factors, such as cold and insufficiency of the lung-qi weakening the body resistance, insufficiency of the spleen-qi with lucid yang failing to rise, insufficiency of the kidney-yang failing to warm the body surface, and the heat accumulated in the lung channels giving invading the nose.Results:After treatment, the symptoms and signs disappeared in all illustrative cases, with no recurrence found after a one-year follow-up.Conclusion:Acupuncture may help to improve the blood rheology indexes with an increased volume of blood flow, and regulate the immunological function of the human body, thus giving therapeutic effects for allergic rhinitis.

  7. Pediatric insomnia: new insights in clinical assessment and treatment options.

    Science.gov (United States)

    Bruni, Oliviero; Angriman, Marco

    2015-01-01

    Sleep disorders in children can compromise quality of life of both children and families and chronic sleep deprivations is associated with poorer developmental outcome, overweight and behavioral disturbances. Clinicians should incorporate questions about sleep into their routine health assessment, and the assessment of insomnia should follow a medical approach primary and secondary contributing factors should be assessed, as well as maladaptive behaviors related to sleep. A careful examination of sleep/wake schedule, abnormal movements or behavior during sleep, and daytime consequences of sleep disruption or deprivation is mandatory. Sleeping environment, and bedtime routines should be examined to identify behavioral issues related to sleep. Polysomnography is not routinely indicated for children with insomnia, but actigraphy can give an objective estimation of sleep parameters. The Authors propose a new classification of pediatric insomnia, based on both genetic and clinical aspects, and suggest specific treatment options, including sleep hygiene, behavioral strategies and pharmacological treatment.

  8. Nineteenth century exercise clinics for the treatment of scoliosis.

    Science.gov (United States)

    Elsaesser, S; Butler, A R

    2014-01-01

    Scoliosis is the abnormal lateral curvature and rotation of the spine. In the past this deformity has been linked with moral depravity, as in the case of Richard III. Treatment for scoliosis began with Hippocrates's use of boards and axial distortion. Today, bracing and surgery are used either to correct the deformity or to prevent further progression. In the past, however, exercise regimens have been used in the belief that strengthening back muscles would reduce curvature progression. This approach was pioneered by Per Henrik Ling in the early nineteenth century and was continued by his followers Mathius Roth and Franz Berwald and, most notably, by Gustav Zander. Even today a few clinics, particularly in Eastern Europe, still use exercise in the treatment of scoliosis. Whether it is effective remains debatable, but even if progression is not prevented the patient's general health will benefit from an exercise regimen.

  9. [Clinical trials of solcoseryl in the treatment of parodontium diseases].

    Science.gov (United States)

    Jedrzejewska, T; Bałczewska, E; Peterson, R; Urbaniak, B; Ostrowska, B

    1990-06-01

    The effect of Solcoseryl on the clinical state of the parodontium was assessed in 26 patients aged from 18 to 57 years with the diagnosis of deep parodontopathies. Each patient received 30 ampoules of 2 ml of Solcoseryl for one course of the treatment. Submucous injections of the drug near the teeth 13, 23, 33 and 43 were done as follows: during the first 10 days one ampoule daily, then 10 injections every other day, and 10 injections at three-day intervals. The condition of the parodontium was assessed before and after the treatment by means of the PI, GI, GBI and teeth mobility indices, and measurements of the depth of gingival pouches--K, and volume of fluid in pouches SFFR according to Brill. The therapeutic method applied in these cases had a good effect on reduction of gingivitis, bleeding and volume of secreted pouch fluid but had only a small effect on teeth mobility and depth of gingival pouches.

  10. Targeted treatment for chronic lymphocytic leukemia: clinical potential of obinutuzumab

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    Smolej L

    2014-12-01

    Full Text Available Lukáš Smolej 4th Department of Internal Medicine – Hematology, University Hospital Hradec Králové and Charles University in Prague, Faculty of Medicine in Hradec Králové, Hradec Králové, Czech Republic Abstract: Introduction of targeted agents revolutionized the treatment of chronic lymphocytic leukemia (CLL in the past decade. Addition of chimeric monoclonal anti-CD20 antibody rituximab to chemotherapy significantly improved efficacy including overall survival (OS in untreated fit patients; humanized anti-CD52 antibody alemtuzumab and fully human anti-CD20 antibody ofatumumab lead to improvement in refractory disease. Novel small molecule inhibitors such as ibrutinib and idelalisib demonstrated excellent activity and were very recently licensed in relapsed/refractory CLL. Obinutuzumab (GA101 is the newest monoclonal antibody approved for the treatment of CLL. This novel, glycoengineered, type II humanized anti-CD20 antibody is characterized by enhanced antibody-dependent cellular cytotoxicity and direct induction of cell death compared to type I antibodies. Combination of obinutuzumab and chlorambucil yielded significantly better OS in comparison to chlorambucil monotherapy in untreated comorbid patients. These results led to approval of obinuzutumab for the treatment of CLL. Numerous clinical trials combining obinutuzumab with other cytotoxic drugs and novel small molecules are currently under way. This review focuses on the role of obinutuzumab in the treatment of CLL. Keywords: chronic lymphocytic leukemia, anti-CD20 antibodies, chlorambucil, rituximab, ofatumumab, obinutuzumab, overall survival

  11. Targeted treatment for chronic lymphocytic leukemia: clinical potential of obinutuzumab.

    Science.gov (United States)

    Smolej, Lukáš

    2015-01-01

    Introduction of targeted agents revolutionized the treatment of chronic lymphocytic leukemia (CLL) in the past decade. Addition of chimeric monoclonal anti-CD20 antibody rituximab to chemotherapy significantly improved efficacy including overall survival (OS) in untreated fit patients; humanized anti-CD52 antibody alemtuzumab and fully human anti-CD20 antibody ofatumumab lead to improvement in refractory disease. Novel small molecule inhibitors such as ibrutinib and idelalisib demonstrated excellent activity and were very recently licensed in relapsed/refractory CLL. Obinutuzumab (GA101) is the newest monoclonal antibody approved for the treatment of CLL. This novel, glycoengineered, type II humanized anti-CD20 antibody is characterized by enhanced antibody-dependent cellular cytotoxicity and direct induction of cell death compared to type I antibodies. Combination of obinutuzumab and chlorambucil yielded significantly better OS in comparison to chlorambucil monotherapy in untreated comorbid patients. These results led to approval of obinuzutumab for the treatment of CLL. Numerous clinical trials combining obinutuzumab with other cytotoxic drugs and novel small molecules are currently under way. This review focuses on the role of obinutuzumab in the treatment of CLL.

  12. Clinical features of pedophilia and implications for treatment.

    Science.gov (United States)

    Cohen, Lisa J; Galynker, Igor I

    2002-09-01

    The authors discuss the diagnostic criteria for pedophilia and review the literature on its clinical features, including data on prevalence, gender, age of onset, number of victims, frequency and type of acts, violence, impulsivity, and insight. Findings concerning the characteristics of victims (e.g., sex, age, relationship to the pedophile) and research on pedophilic subtypes-exclusive versus nonexclusive; incestuous versus nonincestuous; heterosexual, homosexual, or bisexual-are reviewed. Studies have shown that pedophiles may share many psychiatric features beyond deviant sexual desire, including high rates of comorbid axis I disorders (affective disorders, substance use disorders, impulse control disorders, other paraphilias) as well as severe axis II psychopathology (especially antisocial and Cluster C personality disorders). The authors present several possible etiological models for pedophilia and conclude that further research is needed concerning the etiological role of a childhood history of sexual abuse as well as the underlying neurobiology of deviant sexual arousal and decreased erotic differentiation. Finally, findings concerning pharmacological and cognitive-behavioral treatments for pedophilia are briefly reviewed. Recidivism, drop-out, and noncompliance are significant problems in the treatment of pedophilia. The authors review predictors of treatment outcome and conclude that pedophilia is extremely difficult to treat and that effective treatment needs to be intensive, long-term, and comprehensive, possibly with lifetime follow-up.

  13. Nonspecific low back pain: Causes, clinical picture, diagnosis, and treatment

    Directory of Open Access Journals (Sweden)

    A. I. Isaikin

    2015-01-01

    Full Text Available In the current biopsychosocial model of back pain, there are biological (anatomic sources of pain, psychological and social components that promote its occurrence and maintenance. Nonspecific (musculoskeletal, mechanical pain that is diagnosed, with a serious disease and radicular symptoms being ruled out, is encountered most commonly (in 85% of cases in clinical practice. A group of patients with nonspecific back pain is very heterogeneous and needs differential treatment. The most common sources of back pain are abnormally changed discs, facet and sacroiliac joints, and muscles; however, it is often difficult to determine the main source of pain. International guidelines for the management of acute and chronic back pain have been elaborated, which assign an important role to the clarification of the benign pattern of pain to patients; their training; and recommendations for the maintenance of day-to-day activity. Medical treatment involves both nonselective and selective nonsteroidal anti-inflammatory drugs and myorelaxants as the drugs of choice. Non-drug treatments are actively used; these are manual therapy for acute pain, cognitive behavioral therapy, manual therapy, therapeutic exercises, reflex therapy, and yoga exercises for subacute and chronic pain. Whether blockades, ablations, minimally invasive neurosurgery, which are aimed at eliminating the main source of pain, is discussed if the treatment is ineffective.

  14. NS5A Resistance: Clinical Implications and Treatment Possibilities.

    Science.gov (United States)

    Calleja, José Luis; Llerena, Susana; Perelló, Christie; Crespo, Javier

    2016-01-01

    Treatments with interferon-free direct-acting antiviral agents have high efficacy, with sustained virological response rates of more than 90%. Nevertheless, they fail to eliminate the infection in 1-7% of patients. The majority of virological failures are due to relapse following treatment discontinuation, while virological rebound during therapy is rare. Although not the only factor, the presence of resistance-associated variants is one of the major causes for said failure. Resistance-associated variants affect the sequence involved in protein synthesis on which different direct-acting antiviral agents act (NS3/4A, NS5A, NS5B). Of all these variants, the ones with the greatest impact are resistance-associated variants that affect the NS5A region due to their long-term persistence. In this article we will describe the most significant NS5A resistance-associated variants, the clinical relevance of their detection both before and after treatment, their persistence over time, and lastly, we will devote particular attention to discussing what approach to adopt when dealing with treatment failure to an antiviral regimen that includes NS5A inhibitors.

  15. Inpatient Treatment for Adolescents with Anorexia Nervosa: Clinical Significance and Predictors of Treatment Outcome.

    Science.gov (United States)

    Schlegl, Sandra; Diedrich, Alice; Neumayr, Christina; Fumi, Markus; Naab, Silke; Voderholzer, Ulrich

    2016-05-01

    This study evaluated the clinical significance as well as predictors of outcome for adolescents with severe anorexia nervosa (AN) treated in an inpatient setting. Body mass index (BMI), eating disorder (ED) symptoms [Eating Disorder Inventory-2 (EDI-2)], general psychopathology and depression were assessed in 238 patients at admission and discharge. BMI increased from 14.8 + 1.2 to 17.3 + 1.4 kg/m(2). Almost a fourth (23.6%) of the patients showed reliable changes, and 44.7% showed clinically significant changes (EDI-2). BMI change did not significantly differ between those with reliable or clinically significant change or no reliable change in EDI-2. Length of stay, depression and body dissatisfaction were negative predictors of a clinically significant change. Inpatient treatment is effective in about two thirds of adolescents with AN and should be considered when outpatient treatment fails. About one third of patients showed significant weight gain, but did not improve regarding overall ED symptomatology. Future studies should focus on treatment strategies for non-responders.

  16. Clinical features and treatment status of hemifacial spasm in China

    Institute of Scientific and Technical Information of China (English)

    Wang Lin; Hu Xingyue; Dong Hongjuan; Wang Wenzhao; Huang Yue; Jin Lingjing; Luo Yumin

    2014-01-01

    Background Hemifacial spasm (HFS) is a facial nerve disorder characterized by episodic involuntary ipsilateral facial muscle contraction.Information on Chinese patients with HFS has not been well-characterized.This study aimed to evaluate the clinical feature and the treatment status of HFS across China.Methods A cross-sectional study including 1003 primary HFS patients had been carried out in 15 movement disorder clinics in China in 2012.The investigated information was acquired from questionnaires and medical records including demographic data,site of onset,aggravating and relieving factors,treatments prior to the investigation,etc.Results In this study,the ratio of male to female was 1.0:1.8,the mean age at onset was (46.6±11.5) years.About 1.0% patients were bilaterally affected.The most often site of initial onset was the orbicularis oculi muscle.The most often affected sites were orbicularis oculi,zygomatic,and orbicularis oris muscles.Stress/anxiety and relaxation were most often aggravating and relieving factors,respectively; 2.3% patients had family history,28.4% cases were combined with hypertension,and 1.4% patients were with trigeminal neuralgia.Botulinum toxin type A (BTX-A) injection was the most commonly used treatment,followed by acupuncture and oral medication.BTX-A maintained the highest repeat treatment ratio (68.7%),while 98.4% patients gave up acupuncture.The mean latency of BTX-A effect was (5.0±4.7) days,the mean total duration of the effect was (19.5±11.7) weeks,and 95.9% patients developed improvements no worse than moderate in both severity and function.The most common side effect was droopy mouth.Conclusions The onset age of HFS in China is earlier than that in western countries.The most often used two treatments are BTX-A injection and acupuncture,while the latter kept the poor repeat treatment ratio because of dissatisfactory therapeutic effect.

  17. Children with schizophrenia: clinical picture and pharmacological treatment.

    Science.gov (United States)

    Masi, Gabriele; Mucci, Maria; Pari, Cinzia

    2006-01-01

    Awareness of childhood-onset schizophrenia is rapidly increasing, with a more precise definition now available of the clinical picture and early signs, the outcome and the treatment strategies. Premorbid developmental impairments, including language, motor and social deficits, are more frequent and more pronounced in earlier- than in later-onset forms of schizophrenia. This 'pan-dysmaturation' is reported from the first months of life in more than half of the children who will develop childhood-onset schizophrenia, and it suggests a more severe and early disruption of brain development compared with the adolescent- and adult-onset disorder. The insidious onset in at least 75% of children, the high rates of premorbid problems and the hesitancy on the part of clinicians to make a diagnosis of schizophrenia in a child usually delay the recognition of the syndrome. Elementary auditory hallucinations are the most frequent positive symptom, while visual and tactile hallucinations are rarer. Delusions are less complex than in adolescents and are usually related to childhood themes. Negative symptoms are largely predominant, namely flat or inappropriate affect. A marked deterioration from the previous level of functioning is present in all these children, and an impaired outcome is reported in approximately 50-60% of them. The main diagnostic challenges are with differentiating childhood-onset schizophrenia from affective disorders (both depression and bipolar disorder) with psychotic symptoms, pervasive developmental disorders and severe personality disorders. Post-traumatic stress disorder and obsessive-compulsive disorder without insight may also be misdiagnosed as schizophrenia. Furthermore, approximately 10% of children from the community report nonpsychotic hallucinations or delusions. Finally, children with atypical psychotic features that do not strictly fit diagnostic criteria for schizophrenia have been described, and new labels have been proposed to categorise

  18. Clinical and Treatment Features of Orbital Neurogenic Tumors

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    Pınar Bingöl Kızıltunç

    2013-10-01

    Full Text Available Purpose: To evaluate the clinical and treatment features of orbital neurogenic tumors. Material and Method: The records of 35 patients with orbital neurogenic tumors who were diagnosed and treated at Ankara University Faculty of Medicine, Department of Ophthalmology, between 1998 and 2011 were evaluated retrospectively. Results: Orbitotomy via a cutaneous approach was performed in 21 (60% cases and orbitotomy via a transconjunctival approach was performed in 7 (20% cases. Three (8% cases had been operated at different centers. Four (12% cases were diagnosed clinically. Total excisional biopsy was performed in 11 (31.4% cases, subtotal excisional biopsy was performed in 7 (20%, and incisional biopsy was performed in 10 (28.6% cases. 14 (40% 35 cases were diagnosed as meningioma, 12 (34% as peripheral nerve sheath tumor, and 9 (26% cases were diagnosed as optic nerve glioma. Six (43% meningioma cases were optic nerve sheath meningioma, 5 (36% were sphenoid wing meningioma, 2 (14% were ectopic meningioma, and 1 (7% was perisellar meningioma. Six (50% of peripheral nerve sheath tumors were schwannoma, 2 (16% were solitary neurofibroma, 4 (34% were plexiform neurofibroma. External beam radiotherapy was performed in 15 (42.8% cases, cyberknife radiosurgery in 1 (2.8% , chemotherapy in 1 (2.8%, and enucleation ( because of neovascular glaucoma and vitreous hemorrhage was performed in 1 (2.8% case. Discussion: The most common orbital neurogenic tumors are meningioma, peripheral nerve sheath tumor, and optic nerve glioma. For meningioma and glioma, external beam radiotherapy is required; for schwannoma and solitary neurofibroma, total excisional biopsy is the preferred treatment. The success of visual and anatomic results are high after treatment. (Turk J Ophthalmol 2013; 43: 335-9

  19. Symptomatic cranial neuralgias in multiple sclerosis: clinical features and treatment.

    Science.gov (United States)

    De Santi, Lorenzo; Annunziata, Pasquale

    2012-02-01

    In multiple sclerosis, neuropathic pain is a frequent condition, negatively influencing the overall quality of life. Cranial neuralgias, including trigeminal, glossopharyngeal neuralgias, as well as occipital neuralgia, are typical expression of neuropathic pain. Neuralgias are characterised by paroxysmal painful attacks of electric shock-like sensation, occurring spontaneously or evoked by innocuous stimuli in specific trigger areas. In multiple sclerosis, demyelination in the centrally myelinated part of the cranial nerve roots plays an important role in the origin of neuralgic pain. These painful syndromes arising in multiple sclerosis are therefore considered "symptomatic", in contrast to classic cranial neuralgias, in which no cause other than a neurovascular contact is identified. At this time, the evidence on the management of symptomatic cranial neuralgias in multiple sclerosis is fragmentary and a comprehensive review addressing this topic is still lacking. For that reason, treatment is often based on personal clinical experience as well as on anecdotal reports. The aim of this review is to critically summarise the latest findings regarding the pathogenesis, the diagnosis, the instrumental evaluation and the medical as well as neurosurgical treatment of symptomatic trigeminal, glossopharyngeal and occipital neuralgia in multiple sclerosis, providing useful insights for neurologists and neurosurgeons and a broad range of specialists potentially involved in the treatment of these painful syndromes.

  20. SAPHO Syndrome: Current Developments and Approaches to Clinical Treatment.

    Science.gov (United States)

    Firinu, Davide; Garcia-Larsen, Vanessa; Manconi, Paolo Emilio; Del Giacco, Stefano R

    2016-06-01

    SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis) is a rare autoimmune disease which, due to its clinical presentation and symptoms, is often misdiagnosed and unrecognized. Its main features are prominent inflammatory cutaneous and articular manifestations. Treatments with immunosuppressive drugs have been used for the management of SAPHO with variable results. To date, the use of anti-TNF-α agents has proved to be an effective alternative to conventional treatment for unresponsive or refractory SAPHO cases. TNF-α is a pro-inflammatory cytokine and pivotal regulator of other cytokines, including IL-1 β, IL-6, and IL-8, involved in inflammation, acute-phase response induction, and chemotaxis. IL-1 inhibition strategies with anakinra have shown efficacy as first and second lines of treatment. In this review, we will describe the main characteristics of biological drugs currently used for SAPHO syndrome. We also describe some of the promising therapeutic effects of ustekinumab, an antibody against the p40 subunit of IL-12 and IL-23, after failure of multiple drugs including anti-TNF-α and anakinra. We discuss the use and impact of the new anti-IL-1 antagonists involved in the IL-17 blockade, in particular for the most difficult-to-treat SAPHO cases.

  1. Staff attitudes and the associations with treatment organisation, clinical practices and outcomes in opioid maintenance treatment

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    Gossop Michael

    2010-07-01

    Full Text Available Abstract Background In opioid maintenance treatment (OMT there are documented treatment differences both between countries and between OMT programmes. Some of these differences have been associated with staff attitudes. The aim of this study was to 1 assess if there were differences in staff attitudes within a national OMT programme, and 2 investigate the associations of staff attitudes with treatment organisation, clinical practices and outcomes. Methods This study was a cross-sectional multicentre study. Norwegian OMT staff (n = 140 were invited to participate in this study in 2007 using an instrument measuring attitudes towards OMT. The OMT programme comprised 14 regional centres. Data describing treatment organisation, clinical practices and patient outcomes in these centres were extracted from the annual OMT programme assessment 2007. Centres were divided into three groups based upon mean attitudinal scores and labelled; "rehabilitation-oriented", "harm reduction-oriented" and "intermediate" centres. Results All invited staff (n = 140 participated. Staff attitudes differed between the centres. "Rehabilitation-oriented" centres had smaller caseloads, more frequent urine drug screening and increased case management (interdisciplinary meetings. In addition these centres had less drug use and more social rehabilitation among their patients in terms of long-term living arrangements, unemployment, and social security benefits as main income. "Intermediate" centres had the lowest treatment termination rate. Conclusions This study identified marked variations in staff attitudes between the regional centres within a national OMT programme. These variations were associated with measurable differences in caseload, intensity of case management and patient outcomes.

  2. Chinese herbal extracts of Rubia cordifolia and Dianthus superbus suppress IgE production and prevent peanut-induced anaphylaxis

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    Yang Nan

    2011-09-01

    Full Text Available Abstract Background Peanut allergy is characterized by increased levels of peanut-specific IgE in the serum of most patients. Thus, the most logical therapy would be to inhibit the IgE production by committed B-cells. This study aims to investigate the unreported anti-IgE effects of Chinese herbal extracts of Rubia cordifolia (Qiancao and Dianthus superbus (Qumai. Methods Seventy herbal extracts were tested for their ability to reduce IgE secretion by a human B-cell line. Those with the lowest inhibitory concentration 50 (IC50 values were tested in a mouse model of peanut-anaphylaxis. Anaphylactic scores, body temperature, plasma histamine and peanut-specific-immunoglobulins were determined. Results Rubia cordifolia and Dianthus superbus inhibited the in vitro IgE production by a human B-cell line in a dose-dependent manner and the in vivo IgE production in a murine model of peanut allergy without affecting peanut-specific-IgG1 levels. After challenge, all mice in the sham groups developed anaphylactic reactions and increased plasma histamine levels. The extract-treated mice demonstrated significantly reduced peanut-triggered anaphylactic reactions and plasma histamine levels. Conclusion The extracts of Rubia cordifolia and Dianthus superbus inhibited the IgE production in vivo and in vitro as well as reduced anaphylactic reactions in peanut-allergic mice, suggesting potentials for allergy treatments.

  3. Anti-cetuximab IgE ELISA for identification of patients at a high risk of cetuximab-induced anaphylaxis

    Science.gov (United States)

    Mariotte, Delphine; Dupont, Benoît; Gervais, Radj; Galais, Marie-Pierre; Laroche, Dominique; Tranchant, Aurore; Comby, Elisabeth; Bouhier-Leporrier, Karine; Reimund, Jean-Marie

    2011-01-01

    Cetuximab, a chimeric mouse-human IgG1 monoclonal antibody against the epidermal growth factor receptor, has proven effective in the treatment of metastatic colorectal cancer and squamous cell carcinoma of the head and neck. However, a high incidence of immediate hypersensitivity reactions (HSR) to cetuximab after the first infusion has been observed. We have developed a test for identification of patients likely to show treatment-related HSR to cetuximab. An enzyme-linked immunosorbent assay (ELISA) for detecting anti-cetuximab IgEs was developed and tested on serum samples collected from cancer patients before start of cetuximab treatment, and from healthy blood donors. Similar levels of anti-cetuximab IgE were detected in pre-treatment patient sera (24/92, 26.1%) and sera from healthy blood donors (33/117, 28.2%). HSR were observed in 14 out of the 92 patients (15.2%), and 8 of these (57.1%) were grade 3–4. Anti-cetuximab IgEs were detected in 7/8 of the patients (87.5%) with severe HSRs as compared with 14/78 patients (17.9%) with no HSR (p = 0.0002). Predictive value of the anti-cetuximab IgE test for HSR events of grades 3–4 was calculated using Receiver Operating Characteristics analysis. With a cut-off value of 29 arbitrary units for the anti-cetuximab IgE, the ELISA test showed a sensitivity of 87.5%, specificity of 82.1%, positive predictive value of 33.3% and negative predictive value of 98.5%. Anti-cetuximab IgE ELISA detection could be a valuable tool to help the physician anticipate an anaphylaxis episode following cetuximab infusion and opt for a suitable alternative treatment. PMID:21654207

  4. [Cancer treatment in elderly patients: evidence and clinical research].

    Science.gov (United States)

    Repetto, Lazzaro; Luciani, Andrea

    2015-01-01

    In 2020 the percentage of patients with a diagnosis of cancer in people with more than 65 years will exceed 70% and 28% in ethnic minorities. The treatment of cancer in these populations is challenging for the oncologists due to socio-economic issues such as poverty, reduced access to the hospital care, level of education. The clinical pathway "diagnosis-treatment-cure", typical of the care of young patients has to be integrated in elderly patients with a more individualized treatment by means of comprehensive geriatric assessment (CGA). IADL (Instrumental Activities of Daily Living) have the best predictive role in oncological setting and their impairment significantly correlate with overall survival, chemotherapy toxicities and thirty days postoperative morbidities. The CGA is universally accepted as the most appropriate instrument to analitically evaluate the age related problems of elderly patients. The role of CGA is crucial to identify geriatric issues not easily diagnosed, to predict treatment toxicities, functional or cognitive decline, post operative complications and to estimate life expectancy. The CGA items are predictive of severe toxicity, however it is not clearly established which are the best performers and the best cut-offs points. Today CGA is integrated with physical performance tests (the most widely used is the "time up and go" test) and laboratory assay of Interleukin 6 and D-Dimer that correlate with mortality and physical decline. There are few prospective studies that evaluated the role of CGA in treatment choice. The first is a phase II study in solid tumors, the second is a haematological trial on non Hodgkin lymphoma. The largest trial is a 571 patients observational series that confirmed the role of CGA in decision making. The administration of CGA is time consuming and consequently some screening tools were developed. VES-13 is a 13 items tool that explores prevalently the functional status and the self reported health status. VES-13

  5. Clinical Case Studies in Psychoanalytic and Psychodynamic Treatment

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    Willemsen, Jochem; Della Rosa, Elena; Kegerreis, Sue

    2017-01-01

    This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and because it would contribute to theoretical pluralism in the field. We summarize how the case study method is being applied in different schools of psychoanalysis, and we clarify the unique strengths of this method and areas for improvement. Finally, based on the literature and on our own experience with case study research, we come to formulate nine guidelines for future case study authors: (1) basic information to include, (2) clarification of the motivation to select a particular patient, (3) information about informed consent and disguise, (4) patient background and context of referral or self-referral, (5) patient's narrative, therapist's observations and interpretations, (6) interpretative heuristics, (7) reflexivity and counter-transference, (8) leaving room for interpretation, and (9) answering the research question, and comparison with other cases. PMID:28210235

  6. Clinical evaluation of Er:YAG laser caries treatment

    Science.gov (United States)

    Dostalova, Tatjana; Jelinkova, Helena; Kucerova, Hana; Krejsa, Otakar; Hamal, Karel; Kubelka, Jiri; Prochazka, Stanislav

    1997-05-01

    To prepare the enamel, the energy used was mainly 345 mJ and repetition rate 2 Hz, for dentine the optimal energy of Er:YAG drilling machine was 200 mJ and repetition rate from 1 to 2 Hz, depending on cavity depth. Subject of treatment were caries of enamel and dentine and it was possible to remove the old insufficient fillings. The average number of pulses was 111.22, ranging from 16 to 489. During preparation, vibrations of microexplosions were felt by 8 patients, however, neither pain or unpleasant sensations were experienced. The filling materials used were composite resins and glassionomer cements. Their clinical evaluation 6 months post insertion was similar to that of the classical drilling system.

  7. Dementia with Parkinson's disease: Clinical diagnosis, neuropsychological aspects and treatment

    Directory of Open Access Journals (Sweden)

    Jorge Lorenzo Otero

    Full Text Available Abstract Dementia with Parkinson's disease represents a controversial issue in the complex group of alpha-synucleinopathies. The author acknowledges the concept of a "continuum" between Parkinson disease's (PD, Lewy body dementia (LBD, and dementia in Parkinson's disease (PDD. However, the practicing neurologist needs to identify the phenotypic signs of each dementia. The treatment and prognosis are different in spite of the overlaps between them. The main aim of this review was to characterize the clinical diagnoses of dementia associated with Parkinson's disease (PDD. Secondarily, the review discussed some epidemiological and neuropsychological issues. Selection of articles was not systematic and reflects the author's opinion, where the main text selected was the recommendations from the Movement Disorder Society Task Force for PDD diagnosis. The Pub Med, OVID, and Proquest data bases were used for the search.

  8. [Attention deficit syndrome in adults: clinical, psychophysiological features and treatment].

    Science.gov (United States)

    Chutko, L S; Surushkina, S Iu; Iakovenko, E A; Nikishena, I S; Anisimova, T I

    2013-01-01

    The authors present the results of examination of 34 patients, aged from 18 to 30 years, with attention deficit hyperactivity disorder (ADHD) (ICD-10 item F90.0). The study has shown that inattentive type of ADHD is noted in 50%, combined type in 38.3% and hyperactivity/impulsivity type in 11.7% of patients. Adult patients with ADHD also have a high level of anxiety and asthenic disorders. This study evaluated the efficacy and safety of adaptol in dosage 1500 mg daily during 8 weeks in the treatment of this group of patients. The high efficacy (improvement in 64,7% of cases) and safety of adaptol confirmed by the data of clinical, psychological and neurophysiological studies.

  9. 78 FR 11207 - Clinical Study Designs for Surgical Ablation Devices for Treatment of Atrial Fibrillation...

    Science.gov (United States)

    2013-02-15

    ... Treatment of Atrial Fibrillation; Guidance for Industry and Food and Drug Administration Staff; Availability... Ablation Devices for Treatment of Atrial Fibrillation.'' This guidance provides FDA's recommendations on clinical trial designs for surgical ablation devices intended for the treatment of atrial...

  10. Clinical Features and Surgical Treatment of A-pattern Exotropia

    Institute of Scientific and Technical Information of China (English)

    Jingchang Chen; Guanghuan Mai; Daming Deng; Xiaoming Lin; Yan Guo; Xiao Yang; Chunxiu Yuan

    2004-01-01

    Purpose: To investigate the clinical characteristics and determine the effective surgical managements of A-pattern exotropia.Methods: Thirty-two patients with A-pattern exotropia underwent superior oblique muscle weakening procedures, medial rectus resection or (and) lateral rectus recession. Preand post-operative eye position, deviation angle, superior oblique function and binocular vision were examined and analyzed in the cases.Results: Overaction of the superior oblique muscles (31/32) and underaction of the medial rectus muscle (20/32) were presented in the cases. Postoperatively, a satisfactory ocular alignment was obtained in 28 cases (87.5%), and the A-pattern was corrected in 31 cases (96.9%). Four cases got binocular vision after surgery.Conclusions: As one of the most common forms of A and V patterns, A-pattern exotropia showed clinical characteristics of superior oblique muscle overaction and medial rectus muscle underacion, which should be the primary factors in the etiology of A-pattern exotropia, and superior oblique weakening procedures combined with horizontal surgery should be an effective approach to A-pattern exotropia treatment.

  11. Clinical potential of apremilast in the treatment of psoriatic arthritis

    Directory of Open Access Journals (Sweden)

    Cauli A

    2014-06-01

    Full Text Available Alberto Cauli, Giovanni Porru, Matteo Piga, Alessandra Vacca, Grazia Dessole, Alessandro MathieuRheumatology Unit, Department of Medical Sciences, Policlinico of University of Cagliari, Monserrato, ItalyAbstract: Psoriatic arthritis (PsA is a frequent chronic inflammatory disease characterized by joint and skin involvement, and by typical extra-articular manifestations. Although the pathogenesis of PsA is still under investigation, the available evidence suggests the importance of the patient's genetic background, microbial or environmental triggers, and an imbalance in the adaptive and acquired immune system, resulting in the production of inflammatory mediators. New therapeutic approaches have been proposed, among them the use of modulators of intracellular signals and gene transcription such as PDE4-inhibiting compounds, which are able to modulate the activity of transcription factors such as CREB and NF-κB and therefore the synthesis of inflammatory mediators, resulting in immunoregulation. This paper summarizes the mechanism of action of apremilast, a PDE4 inhibitor, and the clinical data available on its clinical efficacy and safety profile in the treatment of PsA patients.Keywords: psoriatic arthritis, apremilast, therapy

  12. Challenge in Clinical Diagnosis and Treatment of Leptospirosis

    Directory of Open Access Journals (Sweden)

    Dora I. Ríos

    2015-01-01

    Full Text Available Abstract: Introduction: Leptospirosis is an acute febrile disease caused by the leptospira. It is considered a zoonosis that affects a variety of animals, both wild and domestic (mainly rodents. Humans become infected accidentally by contact with urine or tissues from infected animals. This pathology has variable clinical manifestations, ranging from inapparent infections and aseptic meningitis, to severe forms such as the Weil syndrome. Development: We present the case of a young patient of 22 years old with fever quantified peaks of 40° C, chills, profuse sweating, headache, muscle and joint pain in knees and malleoli, retroorbital and retrosternal pain; and appetite loss. The symptoms occurred after 20 days of having practiced extreme water sports. Conclusion: The late diagnosis of the patient and hospital readmission are the result of several factors; First, the homology with other infectious diseases that present acute febrile illness with similar symptoms as dengue , malaria, influenza , yellow fever , brucellosis; and secondly the lack of expertise and poor contact with patients who present this disease by the medical staff. Correct antibiotic treatment and proper support reduce morbidity and mortality. The objective of this article is to describe a case of human leptospirosis and make a review of the literature in order to analyze the epidemiological characteristics and relevant clinical manifestations.

  13. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40

    Science.gov (United States)

    Boone, Margaret; Brown, Nancy J.; Moon, Mary A.; Schuman, Deborah J.; Thomas, Josephine; Wright, Denise L.

    2004-01-01

    This Treatment Improvement Protocol (TIP) addresses the clinical use of buprenorphine in the treatment of opioid addiction. TIPs are best-practice guidelines for the treatment of substance use disorders that make the latest research in substance abuse treatment available to counselors and educators. The content was generated by a panel of experts…

  14. DIFFERENTIATION SYNDROME IN PROMYELOCYTIC LEUKEMIA : CLINICAL PRESENTATION, PATHOGENESIS AND TREATMENT

    Directory of Open Access Journals (Sweden)

    Eduardo Magalhães Rego

    2011-10-01

    Full Text Available Differentiation syndrome (DS represents a life-threatening complication in patients with acute promyelocytic leukemia (APL undergoing induction therapy with all-trans retinoic acid (ATRA or arsenic trioxide (ATO. It affects about 20-25% of all patients and there are no definitive diagnostic criteria. Clinically, DS is characterized by weight gain, fever not attributable to infection, respiratory distress, cardiac involvement, hypotension, and/or acute renal failure. At the histological point of view, there is an extensive interstitial and intra-alveolar pulmonary infiltration by maturing myeloid cells, endothelial cell damage, intra-alveolar edema, inter-alveolar hemorrhage, and fibrinous exsudates. DS pathogenesis is not completely understood, but it is believed that an excessive inflammatory response is the main phenomenon involved, which results in increased production of chemokines and expression of adhesion molecules on APL cells. Due to the high morbidity and mortality associated with DS, its recognition and the prompt initiation of the treatment is of utmost importance. Dexamethasone is considered the mainstay of treatment of DS, and the recommended dose is 10 mg twice daily by intravenous route until resolution of DS. In severe cases (respiratory or acute renal failure it is recommended the discontinuation of ATRA or ATO until recovery.

  15. DIAGNOSIS AND TREATMENT OF METACHRONOUS TESTICULAR CANCER: A CLINICAL CASE

    Directory of Open Access Journals (Sweden)

    A. S. Kalpinsky

    2013-01-01

    Full Text Available The incidence of bilateral testicular cancer is 5% in the total cohort of patients. Synchronous and metachronous testicular cancers are detected in 1-2 and 3% of cases, respectively. The standard treatment for testicular cancer is orchifuniculectomy and that for synchronous or metachronous cancer is organ-saving treatment, testectomy.The paper describes a clinical case of multiple primary metachronous testicular cancer. A 24-year-old patient underwent surgery (orchifuniculectomy and received 4 courses of BEP polychemotherapy for embryonal carcinoma of the left testicle at the P.A. Herzen Moscow Oncology Research Institute. After 55 months, a dynamic control examination diagnosed a 9-mm tumor in his single right testis that was thereafter resected. Its histological examination revealed embryonal carcinoma with solitary structures in the immature teratoma. Following 22 months, a control examination showed a recurrence of the disease, for which orchifuniculectomy of the single right testis, followed by hormone replacement therapy, was performed. The follow-up period was 80 months; no recurrence is now observed.

  16. Clinical report of the treatment of locally advanced lung cancer.

    Science.gov (United States)

    Petrovich, Z; Mietlowski, W; Ohanian, M; Cox, J

    1977-07-01

    This paper discusses the results of the treatment of 345 patients entered in the Veterans Administration Lung Group Protocol 13L. The study was activated March 1972, and closed for the patient accesion March 1975. All patients had a histological diagnosis of primary lung cancer considered clinically non-resectable or inoperable. Patients were equally randomized into two groups, radiotherapy alone or radiotherapy with chemotherapy. The analysis of the data included: treatment regimen, radiation dose, initial performance status, performance status change, cell type, duration of survival, quality of survival and age. The strongest influence on median survival was the level of radiation dose. The small cell carcinoma patients treated with radiotherapy and chemotherapy showed significant improvement in the median survival (38.2 weeks) over the patients treated with radiotherapy alone (20.6 weeks). The patients treated with radiotherapy and chemotherapy also showed improvement in performance status more frequently than the patients treated with radiotherapy alone. Other parameters of the analysis will be presented.

  17. Laser Phototherapy As Modality of Clinical Treatment in Bell's Palsy

    Science.gov (United States)

    Marques, A. M. C.; Soares, L. G. P.; Marques, R. C.; Pinheiro, A. L. B.; Dent, M.

    2011-08-01

    Bell's palsy is defined as a peripheral facial nerve palsy, idiophatic, and sudden onset and is considered the most common cause of this pathology. It is caused by damage to cranial nerves VII, resulting in complete or partial paralysis of the facial mimic. May be associated with taste disturbances, salivation, tearing and hyperacusis. It is diagnosed after ruling out all possible etiologies, because its cause is not fully understood.Some researches shows that herpes virus may cause this type of palsy due to reactivation of the virus or by imunnomediated post-viral nerve demielinization. Physical therapy, corticosteroids and antiviral therapy have become the most widely accepted treatments for Bell's palsy. Therapy with low-level laser (LLLT) may induce the metabolism of injured nerve tissue for the production of proteins associated with its growth and to improve nerve regeneration. The success of the treatment of Bell's palsy by using laser phototherapy isolated or in association with other therapeutic approach has been reported on the literature. In most cases, the recovery occurs without uneventfully (complications), the acute illness is not associated with serious disorders. We will present a clinical approach for treating this condition.

  18. Clinical Manifestations, Diagnosis, and Empirical Treatments for Catatonia

    OpenAIRE

    Bhati, Mahendra T.; Datto, Catherine J; O'Reardon, John P.

    2007-01-01

    Objective: Review the medical literature on the history and clinical features of catatonia so as to provide a contemporary clinical guide for successfully diagnosing and treating the various clinical forms of catatonia.

  19. Commissioning and first clinical application of mARC treatment

    Energy Technology Data Exchange (ETDEWEB)

    Dzierma, Yvonne; Nuesken, Frank G.; Kremp, Stephanie; Palm, Jan; Licht, Norbert P.; Ruebe, Christian [Universitaetsklinikum des Saarlandes, Klinik fuer Strahlentherapie und Radioonkologie, Homburg, Saarland (Germany)

    2014-11-15

    The modulated arc (mARC) technique has recently been introduced for Siemens ARTISTE linear accelerators. We present the first experiences with the commissioning of the system and first patient treatments. Treatment planning and delivery are presented for the Prowess Panther treatment planning system or, alternatively, an in-house code. Dosimetric verification is performed both by point dose measurements and in 3D dose distribution. Depending on the target volume, one or two arcs can be used to create highly conformal plans. Dosimetric verification of the converted mARC plans with step-and-shoot plans shows deviations below 1 % in absolute point dose; in the 3D dose distribution, over 95 % of the points pass the 3D gamma criteria (3 % deviation in local dose and 3 mm distance to agreement for doses > 20 % of the maximum). Patient specific verification of the mARC dose distribution with the calculations has a similar pass rate. Treatment times range between 2 and 5 min for a single arc. To our knowledge, this is the first report of clinical application of the mARC technique. The mARC offers the possibility to save significant amounts of time, with single-arc treatments of only a few minutes achieving comparable dose distribution to IMRT plans taking up to twice as long. (orig.) [German] Die mARC (modulated arc) Technik wurde vor kurzen fuer Siemens ARTISTE Linearbeschleuniger eingefuehrt. Wir zeigen die ersten Erfahrungen mit der Kommissionierung des Systems sowie die ersten Patientenbestrahlungen. Bestrahlungsplanung und Behandlung werden fuer das Prowess Panther Bestrahlungsplanungssystem oder alternativ in einer in-house-Loesung praesentiert. Die dosimetrische Verifikation wurde sowohl mit Punktmessungen als auch fuer die 3D-Dosisverteilung durchgefuehrt. Je nach Zielvolumen koennen mit einem oder zwei Boegen hochkonformale Plaene erzeugt werden. Die dosimetrische Verifikation konvertierter mARC-Plaene gegen step-and-shoot-Plaene weicht in absoluter Dosis um

  20. Clinical Features and Treatment of Bronchogenic Cyst in Adults

    Institute of Scientific and Technical Information of China (English)

    Hong-sheng Liu; Shan-qing Li; Zhi-li Cao; Zhi-yong Zhang; Hua Ren

    2009-01-01

    Objective To investigate the clinical features and management of bronchogenic cyst in the adults. Methods We retrospectively reviewed 50 patients admitted to our hospital with histopathologically proved bronchogenic cyst from January 1983 to December 2007. Of all the patients, 28 were male and 22 were female, with an average age of 36.9 (range, 18 to 64) years. The symptoms, location of the cysts, imaging evaluation, surgical treatment manner, and outcome of these patients were analyzed. Results Symptoms were present in 33 of the 50 patients, and cough was the most common symptom. Thirteen patients presented with complications: hemoptysis, infected cyst, dysphagia, paralysis, and hoarseness. The locations of the cysts included the mediastinum (28 cases), pulmonary parenchyma (12 cases), hilar area (3 cases), visceral pleura (1 case), and some rare locations including the intestinal mesentery (1 case), retroperitoneum (1 case), adrenal gland (1 case), neck (2 cases), and dura matter of the cervical vertebrae (1 case). Chest X-ray was performed in 36 patients and computed tomography (CT) was performed in 41 patients. The bronchogenic cyst in CT was characterized as a round, well circumscribed, unilocular mass, with density ranging from that of water to high density (0-50 Hu). As for treatment, complete resection of the bronchogenic cyst was performed in 47 (94%) patients, subtotal resection was performed in 3 (6%) patients. Open surgery was performed in 45 (90%) patients, and thoracoscopy (video-assisted thoracic surgery) was performed in 5 (10%) paitients. Of the 12 patients with intrapulmonary cyst, 11 patients underwent lobectomy and 1 patient underwent wedge resection. Postoperative sequelae occurred in 2 patients, 1 with persistent air leakage and 1 with hoarseness. All patients were proved with bronchogenic cyst pathologically. The average follow-up period was 6.5 years (range, 4 months to 10 years), and no late sequelae or recurrence of the cyst occurred

  1. From the neurobiology of extinction to improved clinical treatments.

    Science.gov (United States)

    Morrison, Filomene G; Ressler, Kerry J

    2014-04-01

    The neural circuitry underlying the fear response is extremely well conserved across mammalian species, which has allowed for the rapid translation of research findings in rodent models of fear to therapeutic interventions in human populations. Many aspects of exposure-based psychotherapy treatments in humans, which are widely used in the treatment of PTSD, panic disorder, phobias, and other anxiety disorders, are closely paralleled by extinction training in rodent fear conditioning models. Here, we discuss how the neural circuitry of fear learning and extinction in rodent animal models may be used to understand the underlying neural circuitry of fear-related disorders, such as PTSD in humans. We examine the factors that contribute to the pathology and development of PTSD. Next, we will review how fear is measured in animal models using classical Pavlovian fear conditioning paradigms, as well as brain regions such as the amygdala, which are involved in the fear response across species. Finally, we highlight the following three systems involved in the extinction of fear, all of which represent promising avenues for therapeutic interventions in the clinic: (1) the role of the glutamatergic N-methyl-d-aspartate (NMDA) receptor, (2) the role of the brain-derived neurotrophic factor (BDNF)-tyrosine kinase B (TrkB) induced signaling pathway, and (3) the role of the renin-angiotensin system. The modulation of pathways underlying fear learning and extinction, such as the ones presented in this review, in combination with extinction-based exposure therapy, represents promising avenues for therapeutic intervention in the treatment of human fear related disorders.

  2. Paravalvular Regurgitation: Clinical Outcomes in Surgical and Percutaneous Treatments

    Directory of Open Access Journals (Sweden)

    Carlos Passos Pinheiro

    2016-01-01

    Full Text Available Abstract Background: Paravalvular regurgitation (paravalvular leak is a serious and rare complication associated with valve replacement surgery. Studies have shown a 3% to 6% incidence of paravalvular regurgitation with hemodynamic repercussion. Few studies have compared surgical and percutaneous approaches for repair. Objectives: To compare the surgical and percutaneous approaches for paravalvular regurgitation repair regarding clinical outcomes during hospitalization and one year after the procedure. Methods: This is a retrospective, descriptive and observational study that included 35 patients with paravalvular leak, requiring repair, and followed up at the Dante Pazzanese Institute of Cardiology between January 2011 and December 2013. Patients were divided into groups according to the established treatment and followed up for 1 year after the procedure. Results: The group submitted to percutaneous treatment was considered to be at higher risk for complications because of the older age of patients, higher prevalence of diabetes, greater number of previous valve surgeries and lower mean creatinine clearance value. During hospitalization, both groups had a large number of complications (74.3% of cases, with no statistical difference in the analyzed outcomes. After 1 year, the percutaneous group had a greater number of re-interventions (8.7% vs 20%, p = 0.57 and a higher mortality rate (0% vs. 20%, p = 0.08. A high incidence of residual mitral leak was observed after the percutaneous procedure (8.7% vs. 50%, p = 0.08. Conclusion: Surgery is the treatment of choice for paravalvular regurgitation. The percutaneous approach can be an alternative for patients at high surgical risk.

  3. Paravalvular Regurgitation: Clinical Outcomes in Surgical and Percutaneous Treatments

    Science.gov (United States)

    Pinheiro, Carlos Passos; Rezek, Daniele; Costa, Eduardo Paiva; de Carvalho, Edvagner Sergio Leite; Moscoso, Freddy Antonio Brito; Taborga, Percy Richard Chavez; Jeronimo, Andreia Dias; Abizaid, Alexandre Antonio Cunha; Ramos, Auristela Isabel de Oliveira

    2016-01-01

    Background Paravalvular regurgitation (paravalvular leak) is a serious and rare complication associated with valve replacement surgery. Studies have shown a 3% to 6% incidence of paravalvular regurgitation with hemodynamic repercussion. Few studies have compared surgical and percutaneous approaches for repair. Objectives To compare the surgical and percutaneous approaches for paravalvular regurgitation repair regarding clinical outcomes during hospitalization and one year after the procedure. Methods This is a retrospective, descriptive and observational study that included 35 patients with paravalvular leak, requiring repair, and followed up at the Dante Pazzanese Institute of Cardiology between January 2011 and December 2013. Patients were divided into groups according to the established treatment and followed up for 1 year after the procedure. Results The group submitted to percutaneous treatment was considered to be at higher risk for complications because of the older age of patients, higher prevalence of diabetes, greater number of previous valve surgeries and lower mean creatinine clearance value. During hospitalization, both groups had a large number of complications (74.3% of cases), with no statistical difference in the analyzed outcomes. After 1 year, the percutaneous group had a greater number of re-interventions (8.7% vs 20%, p = 0.57) and a higher mortality rate (0% vs. 20%, p = 0.08). A high incidence of residual mitral leak was observed after the percutaneous procedure (8.7% vs. 50%, p = 0.08). Conclusion Surgery is the treatment of choice for paravalvular regurgitation. The percutaneous approach can be an alternative for patients at high surgical risk. PMID:27305109

  4. Developing Treatment, Treatment Validation & Treatment Scope in the Setting of an Autism Clinical Trial

    Science.gov (United States)

    2011-10-01

    autism. We will also measure changes in excretion of the polyunsaturated fatty acid ( PUFA ) derived biomarkers of oxidative stress (isoprostanes and...Alternative Treatments in Autism” at the conference. In her talk she will be speaking of the use of Omega -3 fatty acids in autism. We will...T.P. Stein PhD, X. Ming MD, PhD, M.D. Schluter BS, A. Rodriguez PhD, B.W. Spur PhD and G. Lambert MD. POLYUNSATURATED FATTY ACIDS METABOLISM

  5. Inhibitory Action of Ethanolic Extract of Seeds of Moringa oleifera Lam. On Systemic and Local Anaphylaxis.

    Science.gov (United States)

    Mahajan, Shailaja G; Mehta, Anita A

    2007-10-01

    The current study characterizes the mechanism by which the seed extract of Moringa oleifera Lam (Moringaceae) decreases the mast cell-mediated immediate type hypersensitivity reaction. The immediate type hypersensitivity reaction is involved in many allergic diseases such as asthma and allergic rhinitis. Moringa oleifera, a shrub widely used in the traditional medicine in India, has been reported to possess anti-cancer, hypotensive, anti-arthritic, and anti-inflammatory activities. In the present study, the effects of the ethanolic extract of seeds of Moringa oleifera (MOEE-herbal remedy) on systemic and local anaphylaxis were investigated. The potential anti-anaphylactic effect of MOEE was studied in a mouse model of Compound 48/80-induced systemic anaphylactic shock. Passive cutaneous anaphylaxis activated by anti IgE-antibody was also used to assess the effect of MOEE. In addition, rat peritoneal mast cells (RPMC) were used to investigate the effect of MOEE on histamine release induced by compound 48/80. When administered 1 hr before 48/80 injection, MOEE at doses of 0.001-1.000 g/kg completely inhibited the inducible induced anaphylactic shock. MOEE significantly inhibited passive cutaneous anaphylaxis activated by anti-IgE antibody at a dose of 1 g/kg. When MOEE extract was given as pretreatment at concentrations ranging 0.1-100 mg/ml, the histamine release from the mast cells that was induced by the 48/80 was reduced in a dose-dependent manner. These results suggest a potential role for MOEE as a source of anti-anaphylactic agents for use in allergic disorders.

  6. Food Dependent Exercise-induced Anaphylaxis: 3 Cases Report and Literature Review%食物依赖运动诱发严重过敏3例并文献复习

    Institute of Scientific and Technical Information of China (English)

    祝戎飞; 黄南; 刘惠龙; 刘光辉

    2011-01-01

    目的:提高对食物依赖运动诱发严重过敏(FDEIA)的诊疗水平.方法:回顾分析3例食物依赖运动诱发过敏反应患者的临床特征及诊疗情况,并复习相关文献.结果:2例患者在进食小麦面食后,1例患者在进食海虾后由运动诱发全身荨麻疹、呼吸困难及意识障碍,发病时间均在进食食物后30min~2h,经肾上腺素、糖皮质激素及抗组胺药物治疗后缓解.3例患者致敏食物皮肤点刺试验和血清特异性IgE均为阳性.2例患者在禁食致敏食物1年,随访期间未发生过敏反应.结论:FDEIA临床罕见,患者可反复发生过敏性休克而导致死亡,临床进食某些食物过敏原和进食后运动2个因素同时存在时才会诱发FDEIA,治疗方法以抗组胺药物、肾上腺素和糖皮质激素等对症治疗为主,禁食致敏食物及进食致敏食物后4h内避免剧烈运动有可能避免本病的发生.%Objective: To improve the diagnosis and treatment of food-dependent exercise-induced anaphylaxis (FDEIA). Methods: Clinical features, diagnosis and treatment of 3 patients with FDEIA were analyzed with literature review. Results: Three cases experienced exercise induced urticaria, breathing difficulties and impairment of consciousness in 30 minutes to 2 hours after taken allergic foods (2 cases for wheat and 1 case for shrimp). Patients symptoms were relieved after treated with anti-histamine, corticosteroids and adrenaline. The results of skin prick test and specific IgE to food were positive. Two cases had no anaphylaxis attack after avoiding causative food during 1 years follow-up. Conclusions: FDEIA are rare in clinic. Patients may die from repeated anaphylactic shock. Only simultaneous existence of taking allergenic food and subsequent exercise can induce FDEIA. Avoidance of exercise for 4 hours after eating causative food might be helpful to prevent the occurrence of symptoms in many FDEIA cases. Dietary avoidance of causative food ingredients

  7. Food-Dependent Exercise-Induced Anaphylaxis - Kasuistik med hydrolyseret valleprotein

    DEFF Research Database (Denmark)

    Junker Christensen, Morten

    2013-01-01

    Formål / Introduktion: Patienter med Food-Dependent Exercise-Induced Anaphylaxis (FDEIA) eller løbershock kan udvikle livstruende allergiske reaktioner (anafylaksi), når de kombinere fysisk anstrengelse med samtidig indtagelse af et normalt tolereret fødeemne - oftest hvede. Hydrolysering af prot...... proteiner bruges i industrien til at ændre de fødevarekemiske egenskaber, men dette kan også ændre allergeniciteten, hvilket er rapporteret både for hvede og soja hydrolysater. Protein bestanddelen i komælk udgøres overvejende af casein 80% samt 20% valle-proteiner (β-lactoglobulin, α...

  8. The pholcodine Case. Cough Medicines, IgE-Sensitization, and Anaphylaxis: A Devious Connection

    OpenAIRE

    Florvaag, E.; Johansson, SGO

    2012-01-01

    The Scandinavian data on pholcodine (PHO) strongly indicates that there is a biological chain from PHO exposure through IgE-sensitization to IgE-mediated anaphylaxis to neuromuscular blocking agents (NMBA). PHO is probably one of the strongest inducer of an IgE antibody response known. Of individuals taking PHO in cough medicines, over-the-counter accessibility to large populations, as many as 20 to 25% may become IgE sensitized. Once sensitized, PHO re-exposure will booster IgE antibody leve...

  9. European AIDS Clinical Society (EACS) guidelines for the clinical management and treatment of HIV-infected adults

    DEFF Research Database (Denmark)

    Clumeck, N; Pozniak, A; Raffi, F;

    2008-01-01

    virological failure and the treatment of HIV during pregnancy. In Europe, there is a wide range of clinical practices in antiretroviral therapy depending on various factors such as drug registration, national policies, local availability, reimbursement and access to treatment. These can vary greatly from one......A working group of the European AIDS Clinical Society (EACS) have developed these guidelines for European clinicians to help them in the treatment of adults with HIV infection. This third version of the guidelines includes, as new topics, the assessment of patients at initial and subsequent clinic...

  10. Ruxolitinib for the treatment of myelofibrosis: its clinical potential

    Directory of Open Access Journals (Sweden)

    Ostojic A

    2012-03-01

    Full Text Available Alen Ostojic1, Radovan Vrhovac1, Srdan Verstovsek21Division of Hematology, Department of Internal Medicine, University Hospital Center Zagreb, Zagreb, Croatia; 2Department of Leukemia, University of Texas, MD Anderson Cancer Center, Houston, TX, USAAbstract: Ruxolitinib is an orally bioavailable, selective Janus kinase (JAK 1 and 2 inhibitor approved for the treatment of myelofibrosis (MF, a bone marrow disease in which the JAK pathway is dysregulated, leading to impaired hematopoiesis and immune function. By inhibiting JAK1 and JAK2, ruxolitinib modulates cytokine-stimulated intracellular signaling. In a phase II clinical trial in patients with MF, ruxolitinib recipients exhibited durable reductions in spleen size, reductions in circulating pro-inflammatory cytokines, improvements in physical activity, weight gain, and alleviation of symptoms (including constitutional symptoms in patients with and without JAK2 mutation. These findings were confirmed by two phase III clinical MF studies, in which a greater proportion of ruxolitinib recipients achieved a spleen volume reduction of ≥35% from baseline at week 24, compared with placebo in one study (41.9% versus 0.7%; P < 0.0001 and with best available therapy in the other (31.9% versus 0%; P < 0.0001. Alleviation of MF symptoms and improvements in quality of life were also significantly greater in ruxolitinib recipients. Overall survival of patients treated with ruxolitinib was significantly longer than of those receiving the placebo. Owing to risks of potentially serious adverse effects, eg, myelosuppression, ruxolitinib should be used under close physician supervision. Longer follow-up of the phase III MF studies is needed to reach firm conclusions regarding ruxolitinib’s capacity to modify the natural disease course.Keywords: myelofibrosis, JAK2 inhibitor, ruxolitinib

  11. Clinical Research on Acupuncture Treatment of Diabetic Peripheral Neuropathy

    Institute of Scientific and Technical Information of China (English)

    QIAN Wei-hua; QIAN Hong; WU Tong; BEI Yan-hui; LI Lan; QING Liang-cai

    2004-01-01

    目的:探讨针刺治疗糖尿病周围神经病变的相关机理.方法:运用针刺疗法治疗糖尿病周围神经病变,并与口服钙离子拮抗剂加维生素疗法进行随机对照观察,同时作肌电图检测分析.结果:针刺治疗糖尿病周围神经病变可不同程度地改善病人的肢体麻木、疼痛和感觉异常等临床症状,肌电图结果提示神经运动传导速度和感觉传导速度也有明显改善.结论:针刺治疗糖尿病周围神经病变的临床疗效明显优于口服钙离子拮抗剂加维生素治疗.%Purpose: To investigate the mechanism of acupuncture treatment of diabetic peripheral neuropathy. Methods: Acupuncture therapy was used to treat diabetic peripheral neuropathy, and compared with oral calcium antagonist and vitamin therapy by random control observation.Electromyography was performed for analysis at the same time. Results: Acupuncture treatment alleviated symptoms such as extremity numbness, pain and paresthesia in varying degrees in diabetic patients with peripheral neuropathy. The results of electromyography showed a marked improvement in motor and sensory conduction velocities. Conclusion: It is indicated that acupuncture therapy is markedly superior to oral calcium antagonist and vitamin therapy in clinical effect on diabetic peripheral neuropathy, and electromyographic recovery.

  12. Strategies for automatic online treatment plan reoptimization using clinical treatment planning system: A planning parameters study

    Energy Technology Data Exchange (ETDEWEB)

    Li, Taoran; Wu, Qiuwen; Zhang, You; Vergalasova, Irina; Lee, W. Robert; Yin, Fang-Fang; Wu, Q. Jackie [Duke Medical Physics Graduate Program, Duke University, Durham, North Carolina 27705 and Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710 (United States)

    2013-11-15

    Purpose: Adaptive radiation therapy for prostate cancer using online reoptimization provides an improved control of interfractional anatomy variations. However, the clinical implementation of online reoptimization is currently limited by the low efficiency of current strategies and the difficulties associated with integration into the current treatment planning system. This study investigates the strategies for performing fast (∼2 min) automatic online reoptimization with a clinical fluence-map-based treatment planning system; and explores the performance with different input parameters settings: dose-volume histogram (DVH) objective settings, starting stage, and iteration number (in the context of real time planning).Methods: Simulated treatments of 10 patients were reoptimized daily for the first week of treatment (5 fractions) using 12 different combinations of optimization strategies. Options for objective settings included guideline-based RTOG objectives, patient-specific objectives based on anatomy on the planning CT, and daily-CBCT anatomy-based objectives adapted from planning CT objectives. Options for starting stages involved starting reoptimization with and without the original plan's fluence map. Options for iteration numbers were 50 and 100. The adapted plans were then analyzed by statistical modeling, and compared both in terms of dosimetry and delivery efficiency.Results: All online reoptimized plans were finished within ∼2 min with excellent coverage and conformity to the daily target. The three input parameters, i.e., DVH objectives, starting stage, and iteration number, contributed to the outcome of optimization nearly independently. Patient-specific objectives generally provided better OAR sparing compared to guideline-based objectives. The benefit in high-dose sparing from incorporating daily anatomy into objective settings was positively correlated with the relative change in OAR volumes from planning CT to daily CBCT. The use of the

  13. [Clinical Pathological Diagnosis, and Treatment for Pleural Mesothelioma].

    Science.gov (United States)

    Kishimoto, Takumi; Fujimoto, Nobukazu; Nishi, Hideyuki

    2016-05-01

    For the differential diagnosis between fibrous pleuritis and other malignancies such as lung cancer, multiple immunostaining is essential to diagnose pleural mesothelioma. For cytological diagnosis of pleural effusions, differentiation between mesothelioma cells and reactive mesothelial cells is very difficult. Therefore, histological diagnoses of tumor tissues obtained via biopsy are essential. To diagnose epthelioid mesothelioma, more than 2 positive and negative markers must be consistent with those known for mesothelioma. To diagnose sarcomatoid mesothelioma, keratin is usually positive, differentiating the diagnosis from that for real sarcoma. For surgical treatment for pleural mesothelioma, extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) are usually performed. The proportion of P/D increases because of the low death rates with surgery and similar survivals. However, a trimodal approach, such as EPP with chemotherapy and radiotherapy, is best for longer survival and expected to be curative. For chemotherapy, only cisplatin (CDDP) combined with pemetrexed (PEM) is effective, and no other agents have been identified for this disease. Nowadays, clinical immunotherapy trials start with phase II study.

  14. Mucocele and fibroma: treatment and clinical features for differential diagnosis.

    Science.gov (United States)

    Valério, Rodrigo Alexandre; de Queiroz, Alexandra Mussolino; Romualdo, Priscila Coutinho; Brentegani, Luiz Guilherme; de Paula-Silva, Francisco Wanderley Garcia

    2013-01-01

    Mucocele is a benign lesion occurring in the buccal mucosa as a result of the rupture of a salivary gland duct and consequent outpouring of mucin into soft tissue. It is usually caused by a local trauma, although in many cases the etiology is uncertain. Mucocele is more commonly found in children and young adults, and the most frequent site is the lower inner portion of the lips. Fibroma, on the other hand, is a benign tumor of fibrous connective tissue that can be considered a reactionary connective tissue hyperplasia in response to trauma and irritation. They usually present hard consistency, are nodular and asymptomatic, with a similar color to the mucosa, sessile base, smooth surface, located in the buccal mucosa along the line of occlusion, tongue and lip mucosa. Conventional treatment for both lesions is conservative surgical excision. Recurrence rate is low for fibroma and high for oral mucoceles. This report presents a series of cases of mucocele and fibroma treated by surgical excision or enucleation and the respective follow-up routine in the dental clinic and discusses the features to be considered in order to distinguish these lesions from each other.

  15. Clinic application of tissue engineered bronchus for lung cancer treatment

    Science.gov (United States)

    Liu, Ruijun; Chen, Xiaoke; Wu, Jingxiang; Pan, Yinggen; Lu, Shun; Weder, Walter; Luo, Qingquan

    2017-01-01

    Background Delayed revascularization process and substitute infection remain to be key challenges in tissue engineered (TE) airway reconstruction. We propose an “in-vivo bioreactor” design, defined as an implanted TE substitutes perfused with an intra-scaffold medium flow created by an extracorporeal portable pump system for in situ organ regeneration. The perfusate keeps pre-seeded cells alive before revascularization. Meanwhile the antibiotic inside the perfusate controls topical infection. Methods A stage IIIA squamous lung cancer patient received a 5-cm TE airway substitute, bridging left basal segment bronchus to carina, with the in-vivo bioreactor design to avoid left pneumonectomy. Continuous intra-scaffold Ringer’s-gentamicin perfusion lasted for 1 month, together with orthotopic peripheral total nucleated cells (TNCs) injection twice a week. Results The patient recovered uneventfully. Bronchoscopy follow-up confirmed complete revascularization and reepithelialization four months postoperatively. Perfusate waste test demonstrated various revascularization growth factors secreted by TNCs. The patient received two cycles of chemotherapy and 30 Gy radiotherapy thereafter without complications related to the TE substitute. Conclusions In-vivo bioreactor design combines the traditionally separated in vitro 3D cell-scaffold culture system and the in vivo regenerative processes associated with TE substitutes, while treating the recipients as bioreactors for their own TE prostheses. This design can be applied clinically. We also proved for the first time that TE airway substitute is able to tolerate chemo-radiotherapy and suitable to be used in cancer treatment.

  16. Oral candidiasis: pathogenesis, clinical presentation, diagnosis and treatment strategies.

    Science.gov (United States)

    Lalla, Rajesh V; Patton, Lauren L; Dongari-Bagtzoglou, Anna

    2013-04-01

    Oral candidiasis is a clinical fungal infection that is the most common opportunistic infection affecting the human oral cavity. This article reviews the pathogenesis, clinical presentations, diagnosis and treatmentstrategies for oral candidiasis.

  17. Wheat-Dependent Exercise-Induced Anaphylaxis Sensitized with Hydrolyzed Wheat Protein in Soap

    Directory of Open Access Journals (Sweden)

    Yuko Chinuki

    2012-01-01

    Full Text Available Wheat-dependent exercise-induced anaphylaxis (WDEIA is a specific form of wheat allergy typically induced by exercise after ingestion of wheat products. Wheat ω-5 gliadin is a major allergen associated with conventional WDEIA, and detection of serum immunoglobulin E (IgE specific to recombinant ω-5 gliadin is a reliable method for its diagnosis. Recently, an increased incidence of a new subtype of WDEIA, which is likely to be sensitized via a percutaneous and/or rhinoconjunctival route to hydrolyzed wheat protein (HWP, has been observed. All of the patients with this new subtype had used the same brand of soap, which contained HWP. Approximately half of these patients developed contact allergy several months later and subsequently developed WDEIA. In each of these patients, contact allergy with soap exposure preceded food ingestion-induced reactions. Other patients directly developed generalized symptoms upon ingestion of wheat products. The predominant observed symptom of the new WDEIA subtype was angioedema of the eyelids; a number of patients developed anaphylaxis. This new subtype of WDEIA has little serum ω-5 gliadin-specific serum IgE.

  18. Management of levofloxacin induced anaphylaxis and acute delirium in a palliative care setting

    Directory of Open Access Journals (Sweden)

    Arunangshu Ghoshal

    2015-01-01

    Full Text Available Levofloxacin is a commonly prescribed antibiotic for managing chest and urinary tract infections in a palliative care setting. Incidence of Levofloxacin-associated anaphylaxis is rare and delirium secondary to Levofloxacin is a seldom occurrence with only few published case reports. It is an extremely rare occurrence to see this phenomenon in combination. Early identification and prompt intervention reduces both mortality and morbidity. A 17-year-old male with synovial sarcoma of right thigh with chest wall and lung metastasis and with no prior psychiatric morbidity presented to palliative medicine outpatient department with community-acquired pneumonia. He was initiated on intravenous (IV Ceftriaxone and IV Levofloxacin. Post IV Levofloxacin patient developed anaphylaxis and acute delirium necessitating IV Hydrocortisone, IV Chlorpheneramine, Oxygen and IV Haloperidol. Early detection and prompt intervention helped in complete recovery. Patient was discharged to hospice for respite after 2 days of hospitalization and then discharged home. Acute palliative care approach facilitated management of two life-threatening medical complications in a palliative care setting improving both quality and length of life.

  19. Sensitization from chestnuts and bananas in patients with urticaria and anaphylaxis from contact with latex.

    Science.gov (United States)

    Fernández de Corres, L; Moneo, I; Muñoz, D; Bernaola, G; Fernández, E; Audicana, M; Urrutia, I

    1993-01-01

    We present eight patients allergic to latex and fruit (chestnut and banana), seven of whom are women, and aged 17 to 42 years (mean 25 years). Four had family and five personal atopic histories. The total IgE varied from 41 to 520 Ku/L (mean 263). The symptoms followed ingestion of fruit (anaphylaxis) in four patients and contact with rubber (contact urticaria and anaphylaxis) in the other four. Skin prick test (SPT) with latex and radioallergosorbent test to latex were positive in all the patients. Histamine release (HR) to latex was carried out on six patients and was positive in three. In the six patients with symptoms after having eaten chestnuts the SPT was positive and specific IgE was detected in five of them. Histamine release to chestnuts was positive in three of the six patients tested and one of them (-SPT and + IgE) tolerated the fruit. Two out of five patients with symptomatic banana allergy had negative SPT with banana while the test was positive in one patient who tolerated this fruit, this being the only case with specific IgE to banana. Histamine release with banana was only positive in one case. The important correlation between SPT, RAST, and HR results to latex and chestnut together with the total inhibition of the chestnut RAST with a serum pool by preincubation with latex suggests cross-reactivity among these allergens.

  20. Wheat-dependent exercise-induced anaphylaxis sensitized with hydrolyzed wheat protein in soap.

    Science.gov (United States)

    Chinuki, Yuko; Morita, Eishin

    2012-12-01

    Wheat-dependent exercise-induced anaphylaxis (WDEIA) is a specific form of wheat allergy typically induced by exercise after ingestion of wheat products. Wheat ω-5 gliadin is a major allergen associated with conventional WDEIA, and detection of serum immunoglobulin E (IgE) specific to recombinant ω-5 gliadin is a reliable method for its diagnosis. Recently, an increased incidence of a new subtype of WDEIA, which is likely to be sensitized via a percutaneous and/or rhinoconjunctival route to hydrolyzed wheat protein (HWP), has been observed. All of the patients with this new subtype had used the same brand of soap, which contained HWP. Approximately half of these patients developed contact allergy several months later and subsequently developed WDEIA. In each of these patients, contact allergy with soap exposure preceded food ingestion-induced reactions. Other patients directly developed generalized symptoms upon ingestion of wheat products. The predominant observed symptom of the new WDEIA subtype was angioedema of the eyelids; a number of patients developed anaphylaxis. This new subtype of WDEIA has little serum ω-5 gliadin-specific serum IgE.

  1. 儿童严重过敏反应的处理:欧洲变态反应学及临床免疫学会指南%The Management of Anaphylaxis in Childhood:Position Paper of the European Academy of Allergology and Clinical Immunology

    Institute of Scientific and Technical Information of China (English)

    A.Muraro; 青曼丽; G.Roberts; A.Clark; P.A.Eigenmann; S.Halken; G.Lack; A.Moneret-Vautrin; B.Niggemann; F.Ranc

    2009-01-01

    严重过敏反应在儿科急诊越来越多见,但因尚无一致定义,至今难以诊断。很多欧洲国家没有专门针对严重过敏反应的指南。本文由欧洲变态反应学及临床免疫学会(European Academy of Allergology and Clinical Immunology,EAACI)儿童严重过敏反应工作组提供.旨在依据当前有限的资料为儿童严重过敏反应制定一个实用的指南。目前公认,无论在医院还是社区。肌肉注射肾上腺素均是严重过敏反应的一线用药,且一旦诊断就应该使用。

  2. Higher mast cell load decreases the risk of Hymenoptera venom-induced anaphylaxis in patients with mastocytosis

    NARCIS (Netherlands)

    van Anrooij, Bjorn; van der Veer, Eveline; de Monchy, Jan G. R.; van der Heide, Sicco; Kluin-Nelemans, Johanna C.; van Voorst Vader, Pieter C.; van Doormaal, Jasper J.; Oude Elberink, Joanne N. G.

    2013-01-01

    Background: Increased basal serum tryptase (bsT) levels are a well-described risk factor for Hymenoptera venom-induced anaphylaxis (HVAn) in patients allergic to Hymenoptera venom. Increased bsT levels might also indicate the presence of mastocytosis. In this study we evaluated whether the risk of H

  3. Primary varicose veins: Frequency, clinical significance and surgical treatment

    Directory of Open Access Journals (Sweden)

    Vasić Dragan M.

    2004-01-01

    Full Text Available INTRODUCTION According to the definition of the World Health Organization, varicose veins represent abnormally enlarged superficial veins having baggy or cylindrical shape. The most frequent cause of primary varicose veins is the insufficiency of long saphenous vein (LSV, but especially the basin of its connection with femoral vein and perforating veins. OBJECTIVE The objectives of these investigations were: the determination of insufficiency incidence of SSV in cases of LSV insufficiency; the establishment of association of insufficiency of perforating veins of the basin of LSV and SSV; the study of the results of surgical treatment of insufficiency and varicosity of both short and long saphenous veins. METHODS In this study, 100 patients (66 women and 34 men, average age 52.1 years, with clinical symptoms showing the insufficiency and varicosity of long saphenous vein with no change of deep vein system were examined. Ultrasonographic examinations were made using Color Doppler probes - 7.5 and 3.75 MHz (Toshiba Corevison SSA 350 A; the development of incompetence of long saphenous vein (LSV and short saphenous vein (SSV at the level of the junction as well as other incompetent valves were examined. The reflux was defined as a retrograde flow of the duration longer than 0.5 seconds. RESULTS The insufficiency of short saphenous vein was determined by ultrasonographic examination in 34%, while the insufficiency of perforating veins in 80% of patients. 40% of patients were operated (33.3% of females, and 52.9% of males. The most frequent indications for surgical treatment of superficial veins insufficiency were: strong varicosities, clear symptoms and signs, superficial thrombophlebitis and conditions after superficial thrombophlebitis. Surgical treatment was applied in 16% of patients due to recurrence in the basin of long saphenous vein, and in 6% of cases because of the recurrence in the basin of short saphenous vein. Data analysis failed to

  4. Gender-related clinical and neurocognitive differences in individuals seeking treatment for pathological gambling

    DEFF Research Database (Denmark)

    Grant, Jon E; Chamberlain, Samuel R; Schreiber, Liana R N

    2012-01-01

    Understanding variations in disease presentation in men and women is clinically important as differences may reflect biological and sociocultural factors and have implications for selecting appropriate prevention and treatment strategies. The aim of this study was to investigate clinical and cogn...... and cognitive differences in treatment-seeking people with pathological gambling as a function of gender....

  5. Curcumin Ingestion Inhibits Mastocytosis and Suppresses Intestinal Anaphylaxis in a Murine Model of Food Allergy.

    Directory of Open Access Journals (Sweden)

    Shannon R M Kinney

    Full Text Available IgE antibodies and mast cells play critical roles in the establishment of allergic responses to food antigens. Curcumin, the active ingredient of the curry spice turmeric, has anti-inflammatory properties, and thus may have the capacity to regulate Th2 cells and mucosal mast cell function during allergic responses. We assessed whether curcumin ingestion during oral allergen exposure can modulate the development of food allergy using a murine model of ovalbumin (OVA-induced intestinal anaphylaxis. Herein, we demonstrate that frequent ingestion of curcumin during oral OVA exposure inhibits the development of mastocytosis and intestinal anaphylaxis in OVA-challenged allergic mice. Intragastric (i.g. exposure to OVA in sensitized BALB/c mice induced a robust IgE-mediated response accompanied by enhanced OVA-IgE levels, intestinal mastocytosis, elevated serum mMCP-1, and acute diarrhea. In contrast, mice exposed to oral curcumin throughout the experimental regimen appeared to be normal and did not exhibit intense allergic diarrhea or a significant enhancement of OVA-IgE and intestinal mast cell expansion and activation. Furthermore, allergic diarrhea, mast cell activation and expansion, and Th2 responses were also suppressed in mice exposed to curcumin during the OVA-challenge phase alone, despite the presence of elevated levels of OVA-IgE, suggesting that curcumin may have a direct suppressive effect on intestinal mast cell activation and reverse food allergy symptoms in allergen-sensitized individuals. This was confirmed by observations that curcumin attenuated the expansion of both adoptively transferred bone marrow-derived mast cells (BMMCs, and inhibited their survival and activation during cell culture. Finally, the suppression of intestinal anaphylaxis by curcumin was directly linked with the inhibition of NF-κB activation in curcumin-treated allergic mice, and curcumin inhibited the phosphorylation of the p65 subunit of NF-κB in BMMCs. In

  6. [Clinical algorithms in the treatment of status epilepticus in children].

    Science.gov (United States)

    Zubcević, S; Buljina, A; Gavranović, M; Uzicanin, S; Catibusić, F

    1999-01-01

    The clinical algorithm is a text format that is specially suited for presenting a sequence of clinical decisions, for teaching clinical decision making, and for guiding patient care. Clinical algorithms are compared as to their clinical usefulness with decision analysis. We have tried to make clinical algorithm for managing status epilepticus in children that can be applicable to our conditions. Most of the algorithms that are made on this subject include drugs and procedures that are not available at our hospital. We identified performance requirement, defined the set of problems to be solved as well as who would solve them, developed drafts in several versions and put them in the discussion with experts in this field. Algorithm was tested and revised and graphical acceptability was achieved. In the algorithm we tried to clearly define how the clinician should make the decision and to be provided with appropriate feedback. In one year period of experience in working we found this algorithm very useful in managing status epilepticus in children, as well as in teaching young doctors the specifities of algorithms and this specific issue. Their feedback is that they find that it provides the framework for facilitating thinking about clinical problems. Sometimes we hear objection that algorithms may not apply to a specific patient. This objection is based on misunderstanding how algorithms are used and should be corrected by a proper explanation of their use. We conclude that methods should be sought for writing clinical algorithms that represent expert consensus. A clinical algorithm can then be written for many areas of medical decision making that can be standardized. Medical practice would then be presented to students more effectively, accurately and understood better.

  7. A Study of Clinical Supervision Techniques and Training in Substance Abuse Treatment

    Science.gov (United States)

    West, Paul L.; Hamm, Terri

    2012-01-01

    Data from 57 clinical supervisors in licensed substance abuse treatment programs indicate that 28% had completed formal graduate course work in clinical supervision and 33% were professionally licensed or certified. Findings raise concerns about the scope and quality of clinical supervision available to substance abuse counselors. (Contains 3…

  8. A randomized controlled trial of Minnesota day clinic treatment of alcoholics

    DEFF Research Database (Denmark)

    Grønbaek, Morten; Nielsen, Bent

    2007-01-01

    dependence were included in a 1-year clinical trial. MEASUREMENTS: Self-reported drinking pattern and the seven composite scores from the addiction severity index (ASI). FINDINGS: A total of 42 (57%) and 45 (61%) patients (P > 0.05) completed the Minnesota treatment and public treatment, respectively......AIM: To compare the Minnesota day clinic treatment with the traditional public psychosocial treatment. DESIGN: Randomized controlled trial. SETTING: Public out-patient alcohol clinic and privately funded Minnesota day clinic in Denmark. PARTICIPANTS: A total of 148 individuals with alcohol......% of the patients treated according to the Minnesota model were abstainers, while this was the case for 43% of the patients treated in the public out-patient alcohol clinic (P = 0.249). There were insignificant differences in the seven ASI scores. CONCLUSIONS: Twelve months after onset of treatment, the Minnesota...

  9. Clinical Study on Treatment of Senile Vascular Dementia by Acupuncture

    Institute of Scientific and Technical Information of China (English)

    高汉义; 闫乐法; 刘百波; 王燕; 魏学礼; 孙鲁燕; 崔华勤

    2001-01-01

    63 patients with senile vascular dementia were randomly divided into the treatment group (treated by acupuncture) and the control group (treated with piracetam). The authors observed the changes in the score of Hasegawa's dementia scale (HDS), p300, rheoencephalogram, topographic EEG, superoxide dismutase (SOD) activity in erythrocytes, and lipid peroxide (LPO) level in plasma before and after treatment. The statistical data showed that the total effective rate in the treatment group (80.6%) was significantly higher than that in the control group (25%), and the differences in the observed indexes before and after treatment were significant (P0.05), indicating that the acupuncture treatment was superior in immediate therapeutic effect on senile vascular dementia to drug treatment.

  10. CLINICAL RESEARCH ON ACUPUNCTURE TREATMENT OF DEPRESSIVE PSYCHOSIS

    Institute of Scientific and Technical Information of China (English)

    FU Wenbin

    2002-01-01

    Objective: To evaluate the therapeutic effect of acupuncture in the treatment of depressive psychosis.Methods: A total of 62 cases of depressive psychosis patients were randomly divided into treatment group (n=32) and control group (n=30). Acupoints used in treatment group were bilateral Hegu (LI 4), bilateral Taichong (LR 3), Baihui (GV 20) and Yintang (EX-HN 3). Patients of control group were asked to take Fluoxertine hydrochloride 20 mg/d.The therapeutic effect was assessed using Hamilton's depression (HAMD) scales. Results: After 8 weeks' treatment,in treatment and control groups, 4 and 3 cases were cured, 8 and 6 experienced marked improvement, 14 and 14 had improvement, 6 and 7 had no effect, with the effective rates being 81.25% and 76. 66% separately, and no significant difference was found between two groups in HAMD scales (P>0.05). Conclusion: Acupuncture therapy is an effective method for treatment of depressive psychosis.

  11. Regenerative Endodontic Treatment: Report of Two Cases with Different Clinical Management and Outcomes

    Directory of Open Access Journals (Sweden)

    Mehrfam Khoshkhounejad

    2015-11-01

    Full Text Available Endodontic intervention in necrotic immature permanent teeth is usually a clinical challenge. With appropriate case selection, regenerative treatment can be effective, providing a desirable outcome. However, there is still no consensus on the optimal disinfection protocol or the method to achieve predictable clinical outcome. This article presents two cases of regenerative treatment in necrotic immature teeth, using mineral trioxide aggregate (MTA and BiodentineTM as coronal barriers and different irrigants, which led to different clinical outcomes.

  12. Regenerative Endodontic Treatment: Report of Two Cases with Different Clinical Management and Outcomes.

    Science.gov (United States)

    Khoshkhounejad, Mehrfam; Shokouhinejad, Noushin; Pirmoazen, Salma

    2015-06-01

    Endodontic intervention in necrotic immature permanent teeth is usually a clinical challenge. With appropriate case selection, regenerative treatment can be effective, providing a desirable outcome. However, there is still no consensus on the optimal disinfection protocol or the method to achieve predictable clinical outcome. This article presents two cases of regenerative treatment in necrotic immature teeth, using mineral trioxide aggregate (MTA) and Biodentine(TM) as coronal barriers and different irrigants, which led to different clinical outcomes.

  13. Clinical Considerations in Orthodontic Treatment of Teeth with Dentoalveolar Trauma

    OpenAIRE

    2014-01-01

    Dentoalveolar trauma is a very common public health problem. Its influence goes beyond accidents and their impact on teeth, because in the future it becomes a decisive factor if orthodontic treatment is required, because these traumas tend to lead to complications such as root resorption and pulp necrosis. Proper treatment of teeth with a medical history of trauma is essential for successful orthodontic treatment. Los traumas dentoalveolares son un problema de salud pública muy común. La i...

  14. Clinical guide to periodontology: part 3. Multidisciplinary integrated treatment.

    Science.gov (United States)

    Palmer, R M; Ide, M; Floyd, P D

    2014-05-01

    The establishment of periodontal health should be a primary aim in all treatment plans. The methods by which this can be achieved have been dealt with in previous chapters, but there are a number of situations where integration of these treatment methods with other dental disciplines needs to be clarified. To simplify matters this chapter will consider periodontal implications in three main areas: treatment of drifted anterior teeth, pre-restorative procedures and replacement of missing teeth.

  15. Incorporating diagnosis and treatment of hyperhidrosis into clinical practice.

    Science.gov (United States)

    Pariser, David M

    2014-10-01

    Proper billing and coding are essential to document the diagnosis of hyperhidrosis and to assure proper reimbursement for treatment. Providers should become familiar with the payment policies of local health plans to streamline the preauthorization process that is often needed for many treatments commonly used for hyperhidrosis. Having a preprinted letter of medical necessity and patient intake forms that record the necessary historical information about the disease, previous treatments, and other pertinent information will help increase the speed of the office flow. This article presents algorithms for treatment of the various forms of primary focal hyperhidrosis.

  16. A CLINICAL STUDY OF ACUPUNCTURE TREATMENT FOR FACIAL PARALYSIS

    Institute of Scientific and Technical Information of China (English)

    TOH Foh Fook

    2002-01-01

    @@ Peripheral facial paralysis is a common disease with manifestation of facial paralysis. The author's clinical observation on 50 cases of facial paralysis treated mainly with acupuncture showed an effeclive rate of 98%, and the remarkable effectiveness was reported as follow.

  17. Piriformis Syndrome in Fibromyalgia: Clinical Diagnosis and Successful Treatment

    OpenAIRE

    Md Abu Bakar Siddiq; Moshiur Rahman Khasru; Rasker, Johannes J

    2014-01-01

    Piriformis syndrome is an underdiagnosed extraspinal association of sciatica. Patients usually complain of deep seated gluteal pain. In severe cases the clinical features of piriformis syndrome are primarily due to spasm of the piriformis muscle and irritation of the underlying sciatic nerve but this mysterious clinical scenario is also described in lumbar spinal canal stenosis, leg length discrepancy, piriformis myofascial pain syndrome, following vaginal delivery, and anomalous piriformis m...

  18. Hyperthyroidism in four guinea pigs: clinical manifestations, diagnosis, and treatment.

    Science.gov (United States)

    Künzel, F; Hierlmeier, B; Christian, M; Reifinger, M

    2013-12-01

    Hyperthyroidism was diagnosed in four guinea pigs by demonstration of an increased serum total thyroxine concentration. The main clinical signs were comparable with those observed in feline hyperthyroidism and included weight loss despite maintenance of appetite and a palpable mass in the ventral cervical region. Three animals were treated successfully with methimazole for between 13 and 28 months. Clinical signs and regular measurement of circulating total thyroxine concentrations appear to be convenient parameters for monitoring response to medical therapy.

  19. The Journal of Allergy and Clinical Immunology: In Practice - 2016 Year in Review.

    Science.gov (United States)

    Schatz, Michael; Sicherer, Scott H; Zeiger, Robert S

    2017-01-28

    As editors, we concluded that it would be helpful to our readers to write a Year in Review article that highlights the Review, Original, and Clinical Communication articles published in 2016 in The Journal of Allergy and Clinical Immunology: In Practice. We summarized articles on the topics of asthma, rhinitis/rhinosinusitis, food allergy, anaphylaxis, drug allergy, urticarial/angioedema, eosinophilic disorders, and immunodeficiency. Within each topic, epidemiologic findings are presented, relevant aspects of prevention are described, and diagnostic and therapeutic advances are enumerated. Diagnostic tools described include history, skin tests, and in vitro tests. Treatments discussed include behavioral therapy, allergen avoidance therapy, positive and negative effects of pharmacologic therapy, and various forms of immunologic and desensitization management. We hope this review will help you, our readers, consolidate and use this extensive and practical knowledge for the benefit of your patients.

  20. Intracranial Hypotension Syndrome, Diagnosis and Treatment in Radiology Clinics

    Directory of Open Access Journals (Sweden)

    S. Albayram

    2005-08-01

    generalized and pulsating, and often resolve with recumbency. Other clinical features may include nausea or emesis, diplopia, neck pain, disturbance in hearing, vertigo, photophobia, and visual deficits. CSF pressures have reportedly been low, normal, or even high. CSF examination may be normal, or may reveal xanthocromia, lymphocytic pleocytosis, or increased protein possibly secondary to dural venous engorgement. With few exceptions, intracranial MR imaging of intracranial hypotension reveals diffuse pachymeningeal enhancement. Subdural fluid collections and brain descent, as measured by inferior displacement of the iter relative to the incisural line, may also be seen. Pachymeningeal enhancement is characteristically thick, smooth, and uninterrupted . The enhancement is thought to result from accumulation of gadolinium-based contrast material in engorged dural veins and in the interstitium of the dura . Mokri et al reported subdural fluid collections that were mostly bilateral and without mass effect in 69% of patients with intracranial hypotension. The authors also described imaging evidence of brain or brain-stem descent in 62% of patients in their series. Ventricular size in subjects with intracranial hypotension is usually small (1, but can reverse after treatment of the CSF leakage. In the relatively few reports in the literature of spinal imaging findings of intracranial hypotension, MR images showed extradural fluid collections and pachymeningeal enhancement (1, 4–6. MR images may also depict the site of CSF leakage in the spine (1. Herein, we described a case of intracranial hypotension with symmetric bulky epidural enhancement seen along the anterolateral borders of the cervical spine. This enhancement was compatible with engorged epidural venous structures based on their characteristic location in the anterolateral spinal canal and sparing of the midline. Renowden et al (6 described a single case of intracranial hypotension with epidural venous engorgement in

  1. Two Case Reports of Life-Threatening Ethanol-Induced Anaphylaxis

    Directory of Open Access Journals (Sweden)

    S.L. Fernando

    2009-04-01

    Full Text Available Adverse reactions to alcoholic beverages are common and diverse in aetiology. Ethanol-induced anaphylaxis, however, is a rare but often life-threatening condition that warrants careful evaluation in suspected individuals. We present the cases of two patients who developed urticaria, angioedema and throat constriction within minutes of consuming white wine. Both individuals demonstrated no adverse reaction to double-blind placebo-controlled challenges to metabisulphite or sodium salicylate. However, an open challenge to white wine elicited urticaria in both subjects. This reaction was reproduced with a double-blind placebo-controlled challenge to ethanol and was accompanied by a rise in serum total tryptase levels. Positive skin test responses to 2% acetic acid, a breakdown product of ethanol, were elicited from both patients but not from three normal controls. These two cases demonstrate the need for a systematic approach for the evaluation of allergic reactions to alcohol.

  2. Anaphylaxis and other adverse reactions to blue dyes: a case series.

    Science.gov (United States)

    Howard, J D; Moo, V; Sivalingam, P

    2011-03-01

    We report three cases of anaphylaxis during anaesthesia confirmed on intradermal testing to be related to patent blue V dye (Guerbet - Chemical Abstract Service 3536-49-0). All three cases were associated with moderate to severe hypotension. Two cases had delayed onset, and two were associated with a rash. None of the cases were associated with bronchospasm. In all three patients the interference with pulse oximetry readings contributed to difficulties in management. We recommend the use of a test dose of blue dye prior to surgery, as suggested in the manufacturer's product information. We also recommend high vigilance for possible allergic reactions when patent blue dyes are used for sentinel lymph node mapping, because the presentations may be atypical and the reduced pulse oximetry readings may be a distraction.

  3. Motor activity as an unbiased variable to assess anaphylaxis in allergic rats

    Science.gov (United States)

    Abril-Gil, Mar; Garcia-Just, Alba; Cambras, Trinitat; Pérez-Cano, Francisco J; Castellote, Cristina; Franch, Àngels

    2015-01-01

    The release of mediators by mast cells triggers allergic symptoms involving various physiological systems and, in the most severe cases, the development of anaphylactic shock compromising mainly the nervous and cardiovascular systems. We aimed to establish variables to objectively study the anaphylactic response (AR) after an oral challenge in an allergy model. Brown Norway rats were immunized by intraperitoneal injection of ovalbumin with alum and toxin from Bordetella pertussis. Specific immunoglobulin (Ig) E antibodies were developed in immunized animals. Forty days after immunization, the rats were orally challenged with the allergen, and motor activity, body temperature and serum mast cell protease concentration were determined. The anaphylaxis induced a reduction in body temperature and a decrease in the number of animal movements, which was inversely correlated with serum mast cell protease release. In summary, motor activity is a reliable tool for assessing AR and also an unbiased method for screening new anti-allergic drugs. PMID:25716015

  4. CLINICAL RESEARCH ON ACUPUNCTURE TREATMENT OF APHASIS IN AUTISM CHILDREN

    Institute of Scientific and Technical Information of China (English)

    ZHANG Quan-ming; JIN Rui

    2005-01-01

    Objective: To observe the therapeutic effect of acupuncture therapy for aphasis in autism children. Methods: Thirty cases of autism children were divided into acupuncture group (n=20) and medication group (n=10). Intelligence quotient(IQ) and Social adaptive developmental quotient(ADQ) were used to assess the therapeutic effect. Results: After treatment, IQ values increased slightly in medication group and considerably in acupuncture group (P<0.001), and the difference between pre-treatment and post-treatment of acupuncture group was significantly bigger than that of control group (P<0.01). ADQ of two groups increased at different degrees, and that of acupuncture and the difference between post- and pre-treatment of acupuncture group were significantly bigger than those of control group (P<0.001). Conclusion: Acupuncture treatment is effective in improving autism children's speaking ability. raising IQ and ADQ.

  5. A novel model of IgE-mediated passive pulmonary anaphylaxis in rats.

    Science.gov (United States)

    Wex, Eva; Thaler, Eva; Blum, Sylvia; Lamb, David

    2014-01-01

    Mast cells are central effector cells in allergic asthma and are augmented in the airways of asthma patients. Attenuating mast cell degranulation and with it the early asthmatic response is an important intervention point to inhibit bronchoconstriction, plasma exudation and tissue oedema formation. To validate the efficacy of novel pharmacological interventions, appropriate and practicable in vivo models reflecting mast cell-dependent mechanisms in the lung, are missing. Thus, we developed a novel model of passive pulmonary anaphylaxis in rats. Rats were passively sensitized by concurrent intratracheal and intradermal (ear) application of an anti-DNP IgE antibody. Intravenous application of the antigen, DNP-BSA in combination with Evans blue dye, led to mast cell degranulation in both tissues. Quantification of mast cell degranulation in the lung was determined by (1) mediator release into bronchoalveolar lavage, (2) extravasation of Evans blue dye into tracheal and bronchial lung tissue and (3) invasive measurement of antigen-induced bronchoconstriction. Quantification of mast cell degranulation in the ear was determined by extravasation of Evans blue dye into ear tissue. We pharmacologically validated our model using the SYK inhibitor Fostamatinib, the H1-receptor antagonist Desloratadine, the mast cell stabilizer disodium cromoglycate (DSCG) and the β2-adrenergic receptor agonist Formoterol. Fostamatinib was equally efficacious in lung and ear. Desloratadine effectively inhibited bronchoconstriction and ear vascular leakage, but was less effective against pulmonary vascular leakage, perhaps reflecting the differing roles for histamine receptor sub-types. DSCG attenuated both vascular leakage in the lung and bronchoconstriction, but with a very short duration of action. As an inhaled approach, Formoterol was more effective in the lung than in the ear. This model of passive pulmonary anaphylaxis provides a tissue relevant readout of early mast cell activity and

  6. A novel model of IgE-mediated passive pulmonary anaphylaxis in rats.

    Directory of Open Access Journals (Sweden)

    Eva Wex

    Full Text Available Mast cells are central effector cells in allergic asthma and are augmented in the airways of asthma patients. Attenuating mast cell degranulation and with it the early asthmatic response is an important intervention point to inhibit bronchoconstriction, plasma exudation and tissue oedema formation. To validate the efficacy of novel pharmacological interventions, appropriate and practicable in vivo models reflecting mast cell-dependent mechanisms in the lung, are missing. Thus, we developed a novel model of passive pulmonary anaphylaxis in rats. Rats were passively sensitized by concurrent intratracheal and intradermal (ear application of an anti-DNP IgE antibody. Intravenous application of the antigen, DNP-BSA in combination with Evans blue dye, led to mast cell degranulation in both tissues. Quantification of mast cell degranulation in the lung was determined by (1 mediator release into bronchoalveolar lavage, (2 extravasation of Evans blue dye into tracheal and bronchial lung tissue and (3 invasive measurement of antigen-induced bronchoconstriction. Quantification of mast cell degranulation in the ear was determined by extravasation of Evans blue dye into ear tissue. We pharmacologically validated our model using the SYK inhibitor Fostamatinib, the H1-receptor antagonist Desloratadine, the mast cell stabilizer disodium cromoglycate (DSCG and the β2-adrenergic receptor agonist Formoterol. Fostamatinib was equally efficacious in lung and ear. Desloratadine effectively inhibited bronchoconstriction and ear vascular leakage, but was less effective against pulmonary vascular leakage, perhaps reflecting the differing roles for histamine receptor sub-types. DSCG attenuated both vascular leakage in the lung and bronchoconstriction, but with a very short duration of action. As an inhaled approach, Formoterol was more effective in the lung than in the ear. This model of passive pulmonary anaphylaxis provides a tissue relevant readout of early mast cell

  7. POSTTRAUMATIC SHOULDER INSTABILITY IN CHILDREN: CLINICAL PRESENTATION, DIAGNOSIS AND TREATMENT

    Directory of Open Access Journals (Sweden)

    Ярослав Николаевич Прощенко

    2014-09-01

    Full Text Available The article presents an analysis of the treatment of 15 patients with posttraumatic shoulder instability aged 11-17 years, as a result of primary traumatic dislocation and chronic instability. We identified the following causes of chronic shoulder instability: Bankart injury, SLAP-injury; Hill-Sachs defect; fracture of the glenoid, type 3 humeral head-glenoid relation, and retroversion of the humeral head, as well as defects in the treatment of primary shoulder dislocation. Surgical treatment is performed in 7 patients with chronic instability (7 joints. Unsatisfactory result was detected in 1 patient (1 joints, which is caused by a type 3 humeral head-glenoid relation.

  8. Treatment of sepsis: current status of clinical immunotherapy.

    LENUS (Irish Health Repository)

    O'Callaghan, A

    2012-02-03

    While antibiotics address the root cause of sepsis--that of pathogen infection--they fail to provide an adequate cure for the condition. Currently, 30% to 50% of septic patients die, and this figure is likely to increase in line with the proliferation of multi-drug resistant bacteria. With an increased understanding of the immune response, it has been proposed that modulation of this defence mechanism offers the best hope of cure. Many entry-points in the immune system have been identified and targeted therapies have been developed,but why are these not in routine clinical practice? This review examines the latest evidence for the use of immuno-modulating drugs, obtained from human clinical trials. We discuss cytokine-based therapies, steroids and anti-coagulants. Finally, consideration is given as to why successful therapies in the laboratory, and in vivo models, do not automatically translate into clinical benefit

  9. Piriformis syndrome in fibromyalgia: clinical diagnosis and successful treatment.

    Science.gov (United States)

    Siddiq, Md Abu Bakar; Khasru, Moshiur Rahman; Rasker, Johannes J

    2014-01-01

    Piriformis syndrome is an underdiagnosed extraspinal association of sciatica. Patients usually complain of deep seated gluteal pain. In severe cases the clinical features of piriformis syndrome are primarily due to spasm of the piriformis muscle and irritation of the underlying sciatic nerve but this mysterious clinical scenario is also described in lumbar spinal canal stenosis, leg length discrepancy, piriformis myofascial pain syndrome, following vaginal delivery, and anomalous piriformis muscle or sciatic nerve. In this paper, we describe piriformis and fibromyalgia syndrome in a 30-year-old young lady, an often missed diagnosis. We also focus on management of the piriformis syndrome.

  10. Piriformis Syndrome in Fibromyalgia: Clinical Diagnosis and Successful Treatment

    Directory of Open Access Journals (Sweden)

    Md Abu Bakar Siddiq

    2014-01-01

    Full Text Available Piriformis syndrome is an underdiagnosed extraspinal association of sciatica. Patients usually complain of deep seated gluteal pain. In severe cases the clinical features of piriformis syndrome are primarily due to spasm of the piriformis muscle and irritation of the underlying sciatic nerve but this mysterious clinical scenario is also described in lumbar spinal canal stenosis, leg length discrepancy, piriformis myofascial pain syndrome, following vaginal delivery, and anomalous piriformis muscle or sciatic nerve. In this paper, we describe piriformis and fibromyalgia syndrome in a 30-year-old young lady, an often missed diagnosis. We also focus on management of the piriformis syndrome.

  11. Clinical Review of Iressa for the Treatment of NSCLC

    Institute of Scientific and Technical Information of China (English)

    Gang Cheng

    2005-01-01

    ABSTRACT Following development of basic science and the advancement of tumor molecular biology, molecular-target therapy has evolved as a new field for cancer treatment. The agents used act at specific target points such as receptors, kinases and signal transduction systems which are related to tumor growth. These actions result in inhibting proliferation, metastasis, vascularization, and promoting tumor apoptosis. Iressa (gefitinib) which is used for the treatment of NSCLC is a small molecular weight agent acting by inhibition of epidermal growth factor receptor-tyrosine kinase. Iressa was the first approved agent for target therapy for the treatment of NSCLC. This article focuses on the results from clinicai trials and the potential of Iressa for the treatment of NSCLC.

  12. Clinical Presentation And Treatment Outcome In Systemic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    Eapen Bell Raj

    2002-01-01

    Full Text Available The frequency of occurrence of ARA criteria and other constitutional symptoms in SLE and the effect of various treatment modalities on these criteria were studied. Immunological features and arthritis were the commonest findings. Addition of an immunosuppressant.

  13. Clinical competencies for the effective treatment of foster children.

    Science.gov (United States)

    Zilberstein, Karen; Popper, Sally

    2016-01-01

    Despite a high level of documented mental health needs among children who have experienced foster care, research indicates that treatment outcomes are often disappointing. In order to improve outcomes, evidence-based treatments for attachment, trauma and behavioral difficulties are often promoted for this population. However, little research exists on whether or not those interventions effectively address the unique and complex mental health needs of many foster children. While a rather robust literature exists on foster children's multifaceted difficulties, most treatments do not fully represent that range and complexity in their interventions. This article attempts to begin to fill that gap by outlining the knowledge and skills clinicians must acquire if they are to effectively treat foster children. Treatment of foster children should be seen as a subspecialty within the field of child mental health, and trainings that help clinicians gain more knowledge of foster children's unique needs should be more available.

  14. Diabetes mellitus and spinal epidural abscess: clinical or surgical treatment?

    Science.gov (United States)

    Felício, João S; Martins, Carlliane Lins P; Liberman, Bernardo

    2011-12-01

    Spinal epidural abscess (SEA) is an uncommon condition and its most important predisposing factor is diabetes mellitus. Although the treatment of choice is prompt surgical abscess evacuation, followed by antibiotic therapy, successful conservative treatment of SEA has been reported in some cases. We describe a SEA case in a 23-year old white woman with diabetes for 14 years, who was successfully treated only with antibiotics, and achieved full recovery at the fourth month of follow-up.

  15. Treatment of periodontal patients-current clinical concepts

    Institute of Scientific and Technical Information of China (English)

    Cristiano Tomasi; Claudio Soldini; Jan L Wennstr(o)m

    2007-01-01

    The main goal of the treatment of patients with periodontitis is to establish adequate infection control.To satisfy demands for acceptable aesthetics and chewing function with good long-term prognosis in patients with periodontitis requires the establishment of adequate infection control.Pocket instrumentation (scaling and root planing with or without flap elevation),combined with effective self-performed supragingival plaque control measures,constitutes the basic treatment modalities.

  16. CLINICAL RESEARCH ON ACUPUNCTURE TREATMENT OF DEPRESSIVE PSYCHOSIS

    Institute of Scientific and Technical Information of China (English)

    符文彬

    2002-01-01

    Objective:To evaluate the therapeutic effect of acupuncture in the treatment of depressive psychosis.Methods:A total of 62 cases of depressive psychosis patients were randomly divided into treatment group(n=32) and control group(n=30).Acupoints used in treatment group were bilateral Hegu (LI 4),bilateral Taichong (LR 3),Baihui (GV 20) and Yintang (EX-HN 3).Patients of control group were asked to take Fluoxertine hydrochioride 20mg/d.The therapeutic effect was assessed using Hamilton's depression (HAMD) scales.Results:After 8 weeks' treatment,in treatment and control groups,4 and 3 cases were cured,8 and 6experienced marked improvement,14 and 14 had improvement,6 and 7 had no effect,with the effective rates being 81.25% and 76.66% separately,and no significant difference was found between two groups in HAMD scales (P>0.05).Conclusion:Acupuncture therapy is an effective method for treatment of depressive psychosis.

  17. Clinical Experience in TCM Treatment of Chronic Cervicitis

    Institute of Scientific and Technical Information of China (English)

    周宜强; 范宏宇

    2002-01-01

    @@ Chronic cervicitis is a common disease in the female reproductive system, which may be the inducing factor for carcinoma of uterine cervix. It is clinically manifested by sticky and foul leukorrhagia, contact hemorrhage, pain in the lower limbs or lumbosacral region, dysmenorrhea and infertility.

  18. Treatment of hyperlipoidemia by Xiaozhi capsule: a clinical efficacy research

    Institute of Scientific and Technical Information of China (English)

    王建平

    2013-01-01

    Objective To observe the clinical effect and efficacy of Xiaozhi Capsule (XZC) ,a Chinese medicine preparation for tonifying Gan-Shen,invigorating Pi to dissipate dampness (TGSIPDD) on total cholesterol (TC) ,triglyceride (TG) ,high-density lipoprotein cholesterol (HDLC) ,low-density lipoprotein cholesterol (LDL-C) ,and

  19. Experimental and Clinical Approaches to Hernia Treatment and Prevention

    NARCIS (Netherlands)

    J.A. Halm (Jens)

    2007-01-01

    textabstractHernia surgery is one of the earliest forms of surgery altogether. Clinical diagnosis, anatomy and surgical procedures follow each other closely and hernia recurrences present a challenge to all surgeons. Recent developments in the field of herniology encompass biological intervention, t

  20. Clinical analysis and treatment of central pain due to headinjury

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    @@Central pain is induced by the involvement of the abnormal pain pathway due to diseases of the central nervous system. Central pain after brain trauma is common clinically, but it is often misdiagnosed and neglected because of lack of objective disturbances. We treated 20 cases of central pain after head injury by invigorating blood circulation and satisfactory result was obtained.

  1. Trichomonas vaginalis: a review of epidemiologic, clinical and treatment issues.

    Science.gov (United States)

    Kissinger, Patricia

    2015-08-05

    Trichomonas vaginalis (TV) is likely the most common non-viral sexually transmitted infection (STI) in the world. It is as an important source of reproductive morbidity, a facilitator of HIV transmission and acquisition, and thus it is an important public health problem. Despite its importance in human reproductive health and HIV transmission, it is not a reportable disease and surveillance is not generally done. This is problematic since most persons infected with TV are asymptomatic. Metronidazole (MTZ) has been the treatment of choice for women for decades, and single dose has been considered the first line of therapy. However, high rates of retest positive are found among TV infected persons after single dose MTZ treatment. This has not been explained by drug resistance since in vitro resistance is only 2-5 %. Treatment failure can range from 7-10 % and even higher among HIV+ women. Treatment efficacy may be influenced by vaginal ecology. The origins of repeat positives need further explanation and better treatment options are needed.

  2. Clinical update: treatment of hyperthyroidism in Graves' ophthalmopathy.

    Science.gov (United States)

    Azzam, Ibrahim; Tordjman, Karen

    2010-03-01

    The presence of thyroid eye disease (TED) may influence the treatment of hyperthyroidism in patients with Graves' disease. Moreover, treatment of hyperthyroidism may affect the course of Graves' ophthalmopathy (GO). We review the literature and summarise recent knowledge about the impact of treatment modality for hyperthyroidism in GO. Anti-thyroid drugs (ATDs) remain the simplest and safest way to treat hyperthyroidism in patients with GO, but they are associated with a high relapse rate of hyperthyroidism and they have no effect on the course of GO. Radioactive iodine (RAI) treatment may be associated with exacerbation of GO especially in high risk patients, when glucocorticoid prophylaxis may be indicated. Large prospective trials are still lacking to define the exact effect of RAI on the course of GO, particularly in relation to other known risk factors. Likewise, clear guidelines for prophylactic glucocorticoid therapy are needed. RAI should be cautiously used in patients with more severe ophthalmopathy and concomitant I.V glucocorticoids should be considered. Thyroid surgery, whether total or subtotal thyroidectomy, has no effect on the course of ophthalmopathy. However, total thyroid ablation that combines surgery with radioactive iodine, as a means of achieving thyroid antigen disappearance, is increasingly gaining attention for the treatment of patients with GO, especially those undergoing thyroid surgery, but also for those with severe unresponsive ophthalmopathy. Studies supporting this approach are awaited.

  3. CLINICAL GUIDELINE FOR THE TREATMENT OF DIABETIC NEPHROPATHY

    Directory of Open Access Journals (Sweden)

    R. A. Nadeeva

    2015-01-01

    Full Text Available Due to the high prevalence of diabetes the annual increase of the number of patients with diabetic nephropathy is evidenced. The progressive course of this sequellae and a high percentage of end-stage kidney disease requires a clear approach of early diagnosis, the development of methods of prevention and early treatment from the perspective of evidence-based medicine. This review provides recommendations on glucose-lowering treatment, monitoring of blood pressure and proteinuria, hyperlipidemia. Defi ned individual targets of the correction of hyperglycaemia, depending on the level of albuminuria excretion and the severity of the patient. Indicated the possibilities of applications of certain antidiabetic drugs, depending on the level of glomerular fi ltration rate. Drugs of the fi rst and second line are marked for the selection of antihypertensive treatment. Showed the possible ways to reduce the level of albuminuria. Presented recommendations for the management of patients, depending on the stage of nephropathy.

  4. Clinical Research and Surgical Treatment of Posttraumatic Epilepsy

    Institute of Scientific and Technical Information of China (English)

    蒋太鹏; 高永中; 傅友增

    2004-01-01

    In order to investigate the susceptible factors of posttraumatic epilepsy (PTE) and the surgical treatment, the relative factors of 18 eases of intractable PTE and 35 cases of non-PTE patients with posttraumatic seizures (PTS) and the surgical treatment of PTE patients were studied retrospectively, The results showed that there was significant difference in the degree of unconsciousness after head injury, incidence of intracerebral hematoma and acute subdural hematoma between PTE group and non-PTE group. Of the 18 cases of PTE undergoing surgical treatment, the effectiveness of 11 cases was satisfactory and that of the remaining 7 was not. Between the two groups, there was difference in the localization of interictal epileptic discharge (IED) and ictal discharge (ID) as demonstrated by preoperative EEG. It was concluded that PTE was associated with the severity of head injury and intracranial hematoma. The localization of epileptogenic loci by preoperative EEG presumably contributed to the PTE surgical effects.

  5. Clinical Observations on Acupuncture Treatment of Ulcerative Colitis

    Institute of Scientific and Technical Information of China (English)

    YANG Shun-yi

    2003-01-01

    Purpose To observe the curative effect of acupuncture on ulcerative colitis. Methods and Results Sixty-two patients with ulcerative colitis were treated mainly by needle-warming moxibustion at Lower He-Sea points and Front-mu points, with the cooperation of syndomic differentiation-based selection of acupoints and oral administration of patent Chinese medicine. After treatment the total effective rate was 91.94% and T cell subgroups returned nearly to normal. Conclusion This treatment method can help the internal environment of human immune system to tend to balance.

  6. Juvenile nasopharyngeal angiofibroma: Clinical diagnosis and treatment experience

    Directory of Open Access Journals (Sweden)

    Sladoje Radmila

    2002-01-01

    Full Text Available Juvenile nasopharyngeal angiofibroma is an infrequent epi-pharyngeal tumor necessitating particular diagnostic and therapeutic procedures in comparison to other benign epipharyngeal tumors due to its expansive growth tendency. Our retrospective study is aimed at presenting clinical casuistry of the tumor in order to evaluate modern diagnostic and therapeutic possibilities. The study included 13 male patients, aged 13-24 years, who were hospitalized, diagnostically assessed and surgically treated at the Institute of Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia over the period 1990 - June 2001. The following parameters were analyzed: sex, age groups, preoperative symptoms of the disease, diagnostic methods, embolization, local tumor spreading, number and time of tumor relapses and surgical approach.

  7. Digital immediate dentures treatment: A clinical report of two patients.

    Science.gov (United States)

    Neumeier, Toni Tien; Neumeier, Harold

    2016-09-01

    The use of computer-aided engineering (CAE) and computer-aided design and computer-aided manufacturing (CAD-CAM) technology to fabricate complete dentures was introduced in 2011. Clinical procedures for digital immediate dentures can be identical to those for conventional immediate dentures and can be simplified by leaving all remaining dentition until the time of extraction and denture placement. Through the digital process, a single digital design and a definitive digital record are created which can be used to fabricate the immediate digital denture and surgical reduction guide for alveoloplasty. Digital immediate dentures can be relined using the same process as for conventional dentures. The definitive digital dentures can be fabricated with a reline impression and new centric relation record, using the existing digital immediate denture without additional clinical procedures. Providing patients with digital immediate dentures is a viable trend.

  8. Ischemic colitis:Clinical practice in diagnosis and treatment

    Institute of Scientific and Technical Information of China (English)

    Angeliki Theodoropoulou; Ioannis E Koutroubakis

    2008-01-01

    Ischemic colitis is the most common form of ischemic injury of the gastrointestinal tract and can present either as an occlusive or a non-occlusive form.It accounts for 1 in 1000 hospitalizations but its incidence is underestimated because it often has a mild and transient nature.The etiology of ischemic colitis is multifactorial and the clinical presentation variable.The diagnosis is based on a combination of clinical suspicion,radiographic,endoscopic and histological findings.Therapy and outcome depends on the severity of the disease.Most cases of the non-gangrenous form are transient and resolve spontaneously without complications.On the other hand,high morbidity and mortality and urgent operative intervention are the hallmarks of gangrenous ischemic colitis.

  9. A clinical review of the treatment of catatonia

    OpenAIRE

    Pascal eSienaert; Dhossche, Dirk M.; Davy eVancampfort; Marc eDe Hert; Gábor eGazdag

    2014-01-01

    Catatonia is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. A screening instrument, such as the Bush-Francis Catatonia ...

  10. A Clinical Review of the Treatment of Catatonia

    OpenAIRE

    Sienaert, Pascal; Dhossche, Dirk M.; Vancampfort,Davy; De Hert, Marc; Gazdag, Gábor

    2014-01-01

    Catatonia is a severe motor syndrome with an estimated prevalence among psychiatric inpatients of about 10%. At times, it is life-threatening especially in its malignant form when complicated by fever and autonomic disturbances. Catatonia can accompany many different psychiatric illnesses and somatic diseases. In order to recognize the catatonic syndrome, apart from thorough and repeated observation, a clinical examination is needed. A screening instrument, such as the Bush-Francis Catatonia ...

  11. Clinical utility of lenalidomide in the treatment of myelodysplastic syndromes

    Directory of Open Access Journals (Sweden)

    Abou Zahr A

    2014-12-01

    Full Text Available Abdallah Abou Zahr,1 Ehab Saad Aldin,2 Rami S Komrokji,3 Amer M Zeidan4 1Section of Hematology/Oncology, Department of Internal Medicine, Mount Sinai Beth Israel, New York City, New York, NY, 2Department of Internal Medicine, Medstar Good Samaritan Hospital, Baltimore, MD, 3Department of Malignant Hematology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 4Division of Hematology, Department of Medicine, Yale University, New Haven, CT, USA Abstract: Myelodysplastic syndromes (MDS represent a heterogeneous group of acquired clonal hematopoietic disorders characterized by peripheral blood cytopenias, paradoxical BM hypercellularity, ineffective hematopoiesis, and increased risk of leukemic transformation. Risk stratification, using different prognostic scores and markers, is at the core of MDS management. Deletion 5q [del(5q] MDS is a distinct class of MDS characterized by the haploinsufficiency of specific genes, microRNAs, and proteins, which has been linked to increased sensitivity to the drug lenalidomide. Phase II and III clinical trials have demonstrated the efficacy of lenalidomide in improving clinical outcomes of patients with del(5q MDS, including reduction in red blood cell transfusion requirements and improvements in quality of life. Lenalidomide has also demonstrated some activity in non-del(5q lower-risk MDS as well as higher-risk MDS, especially in combination with other agents. In this paper, we review the pathogenesis of del(5q MDS, the proposed mechanisms of action of lenalidomide, the major clinical trials that documented the activity of lenalidomide in different MDS populations, potential predictors of benefit from the drug and suggested mechanisms of resistance, and the use of combination strategies to expand the clinical utility of lenalidomide in MDS. Keywords: deletion 5q, lenalidomide, myelodysplastic syndromes, 5q-syndrome

  12. Demographics, clinical features and treatment of pediatric celiac disease

    OpenAIRE

    Tapsas, Dimitrios

    2015-01-01

    Celiac disease (CD) is a chronic small intestinal immune-mediated enteropathy triggered by ingestion of gluten-containing food in genetically predisposed subjects. The enteropathy is presented with a wide variety of clinical manifestations, which can occur even outside the gastrointestinal tract. In the majority of cases, the diagnosis of CD is based on a small intestinal biopsy showing mucosal alterations, i.e. intraepithelial lymphocytosis, crypt hyperplasia, and villous atrophy. The treatm...

  13. Mandibular condylar hyperplasia: clinical, histopathological, and treatment considerations.

    Science.gov (United States)

    Angiero, Francesca; Farronato, Giampietro; Benedicenti, Stefano; Vinci, Raffaele; Farronato, Davide; Magistro, Sarah; Stefani, Michele

    2009-01-01

    Condylar hyperplasia is a rare disorder characterized by an increased volume of the condyle, ramus, and mandibular body leading to facial asymmetry. We present three cases of condylar hyperplasia: two women and one man, age range 27 to 34. Clinically, all three patients showed a deviation of the mandible to the opposite side and a protruded position of the chin, hypertrophy of the lower border of the mandible, combined with an elongation of the mandibular ramus, open-bite on the deformed side, and cross-bite on the opposite side. In all three cases, scintigraphy showed an increased uptake. Radiography and CT scanning confirmed the clinical diagnosis and patients were subjected to surgery, comprising high condylectomy on the affected side with access in the pre-tragus area. The surgical piece sent to the Institute of Pathological Anatomy for histological examination revealed a nonuniform picture, in terms of both the depth of cartilage islands and the thickness of the fibrous layer covering the joint surface. Common to all three cases, however, was the apparent evolution of fibrous tissue to cartilage, and of this to compact bone tissue. At two-four years, all cases have maintained a good occlusal response. The asymmetric deformity of the mandible resulting from the rare condition of hemimandibular hyperplasia is presented and the clinical, histopathological and therapeutic aspects discussed.

  14. Completion of treatment for latent tuberculosis infection with monthly drug dispensation directly through the tuberculosis clinic.

    Directory of Open Access Journals (Sweden)

    Claudia C Dobler

    Full Text Available SETTING: An Australian metropolitan TB clinic where treatment for latent tuberculosis infection (LTBI comprises six months of isoniazid, self-administered but dispensed monthly by the clinic. OBJECTIVE: To determine the proportion of patients who complete treatment for LTBI and to identify factors associated with non-completion. METHODS: Clinical files of all patients receiving treatment for LTBI between 01/2000 and 12/2010 were reviewed. The study population comprised all patients who were commenced on isoniazid as treatment for LTBI. Odds ratios (OR for completing treatment were estimated by logistic regression. RESULTS: Of 216 patients who commenced isoniazid treatment for LTBI, 163 (75% completed six months treatment [corrected]. Fifty-three percent of the 53 patients who did not complete treatment dropped out after three months treatment. The mean (SD age of the patients was 27 (16 years and 123 (57% were female. The majority of patients (59% were born overseas and 69% received treatment for LTBI because they were contacts of patients with TB. Patients' sex, age, country of birth, time since immigration for overseas born people, health care worker status, TST conversion status, chest x-ray findings, language, employment status and the indication for which treatment of LTBI was prescribed were not significantly related to treatment completion. CONCLUSION: In a setting where isoniazid is dispensed monthly by the TB clinic, a relatively high proportion of patients who commence treatment for LTBI complete the six month scheduled course of treatment. The study did not identify any patient characteristics that predicted treatment completion. Interventions to improve completion rates should extend over the whole duration of treatment.

  15. Predicting Future Clinical Adjustment from Treatment Outcome and Process Variables.

    Science.gov (United States)

    Patterson, G. R.; Forgatch, Marion S.

    1995-01-01

    Issues related to the use of outcome and process data from the treatment of antisocial children to predict future childhood adjustment were examined through a study of 69 children. Data supported the hypothesis that measures of processes thought to produce changes in child behavior would serve to predict future adjustment. (SLD)

  16. Clinical Results of Hypomethylating Agents in AML Treatment

    Directory of Open Access Journals (Sweden)

    Marjan Cruijsen

    2014-12-01

    Full Text Available Epigenetic changes play an important role in the development of acute myeloid leukemia (AML. Unlike gene mutations, epigenetic changes are potentially reversible, which makes them attractive for therapeutic intervention. Agents that affect epigenetics are the DNA methyltransferase inhibitors, azacitidine and decitabine. Because of their relatively mild side effects, azacitidine and decitabine are particularly feasible for the treatment of older patients and patients with co-morbidities. Both drugs have remarkable activity against AML blasts with unfavorable cytogenetic characteristics. Recent phase 3 trials have shown the superiority of azacitidine and decitabine compared with conventional care for older AML patients (not eligible for intensive treatment. Results of treatment with modifications of the standard azacitidine (seven days 75 mg/m2 SC; every four weeks and decitabine (five days 20 mg/m2 IV; every four weeks schedules have been reported. Particularly, the results of the 10-day decitabine schedule are promising, revealing complete remission (CR rates around 45% (CR + CRi (i.e., CR with incomplete blood count recovery around 64% almost comparable with intensive chemotherapy. Application of hypomethylating agents to control AML at the cost of minimal toxicity is a very promising strategy to “bridge” older patients with co-morbidities to the potential curative treatment of allogeneic hematopoietic cell transplantation. In this article, we discuss the role of DNA methyltransferase inhibitors in AML.

  17. Personalised treatment with oral anticoagulant drugs : clinical and economic issues

    NARCIS (Netherlands)

    Verhoef, T.I.

    2013-01-01

    Coumarin derivatives such as acenocoumarol, phenprocoumon and warfarin are frequently used for the prevention of stroke and systemic embolism in patients with atrial fibrillation or for the treatment of venous thromboembolism. These oral anticoagulants have a narrow therapeutic range and a large var

  18. Tiagabine in treatment refractory bipolar disorder : a clinical case series

    NARCIS (Netherlands)

    Suppes, T; Chisholm, KA; Dhavale, D; Frye, MA; Atshuler, LL; McElroy, SL; Keck, PE; Nolen, WA; Kupka, R; Denicoff, KD; Leverich, GS; Rush, AJ; Post, RM

    2002-01-01

    Objectives: Anticonvulsants have provided major treatment advances for patients with bipolar disorder. Many of these drugs, including several with proven efficacy in bipolar mania or depression, enhance the activity of the gamma-amino butyric acid (GABA) neurotransmitter system. A new anticonvulsant

  19. Review of Clinical Studies of the Treatment of Ulcerative Colitis Using Acupuncture and Moxibustion

    Directory of Open Access Journals (Sweden)

    Jun Ji

    2016-01-01

    Full Text Available Background. Clinical studies suggest that acupuncture and moxibustion therapy in ulcerative colitis (UC can regulate bowel inflammation, and these treatments have the advantages of low rates of adverse reactions and recurrence as well as good long-term efficacy. We reviewed the current status of clinical studies of the treatment. Methods. Randomized controlled trials (RCTs using the therapy as the major intervention for treating UC were included from 1995 to 2015. The extracted data mainly included diagnostic standards, treatment methods, selection of acupoints, treatment times and courses, and efficacy determination criteria. Results. The use of diagnostic standards and efficacy criteria lacked unification and standardization. There were two main groups: acupuncture and moxibustion therapy combined with drug treatment and the use of all types of acupuncture and moxibustion therapy alone or in combination. The acupoint compositions included distal-proximal point combinations, back-shu point and front-mu point combinations, and acupuncture through meridians. The treatment courses in all the clinical trials had large variations. Conclusion. The treatment of UC in the examined articles was mainly based on the classical theory. However, many links of the clinical regimen design were still lacking, which affected the repeatability of the clinical studies and the accuracy of the clinical conclusions.

  20. Clinical Observation on Treatment of Migraine with Acupuncture

    Institute of Scientific and Technical Information of China (English)

    CHEN Ze-lin

    2006-01-01

    Objective: To study the effect of puncturing points Taiyang (Ex-HN 5), Jiaosun (TE 20), Qiuxu (GB 40) and Shenmai (BL 62) on migraine. Methods: The 120 cases in the treatment group were treated with routine acupuncture therapy, while the 40 cases in the control group were treated with Ergotamine and Caffeine Tablet, and then the therapeutic effect and recovery time of the two groups were compared. Results: The recovery rate of the treatment group was 90.0%, which is higher than 70.0% of the control group (P< 0.01). The total effective rate of the treatment group was 100%, which is better than 92.5% of the control group (P < 0.05),The therapeutic effect of the treatment group was significantly better than the control group and the treatment group needed shorter treatment period (P< 0.05). Conclusions: Acupuncture has higher recovery rate and total effective rate as well as shorter treatment period than oral ergotamine and caffeine tablets, which indicated that acupuncture is superior to the routinely-administered oral western tablets in treating migraine.%目的:研究针刺太阳、角孙、丘墟和申脉对偏头痛的影响.方法:观察组120例患者采用常规针刺疗法,对照组40例患者采用口服麦咖片法,并将两组的治疗效果和痊愈时间进行对比观察.结果:观察组痊愈率90.0%高于对照组痊愈率70.0%(P<0.05).观察组总有效率100%好于对照组总有效率92.5%(P<0.01).观察组疗效明显优于对照组.而且观察组患者的治疗时间短(P<0.05).结论:针刺疗法痊愈率、总有效率均高于麦角胺咖啡因片,且疗程短,提示本法疗效优于口服常规西药的方法.

  1. Cost and Utilization of Retail Clinics vs. Other Providers for Treatment of Pediatric Acute Otitis Media.

    Science.gov (United States)

    Duncan, Ian; Clark, Kara; Wang, Stacy

    2016-10-01

    A common acute condition seen by providers in retails clinics is the evaluation and treatment of acute otitis media (AOM) in children younger than age 20. Annual direct treatment costs for AOM were US $5.3 billion in 1998 dollars. Based on the experience of a large retail pharmacy employer, the authors compared AOM episodes in covered dependents younger than age 20 in retail clinic states to those in states without retail clinic access. Relative costs as well as frequency of visits and antibiotic prescriptions were analyzed for both retail clinic-based, and non-retail clinic-based episodes. Rates of AOM episodes were lower in retail clinic than in non-retail clinic states (62.5 vs. 76.9 per 1000 members per year; P retail clinic and non-retail clinic states (1.417 vs. 1.430, respectively; P = 0.657), suggesting that retail clinics do not result in an increase in overall utilization. On a risk-adjusted basis, retail clinic episodes cost approximately $30-$130 less than community episodes, depending on year. In retail clinic states, the antibiotic prescription fill rate was 95.4% for retail clinic episodes and 82.8% for community episodes, consistent with rates in the literature. This study confirms results of earlier studies that retail clinics are a less costly setting than the community for the treatment of episodes of otitis media There also is little evidence that retail clinics lead to duplication of services (patients receiving follow-up care in other settings).

  2. Client Preferences Affect Treatment Satisfaction, Completion, and Clinical Outcome: A Meta-Analysis

    Science.gov (United States)

    Lindhiem, Oliver; Bennett, Charles B.; Trentacosta, Christopher J.; McLear, Caitlin

    2014-01-01

    We conducted a meta-analysis on the effects of client preferences on treatment satisfaction, completion, and clinical outcome. Our search of the literature resulted in 34 empirical articles describing 32 unique clinical trials that either randomized some clients to an active choice condition (shared decision making condition or choice of treatment) or assessed client preferences. Clients who were involved in shared decision making, chose a treatment condition, or otherwise received their preferred treatment evidenced higher treatment satisfaction (ESd = .34; p < .001), increased completion rates (ESOR = 1.37; ESd = .17; p < .001), and superior clinical outcome (ESd = .15; p < .0001), compared to clients who were not involved in shared decision making, did not choose a treatment condition, or otherwise did not receive their preferred treatment. Although the effect sizes are modest in magnitude, they were generally consistent across several potential moderating variables including study design (preference versus active choice), psychoeducation (informed versus uninformed), setting (inpatient versus outpatient), client diagnosis (mental health versus other), and unit of randomization (client versus provider). Our findings highlight the clinical benefit of assessing client preferences, providing treatment choices when two or more efficacious options are available, and involving clients in treatment-related decisions when treatment options are not available. PMID:25189522

  3. [Major depression in primary care and clinical impacts of treatment strategies: a literature review].

    Science.gov (United States)

    Beaucage, Clément; Cardinal, Lise; Kavanagh, Mélanie; Aubé, Denise

    2009-01-01

    Major or clinical depression represents a frequent mental illness that is often associated with a high level of morbidity and mortality. Yet, major depression remains under-diagnosed and under-treated. On the level of treatment, it would appear desirable for reasons of better prognosis, to aim more than the simple reduction of depressive symptoms and target their remission resolutely and the fastest return to the individual's optimal functioning. This article presents a systematic review of the literature relating to the clinical impacts of treatment strategies aiming at the improvement of services offered to people who suffer of clinical depression and who consult in primary care. The authors summarize results drawn from 41 studies that include a measurement of the clinical impacts (reduction of symptoms, response, remission and functioning) of various treatment strategies. It appears that using complex treatment strategies favour positive outcomes. The authors propose various paths of research to further increase current knowledge.

  4. The diagnosis, treatment and prevention of gout: The 2014 international clinical guidelines

    Directory of Open Access Journals (Sweden)

    N. T. Vatutin

    2015-01-01

    Full Text Available The given description of the 2014 new international guidelines prepared by the International Panel of Rheumatologists in the 3e Initiative reflects the diagnosis, treatment and prevention of gout, which are adapted for clinical practice.

  5. Topical corticosteroids in the treatment of acute sunburn - A randomized, double-blind clinical trial

    DEFF Research Database (Denmark)

    Faurschou, A.; Wulf, Hans Chr.

    2008-01-01

    Objective: To examine the effect of topical corticosteroid treatment on acute sunburn. Design: Randomized, double-blind clinical trial. Setting: University dermatology department. Patients: Twenty healthy volunteers with Fitzpatrick skin types I (highly sensitive, always burns easily, tans...

  6. Zoonotic bacterial meningitis in adults: clinical characteristics, etiology, treatment and outcome

    NARCIS (Netherlands)

    van Samkar, A.

    2016-01-01

    In this thesis, we describe the clinical characteristics, etiology, treatment and outcome of zoonotic bacterial meningitis. Each chapter describes meningitis patients infected by a specific zoonotic pathogen, such as Streptococcus equi, Streptococcuis suis, Capnocytophaga canimorsus, Campylobacter f

  7. A cautionary tale: anaphylaxis to isosulfan blue dye after 12 years and 3339 cases of lymphatic mapping.

    Science.gov (United States)

    Kaufman, Gabriel; Guth, Amber A; Pachter, H Leon; Roses, Daniel F

    2008-02-01

    Sentinel node biopsy has become the standard method for lymphatic staging in early-stage breast cancer and melanomas. The most commonly used technique uses both a radioactive tracer as well as blue dye, usually isosulfan blue. In this report, we discuss two episodes of anaphylaxis to isosulfan blue during lymphatic mapping, occurring 12 years and 3339 lymphatic mapping cases after adoption of the technique, and discuss management issues raised by these events.

  8. Clinical characteristics and treatment of neurofibroma of the choroid

    Institute of Scientific and Technical Information of China (English)

    WEI Wen-bin; JIE Ying; MO Jing; LI Bin

    2012-01-01

    Background Neurofibroma is a kind of benign neoplasm that derives from nervous tissues.Though this tumor is the most common types in the peripheral nervous system,it is rarely seen in the choroid and easy to be misdiagnosed of choroidal melanoma.The aim of this study was to review the clinical features of neurofibroma of the choroid in the Chinese race.Methods A retrospective case series design was used.Two male and one female patients diagnosed with choroidal neurofibroma in Beijing Tongren Eye Center were included in this study.The clinical histories were abstracted from the patients' medical records.Routine eye examinations including visual acuity,intraocular pressure,slit lamp and ophthalmoscope were performed.Auxiliary examinations included fluorescein fundus angiography (FFA),AB-ultrasound scan,color doppler imaging (CDI),and magnetic resonance imaging (MRI).Local resection of the tumors was performed and the specimens underwent pathological examinations.Results The tumors were of yellow-pink color with pigmentation on the surface.CDI showed arterial blood signals in the tumor and MRI showed high-intensity in the T1-weighted image and a slightly increased intensity in the T2-weighted image.FFA and indocyaninegreen angiography demonstrated the tumors were of hypofluorescence at early stage and hyperfluorescence with prominent leakage at late stage.The pathological examination confirmed the tumors were choroidal neurofibroma.After 5-10-year follow-up,there were no recurrences of the tumors and the retinas were well attached.Conclusions Choroidal neurofibroma is difficult to be diagnosed clinically and pathological confirmation is important.These tumors can be managed conservatively by local resection.

  9. Personalized Clinical Diagnosis in Data Bases for Treatment Support in Phthisiology.

    Science.gov (United States)

    Lugovkina, T K; Skornyakov, S N; Golubev, D N; Egorov, E A; Medvinsky, I D

    2016-01-01

    The decision-making is a key event in the clinical practice. The program products with clinical decision support models in electronic data-base as well as with fixed decision moments of the real clinical practice and treatment results are very actual instruments for improving phthisiological practice and may be useful in the severe cases caused by the resistant strains of Mycobacterium tuberculosis. The methodology for gathering and structuring of useful information (critical clinical signals for decisions) is described. Additional coding of clinical diagnosis characteristics was implemented for numeric reflection of the personal situations. The created methodology for systematization and coding Clinical Events allowed to improve the clinical decision models for better clinical results.

  10. Clinical Characteristics and Treatment of Cardiomyopathies in Children.

    Science.gov (United States)

    Price, Jack F; Jeewa, Aamir; Denfield, Susan W

    2016-01-01

    Cardiomyopathies are diseases of the heart muscle, a term introduced in 1957 to identify a group of myocardial diseases not attributable to coronary artery disease. The definition has since been modified to refer to structural and or functional abnormalities of the myocardium where other known causes of myocardial dysfunction, such as systemic hypertension, valvular disease and ischemic heart disease, have been excluded. In this review, we discuss the pathophysiology, clinical assessment and therapeutic strategies for hypertrophic, dilated and hypertrophic cardiomyopathies, with a particular focus on aspects unique to children.

  11. Caspofungin: Pharmacodynamics, pharmacokinetics, clinical uses and treatment outcomes.

    Science.gov (United States)

    Song, Jessica C; Stevens, David A

    2016-09-01

    Over the past decade, echinocandins have emerged as first-line antifungal agents for many Candida infections. The echinocandins have a unique mechanism of action, inhibiting the synthesis of β-1,3-d-glucan polymers, key components of the cell wall in pathogenic fungi. Caspofungin was the first echinocandin antifungal agent to become licensed for use. The objectives of this review are to summarize the existing published data on caspofungin, under the subject headings of chemistry and mechanism of action, spectrum of activity, pharmacodynamics, pharmacokinetics, clinical studies, safety, drug interactions, dosing, and an overview of the drug's current place in therapy.

  12. [A clinical observation of pericoronitis treatment with pulse semiconductor laser].

    Science.gov (United States)

    Lu, Shan; Fang, Yuan

    2004-08-01

    In order to valuate the effect of pericoronitis treated with pulse semiconductor laser. As a treatment group, 24 ones drawn ramdomly from 48 cases of pericoronitis were given periodontal radiation, point-radiation therapy and pharmacotherapy as well. While another 24 cases as a contrast group were given pharmacotherapy only. On the 3rd day and the 5th day the degree of pain and restriction of mouth opening of the two groups were graded, contrasted and processed by Ridit statistics. Result, The therapy group gained more notable effect in pain-relieving and mouth-opening-improving than the contrast group. Because of no damage, handy and can be done easily, be definite in curative effect, Pulse semiconductor laser treatment pericoronitis deserves popularizing.

  13. Restless legs syndrome: clinical presentation diagnosis and treatment.

    Science.gov (United States)

    Wijemanne, Subhashie; Jankovic, Joseph

    2015-06-01

    Restless legs syndrome (RLS) is a circadian disorder of sensory-motor integration that may be related to genetically determined dysregulation of iron transport across the blood-brain barrier. Dopamine agonists (DAs) have been considered the first-line therapy, but with the growing appreciation of problems associated with long-term treatment, particularly augmentation and impulse control disorder, alpha-2-delta drugs, such as gabapentin, are now considered the first line of treatment in patients with troublesome RLS. Opioids can be considered as an alternative therapy, particularly in patients with DA-related augmentation. In more severe cases, a combination therapy may be required. Intravenous iron therapy may be considered on those patients with refractory RLS.

  14. International dosimetry: an evaluation of treatment planning in clinical trials.

    Science.gov (United States)

    Grant, W; Davis, M J

    1975-08-01

    A tissue-equivalent phantom containing thermoluminescent dosimeters was mailed in succession to Mount Vernon Hospital, Northwood, Middlesex, England, to Groote Schuur Hospital, Capetown, South Africa, and to Winnipeg General Hospital, Winnipeg, Canada, to determine the accuracy and consistency in treatment for carcinoma of the cervix under hyperbaric oxygen conditions. (Protocol of the Medical Research Council's Working Party on Radiotherapy and Hyperbaric Oxygen.) The data were analysed by the Radiological Physics Center, Houston, Texas, and substantiate uniformity at and between the participating institutions.

  15. Radiation-induced xerostomia: pathophysiology, clinical course and supportive treatment.

    Science.gov (United States)

    Guchelaar, H J; Vermes, A; Meerwaldt, J H

    1997-07-01

    Xerostomia, or oral dryness, is one of the most common complaints experienced by patients who have had radiotherapy of the oral cavity and neck region. The hallmarks of radiation-induced damage are acinar atrophy and chronic inflammation of the salivary glands. The early response, resulting in atrophy of the secretory cells without inflammation might be due to radiation-induced apoptosis. In contrast, the late response with inflammation could be a result of radiation-induced necrosis. The subjective complaint of a dry mouth appears to be poorly correlated with objective findings of salivary gland dysfunction. Xerostomia, with secondary symptoms of increased dental caries, difficulty in chewing, swallowing and speaking, and an increased incidence of oral candidiasis, can have a significant effect on the quality of life. At present there is no causal treatment for radiation-induced xerostomia. Temporary symptomatic relief can be offered by moistening agents and saliva substitutes, and is the only option for patients without residual salivary function. In patients with residual salivary function, oral administration of pilocarpine 5-10 mg three times a day is effective in increasing salivary flow and improving the symptoms of xerostomia, and this therapy should be considered as the treatment of choice. Effectiveness of sialogogue treatment requires residual salivary function, which emphasizes the potential benefit from sparing normal tissue during irradiation. The hypothesis concerning the existence of early apoptotic and late necrotic effects of irradiation on the salivary glands theoretically offers a way of achieving this goal.

  16. Clinical problems in the antibiotic treatment of gonorrhoea.

    Science.gov (United States)

    WILLCOX, R R

    1958-01-01

    After briefly reviewing the history of penicillin therapy in gonorrhoea, the author shows that the number of cures effected with the repository penicillins, although originally very high, has diminished considerably in recent years, despite a general tendency to increase the dosage. The reduced efficacy of PAM and benzathine penicillin is demonstrated by an exposition of the current results obtained with these two preparations in the treatment of gonorrhoea patients in London. Some of the difficulties involved in distinguishing between treatment failures and reinfections are discussed.The paper continues with an examination of the possible alternatives to repository penicillin in the treatment of gonorrhoea. Data are given on the comparative efficacy of a number of prepations, including mixed penicillins, phenoxymethyl penicillin and various other antibiotics, such as streptomycin and the tetracycline group.The problem of re-examination of treated gonorrhoea cases is also dealt with, practical reasons being given for restricting the period of follow-up to three weeks.Finally, in a discussion of possible future developments, the author suggests a number of measures designed to prevent a further loss of sensitivity to penicillin in the gonococcus.

  17. Clinical gender differences among adult pathological gamblers seeking treatment.

    Science.gov (United States)

    Echeburúa, Enrique; González-Ortega, Itxaso; de Corral, Paz; Polo-López, Rocío

    2011-06-01

    This study aimed to examine the gender-related differences in demographics, gambling measures, psychological functioning, and motivation for therapy in an outpatient sample of pathological gamblers seeking treatment. Participants in this multisite study included 103 adult outpatients (51 women and 52 men) meeting current DSM-IV-TR criteria for PG. Logistic regression was used to examine if gender was related together to categorical and continuous independent variables. Female gamblers were older than men and more likely to be divorced or widowed and to have a lower annual income. Women became more dependent on bingo and men on slot machines. Gambling motivation and the course of illness for both sexes were also different. Female gamblers were more anxious and with a poorer self-esteem than male gamblers and more affected by depressive symptoms; in turn, men were more impulsive and higher sensation seekers than women and more affected by drug/alcohol abuse. The 68.6% of female gamblers reported being victims of intimate partner violence. There were no gender differences about the motivation for treatment. Future research should examine gambling behaviors and psychological functioning and suggest treatment approaches to address specific goals according to these gender-related differences.

  18. Comparison of treatment effects between animal experiments and clinical trials: systematic review

    OpenAIRE

    2006-01-01

    Objective To examine concordance between treatment effects in animal experiments and clinical trials.Study design Systematic review.Data sources Medline, Embase, SIGLE, NTIS, Science Citation Index, CAB, BIOSIS.Study selection Animal studies for interventions with unambiguous evidence of a treatment effect (benefit or harm) in clinical trials: head injury, antifibrinolytics in haemorrhage, thrombolysis in acute ischaemic stroke, tirilazad in acute ischaemic stroke, antenatal corticosteroids t...

  19. Clinical Use and Mechanisms of Infliximab Treatment on Inflammatory Bowel Disease: A Recent Update

    OpenAIRE

    Yuan Guo; Nonghua Lu; Aiping Bai

    2013-01-01

    The pathogenesis and treatment of inflammatory bowel disease (IBD) have been recently advanced, while it is still challenged with high morbidity and poor prognosis. Infliximab, a monoclonal antibody of tumor necrosis factor (TNF), has emerged as an efficient treatment with many clinical benefits such as quick disease activity reduction and IBD patient life quality improvement. However, the biological effects of infliximab on IBD need to be elucidated. This paper reviewed the clinical use and ...

  20. OM-X®, Fermented Vegetables Extract Suppresses Antigen-Stimulated Degranulation in Rat Basophilic Leukemia RBL-2H3 Cells and Passive Cutaneous Anaphylaxis Reaction in Mice.

    Science.gov (United States)

    Itoh, Tomohiro; Miyake, Yasuyoshi; Kasashima, Takuya; Shimomiya, Yoshie; Nakamura, Yuki; Ando, Masashi; Tsukamasa, Yasuyuki; Takahata, Muneaki

    2015-09-01

    OM-X® is a hand-made and naturally manufactured probiotic supplement. This fermented food product is made from vegetables, fruits, seaweeds and mushrooms, using 12 strains of lactic acid bacteria and bifidobacteria. OM-X® is also known to have beneficial health properties, and some of its components show effects on antigen (Ag)-stimulated degranulation activity, indicating that OM-X® may be useful in the treatment of allergy responses and symptoms. In this study, we evaluated the inhibitory effects of OM-X® on Ag-stimulated degranulation in rat basophilic leukemia RBL-2H3 cells, clarified the underlying mechanisms, and determined the active compounds in OM-X® for suppression of degranulation. Treatment with OM-X® gradually suppressed Ag-stimulated degranulation throughout the maturation period. OM-X® also gradually produced melanoidins by lactic acid bacterial fermentation during the maturation process. There was a high correlation between the suppression levels of Ag-stimulated degranulation and the browning of OM-X®. Furthermore, the inhibition of Ag-stimulated degranulation by OM-X® was found to be partially due to the direct inactivation of NADPH oxidase. To elucidate the in vivo effects of OM- X®, type I allergy model mice were orally administered with OM-X®, and the passive cutaneous anaphylaxis (PCA) reaction was measured. OM-X® intake remarkably suppressed the PCA reaction. Taken together, our findings suggest that OMX® could be a beneficial food to ameliorate allergic reactions.

  1. Pharmacological and clinical overview of cloperastine in treatment of cough

    Directory of Open Access Journals (Sweden)

    Maria Antonietta Catania

    2011-03-01

    Full Text Available Maria Antonietta Catania1, Salvatore Cuzzocrea1,21Department of Clinical and Experimental Medicine and Pharmacology, School of Medicine, University of Messina; 2IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, ItalyAbstract: Cough constitutes an impressive expression of the normal defense mechanisms of the respiratory system. Productive cough associated with catarrh is an important protective system for the lung because it favors the upward movement of secretions and foreign bodies to the larynx and mouth. Cough may also appear without bronchial secretions, as dry cough, which may be persistent when inflammatory disease is chronic or when, in the early stages of respiratory disease, bronchial secretions are not yet fluid. Sometimes bronchitis-induced cough does not significantly affect quality of life, whilst in other cases cough may become so intense as to impair daily activities severely, resulting in permanent disability. This type of cough is one of the most frequent reasons for seeking medical advice. The use of cough suppressants may be appropriate for reaching a precise diagnosis and when dry cough is persistent. Cloperastine has been investigated in various types of cough and, unlike codeine, has been shown to possess dual activity. It also acts as a mild bronchorelaxant and has antihistaminic activity, without acting on the central nervous system or the respiratory center. Here we review the preclinical and clinical evidence of the efficacy and tolerability of cloperastine.Keywords: cough, cloperastine, inflammation, bronchitis

  2. Clinical Application of Antimicrobial Bone Graft Substitute in Osteomyelitis Treatment: A Systematic Review of Different Bone Graft Substitutes Available in Clinical Treatment of Osteomyelitis.

    Science.gov (United States)

    van Vugt, T A G; Geurts, J; Arts, J J

    2016-01-01

    Osteomyelitis is a common occurrence in orthopaedic surgery, which is caused by different bacteria. Treatment of osteomyelitis patients aims to eradicate infection by debridement surgery and local and systemic antibiotic therapy. Local treatment increases success rates and can be performed with different antimicrobial bone graft substitutes. This review is performed to assess the level of evidence of synthetic bone graft substitutes in osteomyelitis treatment. According to the PRISMA statement for reporting systematic reviews, different types of clinical studies concerning treatment of osteomyelitis with bone graft substitutes are included. These studies are assessed on their methodological quality as level of evidence and bias and their clinical outcomes as eradication of infection. In the fifteen included studies, the levels of evidence were weak and in ten out of the fifteen studies there was a moderate to high risk of bias. However, first results of the eradication of infection in these studies showed promising results with their relatively high success rates and low complication rates. Due to the low levels of evidence and high risks of bias of the included studies, these results are inconclusive and no conclusions regarding the performed clinical studies of osteomyelitis treatment with antimicrobial bone graft substitutes can be drawn.

  3. [A case of anaphylaxis due to rose-flavored soft-serve ice cream with pollen food allergy syndrome].

    Science.gov (United States)

    Kitabayashi, Taeru; Sato, Sayuri; Adachi, Mitsuru

    2013-05-01

    We experienced a 10-year-old boy who had anaphylaxis after eating rose-flavored soft-serve ice cream. The patient felt a sense of discomfort in his throat when eating apple, peach, loquat, Japanese pear, and kiwi fruit. Therefore, we measured specific IgE antibodies to allergen components by ImmunoCAP ISAC. Consequently, the patient gave positive results for all PR-10 proteins from birch, alder, hazel, apple, peach, peanut, hazelnut, and soybean, so we diagnosed him with Pollen Food Allergy Syndrome (PFAS) induced by cross reactivity with pollens of birch family and fruits of rose family. When we conducted the skin prick test as is for red rose syrup because of the belief that anaphylaxis was caused by the rose ingredient contained in rose-flavored soft-serve ice cream, the patient gave a strong positive result. However, the results were negative for rose essence and Food Red No. 2 contained. Subsequently, it was found that red rose syrup contained apple juice. Therefore, we conducted the prick-prick test for apple, and the patient was confirmed to be strongly positive to apple. We thus identified apple as the cause of anaphylaxis. Since there is no legal obligation of labeling specific raw materials when directly selling manufactured and processed food products to general consumers, it is possible for general consumers to mistakenly take them in without knowing the containment of allergic substances. It is believed that the labeling method should be improved in the future.

  4. Inhibition of anaphylaxis-like reaction and mast cell activation by water extract from the fruiting body of Phellinus linteus.

    Science.gov (United States)

    Choi, Yun Ho; Yan, Guang Hai; Chai, Ok Hee; Lim, Jung Min; Sung, So Young; Zhang, Xin; Kim, Ji-Hyun; Choi, Su Hwan; Lee, Moo Sam; Han, Eui-Hyeog; Kim, Hyoung Tae; Song, Chang Ho

    2006-07-01

    Mast cell-mediated anaphylactic reaction is involved in many allergic diseases such as asthma and allergic rhinitis. Phellinus linteus has been used as a traditional herb medicine in oriental countries and is known to have anti-tumor, immunomodulatory, anti-inflammatory, and anti-allergic activities. However, roles of Phellinus linteus in the mast cell-mediated anaphylactic reactions have not fully been examined. In the present study, we have investigated the effects of water extract from the fruiting body of Phellinus linteus (WEPL) on mast cell-mediated anaphylaxis-like reactions. Oral administration of WEPL inhibited the compound 48/80-induced systemic anaphylaxis-like reaction and ear swelling response. WEPL also inhibited the anti-dinitrophenyl (DNP) IgE-mediated passive systemic and cutaneous anaphylaxis. WEPL had no cytotoxicity on rat peritoneal mast cells (RPMC). WEPL dose-dependently reduced histamine release from RPMC activated by compound 48/80 or anti-DNP IgE. Moreover, WEPL decreased the compound 48/80-induced calcium uptake into RPMC. Furthermore, WEPL increased the level of intracellular cAMP and significantly inhibited the compound 48/80-induced cAMP reduction in RPMC. These results suggest that WEPL may serve as an effective therapeutic agent for allergic diseases.

  5. Community vs. Clinic-Based Modular Treatment of Children with Early-Onset ODD or CD: A Clinical Trial with 3-Year Follow-Up

    Science.gov (United States)

    Kolko, David J.; Dorn, Lorah D.; Bukstein, Oscar G.; Pardini, Dustin; Holden, Elizabeth A.; Hart, Jonathan

    2009-01-01

    This study examines the treatment outcomes of 139, 6-11 year-old, clinically referred boys and girls diagnosed with Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) who were randomly assigned to a modular-based treatment protocol that was applied by research study clinicians either in the community (COMM) or a clinic office (CLINIC).…

  6. Clinical way method in treatment of out-patients with ischemic heart disease after cardiosurgery

    Directory of Open Access Journals (Sweden)

    Vardosanidze S.L.

    2010-12-01

    Full Text Available 158 patients with ischemic heart disease (IHD have been understudy during the period of 12 months in out-patient conditions. After completion of the primary examination all the patients of basic group (118 patients received clinical way method of treatment. Patients of the comparison group (40 patients after provided treatment were cared by their local therapeutists (cardiologists. The findings proved the fact that treatment of patients after cardiosurgery by clinical way method in out-patient conditions enabled to raise patient motivation to treatment, thereby assisting them to feel better, promoting normalization of arterial pressure data. The research results stated that clinical way method of treatment may be considered as rational and effective

  7. Social influences on the duration of antibiotic treatment of clinical mastitis in dairy cows

    NARCIS (Netherlands)

    Swinkels, J M; Hilkens, A; Zoche-Golob, V; Krömker, V; Buddiger, M; Jansen, J; Lam, T J G M|info:eu-repo/dai/nl/14686820X

    2015-01-01

    Clinical mastitis of dairy cows is a visible inflammation of the udder, which is usually caused by bacteria and treated with antibiotics. Although pressure is increasing to reduce antibiotic usage in livestock in the European Union, feedback from the field suggests that clinical mastitis treatment i

  8. 75 FR 62844 - Innovations in Technology for the Treatment of Diabetes: Clinical Development of the Artificial...

    Science.gov (United States)

    2010-10-13

    ...: Clinical Development of the Artificial Pancreas (an Autonomous System); Public Workshop AGENCY: Food and... Technology for the Treatment of Diabetes: Clinical Development of the Artificial Pancreas (an Autonomous... various development plans for the Artificial Pancreas System. The discussion of these general...

  9. Empirically and Clinically Useful Decision Making in Psychotherapy: Differential Predictions with Treatment Response Models

    Science.gov (United States)

    Lutz, Wolfgang; Saunders, Stephen M.; Leon, Scott C.; Martinovich, Zoran; Kosfelder, Joachim; Schulte, Dietmar; Grawe, Klaus; Tholen, Sven

    2006-01-01

    In the delivery of clinical services, outcomes monitoring (i.e., repeated assessments of a patient's response to treatment) can be used to support clinical decision making (i.e., recurrent revisions of outcome expectations on the basis of that response). Outcomes monitoring can be particularly useful in the context of established practice research…

  10. Do Treatment Manuals Undermine Youth-Therapist Alliance in Community Clinical Practice?

    Science.gov (United States)

    Langer, David A.; McLeod, Bryce D.; Weisz, John R.

    2011-01-01

    Objective: Some critics of treatment manuals have argued that their use may undermine the quality of the client-therapist alliance. This notion was tested in the context of youth psychotherapy delivered by therapists in community clinics. Method: Seventy-six clinically referred youths (57% female, age 8-15 years, 34% Caucasian) were randomly…

  11. Critical appraisal of clinical prediction rules that aim to optimize treatment selection for musculoskeletal conditions

    NARCIS (Netherlands)

    T.R. Stanton (Tasha); M.J. Hancock (Mark J.); C. Maher (Chris); B.W. Koes (Bart)

    2010-01-01

    textabstractBackground. Clinical prediction rules (CPRs) for treatment selection in musculoskeletal conditions have become increasingly popular. Purpose. The purposes of this review are: (1) to critically appraise studies evaluating CPRs and (2) to consider the clinical utility and stage of developm

  12. Clinical risk factors and urodynamic predictors prior to surgical treatment for stress urinary incontinence

    DEFF Research Database (Denmark)

    Bing, Mette Hornum; Gimbel, Helga; Greisen, Susanne

    2015-01-01

    INTRODUCTION AND HYPOTHESIS: Knowledge about clinical risk factors and the value of urodynamic testing is important to optimize treatment strategy and secure true informed consent. METHODS: We reviewed the relevant literature to clarify the evidence regarding clinical risk factors and the predict...

  13. DNA damage in human skin fibroblasts exposed to UVA light used in clinical PUVA treatment

    Energy Technology Data Exchange (ETDEWEB)

    Bredberg, A.

    1981-06-01

    Human skin fibroblasts were irradiated with a clinically used UVA light source. The doses (1.1 and 3 J/cm2) were similar to those reaching the dermis during clinical PUVA treatment of psoriasis. DNA strand breaks, as determined by alkaline elution, were formed in a dose-dependent way and disappeared within 1 hr of postincubation at 37 degrees C. These findings have clinical implications since UVA-induced DNA damage may be accompanied by mutagenic and tumor promoting effects.

  14. Clinical Observation on Acupuncture Treatment of Parkinson's Syndrome

    Institute of Scientific and Technical Information of China (English)

    邹勇

    2006-01-01

    Objective:To explore if the therapeutic effect can be enhanced, the dose of levodopa-like medications can be decreased and the complications can be reduced by acupuncture treatment in the patients with Parkinson's disease (PD) who took levodopa-like medications for a long time. Methods: thirty cases of the patients, most of whom were noticed with the decreased therapeutic effect and drug-induced complications, were treated by puncturing Shuigou (GV 26) and Baihui (GV 20), by reduction of Madopa dose, and the patients' conditions and complications were evaluated six months later. Results:After treatments for six months, the physiological functions were improved and the dose of Madopa was reduced and the total effective rate was 66.7%. Conclusion: After acupuncture treatments in PD patients, the therapeutic effects of levodopa were enhanced, with its dose and complications reduced.%目的:探索长期用左旋多巴(L-Dopa)类药物的帕金森病(PD)患者, 经针刺治疗后能否提高疗效, 降低左旋多巴剂量和减少并发症.方法:选择30例PD患者, 多数存在疗效减退或药物并发症, 针刺水沟、百会等穴, 减少美多巴用量, 6个月后对患者病情和并发症评价.结果: 治疗6个月后, 功能程度好转, 美多巴用量减少, 总有效率66.7%.结论:PD患者经针刺治疗后, 左旋多巴类药物疗效提高, 降低药物剂量和减少并发症等.

  15. Sleep disturbance in childhood epilepsy: clinical implications, assessment and treatment.

    Science.gov (United States)

    Stores, Gregory

    2013-07-01

    The ways in which sleep can affect epilepsy, and epilepsy can influence sleep and wakefulness, are described. Different forms of sleep disturbance have been reported in patients with epilepsy, depending on the type of seizure disorder. Confusions between epilepsy and non-epileptic parasomnias can be a particular diagnostic problem but they can be avoided. Untreated sleep disturbance is likely to have harmful psychological, physical and family effects. Screening for sleep disturbance should be routine, and leading, if indicated, to precise diagnosis of the underlying sleep disorder on which choice of advice and treatment depends.

  16. [Clinical findings, pathogenesis and treatment of Bartter's syndrome (author's transl)].

    Science.gov (United States)

    Ploier, R; Tulzer, W

    1981-01-01

    In three children Bartter's syndrome was diagnosed on the basis of the typical laboratory findings and the characteristic histological changes of the kidney. Apart from the description of three cases especially the latest pathogenic findings are represented because of their important therapeutic consequences. In one of the patients the therapeutic effect of the prostaglandin synthetase inhibitor Indomethazin was statistically proved in a balance study performed under inpatient conditions and so it was indirectly proved that the prostaglandines play an essential role in the pathogenesis of Bartter's syndrome. The patients have now received Indomethazin for a period of 11 months up to two and a half years with the result of an impressive improvement of the clinical symptoms and an unequivocal increase of the serum potassium. The fact that despite of normal renin and aldosterone levels there was no complete normalization of the serum potassium level indicates that in addition of prostaglandines probably a superior mechanism plays a part in the origin Bartter's syndrome.

  17. Clinical implications and treatment of multiresistant Streptococcus pneumoniae pneumonia.

    Science.gov (United States)

    File, T M

    2006-05-01

    Streptococcus pneumoniae is the leading bacterial cause of community-acquired respiratory tract infections. Prior to the 1970s this pathogen was uniformly susceptible to penicillin and most other antimicrobials. However, since the 1990s there has been a significant increase in drug-resistant Streptococcus pneumoniae (DRSP) due, in large part, to increased use of antimicrobials. The clinical significance of this resistance is not definitely established, but appears to be most relevant to specific MICs for specific antimicrobials. Certain beta-lactams (amoxicillin, cefotaxime, ceftriaxone), the respiratory fluoroquinolones, and telithromycin are among several agents that remain effective against DRSP. Continued surveillance studies, appropriate antimicrobial usage campaigns, stratification of patients based on known risk factors for resistance, and vaccination programmes are needed to appropriately manage DRSP and limit its spread.

  18. Traditional Chinese medicine: potential for clinical treatment of rheumatoid arthritis.

    Science.gov (United States)

    Moudgil, Kamal D; Berman, Brian M

    2014-07-01

    Rheumatoid arthritis (RA) is a chronic debilitating autoimmune disease affecting people worldwide. Increasing numbers of RA patients in the west are resorting to various complementary and alternative medicine modalities for relief of symptoms and well-being. Herbal products and acupuncture representing traditional Chinese medicine (TCM) are two of the most commonly used forms of complementary and alternative medicine. Frequently, their efficacy against RA and safety have been inferred from anecdotal experience or pilot testing on a relatively small number of patients following inadequate study designs. Accordingly, significant efforts need to be invested in objectively testing TCM in clinical trials that are sufficiently powered, randomized, blinded, possess appropriate controls and follow standard criteria for assessment of the outcomes. In addition, the mechanisms underlying the immunomodulatory and other antiarthritic activities of TCM modalities need to be better defined. These efforts would help validate the scientific rationale for the use of TCM for the management of RA.

  19. Clinical Manifestations, Diagnosis, and Treatment of Mycobacterium haemophilum Infections

    Science.gov (United States)

    Lindeboom, Jerome A.; Bruijnesteijn van Coppenraet, Lesla E. S.; van Soolingen, Dick; Prins, Jan M.; Kuijper, Eduard J.

    2011-01-01

    Summary: Mycobacterium haemophilum is a slowly growing acid-fast bacillus (AFB) belonging to the group of nontuberculous mycobacteria (NTM) frequently found in environmental habitats, which can colonize and occasionally infect humans and animals. Several findings suggest that water reservoirs are a likely source of M. haemophilum infections. M. haemophilum causes mainly ulcerating skin infections and arthritis in persons who are severely immunocompromised. Disseminated and pulmonary infections occasionally occur. The second at-risk group is otherwise healthy children, who typically develop cervical and perihilar lymphadenitis. A full diagnostic regimen for the optimal detection of M. haemophilum includes acid-fast staining, culturing at two temperatures with iron-supplemented media, and molecular detection. The most preferable molecular assay is a real-time PCR targeting an M. haemophilum-specific internal transcribed spacer (ITS), but another approach is the application of a generic PCR for a mycobacterium-specific fragment with subsequent sequencing to identify M. haemophilum. No standard treatment guidelines are available, but published literature agrees that immunocompromised patients should be treated with multiple antibiotics, tailored to the disease presentation and underlying degree of immune suppression. The outcome of M. haemophilum cervicofacial lymphadenitis in immunocompetent patients favors surgical intervention rather than antibiotic treatment. PMID:21976605

  20. [Sodium azide--clinical course of the poisoning and treatment].

    Science.gov (United States)

    Łopaciński, Bogdan; Kołacinski, Zbigniew; Winnicka, Renata

    2007-01-01

    Sodium azide poisonings occur very rarely. The mechanism of sodium azide toxic effect has not yet been fully explained. Despite the lack of an explicit procedure for the cases of sodium azide poisonings, in vitro tests and rare case reports suggest that treatment with antidotes for cyanide poisoning victims can be effective. This study describes two cases of suicidal sodium azide ingestion. Case 1. 30-year-old male ingested ca. 180 mg of sodium azide. On admission to hospital, within 4 hours from poisoning, the man complained of dizziness and anxiety. Physical examination revealed horizontal nystagmus, flapping tremor, HR 135/min. In laboratory tests, higher blood concentration of lactates (3 mmol/l) was detected, as well as lower potassium concentration (3.4 mmol/L) and increased transaminase activity (ALT 74 U/l, AST 90 U/l). Electrocardiographic tests showed a negative T wave in limb lead III. Other results were within normal. As the patient ingested a toxic dose of sodium azide, he was treated according to the therapy prescription for cyanide poisoning (amyl nitrite inhalation followed by intravenous administration of sodium nitrite and sodium thiosulphate). ECG record of the last day of hospitalization (7th day of treatment) showed negative T waves in lead III, V4-V6. He was discharged from hospital in good condition. Case 2.23-year-old male ingested 10 g of sodium azide 1.5 hours prior to admission to hospital. At the beginning, the patient's condition was good, but it changed to critical state within the first hours of hospitalization. He developed a deep coma, respiratory and circulatory insufficiency, metabolic acidosis, cardiac dysrrhythmias and anuria. Cardiac activity monitoring showed alternating tachycardia (140 beats per minute) and bradycardia (48 beats per minute), numerous additional supraventricular and ventricular extrasystoles and sinus dysrrhythmia. Cardiac arrest (asystolia) occurred twice, the second incident with fatal outcome. The patient

  1. Buprenorphine: clinical pharmacokinetics in the treatment of opioid dependence.

    Science.gov (United States)

    Elkader, Alexander; Sproule, Beth

    2005-01-01

    Buprenorphine is a semi-synthetic opioid derived from thebaine, a naturally occurring alkaloid of the opium poppy, Papaver somniferum. The pharmacology of buprenorphine is unique in that it is a partial agonist at the opioid mu receptor. Buprenorphine undergoes extensive first-pass metabolism and therefore has very low oral bioavailability; however, its bioavailability sublingually is extensive enough to make this a feasible route of administration for the treatment of opioid dependence. The mean time to maximum plasma concentration following sublingual administration is variable, ranging from 40 minutes to 3.5 hours. Buprenorphine has a large volume of distribution and is highly protein bound (96%). It is extensively metabolised by N-dealkylation to norbuprenorphine primarily through cytochrome P450 (CYP) 3A4. The terminal elimination half-life of buprenorphine is long and there is considerable variation in reported values (mean values ranging from 3 to 44 hours). Most of a dose of buprenorphine is eliminated in the faeces, with approximately 10-30% excreted in urine. Naloxone has been added to a sublingual formulation of buprenorphine to reduce the abuse liability of the product. The presence of naloxone does not appear to influence the pharmacokinetics of buprenorphine. Buprenorphine crosses the placenta during pregnancy and also crosses into breast milk. Buprenorphine dosage does not need to be significantly adjusted in patients with renal impairment; however, since CYP3A activity may be decreased in patients with severe chronic liver disease, it is possible that the metabolism of buprenorphine will be altered in these patients. Although there is limited evidence in the literature to date, drugs that are known to inhibit or induce CYP3A4 have the potential to diminish or enhance buprenorphine N-dealkylation. It appears that the interaction between buprenorphine and benzodiazepines is more likely to be a pharmacodynamic (additive or synergistic) than a

  2. Current role of anticholinergic drugs in the treatment of asthma : Key messages for clinical practice

    NARCIS (Netherlands)

    Pizzichini, Marcia M. M.; Kerstjens, Huib A. M.; Pizzichini, Emilio

    2015-01-01

    Anticholinergic bronchodilators such as tiotropium, a potent long-acting drug, are central to the symptomatic treatment of chronic obstructive pulmonary disease. Its role in asthma treatment has been recently investigated. This review critically evaluates documented evidence of clinical trials and a

  3. Follow-up study of the treatment outcomes at a psychiatric trauma clinic for refugees

    DEFF Research Database (Denmark)

    Buhmann, Christine Cæcilie Böck; Mortensen, Erik Lykke; Nordentoft, Merete;

    2015-01-01

    PURPOSE: To describe change in mental health after treatment with antidepressants and trauma-focused cognitive behavioral therapy. METHODS: Patients receiving treatment at the Psychiatric Trauma Clinic for Refugees in Copenhagen completed self-ratings of level of functioning, quality of life...

  4. Treatment with beta-blockers in nurse-led heart failure clinics

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Schou, Morten; Videbaek, Lars

    2007-01-01

    BACKGROUND: Beta-blockers (BBs) are a cornerstone in the treatment of chronic heart failure (HF), but several surveys have documented that many patients are not offered treatment or are not titrated to target doses. In part to address this problem, specialized, nurse-led HF clinics have been...

  5. HIV Rapid Testing in Substance Abuse Treatment: Implementation Following a Clinical Trial

    Science.gov (United States)

    Haynes, L. F.; Korte, J. E.; Holmes, B. E.; Gooden, L.; Matheson, T.; Feaster, D. J.; Leff, J. A.; Wilson, L.; Metsch, L. R.; Schackman, B. R.

    2011-01-01

    The Substance Abuse Mental Health Services Administration has promoted HIV testing and counseling as an evidence-based practice. Nevertheless, adoption of HIV testing in substance abuse treatment programs has been slow. This article describes the experience of a substance abuse treatment agency where, following participation in a clinical trial,…

  6. Cognitive Behavioral Treatment of Panic Disorder and Agoraphobia in a Multiethnic Urban Outpatient Clinic: Initial Presentation and Treatment Outcome

    Science.gov (United States)

    Friedman, Steven; Braunstein, Jeffrey W.; Halpern, Beth

    2006-01-01

    Few studies examine the effectiveness of panic control treatment across diverse ethnic groups. In this paper we present data on 40 patients (African American, n = 24; Caucasian, n = 16) with panic disorder and comorbid agoraphobia who presented at an anxiety disorder clinic in an inner-city area. On initial assessment both groups were similar on…

  7. Clinical characteristics and treatment of ovarian serous borderline tumors

    Institute of Scientific and Technical Information of China (English)

    Lian Li-jian; Guo Li-na

    2004-01-01

    Ovarian serous borderline tumors (SBTs) are characterized by good prognosis and occasional late recurrence. The 5-year and 10-year survival rates are all more than 90%. But traditionally patients with SBTs used to be treated with bilateral oophorectomy, hysterectomy and postoperative chemotherapy. A high proportion of SBTs occurred in young patients. The traditional treatment with complete excision of reproductive organs seemed to be too aggressive for young patients. It is imperative that conservative surgical procedures with fertility sparing should be employed to them. In this paper the literatures in regard to the final outcome of the conservative surgical therapy for SBTs were reviewed and the appropriate extent of conservative surgical procedures was discussed in detail.

  8. [Probiotics for the treatment of infant colic: a clinical case].

    Science.gov (United States)

    Pérez-Moreno, Jimena; Taboada Castro, Luz; Tolín Hernani, Mar; Sánchez Sánchez, César; Álvarez-Calatayud, Guillermo

    2015-02-07

    Infant colic is a prevalent physiological event of healthy children under 3 months of age which can disrupt the child's home environment. Despite its benign natural history, sometimes requires a therapeutic approach. Numerous therapeutical lines have been proposed although its pathogenesis remains unknown and multifactorial. The gut microbiota plays an important role in the infant colic. Several studies have shown less bifidobacteria and lactobacilli in infant colic meanwhile Escherichia, Klebsiella, Serratia, Vibrio, Yersinia and Pseudomonas are more prominent in colon. The probiotic strain L. reuteri DSM 17938, when administered once daily to 10⁸ cfu / day, seems to have the most scientific evidence up to date in the treatment of infant colic, without significant side effects.

  9. Clinical utility of nivolumab in the treatment of advanced melanoma

    Directory of Open Access Journals (Sweden)

    Asmar R

    2016-02-01

    Full Text Available Ramsey Asmar,1 Jessica Yang,1 Richard D Carvajal1,2 1Department of Medicine, College of Physicians and Surgeons, 2Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA Abstract: Melanomas are highly immunogenic tumors that evade the immune system by exploiting innate checkpoint pathways, rendering effector T-cells anergic. The immunotherapeutic approach of checkpoint inhibition can restore and invigorate endogenous antitumor T-cell responses and has become an important treatment option for patients with advanced melanoma. The CTLA-4 inhibitor ipilimumab and the PD-1 inhibitors nivolumab and pembrolizumab have been shown to induce durable responses and improve overall survival in metastatic, refractory melanoma. Optimization and validation of pretreatment biomarkers to predict response to these agents is a crucial area of ongoing research. Combination immunotherapy has recently demonstrated superior response rates compared to monotherapy; further investigation is needed to refine combinatorial strategies. Keywords: nivolumab, immune checkpoint inhibitors, PD-1, melanoma

  10. Clinical Study on Treatment of Depression with Combined Acupuncture & Medicine

    Institute of Scientific and Technical Information of China (English)

    XU Hong; WANG Qiao-chu; HAN Chou-ping

    2003-01-01

    Purpose To observe and compare the curative effects of combined acupuncture and medicine with simple herbal medicine on treatment of depression. Method Altogether 63 cases were enrolled according to the determination of internationally accepted self-evaluation depression scales (SDS), among them 33 cases were treated with combination of acupuncture and herbal medicine (acupuncture-medicine group) and the other 30 cases were in treated with herbal medicine alone (herbal medicine group) Results The total effective rate of acupuncture-medicine group was 90.9% and that of herbal group was 80.0%. And there was significant statistics difference between the curative effects of two groups (P <0.05) without obvious adverse reaction. Conclusion Combination of acupuncture and medicine has better effect in treating depression than herbal medicine group.

  11. Serious pain treatment with intrathecal ziconotide pathway - clinical case

    Directory of Open Access Journals (Sweden)

    Giovanni Nicotera

    2008-04-01

    Full Text Available The aim of this report is to describe the emission of a erious painful symptomatology in a 57 years patient that suffered from low back pain and pain to the inferior limbs for several years. The pain was a result of surgical treatment (Failed Back Surgery Syndrome, FBSS and the gravity of the symptoms had negatively influenced the patient’s quality of life. The pain, nociceptive and neuropathic,was resistant to several therapeutic approaches (pharmacological or not. Also a period of test with dorsal spinal cord stimulation (SCS was ineffective. After careful analysis, the patient has been submitted to period of test with ziconotide intrathecally administered. The result that surpassed all one’s expectations, was a remarkable reduction of the pain. Such reduction allowed the patient to totally recover its autonomy and clearly improve the quality of life.

  12. Clinical outcome after treatment of infected primary total knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Jensen, Tim Toftgaard

    2002-01-01

    Twenty-six consecutive cases of infected primary total knee arthroplasties were treated at our institution from 1989 through 2000. Eleven patients had debridement and irrigation performed within 2 months of index arthroplasty or hematogenous spread; only one infection was eradicated. Twenty......-five patients had their prostheses removed; 17 had two-stage revision arthroplasty, following which infection was eradicated in 15; one had a permanent spacer, 7 had arthrodesis (following failed revision arthroplasty in one) and 2 had a femur amputation (following failed revision arthroplasty in one) at follow......-up of mean 24 months. Infections were cured equally well with revision arthroplasty and arthrodesis. Among the 15 patients who ended up with revision arthroplasty, 11 had a better range of motion compared to the index arthroplasty, but 8 had daily pain. We present our treatment protocol, which eradicated 15...

  13. Bicipitoradial Bursitis: A Review of Clinical Presentation and Treatment

    Directory of Open Access Journals (Sweden)

    Tsz-Lung Choi

    2014-06-01

    Full Text Available The bicipitoradial bursa lies at the insertion of the biceps tendon on the radial tuberosity. It is an unusual site for chronic bursitis and most often results from repetitive mechanical trauma or overuse. Other causes include tuberculosis, immunological complications of rheumatological disease and synovial chondromatosis. Accurate diagnosis requires imaging studies and sometimes histological study. It can be treated conservatively with aspiration and steroid injection. Surgical excision of the bursa is indicated in the case of infection cause, failed conservative treatment with recurrence of the enlarged bursa and pain after aspiration, presence of nerve compression with neurological impairment, mechanical limitation to flexion, and extension of the elbow or biceps tendon degeneration and/or functional impairment.

  14. Clinical research on the efficacy of Mirena in combined with mifepristone in the treatment of adenomyosis

    Institute of Scientific and Technical Information of China (English)

    Li-Juan Cao; Xin-Jun Shu

    2016-01-01

    Objective:To observe the clinical effect of levonorgestrel slow-release system (LNG-IUS, Mirena) in combined with mifepristone in the treatment of adenomyosis (AM). Methods:A total of 76 patients with AM who were admitted in our hospital from January, 2013 to January, 2015 were included in the study and randomized into the treatment group and the control group with 38 cases in each group. The patients in the treatment group were given Mirena in combined with mifepristone, while the patients in the control group were only placed with Mirena. The changes of symptoms and sex hormone levels before and after treatment between the two groups were compared. B ultrasound was used to examine the uterine volume and intimal thickness. Results:The comparison of menstrual cycle before and after treatment between the two groups was not statistically significant. After treatment, the menstrual duration in the two groups was significantly shortened when compared with before treatment, PBAC and VAS scores were significantly reduced. The improvement degree of dysmenorrhea after treatment in the treatment was significantly superior to that in the control group. The endometrial thickness and uterine volume after treatment in the two groups were significantly reduced when compared with before treatment, but the comparison between the two groups was not statistically significant. The serum CA125 after treatment in the treatment group was significantly lower than that in the control group. The comparison of LH, FSH, and E2 levels before and after treatment between the two groups was not statistically significant. Conclusions:Mirena in combined with mifepristone in the treatment of AM can effectively alleviate the clinical symptoms with no effect on sex hormone levels;therefore, it deserves to be widely recommended in the clinic.

  15. Achalasia: a review of clinical diagnosis, epidemiology, treatment and outcomes.

    Science.gov (United States)

    O'Neill, Orla M; Johnston, Brian T; Coleman, Helen G

    2013-09-21

    Achalasia is a neurodegenerative motility disorder of the oesophagus resulting in deranged oesophageal peristalsis and loss of lower oesophageal sphincter function. Historically, annual achalasia incidence rates were believed to be low, approximately 0.5-1.2 per 100000. More recent reports suggest that annual incidence rates have risen to 1.6 per 100000 in some populations. The aetiology of achalasia is still unclear but is likely to be multi-factorial. Suggested causes include environmental or viral exposures resulting in inflammation of the oesophageal myenteric plexus, which elicits an autoimmune response. Risk of achalasia may be elevated in a sub-group of genetically susceptible people. Improvement in the diagnosis of achalasia, through the introduction of high resolution manometry with pressure topography plotting, has resulted in the development of a novel classification system for achalasia. This classification system can evaluate patient prognosis and predict responsiveness to treatment. There is currently much debate over whether pneumatic dilatation is a superior method compared to the Heller's myotomy procedure in the treatment of achalasia. A recent comparative study found equal efficacy, suggesting that patient preference and local expertise should guide the choice. Although achalasia is a relatively rare condition, it carries a risk of complications, including aspiration pneumonia and oesophageal cancer. The risk of both squamous cell carcinoma and adenocarcinoma of the oesophagus is believed to be significantly increased in patients with achalasia, however the absolute excess risk is small. Therefore, it is currently unknown whether a surveillance programme in achalasia patients would be effective or cost-effective.

  16. Clinical Observations on Acupuncture Treatment of 68 Migraine Patients

    Institute of Scientific and Technical Information of China (English)

    ZHOU Wen-xue

    2006-01-01

    Objective To investigate the curative effect of points Fengchi(GB 20), Tianzhu(BL 10) and Wangu(GB 12) on migraine. Methods: A treatment group of 68 patients received acupuncture of bilateral points Fengchi(GB 20), Tianzhu(BL 10) and Wangu(GB 12) and a control group of 40 patients took orally Nimodipine and Oryzanol. The curative effect was evaluated in both groups after two courses of treatment. Results: The total efficacy rate was 92.7% and 72.5% and the control rate was 45.6% and 22.5%, respectively, in the two groups.Conclusion: Acupuncture is significantly more effective than Western medicine in treating migraine.%目的:观察风池、天柱和完骨穴对偏头痛得治疗效果.方法:68例患者接受双侧风池、天柱和完骨穴针刺治疗为治疗组;40例患者口服西药尼莫地平和谷维素为对照组,两组均治疗2个疗程后观察疗效.结果:两组总有效率分别为92.7%和72.5%,控制率分别为45.6%和22.5%.结论:针刺治疗偏头痛的效果明显优于西药治疗.

  17. Еctopic ACTH syndrome: clinical picture, diagnosis, treatment

    Directory of Open Access Journals (Sweden)

    N S Kuznetsov

    2012-03-01

    Full Text Available Diagnosis and treatment of ectopic ACTH-syndrome currently is one of the most challenging problems among other forms of endogenous hypercorticism. This syndrome is associated with presence of extrapituitary tumors characterized with different histogenesis and localization, which produce adrenocorticotropic hormone (ACTH, or – rarely – corticotrophin-releasing hormone. In most cases the ectopic synthesis of ACTH is performed in bronchial carcinoid tumors (36–46%, oat cell cancer (18–20%, medullary thyroid cancer (3–7%, pheochromocytoma (9–23%, other sites are infrequent (pancreas, thymus, parotid gland, ovaries, uterus, prostate, colon, stomach, esophagus, etc.. Much of these tumors are aggressive and are characterized with propensity to metastasize and relapse. Currently there are few contradictory data on the comparative evaluation of the effectiveness of methods of topical diagnosis of the source of ectopic ACTH-secretion, and therefore there is an urgent need to develop an optimal and most efficient algorithm for diagnostic procedures to determine the extent of the tumor in patients with ectopic ACTH-syndrome. Indications for surgery, timing and extent of surgical intervention, the effectiveness of the operation, the causes and frequency of relapses are still discussed.The present difficulties of diagnosis, as well as the lack of a unified approach to the treatment of this disease in the complex, often lead to the progression and development of a large number of serious complications functions of up to disability, which in turn does not lead to significant improvement of quality of life. Thus further research is necessary to study of this disease

  18. Rhino-Orbito-Cerebral Mucormycosis. A Retrospective Analysis of Clinical Features and Treatment Outcomes

    Directory of Open Access Journals (Sweden)

    Nithyanandam Suneetha

    2003-01-01

    Full Text Available Objective: The conventional management of rhino-orbito-cerebral (ROC mucormycosis includes control of metabolic abnormality, administration of amphotericin B and surgery that spans simple sinus clearance, radical debridement and orbital exenteration. Recent literature includes anecdotal descriptions of successful treatment with conservative management of involved orbits. We evaluated the clinical features and outcome of treatment for the different stages of ROC mucormycosis. Method: In this retrospective case series, 34 case records of patients with a histopathological diagnosis of ROC mucormycosis treated between 1992 and 2000 were reviewed. Three clinical stages and three treatment groups were identified. Patients with limited sino-nasal disease (Clinical stage I underwent sino-nasal debridement (Treatment group A. Patients with limited rhino-orbital disease (Clinical stage II underwent either sino-nasal debridement alone (Treatment group A or orbital exenteration in addition to sino-nasal debridement (Treatment group B. Patients with rhino-orbito-cerebral disease (Clinical stage III did not undergo any surgical procedure (Treatment group C. Thirty-three patients received intravenous amphotericin B. Outcome for each group was measured as "Treatment success" (disease free, stable patient with metabolic abnormality under control and "Treatment failure" (progression of disease with worsening general condition or mortality due to the disease. Results: Uncontrolled diabetes in 30 (88.2% of 34 patients was the commonest underlying disease and 16 (53.3% of 30 diabetics had ketoacidosis. Chronic renal failure (n = 4, hepatic disease (n = 3 and idiopathic thrombocytopenia (n = 1 were the other underlying diseases. Eleven patients had stage I disease, 16 patients had stage II disease and seven patients had stage III disease. All 11 patients with stage I disease received treatment A; of 16 patients with stage II disease, 7 received treatment A and the

  19. Omalizumab in the treatment of chronic urticaria.

    Science.gov (United States)

    Francés, L; Leiva-Salinas, M; Silvestre, J F

    2014-01-01

    Omalizumab is a monoclonal anti-immunoglobulin E antibody currently only approved for use in severe, refractory asthma. In recent years, many authors have reported satisfactory results with omalizumab in patients with difficult-to-treat chronic urticaria. As a result, clinical trials were undertaken to broaden the indication of omalizumab to include chronic urticaria, and the drug was recently cited as a third-line treatment after selective antihistamines at high doses in a consensus document on the treatment of chronic urticaria. In this article our aim is to provide a comprehensive update on the use of omalizumab in the treatment of chronic urticaria. The structure of this biologic agent and its possible mechanisms of actions in this setting will be presented. Treatment strategies and the different dosage regimens used in the series of cases published to date will also be reviewed. Finally, we will discuss the adverse effects that may arise with treatment and the recommended strategies for minimizing the most feared effect, anaphylaxis. Based on the experience of many researchers, omalizumab is emerging as a novel treatment for certain types of spontaneous refractory chronic urticaria and has shown promising results in this setting. The drug has a good safety profile and the main limitation is its high cost.

  20. Antipsychotic drug treatment for patients with schizophrenia: theoretical background, clinical considerations and patients preferences

    DEFF Research Database (Denmark)

    Nielsen, René Ernst; Nielsen, Jimmi

    2009-01-01

      The cornerstone in treatment of psychosis is antipsychotic drugs. Treatment options have increased over the years; newer antipsychotic drugs with a proposed efficacy regarding negative and cognitive symptoms, but also a shift in side-effects from neurological side-effects to metabolic side-effects...... have arisen as the new challenge. The basis of successful pharmacological treatment is a fundamental understanding of the mechanisms of action, the desired effects and side-effects of antipsychotic drugs, a good relationship with the patient and a thorough monitoring of the patient before and during...... treatment. The clinically relevant aspects of antipsychotic drug treatment are reviewed; mechanism of antipsychotic drug action, clinical considerations in treatment, switching antipsychotic drugs, polypharmacy, safety and patient preference.  ...

  1. Progress on Clinical Study of Acupuncture Treatment for Chronic Pelvic Inflammation

    Institute of Scientific and Technical Information of China (English)

    ZHAO Wen-jie; HUANG Guo-qi

    2008-01-01

    @@ Chronic pelvic inflammation is mostly caused byincomplete treatment of acute pelvic inflammation orby transference from pathologic condition due to poorbody constitution, including chronic endometritis,chronic salpingo-oophoritis and chronic inflammationof connective tissue, and is a commonly andfrequently encountered disease in the gynecologydepartment. Due to long duration, intractablecondition and high recurrent rate, it is also acommonly encountered reason to induce heterotopicpregnancy, sterility, pelvic pain and pelvic adhesivediseases. In the investigative study on the domesticliterature about acupuncture treatment of chronicpelvic inflammation in the recent five years, theauthor hopes to summarize the information forreference in the clinical treatment and to point outsome issues existing in the current clinical study.

  2. Clinical and image improvement of Raynaud's phenomenon after botulinum toxin type A treatment.

    Science.gov (United States)

    Zhao, HongMei; Lian, YaJun

    2015-08-01

    Raynaud's phenomenon is often accompanied by pain, digital ulceration and compromised daily activities. Pharmacological therapy or sympathectomies have been administered to diminish these symptoms but existing treatments are not invariably efficacious. A recent case series has described the use of botulinum toxin type A in the treatment of Raynaud's phenomenon. We report two patients with severe or mild Raynaud's phenomenon who were injected with BTX-A; both of whom experienced clinical and image improvement after treatment.

  3. METHODOLOGICAL EVALUATION ON CLINICAL RESEARCH LITERATURE OF ACUPUNCTURE TREATMENT OF FACIAL PARALYSIS

    Institute of Scientific and Technical Information of China (English)

    梁繁荣; 李瑛

    2003-01-01

    Objective: To try to give an objective evaluation on the clinical research situation about acupuncturetreatment of facial paralysis in the past 50 years and try to provide a possible evidence for clinical practice. Methods:All papers are searched and assessed according to the international standards and clinical epidemiology. Results:There is no systematic review (SR) on acupuncture treatment of facial palsy in a total of 1021 articles enlisted in thepresent paper. Comparing with the quantity of the descriptive studies and expert opinions (constituting 84.84% ), thatof the randomized controlled trials (RCTs) and clinical controlled trials (CCTs) is smaller (constituting 15. 16%), be-sides, the quality of RCTs and CCTs is unsatisfactory. Conclusion: At present, the quantity and quality of studies withRCTs about acupuncture treatment of facial paralysis can't meet the need of clinical practice, and in order to improvethe therapeutic effect, a higher quality of RCTs and SR is required.

  4. The clinical diagnosis and treatment about 22 cases of limbic encephalitis were retrospectively analyzed.

    Science.gov (United States)

    Zang, Weiping; Zhang, Zhijun; Feng, Laihui; Zhang, Ailing

    2016-03-01

    To summarize and analyze the clinical characteristics and treatment of limbic encephalitis, in order to provide the basis for clinical work. We retrospectively analyzed the clinical characteristics, magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) and self immune antibody results of 22 patients with limbic encephalitis in Zheng zhou people's Hospital from March 2013 to May 2014. 22 cases of patients with psychiatric disturbance, such as hallucinations being typical clinical manifestations: Memory decline in 18 cases: Seizures in 13 patients: Altered level of consciousness in 10 cases; Movement disorders in 7 cases and 9 cases with febrile.14 cases have relieved after treating with antiviral and immunosuppressive therapy, 5 cases left memory decline, 2 patients left overwhelmingly excited, 1 cases of seizures. The clinical symptoms of patients with limbic encephalitis are complicated changeable and unspecific. so earlier diagnosis and treatment are very important for the prognosis of patients.

  5. Treatment of occult bacteremia: a prospective randomized clinical trial.

    Science.gov (United States)

    Carroll, W L; Farrell, M K; Singer, J I; Jackson, M A; Lobel, J S; Lewis, E D

    1983-11-01

    Antibiotic therapy for children without foci of infection and at risk for bacteremia is controversial. A prospective randomized clinical trial was conducted using expectant antibiotic therapy in children at risk for bacteremia. A total of 96 children (aged 6 to 24 months) with temperature of more than 40 degrees C, no identifiable source of infection, and a leukocyte count greater than or equal to 15,000/microL and/or sedimentation rate greater than or equal to 30 were enrolled. The following tests were performed on all children: blood culture, chest roentgenogram, urinalysis, and urine culture. A lumbar puncture was performed if a child was 12 months or less. Patients were randomized to receive either no antibiotic therapy or Bicillin C-R, 50,000 U/kg intramuscularly, followed by penicillin V, 100 mg/kg/d, orally four times a day for three days. Patients were examined at 24 and 72 hours. Fifty patients were treated expectantly and 46 received no antimicrobial therapy. Ten of the 96 patients were bacteremic (nine had Streptococcus pneumoniae, one had Haemophilus influenzae). Four of the five children treated for bacteremia showed improvement at the first follow-up visit (afebrile and no obvious focus of infection). The five untreated patients showed no improvement; four patients developed focal infections (two had meningitis, two had otitis media) (P less than or equal to .05, Fisher exact test). No complications of expectant therapy were detected. Thus, expectant antibiotic therapy for children who have no obvious source of infection and who meet these criteria associated with occult bacteremia is warranted.

  6. Development and clinical introduction of automated radiotherapy treatment planning for prostate cancer

    Science.gov (United States)

    Winkel, D.; Bol, G. H.; van Asselen, B.; Hes, J.; Scholten, V.; Kerkmeijer, L. G. W.; Raaymakers, B. W.

    2016-12-01

    To develop an automated radiotherapy treatment planning and optimization workflow to efficiently create patient specifically optimized clinical grade treatment plans for prostate cancer and to implement it in clinical practice. A two-phased planning and optimization workflow was developed to automatically generate 77Gy 5-field simultaneously integrated boost intensity modulated radiation therapy (SIB-IMRT) plans for prostate cancer treatment. A retrospective planning study (n  =  100) was performed in which automatically and manually generated treatment plans were compared. A clinical pilot (n  =  21) was performed to investigate the usability of our method. Operator time for the planning process was reduced to  cancer.

  7. Huntington's disease: from molecular pathogenesis to clinical treatment.

    Science.gov (United States)

    Ross, Christopher A; Tabrizi, Sarah J

    2011-01-01

    Huntington's disease is a progressive, fatal, neurodegenerative disorder caused by an expanded CAG repeat in the huntingtin gene, which encodes an abnormally long polyglutamine repeat in the huntingtin protein. Huntington's disease has served as a model for the study of other more common neurodegenerative disorders, such as Alzheimer's disease and Parkinson's disease. These disorders all share features including: delayed onset; selective neuronal vulnerability, despite widespread expression of disease-related proteins during the whole lifetime; abnormal protein processing and aggregation; and cellular toxic effects involving both cell autonomous and cell-cell interaction mechanisms. Pathogenic pathways of Huntington's disease are beginning to be unravelled, offering targets for treatments. Additionally, predictive genetic testing and findings of neuroimaging studies show that, as in some other neurodegenerative disorders, neurodegeneration in affected individuals begins many years before onset of diagnosable signs and symptoms of Huntington's disease, and it is accompanied by subtle cognitive, motor, and psychiatric changes (so-called prodromal disease). Thus, Huntington's disease is also emerging as a model for strategies to develop therapeutic interventions, not only to slow progression of manifest disease but also to delay, or ideally prevent, its onset.

  8. Intraocular lenses and clinical treatment in paediatric cataract

    Directory of Open Access Journals (Sweden)

    Camila Ribeiro Koch Pena

    2015-06-01

    Full Text Available Pediatric cataract is the most common treatable cause of blindness in children. Prevalence, etiology and morphology vary with the socioeconomic development. The treatment goal is to reduce amblyopia, being difficult management especially in unilateral cases. The decision on aphakia or primary intraocular lens should be individualized as well as correction with contact lens or spectacles. The intraocular lens single-piece hydrophobic acrylic are the most implanted in children and the preferably is in the capsular bag. The Sanders-Retzlaff-Kraff theoretic (SRK/T stressing that is described as more predictable, following Holladay I and SRK II and the recommendation is to under correction +6.0 or +8.0 dioptrias expecting the growth of the eye. The posterior capsule opacity is the most frequent complication and varies with the material choice of the lens. Glaucoma is the most serious postoperative complication and depends on the timing of the surgery, primary lens implantation and time of post surgical follow-up. The adherence to occlusion therapy with patching is critical to the visual prognosis and is determined by the child’s age and laterality of the cataract. There was significant improvement in the surgery and in IOLs, however the final visual prognosis is still not desirable.

  9. Treatment of Dentine Hypersensitivity by Diode Laser: A Clinical Study

    Directory of Open Access Journals (Sweden)

    Romeo Umberto

    2012-01-01

    Full Text Available Introduction. Dentine hypersensitivity (DH is characterized by pain after stimuli that usually provoke no symptoms. This study compared the effectiveness of GaAlAs diode laser alone and with topical sodium fluoride gel (NaF. Materials and Methods. The study was conducted on 10 patients (8 F/2 M, age 25–60 and 115 teeth with DH assessed by air and tactile stimuli measured by Numeric Rating Scale (NRS. Teeth were randomly divided into G1 (34 teeth treated by 1.25% NaF; G2 (33 teeth lased at 0.5 W PW (T on 100 m and T off 100 ms, fluence 62.2 J/cm2 in defocused mode with a 320 μ fiber. Each tooth received three 1′ applications; G3 (48 teeth received NaF gel plus laser at same G2 parameters. NRS was checked at each control. Results. Significant pain reduction was showed. The NRS reduction percentages were calculated, and there was a concrete decrease of DH above all in G3 than G2 and G1. Conclusion. Diode laser is a useful device for DH treatment if used alone and mainly if used with NaF gel.

  10. A Review of Gaucher Disease Pathophysiology, Clinical Presentation and Treatments

    Directory of Open Access Journals (Sweden)

    Jérôme Stirnemann

    2017-02-01

    Full Text Available Gaucher disease (GD, ORPHA355 is a rare, autosomal recessive genetic disorder. It is caused by a deficiency of the lysosomal enzyme, glucocerebrosidase, which leads to an accumulation of its substrate, glucosylceramide, in macrophages. In the general population, its incidence is approximately 1/40,000 to 1/60,000 births, rising to 1/800 in Ashkenazi Jews. The main cause of the cytopenia, splenomegaly, hepatomegaly, and bone lesions associated with the disease is considered to be the infiltration of the bone marrow, spleen, and liver by Gaucher cells. Type-1 Gaucher disease, which affects the majority of patients (90% in Europe and USA, but less in other regions, is characterized by effects on the viscera, whereas types 2 and 3 are also associated with neurological impairment, either severe in type 2 or variable in type 3. A diagnosis of GD can be confirmed by demonstrating the deficiency of acid glucocerebrosidase activity in leukocytes. Mutations in the GBA1 gene should be identified as they may be of prognostic value in some cases. Patients with type-1 GD—but also carriers of GBA1 mutation—have been found to be predisposed to developing Parkinson’s disease, and the risk of neoplasia associated with the disease is still subject to discussion. Disease-specific treatment consists of intravenous enzyme replacement therapy (ERT using one of the currently available molecules (imiglucerase, velaglucerase, or taliglucerase. Orally administered inhibitors of glucosylceramide biosynthesis can also be used (miglustat or eliglustat.

  11. A Review of Gaucher Disease Pathophysiology, Clinical Presentation and Treatments.

    Science.gov (United States)

    Stirnemann, Jérôme; Belmatoug, Nadia; Camou, Fabrice; Serratrice, Christine; Froissart, Roseline; Caillaud, Catherine; Levade, Thierry; Astudillo, Leonardo; Serratrice, Jacques; Brassier, Anaïs; Rose, Christian; Billette de Villemeur, Thierry; Berger, Marc G

    2017-02-17

    Gaucher disease (GD, ORPHA355) is a rare, autosomal recessive genetic disorder. It is caused by a deficiency of the lysosomal enzyme, glucocerebrosidase, which leads to an accumulation of its substrate, glucosylceramide, in macrophages. In the general population, its incidence is approximately 1/40,000 to 1/60,000 births, rising to 1/800 in Ashkenazi Jews. The main cause of the cytopenia, splenomegaly, hepatomegaly, and bone lesions associated with the disease is considered to be the infiltration of the bone marrow, spleen, and liver by Gaucher cells. Type-1 Gaucher disease, which affects the majority of patients (90% in Europe and USA, but less in other regions), is characterized by effects on the viscera, whereas types 2 and 3 are also associated with neurological impairment, either severe in type 2 or variable in type 3. A diagnosis of GD can be confirmed by demonstrating the deficiency of acid glucocerebrosidase activity in leukocytes. Mutations in the GBA1 gene should be identified as they may be of prognostic value in some cases. Patients with type-1 GD-but also carriers of GBA1 mutation-have been found to be predisposed to developing Parkinson's disease, and the risk of neoplasia associated with the disease is still subject to discussion. Disease-specific treatment consists of intravenous enzyme replacement therapy (ERT) using one of the currently available molecules (imiglucerase, velaglucerase, or taliglucerase). Orally administered inhibitors of glucosylceramide biosynthesis can also be used (miglustat or eliglustat).

  12. A Review of Gaucher Disease Pathophysiology, Clinical Presentation and Treatments

    Science.gov (United States)

    Stirnemann, Jérôme; Belmatoug, Nadia; Camou, Fabrice; Serratrice, Christine; Froissart, Roseline; Caillaud, Catherine; Levade, Thierry; Astudillo, Leonardo; Serratrice, Jacques; Brassier, Anaïs; Rose, Christian; Billette de Villemeur, Thierry; Berger, Marc G.

    2017-01-01

    Gaucher disease (GD, ORPHA355) is a rare, autosomal recessive genetic disorder. It is caused by a deficiency of the lysosomal enzyme, glucocerebrosidase, which leads to an accumulation of its substrate, glucosylceramide, in macrophages. In the general population, its incidence is approximately 1/40,000 to 1/60,000 births, rising to 1/800 in Ashkenazi Jews. The main cause of the cytopenia, splenomegaly, hepatomegaly, and bone lesions associated with the disease is considered to be the infiltration of the bone marrow, spleen, and liver by Gaucher cells. Type-1 Gaucher disease, which affects the majority of patients (90% in Europe and USA, but less in other regions), is characterized by effects on the viscera, whereas types 2 and 3 are also associated with neurological impairment, either severe in type 2 or variable in type 3. A diagnosis of GD can be confirmed by demonstrating the deficiency of acid glucocerebrosidase activity in leukocytes. Mutations in the GBA1 gene should be identified as they may be of prognostic value in some cases. Patients with type-1 GD—but also carriers of GBA1 mutation—have been found to be predisposed to developing Parkinson’s disease, and the risk of neoplasia associated with the disease is still subject to discussion. Disease-specific treatment consists of intravenous enzyme replacement therapy (ERT) using one of the currently available molecules (imiglucerase, velaglucerase, or taliglucerase). Orally administered inhibitors of glucosylceramide biosynthesis can also be used (miglustat or eliglustat). PMID:28218669

  13. CLINICAL PROFILE AND TREATMENT OUTCOMES IN PATIENTS WITH ANKYLOSING SPONDYLITIS

    Directory of Open Access Journals (Sweden)

    Ramesh Naidu

    2015-09-01

    Full Text Available Ankylosing spondylitis belongs to a group of diseases known as Spondyloarthritides characterized by inflammatory low backache. It is a chronic inflammatory disease of unknown etiology, mostly associated with HLA B27 positivity affecting skeletal (both axial and extra - axial and extra skeletal system. In general population Ankylosing spondylitis is likely to develop in about 1% to 2% of HLA - B27+ who have a disease - associated B27 subtype and is much more common among HLA - B27+ first degree relatives of HLA - B27+ AS Patients. Positive family history is a strong risk factor for the development of the disease. Ankylosing Spondylitis is a disease which mostly affects young males and working population. It is a chronic illness with exacerbations and remissions and leads to debility and significant morbidity and hence affects the quality of life significantly. This study has been carried out in Medicine department of Ra ngaraya medical college GGH Kakinada, Sraddha Hospital, Visakhapatnam, Andhra medical college, KGH, Visakhapatnam, GEMS College and Hospital, Srikakulam with an aim to study the articular and extra articular manifestations of Ankylosing Spondylitis, factor s affecting exacerbations and remissions. Correlation between disease activity and acute phase reactants, familial association, and to study the short term treatment outcomes.

  14. [Nighttime eating disorders--clinical symptoms and treatment].

    Science.gov (United States)

    Zawilska, Jolanta B; Santorek-Strumiłło, Edyta J; Kuna, Paulina

    2010-01-01

    Nighttime eating is categorized as either night eating syndrome (NES) or the sleep-related eating disorder (SRED). Both diseases are often connected with an increase of the body mass, obesity, and with psychiatric disturbances. NES is characterized by evening hyperphagia, abnormally increased food intake after the evening meal, nocturnal awakings with ingestions, morning anorexia, and insomnia. Patients suffering from NES are aware of their nocturnal ingestions. It is suggested that NES is an abnormality in the circadian rhythm of meal timing that occurs in people with normal circadian rhythm of sleep. Other factors underlying NES include genetic predispositions, hormonal and neurochemical disturbances, and mood disorders. SRED is characterized by recurrent episodes of eating or drinking after arousal from nighttime sleep, unaware in tight the most cases, with adverse consequences. The distinctive features of SRED are amnesia of night eating episodes and consumption of non-typical food or dangerous articles. SRED is frequently associated with other sleep disorders, e.g., restless leg syndrome, periodic limb movement disorder, obstructive sleep apnea, and somnambulism. It can be also induced by medicines applied by a patient (e.g. zolpidem). It is hypothesized that the syndrome represents a variation of somnambulism. In the treatment of NES both non-pharmacological methods (psychotherapy, phototherapy) as well as the pharmacotherapy (aimed to increase serotoninergic neurotransmission in the brain, predominantly by sertraline, a selective serotonin re-uptake inhibitor) are used. SRED can be treated by controlling comorbid sleep disorders and eliminating provocative sedative hypnotics.

  15. Bone biology in the elderly: clinical importance for fracture treatment

    Directory of Open Access Journals (Sweden)

    Rolvien Tim

    2016-12-01

    Full Text Available Age-related bone impairment often leads to fragility fractures in the elderly. Although excellent surgical care is widely provided, diagnosis and treatment of the underlying bone disorder are often not kept in mind. The interplay of the three major bone cells – osteoblasts, osteoclasts, and osteocytes – is normally well regulated via the secretion of messengers to control bone remodeling. Possible imbalances that might occur in the elderly are partly due to age, genetic risk factors, and adverse lifestyle factors but importantly also due to imbalances in calcium homeostasis (mostly due to vitamin D deficiency or hypochlorhydria, which have to be eliminated. Therefore, the cooperation between the trauma surgeon and the osteologist is of major importance to diagnose and treat the respective patients at risk. We propose that any patient suffering from fragility fractures is rigorously screened for osteoporosis and metabolic bone diseases. This includes bone density measurement by dual-energy X-ray absorptiometry, laboratory tests for calcium, phosphate, vitamin D, and bone turnover markers, as well as additional diagnostic modalities if needed. Thereby, most risk factors, including vitamin D deficiency, can be identified and treated while patients who meet the criteria for a specific therapy (i.e. antiresorptive and osteoanabolic receive such. If local health systems succeed to manage this process of secondary fracture prevention, morbidity and mortality of fragility fractures will decline to a minimum level.

  16. Critical review of available treatment options for treatment refractory depression and anxiety - clinical and ethical dilemmas

    Directory of Open Access Journals (Sweden)

    Kolar Dušan

    2016-01-01

    Full Text Available Treatment-resistant mood and anxiety disorders require an intensive therapeutic approach, and it should balance benefits and adverse effects or other potential detrimental effects of medications. The goal of treatment is to provide consistent and lasting improvement in symptoms of depression and anxiety. Benzodiazepines are effective for anxiety symptoms, but with no sustained treatment effects. Other medication treatment options for anxiety disorders are outlined. Ketamine is usually very effective in treating major depressive disorder but without sustained benefits. Long-term use may pose a significant risk of developing tolerance and dependence. Stimulant medication augmentation for treatment-resistant depression is effective for residual symptoms of depression, but effects are usually short-lasting and it sounds more as an artificial way of improving energy, alertness and cognitive functioning. Synthetic cannabinoids and medical marijuana are increasingly prescribed for various medical conditions, but more recently also for patients with mood and anxiety disorders. All of these treatments may raise ethical dilemmas about appropri­ateness of prescribing these medications and a number of questions regarding the optimal treatment for patients with treatment-resistant depression and treatment refractory anxiety disorders.

  17. Anaphylaxis after hymenoptera sting: is it venom allergy, a clonal disorder, or both?

    Science.gov (United States)

    Castells, Mariana C; Hornick, Jason L; Akin, Cem

    2015-01-01

    A 47-year-old man presented with loss of consciousness 5 minutes after being stung by a yellow jacket in his backyard. Epinephrine and fluids were required for resuscitation. Allergy evaluation revealed specific IgE to yellow jacket and honeybee, and the patient was started on venom immunotherapy. He had systemic reactions during buildup and a severe anaphylactic episode requiring 3 doses of intramuscular epinephrine at maintenance doses. Immunotherapy was discontinued. Serum tryptase level after 1 such episode was 29 ng/mL, with a baseline level of 25 ng/mL 4 weeks later. The physical examination was unremarkable including no skin lesions of cutaneous mastocytosis. Because of elevated baseline tryptase level, a bone marrow biopsy was performed, which revealed multifocal dense infiltrates of mast cells. A diagnosis of systemic mastocytosis was made. The patient was treated with omalizumab and was able to tolerate immunotherapy and is currently maintained on lifelong immunotherapy. He was restung in the field and has not had anaphylaxis.

  18. Imidacloprid inhibits IgE-mediated RBL-2H3 cell degranulation and passive cutaneous anaphylaxis

    Science.gov (United States)

    Shi, Linbo; Zou, Li; Gao, Jinyan; Xu, Huaing; Shi, Xiaoyun

    2016-01-01

    Background Imidacloprid has been commonly used as a pesticide for crop protection and acts as nicotinic acetylcholine receptor agonists. Little information about the relationship between imidacloprid and allergy is available. Objective This study aims to examine the effects of imidacoprid on IgE-mediated mast cell activation. Methods The rat basophilic leukemia cell line RBL-2H3 (RBL-2H3 cells) were treated with 10-3 – 10-12 mol/L imidacloprid, followed by measuring the mediator production, influx of Ca2+ in IgE-activated RBL-2H3 cells, and the possible effects of imidacoprid on anti-dinitrophenyl IgE-induced passive cutaneous anaphylaxis (PCA). Results It was shown that imidacoprid suppressed the production of histamine, β-hexosaminidase, leukotriene C4, interleukin-6, tumor necrosis factor-α, and Ca2+ mobilization in IgE-activated RBL-2H3 cells and decreased vascular extravasation in IgE-induced PCA. Conclusion It is the first time to show that imidacloprid suppressed the activation of RBL-2H3 cells. PMID:27803884

  19. A Model of Intestinal Anaphylaxis in Whey Sensitized Balb/c Mice

    Directory of Open Access Journals (Sweden)

    Kheroua Omar

    2009-01-01

    Full Text Available Problem statement: Cow’s Milk Allergy (CMA is a common disease in childhood. Pathophysiological mechanisms involved in gastrointestinal symptoms are relatively poorly understood. Approach: Therefore, an experimental model of intestinal anaphylaxis was needed to approach the problem. The aim of this study was to examine the effect of the parenteral sensitization to whey proteins through immune response and local intestine inflammation using a murine model of allergy. Sensitization of Balb/c mice with ß-lactoglobulin (ß-Lg or whey was performed in presence of Alum Al (OH3. Mice were analyzed for ß-Lg or whey specific serum antibodies by ELISA. Local anaphylactic responses were performed in vitro in using chamber by intestine challenge with ß-Lg or whey. Histological study was used to assess gut inflammation. Results: The sensitization induced the production of anti- ß-Lg or anti whey IgG, IgG1, IgG2a and IgE with a high IgG1/IgG2a ratio translating Th2 type response. The addition of ß-Lg or whey to the serosal side of the mouse intestinal epithelium in using chamber produced electrogenic chloride secretion as shown by Isc stimulation. Histological findings were mild with villi atrophy and lymphocyte hyperplasia. Conclusion: After sensitization, the mice became prone to developing anaphylactic response and may be useful experimental model for mechanistic studies of CMA or for hydrolyzed formulae.

  20. Anaphylaxis to Spirulina confirmed by skin prick test with ingredients of Spirulina tablets.

    Science.gov (United States)

    Le, Thuy-My; Knulst, André C; Röckmann, Heike

    2014-12-01

    Spirulina (Arthrospira platensis), blue-green microalgae, has high content in proteins, γ-linoleic acid and vitamins and therefore gained popularity as food supplement. According to the Food and Agriculture Organization of the United Nations Spirulina is also an interesting alternative and sustainable protein source with the growing world population. We present a case of a 17-year-old male, who developed anaphylaxis the first time he ingested a Spirulina tablet. Skin prick test with diluted Spirulina tablet was positive. Further skin prick testing with separated ingredients (Spirulina platensis algae, silicon dioxide, inulin and magnesium stearate) was only positive for Spirulina platensis algae and negative in controls, confirming the allergy was caused by Spirulina and not by one of the additives. This case report shows that diagnosis of Spirulina allergy can safely be made by skin prick test with dilutions of the A. platensis or even more simple by skin prick test with the diluted tablet. Since Spirulina has gained popularity as food and nutritional supplement, it is important to realize the potential risk of this dietary supplement. Before Spirulina is produced and consumed on a wider scale, allergenicity risk assessment should be performed, including investigation of potential crossreactivity with well-known inhalant allergens and foods.

  1. Inhibition by drugs of passive cutaneous anaphylaxis-induced skin histamine decrease.

    Directory of Open Access Journals (Sweden)

    Yokoyama,Hiroshi

    1984-08-01

    Full Text Available Passive cutaneous anaphylaxis (PCA was produced in the rat with mouse IgE-rich antiserum. The effect of drugs on the PCA-induced skin histamine decrease and leakage of protein-bound dye was studied. Salbutamol (0.5 mg/kg i.v. or 1.0 mg/kg s.c. and cromoglycate (10 mg/kg i.v. significantly inhibited the skin histamine decrease. A combination of salbutamol (0.5 mg/kg i.v. or 1.0 mg/kg s.c. and aminophylline (25 mg/kg i.v. or 75 mg/kg s.c. had an additive or greater than additive effect on the histamine decrease. Salbutamol (1.0 mg/kg s.c. inhibited the dye leakage markedly, and aminophylline (75 mg/kg s.c. slightly. These results indicate that the decrease in the skin histamine content is useful as an index of the in vivo inhibitory effect of antiallergic drugs on the antigen-induced histamine release.

  2. Gastric electrical stimulation for treatment of clinically severe gastroparesis

    Directory of Open Access Journals (Sweden)

    Naga Venkatesh G Jayanthi

    2013-01-01

    Full Text Available Background: Severe, drug-resistant gastroparesis is a debilitating condition. Several, but not all, patients can get significant relief from nausea and vomiting by gastric electrical stimulation (GES. A trial of temporary, endoscopically delivered GES may be of predictive value to select patients for laparoscopic-implantation of a permanent GES device. Materials and Methods: We conducted a clinical audit of consecutive gastroparesis patients, who had been selected for GES, from May 2008 to January 2012. Delayed gastric emptying was diagnosed by scintigraphy of ≥50% global improvement in symptom-severity and well-being was a good response. Results: There were 71 patients (51 women, 72% with a median age of 42 years (range: 14-69. The aetiology of gastroparesis was idiopathic (43 patients, 61%, diabetes (15, 21%, or post-surgical (anti-reflux surgery, 6 patients; Roux-en-Y gastric bypass, 3; subtotal gastrectomy, 1; cardiomyotomy, 1; other gastric surgery, 2 (18%. At presentation, oral nutrition was supplemented by naso-jejunal tube feeding in 7 patients, surgical jejunostomy in 8, or parenterally in 1 (total 16 patients; 22%. Previous intervention included endoscopic injection of botulinum toxin (botox into the pylorus in 16 patients (22%, pyloroplasty in 2, distal gastrectomy in 1, and gastrojejunostomy in 1. It was decided to directly proceed with permanent GES in 4 patients. Of the remaining, 51 patients have currently completed a trial of temporary stimulation and 39 (77% had a good response and were selected for permanent GES, which has been completed in 35 patients. Outcome data are currently available for 31 patients (idiopathic, 21 patients; diabetes, 3; post-surgical, 7 with a median follow-up period of 10 months (1-28; 22 patients (71% had a good response to permanent GES, these included 14 (68% with idiopathic, 5 (71% with post-surgical, and remaining 3 with diabetic gastroparesis. Conclusions: Overall, 71% of well-selected patients

  3. Actinomycosis: etiology, clinical features, diagnosis, treatment, and management

    Directory of Open Access Journals (Sweden)

    Valour F

    2014-07-01

    Full Text Available Florent Valour,1–3 Agathe Sénéchal,1,2 Céline Dupieux,2–4 Judith Karsenty,1,2 Sébastien Lustig,2,5 Pierre Breton,2,6 Arnaud Gleizal,2,7 Loïc Boussel,2,8,9 Frédéric Laurent,2–4 Evelyne Braun,1 Christian Chidiac,1–3 Florence Ader,1–3 Tristan Ferry1–3 1Service des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon, France; 2Université Claude Bernard Lyon 1, Lyon, France; 3Centre International de Recherche en Infectiologie, CIRI, INSERM U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon, France; 4Laboratoire de Bactériologie, Centre de Biologie du Nord, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon, France; 5Chirurgie Orthopédique, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon, France; 6Stomatologie et Chirurgie Maxillo-faciale, Hospices Civils de Lyon, Groupement Hospitalier Sud, Lyon, France; 7Chirurgie Maxillo-faciale, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon, France; 8Radiologie, Hospices Civils de Lyon, Groupement Hospitalier Nord, Lyon, France; 9Creatis, CNRS UMR 5220, INSERM U1044, Université Lyon 1, INSA Lyon, Lyon, France Abstract: Actinomycosis is a rare chronic disease caused by Actinomyces spp., anaerobic Gram-positive bacteria that normally colonize the human mouth and digestive and genital tracts. Physicians must be aware of typical clinical presentations (such as cervicofacial actinomycosis following dental focus of infection, pelvic actinomycosis in women with an intrauterine device, and pulmonary actinomycosis in smokers with poor dental hygiene, but also that actinomycosis may mimic the malignancy process in various anatomical sites. Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with

  4. Clinical Observation The Thoughts and Methods for Clinical Research on Acupuncture Treatment of Chronic Fatigue Syndrome

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The general situation of chronic fatigue syndrome (CFS) and the criteria for its diagnosis are discussed, and it is put forward that making qi and blood of the zang-fu organs balanced is the key to acupuncture treatment of the disease. Such aspects as case selection, point selection and therapeutic assessment are also discussed in the present paper.

  5. Coronary artery spasm--clinical features, diagnosis, pathogenesis, and treatment.

    Science.gov (United States)

    Yasue, Hirofumi; Nakagawa, Hitoshi; Itoh, Teruhiko; Harada, Eisaku; Mizuno, Yuji

    2008-02-01

    Coronary (artery) spasm plays an important role in the pathogenesis of ischemic heart disease, including stable angina, unstable angina, myocardial infarction, and sudden death. The prevalence of coronary spasm differs among populations, is higher in Japan and Korea than in the Western countries probably due to genetic as well as environmental factors. Coronary spasm occurs most often from midnight to early morning and is usually not induced by exercise in the daytime. The attacks of coronary spasm are associated with either ST segment elevation or depression, or negative U wave on ECG. Patients with multi-vessel coronary spasm may suffer from lethal arrhythmia, including advanced AV block, ventricular tachycardia or fibrillation, or even sudden death, and they are often resistant to conventional medical therapy including Ca-channel blockers (CCBs). Endothelial nitric oxide (NO) activity is reduced and markers of oxidative stress are elevated in patients with coronary spasm. Thrombogenesis is enhanced and plasma levels of hsCRP and P-selection are elevated in patients with coronary spasm. Thus, patients with coronary spasm have endothelial dysfunction and are suffering from a low-grade chronic inflammation. Polymorphisms of endothelial NO synthase, smoking, and low-grade inflammation are the most important risk factors for coronary spasm. Coronary spasm is a hyper-contraction of coronary smooth muscle triggered by an increase of intracellular Ca2+ in the presence of an increased Ca2+ sensitivity. It has been shown that RhoA/ROCK pathway is involved in Ca2+ sensitivity and that the reduced endothelial NO activity results in increased Ca2+ sensitivity through enhanced RhoA/ROCK pathway. Accordingly, it is possible that in addition to CCBs, RhoA/ROCK pathway blockers may prove to be useful for the treatment of coronary spasm.

  6. Inhibitory effects of whisky congeners on IgE-mediated degranulation in rat basophilic leukemia RBL-2H3 cells and passive cutaneous anaphylaxis reaction in mice.

    Science.gov (United States)

    Itoh, Tomohiro; Tsukane, Mariko; Koike, Minako; Nakamura, Chizu; Ohguchi, Kenji; Ito, Masafumi; Akao, Yukihiro; Koshimizu, Seiichi; Nozawa, Yoshinori; Wakimoto, Toshiyuki; Nukaya, Haruo; Suwa, Yoshihide

    2010-06-23

    Whisky is matured in oak casks. Many nonvolatile substances (whisky congeners, WC) seep from the oak cask during the maturing process. In this study, three antiallergic agents (syringaldehyde, SA; lyoniresinol, Lyo; and ellagic acid, EA) were isolated from WC. Treatment with SA, Lyo, and EA reduced the elevation of intracellular free Ca(2+) concentration ([Ca(2+)]i) and intracellular ROS production caused by FcepsilonRI activation. The inhibitions of the elevation of [Ca(2+)]i and intracellular ROS production by SA and Lyo were mainly due to the suppression of the NADPH oxidase activity and scavenging of the produced radical, respectively. On the other hand, EA inactivated spleen tyrosine kinase and led to the inhibition of the elevation of [Ca(2+)]i and intracellular ROS production. Furthermore, it was found that WC strongly inhibited IgE binding to the FcepsilonRIalpha chain, whereas SA, Lyo, and EA did not indicate this inhibitory effect. These results suggest that WC inhibits allergic reactions through multiple mechanisms. To disclose the in vivo effects of WC, SA, Lyo, and EA, these compounds were administered to type I allergic model mice, and the passive cutaneous anaphylaxis (PCA) reaction was measured. These compounds remarkably suppressed the PCA reaction. Taken together, these findings suggest that WC seemed to be beneficial to ameliorate allergic reactions.

  7. Improving treatment of depression in the elderly: two innovations in statistical design of clinical trials.

    Science.gov (United States)

    Lavori, Philip W

    2005-08-01

    Depression in the elderly patient may present special challenges for the design of clinical treatment trials due to a complex antidepressant treatment history, individual contraindications to certain medications, medical comorbidity, as well as concurrent medications for other medical conditions. The chronic, relapsing, and remitting nature of depression calls for a dynamic, adaptive treatment strategy, matching treatment changes to patient responses. To market a drug successfully in a cost-conscious environment, it also may be necessary to define the unique contribution that a new drug makes to the treatment of patients, in addition to proving that it is efficacious (by comparison to placebo). These issues, although not unique to the elderly, take on greater importance and weight as patient populations age. This article describes 2 innovations in clinical trials design that may help deal with these issues.

  8. Review of Clinical Pharmacology of Aloe vera L. in the Treatment of Psoriasis.

    Science.gov (United States)

    Miroddi, Marco; Navarra, Michele; Calapai, Fabrizio; Mancari, Ferdinando; Giofrè, Salvatore Vincenzo; Gangemi, Sebastiano; Calapai, Gioacchino

    2015-05-01

    Aloe vera L., is a plant used worldwide as folk remedy for the treatment of various ailments, including skin disorders. Its gel is present in cosmetics, medicinal products and food supplements. Psoriasis, an immune-mediated chronic inflammatory disease, involving mainly the skin, affects about the 2-3% of general population. Conventional pharmacological treatments for psoriasis can have limited effectiveness and can cause adverse reactions. For this reason often psoriatic patients look for alternative treatments based on natural products containing Aloe vera. We conducted a systematic review of clinical trials assessing effectiveness and safety of aloe for the treatment of psoriasis. Clinical studies published in English were considered; a total of four clinical trials met inclusion criteria. Studies were also evaluated by using the Jadad scale and Consort Statement in Reporting Clinical trials of Herbal Medicine Intervention. Quality and methodological accuracy of considered studies varied considerably, and some crucial information to reproduce clinical results was missing. We conclude that administration of aloe as cutaneous treatment is generally well tolerated, as no serious side effects were reported. Results on the effectiveness of Aloe vera are contradictory; our analysis reveals the presence of methodological gaps preventing to reach final conclusions.

  9. Prevention and Treatment of Postoperative Infections after Sinus Elevation Surgery: Clinical Consensus and Recommendations

    Directory of Open Access Journals (Sweden)

    Tiziano Testori

    2012-01-01

    Full Text Available Introduction. Maxillary sinus surgery is a reliable and predictable treatment option for the prosthetic rehabilitation of the atrophic maxilla. Nevertheless, these interventions are not riskless of postoperative complications with respect to implant positioning in pristine bone. Aim. The aim of this paper is to report the results of a clinical consensus of experts (periodontists, implantologists, maxillofacial surgeons, ENT, and microbiology specialists on several clinical questions and to give clinical recommendations on how to prevent, diagnose, and treat postoperative infections. Materials and Methods. A panel of experts in different fields of dentistry and medicine, after having reviewed the available literature on the topic and taking into account their long-standing clinical experience, gave their response to a series of clinical questions and reached a consensus. Results and Conclusion. The incidence of postop infections is relatively low (2%–5.6%. A multidisciplinary approach is advisable. A list of clinical recommendation are given.

  10. Selection and utilization of assessment instruments in substance abuse treatment trials: the National Drug Abuse Treatment Clinical Trials Network experience

    Directory of Open Access Journals (Sweden)

    Rosa C

    2012-07-01

    Full Text Available Carmen Rosa, Udi Ghitza, Betty TaiCenter for the Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MD, USAAbstract: Based on recommendations from a US Institute of Medicine report, the National Institute on Drug Abuse established the National Drug Abuse Treatment Clinical Trials Network (CTN in 1999, to accelerate the translation of science-based addiction treatment research into community-based practice, and to improve the quality of addiction treatment, using science as the vehicle. One of the CTN's primary tasks is to serve as a platform to forge bi-directional communications and collaborations between providers and scientists, to enhance the relevance of research, which generates empirical results that impact practice. Among many obstacles in moving research into real-world settings, this commentary mainly describes challenges and iterative experiences in regard to how the CTN develops its research protocols, with focus on how the CTN study teams select and utilize assessment instruments, which can reasonably balance the interests of both research scientists and practicing providers when applied in CTN trials. This commentary also discusses the process by which the CTN further selects a core set of common assessment instruments that may be applied across all trials, to allow easier cross-study analyses of comparable data.Keywords: addiction, assessment, drug abuse treatment, drug dependence, NIDA Clinical Trials Network, substance use disorder

  11. Variables associated with environmental scanning among clinicians at substance abuse treatment clinics

    Directory of Open Access Journals (Sweden)

    Alison L. Koch

    2005-01-01

    Full Text Available Introduction. Environmental scanning, as a component of absorptive capacity, has been shown to be associated with increased use of innovative treatment techniques at substance abuse treatment programmes. As the transfer of innovative, evidence-based treatment techniques from research to practice is gaining attention, we aimed to identify variables associated with higher levels of environmental scanning among substance abuse treatment clinicians. Method. A cross-sectional survey was administered to 162 clinicians at 15 substance abuse treatment clinics in Michigan. Measures: Environmental scanning was measured by frequency of use of the Internet, journals, seminars or conferences, and people at other treatment clinics for new substance abuse treatment information. Clinicians were asked for their perceptions of their clinic’s openness to new treatment techniques and support for acquiring new information, access to and satisfaction with information sources at work, as well as if they feel it is their job to keep up to date with current treatment research. Additional measures included whether they intended to quit their jobs and whether they were emotionally drained from work. Findings: We found positive associations between environmental scanning and perceived clinic support for acquiring new information, perceived clinic openness to new treatment techniques, access to e-mail and Internet at work, and satisfaction with resources. Turnover intention and being emotionally drained were negatively associated with environmental scanning. Conclusion. : Individual and organizational level variables were found to be associated with higher levels of environmental scanning activity. Although the causal directions of these associations are not known, the findings suggest ways to increase environmental scanning among clinicians.

  12. Assessing and reporting heterogeneity in treatment effects in clinical trials: a proposal

    Directory of Open Access Journals (Sweden)

    Kent David M

    2010-08-01

    Full Text Available Abstract Mounting evidence suggests that there is frequently considerable variation in the risk of the outcome of interest in clinical trial populations. These differences in risk will often cause clinically important heterogeneity in treatment effects (HTE across the trial population, such that the balance between treatment risks and benefits may differ substantially between large identifiable patient subgroups; the "average" benefit observed in the summary result may even be non-representative of the treatment effect for a typical patient in the trial. Conventional subgroup analyses, which examine whether specific patient characteristics modify the effects of treatment, are usually unable to detect even large variations in treatment benefit (and harm across risk groups because they do not account for the fact that patients have multiple characteristics simultaneously that affect the likelihood of treatment benefit. Based upon recent evidence on optimal statistical approaches to assessing HTE, we propose a framework that prioritizes the analysis and reporting of multivariate risk-based HTE and suggests that other subgroup analyses should be explicitly labeled either as primary subgroup analyses (well-motivated by prior evidence and intended to produce clinically actionable results or secondary (exploratory subgroup analyses (performed to inform future research. A standardized and transparent approach to HTE assessment and reporting could substantially improve clinical trial utility and interpretability.

  13. Clinical management of carbamazepine intoxication during anti-tubercular treatment: a case report

    Directory of Open Access Journals (Sweden)

    Massimo Calderazzo

    2015-06-01

    Full Text Available We describe a 67-year-old man with medical history of focal post-stroke seizure and type 2 diabetes mellitus treated with carbamazepine, clobazam, gliclazide, insulin glargine, and omeprazole we visited for the onset in the last 7 days of asthenia, cough with mucus, breathing difficulty, chest pain, and weight loss. After clinical and laboratory tests, pulmonary tuberculosis was diagnosed, and a treatment with isoniazid, ethambutol, pyrazinamide rifampicin, and pyridoxine was started. Therapeutic drug monitoring of tuberculosis treatment documented that all drugs were in normal therapeutic range. Four days after the beginning of the treatment, we documented the improvement of fever, and three days later the patient showed sleepiness, visual disorder and asthenia. Clinical and pharmacological evaluation suggested a carbamazepine toxicity probably related to a drug interaction (Drug Interaction Probability Scale score = 6. The impossibility to switch carbamazepine for another antiepileptic drug, due to a resistant form of seizure, induced the discontinuation of tuberculosis treatment, resulting in the normalization of serum carbamazepine levels in one day (10 µg/ml and in the worsening of fever, requiring a new clinical and pharmacological evaluation. The titration dosage of carbamazepine and its therapeutic drug monitoring allowed to continue the treatment with both antitubercular drugs and carbamazepine, without the development of adverse drug reactions. To date, tuberculosis treatment was stopped and clinical evaluation, radiology and microbiology assays documented the absence of tubercular infection and no seizures appeared (carbamazepine dosage 800 mg/bid; serum levels 9.5 µg/ml.

  14. Cognitive behavioral psychotherapeutic treatment at a psychiatric trauma clinic for Refugees

    DEFF Research Database (Denmark)

    Buhmann, Christine Cæcilie Böck; Andersen, Ida; Mortensen, Erik Lykke;

    2015-01-01

    INTRODUCTION: Cognitive behavioural therapy (CBT) with trauma focus is the most evidence supported psychotherapeutic treatment of PTSD, but few CBT treatments for traumatized refugees have been described in detail. PURPOSE: To describe and evaluate a manualized cognitive behavioral therapy...... for traumatized refugees incorporating exposure therapy, mindfulness and acceptance and commitment therapy. MATERIAL AND METHODS: 85 patients received six months' treatment at a Copenhagen Trauma Clinic for Refugees and completed self-ratings before and after treatment. The treatment administered to each patient...... and the observed change. CONCLUSION: The study suggests that CBT treatment incorporating mindfulness and acceptance and commitment therapy is promising for traumatized refugees and punctures the myth that this group of patients are unable to participate fully in structured CBT. However, treatment methods must...

  15. Gingival recession and adult orthodontics: a clinical evidence-based treatment proposal.

    Science.gov (United States)

    Dersot, Jean-Marc

    2012-03-01

    The presence of a gingival recession prior to orthodontic treatment is a real problem. Patients are concerned about losing their teeth but may also complain of their unpleasant appearance or root sensitivity in the exposed area. The orthodontist is not sure whether orthodontic treatment can be performed or whether the tooth movement will not aggravate the recession and whether periodontal surgery needs to be done before or after orthodontic treatment. The aim of this paper is to present recent data from the literature and several clinical situations in adults in order to submit a treatment sequence and clarify the role of different periodontal plastic surgery root coverage procedures.

  16. Some comments on clinical studies in orthodontics and their applications to orthodontic treatment.

    Science.gov (United States)

    Baumrind, S

    1999-06-01

    This article indicates the origins and background of the current series of National Institute of Dental and Craniofacial Research-funded, university-based clinical studies of orthodontic treatment. It suggests that future studies should be less focused on refining our estimates of mean changes during treatment and concentrate research on the systematic analysis of individual differences among patients' responses to treatment, and study how skilled clinicians make in-course corrections in response to unexpected changes in treatment conditions. Finally, some suggestions are made concerning optimization of decision making in the presence of uncertainty.

  17. Follow-up study of the treatment outcomes at a psychiatric trauma clinic for refugees

    DEFF Research Database (Denmark)

    Buhmann, Cæcilie; Lykke Mortensen, Erik; Nordentoft, Merete;

    2015-01-01

    PURPOSE: To describe change in mental health after treatment with antidepressants and trauma-focused cognitive behavioral therapy. METHODS: Patients receiving treatment at the Psychiatric Trauma Clinic for Refugees in Copenhagen completed self-ratings of level of functioning, quality of life......, and symptoms of PTSD, depression and anxiety before and after treatment. Changes in mental state and predictors of change were evaluated in a sample that all received well-described and comparable treatment. RESULTS: 85 patients with PTSD or depression were included in the analysis. Significant improvement...

  18. Influence networks among substance abuse treatment clinics: implications for the dissemination of innovations.

    Science.gov (United States)

    Johnson, Kimberly; Quanbeck, Andrew; Maus, Adam; Gustafson, David H; Dearing, James W

    2015-09-01

    Understanding influence networks among substance abuse treatment clinics may speed the diffusion of innovations. The purpose of this study was to describe influence networks in Massachusetts, Michigan, New York, Oregon, and Washington and test two expectations, using social network analysis: (1) Social network measures can identify influential clinics; and (2) Within a network, some weakly connected clinics access out-of-network sources of innovative evidence-based practices and can spread these innovations through the network. A survey of 201 clinics in a parent study on quality improvement provided the data. Network measures and sociograms were obtained from adjacency matrixes created by UCINet. We used regression analysis to determine whether network status relates to clinics' adopting innovations. Findings suggest that influential clinics can be identified and that loosely linked clinics were likely to join the study sooner than more influential clinics but were not more likely to have improved outcomes than other organizations. Findings identify the structure of influence networks for SUD treatment organizations and have mixed results on how those structures impacted diffusion of the intervention under study. Further study is necessary to test whether use of knowledge of the network structure will have an effect on the pace and breadth of dissemination of innovations.

  19. Labile and Paroxysmal Hypertension: Common Clinical Dilemmas in Need of Treatment Studies.

    Science.gov (United States)

    Mann, Samuel J

    2015-11-01

    Although "labile hypertension" is regularly encountered by clinicians, there is a paucity of information available to guide therapeutic decisions. This review discusses its clinical relevance, the limitations of current knowledge, and possible directions for future research and clinical management. Results of studies that assessed measures of blood pressure variability or reactivity are reviewed. The limited information about effects of antihypertensive drugs on blood pressure variability is discussed. Two different clinical presentations are differentiated: labile hypertension and paroxysmal hypertension. Labile hypertension remains a clinical impression without defined criteria or treatment guidance. Paroxysmal hypertension, also called pseudopheochromocytoma, presents as dramatic episodes of abrupt and severe blood pressure elevation. The disorder can be disabling. Although it regularly raises suspicion of a pheochromocytoma, such a tumor is found in <2 % of patients. The cause, which involves both emotional factors and the sympathetic nervous system, and treatment approaches, are presented.

  20. Clinical Observation on Abdominal Cluster-Needling for Treatment of Chronic Annexitis

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@Chronic annexitis is a frequently encountered disease at clinic. According to clinical experience in acupuncture treatment of annexitis, the author has developed an effective acupuncture method called abdominal cluster-needling, with quite good therapeutic results as reported in the following. Clinical Data There were altogether 66 cases of chronic annexitis in this series, which were divided randomly into the treatment group and control group. The treatment group consisted of 36 cases, ranging in age from 20-40 years, and duration of illness from 0.5-9 years. The control group consisted of 30 cases, ranging in age from 21-38 years, and duration of illness from 1-8 years.

  1. Clinical results after different operative treatment methods of radial head and neck fractures

    DEFF Research Database (Denmark)

    Zwingmann, J; Welzel, M; Dovi-Akue, D

    2013-01-01

    was placed on extracting data describing clinical efficacy and outcome by using the Mason classification and including elbow function scores. A total of 841 clinical studies were identified describing in total the clinical follow-up of 1264 patients. RESULTS: For type II radial head and neck fractures....... If a prosthesis was implanted, the primary implantation seems to be associated with a better outcome after type III (87%) and IV (82%) fractures compared to the results after a secondary implantation. DISCUSSION: Recommendations for surgical treatment of radial head and neck fractures according to the Mason...... the significant best treatment option seems to be ORIF with an overall success rate of 98% by using screws or biodegradable (polylactide) pins. ORIF with a success rate of 92% shows the best results in the treatment of type III fractures and seem to be better than resection and implantation of a prosthesis...

  2. Clinical characteristics and treatment outcomes in 132 patients with malignant mesothelioma

    Directory of Open Access Journals (Sweden)

    Abdurrahman Abakay

    2011-01-01

    Full Text Available Purpose: Our objective is to scrutinize clinical, laboratory, radiological characteristics, treatment regimens, and treatment outcomes of malignant mesothelioma (MM cases in our hospital. Materials and Methods: We investigated, retrospectively, the clinical characteristics and treatment outcomes of all 132 MM patients at Dicle University Hospital between January 2006 and April 2010. Results: A total of 82 (62.1% patients were male, and 50 (37.9% female. Median age was 56.0 years. Mean survival time was 9.6±6.9 months. Mean survival time of patients who had received best supportive care was 7.5 months, chemotherapy 10.4 months, and multimodality treatment regimen 12.6 months. Patients in the multimodality treatment group survived longer than did those in the other two groups (P=0.042. A total of 76 patients received chemotherapy, of whom 17 (22.3% were administered Cisplatin/Carboplatin and Gemcitabine, 58 (76.4% Cisplatin/Carboplatin and Pemetrexed, and one (1.3% Cisplatin + Docetaxel. Complete and partial response to treatment in patients receiving Cisplatin/Carboplatin and Gemcitabine was found 47.1% and Cisplatin/Carboplatin and Pemetrexed was found 50.0% (P>0.05. Conclusions: MM related to asbestos exposure is seen frequently in Turkey. Patients present with the typical clinical features of dyspnea, weight loss, and chest pain. Survival analysis shows that patients receiving multimodality treatment may be better.

  3. Empirically supported treatments for panic disorder with agoraphobia in a Spanish psychology clinic.

    Science.gov (United States)

    Ballesteros, Francisco; Labrador, Francisco J

    2014-10-27

    The aim of this work is to study the sociodemographic and clinical characteristics of patients diagnosed with Panic Disorder with Agoraphobia (PD/Ag), as well as the characteristics of the treatment and its results and cost in a University Psychology Clinic. Fifty patients demanded psychological assistance for PD/Ag; 80% were women, with an average age of 29.22 years (SD = 9.03). Mean number of evaluation sessions was 3.26 (SD = 1.03), and of treatment sessions, 13.39 (SD = 9.237). Of the patients, 83.33% were discharged (that is, questionnaire scores were below the cut-off point indicated by the authors, and no PD/Ag was observed at readministration of the semistructured interview), 5.5% refused treatment, and 11% were dropouts. The average number of treatment sessions of patients who achieved therapeutic success was 15.13 (SD = 8.98). Effect sizes (d) greater than 1 were obtained in all the scales. Changes in all scales were significant (p < .05). The estimated cost of treatment for patients who achieved therapeutic success was 945.12€. The treatment results are at least similar to those of studies of efficacy and effectiveness for PD/Ag. The utility of generalizing treatments developed in research settings to a welfare clinic is discussed.

  4. A Clinical Report of Localized Itching After Treatment with Sweet Bee Venom

    Directory of Open Access Journals (Sweden)

    Choi Seok-woo

    2010-09-01

    Full Text Available Objectives : This study is to report the percentage of localized itching which occurred, when we injected to patients with Sweet Bee Venom(Sweet BV. Methods : We investigated 374 patients who had injected with Sweet BV in our clinic from February 15. 2009 to April 30, 2010. We checked the number and percentage of patients who occured localized itching on injection area. Then we analyzed those according to times in treatment, the body parts of injection and treatment dosage. Results and Conclusion : Localized itching was lower by 1.60% in the first treatment with Sweet BV. However localized itching was 12.83% in the whole course of treatment, which showed a similar incidence of 13% in Bee Venom. Therefore it can be interpreted that Sweet BV may help suppress the immune responses such as itching in the initial treatment, but the occurrence of local immune responses of Sweet BV may be similar to that of Bee Venom in continued treatment. We suppose that we should be careful of the occurrence of local immune responses as Bee Venom at least until the fourth treatment in clinical application with Sweet BV, although localized itching did not occur in the first treatment. Also we should be careful of treatment with Sweet BV in body parts, such as wrist, hand, chest and abdominal, because the percentage of localized itching was relatively high in those parts.

  5. Burst fracture of the thoracolumbar spine: correlation between kyphosis and clinical result of the treatment

    Directory of Open Access Journals (Sweden)

    Rodrigo Arnold Tisot

    2015-06-01

    Full Text Available OBJECTIVE: To evaluate the correlation between kyphosis due to burst fractures of thoracic and lumbar spine and clinical outcome in patients undergoing conservative or surgical treatment.METHODS: A retrospective, cross-sectional study was conducted with 29 patients with thoracolumbar burst fractures treated by the Spine Group in a trauma reference hospital between the years 2002 and 2011. Patients were followed-up as outpatients for a minimum of 24 months. All cases were clinically evaluated by Oswestry and SF-36 quality of life questionnaires and the visual analogue scale (VAS of pain. They were also evaluated by X-ray examinations and CT scans of the lumbosacral spine at the time of hospitalization and subsequently as outpatients by Cobb method for measuring the degree of kyphosis.RESULTS: There was no statistically significant correlation between the degree of initial kyphosis and clinical outcome measured by VAS and by most of the SF-36 domains in both patients treated conservatively and the surgically treated. The Oswestry questionnaire showed benefits for patients who received conservative treatment (p=0.047 compared to those surgically treated (p=0.335. The analysis of difference between initial and final kyphosis and final kyphosis alone in relation to clinical outcome showed no statistical correlation in any of the scores used.CONCLUSION: The clinical outcome of treatment of the thoracic and lumbar burst fractures was not influenced by a greater or lesser degree of initial or residual kyphosis, regardless of the type of treatment.

  6. Level of analysis issues in assessing treatment beliefs in substance abuse clinics.

    Science.gov (United States)

    Mitchelson, Jacqueline K; Dickson, Marcus W; Arfken, Cynthia L; Agius, Elizabeth

    2007-12-01

    The current study applies the growing literature in the organizational sciences regarding levels of analysis issues to the analysis of substance abuse treatment beliefs. Research on clinicians' beliefs in substance abuse treatment is often based on the assumption that the beliefs are sufficiently shared by clinicians within a clinic and sufficiently vary across clinics that they can be treated as a group-level phenomenon. Further, efforts to introduce new innovations are often focused at the group or clinic level without testing this assumption, which can lead to failure to adopt or to successfully implement the innovation. We tested the assumption of sharedness by examining if there was sufficient agreement about treatment beliefs within clinics, within groups of clinics or within groups of clinicians to justify treating these aggregations as meaningful groups. Using three statistical approaches to examining level of analysis (Within and Between Analysis (WABA I), Intraclass Correlation Coefficients (ICC(1)), and r(wg)), we found that variability in treatment beliefs largely occurred at the individual rather than at the tested aggregate levels of analysis. These findings serve as an example of the importance of testing the assumption of shared perceptions in future research.

  7. Level of analysis issues in assessing treatment beliefs in substance abuse clinics

    Science.gov (United States)

    Mitchelson, Jacqueline K.; Dickson, Marcus W.; Arfken, Cynthia L.; Agius, Elizabeth

    2010-01-01

    The current study applies the growing literature in the organizational sciences regarding levels of analysis issues to the analysis of substance abuse treatment beliefs. Research on clinicians' beliefs in substance abuse treatment is often based on the assumption that the beliefs are sufficiently shared by clinicians within a clinic and sufficiently vary across clinics that they can be treated as a group-level phenomenon. Further, efforts to introduce new innovations are often focused at the group or clinic level without testing this assumption, which can lead to failure to adopt or to successfully implement the innovation. We tested the assumption of sharedness by examining if there was sufficient agreement about treatment beliefs within clinics, within groups of clinics or within groups of clinicians to justify treating these aggregations as meaningful groups. Using three statistical approaches to examining level of analysis (Within and Between Analysis (WABA I), Intraclass Correlation Coefficients (ICC(1)), and rwg), we found that variability in treatment beliefs largely occurred at the individual rather than at the tested aggregate levels of analysis. These findings serve as an example of the importance of testing the assumption of shared perceptions in future research. PMID:17570604

  8. Reasons for students’ poor clinical competencies in the Primary Health Care: Clinical nursing, diagnosis treatment and care programme

    Directory of Open Access Journals (Sweden)

    Ann Müller

    2010-03-01

    .

    How to cite this article:Magobe, N.B.D., Beukes, S.,Müller, A., 2010, 'Reasons for students’ poor clinical competencies in the Primary Health Care: Clinical nursing, diagnosis treatment and care programme’, Health SA Gesondheid 15(1, Art.#525, 6 pages. DOI: 10.4102/hsag.v15i1.525

  9. Comparison of microsurgery and endovascular treatment on clinical outcome following poor-grade subarachnoid hemorrhage.

    Science.gov (United States)

    Sandström, Niklas; Yan, Bernard; Dowling, Richard; Laidlaw, John; Mitchell, Peter

    2013-09-01

    Poor-grade (World Federation of Neurological Surgeons [WFNS] clinical grading scale grades IV and V) subarachnoid hemorrhage (SAH) is associated with significant morbidity and mortality. However, the correlation between the timing, modality of intervention (clipping or coiling) and the clinical outcome is not clear. This study aims to examine this correlation. Patients presenting with WFNS grades IV and V aneurysmal SAH between 1997 and 2008 to a single centre were studied. An aggressive policy of early intervention was followed, and the selection of endovascular versus microsurgical intervention was made according to angiographic rather than clinical features. Clinical outcomes were graded using the modified Rankin scale (mRS) at 6 month follow-up. One hundred and forty-three poor-grade patients (23.9% of all 598 aneurysmal SAH patients) were studied. Treatment was microsurgical in 83 (58.0%) and endovascular in 60 (42%) patients. Twenty patients (14.0%) were lost to follow-up. Good outcome (mRS 0-2) at 6 months was found in 45 microsurgical patients (63.3%) and 24 endovascular patients (46.1%). This trend towards better clinical outcomes in the microsurgical group was not statistically significant. With an aggressive early treatment policy more than half of the poor-grade SAH patients demonstrated a good clinical outcome. Microsurgery and endovascular treatment, when selected primarily according to angiographic features, were equally likely to achieve good outcome.

  10. Clinical diagnosis and surgical treatment of pancreatic and/or duodenal injuries

    Institute of Scientific and Technical Information of China (English)

    Zekuan Xu; Leyao Lian; Yi Miao; Xunliang Liu

    2005-01-01

    Objective: To investigate the points of the clinical diagnosis and surgical treatment for pancreatic and/or duodenal injuries. Methods: Clinical data of 30 patients who suffered from pancreatic and/or duodenal injuries were reviewed. Results: There were 29 cases who received surgical management. Of the 30 cases, 22 cases were cured, seven cases died, and postoperative complications occurred in 16 cases. The cure rate was 73.3%. Conclusion: Pancreatic and/or duodenal injuries are severe abdominal injuries and difficult to treat. The mortality and complication rate are high. The keys to successful treatments for pancreatic and/or duodenal injuries are early diagnosis, careful exploration and proper operational management.

  11. [FEDERAL CLINICAL RECOMMENDATIONS IN DIAGNOSIS, TREATMENT AND PREVENTION OF HEARING LOSS DUE TO NOISE].

    Science.gov (United States)

    Adeninskaya, E E; Bukhtiarov, I V; Bushmanov, A Iu; Dayhes, N A; Denisov, E I; Izmerov, N F; Mazitova, N N; Pankova, V B; Preobrazhenskaya, E A; Prokopenko, L V; Simonova, N I; Tavartkiladze, G A; Fedina, I N

    2016-01-01

    Noise induced hearing loss is a slowly developing hearing impairment, caused by occupational exposure to excessive noise levels, constitutes a lesion of the auditory analyzer and clinically manifested as chronic bilateral sensorineural hearing loss. Currently, there is not a treatment that provide a cure of sensorineural hearing loss. Regular, individually tailored treatment should be directed to the pathogenic mechanisms and specific clinical symptoms of hearing loss, as well as the prevention of complications. We recommend using non-drug therapies that can improve blood flow in labyrinth, tissue and cellular metabolism.

  12. Clinical epidemiology and treatment findings of acute tuberculosis patients in Babol City (2009-2013)

    Institute of Scientific and Technical Information of China (English)

    Hossein Ali Nikbakht; Seyed Reza Hosseini; Heidar Sharifi-fathabad; Rahmat Habibzade; Amin Daemi; Saber Ghaffari-fam

    2016-01-01

    Objective: To examine the clinical epidemiology and treatment findings of tuberculosis in Babol, Northern Iran. Methods: This cross-sectional study was carried out on medical records of tuberculosis registry pertaining to health center of Babol City, Mazandaran, Iran. The investigated vari-ables included demographic characteristics and some clinical patterns of patients. To present the findings, the descriptive statistics such as mean (and SD) and frequency (%) was used. Analytical statistics was applied by using Chi-square test and independent samples t-test. Results: The average age of 200 patients infected with tuberculosis was 47.51 years (SD=21.36), and 58.5%of the cases were male. In both genders, the highest number of tuberculosis patient was found in 18–38 age group. During the 5-year study period, 95%of the patients received treatment protocol 1 (including new cases with positive smear, negative smear, extra-pulmonary) and in the end of treatment given to patients, 90.5%were improved or treatment period completed. The most important clinical symptoms for referring the patients to the therapeutic centers were cough (75.1%) and fever (60.9%). Conclusions: Education and giving information to general population about the most important clinical symptoms of tuberculosis such as fever and cough might be effective in early detection and prevention of Mycobacterium tuberculosis. Then treatment might be effective in decreasing the burden of the disease.

  13. From bedside to bench to clinic trials: identifying new treatments for severe asthma

    Directory of Open Access Journals (Sweden)

    Amarjit Mishra

    2013-07-01

    Full Text Available Asthmatics with a severe form of the disease are frequently refractory to standard medications such as inhaled corticosteroids, underlining the need for new treatments to prevent the occurrence of potentially life-threatening episodes. A major obstacle in the development of new treatments for severe asthma is the heterogeneous pathogenesis of the disease, which involves multiple mechanisms and cell types. Furthermore, new therapies might need to be targeted to subgroups of patients whose disease pathogenesis is mediated by a specific pathway. One approach to solving the challenge of developing new treatments for severe asthma is to use experimental mouse models of asthma to address clinically relevant questions regarding disease pathogenesis. The mechanistic insights gained from mouse studies can be translated back to the clinic as potential treatment approaches that require evaluation in clinical trials to validate their effectiveness and safety in human subjects. Here, we will review how mouse models have advanced our understanding of severe asthma pathogenesis. Mouse studies have helped us to uncover the underlying inflammatory mechanisms (mediated by multiple immune cell types that produce Th1, Th2 or Th17 cytokines and non-inflammatory pathways, in addition to shedding light on asthma that is associated with obesity or steroid unresponsiveness. We propose that the strategy of using mouse models to address clinically relevant questions remains an attractive and productive research approach for identifying mechanistic pathways that can be developed into novel treatments for severe asthma.

  14. Clinical application of multimodality imaging in radiotherapy treatment planning for rectal cancer.

    Science.gov (United States)

    Wang, Yan Yang; Zhe, Hong

    2013-12-11

    Radiotherapy plays an important role in the treatment of rectal cancer. Three-dimensional conformal radiotherapy and intensity-modulated radiotherapy are mainstay techniques of radiotherapy for rectal cancer. However, the success of these techniques is heavily reliant on accurate target delineation and treatment planning. Computed tomography simulation is a cornerstone of rectal cancer radiotherapy, but there are limitations, such as poor soft-tissue contrast between pelvic structures and partial volume effects. Magnetic resonance imaging and positron emission tomography (PET) can overcome these limitations and provide additional information for rectal cancer treatment planning. PET can also reduce the interobserver variation in the definition of rectal tumor volume. However, there is a long way to go before these image modalities are routinely used in the clinical setting. This review summarizes the most promising studies on clinical applications of multimodality imaging in target delineation and treatment planning for rectal cancer radiotherapy.

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

    Directory of Open Access Journals (Sweden)

    Jesús Rodríguez-Pulido

    2016-04-01

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

  16. Clinical Studies on Treatment of Chronic Prostatitis with Acupuncture and Mild Moxibustion

    Institute of Scientific and Technical Information of China (English)

    Yu Yang; Kang Jingli; Duan Shumin

    2005-01-01

    To observe the therapeutic effect of acupuncture and mild moxibustion on chronic prostatitis and to probe into the mechanism of the therapy. Two hundred patients with chronic prostatitis were randomly divided into two groups so as to observe respectively the changes in clinical symptoms, count of WBC and lecithin corpuscles in succus prostaticus, prostatic capcules and internal echo, tenderness and elasticity of prostate by palpation before and after treatment. After treatment, a remarkable improvement was found in clinical symptoms, succus prostaticus test and ultrasonic examination in the treatment group with a statistically significant difference (P<0.05) as compared to the control group. The treatment of chronic prostatitis with acupuncture and mild moxibustion can remove the stagnation of succus prostaticus, improve the blood circulation in prostate, inhibit or kill the pathogenic micro-organisms, strengthen or regulate the immune function of the patients, improve local blood circulation, eliminate the accumulation of secretion and relieve the obstruction of the prostatic ducts.

  17. [Image guided and robotic treatment--the advance of cybernetics in clinical medicine].

    Science.gov (United States)

    Fosse, E; Elle, O J; Samset, E; Johansen, M; Røtnes, J S; Tønnessen, T I; Edwin, B

    2000-01-10

    The introduction of advanced technology in hospitals has changed the treatment practice towards more image guided and minimal invasive procedures. Modern computer and communication technology opens up for robot aided and pre-programmed intervention. Several robotic systems are in clinical use today both in microsurgery and in major cardiac and orthopedic operations. As this trend develops, professions which are new in this context such as physicists, mathematicians and cybernetic engineers will be increasingly important in the treatment of patients.

  18. Randomized, Placebo-Controlled Clinical Trial of Omega-3 as Supplemental Treatment in Schizophrenia

    OpenAIRE

    Jamilian, Hamidreza; Solhi, Hasan; Jamilian, Mehri

    2014-01-01

    Introduction: Recent studies found omega-3 fatty acid deficiency in brain cell membranes of schizophrenic patients. Conventional antipsychotics have many adverse reactions. Safety, availability and low price made omega-3 as a potential supplement for treatment of these patients. This study investigated the efficacy of omega-3 fatty acid as add-on treatment in schizophrenia. Material & Methods: A randomized, double blind, placebo controlled fixed-dose, add-on clinical trial conducted over 8 we...

  19. Clinical signif icance of C-reactive protein values in antibiotic treatment for pyogenic liver abscess

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM:To investigate the clinical signifi cance of C-reactive protein (CRP) values in determining the endpoint of antibiotic treatment for liver abscess after drainage. METHODS: The endpoints of antibiotic treatment in 46 patients with pyogenic liver abscess after complete percutaneous drainage were assessed by performing a retrospective study. After complete percutaneous drainage, normal CRP values were considered as the endpoint in 18 patients (experimental group), and normal body temperature for at least 2...

  20. Patients’ ability to treat anaphylaxis using adrenaline autoinjectors: a randomized controlled trial

    Science.gov (United States)

    Umasunthar, T; Procktor, A; Hodes, M; Smith, J G; Gore, C; Cox, H E; Marrs, T; Hanna, H; Phillips, K; Pinto, C; Turner, P J; Warner, J O; Boyle, R J

    2015-01-01

    Background Previous work has shown patients commonly misuse adrenaline autoinjectors (AAI). It is unclear whether this is due to inadequate training, or poor device design. We undertook a prospective randomized controlled trial to evaluate ability to administer adrenaline using different AAI devices. Methods We allocated mothers of food-allergic children prescribed an AAI for the first time to Anapen or EpiPen using a computer-generated randomization list, with optimal training according to manufacturer's instructions. After one year, participants were randomly allocated a new device (EpiPen, Anapen, new EpiPen, JEXT or Auvi-Q), without device-specific training. We assessed ability to deliver adrenaline using their AAI in a simulated anaphylaxis scenario six weeks and one year after initial training, and following device switch. Primary outcome was successful adrenaline administration at six weeks, assessed by an independent expert. Secondary outcomes were success at one year, success after switching device, and adverse events. Results We randomized 158 participants. At six weeks, 30 of 71 (42%) participants allocated to Anapen and 31 of 73 (43%) participants allocated to EpiPen were successful – RR 1.00 (95% CI 0.68–1.46). Success rates at one year were also similar, but digital injection was more common at one year with EpiPen (8/59, 14%) than Anapen (0/51, 0%, P = 0.007). When switched to a new device without specific training, success rates were higher with Auvi-Q (26/28, 93%) than other devices (39/80, 49%; P < 0.001). Conclusions AAI device design is a major determinant of successful adrenaline administration. Success rates were low with several devices, but were high using the audio-prompt device Auvi-Q. PMID:25850463