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Sample records for clinically diagnosed cases

  1. STUDY OF INTRAOPERATIVELY AND HISTOLOGICALLY NEGATIVE CASES IN CLINICALLY DIAGNOSED CASES OF ACUTE APPENDICITIS

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    Muralidhar Manga

    2016-07-01

    Full Text Available BACKGROUND Acute appendicitis remains the most common cause of acute abdomen requiring surgical intervention. Diagnosis of appendicitis is done on clinical grounds. The aetiology and pathogenesis of appendicitis are poorly understood. The cause of pain in the cases with clinical diagnosis of acute appendicitis but intraoperatively normal looking appendix remains controversial. The present study aims at determining the cause of pain in these cases by combining routine histopathology, IHC to investigate the status of the enteric nervous system in normal and inflamed appendices. MATERIALS AND METHODS In the present study, 694 patients who underwent appendicectomy with diagnosis of acute appendicitis were included. In 89 cases, there were no signs of inflammation intraoperatively. These appendix specimens were followed by histopathological examination by H&E staining. 69 out of 89 specimens did not have signs of inflammation in histological examination by H&E staining. Cases which are diagnosed as acute appendicitis but histologically negative in H&E staining are taken as study cases. 49 acute appendicitis cases- histologically positive acute appendicitis (HPAA and 20 appendices from right hemicolectomy specimens were taken as controls. All these specimens were subjected to; 1 Routine Haematoxylin & Eosin staining. 2 Toluidine blue stain for mast cell evaluation. 3 Immunohistochemistry by S-100 stain for evaluating size and number of the ganglia. OBSERVATION The mean mast cell count was more in the histologically negative acute appendicitis group when compared to histologically positive acute appendicitis and control group. The mean size and number of the ganglia were more in the histologically negative acute appendicitis group when compared to histologically positive acute appendicitis and control groups. CONCLUSION Neuronal hypertrophy and mast cells may play a role in the pathogenesis of “appendicitis like pain” in patients with

  2. Clinical, endoscopic and histopathological profiles of parasitic duodenitis cases diagnosed by upper digestive endoscopy

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    Reinaldo Benevides dos Santos

    2011-12-01

    Full Text Available CONTEXT: Intestinal parasites induce detectable histopathological changes, which have been studied in groups with known diagnosis of parasitic disease. There is no available study with a larger base without previous diagnosis. OBJECTIVE: To describe clinical and histopathological findings of parasitosis diagnosed by endoscopic biopsy in patients submitted to upper digestive endoscopy. METHODS: Recorded biopsies archive at "Complexo Hospitalar Professor Edgar Santos" , a general teaching Hospital in the state of Bahia, Northeast Brazil, from January 1995 to January 2009, were reviewed. One thousand ten duodenal biopsy reports were found. Reports positive for parasites had their specimens reviewed and photographed. All blocks of biopsy selected as case were retrieved and reviewed by an experienced pathologist. Clinical, laboratorial and endoscopic data were collected. RESULTS: Eleven biopsies showed parasites, including cases of Cryptosporidium sp. and Strongyloides stercoralis. Vomiting (91%, abdominal pain (78%, diarrhea (78% and weight loss (78% were usual symptoms. Seventy-five percent had duodenal mucosa changes on endoscopy, while 25% have no changes. Anemia and low serum albumin were important laboratorial data. HIV infection association was observed. Villus atrophy and reactive epithelium were usual in Strongyloides cases. CONCLUSIONS: No endoscopic or histopathologic finding was pathognomonic. One percent of duodenal endoscopic biopsies showed parasites.

  3. Clinical, endoscopic and histopathological profiles of parasitic duodenitis cases diagnosed by upper digestive endoscopy

    OpenAIRE

    2011-01-01

    p.225-230 Context - Intestinal parasites induce detectable histopathological changes, which have been studied in groups with known diagnosis of parasitic disease. There is no available study with a larger base without previous diagnosis. Objective - To describe clinical and histopathological findings of parasitosis diagnosed by endoscopic biopsy in patients submitted to upper digestive endoscopy. Methods - Recorded biopsies archive at “Complexo Hospitalar Professor Edgar Santos”, a general...

  4. Using Plant Clinic Registers to Assess the Quality of Diagnoses and Advice Given to Farmers: A Case Study from Uganda

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    Danielsen, Solveig; Boa, Eric; Mafabi, Moses; Mutebi, Emmanuel; Reeder, Robert; Kabeere, Flavia; Karyeija, Robert

    2013-01-01

    Purpose: This study developed a framework for quality assessment of diagnoses and advice given at plant clinics. Design/methodology/approach: Clinic registers from five plant clinics in Uganda (2006-2010) were used to develop quality assessment protocols for diagnoses and advice given by plant doctors. Assessment of quality of diagnoses was based…

  5. Sneddon syndrome: rare disease or under diagnosed clinical entity? Review of the literature related to a clinical case.

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    Orac, Amalia; Artenie, Anca; Toader, Mihaela Paula; Harnagea, Raluca; Dinu-Mitrofan, Diana; Grigorovici, Mirela; Ungureanu, G

    2014-01-01

    Sneddon syndrome is defined by the association of livedo racemosa and recurrent cerebrovascular ischemic lesions. The annual incidence is 4/1,000,000. This syndrome particularly affects young women, some reports suggesting a family predisposition. It is a chronic, progressive, arterio-occlusive disease of unknown etiology that involves small and medium-sized arteries. It is usually associated with antiphospholipid antibodies. We report the case of a female patient with Sneddon syndrome with significant family history, personal history of stroke, epilepsy, migraine, cardiovascular involvement, three miscarriages, cognitive decline, noncompliant to therapy, in the absence of antiphospholipid antibodies. This paper aims to analyze the main characteristic features and management of Sneddon syndrome by conducting a literature review related to a clinical case.

  6. The Clinical Course of Late Diagnosed Fatal Cases of A (H1N1 Influenza in Poland 

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    Marta Rorat

    2013-06-01

    Full Text Available Introduction: The most frequent complication of A (H1N1 influenza and the leading cause of death was pneumonia with a primary viral or mixed viral and bacterial etiology. 182 patients had died because of a pandemic influenza in Poland by 31st July 2010.Material and Methods: A retrospective study of 6 fatal cases of pandemic influenza, aged 23-41, including 3 women, hospitalised between November 2009 and February 2011 in different Polish medical centres.Results: We present the clinical course of 6 late diagnosed cases of A (H1N1 influenza. All patients presented typical flu-like symptoms in the beginning. 4/6 patients had severe disease risk factors: pregnancy, arthritis, Wegener granulomatosis and obesity. All patients were seen by doctors, no one had received antiviral therapy, 4/5 were treated with antibiotics before they were hospitalized. One patient had nosocomial infection. Patients were admitted to the hospital on the 3rd to 8th day of the disease. They received oseltamivir treatment on the 4th to 9th day. All patients developed pneumonia complicated by acute respiratory distress syndrome. Death appeared between the 4th and 27th day after the onset of symptoms. Autopsies were performed in 5 cases and revealed haemorrhagic pneumonia in 2 patients.Conclusion: Delayed diagnosis and antiviral treatment initiation has a significant impact on mortality in A (H1N1 influenza. During the influenza epidemic, patients presenting typical symptoms should always be suspected of having influenza. Antiviral treatment has to be initiated immediately, especially ifthere are risk factors of severe disease.

  7. Bulimia nervosa patient diagnosed with previously unsuspected ADHD in adulthood: clinical case report, literature review, and diagnostic challenges.

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    Ioannidis, Konstantinos; Serfontein, Jaco; Müller, Ulrich

    2014-05-01

    There is increasing literature suggesting a link between attention-deficit hyperactivity disorder (ADHD) and eating disorders (EDs), especially bulimia nervosa. ADHD is under-diagnosed in girls and children of high intelligence are typically missed. We identified a case of a 23-year-old woman suffering from severe bulimia nervosa and previously unsuspected ADHD in adulthood; we diagnosed and treated her with extended-release methylphenidate. We performed a literature review on the ADHD and bulimia nervosa comorbidity. We discuss the reasons why her ADHD remained undiagnosed and the difficulties in diagnosing ADHD in patients with EDs. We suggest that identifying comorbid ADHD is crucial for these patients and argue for the use of a structured interview, collateral history and investigation of onset of symptoms to establish a diagnosis of ADHD in adults with bulimia nervosa. Comorbidities and overlap of symptomatology need to be taken into account. Copyright © 2013 Wiley Periodicals, Inc.

  8. Comparing ICD9-encoded diagnoses and NLP-processed discharge summaries for clinical trials pre-screening: a case study.

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    Li, Li; Chase, Herbert S; Patel, Chintan O; Friedman, Carol; Weng, Chunhua

    2008-11-06

    The prevalence of electronic medical record (EMR) systems has made mass-screening for clinical trials viable through secondary uses of clinical data, which often exist in both structured and free text formats. The tradeoffs of using information in either data format for clinical trials screening are understudied. This paper compares the results of clinical trial eligibility queries over ICD9-encoded diagnoses and NLP-processed textual discharge summaries. The strengths and weaknesses of both data sources are summarized along the following dimensions: information completeness, expressiveness, code granularity, and accuracy of temporal information. We conclude that NLP-processed patient reports supplement important information for eligibility screening and should be used in combination with structured data.

  9. Clinically and electrophysiologically diagnosed botulinum intoxication.

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    Kotan, Dilcan; Aygul, Recep; Ceylan, Mustafa; Yilikoglu, Yalcin

    2013-01-03

    In this case report, clinical and electrophysiological findings of 43-year-old female patient who developed Clostridium botulinum intoxication after consumption of home-made canned food are presented. Following the sudden onset of severe nausea and vomiting, diplopia, blurred vision, bilateral ptosis, weakness, speech and swallowing difficulties have developed and the patient declared that she has just tasted the canned beans after she had rinsed them several times. The case, where serological tests cannot be performed, was diagnosed clinically and treated with antitoxin immediately. During follow-up, consecutive nerve stimulation was performed and significant incremental response was observed. There was an improvement in symptoms within 2 weeks, and in 5 or 6 weeks the symptoms had disappeared completely. Electrodiagnostic studies revealed that the findings turned to normal. The case showed that immediate antitoxin treatment is life-saving even the diagnosis of botulinum intoxication is based on clinical findings.

  10. The added value of using mutational profiling in addition to cytology in diagnosing aggressive pancreaticobiliary disease: review of clinical cases at a single center

    Science.gov (United States)

    2014-01-01

    Background This study aimed to better understand the supporting role that mutational profiling (MP) of DNA from microdissected cytology slides and supernatant specimens may play in the diagnosis of malignancy in fine-needle aspirates (FNA) and biliary brushing specimens from patients with pancreaticobiliary masses. Methods Cytology results were examined in a total of 30 patients with associated surgical (10) or clinical (20) outcomes. MP of DNA from microdissected cytology slides and from discarded supernatant fluid was analyzed in 26 patients with atypical, negative or indeterminate cytology. Results Cytology correctly diagnosed aggressive disease in 4 patients. Cytological diagnoses for the remaining 26 were as follows: 16 negative (9 false negative), 9 atypical, 1 indeterminate. MP correctly determined aggressive disease in 1 false negative cytology case and confirmed a negative cytology diagnosis in 7 of 7 cases of non-aggressive disease. Of the 9 atypical cytology cases, MP correctly diagnosed 7 as positive and 1 as negative for aggressive disease. One specimen that was indeterminate by cytology was correctly diagnosed as non-aggressive by MP. When first line malignant (positive) cytology results were combined with positive second line MP results, 12/21 cases of aggressive disease were identified, compared to 4/21 cases identified by positive cytology alone. Conclusions When first line cytology results were uncertain (atypical), questionable (negative), or not possible (non-diagnostic/indeterminate), MP provided additional information regarding the presence of aggressive disease. When used in conjunction with first line cytology, MP increased detection of aggressive disease without compromising specificity in patients that were difficult to diagnose by cytology alone. PMID:25084836

  11. Reliability of clinical ICD-10 schizophrenia diagnoses

    DEFF Research Database (Denmark)

    Jakobsen, Klaus D; Frederiksen, Julie N; Hansen, Thomas;

    2005-01-01

    value (87%) of ICD-10 schizophrenia and an overall good agreement between clinical and OPCRIT-derived diagnoses (kappa=0.60). An even higher positive predictive value was obtained when diagnoses were amalgamated into a diagnostic entity of schizophrenia-spectrum disorders (98%). Near perfect agreement...

  12. The evaluation of the clinical, laboratory and the radiological findings of the fifty-five cases diagnosed with tuberculous, Brucellar and pyogenic spondylodiscitis

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    Kadriye Yasar

    2012-01-01

    Full Text Available Objective: In this study, the evaluation of the clinical, laboratory and radiological findings belonging to 55 cases that were hospitalized in our clinic to be followed-up and were diagnosed with tuberculous, brucellar and pyogenic spondylodiscitis (SD was aimed. Materials and Methods: The cases with SD were evaluated retrospectively. Hematological, serological, biochemical laboratory tests and imaging technics were used for diagnosis. Results: Of 55 cases aged ranging between 25 to 79, 33 (59% were female. The cases with tuberculous SD (TBSD, brucellar SD (BSD and pyogenic SD (PSD were found in 24 (43%, 12 (21% and in 19 (34% patients.Erytrocyte sedimentation rate, increased C-reactive protein, and leucocytosis were present in 51 (91%, 22 (39% and 8 (14% cases. The number of the cases with history of previous surgery or trauma was 14 (25%. Diagnosis of TBSD was established by acid fast bacilli positiveness and Löwenstein Jensen culture positiveness, in two and seven patients, respectively. While all 12 cases with BSD had positive standard tube aglutination test, only 3 (25% had hemoculture positivity. In PSDs, diagnosis was confirmed with culture positivity in 9 of 19 cases.Of the cases in our study, 89% responded to medical treatment while three required surgery and three died (5.5% and 5.5%, respectively. Conclusion: SD may develop secondary to infections or following spinal surgical procedures and traumas. Also, the importance of endemicity should be kept in mind, beside the helpful diagnostic findings while treatment regulation.

  13. Reliability of clinical ICD-10 schizophrenia diagnoses

    DEFF Research Database (Denmark)

    Jakobsen, Klaus D; Frederiksen, Julie N; Hansen, Thomas

    2005-01-01

    Concern has been expressed as to the reliability of clinical ICD-10 diagnosis of schizophrenia. This study was designed to assess the diagnostic reliability of the clinical ICD-10 diagnosis of schizophrenia in a random sample of Danish in- and outpatients with a history of psychosis. A sample...... value (87%) of ICD-10 schizophrenia and an overall good agreement between clinical and OPCRIT-derived diagnoses (kappa=0.60). An even higher positive predictive value was obtained when diagnoses were amalgamated into a diagnostic entity of schizophrenia-spectrum disorders (98%). Near perfect agreement...... was seen between OPCRIT-derived ICD-10 and DSM-IV diagnoses (kappa=0.87). Thus, this study demonstrates high reliability of the clinical diagnosis of schizophrenia and even more so of the diagnosis of schizophrenia-spectrum disorder....

  14. Utilization of Gene Mapping and Candidate Gene Mutation Screening for Diagnosing Clinically Equivocal Conditions:A Norrie Disease Case Study

    Institute of Scientific and Technical Information of China (English)

    Vasiliki Chini; Danai Stambouli; Florina Mihaela Nedelea; George Alexandru Filipescu; Diana Mina; Marios Kambouris; Hatem El-Shanti

    2014-01-01

    Prenatal diagnosis was requested for an undiagnosed eye disease showing X-linked inheritance in a family. No medical records existed for the affected family members..Mapping of the X chromosome and candidate gene mutation screening i-dentified a c.C267A[p.F89L] mutation in NPD previously de-scribed as possibly causing Norrie disease..The detection of the c.C267A[p.F89L] variant in another unrelated family con-firms the pathogenic nature of the mutation for the Norrie dis-ease phenotype. Gene mapping, haplotype analysis, and can-didate gene screening have been previously utilized in research applications but were applied here in a diagnostic setting due to the scarcity of available clinical information..The clinical diagnosis and mutation identification were critical for provid-ing proper genetic counseling and prenatal diagnosis for this family.

  15. Discrepancies between clinical and autoptic diagnoses in Italy: evaluation of 879 consecutive cases at the "Policlinico of Bari" teaching hospital in the period 1990-2009

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    Sara Sblano

    2014-03-01

    Full Text Available INTRODUCTION: In spite of the benefits of autopsies, there has been in recent years a drastic decline in the number of autopsies performed, mainly due to an apparent unattractive cost-benefit ratio and fears of the medico-legal consequences. MATERIAL AND METHODS: A retrospective study was conducted on the reports of all the 879 consecutive autopsies performed at "Policlinico of Bari" from 1990 to 2009. RESULTS: All clinical diagnoses were compared with autopsy findings showing 558 concordant diagnoses (most of all neoplasms; 123 certain discordant diagnoses (69 of them with potential impact on survival, such as acute myocardial infarctions, pulmonary thromboembolisms, internal haemorrhages, surgery complications, aortic aneurism ruptures, and so on; 116 uncertain discrepant diagnoses; 82 unclear diagnoses. CONCLUSIONS: The rate of discrepancy allows the authors to hypothesize that a better diagnostic assessment could lead to a different outcome. In terms of risk-management this negative performance needs to be carefully analysed and requires a comprehensive audit of all services provided. In this sense, the authors underline the crucial importance of autopsy as an essential tool to address unresolved clinical questions and highlight previously undiagnosed medical conditions.

  16. Cases with manifestation of chemodectoma diagnosed in dogs in Department of Internal Diseases with Horses, Dogs and Cats Clinic, Veterinary Medicine Faculty, University of Environmental and Life Sciences, Wroclaw, Poland

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    Atamaniuk Wojciech

    2010-05-01

    Full Text Available Abstract In the period of 3 years, 9 tumours of chemodectoma were supravitally diagnosed and histopathologically verified in dogs. In this period 15 351 dogs were admitted to the Clinic of Dogs and Cats and 2 145 dogs were examined in the cardiological outpatient clinic for dogs. This tumour is located in a typical place - at the base of the heart. Most frequently the tumour manifested in older boxers. Only in one case such a tumour was diagnosed in another breed of dogs. The tumours ranged in size between 3 and 16 cm in diameter. The principal sign accompanying tumours of cardiac base involved dyspnoea but in 3 cases the tumours yielded no clinical signs. All the diagnoses were additionally verified using immunohistochemical examination. We used antibodies to chromogranin A (clone DAK-A3 1:100, synaptophysin (clone SY38 1:20 and neuron-specific enolase (clone BBS/NC/VI-H14 1:150. An immunohistochemical examination is vital for the diagnosis since it allows to differentiate histologically distinct types of neoplasia which may locate in the same site and may manifest a similar histological pattern.

  17. A CYTOLOGICALLY DIAGNOSED CASE OF GIANT FIBROADENOMA: A CASE REPORT

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    Metta Raja Gopal

    2015-02-01

    Full Text Available Fibroadenomas are benign solid tumors which occur most frequently in child bearing age with 68% occurrence in adolescents. Giant fibroadenomas are uncommon variants of fibroadenomas usually presenting in adolescents characterized by massive and rapid enlargement of bre ast tissue which may be quite alarming to the young girls. We present a case of giant fibroadenoma diagnosed by FNAC in the 14 yr adolescent who presented with large unilateral left breast enlargement which grew rapidly over a period of 10 months.

  18. Clinical practice guideline: screening and diagnosing autism.

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    Blackwell, J

    2001-12-01

    The clinical practice guideline (CPG) reviewed in this month's column concerns the screening and diagnosis of autism. Autism is the third most common developmental disability and affects more than 1 in 500 children, or nearly 400,000 people in the United States, in some form. Primary care providers of children, including pediatric nurse practitioners (PNPs) and family nurse practitioners (FNPs), should reasonably expect to care for at least one child with autism (CWA). The American Academy of Neurology (AAN) has therefore developed guidelines to help healthcare providers facilitate the early identification of children with autism.

  19. Selecting clinical diagnoses: logical strategies informed by experience.

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    Stanley, Donald Edward; Campos, Daniel G

    2016-08-01

    This article describes reasoning strategies used by clinicians in different diagnostic circumstances and how these modes of inquiry may allow further insight into the evaluation and treatment of patients. Specifically, it aims to make explicit the implicit logical considerations that guide a variety of strategies in the diagnostic process, as exemplified in specific clinical cases. It focuses, in particular, in strategies that clinicians use to move from a large set of possible diagnoses initially suggested by abductive inferences - the process of hypothesis generation that creates a diagnostic space - to a narrower set or even to a single 'best' diagnosis, where the criteria to determine what is 'best' may differ according to different strategies. Experienced clinicians should have a diversified kit of strategies - for example, Bayesian probability or inference to a lovely explanation - to select from among previously generated hypotheses, rather than rely on any one approach every time.

  20. Confounding factors in diagnosing brain death: a case report

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    Login Ivan S

    2002-06-01

    Full Text Available Abstract Background Brain death is strictly defined medically and legally. This diagnosis depends on three cardinal neurological features: coma, absent brainstem reflexes, and apnea. The diagnosis can only be made, however, in the absence of intoxication, hypothermia, or certain medical illnesses. Case presentation A patient with severe hypoxic-ischemic brain injury met the three cardinal neurological features of brain death but concurrent profound hypothyroidism precluded the diagnosis. Our clinical and ethical decisions were further challenged by another facet of this complex case. Although her brain damage indicated a hopeless prognosis, we could not discontinue care based on futility because the only known surrogate was mentally retarded and unable to participate in medical planning. Conclusion The presence of certain medical conditions prohibits a diagnosis of brain death, which is a medicolegal diagnosis of death, not a prediction or forecast of future outcome. While prognostication is important in deciding to withdraw care, it is not a component in diagnosing brain death.

  1. Diagnosing epilepsy in neurology clinics: a prospective study.

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    Angus-Leppan, Heather

    2008-07-01

    The certainty of the initial diagnosis of epilepsy was assessed prospectively by one neurologist in outpatients. One hundred and fifty-eight consecutive referrals with loss of consciousness or possible epilepsy were seen. The relative contributions to the initial diagnosis from the referral letter, history taking in clinic, physical examination, and investigation were compared. There was a referring diagnosis in 28.5%. The neurologist reached a diagnosis in 87% of the 158 cases: in 43% epilepsy, 25% syncope, 12% non-epileptic seizures and in 7% other diagnoses. There was a low correlation between referral and specialist diagnosis. Physical examination did not change the diagnosis in any patient. Investigations changed the diagnosis in one patient. Neuro-imaging revealed a relevant abnormality in 12/43 (27.9%) scanned. The yield from EEG was 7/25 (28%), but the EEG changed the diagnosis in only one case. Cardiac testing confirmed the type of syncope in 2/47 (4.3%) of patients. Blood tests did not contribute to the diagnosis in any patient. The neurology consultation significantly increased diagnostic certainty. The diagnosis of epilepsy remains largely clinical. It is important that patients are aware of this prior to investigation.

  2. A case of taeniasis diagnosed postpartum.

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    Noss, Matthew R; Gilmore, Katherine; Wittich, Arthur C

    2013-04-01

    A case of postpartum taeniasis will be discussed along with the pathophysiology, proper treatment, potential risks, and prevention of taeniasis infections to the pregnant mother, her infant, and her family members. Taenia spp. infections are relatively rare in developed societies. Increasing immigration to developed countries and an expanding role of medical aid in developing countries will lead to an increase in the number of taeniasis cases seen by medical providers. Taenia solium and T. saginata are the most common species and can be differentiated by proglottids (a segment of a tapeworm containing both male and female reproductive organs) or scolex (the head of a tapeworm which attaches to the intestine of the definitive host). Both carry different risks when considering autoinfection and transmission. Cystercercosis caused by T. solium is a risk for neonates and is cause for immediate treatment of the mother. A 23-year-old new mother, originally from Ethiopia, passed T. strobili shortly after giving birth. Her pregnancy was complicated by limited prenatal care. She did not experience any symptoms related to tapeworm infection. The patient received treatment with praziquantel. With a possible future increase in the number of cases seen by health care providers, understanding the risks of Taenia sp. infection is important as proper treatment and education are needed to halt the life cycle of the tapeworm before more serious infection ensues.

  3. First Case of Zika-Linked Glaucoma Diagnosed in Infant

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    ... gov/news/fullstory_162294.html First Case of Zika-Linked Glaucoma Diagnosed in Infant Brazilian baby developed ... who developed glaucoma after being exposed to the Zika virus while in the womb has been reported ...

  4. Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy

    DEFF Research Database (Denmark)

    Luk, Adriana; Metawee, Mohammed; Ahn, Eric

    2009-01-01

    . Patient records were reviewed for preoperative clinical diagnoses and other relevant data, including pretransplant endomyocardial biopsy (EMB) results, information regarding left ventricular assist devices and, finally, evidence of disease recurrence in the grafted heart. RESULTS: A shift......, arrhythmogenic right ventricle dysplasia (100%), cardiac sarcoidosis (83%) and iron overload toxicity- associated cardiomyopathy (100%) had been misdiagnosed in pretransplantation investigations. Investigations before transplantation did not include an EMB. Of all 296 patients, 51 patients (17%) were...

  5. A Histologically Diagnosed Case with Infantile Osteopetrosis Complicated by Hypopituitarism

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    Gulden Diniz

    2015-01-01

    Full Text Available Malignant infantile osteopetrosis is a rarely seen severe disorder which appears early in life with general sclerosis of the skeleton. It is caused by functionally defective osteoclasts which fail to resorb bone. Affected infants can exhibit a wide spectrum of clinical manifestations including impaired hematopoiesis, hepatosplenomegaly, visual impairment, and hypocalcemia. With the exception of secondary hyperparathyroidism, involvement of the endocrine system seems to be quite rare. Hypopituitarism is defined as underproduction of the growth hormone in combination with deficiencies of other pituitary hormones. Any lesion that damages hypothalamus, pituitary stalk, or anterior pituitary can cause secondary hypopituitarism. In this report, we presented a rare combination of malignant infantile osteopetrosis and secondary hypopituitarism in a newborn who presented predominantly with endocrinological symptoms. This is the first case report of malignant infantile osteopetrosis accompanied by hypopituitarism secondary to sclerosis of the sella turcica. On the other hand, this is a very interesting case which was diagnosed based on histological examination of bone marrow biopsy specimens despite lack of any clinical suspicion.

  6. Clinical features, outcome and prognostic factors in dogs diagnosed with non-cortisol-secreting adrenal tumours without adrenalectomy: 20 cases (1994-2009).

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    Arenas, C; Pérez-Alenza, D; Melián, C

    2013-11-23

    The aims of this study were to describe the clinical features, the outcome and the prognostic factors of dogs with non-cortisol-secreting adrenal masses without adrenalectomy, and also to provide clinical data that can be useful for making decisions when managing dogs with these types of neoplasms. Medical records from 1994 to 2009 were reviewed and 20 dogs were included in the study. The results showed that mean age at diagnosis for dogs with non-cortisol-secreting adrenal masses was 12 years with no sex predisposition. Most dogs were asymptomatic. The most frequent clinical signs, when present, were lethargy, weakness and hypertension. Radiological evidence of metastases at diagnosis was not frequent. The maximal dorso-ventral thickness of the adrenal mass ranged from 10.0 to 45.0 mm. Right adrenal gland masses were more frequent than left-sided. Hypertension was found to be related to tumour growth during follow-up. The median survival time of dogs with non-cortisol-secreting tumours was 17.8 months. Body weight at diagnosis, tumour size and the presence of metastases at diagnosis were inversely related to survival. In conclusion, survival of dogs with non-cortisol-secreting adrenal tumours without adrenalectomy is relatively high and comparable with that of dogs treated with adrenalectomy. Dogs with metastasis and large adrenal tumours have a poorer prognosis. Hypertension is related to tumour growth, and might be used as an additional tool to assess the potential growing capacity of the tumour.

  7. 临床诊断湿疹患者400例的病理诊断分析%Pathological diagnosis of 400 cases of clinically diagnosed eczema: a retrospective analysis

    Institute of Scientific and Technical Information of China (English)

    关欣; 张倩; 李邻峰

    2014-01-01

    Objective To analyze the pathological diagnosis of patients with clinically diagnosed eczema,to describe the spectrum of skin diseases tending to be misdiagnosed as eczema,and to investigate factors associated with their misdiagnosis.Methods A retrospective study was performed on 400 patients who were clinically diagnosed as eczema and received pathological examination at the dermatology clinic of Peking University Third Hospital from August 2006 to April 2013.Skin biopsy specimens were re-reviewed for these patients,and pathological diagnosis was made in combination with clinical presentations.Results Of the 400 outpatients with clinically diagnosed eczema,110 (27.5%) were finally diagnosed as non-eczema skin diseases pathologically,including 16 cases of psoriasis,13 bullous pemphigoid (BP),11 lichen planus (LP),9 cutaneous amyloidosis,8 mycosis fungoides (MF),14 skin malignancies,and 39 other skin diseases.The highest misdiagnosis rate was observed in people aged 60 to 79 years (33.9%) and lesions at the genital sites (46.2%).Conclusions Many conditions tend to be misdiagnosed as eczema in clinic,including psoriasis,BP,LP,cutaneous amyloidosis,MF and skin malignancies.Misdiagnosis is rather frequent in elderly people and eczematous lesions in genital areas,and pathological examination should be taken actively for uncertain cases.%目的 根据临床诊断为湿疹的患者的病理诊断,分析误诊情况.探讨临床容易误诊为湿疹的皮肤病及容易导致误诊的相关因素.方法 回顾性分析我院皮肤科门诊2006年8月到2013年4月间临床以湿疹为诊断并做组织病理检查的所有病例,收集临床数据,重新阅片确定病理诊断,对获得的资料进行分析.结果 400例临床诊断为湿疹的患者中,110例病理诊断为非湿疹皮炎,占27.5%.误诊病种包括银屑病16例,大疱性类天疱疮13例,扁平苔藓11例,皮肤淀粉样变9例,蕈样肉芽肿8例,恶性肿瘤14例等,其他39例.60 ~ 79岁

  8. Clinical characteristics of 297 newly diagnosed Chinese HIV / AIDS patients

    Institute of Scientific and Technical Information of China (English)

    曹玮

    2014-01-01

    Objective To determine the clinical characteristics of HIV infected patients in China in order to improve early recognition and diagnosis of AIDS.Methods A total of297 newly diagnosed HIV/AIDS patients were enrolled in Peking Union Medical College Hospital(PUMCH)from January 2001 to December 2012,including 19 patients of primary phase,115 of asymptomatic phase and 163 of AIDS phase.Clinical characteristics of these patients were retrospectively analyzed.Results Two hundred and

  9. Clinical Analysis of 320 Cases Diagnosed Fetal Growth Restriction%320例胎儿生长受限临床分析

    Institute of Scientific and Technical Information of China (English)

    阮焱; 王欣

    2015-01-01

    Objective To detect the related factors of the maternal hemodynamic change and disease onset by analyzing 320 cases of fetal growth restriction ( FGR ) .Methods Retrospective analysis of 320 in-patients with FGR from Beijing Obstetrics and Gynecology Hospital,Capital Medical University during Jan-uary and December 2012 were included in the study,including 310 cases after delivery.All statistical com-parisons were performed,investigating the change of D-dimmer,hematocrit(HCT) and pregnant induced hypertension surveillance system test(MP),with combined consideration of amniotic fluid volume,umbilical cord resistance index(RI) and placenta pathology,analyzing the effect of umbilical cord and placenta on FGR and outcome of the fetus.Results 235 cases(73.4%) HCT≥0.36,122 cases(65.6%) MP were abnormal, who had higher incidence of abnormal RI(χ2 =4.776,P=0.029).Regardless of PIH complica-tion,the incidence of oligohydramnios was about 20%(P=0.873).Placenta pathology were performed for 122 cases,119 cases(97.4%) were chronic deciduitis,1 case(1.4%) was acute inflammation of chorionic plate,40 cases(32.8%) showed chronic focus of infarction,49 cases(40.2%) showed stenosis intervillous lacuna.Conclusion The pathologic change of FGR is similar with PIH , besides changes of hemodynamics, placenta dysfunction of development and circulation is the direct cause of FGR .%目的:分析320例胎儿生长受限( FGR)患者临床资料,探讨母体血流动力学改变与发病的相关因素。方法选择2012年1~12月首都医科大学附属北京妇产医院收治的 FGR 患者320例,已分娩310例,分析孕妇D-二聚体、血细胞比容( HCT)、MP-妊娠高血压疾病监测系统的血流动力学参数,结合羊水量、脐血流阻力指数及胎盘病理,分析脐带、胎盘因素对 FGR及胎儿预后的影响。结果235例(73.4%)HCT≥0.36,122例(65.6%)MP监测血流异常,MP血流异常组脐血流阻力增高

  10. Concoradance of clinical and neurophysiologic diagnoses of carpal tunnel syndrome

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    Martić Vesna

    2015-01-01

    Full Text Available Introduction/Aim. Clinical presentation and neurophysiological examination are crucial in diagnosing carpal tunnel syndrome (CTS. The aim of this study was to determine sensitivity and specificity of clinical examination for diagnosing of CTS in relation to neurophysiological evaluation. Methods. The sample included 181 patients referred to the neurologist for further diagnosis of pain and parestesias in the arm (81 women and 100 men mean age 42 ± 14 years and 52 ± 16 years, respectively. All the patients were neurophysiologicly tested. Results. Out of 181 patients, clinical findings were considered positive for CTS in 37 patients. The neurophysiological findings for CTS were positive in 60 patients. Both clinical and neurophysiological findings were positive in 31 patients and both findings were negative in 115 patients (sensitivity 0,51; specificity 0,95. Conclusion. Low sensitivity and high specificity suggest that it is easier to exclude rather than to accurately diagnose CTS based on clinical examination alone. Thus, there is the need for neurophysiological evaluation of patients with complains in the arm.

  11. Misdiagnostic analysis of clinically diagnosed severe acute respiratory syndrome after following up 197 convalescent patients

    Institute of Scientific and Technical Information of China (English)

    LIU You-ning; TIAN Qing; HU Hong; XIE Li-xin; FAN Bao-xing; XU Hong-min; CHEN Wei-jun

    2005-01-01

    @@ The severe acute respiratory syndrome (SARS) is an emerging and highly contagious infection caused by a newly discovered strain of coronavirus.1 Since the clinical case definition of SARS is similar to other severe atypical pneumonias, specific laboratory tests that can accurately diagnose SARS-associated coronavirus (SARS-CoV) infection are important. However, published data are insufficient to investigate whether clinically diagnosed SARS patients may include some non-SARS pneumonia. Therefore, we aimed to determine clinical and laboratory features to differentiate SARS patients from non-SARS pneumonias that could reduce misdiagnosis of SARS. A retrospective analysis of clinical and laboratory characteristics after the initial onset of SARS, as well as its convalescent-phase, was examined from clinically diagnosed 197 SARS patients.

  12. Spinal cord diseases diagnosed as spinal cord multiple sclerosis: clinical analysis of 68 cases%诊断为脊髓型多发性硬化的脊髓疾病附68例临床分析

    Institute of Scientific and Technical Information of China (English)

    录海斌; 李振新; 俞海; 吕传真

    2013-01-01

    Objective To analyze the cases diagnosed as spinal cord multiple sclerosis with the new diagnostic criteria of multiple sclerosis and optic myelitis, and explore the different types of demyeiinating diseases related to the spinal cord. Methods To analyze the 68 cases in the hospital from 1994 to 2012 who had been diagnosed as "multiple sclerosis" Results With following up,we found that only 17.65% of the cases can comply with the mcdonald criterion completely, but most of them were actually afflicted by optic myelitis. The others such as spinal cord diseases and systemic autoimmune disease were also easily misdiagnosed as multiple sclerosis. Conclusion We should diagnose, identify and follow-up visit the isolated spinal cord syndrome according to certain clinical guidelines. It is suggested that the term of spinal cord multiple sclerosis should no longer be used.%目的 应用新的多发性硬化和视神经脊髓炎诊断标准,回顾分析以往被诊断为“脊髓型多发性硬化”的病例,探讨与主要累及脊髓的脱髓鞘疾病相鉴别的重要疾病类型.方法 应用2010年新修订的McDonald多发性硬化诊断标准,以及2006年Wingerchuk视神经脊髓炎的诊断标准,回顾分析我院1994年~2012年之间曾被诊断为“脊髓型多发性硬化”的患者68例,并进行随访.结果 仅17.65%的患者完全符合McDonald标准,多数脊髓型多发性硬化患者最终转变为视神经脊髓炎,其它疾病如脊髓血管病和系统性自身免疫病也易被误诊为脊髓型多发性硬化.结论 对于孤立的脊髓综合征应该按照一定的诊疗规范进行诊断、鉴别和随访,不建议再使用脊髓型多发性硬化的名称.

  13. Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets: clinical article.

    Science.gov (United States)

    Duhaime, Ann-Christine; Beckwith, Jonathan G; Maerlender, Arthur C; McAllister, Thomas W; Crisco, Joseph J; Duma, Stefan M; Brolinson, P Gunnar; Rowson, Steven; Flashman, Laura A; Chu, Jeffrey J; Greenwald, Richard M

    2012-12-01

    Concussive head injuries have received much attention in the medical and public arenas, as concerns have been raised about the potential short- and long-term consequences of injuries sustained in sports and other activities. While many student athletes have required evaluation after concussion, the exact definition of concussion has varied among disciplines and over time. The authors used data gathered as part of a multiinstitutional longitudinal study of the biomechanics of head impacts in helmeted collegiate athletes to characterize what signs, symptoms, and clinical histories were used to designate players as having sustained concussions. Players on 3 college football teams and 4 ice hockey teams (male and female) wore helmets instrumented with Head Impact Telemetry (HIT) technology during practices and games over 2-4 seasons of play. Preseason clinical screening batteries assessed baseline cognition and reported symptoms. If a concussion was diagnosed by the team medical staff, basic descriptive information was collected at presentation, and concussed players were reevaluated serially. The specific symptoms or findings associated with the diagnosis of acute concussion, relation to specific impact events, timing of symptom onset and diagnosis, and recorded biomechanical parameters were analyzed. Data were collected from 450 athletes with 486,594 recorded head impacts. Forty-eight separate concussions were diagnosed in 44 individual players. Mental clouding, headache, and dizziness were the most common presenting symptoms. Thirty-one diagnosed cases were associated with an identified impact event; in 17 cases no specific impact event was identified. Onset of symptoms was immediate in 24 players, delayed in 11, and unspecified in 13. In 8 cases the diagnosis was made immediately after a head impact, but in most cases the diagnosis was delayed (median 17 hours). One diagnosed concussion involved a 30-second loss of consciousness; all other players retained

  14. A Case of Multiple Myeloma Diagnosed by Skin Lesions

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    Fatma Gülru Erdoğan

    2010-10-01

    Full Text Available Multiple myeloma, being a malignant proliferation of plasma cells in the bone marrow, has clinical spectrum varying from monoclonal gammopathy with unknown significance to plasma cell leukemia. The presenting symptoms have usually been bone pain, pathologic fractures or repeating infections. In patients with multiple myeloma, amyloid depositions may be seen in the skin. This form, defined as primary systemic amyloidosis, is characterized by light-chain amyloid fibril depositions. Our case applied with multiple, asymptomatic, yellowish papules localized on the face, trunk, oral and genital mucosa, gradually increasing during the last two years. He had no complaints, except for slight weight loss. In routine tests, the patient had no pathological laboratory findings, except high C-reactive protein levels. Further research revealed histopathologic and immunohistochemical findings consistent with amyloidosis. Upon these results, immunoglobulin G levels were measured and found high, and in protein electrophoresis, IgG monoclonal gammopathy was determined. The diagnosis of multiple myeloma is made by bone marrow biopsy. This patient is presented for being an asymptomatic case diagnosed by skin findings of amyloidosis.

  15. Lupus vulgaris diagnosed after 37 years: a case of delayed diagnosis.

    Science.gov (United States)

    Turan, Enver; Yurt, Nurdan; Yesilova, Yavuz; Celik, Ozgur Ilhan

    2012-05-15

    Lupus vulgaris is the most common chronic, progressive form of cutaneous tuberculosis. Lesions are generally solitary and found on the head and neck region. Cutaneous tuberculosis can present with different clinical appearances. Therefore, it does not necessarily have characteristic findings and can be difficult to diagnose. Although there were typical clinical findings, the diagnosis of our case was delayed because of its asymptomatic course.

  16. Frequency of nursing diagnoses in a surgical clinic

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    Andreza Cavalcanti Vasconcelos

    2015-12-01

    Full Text Available Objective: to identify the frequency of Nursing Diagnoses of patients in a surgical clinic. Methods: cross-sectional study, performed with 99 patients in the postoperative of general surgery. Data were collected through a questionnaire validated according to domains of NANDA International, including physical and laboratory examination. Results: 17 nursing diagnoses were found; eight had a frequency higher than 50.0% (infection risk, impaired tissue integrity, constipation risk, anxiety, bleeding risk, acute pain, delayed surgical recovery, dysfunctional gastrointestinal motility. It was observed in all patients the Nursing Diagnostics: risk of infection, impaired tissue integrity and risk of constipation. Conclusion: the frequency of the most prevalent diagnosis is inserted in the domains safety/protection and nutrition, which determines the need to redirect nursing care, prioritizing the patient's clinic.

  17. Two Cases of True Uterine Artery Aneurysms Diagnosed during Pregnancy

    DEFF Research Database (Denmark)

    Schlütter, Jacob Mørup; Johansen, Gry; Helmig, Rikke Bek;

    2016-01-01

    We report 2 cases of true uterine artery aneurysms diagnosed during pregnancy. Both cases presented with nonspecific symptoms such as urethral obstruction, minimal vaginal bleeding and lower abdominal pain in the 2nd trimester. Both aneurysms were diagnosed by color Doppler ultrasound. In the fir...... masses, vague bladder symptoms or radiating pelvic pain. The diagnosis is readily made by color Doppler imaging. Elective Caesarean section should be the preferred mode of delivery to avoid rupture of the aneurysm during labor.......We report 2 cases of true uterine artery aneurysms diagnosed during pregnancy. Both cases presented with nonspecific symptoms such as urethral obstruction, minimal vaginal bleeding and lower abdominal pain in the 2nd trimester. Both aneurysms were diagnosed by color Doppler ultrasound. In the first...... case labor was induced at 37 + 4 weeks of gestation. However, due to sudden fetal distress and maternal abdominal pain, an emergency Caesarean section was performed during labor, and 3 liters of intra-peritoneal blood were encountered upon laparotomy, secondary to a ruptured uterine artery aneurysm...

  18. Chondroblastoma: Report of two cases diagnosed by cytology

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    Jayasudha A Vasudevan

    2015-01-01

    Full Text Available Chondroblastoma is an uncommon benign cartilage producing neoplasm with a characteristic epiphyseal location. This report documents the cytological features of two cases of chondroblastomas diagnosed by cytology. One of the two cases had an unusual location in the temporomandibular region and the other was located in the epi-metaphyseal region of the right humerus. Smears characteristically revealed chondroblasts and osteoclast-like giant cells. The cytologic diagnosis of chondroblastoma was confirmed on both cases by histopathology. The radiologic appearance and differential diagnosis in both cases are discussed.

  19. Pituitary carcinoma diagnosed on fine needle aspiration: Report of a case and review of pathogenesis

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    Yakoushina Tatiana

    2010-01-01

    Full Text Available Pituitary carcinoma (PC is a very rare entity (0.2% of all pituitary tumors, with only about 140 cases reported in English literature. There are no reliable histological, immunohistochemical or ultrastructural features distinguishing pituitary adenoma (PA from PC. By definition, a diagnosis of PC is made after a patient with PA develops non-contiguous central nervous system (CNS or systemic metastases. To date, only three cases of PC have been reportedly diagnosed on fine needle aspiration (FNA. Two of the reported cases were diagnosed on FNA of the cervical lymph nodes and one on FNA of the vertebral bone lesion. Herein, we present a case of PC, diagnosed on FNA of the liver lesion. In this case, we describe cytologic features of PC and compare them to histologic features of the tumor in the pituitary. Clinical behavior of tumor, pathogenesis of metastasis and immunochemical and prognostic markers will also be described.

  20. Clinical Case Registries (CCR)

    Data.gov (United States)

    Department of Veterans Affairs — The Clinical Case Registries (CCR) replaced the former Immunology Case Registry and the Hepatitis C Case Registry with local and national databases. The CCR:HIV and...

  1. The prevalence of clinically diagnosed ankylosing spondylitis and its clinical manifestations: a nationwide register study.

    Science.gov (United States)

    Exarchou, Sofia; Lindström, Ulf; Askling, Johan; Eriksson, Jonas K; Forsblad-d'Elia, Helena; Neovius, Martin; Turesson, Carl; Kristensen, Lars Erik; Jacobsson, Lennart T H

    2015-05-09

    Prevalence estimates of ankylosing spondylitis vary considerably, and there are few nationwide estimates. The present study aimed to describe the national prevalence of clinically diagnosed ankylosing spondylitis in Sweden, stratified according to age, sex, geographical, and socio-economic factors, and according to subgroups with ankylosing spondylitis-related clinical manifestations and pharmacological treatment. All individuals diagnosed with ankylosing spondylitis according to the World Health Organization International Classification of Disease codes, between 1967 and 2009, were identified from the National Patient Register. Data regarding disease manifestations, patient demographics, level of education, pharmacological treatment, and geographical region were retrieved from the National Patient Register and other national registers. A total of 11,030 cases with an ankylosing spondylitis diagnosis (alive, living in Sweden, and 16 to 64 years old in December 2009) were identified in the National Patient Register, giving a point prevalence of 0.18% in 2009. The prevalence was higher in northern Sweden, and lower in those with a higher level of education. Men had a higher prevalence of ankylosing spondylitis (0.23% versus 0.14%, P ankylosing spondylitis of 0.18%. It revealed phenotypical and treatment differences between the sexes, as well as geographical and socio-economic differences in disease prevalence.

  2. Cost-effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia

    Directory of Open Access Journals (Sweden)

    Chanda Pascalina

    2009-04-01

    Full Text Available Abstract Background Malaria in Zambia accounts for about 4 million clinical cases and 8 000 deaths annually. Artemether-lumefantrine (ACT, a relatively expensive drug, is being used as first line treatment of uncomplicated malaria. However, diagnostic capacity in Zambia is low, leading to potentially avoidable wastage of drugs due to unnecessary anti malarial treatment. Methods A cost-effectiveness evaluation of the three current alternatives to malaria diagnosis (clinical, microscopy and Rapid Diagnostic Tests- RDT was conducted in 12 facilities from 4 districts in Zambia. The analysis was conducted along an observational study, thus reflecting practice in health facilities under routine conditions. Average and incremental cost effectiveness ratios were estimated from the providers' perspective. Effectiveness was measured in relation to malaria cases correctly diagnosed by each strategy. Results Average cost-effectiveness ratios show that RDTs were more efficient (US$ 6.5 than either microscopy (US$ 11.9 or clinical diagnosis (US$ 17.1 for malaria case correctly diagnosed. In relation to clinical diagnoses the incremental cost per case correctly diagnosed and treated was US$ 2.6 and US$ 9.6 for RDT and microscopy respectively. RDTs would be much cheaper to scale up than microscopy. The findings were robust to changes in assumptions and various parameters. Conclusion RDTs were the most cost effective method at correctly diagnosing malaria in primary health facilities in Zambia when compared to clinical and microscopy strategies. However, the treatment prescription practices of the health workers can impact on the potential that a diagnostic test has to lead to savings on antimalarials. The results of this study will serve to inform policy makers on which alternatives will be most efficient in reducing malaria misdiagnosis by taking into account both the costs and effects of each strategy.

  3. Commentary: the problem of agreement on diagnoses in criminal cases.

    Science.gov (United States)

    Patterson, Raymond F

    2010-01-01

    The authors present an important two-part study as they strive to provide an empirical analysis of psychiatric diagnoses in criminal case reports in Australia. In the first part, they compare the level of agreement or correlation of diagnoses between pairs of experts who prepared reports for either the prosecution or defense with other reports prepared for the same and opposing sides and by profession (i.e., psychiatrists and/or psychologists). In the second part, they compare the level of agreement or correlation between experts retained by either the prosecution or defense and treating practitioners. Psychiatric diagnoses are fundamental requirements that may affect the adjudication of criminal and civil cases. Both parts of the study focus on criminal cases and are very exciting in that they review not only the correlation of agreements in these areas but also address indirectly the concept of the so-called hired gun. The development of specialized expertise in the evaluation and assessment of defendants by designated opinion or expert witnesses has progressed over time. The nexus between psychiatry and the law (i.e., forensic psychiatry) has included the presentation of psychiatric diagnosis to the courts and the necessity for the expert or treating practitioner to address legal questions raised by the court. This study makes important steps in the direction of examining and analyzing the role of psychiatric diagnosis according to the responsibilities of the evaluator (i.e., as independent examiner or treating practitioner), as well as the possible influence of professional training and experience on differences in diagnoses between two evaluators. It is anticipated that there will be further work in these areas to address not only diagnoses but forensic recommendations and opinions.

  4. Three cases of retroperitoneal schwannoma diagnosed by EUS-FNA

    Institute of Scientific and Technical Information of China (English)

    Taiki Kudo; Hiroshi Kawakami; Masaki Kuwatani; Nobuyuki Ehira; Hiroaki Yamato; Kazunori Eto; Kanako Kubota; Masahiro Asaka

    2011-01-01

    Schwannomas are peripheral nerve tumors that are typically solitary and benign. Their diagnosis is largely based on surgically resected specimens. Recently, a number of case reports have indicated that retroperitoneal schwannomas could be diagnosed with endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)We report the diagnosis of three cases of schwannoma using EUS-FNA. Subjects weree two males and one fe-twomale,ages 22, 40, and 46 years, respectively, all of whom were symptom-free. Imaging findings showed well-circumscribed round tumors.However, as the tumors could not be diagnosed using these findings alone, EUS-FNA was performed. Hematoxylin-eosin staining of the resulting tissue fragments revealed bland spindle cells with nuclear palisading. There was no disparity in nuclear sizes.Immunostaining revealed S-100 protein positivity and all cases were diagnosed as schwannomas. Ki-67 indexes were 3%-15%,2%-3%,and 3%, respectively. No case showed any signs of malignancy.As most schwannomas are benign tumors and seldom become malignant, we observed these patients without therapy. All tumors demonstrated no enlargement and no change in characteristics.Schwannomasa are almost always benign and can be observed following diagnosis by EUS-FNA.

  5. Adult colocolic intussusception diagnosed by ultrasonography: a case report

    Directory of Open Access Journals (Sweden)

    Benazzouz Moustapha

    2011-07-01

    Full Text Available Abstract Introduction Intussusception is highly uncommon in adults and accounts for only 5% of all reported cases. It is more commonly secondary to an identifiable bowel lesion in 90% of cases, whereas 10% have no discernable cause. Diagnosis is difficult due to non-specific symptoms of the disease. Diagnostic imaging plays an important role in the diagnosis of the condition. Sonography and computed tomography are the most commonly used imaging techniques. In adults, intussusception usually requires treatment by surgical resection of the affected bowel. Case presentation A 35-year-old Moroccan woman presented with a five-month history of intermittent abdominal pain and one episode of bleeding from the rectum. At physical examination an abdominal mass was noted. Abdominal sonography revealed a 6.3 × 8.5 cm midline mass in her upper abdomen that was tender. In transverse section, the mass had the multiple concentric rings of hypoechoic and echogenic layers associated with the sonographic appearance of intussusception. In longitudinal section, the mass had the sonographic aspect of multiple parallel lines, giving the so-called "sandwich appearance". A corresponding contrast-enhanced abdominal computed tomography scan also demonstrated the intussusception. Surgery confirmed a colocolic intussusception with a large, firm, indurated mass as the lead point. A right hemicolectomy was undertaken because of concern about possible malignancy. The resected ascending colon was then opened up, to find a protruding tumor of the ascending colon that was acting as the lead point. It measured 7.6 × 6.9 × 2.4 cm. Pathology diagnosed an infiltrating, differentiated adenocarcinoma of the ascending colon invading through the muscularis propria. No lymphovascular invasion was seen. Our patient has recovered well. Conclusion Intussusception is relatively rare in the adult population, and this, along with the vague clinical features, makes diagnosis difficult

  6. Colouterine fistula complicating diverticulitis diagnosed at hysteroscopy: case report.

    Science.gov (United States)

    Mandato, Vincenzo Dario; Abrate, Martino; Sandonà, Francesco; Costagliola, Luigi; Gastaldi, Alfredo; La Sala, Giovanni Battista

    2012-01-01

    Since Noecker first reported a colouterine fistula secondary to diverticulitis in 1929, about 20 cases have been reported in the literature. Methods for diagnosis have yet to be established. Herein we report the first case of a colouterine fistula at the level of the isthmus diagnosed at hysteroscopy. Diagnostic hysteroscopy enabled rapid diagnosis of the colouterine fistula. Diagnostic hysteroscopy is the first-choice diagnostic tool for investigation of any abnormal vaginal discharge such as blood or stool because it enables direct vision and biopsy of the lesions of the lower genital tract quickly and at low cost.

  7. A case of Ramsay Hunt syndrome diagnosed after kidney transplantation

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    Yoo Min Park

    2015-12-01

    Full Text Available We report the first case of Ramsay Hunt syndrome (RHS diagnosed after kidney transplantation in Korea. RHS is a disease caused by latent varicella-zoster characterized to involve geniculate ganglion of the seventh cranial nerve. Patients who have undergone kidney transplantation can be easily affected by viral infections because of their immune-compromised status. A 35-year-old man with hypertensive end-stage renal disease underwent kidney transplantation. Two months after surgery, the recipient was diagnosed with RHS and treated with antivirals and steroids. However, after using the antiviral agents for the recommended duration, facial paralysis occurred as a new presentation and he required further treatment. Otalgia and periauricular vesicles improved, but the facial palsy remained.

  8. 初诊原发性干燥综合征86例临床研究%Clinical features of newly-diagnosed primary Sj(o)gren's syndrome: analysis of 86 cases

    Institute of Scientific and Technical Information of China (English)

    冯学兵; 张华勇; 周康兴; 刘布骏; 孙凌云

    2009-01-01

    Objective To assess the clinical features of newly diagnosed primary Sjogren's syndrome (pSS). Methods Patients were diagnosed according to the international consensus criteria for Sjogren's Syndrome published in 2002. Clinical manifestations and laboratory tests of 86 pSS cases hospitalized in Nanjing Drum Tower Hospital in the past two years were reviewed. Results Among the 86 patients, 95.3% were female and the average disease onset age was 38.6 years. The median time from disease onset to diagnosis was 6 months. Dry mouth, dry eyes and arthralgia were the most common symptoms. Hematologic involvement was found to be prominent in these patients (69.8%). The incidence of abnormal liver function, interstitial lung disease and pulmonary arterial hypertension was 19.8%, 8.2% and 5.8% simultaneously. Younger patients (less than 18 years old) had lower frequency of dry mouth and dry eyes but higher ffrequency of fever and lymph nodes enlargement than the elderly patients (P<0.05). Patients with positive anti-SSA or anti-SSB antibodies had higher incidence of hematological changes as well as ESR than those with negative auto-antibodia. Elevated globulin/IgG and positive antinuclear antibody or rheumatoid factor (P< 0.05). Conclusion pSS is not always a benign disease. Some patients will develop vital organ damages very early and thus need to be identified and treated in time. It should not be overemphasize the importance of dry mouth and dry eyes for the diagnosis of pSS, especially in young patients. Those patients who have fever, high globulin level and positive rheumatoid factor of unknown origin should be screened for pSS.%目的 探讨初诊原发性干燥综合征(pSS)的临床特点,旨在提高对pSS的早期诊断水平.方法 对2006~2007本院86例旨次诊断为pSS的住院患者临床表现及实验室指标进行回顾总结.结果 除口干、眼干、关节痛外,患者血液系统受累较为多见.18岁以下青少年患者口干、眼干发生率

  9. The need for genetic study to diagnose some cases of distal renal tubular acidosis.

    Science.gov (United States)

    Heras Benito, Manuel; Garcia-Gonzalez, Miguel A; Valdenebro Recio, María; Molina Ordás, Álvaro; Callejas Martínez, Ramiro; Rodríguez Gómez, María Astrid; Calle García, Leonardo; Sousa Silva, Lisbeth; Fernández-Reyes Luis, María José

    We describe the case of a young woman who was diagnosed with advanced kidney disease, with an incidental finding of nephrocalcinosis of unknown aetiology, having been found asymptomatic throughout her life. The genetic study by panels of known genes associated with tubulointerstitial disease allowed us to discover autosomal dominant distal renal tubular acidosis associated with a de novo mutation in exon 14 of the SLC4A1 gene, which would have been impossible to diagnose clinically due to the advanced nature of the kidney disease when it was discovered.

  10. A case of prenatally diagnosed partial monosomy 13q syndrome

    Directory of Open Access Journals (Sweden)

    Serenat Eris Yalcin

    2017-03-01

    Full Text Available Partial deletion of the long arm of chromosome 13 is a rare chromosomal aberration which is related to mental retardation, growth restriction and various congenital malformations. Central nervous system, cardiac, genitourinary, skeletal malformations and craniofacial dysmorphism can be observed. Prenatal diagnosis is possible by karyotyping and early genetic sonogram. Prenatal diagnosis can be difficult in cases that are not accompanied by major malformations but mental retardation and developmental delay in the forefront. In this report we aimed to present a case diagnosed 13-q syndrome prenatally as a result of karyotyping done due to multiple abnormal ultrasound findings in 14 weeks of pregnancy. [Cukurova Med J 2017; 42(1.000: 189-191

  11. A failure to reproduce the intermediate effect in clinical case recall

    NARCIS (Netherlands)

    M.W.J. van de Wiel (Margje); H.G. Schmidt (Henk); H.P.A. Boshuizen (Henny)

    1998-01-01

    textabstractPURPOSE: To investigate the differences between experts, intermediates, and novices in diagnosing and representing clinical cases under various time constraints. METHOD: Second-, fourth-, and sixth-year medical students, and internists studied, diagnosed, and recalled four clinical cases

  12. An update of 77 cases diagnosed as oral hemangiomas based on GLUT-1 positivity.

    Science.gov (United States)

    da Silva Filho, Tiago João; de Oliveira, Denise Hélen Imaculada Pereira; Brasil, Veruska Lima Moura; Nonaka, Cassiano Francisco Weege; da Silveira, Éricka Janine Dantas; Queiroz, Lélia Maria Guedes

    2017-08-01

    To evaluate cases diagnosed as "oral hemangiomas" based on the immunohistochemical expression of human glucose transporter protein (GLUT-1) and on histopathological features, and to investigate whether the classification proposed by the ISSVA was used correctly to classify these lesions. All cases stored in the archives of an Oral Pathology Service and diagnosed as "oral hemangiomas" were reviewed. Seventy-seven cases were analyzed regarding the expression of GLUT-1. GLUT-1(+) specimens were classified as true infantile hemangioma (IH) and GLUT-1(-) specimens were reclassified based on their histopathological features. The nomenclature of these lesions was evaluated and some cases were reclassified. Only 26 (33.8%) of the specimens were indeed IHs. Among the GLUT-1(-) specimens, 20 (26.0%) were reclassified as pyogenic granulomas (PGs) and 31 (40.2%) as vascular malformations. Considering the previously applied nomenclature, only 47.5% of the cases initially diagnosed as "hemangiomas" were IHs. In the group of "capillary hemangiomas", most cases (56.2%) were PGs. Among the three "cellular hemangiomas", two were PGs and one was IH. Most (88.8%) "cavernous hemangiomas" were vascular malformations. Careful and parameterized review of cases of vascular anomalies is necessary using auxiliary tools such as GLUT-1, since the exclusive use of histopathological findings might be insufficient to differentiate some anomalies. Accurate clinical examination and the use of biomarkers such as GLUT-1 are essential for the diagnosis. Copyright © 2017. Published by Elsevier Inc.

  13. Delusional infestations: case series, differential diagnoses, and management strategies.

    Science.gov (United States)

    Diaz, James H; Nesbitt, Lee T

    2014-01-01

    Physicians are not infrequently consulted by distraught patients with delusions of infestation who believe that they are infested with external or internal parasites and describe a crawling sensation of bugs or worms on or under their skin. Internet search engines were queried with the keywords as search terms to examine the latest articles on delusional infestations in order to describe presenting manifestations, differential diagnoses, and effective management strategies. The demographic and behavioral features of delusional infestations have remained constant and include: (1) onset in well-educated, middle-aged adults who are pet owners; (2) production of purported specimens of causative parasites; (3) pesticide overtreatment of themselves, their households, and pets; (4) excessive cleaning or vacuuming of households; (5) intense anger and resentment directed at physicians failing to confirm their self-diagnoses; and (6) sharing delusional symptoms with spouses or relatives. Although some reports have suggested that cases of delusional infestation are increasing today in the tropics, most studies have confirmed a stable incidence over time and similar disorder demographics worldwide. However, management strategies for delusional infestations have changed significantly over time with second generation, atypical antipsychotics offering safer adverse effect profiles and better prognoses than earlier therapies with first generation, typical antipsychotics. The most effective management strategies for delusional infestations include empathetic history-taking and active listening to the patient, careful exclusion of true parasitoses, and a therapeutic regimen that includes a second generation neuroleptic agent.

  14. Late diagnosed Ochoa Syndrome: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Letícia Alves Antunes

    2016-07-01

    Full Text Available Ochoa syndrome, also known as urofacial syndrome, is a rare genetic disease (OMIM #236730 with autosomal recessive inheritance of mutations in the heparanase 2 (HPSE2 and the LRIG2 genes, characterized by functional obstructive uropathy and unusual facial abnormalities. Progression to renal failure if not early diagnosed is inevitable. The therapeutic goals are to restore bladder emptying, preventing damage to the urinary tract with the use of prophylactic antibiotics, clean intermittent catheterization, anticholinergic use, botulinum toxin injection, urinary diversion and bladder augmentation to slow the evolution of the disease. This article aims to report a patient with late diagnosis of Ochoa Syndrome, as well as describe its characteristics and clinical outcome.

  15. Four Cases of Parkinson Disease Diagnosed During the Postpartum Period.

    Science.gov (United States)

    Maltête, David; Grangeon, Lou; Le Goff, Floriane; Ozel, Gulden; Fetter, Damien; Ahtoy, Patrick; Temgoua, Olivier; Rouillé, Audrey; Lefaucheur, Romain

    2017-07-01

    There is little experience with the effect of pregnancy on Parkinson disease because the number of women with Parkinson disease who are of childbearing age is small. We report four cases beginning during the postpartum period and discuss the potential contribution of different factors that may influence the occurrence of Parkinson disease in this time period. Four women aged 29-35 years developed arm tremor, shoulder pain, dizziness, or decreased dexterity of the hand in the first few days or months after childbirth. They were initially diagnosed with postpartum depression or psychogenic parkinsonism. Finally, dopamine transporter imaging confirmed the diagnosis of young-onset Parkinson disease. Early-onset Parkinson disease may present in postpartum women. In women with atypical motor symptoms in addition to depression, this diagnosis should be considered.

  16. Histoplasmosis diagnosed after arthroscopy of the knee: case report

    Directory of Open Access Journals (Sweden)

    Lorenzo Falster

    2015-10-01

    Full Text Available ABSTRACTFungal arthritis is a rare complication of arthroscopic surgeries, but its possibility should always be considered due its deleterious effects on any joint. Infection caused by the fungus Histoplasma capsulatum is the most common cause of respiratory tract infections by fungi, meanwhile histoplasmosis arthritis is more rare than all other fungal infections. However, their atypical forms of arthritis and the importance of early diagnosis and treatment cannot be over-emphasized. Herein we report a case of knee monoarthritis in an immunocompetent patient with histoplasmosis arthritis following an arthroscopic meniscetomy, diagnosed by synovial biopsy and culture performed during a second arthroscopic procedure. The joint was debrided in this second intervention and the patient received itraconazole initially and fluconazole latter on. The arthritis subsided after 10 months of treatment.

  17. Histoplasmosis diagnosed after arthroscopy of the knee: case report.

    Science.gov (United States)

    Falster, Lorenzo; Marin, Maurício B; Gomes, João Luiz Ellera

    2015-01-01

    Fungal arthritis is a rare complication of arthroscopic surgeries, but its possibility should always be considered due its deleterious effects on any joint. Infection caused by the fungus Histoplasma capsulatum is the most common cause of respiratory tract infections by fungi, meanwhile histoplasmosis arthritis is more rare than all other fungal infections. However, their atypical forms of arthritis and the importance of early diagnosis and treatment cannot be over-emphasized. Herein we report a case of knee monoarthritis in an immunocompetent patient with histoplasmosis arthritis following an arthroscopic meniscetomy, diagnosed by synovial biopsy and culture performed during a second arthroscopic procedure. The joint was debrided in this second intervention and the patient received itraconazole initially and fluconazole latter on. The arthritis subsided after 10 months of treatment.

  18. Klinefelter syndrome: clinical and auxological features of 14 patients diagnosed in childhood

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    M.F. Messina

    2013-08-01

    Full Text Available Klinefelter syndrome (KS is the most frequent chromosomal aneuploidy with a prevalence of 1: 500 men but it often remains a largely undiagnosed condition and only 10% of cases are identified in childhood and adolescence. We report the anamnestic, clinical and auxological findings of 14 KS patients diagnosed in paediatric age. 3/14 patients (21% with KS were diagnosed in prenatal age by amniocentesis, 1 patient was diagnosed at birth due to genital ambiguity and the remaining 10/14 (71.4% were diagnosed at a chronological age younger than 15 years old for a clinical picture characterized by a peculiar cognitive and behavioral pattern or genital anomalies and abnormalities of pubertal development. The classical karyotype 47 XXY was present in 10/14 subjects (72%, a mosaic form (46 XY/47 XXY was present in 2/14 (14% and a complex aneuploidy (48 XXYY and 48 XXXY was present in the remaining 2/14 (14% patients. All KS patients diagnosed in childhood and adolescence (10/14 =71.4 % showed a stature taller than the respective target height and also the predicted final height (calculated from a chronological age older than 7 years old and the reached final height were significantly taller than target height. Conclusion: according to our retrospective data we can assert that KS in paediatric age is characterized by a stature taller than target height, often associated with a characteristic cognitive and behavioral pattern while the typical clinical signs and symptoms of KS are lacking and manifest only in late adolescence or adulthood.

  19. The Investigation of First Diagnosed Case and Analysis of Clinical Characteristics of Adolescent Depression%青少年抑郁症的首诊状况调查与临床特征分析

    Institute of Scientific and Technical Information of China (English)

    程道猛; 刘靖雯; 黄鹏; 徐世超; 王春江

    2013-01-01

    Objective :To investigate first diagnosed Case and clinical characteristics of adolescent Depression ,and to provide a reference for the early diagnosis .Methods :Make a retrospective analysis of 115 adolescent depression data ,all patients were judged by Depression Rating Scale (HAMD) and Homemade somatic symptoms questionnaire .Results:(1) 33 adolescents depression went to psychiatric when initial outbreak ,accounting for 28 .70% in 115 adolescents de-pression ;the other 82 adolescents depression went to non-psychiatric treatment when initial outbreak ,accounting for 71 .30% in 115 adolescents depression ;(2)82 adolescents depression which went to non-psychiatric treatment were misdiagnosed as autonomic dysfunction ,nervous headache;(3) all adolescents depression had physical discomfort ,11 patients (9 .57% ) had ≤ 11 somatic symptoms ,104 patients (90 .43% ) had > 11 somatic symptoms .Conclusion:The main symptoms of adolescent depression are somatic symptoms ,most adolescent depression go to non-psychiatric treat-ment when initial outbreak ,have high misdiagnosis rate and missed rate ,doctor should strengthen and enhance under-standing of somatic symptoms of adolescents depression ,take timely and reasonable scientific treatment ,improve clini-cian recognition rate ,diagnosis rate ,treatment rates .%  目的:调查分析青少年抑郁症的首诊状况与临床特征,为早期诊断提供借鉴。方法:回顾分析我院就诊的115例青少年抑郁症患者的临床资料,所有患者均采用密尔顿抑郁量表(HAMD)和自制躯体症状调查表进行评定。结果:(1)115例青少年抑郁患者中初次发病就到精神专科就诊者33例(28.70%),其他82例(71.30%)均为到非精神科就诊;(2)82例在非精神专科就诊患者主要被误诊为植物神经功能紊乱、神经性头痛;(3)所有患者就诊时均有躯体不适的突出主诉,11例(9.57%)患者伴有≤11

  20. Using plant clinic registers to assess the quality of diagnoses and advice given to farmers

    DEFF Research Database (Denmark)

    Danielsen, Solveig; Boa, Eric; Mafabi, Moses;

    2012-01-01

    Purpose: This study developed a framework for quality assessment of diagnoses and advice given at plant clinics. Design/methodology/approach: Clinic registers from five plant clinics in Uganda (2006-2010) were used to develop quality assessment protocols for diagnoses and advice given by plant do...

  1. Prenatal Diagnoses with Cordocentesis: Evaluation of 172 Cases

    OpenAIRE

    Mahmut Erdemoğlu; Ahmet Kale; Nurten Akdeniz

    2007-01-01

    The aim of this study was to evaluate the results of 172 cordosentesis cases for chromosomal analysis in high risk pregnant patients which were performed in our clinic during 2001 and 2004. Cordosentesis procedure were performed mainly for, fetal anomaly, positive triplescreening test. Fetal chromosomal anomaly ratio was 7.5%. Trisomi 21,18,13 were found in fetal anomaly group. The invasive procedure success rate was %98.8. Cordosentes is a safe and easily performed prenatal diagnosis and t...

  2. Clinical value of CT three-dimensional imaging in diagnosing gastrointestinal tract diseases

    Institute of Scientific and Technical Information of China (English)

    Shao-Yin Duan; Dan-Tong Zhang; Qing-Chi Lin; Yan-Huan Wu

    2006-01-01

    AIM: To discuss the clinical value of CT three-dimensional (3-D) imaging in diagnosing gastrointestinal tract diseases.METHODS: Three-D imaging findings of 52 patients were retrospectively analyzed. Three-D imaging methods included shaded surface display (SSD), volume rendering (VR), virtual endoscopy (VE) and multiplanar reformatting (MPR). The diagnosis results of CT 3-D were evaluated by comparison with those of endoscopy and/or surgical finding.RESULTS: Fifty-two patients with gastrointestinal tract diseases were diagnosed by CT 3-D imaging, of whom 50 cases were correctly diagnosed and 2 were misdiagnosed. There were 33 cases of gastric diseases (27 with carcinoma, 5 with peptic ulcer and 1 with leiomyoma) and 19 large intestinal diseases (10 with colon carcinoma, 2 with carcinoma of the rectum, 5 with colon polypus and 2 with tuberculosis of the ileocecal junction). Twenty-two cases with prominent lesions (9 with subsequent hollow lesions), 20 with stenosis of cavity (8 with concomitant prominent lesions) and 10 with hollow lesions (5 with concomitant prominent lesions) were shown in 3-D images. The minimal lesion shown was 1.0 cm × 0.8 cm × 0.5 cm.CONCLUSION: CT 3-D imaging, a non-invasive examination without pain, can display clearly and directly the lesions of gastrointestinal tract with accurate location and high diagnosis accuracy. It is an important complementary technique to endoscopy.

  3. Clinical characteristics and primary management of patients diagnosed with prostate cancer between 2007 and 2013

    DEFF Research Database (Denmark)

    Thomsen, Frederik B; Mikkelsen, Marta K; Hansen, Rikke B

    2016-01-01

    are not registered. The objective of the study was to report clinical characteristics and primary management of men diagnosed with PCa from a primary referral center in Denmark. MATERIAL AND METHODS: Records on all men diagnosed with PCa at the Department of Urology, Frederiksberg Hospital, 1 January 2007 - 31...... resulting in an incidence rate (World Standard Population) of 84/100 000. Overall, 18% were classified as low-risk, 34% as intermediate-risk, 23% as high-risk, 8% as very high-risk and 17% had metastatic disease at diagnosis. Among men age ... this was the case for 58% of men aged 65-75 and 22% of men aged >75. Metastatic disease was found in 11% of men 75 years. In total 73% of men with low-risk PCa were managed on watchful waiting or active surveillance. Curatively intended treatment was performed in 56...

  4. Pleuritis clinically diagnosed as aspergillosis during the course of microscopic polyangiitis.

    Science.gov (United States)

    Kimoto, Yasutaka; Oryoji, Kensuke; Uchino, Ayumi; Yoshizawa, Shigeru; Niiro, Hiroaki; Tsukamoto, Hiroshi; Horiuchi, Takahiko

    2014-01-01

    Pleural aspergillosis is a rare fungal infection. We herein report a case of pleuritis clinically diagnosed as aspergillosis without apparent Aspergillus lung lesions. A 75-year-old man receiving immunosuppressive therapy due to microscopic polyangiitis was admitted for treatment of massive pleural effusion. Histology of the parietal pleura revealed septate hyphae. In addition, a hematological marker of Aspergillus indicated Aspergillus pleuritis. The pleural effusion resolved after administration of the voriconazole. The trigger for invasion of Aspergillus into the pleura was thought to be spontaneous pneumothorax, which had occurred five months earlier.

  5. The prevalence of clinically diagnosed ankylosing spondylitis and its clinical manifestations

    DEFF Research Database (Denmark)

    Exarchou, Sofia; Lindström, Ulf; Askling, Johan

    2015-01-01

    INTRODUCTION: Prevalence estimates of ankylosing spondylitis vary considerably, and there are few nationwide estimates. The present study aimed to describe the national prevalence of clinically diagnosed ankylosing spondylitis in Sweden, stratified according to age, sex, geographical, and socio......-economic factors, and according to subgroups with ankylosing spondylitis-related clinical manifestations and pharmacological treatment. METHODS: All individuals diagnosed with ankylosing spondylitis according to the World Health Organization International Classification of Disease codes, between 1967 and 2009...... with an ankylosing spondylitis diagnosis (alive, living in Sweden, and 16 to 64 years old in December 2009) were identified in the National Patient Register, giving a point prevalence of 0.18% in 2009. The prevalence was higher in northern Sweden, and lower in those with a higher level of education. Men had a higher...

  6. Identification of Legionella from clinically diagnosed pneumonia patients and environmental samples.

    Science.gov (United States)

    Jahan, R; Tarafder, S; Saleh, A A; Miah, M R A

    2015-04-01

    Legionnaires' disease is a multisystem disease with life-threatening acute and severe form of pneumonia which is responsible for 2-9% pneumonia with high mortality. Eighty six respiratory tract samples and urine were collected from clinically diagnosed pneumonia patients and 12 water samples were collected from different environment. Identification of Legionella was done by culture and Polymerase Chain Reaction (PCR) of respiratory tract samples and environmental samples and Legionella Antigen (Ag) in urine was detected by Immunochromatographic test (ICT). Legionella was identified from 4 (4.65%) clinically diagnosed pneumonia patients of which 1(1.16%) case was culture positive, 1(1.16%) case was urine ICT positive and PCR was positive in all four cases. Of the 12 water samples tested, 4 (33.33%) samples were Legionella positive by PCR but culture results of these samples were negative. Identification of Legionella should be done by PCR in parallel with culture and urine ICT. Detection of Legionella in environmental samples is also needed to explore possible links between the water sources and disease transmission in population.

  7. Do All Cases of Diagnosed Carcinoma Cervix Need HIV Screening?

    Directory of Open Access Journals (Sweden)

    Anil Khurana

    2014-05-01

    Full Text Available Background: This observational study was aimed to determine the frequency of existence of sero-positivity for human immunodeficiency virus (HIV infection among women of age between 25 to 75 years with invasive cervical carcinoma and to decide whether HIV testing should be included as part of the initial routine work-up of cervical cancer patients. Methods: Histologically proven 120 cases of invasive carcinoma cervix, who came for treatment between 2009-2013, in the department of radiotherapy, after counselling gave consent were investigated for HIV by immunochromatography based rapid test. Results: Out of 120 patients investigated, reports revealed that only two patients (1.67% were HIV seropositive. Both of these patients were already HIV seropositive and on gynaecological screening were found to have malignancy of cervix. No patient of diagnosed carcinoma cervix was found seropositive for HIV. Most patients (106/120 were above 40 years of age, from rural background (92/120 and housewives (80/120. Only 15% (18/120 were smokers. 95.8% (115/120 were of stage II and III. None presented with metastasis. Most common pathology was moderately differentiated carcinoma, in 76 patients (63.3%. Conclusion: Screening for HIV, as part of the initial work up for cervical cancer is not necessary in countries with limited resources and low HIV prevalence.

  8. Retrospective Evaluation of Cases Diagnosed with Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Gülseren Şahin

    2012-04-01

    Full Text Available In­tro­duc­ti­on: Inflammatory bowel disease (IBD is a chronic inflammatory disease of the gastrointestinal canal characterised by remissions and exacerbations. This study aimed to make a retrospective evaluation of clinical and laboratory findings of patients being monitored with a diagnosis of IBD.Materials and Methods: Medical records of 18 patients with a diagnosis of IBD and 7 years of follow-up at our pediatric gastroenterology departments were investigated with respect to demographic data, complaints on presentation and accompanying diseases. Unusual findings from physical examination, endoscopic findings, histopathological findings and the applied treatments were examined.Results: The 18 patients (10 female, 8 male included in this study had a mean age of 13.6±2.9 years and the mean time from onset of symptoms to diagnosis was 6.9±4.5 months. Seventeen patients were diagnosed with ulcerative colitis and 1 patient with intermediate colitis. There was a positive family history of the disease in 2 patients (11%. At the time of diagnosis, the most common complaints on presentation were found to be abdominal pain (100%, bloody diarrhea (94.5% and tenesmus (44.4%. The most frequent laboratory findings were CRP positivity (89%, increased sedimentation rate (83.3% and iron-deficient anaemia (77.7%. On colonoscopy, pancolitis involvement (66.6% was most frequently encountered. Accompanying diseases to IBD were found to be familial Mediterranean fever (FMF (11%, celiac disease (5.5% and Heliobacter pylori gastritis (5.5%. One patient (5.5% who did not respond to medical treatment for pancolitis involvement underwent a colectomy. Discussion: The number of diagnoses of IBD in childhood is gradually increasing. Nonetheless, it can be difficult to define diseases with non-specific symptoms and this may cause a delay in diagnosis. Because of the association of autoimmune diseases with IBD, despite appropriate therapy, diseases with no remission

  9. A Case with Bilateral Periventricular Nodular Heterotopia Diagnosed as Depression

    Directory of Open Access Journals (Sweden)

    Melek Kandemir

    2010-06-01

    Full Text Available Periventricular nodular heterotopia is a form of neuronal migration abnormality. Periventricular nodular heterotopia can easily be recognized by cranial magnetic resonance imaging. The most common clinical appearance is epileptic seizures. In some cases, symptoms are accompanied with psychiatric complaints. In this article, we report a 33-year-old female with complaints of left-sided paresthesia induced by emotional stress. She had been followed at an outpatient psychiatry clinic for about 10 years with the diagnosis of somatization disorder. Her electroencephalography recordings -awake as well as during sleep- were found to be normal. The cranial magnetic resonance imaging showed bilateral periventricular nodular heterotopia. Her seizures were controlled with carbamazepine treatment. Partial epileptic seizures might also be observed, even though the cerebral heterotopic lesions are bilateral. When a history is obtained from a patient with somatoform complaints, it should be kept in mind that these symptoms might be seizures, and the patient should be questioned accordingly.

  10. Prenatal Diagnoses with Cordocentesis: Evaluation of 172 Cases

    Directory of Open Access Journals (Sweden)

    Mahmut Erdemoğlu

    2007-01-01

    Full Text Available The aim of this study was to evaluate the results of 172 cordosentesis cases for chromosomal analysis in high risk pregnant patients which were performed in our clinic during 2001 and 2004. Cordosentesis procedure were performed mainly for, fetal anomaly, positive triplescreening test. Fetal chromosomal anomaly ratio was 7.5%. Trisomi 21,18,13 were found in fetal anomaly group. The invasive procedure success rate was %98.8. Cordosentes is a safe and easily performed prenatal diagnosis and treatment method in modern perinatology.

  11. Face symmetry assessment abilities: Clinical implications for diagnosing asymmetry

    Science.gov (United States)

    Jackson, Tate H.; Mitroff, Stephen R.; Clark, Kait; Proffit, William R.; Lee, Jessica Y.; Nguyen, Tung T.

    2014-01-01

    Introduction An accurate assessment of face symmetry is necessary for the development of a dentofacial diagnosis in orthodontics, and an understanding of individual differences in perception of face symmetry between patients and providers is needed to facilitate successful treatment. Methods Orthodontists, general dentists, and control participants completed a series of tasks to assess symmetry. Judgments were made on pairs of upright faces (similar to the longitudinal assessment of photographic patient records), inverted faces, and dot patterns. Participants completed questionnaires regarding clinical practice, education level, and self-confidence ratings for symmetry assessment abilities. Results Orthodontists showed expertise compared with controls (P <0.001), whereas dentists showed no advantage over controls. Orthodontists performed better than dentists, however, in only the most difficult face symmetry judgments (P = 0.006). For both orthodontists and dentists, accuracy increased significantly when assessing symmetry in upright vs inverted faces (t = 3.7, P = 0.001; t = 2.7, P = 0.02, respectively). Conclusions Orthodontists showed expertise in assessing face symmetry compared with both laypersons and general dentists, and they were more accurate when judging upright than inverted faces. When using accurate longitudinal photographic records to assess changing face symmetry, orthodontists are likely to be incorrect in less than 15% of cases, suggesting that assistance from some additional technology is infrequently needed for diagnosis. PMID:24182582

  12. Paracoccidioidomycosis in southern Rio Grande do Sul: a retrospective study of histopathologically diagnosed cases

    Directory of Open Access Journals (Sweden)

    Silvana Pereira de Souza

    2014-01-01

    Full Text Available Paracoccidioidomycosis (PCM is a systemic mycosis caused by the fungus Paracoccidioides brasiliensis and is endemic to Brazil. The aim of this study was to perform a retrospective analysis of the PCM cases in the countryside south of Rio Grande do Sul, Brazil. The files from four histopathology laboratories located in the city of Pelotas were obtained, and all of the epidemiological and clinical data from the PCM diagnosed cases were collected for analysis. A total of 123 PCM cases diagnosed between 1966 and 2009 were selected. Of these patients, 104 (84.5% were male, and 17 were female. The patients ranged from 02 to 92 years of age. Fifty-two cases (41.9% were obtained from the oral pathology laboratory, and the remaining 71 cases (58.1% were obtained from the three general pathology laboratories. Of all of the patients studied, 65.2% lived in rural zones and worked in agriculture or other related fields. Data on the evolution of this disease was available for 43 cases, and the time frame ranged from 20 to 2920 days (mean = 572.3 days. An accurate diagnosis performed in less than 30 days only occurred in 21% of the cases. PCM is endemic to the countryside of Rio Grande do Sul. Therefore, it is recommended that PCM be included as a differential diagnosis, mainly for individuals between 30 and 60 years of age, living in rural zones and who have respiratory signs and associated-oropharyngeal lesions.

  13. Clinical analysis of 29 cases of fetal digestive tract malformation diagnosed prenatally by ultrasound%产前超声诊断胎儿消化道畸形29例临床分析

    Institute of Scientific and Technical Information of China (English)

    卓娜; 段清; 张晖; 田晶; 孙彤

    2015-01-01

    目的:探讨产前超声检查诊断胎儿消化道发育畸形的临床意义。方法对孕期30~32周于本院检查出存在先天性消化道发育畸形的29例胎儿根据超声图像的不同特点进行分类分析,探讨其不同超声表现。结果29例中无胃泡或小胃泡11例(37.93%),合并多发畸形4例,合并羊水过多9例。管扩张、肠管多囊泡有7例(24.14%),其中合并多发畸形3例,羊水过多3例。双泡征有8例(27.58%),其中合并多发畸形1例,羊水过多7例。另3例无明显超声影像特征。结论30~32周胎儿进行产前超声检查对发现胎儿消化道发育畸形有很高的诊断价值,值得在临床推广应用。%Objective To investigate the clinical significance of prenatal ultrasound examination in the diagnosis of fe⁃tal digestive tract development. Methods Twenty-nine cases of congenital digestive tract malformation were examined in according to the different characteristics of their different fetal ultrasound images. Results There were 11 cases with non-magenblase or less magenblase (37.93%), 4 cases with combination of multiple malformations, and 9 cases with combination of amniotic fluid in the 29 cases. There were 7 cases (24.14%) with dilatation of intestine and intestinal vesicles, in which 3 with multiple malformations and 3 with polyhydramnios. There were 8 cases (27.58%) with double bubbles, in which 1 case with multiple malformations and 7 cases with amniotic fluid. Conclusion The prenatal ultrasound examination in 30 to 32 weeks of pregnancy is very valuable in diagnosis of fetal digestive tract development, which is worthy of clinical application.

  14. Acute venous thrombosis as complication and clue to diagnose a SAPHO syndrome case. A case report.

    Science.gov (United States)

    Rosero, A; Ruano, R; Martin, M; Hidalgo, C; Garcia-Talavera, J

    2013-01-01

    This report concerns a male adult admitted for sternal and left arm pain, who was diagnosed and treated for acute deep venous thrombosis in the left subclavian and axillary veins. X-ray and a hybrid single photon emission tomography and computed tomography (SPECT-CT) scintigraphy scan revealed high intensity uptake in both sternoclavicular joints, which corresponded to hyperostosis, thereby suggesting a SAPHO syndrome. Upon reviewing the patient's medical history, we found dermatological pustulosis disease and an intermittent sternal chest pain untreated since 10 years ago. In the biochemical study we found erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) elevation, hyperglobulinemia, and mild anaemia. Initial treatment included nonsteroidal anti-inflammatory drugs (NSAIDs) with low response, which then changed to methotrexate, sulfasalazine, and prednisone. The patient's pain was controlled almost completely in 10 months. A control bone scan revealed a marked decrease in intensity of bone deposits according to clinical response. To our knowledge, there are only a few cases of SAPHO and thrombosis and none are followed up with a bone SPECT-CT scan.

  15. A case of severe preeclampsia diagnosed as post-partum hemolytic uremic syndrome

    Institute of Scientific and Technical Information of China (English)

    WANG Yong-qing; WANG Jing; JIANG Yuan-hui; YE Rong-hua; ZHAO Yang-yu

    2012-01-01

    Post-partum hemolytic uremic syndrome (PHUS) is a severe thrombotic microangiopathy clinically characterized by hemolytic anemia,renal dysfunction,and low platelets after birth with rapid progression and poor prognosis.Here,we reported a rare case of severe preeclampsia diagnosed as hemolytic uremic syndrome after birth.The patient was diagnosed with PHUS and underwent intermittent plasma exchange with supportive treatment including glucocorticoid injections and transfusion of suspended red blood cells.After these treatments,the patient experienced no apparent remission and chronic renal dysfunction occurred on her.PHUS is a severe emergency with acute onset,rapid progress,and poor prognosis.Early detection,diagnosis,and treatment can significantly improve the prognosis.

  16. AMBIGUITY IN DIAGNOSING ESTHESIONEUROBLASTOMA – A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Swarnagowri

    2013-10-01

    Full Text Available Esthesioneuroblastomas (ENBs are undifferentiated tumours of neuroectodermal origin derived from the olfactory epithelium. Inconsistent histologic presentations can lead to the controversy regarding the exact histologic origin of ENBs, and this ambiguity can confound clinical and prognostic decisions. These tumours often display varying biologic activity ranging from indolent growth, with patient survival exceeding 20 years, to a highly aggressive neoplasm capable of rapid widespread metastasis, with survival limited to a few months. Due to the rare and complex nature of ENB, multiple opinions exist regarding the etiology, optimal staging system and treatment modalities. We ha ve come across a case of Esthesioneuroblastoma, presenting as recurrent nasal mass with bleeding in a 50 yr old male. Histological presentation was unusual but the diagnosis was confirmed by Immunohistochemistry

  17. Case of lupus vulgaris diagnosed 50 years after onset.

    Science.gov (United States)

    Uttawichai, Pattanawadee; Igarashi, Tsukasa; Kawana, Seiji

    2009-02-01

    Cutaneous tuberculosis is an infrequent form of extrapulmonary tuberculosis, but is a symptom that can lead to diagnosis of tuberculosis. We describe a case of lupus vulgaris in a 79-year-old woman who had a 50-year history of a slowly growing plaque on her right cheek. She visited many hospitals without resolution and the plaque gradually enlarged. Recently, she was misdiagnosed with eczema and prescribed topical steroids that had no effect, and she subsequently visited our outpatient clinic. A diagnosis of lupus vulgaris was made based on histopathology, culture and polymerase chain reaction, and isoniazid, rifampicin and ethambutol were administered as antituberculosis treatment. Although the incidence of cutaneous tuberculosis has decreased significantly in developed countries, knowledge and awareness of the disease are still of importance for proper diagnosis and treatment.

  18. A Rare Case of Meconium Periorchitis Diagnosed in Utero

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    Daigo Ochiai

    2015-01-01

    Full Text Available Meconium periorchitis is a rare disorder caused by fetal meconium peritonitis, with subsequent passage of meconium into the scrotum via a patent processus vaginalis. To date, clinical significance of meconium periorchitis for the prenatal diagnosis of meconium peritonitis and prediction for postnatal surgery remains to be determined. We present a clinical course of a fetus presenting with meconium periorchitis induced by meconium peritonitis. At 28 weeks’ gestation, fetal ultrasonography indicated fetal ascites associated with bilateral hydrocele and peritesticular calcification without other signs of meconium peritonitis. The pregnancy was uneventful until delivery and the infant was delivered at 37 weeks’ gestation. No abdominal distension was observed at birth, and radiography did not reveal any abdominal calcification except for scrotal calcification. Abdominal distension was observed 3 days after birth and laparotomy was performed. The diagnosis of meconium peritonitis was confirmed at surgery. Our case illustrated that careful examination of the scrotum during fetal life was helpful for prenatal diagnosis of meconium peritonitis as well as postnatal management.

  19. Psychiatric disorders in adults diagnosed as children with atypical autism. A case control study

    DEFF Research Database (Denmark)

    Mouridsen, S.E.; Rich, B.; Isager, T.

    2008-01-01

    The prevalence and types of psychiatric disorders were studied in a clinical sample of 89 individuals with atypical autism (AA) first seen as children, and 258 matched controls from the general population using data from the nationwide Danish Psychiatric Central Register. The average observation...... is not seen to be associated with any specific mental disorder. Schizophrenia spectrum disorders were the most commonly associated psychiatric disorders, diagnosed at least one time in 34.8% of the AA cases. Our findings underscore that it is important for clinicians working in adult psychiatric services...

  20. [Scurvy, a serious and rare form of avitaminosis, easily diagnosed and treated. Presentation of a case].

    Science.gov (United States)

    Gil Llano, J R; Grespo Rincón, L; Ruiz Llano, F C; Costo Campoamor, A; Mateos Polo, L; González, M A

    1995-09-01

    We report a 66 years-old man case that was admitted with abdominal wall hemorrhagic swelling ecchymosis on inferior extremities and perifollicular purpura with hyperkeratosis of the follicles, which gives it an appearance of palpable purpura, together with gingival hemorrhage and moderate anemia. He was a well-nourished sick man but who made a peculiar diet, practically free from fruit and vegetables which developed a pure and serious form of scurvy. We report this case because we consider that the features which appear are illustrative to provide the immediate clinical diagnosis of this uncommon disease, potentially mortal, but easy to diagnose, if we think about it in the adequate clinical contexts, and which it is quickly curable with the administration of ascorbic acid.

  1. Stress fractures of the ankle malleoli diagnosed by ultrasound: a report of 6 cases

    Energy Technology Data Exchange (ETDEWEB)

    Bianchi, Stefano [CIM SA, Cabinet Imagerie Medicale, Geneve (Switzerland); Luong, Dien Hung [CIM SA, Cabinet Imagerie Medicale, Geneve (Switzerland); University of Montreal, Department of Physical Medicine and Rehabilitation, Montreal (Canada)

    2014-06-15

    To present the ultrasound appearance of stress fractures (SF) of the ankle malleoli. We present a retrospective review of 6 patients (4 women and 2 men, with an age range of 24-52 years, mean age of 39 years) in which ultrasound diagnosed, together with the clinical findings, an SF of the ankle malleoli. For all of these patients ultrasound was the first imaging technique applied because of a clinical suspicion of soft tissue injuries following excessive exertion. Patients were subsequently examined using standard radiographs and/or MRI. At ultrasound patients showed thickening of the periosteum in all patients, calcified bone callus was evident in 3 out of 6 patients. Cortical irregularities and subcutaneous oedema were found in all but one patient. Colour Doppler showed local hypervascular changes in all patients. Local compression with the transducers during real-time scanning increased pain in all cases. Ultrasound, together with the clinical findings, can diagnose an SF of the ankle malleoli. We suggest that sonologists should include malleolar SF in their differential diagnosis, particularly in the case of perimalleolar pain from over-solicitation. They must also include, as part of every ultrasound examination of the ankle, the evaluation of both malleoli and should be aware of the ultrasound appearance of malleolar SF. If the diagnosis remains uncertain, an MRI should be prescribed. (orig.)

  2. CLINICAL AND FAMILY PROFILE OF PATIENTS DIAGNOSED WITH KERATOCONUS

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    Kalpana

    2015-03-01

    Full Text Available PURPOSE: To screen the first degree relatives of patient diagnosed with keratoconus . MATERIALS AND METHODS : All the patients included in the study, patient details were taken which included - name, age, gender, hospital number, address and family history [pedigree tree] . All the patients underwent refraction, best corrected visual acuity, colour vision , keratometry, intraocular pressure measurement and corneal topography [orbscan]. Family screening was done, which included - refraction, best corrected visual acuity, colour vision, keratometry, intraocular pressure and corneal topography [orbscan]. RESULTS: In this study of 40 eyes, 24 eyes [Right eyes - 12 & Left eyes - 12] i.e. 60% have keratoconus, 3 eyes [2 - Right eyes & 1 - Left eye] i.e.15% have advanced keratoconus, 12 eyes [Right eye - 6 & Left eye - 6] i.e. 30% have VKC & Keratoconus, 1 eye have acute hydrops. Total family members screened 55, out of that 17 members are fathers, 20 members are mothers, 12 members are brothers and 6 are sisters

  3. Cardiac autonomic testing and diagnosing heart disease. 'A clinical perspective'

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    Nicholas L. DePace

    2014-12-01

    Full Text Available Background Coronary heart disease (CHD is a major health concern, affecting nearly half the middle-age population and responsible for nearly one-third of all deaths. Clinicians have responsibilities beyond diagnosing CHD, including risk stratification of patients for major adverse cardiac events (MACE, modifying the risks and treating the patient. In this first of a two-part review, identifying risk factors is reviewed, including more potential benefit from autonomic testing. Methods Traditional and non-traditional, and modifiable and non-modifiable risk factors for MACE where compared, including newer risk factors, such as inflammation, carotid intimal thickening, ankle-brachial index, CT calcium scoring, and autonomic function testing, specifically independent measurement of parasympathetic and sympathetic (P&S activity. Results The Framingham Heart Study, and others, have identified traditional risk factors for the development of CHD. These factors effectively target high-risk patients, but a large number of individuals who will develop CHD and MACE are not identified. Many patients with CHD who appear to be well-managed by traditional therapies still experience MACE. In order to identify these patients, other possible risk factors have been explored. Advanced autonomic dysfunction, and its more severe form, cardiac autonomic neuropathy, have been strongly associated with an elevated risk of cardiac mortality and are diagnosable through P&S testing. Conclusions Independent measures of P&S activity, provides additional information and has the potential to incrementally add to risk assessment. This additional information enables physicians to (1 specifically target more high-risk patients and (2 titrate therapies, with autonomic testing guidance, in order to minimize risk of cardiac mortality and morbidity.

  4. A study on clinical findings about vertebral disease diagnosed with MRI

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ham-Gyum [Ansan College, Seoul (Korea, Republic of)

    2006-09-15

    In order to analyze clinical characteristics like sex-and age-based onset frequency and onset region from vertebral disease cases, this study investigated total 1,291 cases of vertebral disease that were diagnosed via magnetic resonance imaging (MRI) from January to December 2004 at B University Hospital in metropolitan area. For higher diagnostic accuracy in cases of spinal disorder diagnosed, this study analyzed findings from data reading conducted by veteran specialists in diagnostic radiology. But this study excluded uncertain lesion cases, the cases requiring differential diagnosis from other disorders and so on from subjects under analysis. This study employed superconductive 1.5 Tesla SIGNA MR/i for MRI test and basically received resulting images via FSE (fast spin echo). In particular, this study obtained T1 and T2 myelogram with regard to regional characteristics (such as cervical vertebrae, thoracic vertebrae and lumbar vertebra) and imaging characteristics for sagittal and transverse section. As a result, this study came to the following conclusions: 1. In terms of general characteristics of subjects under analysis, male group comprised 53.5% and female 46.5% out of total 1,291 subjects. 2. The regional onset frequency of spinal disorders was converged primarily on lumbar vertebra (65.5%), which was followed by cervical vertebrae (27.3%) and thoracic vertebrae (7.0%) respectively. 3. Top 10 cases with high onset frequency of spinal disorders can be listed as follows: 1) posterior bulging disc 65.8% 2) narrowing of neural foramen 23.8% 3) herniated intervertebral disc (HIVD) 22.4% 4) spinal stenosis 16.7% 5) osteochondrosis 6.4% 6) compression fracture 6.4% 7) facet joint arthropathy 6.2% 8) spondylolisthesis 6.0% 9) spinal cord tumor 3.5% 10) inter body fusion 2.6%.

  5. Traumatic Lumbar Hernia Diagnosed by Ultrasonography: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kwang Lae; Yim, Yoon Myung; Lim, Oh Kyung; Park, Ki Deok; Choi, Chung Hwan; Lee, Ju Kang [Gachon University of Medicine and Science, Incheon (Korea, Republic of)

    2009-12-15

    Traumatic lumbar hernia describes the extrusion of intraperitoneal or extraperitoneal contents through a defect in the posterolateral abdominal wall caused by a trauma. This is a rare entity and usually diagnosed by computed tomography. A 64-year-old male received an injury on his cervical spinal cord after an accident in which he fell down. He complained of a mass on his left posterolateral back area. We diagnosed the mass as a traumatic lumbar hernia by ultrasonography and confirmed it by computed tomography. We conclude that the ultrasonography can be a useful diagnostic tool for traumatic lumbar hernia

  6. Reliability of clinical ICD-10 diagnoses among electroconvulsive therapy patients with chronic affective disorders

    Directory of Open Access Journals (Sweden)

    Klaus Damgaard Jakobsen

    2008-09-01

    Full Text Available Background and Objectives: Diagnostic reliability is of major concern both to clinicians and researchers. The aim has been to investigate the trustworthiness of clinical ICD-10 affective disorder diagnoses for research purpose. Methods: 150 ECT patients with chronic affective disorders were investigated. A standardized schema for basic anamnesis and the Operational Criteria Checklist for Psychotic and Affective Illness (OPCRIT were used. The sensitivity, specificity, positive and negative predictive values of clinical affective disorder ICD-10 diagnoses and the formal agreement between clinical ICD-10, OPCRIT ICD-10 and DSM-IV diagnoses were determined using unweighted κ-statistics. Results: The sensitivity, specificity, positive and negative predictive values of the clinical bipolar diagnoses was 0.55, 0.75, 0.42 and 0.84, respectively. The sensitivity, specificity, positive and negative predictive values of the clinical unipolar diagnoses was 0.79, 0.55, 0.77 and 0.58, respectively. The agreement between clinical ICD-10 and OPCRIT ICD-10 bipolar vs. non-bipolar diagnoses was low, κ = 0.28. The agreement between clinical ICD-10 and OPCRIT ICD-10 unipolar vs. non-unipolar diagnoses was low, κ = 0.35. The agreement between OPCRIT ICD-10 and DSM-IV diagnoses on bipolar vs. non-bipolar disorders was high, κ = 0.91, and the agreement on unipolar vs. non-unipolar disorders was fairly high, κ = 0.78. Conclusions: This study demonstrates that the reliability of clinical ICD-10 diagnoses of affective disorders from chronic subjects with a history of ECT is problematic despite sample homogeneity on basic clinical, demographic and epidemiological parameters.

  7. Experience with Clinically Diagnosed Down Syndrome Children Admitted with Diarrhea in an Urban Hospital in Bangladesh.

    Science.gov (United States)

    Das, Rina; Sarker, Anupam; Saha, Haimanti; Bin Shahid, Abu Sadat Mohammad Sayeem; Shahunja, K M; Chisti, Mohammod Jobayer

    2015-01-01

    There is lack of information in the medical literature on clinically diagnosed Down syndrome children presenting with diarrhea. Our aim was to describe our experience with Down syndrome patients admitted with diarrhea by evaluating the factors associated with Down syndrome presenting with diarrheal illness. In this retrospective chart analysis, we enrolled all the diarrheal children aged 0-59 months admitted to the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), from March 2011 to February 2013. Down syndrome children with diarrhea constituted cases and randomly selected threefold diarrheal children without Down syndrome constituted controls. Among 8422 enrolled children 32 and 96 were the cases and the controls, respectively. Median age (months) of the cases and the controls was comparable (7.6 (4.0, 15.0) versus 9.0 (5.0, 16.8); p = 0.496). The cases more often presented with severe acute malnutrition, developmental delay, congenital heart disease, hypothyroidism, sepsis, hypocalcemia, developed hospital acquired infection (HAI) during hospitalization, and required prolonged stay at hospital compared to the controls (for all p syndrome should be investigated for these simple clinical parameters for their prompt management that may prevent HAI and prolonged hospital stay.

  8. Abdominal neoplasia with sarcomatoid features as the presenting illness of a patient with a newly diagnosed HIV infection and no AIDS-related disorders. Case report, clinical and diagnostic features, and literature discussion

    Directory of Open Access Journals (Sweden)

    Roberto Manfredi

    2014-12-01

    Full Text Available We aim to describe a patient with an already advanced HIV infection disclosed for the first time during a complex diagnostic workup, which detected a gross abdominal mass attributable to a poorly differentiated mesenchymal cancer with sarcomatoid features which rapidly led our patient to death, in absence of other potential HIV-associated opportunistic diseases. Although extremely rare and rapidly lethal, our case report underscores the need of all caregivers who follow HIV-infected patients also in the cART era to maintain an elevated attention toward infrequent, unexpected, and clinically atypical solid tumors, in order to ensure a timely diagnosis and management when possible.http://dx.doi.org/10.7175/cmi.v8i4.961

  9. Study on fatty liver diagnosed by abdominal ultrasonography and clinical laboratory findings

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Jeong Hwa [Cheju Halla College, Cheju (Korea, Republic of)

    2006-03-15

    The study obtained the following conclusions by making a comparative study on fatty liver diagnosed by abdominal ultrasonography and clinical laboratory findings. I surveyed the value of abdominal ultrasound in 400 patients without clinical symptoms at C Health Clinic Center, Seoul. Compare with blood pressure was high (systolic/diastolic) in 7.5%/4.5% on persons who were diagnosed fatty liver. At the time of the diagnosis, Total cholesterol level was increased in fatty liver patients, HDL-cholesterol level was high in fatty liver patients. And Trigryceride level was increased in fatty liver persons, LDL-cholesterol was high in fatty liver persons. SGOT level was increased in 5.5% on patients who were diagnosed fatty liver, 0% on persons who were normal and SGPT level was high in 29.5% on people who were diagnosed fatty liver, 0% on patients who were diagnosed normal.

  10. The Evaluation Clinical and Demographic Characteristics of 115 Patients Diagnosed with Herpes Zoster in Eeastern Turkey

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    Hatice Uce Özkol

    2013-12-01

    Full Text Available Objective: The aim of this study was to investigate the clinical and demographic characteristics of patients diagnosed with herpes zoster and to explore the similarities and differences with other epidemiological studies from Turkey and the world. Methods: We retrospectively reviewed the records of 115 patients diagnosed with herpes zoster in the Yuzuncu Yıl University Medical Faculty Dermatology Department between January 2007 and December 2010. Results: The mean age of the patients was 42.21±23.88 years. 115 patients, -47 female (40.9%, 68 male (59.1%- aged between 2 and 93 years were assessed. Pediatric age group, 20 (17.4%, adult age group, 95 (82.6% patients, respectively. The incidence of HZ was found to be 0.43%. HZ was observed winter rarely (13.04%. Is mostly seen in the months of March (17.39% The affected dermatome were thorasic (49 patient, 42.6%, servical (21 patient, 18.3%, ophtalmic (22 patient, 19.1%, lomber (16 patient, 13.9%, sacral (7 patient, 6.1% respectively. Complications developed in 13% of patients. Conclusion: We observed that our findings were more or less similar to the findings of the literature data. Cases of HZ in our study was very rare during the winter season. Multi-center studies are needed to the emergence of clinical and epidemiological characteristics of HZ in Turkey.

  11. The utility of clinical decision tools for diagnosing osteoporosis in postmenopausal women with rheumatoid arthritis.

    Science.gov (United States)

    Brand, Caroline; Lowe, Adrian; Hall, Stephen

    2008-01-29

    Patients with rheumatoid arthritis have a higher risk of low bone mineral density than normal age matched populations. There is limited evidence to support cost effectiveness of population screening in rheumatoid arthritis and case finding strategies have been proposed as a means to increase cost effectiveness of diagnostic screening for osteoporosis. This study aimed to assess the performance attributes of generic and rheumatoid arthritis specific clinical decision tools for diagnosing osteoporosis in a postmenopausal population with rheumatoid arthritis who attend ambulatory specialist rheumatology clinics. A cross-sectional study of 127 ambulatory post-menopausal women with rheumatoid arthritis was performed. Patients currently receiving or who had previously received bone active therapy were excluded. Eligible women underwent clinical assessment and dual-energy-xray absorptiometry (DXA) bone mineral density assessment. Clinical decision tools, including those specific for rheumatoid arthritis, were compared to seven generic post-menopausal tools to predict osteoporosis (defined as T score perform better than generic tools, however, the National Osteoporosis Foundation score could potentially reduce the number of unnecessary DXA tests by approximately 45% in this population. There was limited utility of clinical decision tools for predicting osteoporosis in this patient population. Fracture prediction tools that include risk factors independent of BMD are needed.

  12. [Report of an amyopathic dermatomyositis clinical case].

    Science.gov (United States)

    Monteiro, Paulo; Duarte, Cátia; Salvador, Maria João; Malcata, Armando

    2009-01-01

    The authors report a clinical case of a 41-years-old man with astenia and myalgias maintained for many years without an accurate diagnosis. Amyopathic dermatomyositis was diagnosed based on the presence of typical cutaneous lesions and the absence of myositis. Subsequent evidence of subclinical myositis allowed the diagnosis of hypomyophatic dermatomyositis. Finally, the diagnosis of classical dermatomyositis could be made when the patient presented elevated levels of muscle enzimes. There was a good clinical response to imunossupressor therapy and the patient remains asymptomatic. Differences in the clinical management of amyopathic, hypomyopathic and classic dermatomyositis are discussed.

  13. Diagnosing MS

    Science.gov (United States)

    ... a Local Support Group Ask an MS Navigator Edward M. Dowd Personal Advocate Program Connect with Peers ... Symptoms & Diagnosis Diagnosing MS Possible MS Clinically Isolated Syndrome (CIS) Newly Diagnosed Diagnosing Tools Other Conditions to ...

  14. A New Case of Prenatally Diagnosed Pentasomy X: Review of the Literature

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    Linda Maria Azzurra Pirollo

    2015-01-01

    Full Text Available Pentasomy X is a rare chromosomal abnormality probably due to a nondisjunction during the meiosis. Only four cases prenatally diagnosed were described until now. Our case is the fifth one prenatally diagnosed at 20 weeks of gestational age in a 39-years-old woman. She underwent invasive prenatal diagnosis for her advanced maternal age without any other known risk factor. Amniocentesis performed at 17 weeks showed a female 49, XXXXX karyotype. The ultrasonographic examination revealed nonspecific signs of a mild early fetal growth retardation and no significant increased nuchal fold. The fetal autopsy and the X-ray excluded major malformations. Prenatal diagnosis is often difficult due to the lack of indicative ultrasonographic findings and the rarity of described cases. The influence of the mother’s age on the occurrence of penta-X syndrome has not been determined. Considering the lack of correlation between advanced maternal age and increased risk for pentasomy X, as well as the absence of typical echographic signs, evaluation of the inclusion of a noninvasive prenatal test (NIPT that expands clinical coverage to include the X and Y chromosomes in routine prenatal diagnosis should be considered as well as three-dimensional ultrasound to detect any helpful indicative prognostic signs.

  15. A New Case of Prenatally Diagnosed Pentasomy X: Review of the Literature

    Science.gov (United States)

    Pirollo, Linda Maria Azzurra; Salehi, Leila Baghernajad; Sarta, Simona; Cassone, Marco; Capogna, Maria Vittoria; Piccione, Emilio; Novelli, Giuseppe; Pietropolli, Adalgisa

    2015-01-01

    Pentasomy X is a rare chromosomal abnormality probably due to a nondisjunction during the meiosis. Only four cases prenatally diagnosed were described until now. Our case is the fifth one prenatally diagnosed at 20 weeks of gestational age in a 39-years-old woman. She underwent invasive prenatal diagnosis for her advanced maternal age without any other known risk factor. Amniocentesis performed at 17 weeks showed a female 49, XXXXX karyotype. The ultrasonographic examination revealed nonspecific signs of a mild early fetal growth retardation and no significant increased nuchal fold. The fetal autopsy and the X-ray excluded major malformations. Prenatal diagnosis is often difficult due to the lack of indicative ultrasonographic findings and the rarity of described cases. The influence of the mother's age on the occurrence of penta-X syndrome has not been determined. Considering the lack of correlation between advanced maternal age and increased risk for pentasomy X, as well as the absence of typical echographic signs, evaluation of the inclusion of a noninvasive prenatal test (NIPT) that expands clinical coverage to include the X and Y chromosomes in routine prenatal diagnosis should be considered as well as three-dimensional ultrasound to detect any helpful indicative prognostic signs. PMID:25699192

  16. Case of acute orbital myositis which was difficult to diagnose at first

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Kiyoshi; Terabayashi, Tadasu; Mori, Hiroshi; Niida, Hirohito; Sugiyama, Yoshiaki; Nakagawa, Masato

    1988-02-01

    We report a case of acute orbital myositis. A 61-year-old woman exhibited acute orbital pain, diplopia, and left proptosis. Examination revealed a 5-mm left proptosis, left chemosis, and limitations in all directions of the movement of the left eye. Visual acuity was unimpaired, however, and the neurological examination was otherwise normal. CT demonstrated a left inferior orbital mass. We suspected an acute orbital pseudotumor based on the rapid onset and the clinical symptoms. We treated her with systemic corticosteroids. Four weeks later CT documented a reduced left orbital mass; there seemed to be left only an inferior rectus muscle enlargement. We diagnosed acute orbital myositis, a subgroup of orbital pseudotumors, based upon the rapid clinical presentation, the CT features, and the resolution after treatment with systemic corticosteroids.

  17. Primary cardiac lymphoma initially diagnosed by routine cytology. Case report and literature review.

    Science.gov (United States)

    Castelli, M J; Mihalov, M L; Posniak, H V; Gattuso, P

    1989-01-01

    A case of primary cardiac lymphoma initially diagnosed by routine cytologic examination of pericardial fluid is presented. In a 64-year-old woman woman who originally presented with chest pain and heart block, the initial clinical impression was ischemic heart disease. However, coronary angiography failed to reveal significant disease. An echocardiogram demonstrated pericardial fluid, which was drained. A small amount was sent for cytologic examination, and the diagnosis of malignant lymphoma, large cell type, was made. Subsequent radiologic examinations revealed an intracardiac mass involving the atrioventricular canal; surgical biopsy confirmed the diagnosis of a large cell lymphoma. While primary malignant lymphoma of the heart is rare, this case highlights the efficacy of routine cytologic examination of an effusion fluid (often drained therapeutically) in establishing the correct diagnosis.

  18. Transverse testicular ectopia diagnosed by US and MR imaging: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Hye Sun; Kim, Yong Woo; Choi, Seok Jin; Cha, Seong Sook [Inje University, Busan Paik Hospital, Busan (Korea, Republic of)

    2007-01-15

    Transverse testicular ectopia (TTE) is a rare congenital anomaly in which both testes migrate toward the same hemiscrotum. In most cases, the correct diagnosis is not made preoperatively, but it's made during an inguinal herniotomy or during surgical exploration for an undescended testis because TTE is clinically misdiagnosed as an symptomatic inguinal hernia or as a tumor of the testis on the side to which the ectopic testis has migrated or as an undescended testis on the contralateral side. US and MR imaging can detect the transverse testicular ectopia by its characteristic appearance and so provide useful information about any associated anomalies. We report here on a case of transverse testicular ectopia that was diagnosed by US and MR imaging in a 10-month-old boy, and we review the relevant literature.

  19. Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions

    DEFF Research Database (Denmark)

    El-Galaly, Tarec Christoffer; Hutchings, Martin; Juul Mylam, Karen;

    Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions......Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions...

  20. Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions

    DEFF Research Database (Denmark)

    El-Galaly, Tarec Christoffer; Hutchings, Martin; Juul Mylam, Karen

    Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions......Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions...

  1. Multiple malignant tumors – a clinical case

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    Daciana N. Chirilă

    2012-06-01

    Full Text Available Objective: We present a clinical case of an old woman who suffered at different ages surgical excisions for three different primarymalignant tumors. The patient is now 86 years old. She was diagnosed at the age of 35 with a malignant tumor of the corpus uteri, and thenwhen she was 78 with a basocellular carcinoma of the nose skin and at 81 she was diagnosed with an ascendant large bowel adenocarcinoma.Despite the occurrence of three different tumors she is alive five years later and cancer-free, but suffering because of other medical diseasesincluding diabetes, hypertension, myocardial ischemia and migraines. Conclusion: a patient diagnosed with a cancer and who survive from itmust be submitted to periodically medical controls because of the possibility to develop several other cancers. With an increasing survival inpatients after malignant tumors therapy, there is an increased risk to develop other cancers as the patients are getting older.

  2. Aromatic L-amino acid decarboxylase deficiency diagnosed by clinical metabolomic profiling of plasma.

    Science.gov (United States)

    Atwal, Paldeep S; Donti, Taraka R; Cardon, Aaron L; Bacino, C A; Sun, Qin; Emrick, L; Reid Sutton, V; Elsea, Sarah H

    2015-01-01

    Aromatic L-amino acid decarboxylase (AADC) deficiency is an inborn error of metabolism affecting the biosynthesis of serotonin, dopamine, and catecholamines. We report a case of AADC deficiency that was detected using the Global MAPS platform. This is a novel platform that allows for parallel clinical testing of hundreds of metabolites in a single plasma specimen. It uses a state-of-the-art mass spectrometry platform, and the resulting spectra are compared against a library of ~2500 metabolites. Our patient is now a 4 year old boy initially seen at 11 months of age for developmental delay and hypotonia. Multiple tests had not yielded a diagnosis until exome sequencing revealed compound heterozygous variants of uncertain significance (VUS), c.286G>A (p.G96R) and c.260C>T (p.P87L) in the DDC gene, causal for AADC deficiency. CSF neurotransmitter analysis confirmed the diagnosis with elevated 3-methoxytyrosine (3-O-methyldopa). Metabolomic profiling was performed on plasma and revealed marked elevation in 3-methoxytyrosine (Z-score +6.1) consistent with the diagnosis of AADC deficiency. These results demonstrate that the Global MAPS platform is able to diagnose AADC deficiency from plasma. In summary, we report a novel and less invasive approach to diagnose AADC deficiency using plasma metabolomic profiling.

  3. New clinical score to diagnose nonalcoholic steatohepatitis in obese patients

    Directory of Open Access Journals (Sweden)

    Pulzi Fernanda BU

    2011-02-01

    Full Text Available Abstract Background Nonalcoholic fatty liver disease (NAFLD is the most frequent disease associated with abnormal liver tests that is characterized by a wide spectrum of liver damage, ranging from simple macro vesicular steatosis to steatohepatitis (NASH, cirrhosis or liver carcinoma. Liver biopsy is the most precise test to differentiate NASH from other stages of NAFLD, but it is an invasive and expensive method. This study aimed to create a clinical laboratory score capable of identify individual with NASH in severely obese patients submitted to bariatric surgery. Methods The medical records from 66 patients submitted to gastroplasty were reviewed. Their chemistry profile, abdominal ultrasound (US and liver biopsy done during the surgical procedure were analyzed. Patients were classified into 2 groups according to liver biopsy: Non-NASH group - those patients without NAFLD or with grade I, II or III steatosis; and NASH group - those with steatohepatitis or fibrosis. The t-test was used to compare each variable with normal distribution between NASH and Non-NASH groups. When comparing proportions of categorical variables, we used chi-square or z-test, where appropriate. A p-value Results 83% of patients with obesity grades II or III showed NAFLD, and the majority was asymptomatic. Total Cholesterol (TC≥200 mg/dL, alanine aminotransferase (ALT ≥30, AST/ALT ratio (AAR≤ 1, gammaglutaril-transferase (γGT≥30 U/L and abdominal US, compatible with steatosis, showed association with NASH group. We proposed 2 scores: Complete score (TC, ALT, AAR, γGT and US and the simplified score, where US was not included. The combination of biochemical and imaging results improved accuracy to 84.4% the recognition of NASH (sensitivity 70%, specificity 88.6%, NPV 91.2%, PPV 63. 6%. Conclusion Alterations in TC, ALT, AAR, γGT and US are related to the most risk for NASH. The combination of biochemical and imaging results improved accuracy to 84.4% the

  4. Determinants of sexual dysfunction among clinically diagnosed diabetic patients

    Directory of Open Access Journals (Sweden)

    Sarpong Charity

    2011-05-01

    Full Text Available Abstract Background Diabetes mellitus is a chronic disease that can result in various medical, psychological and sexual dysfunctions (SD if not properly managed. SD in men is a common under-appreciated complication of diabetes. This study assessed the prevalence and determinants of SD among diabetic patients in Tema, Greater Accra Region of Ghana. Method Sexual functioning was determined in 300 consecutive diabetic men (age range: 18-82 years visiting the diabetic clinic of Tema General Hospital with the Golombok Rust Inventory of Sexual Satisfaction (GRISS questionnaire, between November, 2010 and March, 2011. In addition to the socio-demographic characteristics of the participants, the level of glycosylated haemoglobin, fasting blood sugar (FBS and serum testosterone were assessed. All the men had a steady heterosexual relationship for at least 2 years before enrolment in the study. Results Out the 300 participants contacted, the response rate was 91.3% after 20 declined participation and 6 incomplete data were excluded All the respondents had at least basic education, 97.4% were married, 65.3% were known hypertensive, 3.3% smoked cigarettes, 27% took alcoholic beverages and 32.8% did some form of exercise. The 69.3% SD rate observed in this study appears to be related to infrequency (79.2%, non-sensuality (74.5%, dissatisfaction with sexual acts (71.9%, non-communication (70.8% and impotence (67.9%. Other areas of sexual function, including premature ejaculation (56.6% and avoidance (42.7% were also substantially affected. However, severe SD was seen in only 4.7% of the studied population. The perceived "adequate", "desirable", "too short" and "too long intra-vaginal ejaculatory latency time (IELT are 5-10, 5-10, 1-2 and 15-30 minutes respectively. Testosterone correlates negatively with glycated haemoglobin (HBA1c, FBS, perceived desirable, too short IELT, and weight as well as waist circumference. Conclusion SD rate from this study is high

  5. Determinants of sexual dysfunction among clinically diagnosed diabetic patients

    Science.gov (United States)

    2011-01-01

    Background Diabetes mellitus is a chronic disease that can result in various medical, psychological and sexual dysfunctions (SD) if not properly managed. SD in men is a common under-appreciated complication of diabetes. This study assessed the prevalence and determinants of SD among diabetic patients in Tema, Greater Accra Region of Ghana. Method Sexual functioning was determined in 300 consecutive diabetic men (age range: 18-82 years) visiting the diabetic clinic of Tema General Hospital with the Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire, between November, 2010 and March, 2011. In addition to the socio-demographic characteristics of the participants, the level of glycosylated haemoglobin, fasting blood sugar (FBS) and serum testosterone were assessed. All the men had a steady heterosexual relationship for at least 2 years before enrolment in the study. Results Out the 300 participants contacted, the response rate was 91.3% after 20 declined participation and 6 incomplete data were excluded All the respondents had at least basic education, 97.4% were married, 65.3% were known hypertensive, 3.3% smoked cigarettes, 27% took alcoholic beverages and 32.8% did some form of exercise. The 69.3% SD rate observed in this study appears to be related to infrequency (79.2%), non-sensuality (74.5%), dissatisfaction with sexual acts (71.9%), non-communication (70.8%) and impotence (67.9%). Other areas of sexual function, including premature ejaculation (56.6%) and avoidance (42.7%) were also substantially affected. However, severe SD was seen in only 4.7% of the studied population. The perceived "adequate", "desirable", "too short" and "too long intra-vaginal ejaculatory latency time (IELT) are 5-10, 5-10, 1-2 and 15-30 minutes respectively. Testosterone correlates negatively with glycated haemoglobin (HBA1c), FBS, perceived desirable, too short IELT, and weight as well as waist circumference. Conclusion SD rate from this study is high but similar to

  6. A rare case of cardiac anomaly: prenatally diagnosed ectopia cordis.

    Science.gov (United States)

    Çelik, Yalçın; Hallıoğlu, Olgu; Basut, Nursel; Demetgül, Hasan; Esin Kibar, A

    2015-06-01

    Ectopia cordis is a rare congenital malformation in which the heart is located partially or totally outside the thoracic cavity. The estimated prevalence of ectopia cordis is 5.5-7.9 per million births and it comprises 0.1% of congenital heart diseases. Ectopia cordis is associated with other congenital heart diseases and various tissue and organ disorders. Common cardiac anomalies associated with ectopia cordis include ventricular septal defect, atrial septal defect, pulmonary stenosis, right ventricular diverticulum, double right ventricular outflow tract and tetralogy of Fallot. Extracardiac anomalies associated with ectopia cordis reported in the literature include omphalocele, gastrochisis, cleft lip and palate, scollosis and central nervous system malformations. Here we report a newborn with ectopia cordis who was diagnosed prenatally.

  7. Primary Thyroid Lymphoma Diagnosed During Pregnancy: A Case Report

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    Eda Demir Önal

    2013-06-01

    Full Text Available The incidence of non-Hodgkin lymphoma (NHL during pregnancy is quite low. There have been a few anecdotal reports of NHL arising in the thyroid gland. Here, we present a 28-year-old female patient who developed a neck swelling, pain and respiratory distress in the 17th week of her first pregnancy. She was diagnosed as having an aggressive NHL of the thyroid gland after subtotal thyroidectomy. She had 4 cycles of chemotherapy before successful cesarean delivery of a healthy, full-term male infant at 39 weeks of gestation. Four additional courses of chemotherapy were administered, after which the patient did not show any signs of relapse. Turk Jem 2013; 17: 49-51

  8. Extramedullary Plasmacytoma Diagnosed in an HIV-Positive Patient by an Unusual Clinical Presentation

    Science.gov (United States)

    de Camargo Moraes, Paulo; Thomaz, Luiz Alexandre; Montalli, Victor Angelo Martins; Junqueira, José Luiz Cintra; Ribeiro, Camila Maria Beder

    2016-01-01

    The aim of this paper is to describe a case report of EMP in an HIV-positive patient. A 44-year-old, dark-skinned HIV-infected woman was referred to the Oral Diseases Treatment Center with a swelling at palate and left gingival fornix in the maxilla. Biopsy was taken and the oral lesion was diagnosed as EMP with well-differentiated plasma cells and restriction of the lambda light-chain. Skeletal survey was performed and no radiograph alterations were observed, thus supporting the diagnosis of EMP. Patient was referred to treatment and after two months of chemo and radiotherapy, an expanding lesion was observed in L5/S1 patient's vertebrae. Biopsy of the spinal lesion was consistent with lymphoma with plasmocitary differentiation, supporting the diagnosis of multiple myeloma (MM). Regarding the medical history, the final diagnostic was an oral extramedullary plasmacytoma with rapid progression into multiple myeloma. It is crucial to emphasize the relevance of HIV infection as a risk factor for both aggressive clinical behavior and unusual clinical presentation of extramedullary plasmacytoma cases. PMID:27980867

  9. The utility of clinical decision tools for diagnosing osteoporosis in postmenopausal women with rheumatoid arthritis

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    Brand Caroline

    2008-01-01

    Full Text Available Abstract Background Patients with rheumatoid arthritis have a higher risk of low bone mineral density than normal age matched populations. There is limited evidence to support cost effectiveness of population screening in rheumatoid arthritis and case finding strategies have been proposed as a means to increase cost effectiveness of diagnostic screening for osteoporosis. This study aimed to assess the performance attributes of generic and rheumatoid arthritis specific clinical decision tools for diagnosing osteoporosis in a postmenopausal population with rheumatoid arthritis who attend ambulatory specialist rheumatology clinics. Methods A cross-sectional study of 127 ambulatory post-menopausal women with rheumatoid arthritis was performed. Patients currently receiving or who had previously received bone active therapy were excluded. Eligible women underwent clinical assessment and dual-energy-xray absorptiometry (DXA bone mineral density assessment. Clinical decision tools, including those specific for rheumatoid arthritis, were compared to seven generic post-menopausal tools to predict osteoporosis (defined as T score Results One hundred and twenty seven women participated. The median age was 62 (IQR 56–71 years. Median disease duration was 108 (60–168 months. Seventy two (57% women had no record of a previous DXA examination. Eighty (63% women had T scores at femoral neck or lumbar spine less than -1. The area under the ROC curve for clinical decision tool prediction of T score Conclusion There was limited utility of clinical decision tools for predicting osteoporosis in this patient population. Fracture prediction tools that include risk factors independent of BMD are needed.

  10. Retrospective study of disease incidence and other clinical conditions diagnosed in owned dogs in Delta State, Nigeria

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    Kundu F. Shima

    2015-12-01

    Full Text Available In Nigeria, knowledge on the epidemiology of diseases of dogs is limited. A retrospective study of data from clinical records of six veterinary clinics was undertaken to determine the incidence of disease in owned dogs in Delta State, Nigeria from 2012 to 2014. Association between the diagnosed diseases and the studied variables was explored using Chi-Squared test statistics. This study revealed that most of the conditions presented to the veterinary clinics were preventable. Thirty-one (31 clinical conditions were diagnosed from 571 cases recorded, involving nonspecific (21.6%, infectious (70.9%; P=0.001 and non-infectious (7.5% diseases. The most occurring clinical conditions comprised helminthoses (21.4%, mange (10.5%, parvovirosis (8.4%, babesiosis (7.9%, septicemia (7.2%, gastroenteritis (7.0%, myiasis (7.0%, trauma (6.3%, poisoning (6.0%, ectoparasitism (3.7%, ascites (2.5%, dermatitis (2.3%, aural hematoma (1.2%, and orchitis (1.1%. Disease incidence was highest in Alsatian (40.3%, mixed/cross (33.1%, Rottweiler (7.0% and toy breeds (4.6%. Details on the least occurring diseases and the association between disease and the studied variables are given. The outcomes demonstrate the prevalence of the clinical conditions diagnosed, inadequate husbandry and veterinary care accorded to owned dogs in the State. Education of dog owners on preventive measures is paramount in alleviating some of these health problems.

  11. Incidence, clinical characteristics, and timing of objectively diagnosed venous thromboembolism during pregnancy.

    Science.gov (United States)

    Gherman; Goodwin; Leung; Byrne; Montoro

    1998-07-01

    Objective: To determine the incidence, timing, and associated clinical characteristics of objectively diagnosed pregnancy-associated venous thromboembolism (VTE).Methods: A retrospective review of VTE cases occurring between 1978 and 1996 was performed. Cases of deep venous thrombosis (DVT) and pulmonary embolism (PE) were identified by ICD-9 discharge diagnosis code and review of antepartum and coagulation laboratory databases. Study inclusion criteria required the objective diagnosis of VTE with either Doppler ultrasound, impedance plethysmography, pulmonary angiography, ventilation-perfusion scanning, or CT/MRI.Results: Among 268,525 deliveries there were 165 (0.06%) episodes of VTE (1/1627 births). There were 127 cases of DVT and 38 cases of PE. Only 14% (23/165) had a prior history of DVT or PE. Most DVTs occurred in the left leg (104/127, 81.9%). Nearly three quarters of the DVTs (95/127, 74.8%) occurred in the antepartum period. Among the antepartum DVT cases, half were detected prior to 15 weeks of gestation (47/95, 49.5%), with only 28 cases occurring after 20 weeks (P cesarean section. Only 1 patient developed PE while on heparin therapy for DVT while 11 others had complications attributable to heparin use.Conclusion: Most pregnancy-related VTE occurs in the antepartum period. The risk of deep venous thrombosis appears to begin early in pregnancy, even before the second trimester. The highest risk period for pulmonary embolism is after cesarean delivery. Maternal complications of heparin anticoagulation during pregnancy are rare.

  12. Reliability of Diagnosing Clinical Hypothyroidism in Adults with Down Syndrome. Brief Report.

    Science.gov (United States)

    Prasher, V. P.

    1995-01-01

    The accuracy of diagnosing hypothyroidism in 160 adults with Down syndrome was examined. A significant association between a clinical diagnosis of hypothyroidism and increasing age was found but no significant association was found between a clinical and a biochemical diagnosis. Regular biochemical screening is recommended. (Author/SW)

  13. Characterization of Dengue Virus Infections Among Febrile Children Clinically Diagnosed With a Non-Dengue Illness, Managua, Nicaragua.

    Science.gov (United States)

    Waggoner, Jesse J; Gresh, Lionel; Mohamed-Hadley, Alisha; Balmaseda, Angel; Soda, K James; Abeynayake, Janaki; Sahoo, Malaya K; Liu, Yuanyuan; Kuan, Guillermina; Harris, Eva; Pinsky, Benjamin A

    2017-06-15

    We sought to characterize dengue virus (DENV) infections among febrile children enrolled in a pediatric cohort study who were clinically diagnosed with a non-dengue illness ("C cases"). DENV infections were detected and viral load quantitated by real-time reverse transcription-polymerase chain reaction in C cases presenting between January 2007 and January 2013. One hundred forty-one of 2892 C cases (4.88%) tested positive for DENV. Of all febrile cases in the study, DENV-positive C cases accounted for an estimated 52.0% of patients with DENV viremia at presentation. Compared with previously detected, symptomatic dengue cases, DENV-positive C cases were significantly less likely to develop long-lasting humoral immune responses to DENV, as measured in healthy annual serum samples (79.7% vs 47.8%; P dengue. These findings have important implications for DENV transmission modeling, immunology, and epidemiologic surveillance.

  14. Clinical or radiological diagnosis of impingement; Klinische oder radiologische Diagnose des Impingements

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    Kloth, J.K.; Weber, M.A. [Universitaetsklinikum Heidelberg, Klinik fuer diagnostische und interventionelle Radiologie, Heidelberg (Germany); Zeifang, F. [Universitaetsklinikum Heidelberg, Zentrum fuer Orthopaedie, Unfallchirurgie und Paraplegiologie, Heidelberg (Germany)

    2015-03-01

    Shoulder impingement syndrome is a clinically common entity involving trapping of tendons or bursa with typical clinical findings. Important radiological procedures are ultrasound, magnetic resonance imaging (MRI) and MR arthrography. Projection radiography and computed tomography (CT) are ideal to identify bony changes and CT arthrography also serves as an alternative method in cases of contraindications for MRI. These modalities support the clinically suspected diagnosis of impingement syndrome and may identify its cause in primary diagnosis. In addition, effects of impingement are determined by imaging. Therapy decisions are based on a synopsis of radiological and clinical findings. The sensitivity and specificity of these imaging modalities with regard to the diagnostics of a clinically evident impingement syndrome are given in this review article. Orthopedic and trauma surgeons express the suspicion of an impingement syndrome based on patient history and physical examination and radiologists confirm structural changes and damage of intra-articular structures using dedicated imaging techniques. (orig.) [German] Das Impingementsyndrom der Schulter ist ein haeufiges Einklemmungsphaenomen von Sehnen oder Bursen mit typischem klinischem Befund. Wichtige radiologische Verfahren sind Sonographie, MRT und MR-Arthrographie. Projektionsradiographie und CT sind ideal, um knoecherne Veraenderungen aufzuzeigen. Die CT-Arthrographie dient zudem als Ersatzverfahren bei Kontraindikationen fuer die MRT. Diese genannten Modalitaeten koennen in der Primaerdiagnostik die Diagnose eines Impingementsyndroms stuetzen und dessen Ursache aufzeigen. Zudem werden bildgebend Folgen der Einklemmung festgestellt und in Zusammenschau von klinischer Symptomatik und radiologischem Befund Therapieentscheidungen getroffen. Die Sensitivitaet und Spezifitaet der zuvor genannten bildgebenden Verfahren in Bezug auf die diagnostische Aufarbeitung einer klinisch evidenten Impingementsymptomatik

  15. Molecular confirmation of nine cases of Cornelia de Lange syndrome diagnosed prenatally.

    Science.gov (United States)

    Dempsey, M A; Knight Johnson, A E; Swope, B S; Moldenhauer, J S; Sroka, H; Chong, K; Chitayat, D; Briere, L; Lyon, H; Palmer, N; Gopalani, S; Siebert, J R; Lévesque, S; Leblanc, J; Menzies, D; Haverfield, E; Das, S

    2014-02-01

    Cornelia de Lange syndrome (CdLS) is characterized by distinct facial features, growth retardation, upper limb reduction defects, hirsutism, and intellectual disability. NIPBL mutations have been identified in approximately 60% of patients with CdLS diagnosed postnatally. Prenatal ultrasound findings include upper limb reduction defects, intrauterine growth restriction, and micrognathia. CdLS has also been associated with decreased PAPP-A and increased nuchal translucency (NT). We reviewed NIPBL sequence analysis results for 12 prenatal samples in our laboratory to determine the frequency of mutations in our cohort. This retrospective study analyzed data from all 12 prenatal cases with suspected CdLS, which were received by The University of Chicago Genetic Services Laboratories. Diagnostic NIPBL sequencing was performed for all samples. Clinical information was collected from referring physicians. NIPBL mutations were identified in 9 out of the 12 cases prenatally (75%). Amongst the NIPBL mutation-positive cases with clinical information available, the most common findings were upper limb malformations and micrognathia. Five patients had NT measurements in the first trimester, of which four were noted to be increased. We demonstrate that prenatally-detected phenotypes of CdLS, particularly severe micrognathia and bilateral upper limb defects, are associated with an increased frequency of NIPBL mutations. © 2013 John Wiley & Sons, Ltd.

  16. Pancreatic Somatostatinoma Diagnosed Preoperatively: Report of a Case

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    Yasuhisa Mori

    2014-01-01

    Full Text Available Context Somatostatinoma is a rare neoplasm of the pancreas. Preoperative diagnosis is often difficult. Case report We report a 72-year-old woman with a pancreatic head tumor measuring 37 mm in diameter, and enlargement of the lymphnodes on the anterior surface of the pancreatic head and the posterior surface of the horizontal part of the duodenum.Laboratory data showed an elevated plasma somatostatin concentration. Examination of a biopsy specimen of thepancreatic head mass obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA showedhistopathological features of a neuroendocrine tumor. Immunohistochemical staining showed that the tumor cells werepositive for somatostatin, leading to a preoperative diagnosis of pancreatic somatostatinoma. The patient underwentpylorus-preserving pancreaticoduodenectomy. The plasma somatostatin concentration decreased progressively aftersurgery. Conclusions A rare case of pancreatic somatostatinoma with lymph node metastases was presented.Immunohistochemical analysis of a biopsy specimen obtained by EUS-FNA was useful for preoperative diagnosis.

  17. Four cases of pulmonary thromboembolism diagnosed by endobronchial ultrasound.

    Science.gov (United States)

    Erer, Onur Fevzi; Cimen, Pinar; Unlu, Mehmet; Katgi, Nuran

    2017-09-01

    Endobronchial ultrasound (EBUS) is a technique for the detection of mediastinal abnormalities. A total of 548 EBUS procedures were performed for various indications, and in four cases (0.7%), filling defects in central pulmonary arteries were demonstrated fortuitously during the procedure. Subsequently, all patients underwent contrast-enhanced CT of the thorax to confirm the diagnosis of pulmonary thromboembolism (PTE). In three of the four cases, there was a concomitant lung cancer. PTE can be incidentally detected during EBUS; therefore, pulmonary arteries should be examined carefully during EBUS in all patients, particularly in patients with suspected or proven malignancy. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:441-444, 2017. © 2016 Wiley Periodicals, Inc.

  18. A Case of Ataxia with Isolated Vitamin E Deficiency Initially Diagnosed as Friedreich’s Ataxia

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    Michael Bonello

    2016-01-01

    Full Text Available Ataxia with isolated vitamin E deficiency (AVED is a rare autosomal recessive condition that is caused by a mutation in the alpha tocopherol transfer protein gene. It is almost indistinguishable clinically from Friedreich’s ataxia but with appropriate treatment its devastating neurological features can be prevented. Patients can present with a progressive cerebellar ataxia, pyramidal spasticity, and evidence of a neuropathy with absent deep tendon reflexes. It is important to screen for this condition on initial evaluation of a young patient presenting with progressive ataxia and it should be considered in patients with a long standing ataxia without any diagnosis in view of the potential therapeutics and genetic counselling. In this case report we present a patient who was initially diagnosed with Friedreich’s ataxia but was later found to have AVED.

  19. Bilateral Obturator Hernia Diagnosed by Computed Tomography: A Case Report with Review of the Literature

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    Sanjay M. Khaladkar

    2014-01-01

    Full Text Available Obturator hernia is a rare form of abdominal hernia and a diagnostic challenge. It is commonly seen in elderly thin females. Its diagnosis is often delayed with resultant increased morbidity and mortality due to bowel ischemia/gangrene. It is mistakenly diagnosed as femoral or inguinal hernia on USG. Computed tomography is diagnostic and is a valuable tool for preoperative diagnosis. This report presents a case of 70-year-old thin female presenting with intestinal obstruction due to left sided obstructed obturator hernia. USG showed small bowel obstruction and an obstructed left sided femoral hernia. CT scan of abdomen and pelvis with inguinal and upper thigh region disclosed left sided obturator hernia. It also detected clinically occult right sided obturator hernia. Early diagnosis and surgical treatment contribute greatly in reducing the morbidity and mortality rate.

  20. Findings, diagnoses and results of a halitosis clinic over a seven year period.

    Science.gov (United States)

    Zürcher, Andrea; Filippi, Andreas

    2012-01-01

    Halitosis or bad breath is a taboo subject that is a widespread problem in the general population. Causes of bad breath can be multifactorial and long time sufferers can be marred from deep psychological stress. Because nine out of ten cases have an oral cause, the initial inquiry should be with a dentist. In a retrospective study from February 2003 to February 2010, the halitosis clinic at the University of Basel analyzed data from 465 patient medical histories. Study objectives evaluated the causes of halitosis, gender distribution and treatment success. All patients reported to have suffered from bad breath. However, 82.7% were actually diagnosed as having halitosis. Within this group, 96.2% showed an oral etiology and 3.8% showed an extra-oral cause. Women suffered significantly more from psychogenic halitosis. Success rates of 92.6% subjectively and 94.5% objectively reflect the treatment success of the diagnostic and therapeutic concepts presented at the University of Basel halitosis clinic over a seven year period.

  1. A Case of Taenia asiatica Infection Diagnosed by Colonoscopy

    Science.gov (United States)

    Kim, Heung Up; Chung, Young-Bae

    2017-01-01

    A case of Taenia asiatica infection detected by small bowel series and colonoscopy is described. The patient was a 42-year-old Korean man accompanied by discharge of movable proglottids via anus. He used to eat raw pig liver but seldom ate beef. Small bowel series radiologic examinations showed flat tape-like filling defects on the ileum. By colonoscopy, a moving flat tapeworm was observed from the terminal ileum to the ascending colon. The tapeworm was identified as T. asiatica by mitochondrial DNA sequencing. The patient was prescribed with a single oral dose (16 mg/kg) of praziquantel. PMID:28285508

  2. AMBIGUITY IN DIAGNOSING CHONDROID CHORDOMA-A CASE REPORT

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    Swarnagowri

    2014-08-01

    Full Text Available "Chondroid chordoma" is a controversial and confusing entity, a biphasic malignant neoplasm possessing elements of both chordoma and cartilaginous tissue. The annual incidence of chordoma is approximately one in one million. Chondroid chordoma is a subtype of chordoma possessing elements of both chordoma and cartilaginous tissue with better prognosis than classic (non chondroid chordomas. We have come across a case of Chondroid Chordoma in a 55 year old male. Our report features particularly a rare entity, chondroid chordoma, with an exceptional localization to the nasal septum. Chondroid Chordomas are likely to recur and hence diagnostically important to institute effective treatment

  3. X-linked agammaglobulinemia diagnosed late in life: case report and review of the literature

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    Krishnaswamy Guha

    2008-06-01

    Full Text Available Abstract Background Common variable immune deficiency (CVID, one of the most common primary immunodeficiency diseases presents in adults, whereas X-linked agammaglobulinemia (XLA, an inherited humoral immunodeficiency, is usually diagnosed early in life after maternal Igs have waned. However, there have been several reports in the world literature in which individuals have either had a delay in onset of symptoms or have been misdiagnosed with CVID and then later found to have mutations in Bruton's tyrosine kinase (BTK yielding a reclassification as adult-onset variants of XLA. The typical finding of absent B cells should suggest XLA rather than CVID and may be a sensitive test to detect this condition, leading to the more specific test (Btk mutational analysis. Further confirmation may be by mutational analyses. Methods The records of 2 patients were reviewed and appropriate clinical data collected. BTK mutational analysis was carried out to investigate the suspicion of adult-presentation of XLA. A review of the world literature on delayed diagnosis of XLA and mild or "leaky" phenotype was performed. Results 2 patients previously diagnosed with CVID associated with virtual absence of CD19+ B cells were reclassified as having a delayed diagnosis and adult-presentation of XLA. Patient 1, a 64 yr old male with recurrent sinobronchial infections had a low level of serum IgG of 360 mg/dl (normal 736–1900, IgA Patient 2, a 46 yr old male with recurrent sinopulmonary infections had low IgG of 260 mg/dl, low IgA Conclusion These two cases represent an unusual adult-presentation of XLA, a humoral immunodeficiency usually diagnosed in childhood and the need to further investigate a suspicion of XLA in adult males with CVID particularly those associated with low to absent CD19+ B cells. A diagnosis of XLA can have significant implications including family counseling, detecting female carriers, and early intervention and treatment of affected male

  4. Clinical characteristics and outcome of patients diagnosed with psychogenic nonepileptic seizures: a 5-year review.

    LENUS (Irish Health Repository)

    O'Sullivan, S S

    2012-02-03

    OBJECTIVE: The goal of this article was to describe the clinical characteristics and outcomes of patients diagnosed with psychogenic nonepileptic seizures (PNES). METHODS: We conducted a retrospective review of patients diagnosed with PNES in a 5-year period. RESULTS: Fifty patients with PNES were identified, giving an estimated incidence of 0.91\\/100,000 per annum. Thirty-eight were included for review, 15 of whom were male (39%). Eighteen patients had been diagnosed with epilepsy as well as PNES (47%). We demonstrated a gender difference in our patients, with males having higher seizure frequencies, more antiepileptic drug use, and a longer interval before diagnosis of PNES. Females were diagnosed with other conversion disorders more often than males. Impaired social function was observed in PNES, as was resistance to psychological interventions with a subsequent poor response to treatments. CONCLUSIONS: PNES remains a difficult condition to treat, and may affect males in proportions higher than those described in previous studies.

  5. Uveal effusion syndrome (clinical case

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    Yu. A. Belyy

    2015-01-01

    Full Text Available The purpose — to evaluate the effectiveness of the posterior sclerectomy with the corneal trepan in a uveal effusion syndrome.Patients and methods. Patient 1. The man, 61 years, complained about a blindness of the right eye and the progressing decrease in vision of the left eye. According to data of examinations the diagnosis was: uveal effusion syndrome, detachment of the choroid, exudative retinal detachment, the complicated cataract of both eyes. Patient 2. The man, 62 years, with complaints to low vision of the right eye and a blindness of the left-hand eye. Diagnosis: uveal effusion syndrome, detachment of the choroid, exudative retinal detachment, the initial complicated cataract of the right eye. Subatrophy operated retinal detachment, complicated cataract, silicone into the vitreal cavity of the left eye. Both patients underwent trepanation posterior sclera. Results. The patient 1noted significant improvement of vision in both eyes at the last examination. Мisual acuity with correction was OD — 0,2, OS — 0.3. Intraocular pressure was normal, improvement of electrical sensitivity and lability was diagnosed. On ultrasound examination of the retina belonged, moderate swelling of the choroid remained. Patient 2. Visual acuity was 0,1 + 3,0 D at the time of the last inspection. According to the ultrasonic B-scan of the right eye retinal detachment decreased to 3,8 mm, moderate swelling of the choroid remained. The OСT has showed detachment of the neuroepithelium in the macula to 60 μm. In ultrasonic biomicroscopy circular, ciliochoroidal detachment to 0,15 mm was diagnised.Conclusion. Described clinical cases confirmed the almost complete recovery of patients with the uveal effusion syndrome. Sclerectomy with the use of corneal trepan is a technically simple procedure and helps to define the path of the outflow suprachoroidal fluid subtenon space.

  6. Infantile-onset Pompe disease (the first case diagnosed in Voronezh

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    V. P. Fedotov

    2013-01-01

    Full Text Available Pompe disease (PD, or glycogen storage disease type II, is a rare autosomal recessive lysosomal disease caused by glycogen storage in the myocardium, skeletal muscles, and liver. PD, as an orphan disease with a very low prevalence rate, shows a marked clinical polymorphism, making its early diagnosis difficult. Yet, the efficiency of pathogenetic treatment for the disease is closely related to the time of its diagnosis, what is particularly relevant for infantile-onset PD. We present our clinical case of a sick baby with this condition diagnosed during life. The clinical diagnostic criteria were the neonatal form of rapidly progressive hypertrophic cardiomyopathy, macroglossia, floppy baby syndrome. Enzymatic diagnosis in the dried blood spots revealed the low activity of the enzyme α-glucosidase. Direct GAA gene sequencing identified heterozygous mutations in the infant’s parents: с.1799 G>A (p.Arg600His in his father and c.1951_1952 delGGinsT in his mother, which allows its early prenatal diagnosis at 9-11 weeks of gestation.

  7. [Two cases with SLE and MCTD developed after a long period of chronic arthritis that was initially diagnosed as JRA].

    Science.gov (United States)

    Takei, S; Maeno, N; Shigemori, M; Nakae, Y; Mori, H; Nerome, Y; Imanaka, H; Hokonohara, M; Miyata, K

    1997-10-01

    In order to discuss the diversity of clinical features and the difficulty in diagnosis of children with juvenile rheumatoid arthritis (JRA), we present two cases who have documented the development of systemic lupus erythematosus (SLE) and mixed connective tissue disease (MCTD) after a long period of disease characterized only by arthritis that was initially diagnosed as JRA. The first case was a girl diagnosed for her arthritic joints as polyarticular JRA at 15 years of age. At onset, she had Raynaud phenomenon but autoantibodies such as anti-nuclear antibody (ANA), anti-DNA antibody, and rheumatoid factor were negative. Five years after onset, she became ANA positive and 3 years later she became pregnant. During her pregnancy, she became positive for anti-DNA antibody without any signs of nephritis. One month after the delivery, however, she developed butterfly rash, carditis, nephritis, and was diagnosed as SLE. No destructive changes were observed in her joints though arthritis continued for 8 years form onset to pregnancy. The second case was a 3 years old girl who was diagnosed as polyarticular JRA. Treatment by aspirin induced complate remission after one year from the onset. However, 10 years after that remission, she developed Raynaud phenomenon and arthralgia in her knees and hip joints. Her laboratory findings showed hypergammaglobulinemia, positive ANA, positive anti-DNA antibody, positive anti-RNP antibody. She was eventually diagnosed as MCTD when she was found to have polymyositis by EMG and serum CK. In the present paper, two cases imply the difficulty in diagnosing JRA and diversity of rheumatic diseases such as JRA, SLE and MCTD. Closer and longer period of observation is essential for the JRA patients with nondestructive arthritis.

  8. Manubrial stress fractures diagnosed on MRI: report of two cases and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Baker, Jonathan C.; Demertzis, Jennifer L. [Washington University School of Medicine, Mallinckrodt Institute of Radiology, Musculoskeletal Section, St Louis, MO (United States)

    2016-06-15

    In contrast to widely-reported sternal insufficiency fractures, stress fractures of the sternum from overuse are extremely rare. Of the 5 cases of sternal stress fracture published in the English-language medical literature, 3 were in the sternal body and only 2 were in the manubrium. We describe two cases of manubrial stress fracture related to golf and weightlifting, and present the first report of the MR findings of this injury. In each of these cases, the onset of pain was atraumatic, insidious, and associated with increased frequency of athletic activity. Imaging was obtained because of clinical diagnostic uncertainty. On MRI, each patient had a sagittally oriented stress fracture of the lateral manubrium adjacent to the first rib synchondrosis. Both patients had resolution of pain after a period of rest, with subsequent successful return to their respective activities. One patient had a follow-up MRI, which showed resolution of the manubrial marrow edema and fracture line. Based on the sternal anatomy and MR findings, we hypothesize that this rare injury might be caused by repetitive torque of the muscle forces on the first costal cartilage and manubrium, and propose that MRI might be an effective means of diagnosing manubrial stress fracture. (orig.)

  9. Randomized controlled trial of oral vs intravenous therapy for the clinically diagnosed acute uncomplicated diverticulitis.

    LENUS (Irish Health Repository)

    Ridgway, P F

    2009-11-01

    Despite the high prevalence of hospitalization for left iliac fossa tenderness, there is a striking lack of randomized data available to guide therapy. The authors hypothesize that an oral antibiotic and fluids are not inferior to intravenous (IV) antibiotics and \\'bowel rest\\' in clinically diagnosed acute uncomplicated diverticulitis.

  10. Differences between men with screening-detected versus clinically diagnosed prostate cancers in the USA

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    Stone S Noell

    2005-03-01

    Full Text Available Abstract Background The advent of prostate specific antigen (PSA testing in the United States of America (USA has led to a dramatic increase in the incidence of prostate cancer in the United States as well as the number of men undergoing aggressive treatment with radical prostatectomy and radiation therapy. We compared patient characteristics and treatment selection between American men with screening-detected versus clinically diagnosed prostate cancers. Methods We evaluated 3,173 men with prostate cancer in the USA. Surveys and medical records provided information on demographics, socioeconomic status, comorbidities, symptoms, tumor characteristics, and treatment. We classified men presenting with symptoms of advanced cancer – bone pain, weight loss, or hematuria – as "clinically diagnosed"; asymptomatic men and those with only lower urinary tract symptoms were considered "screening-detected." We used multivariate analyses to determine whether screening predicted receiving aggressive treatment for a clinically localized cancer. Results We classified 11% of cancers as being clinically diagnosed. Men with screening-detected cancers were more often non-Hispanic white (77% vs. 65%, P Conclusion Most cancers were detected by screening in this American cohort. Appropriately, younger, healthier men were more likely to be diagnosed by screening. Minority status and lower socio-economic status appeared to be screening barriers. Screening detected earlier-stage cancers and was associated with receiving aggressive treatment.

  11. Annual Research Review: Progress in Using Brain Morphometry as a Clinical Tool for Diagnosing Psychiatric Disorders

    Science.gov (United States)

    Haubold, Alexander; Peterson, Bradley S.; Bansal, Ravi

    2012-01-01

    Brain morphometry in recent decades has increased our understanding of the neural bases of psychiatric disorders by localizing anatomical disturbances to specific nuclei and subnuclei of the brain. At least some of these disturbances precede the overt expression of clinical symptoms and possibly are endophenotypes that could be used to diagnose an…

  12. Reliability of clinical ICD-10 diagnoses among electroconvulsive therapy patients with chronic affective disorders

    DEFF Research Database (Denmark)

    Jakobsen, Klaus Damgaard; Hansen, Thomas Folkmann; Dam, Henrik

    2008-01-01

    Background and Objectives: Diagnostic reliability is of major concern both to clinicians and researchers. The aim has been to investigate the trustworthiness of clinical ICD-10 affective disorder diagnoses for research purpose. Methods: 150 ECT patients with chronic affective disorders were inves...

  13. Clinical Significance of the Degree of Fatty Liver Diagnosed by Ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yong Kyun [Dept. of Diagnostic Radiology, Koeralife Daejeon Healthcare Center, Daejeon (Korea, Republic of)

    2008-06-15

    Fatty liver is one of the most commonly found disease by abdominal ultrasonography. The status of fatty liver is classified into mild, moderate and severe degrees. The study was conducted to investigate the clinical significance of fatty liver using ultrasonography. Test set consisted of 2,185 patients who visited D healthcare center in Daejeon to receive an abdominal ultrasonic test from January to December 2007. Out of the 2185 patients, 524 patients was diagnosed as fatty liver (290 male and 234 female patients). They were divided into three groups, group I for mild degree. II for moderate degree, and III for severe degree, depending on the echo of liver parenchyma, the sound attenuation, and the visibility of intrahepatic blood vessels and diaphragm. Then the correlation of obesity indices, liver function tests and metabolic syndrome was analyzed for males and females separately. As for the degree of fatty liver, 350 cases (66.8%) were classified as group I, 153 cases (29.2%) as group II, and 21 cases (4.1%) as group III. In addition, severe degree of fatty liver was more frequently found in males than in females. The mean ages of three groups for males were 46.1, 44.5, and 39.1, and those for females were 48.8, 50.2, 52.4, respectively. Males with lower mean ages have severely of fatty liver for both males and females. The results in this study show that the classification into three degrees of fatty liver in ultrasonography practice is helpful to treat and observe the progress of fatty liver. In addition, careful examination is required to measure the severity of fatty liver as well as detection of it. A standardized method to classify the degree of fatty liver is also needed for more objective measurement.

  14. 儿童颅内动脉瘤的诊断与治疗(附16例报道)%Diagnoses and treatments of pediatric intracranial aneurysms:a clinical analysis of 16 cases

    Institute of Scientific and Technical Information of China (English)

    周杰; 黄昌仁; 刘洛同; 董劲虎; 周牮; 董程远; 江涌; 明杨; 陈礼刚

    2016-01-01

    Objective To investigate the clinical features, treatments and prognoses of pediatric intracranial aneurysms. Methods The clinical and follow-up data of 16 consecutive patients with pediatric intracranial aneurysms (≤16 years), admitted to our hospital from January 2003 to December 2014, were analyzed retrospectively. Results Pediatric intracranial aneurysms in this study accounted for 0.78%of all intracranial aneurysms. Of the 16 children, 14 were male, 2 were female. There were 12 anterior circulation aneurysms and 5 posterior circulation aneurysms; there were 4 large aneurysms (diameter 11-25 mm) and 2 giant aneurysms (diameter≥25 mm);there were 14 complex aneurysms. At a mean follow-up duration of 16.8 months, no death was noted. Of the 12 patients received microsurgical therapy, 10 patients had favorable outcomes (modified Rankin scale [mRS] 0-1) and 2 patients had some sequelae: different degrees of disability (mRS 2-4). Of the 4 patients received endovascular therapy, 3 patients had favorable outcomes (mRS 0-1) and one patient had hemiparesis (mRS 2). Conclusions Pediatric intracranial aneurysms are different from adult intracranial aneurysms. The treatment effects and prognosis are relatively well when we select individualized treatment mode according to the clinical features of pediatric intracranial aneurysms.%目的:探讨儿童颅内动脉瘤的临床特点﹑治疗及预后。方法回顾性分析西南医科大学附属医院神经外科自2003年1月至2014年12月收治的16例颅内动脉瘤患儿(≤16岁)的临床资料和随访结果。结果本组儿童颅内动脉瘤占总颅内动脉瘤发病率的0.78%,其中男14例,女2例﹔前循环动脉瘤12个,后循环动脉瘤5个﹔大动脉瘤(直径11~25 mm)4个,巨大动脉瘤(直径>25 mm)2个﹔复杂动脉瘤14例。本组患儿无死亡病例,平均随访16.8月。12例患儿行开颅手术,10例患儿预后良好[改良Rankin量表(mRS)评分0~1分],2例患儿出现不同程

  15. A Case of Lung Cancer with Brain Metastases Diagnosed After Epileptic Seizure

    Directory of Open Access Journals (Sweden)

    Hakan Simsek

    2016-04-01

    Full Text Available  LETTER TO THE EDITOR CONCERNING THE CASE REPORT “A case of lung cancer with brain metastases diagnosed after epileptic seizure” by M. Eroglu et al. J Clin Anal Med 2015; 6(3: 384-6

  16. Economic evaluation of a clinical protocol for diagnosing emergency patients with suspected pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Wolfe Rory

    2006-06-01

    Full Text Available Abstract Background The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001–2002. Methods A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. Thenumber and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspectedPE during an eight month period prior to the clinical trial (January 2002 -August 2002 were compared with the number and type of diagnostic tests in745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were usedas unit costs to calculate the mean aggregated cost of diagnostic investigation per patient in both study groups. A t-test was used to estimate the statistical significance of the difference in the cost of resources used for diagnosing PE in the control and in the intervention group. Results The trial demonstrated that diagnosing PE using an evidence-based clinical protocol was as effective as the existing clinical practice. The clinical protocol offers the advantage of reducing the use of diagnostic imaging, resulting in an average cost savings of at least $59.30 per patient. Conclusion Extrapolating the observed cost-savings of $59.30 per patient to the wholeof Australia could potentially result in annual savings between $3.1 million to $3.7 million.

  17. Lumbar stenosis: clinical case

    Directory of Open Access Journals (Sweden)

    Pedro Sá

    2014-08-01

    Full Text Available Lumbar stenosis is an increasingly common pathological condition that is becoming more frequent with increasing mean life expectancy, with high costs for society. It has many causes, among which degenerative, neoplastic and traumatic causes stand out. Most of the patients respond well to conservative therapy. Surgical treatment is reserved for patients who present symptoms after implementation of conservative measures. Here, a case of severe stenosis of the lumbar spine at several levels, in a female patient with pathological and surgical antecedents in the lumbar spine, is presented. The patient underwent two different decompression techniques within the same operation.

  18. Clinical tests to diagnose lumbar spondylolysis and spondylolisthesis: A systematic review.

    Science.gov (United States)

    Alqarni, Abdullah M; Schneiders, Anthony G; Cook, Chad E; Hendrick, Paul A

    2015-08-01

    The aim of this paper was to systematically review the diagnostic ability of clinical tests to detect lumbar spondylolysis and spondylolisthesis. A systematic literature search of six databases, with no language restrictions, from 1950 to 2014 was concluded on February 1, 2014. Clinical tests were required to be compared against imaging reference standards and report, or allow computation, of common diagnostic values. The systematic search yielded a total of 5164 articles with 57 retained for full-text examination, from which 4 met the full inclusion criteria for the review. Study heterogeneity precluded a meta-analysis of included studies. Fifteen different clinical tests were evaluated for their ability to diagnose lumbar spondylolisthesis and one test for its ability to diagnose lumbar spondylolysis. The one-legged hyperextension test demonstrated low to moderate sensitivity (50%-73%) and low specificity (17%-32%) to diagnose lumbar spondylolysis, while the lumbar spinous process palpation test was the optimal diagnostic test for lumbar spondylolisthesis; returning high specificity (87%-100%) and moderate to high sensitivity (60-88) values. Lumbar spondylolysis and spondylolisthesis are identifiable causes of LBP in athletes. There appears to be utility to lumbar spinous process palpation for the diagnosis of lumbar spondylolisthesis, however the one-legged hyperextension test has virtually no value in diagnosing patients with spondylolysis.

  19. [Neuroretinitis. Clinical cases].

    Science.gov (United States)

    Valverde-Gubianas, M; Ramos-López, J F; López-Torres, J A; Toribio-García, M; Milla-Peñalver, C; Gálvez Torres-Puchol, J; Medialdea-Marcos, S

    2009-08-01

    Evaluate the etiology and the most frequent funduscopic alterations of the neuroretinitis. We present the case of a woman 24 years old with a bilateral decrease of visual sharpness (AV), painless and progressive, the funduscopic examination of which reveals a bilateral optical disc edema, with no hemorrhages or exudates, retina edema of the posterior pole and phlebitic areas. The systematic study was normal except for the hemogram (18,000/mm(3) leucocytes with 79% neutrophils) and the positive serology next to a Chlamydia. We also present the case of a 64 years old woman with a decrease of AV at the right eye of one week duration. At the back of the eye a macular star can be seen, and papilla edema. A systematic study gave normal results and positive serology at Bartonella henselae. The illness produced by a cat scratch is the most common cause of neuroretinitis. The customary findings are a loss of AV, discromatopsia, afferent papillary defects and abnormality on the visual field. Other frequent findings at the back of the eye are hemorrhagic nerve fibers, cotton-like exudates, papilla edema, macular star and glassy inflammation. The roll of antibiotic therapy is questionable. Oral ciprofloxacine seems to give good results.

  20. Leiomyomas and massive digestive hemorrhages: Case reports of patients diagnosed in 2004

    Directory of Open Access Journals (Sweden)

    Golubović Gradimir

    2007-01-01

    Full Text Available Introduction: During 2004, there were 6 patients with leiomyomas diagnosed and treated at the Department of Gastroenterology and Clinical Pathology of the Zemun Clinical Center. The most common location of these benign submucosal tumors is stomach, followed by small intestine and large intestine. Case report: The most common symptoms of these patients were massive intestinal hemorrhage, with haematemesis and melaena. Hemorrhages resulted from superficial lesions, caused by pressure of the tumour on the intestinal blood vessels. A significant contribution in reaching the final diagnosis and selecting appropriate therapeutic approach was provided by CT and arteriography. Most patients underwent surgical treatment, which provided precise diagnosis (based on histopathological findings, and at the same time a definite therapeutic procedure. Discussion and conclusion: According to the literature data, gastrointestinal leiomyomas account for 20%-30% of all types of gastrointestinal tumors. Our research revealed that the incidence of leiomyomas was significantly lower within our group of patients, accounting for 12% of all benign gastrointestinal tumors. They were also the main cause of hemodynamic instability in our patients having massive and recurrent intestinal hemorrhages, which is not often seen in practice. All of them originated either from muscularis propria or muscularis mucosae. These tumors are often an accidental finding at autopsy, especially if they are smaller than 3 centimeters and not followed by consequential complications. Presently, endoscopic ultrasonography is considered to be the the most accurate procedure in the diagnosis of leiomyoma, with a diagnostic specificity that is superior to other imaging techniques.

  1. Comparison of clinically diagnosed asthma with parental assessment of children's asthma in a questionnaire

    DEFF Research Database (Denmark)

    Hederos, C.A.; Hasselgren, M.; Hedlin, G.;

    2007-01-01

    Epidemiological evaluations of the prevalence of asthma are usually based on written questionnaires (WQs) in combination with validation by clinical investigation. In the present investigation, we compared parental assessment of asthma among their preschool children in response to a WQ...... with the corresponding medical records in the same region. An International Study of Asthma and Allergies in Childhood (ISAAC)-based WQ was answered by 75% of the parents of 6295 children aged 1-6 yr. Clinically diagnosed asthma, recorded in connection with admissions to the hospital or a visit to any of the outpatient...... clinics in the same region, were analysed in parallel. Finally, a complementary WQ was sent to the parents of children identified as asthmatic by either or both of this approaches. In response to the WQ 5.9% were claimed to suffer from asthma diagnosed by a doctor. According to the medical records...

  2. Report - Recurrent hip arthritis diagnosed as juvenile idiopathic arthritis: A case report.

    Science.gov (United States)

    Chang, Tung-Ming; Yang, Kuender D; Yong, Su-Boon

    2016-05-01

    Juvenile idiopathic arthritis is the most common rheumatic disease in childhood. It is a chronic inflammatory disease associated with arthritis of unknown etiology that begins before the age of 16 and persists for longer than 6 weeks. In this report, the case of a child who suffered recurrent alternative hip arthritis with bilateral hip arthritis is examined, in which he was finally diagnosed as suffering from Juvenile idiopathic arthritis. A 14-year-old boy of Taiwanese origin presented with a normal birth and developmental history. At the age of 10, right-side hip joint pain was experienced, which later migrated to the left side. On further inspection, synovium hypertrophy, cartilage erosion and hip turbid fluid accumulation were found and aseptic arthritis was presumed to be the primary cause. However, after re-examining both his clinical history and presentation, Juvenile idiopathic arthritis was the final diagnosis. Any child presenting with repeat joint swelling are at risk of Juvenile idiopathic arthritis. This is still to be the case if symptoms recede or heal and no initial diagnosis is made. Therefore, a better understanding of the risk of recurrent arthritis is needed. It cannot be emphasized strongly enough that Juvenile idiopathic arthritis should be suspected at all times when a child suffers from recurrent aseptic arthritis of the hip joint.

  3. A Case of Newly Diagnosed Klippel Trenaunay Weber Syndrome Presenting with Nephrotic Syndrome

    Directory of Open Access Journals (Sweden)

    Egemen Cebeci

    2015-01-01

    Full Text Available Klippel Trenaunay Weber syndrome (KTWS is a rare disease characterized by hemihypertrophy, variceal enlargement of the veins, and arteriovenous (AV malformations. Renal involvement in KTWS is not known except in rare case reports. Herein, we present a case of KTWS with nephrotic syndrome. A 52-year-old male was admitted due to dyspnea and swelling of the body for the last three months. The pathological physical findings were diffuse edema, decreased lung sounds at the right basal site, increased diameter and decreased length of the left leg compared with the right one, diffuse variceal enlargements, and a few hemangiomatous lesions on the left leg. The pathological laboratory findings were hypoalbuminemia, hyperlipidemia, increased creatinine level (1.23 mg/dL, and proteinuria (7.6 g/day. Radiographic pathological findings were cystic lesions in the liver, spleen, and kidneys, splenomegaly, AV malformation on the left posterolateral thigh, and hypertrophy of the soft tissues of the proximal left leg. He was diagnosed to have KTWS with these findings. Renal biopsy was performed to determine the cause of nephrotic syndrome. The pathologic examination was consistent with focal segmental sclerosis (FSGS. He was started on oral methylprednisolone at the dosage of 1 mg/kg and began to be followedup in the nephrology outpatient clinic.

  4. Clinical profile, nursing diagnoses and nursing care for postoperative bariatric surgery patients.

    Science.gov (United States)

    Steyer, Nathalia Helene; Oliveira, Magáli Costa; Gouvêa, Mara Regina Ferreira; Echer, Isabel Cristina; Lucena, Amália de Fátima

    2016-03-01

    Objective To analyze the clinical profile, nursing diagnoses, and nursing care established for postoperative bariatric surgery patients. Method Cross-sectional study carried out in a hospital in southern Brazil with a sample of 143 patients. Data were collected retrospectively from electronic medical records between 2011 and 2012 and analyzed statistically. Results We found a predominance of adult female patients (84%) with class III obesity (59.4%) and hypertension (72%). Thirty-five nursing diagnoses were reported, among which the most frequent were: Acute Pain (99.3%), Risk for perioperative positioning injury (98.6%), and Impaired tissue integrity (93%). The most frequently prescribed nursing care were: to use protection mechanisms in the surgical patient positioning, to record pain as 5th vital sign, and to take vital signs. There was an association between age and comorbidities. Conclusion The nursing diagnoses supported the nursing care prescription, which enables the qualification of nursing assistance.

  5. Management of Newly Diagnosed Atrial Fibrillation in an Outpatient Clinic Setting

    DEFF Research Database (Denmark)

    Thrysoee, Lars; Strömberg, Anna; Brandes, Axel

    2017-01-01

    AIMS: To gain in-depth knowledge of patients' experiences of the consultation processes at a multidisciplinary atrial fibrillation outpatient clinic in a university hospital in Denmark. BACKGROUND: Atrial fibrillation is the most common cardiac arrhythmia associated with morbidity and mortality...... if not diagnosed and treated as recommended. Patients with newly diagnosed atrial fibrillation preferably should be managed in an outpatient setting which includes medical examination, patient education and decision making on medical therapy. DESIGN: This is a qualitative study of 14 patients newly diagnosed......: Patients were referred with limited information on AF and knowledge about the management consultation procedures. The consultations were performed in a professional way by the cardiologist as well as by the nurses with an emphasis on the medical aspects of atrial fibrillation. The understanding that atrial...

  6. Capturing Key NANDA-I Nursing Diagnoses From Actual Clinical Data for Patients With Heart Failure.

    Science.gov (United States)

    Park, Hyejin; Tucker, Denise A

    2017-01-01

    The purpose of the study was to identify key nursing diagnoses with related factors and signs/symptoms using NANDA-I for patients with heart failure (HF). A retrospective descriptive design was used to address the research questions. Data were obtained from the records of patients discharged for 1 year with the medical diagnoses of HF from a Midwestern community hospital. A total of 272 inpatient records were analyzed to describe the frequency and percentage of NANDA-I diagnosis with related factors and signs/symptoms. The top 10 NANDA-I diagnoses associated with related factors and signs/symptoms were identified. Further research related to standardized nursing terminologies such as NANDA-I using large clinical databases from health information systems is needed to support evidence-based nursing diagnosis decision making. © 2015 NANDA International, Inc.

  7. Clinical characteristics and distinctiveness of DSM-5 eating disorder diagnoses: findings from a large naturalistic clinical database

    Science.gov (United States)

    2013-01-01

    Background DSM-IV eating disorder (ED) diagnoses have been criticized for lack of clinical utility, diagnostic instability, and over-inclusiveness of the residual category “ED not otherwise specified” (EDNOS). Revisions made in DSM-5 attempt to generate a more scientifically valid and clinically relevant system of ED classification. The aim with the present study was to examine clinical characteristics and distinctiveness of the new DSM-5 ED diagnoses, especially concerning purging disorder (PD). Methods Using a large naturalistic Swedish ED database, 2233 adult women were diagnosed using DSM-5. Initial and 1-year follow-up psychopathology data were analyzed. Measures included the Eating Disorder Examination Questionnaire, Structural Eating Disorder Interview, Clinical Impairment Assessment, Structural Analysis of Social Behavior, Comprehensive Psychiatric Rating Scale, and Structured Clinical Interview for DSM-IV Axis I Disorders. Results Few meaningful differences emerged between anorexia nervosa binge/purge subtype (ANB/P), PD, and bulimia nervosa (BN). Unspecified Feeding and Eating Disorders (UFED) showed significantly less severity compared to other groups. Conclusions PD does not appear to constitute a distinct diagnosis, the distinction between atypical AN and PD requires clarification, and minimum inclusion criteria for UFED are needed. Further sub-classification is unlikely to improve clinical utility. Instead, better delineation of commonalities is important. PMID:24999410

  8. Retrospective study of intravascular large B-cell lymphoma cases diagnosed in Quebec

    Science.gov (United States)

    Brunet, Vanessa; Marouan, Sofia; Routy, Jean-Pierre; Hashem, Mohamed Amin; Bernier, Vincent; Simard, Raynald; Petrella, Tony; Lamarre, Louis; Théorêt, Gilles; Carrier, Christian; Knecht, Hans; Fleury, Isabelle; Pavic, Michel

    2017-01-01

    Abstract Introduction: Intravascular large B-cell lymphoma (IVL) is an extremely rare malignancy, mainly studied through European and Asian series. Due to the low incidence of this condition, our understanding of the clinical presentation as well as the management of IVL relies on a limited number of patients. We report the largest North American study to date on IVL with 29 cases from Quebec hospital diagnosed between 1990 and 2016. The aim of our study is to describe the clinical presentations, diagnostic and staging procedures, therapeutic management and clinical outcomes of IVL patients in our population and compare the disease phenotype to European and Asian series reported. In our cohort, all patients had stage IV IVL at diagnosis, with a median age of 66.7 years (range 47.2–90.8). Clinical presentation was characterized by constitutional symptoms (100%), poor ECOG-PS (100% ≥ 2), cytopenias (93% anemia), and elevated lactate dehydrogenase (97%) and C-reactive protein (96%). Our cohort presented with mainly cutaneous and neurological symptoms. However, neurological involvement (75.9%) was predominant and no “cutaneous variant” was observed; this differs from European literature, where “classical” IVL is reported with mainly cutaneous involvement. Two of our Caucasian patients presented “Asian variant” IVL; this observation is not unusual, as cases of “classical” IVL have been reported in Asians and “Asian variant” IVL has been reported in Europeans. All patients were classified according to their immunophenotypic features in 3 different subgroups (CD5+ or CD5−CD10+, CD5−CD10−, CD5+CD10−) with no difference in outcome. Finally, 62% of our cohort received anthracycline-based chemotherapy and 53% of them achieved a complete response. After a median follow-up of 328 days, OS at 3 years was 42.7% for the entire cohort and 47.4% for the cases with in vivo diagnosis. Conclusion: Unlike European studies on “classical” IVL, our study

  9. A 30-year Evaluation of the Agreement between Clinical and Histopathological Diagnoses of Peripheral Epithelial and Mesenchymal Lesions in Mashhad Dental School: 1976-2006

    Directory of Open Access Journals (Sweden)

    Salehinejad J.

    2011-10-01

    Full Text Available Statement of Problems: Sufficient knowledge, experience and careful examination usually lead to appropriate clinical diagnosis. However, lesions with similar clinical features present a diagnostic challenge. Therefore, a confirmatory histopathological examination can be helpful to reach the final diagnosis. Purpose: The present study was conducted to evaluate the agreement between clinical and histopathological diagnoses of oral epithelial and mesenchymal lesions in a period of 30-years (1976-2006 at Mashhad Dental School.Materials and Methods: The percentage of concurrence and discrepancy between clinical and histopathological diagnoses of 625 epithelial and 2480 mesenchymal lesions was compared. Clinical data including the patient’s gender and age and the lesion’s location were also evaluated in cases with discrepancy. Data were analyzed using Mann-Whitney, T-Test, Chi-Square, Likehood Ratio, Fisher’s Exact and Kappa tests.Results: An overall agreement between clinical and histopathological diagnoses was seen in 71/4% of epithelial lesion cases, with maximum parity in squamous cell carcinoma and papilloma. In 57/1% of the mesenchymal cases, the diagnosis was in total agreement. Denture hyperplasia, epulis fissuratum, and pregnancy tumor showed the highest concurrence, respectively.Conclusion: Although histopathological examination leads to final diagnosis, in some cases proper strategies and more attention to clinical features of the lesion are necessary to minimize the discrepancy, especially for those with non-specific clinical presentation.

  10. newly diagnosed CP-CML patients | EU Clinical Trials Register [EU Clinical Trials Register

    Lifescience Database Archive (English)

    Full Text Available treatment. Studio non randomizzato di fase II con Nilotinib 300 mg BID in pazienti con nuova diagnosi di leucemia...wduring treatment. Studio non randomizzato di fase II con Nilotinib 300 mg BID in pazienti con nuova diagnosidi leucemia...pazienti con nuova diagnosi di leucemia mieloide cronica (LMC) in fase cronica E....1.1.1Medical condition in easily understood language newly diagnosed CP-CML patients pazienti con nuova diagnosi di leucemia

  11. Predictive value of combined clinically diagnosed bruxism and occlusal features for TMJ pain.

    Science.gov (United States)

    Manfredini, Daniele; Peretta, Redento; Guarda-Nardini, Luca; Ferronato, Giuseppe

    2010-04-01

    Several works showed a decreased role for occlusion in the etiology of temporomandibular disorders (TMD). Nonetheless, it may be hypothesized that occlusion acts as a modulator through which bruxism activities may cause damage to the stomatognathic structures. To test this hypothesis, a logistic regression model was created with the inclusion of clinically diagnosed bruxism and eight occlusal features as potential predictors for temporomandibular joint (TMJ) pain in a sample of 276 consecutive TMD patients. The final logit showed that the percentage of the total log likelihood for TMJ pain explained by the significant factors was small and amounted to 13.2%, with unacceptable levels of sensitivity (16.4%). The parameters overbite > or = 4 mm combined with clinically diagnosed bruxism [OR (odds ratio) 4.62], overjet > or = 5 mm (OR 2.83), and asymmetrical molar relationship combined with clinically diagnosed bruxism (OR 2.77) were those with the highest odds for disease, even though none of those values was significant with respect to confidence intervals. Thus, the hypothesis under evaluation has to be rejected. It is possible that future studies with a higher discriminatory power for the different bruxism activities might be indicated to get deeper into the analysis of the potential mechanisms through which occlusion may play a role, even if small, in the etiology of the different TMD.

  12. Microbiological study and antimicrobial susceptibilities of brucella isolates in serologic diagnosed cases

    Directory of Open Access Journals (Sweden)

    Abtin Heidarzadeh

    2009-01-01

    Full Text Available (Received 25 Nov, 2008 ; Accepted 4 Mar, 2009AbstractBackground and purpose: Brucellosis is a zoonotic disease with worldwide distribution that is endemic in Iran. Worldwide, brucellosis remains a major cause of morbidity in humans and domesticated animals. The disease has a wide spectrum of clinical manifestation and can affect a variety of organs and systems. This study focused on blood culture of serologic diagnosed brucellosis and antimicrobial susceptibility test.Materials and methods: In this cross sectional study, microbiologic survey was done on a total of 30 serum samples with STA titer of 1:160 or greater and 2ME titer of 1:40 or greater, which were presumptive for brucellosis. Blood cultures were done by lysis centrifugation and antimicrobial susceptibility test, against 9 antimicrobial agents by disk method. The data was analyzed by stata V8.0 software.Results: At the end this study, the blood culture isolation rate was 23.3 %( 7 cases out of 30 patients and all of the isolates were brucella melitensis. Antimicrobial susceptibility tests showed high in vitro activity of ofloxacin, ciprofloxacin and doxycycline and also, low in vitro activity of streptomycin and cotrimoxazole.Conclusion: Brucellosis is endemic in Iran. Brucella melitensis was the most common strain of brucella in our patients. Except cotrimoxazole and streptomycin, high in vitro activity was found with other antibrucella agents, especially with ofloxacin, ciprofloxacin and doxycycline. J Mazand Univ Med Sci 2009; 19(68: 74-78 (Persian

  13. Chikungunya virus infection: report of the first case diagnosed in Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Isabella Gomes Cavalcanti de Albuquerque

    2012-02-01

    Full Text Available Initially diagnosed in Africa and Asia, the Chikungunya virus has been detected in the last three years in the Caribbean, Italy, France, and the United States of America. Herein, we report the first case for Rio de Janeiro, Brazil, in 2010.

  14. Case Study Analyses of Play Behaviors of 12-Month-Old Infants Later Diagnosed with Autism

    Science.gov (United States)

    Mulligan, Shelley

    2015-01-01

    Case study research methodology was used to describe the play behaviors of three infants at 12 months of age, who were later diagnosed with an autism spectrum disorder. Data included standardized test scores, and analyses of video footage of semi-structured play sessions from infants identified as high risk for autism, because of having a sibling…

  15. Clinical case of toxocariasis chorioretinitis

    Directory of Open Access Journals (Sweden)

    I. G. Pikhovskaia

    2014-07-01

    Full Text Available The clinical case of a toxocariasis chorioretinitis which is of interest for ophthalmologists is described. Insufficient knowledge of clinic and diagnostics of a lesion of eyes by Toxocara canis, their infrequent occurrence, similarity of the ophthalmologic picture with inflammatory diseases and eye neoplasms can be at the bottom of gross diagnostic mistake and wrong choice of treatment tactics.

  16. Clinical case of toxocariasis chorioretinitis

    Directory of Open Access Journals (Sweden)

    I. G. Pikhovskaia

    2013-01-01

    Full Text Available The clinical case of a toxocariasis chorioretinitis which is of interest for ophthalmologists is described. Insufficient knowledge of clinic and diagnostics of a lesion of eyes by Toxocara canis, their infrequent occurrence, similarity of the ophthalmologic picture with inflammatory diseases and eye neoplasms can be at the bottom of gross diagnostic mistake and wrong choice of treatment tactics.

  17. [MICROSCOPIC COLITIS: THE CLINICAL CASE].

    Science.gov (United States)

    Kulygina, Y A; Skalinskaya, M I; Ageeva, T A

    2015-01-01

    During past years incidence and prevalence of microscopic colitis (MC) have increased, that is possible caused to the improvement of knowledge of doctors about the disease. This article contain modern views on epidemiology, diagnostic and variant of microscopic colitis treatment. A typical clinical picture of MC in the form of recurrent a watery diarrhea, with the absence of pathologic changes at roentgenologic and endoscopic investigations is described with the example of a clinical case.

  18. Pneumoperitoneum diagnosed as an incidental finding using focus assessed transthoracic echocardiography: a case report

    DEFF Research Database (Denmark)

    Laursen, Christian Borbjerg

    2010-01-01

    Introduction In this case report we describe how pneumoperitoneum was diagnosed in a patient admitted with acute chest pain, as an incidental finding using focus assessed transthoracic echocardiography (FATE). Case report A 79-year-old male smoker with arterial hypertension was admitted to a coro......Introduction In this case report we describe how pneumoperitoneum was diagnosed in a patient admitted with acute chest pain, as an incidental finding using focus assessed transthoracic echocardiography (FATE). Case report A 79-year-old male smoker with arterial hypertension was admitted...... to a coronary unit with a sudden onset of constant left sided thoracic pain. At position 1 (subcostal) of the FATE protocol, the heart and liver could not be visualised. Instead the peritoneum could be seen as a hyperechoic stripe, corresponding horizontal reverberation artefacts was visible under...... in extracardial diseases can directly ensure the patients a quicker diagnosis and treatment....

  19. Pneumoperitoneum diagnosed as an incidental finding using focus assessed transthoracic echocardiography: a case report

    DEFF Research Database (Denmark)

    Laursen, Christian Borbjerg

    2010-01-01

    Introduction In this case report we describe how pneumoperitoneum was diagnosed in a patient admitted with acute chest pain, as an incidental finding using focus assessed transthoracic echocardiography (FATE). Case report A 79-year-old male smoker with arterial hypertension was admitted to a coro......Introduction In this case report we describe how pneumoperitoneum was diagnosed in a patient admitted with acute chest pain, as an incidental finding using focus assessed transthoracic echocardiography (FATE). Case report A 79-year-old male smoker with arterial hypertension was admitted...... the peritoneal line. Based on these findings, a conventional X-ray image of the abdomen was taken with the patient in the left lateral decubitus position, confirming the diagnosis of pneumoperitoneum. Conclusion This demonstrates how systematic use of FATE combined with knowledge of sonographic patterns...... in extracardial diseases can directly ensure the patients a quicker diagnosis and treatment....

  20. CLINICOPATHOLOGICAL ANALYSIS OF 50 RECTAL CANCER CASES DIAGNOSED AS ADENOMA IN BIOPSY

    Institute of Scientific and Technical Information of China (English)

    BU Zhao-de; LI Zi-yu; XIE Yu-quan; JI Jia-fu; SU Xiang-qian

    2005-01-01

    Objective: To evaluate the clinicopathological characteristics of rectal cancer diagnosed as adenoma in biopsy. Methods: 50 rectal cancer cases diagnosed as adenoma in biopsy were analyzed retrospectively in this study by comparing the biopsy and postoperative pathology. Results: Among these 50 patients, biopsy pathology showed 26% (13/50) adenoma with mild dysplasia, 30% (15/50) adenoma with moderate dysplasia, and 44% (22/50) adenoma with severe dysplasia. In 8 cases, the adenomas were smaller than 2cm. On postoperatively surgical pathology, only 10 cases were carcinoma-in-situ, while 40 cases were invasive cancer. Conclusion: Special emphasis should be taken to biopsy-negative rectal adenomas and those smaller than 2cm.

  1. Supernumerary Jawbone Tooth: Clinical Case

    OpenAIRE

    Rivas Gutiérrez, Jesús; Carlos Sánchez, María Dolores

    2016-01-01

    Introduction: supernumerary teeth are dental development anomalies, alsoknown as hyperdontia or extra teeth. Their prevalence ranges between 0.3% and 3.8%.Their morphology may be normal or dismorphic and are associated to the etiology ofocclusal alterations. It is important to make an early diagnostic through a radiographicalstudy. Case presentation:this article presents a clinical case of a supernumerary tooth thatcaused rotation and crowding of the anterior bottom teeth, which was addressed...

  2. Implementing the K-SADS-PL as a standard diagnostic tool: Effects on clinical diagnoses.

    Science.gov (United States)

    Matuschek, Tina; Jaeger, Sonia; Stadelmann, Stephanie; Dölling, Katrin; Grunewald, Madlen; Weis, Steffi; von Klitzing, Kai; Döhnert, Mirko

    2016-02-28

    Diagnostic interviews are valuable tools for generating reliable and valid psychiatric diagnoses. However, little is known about the diagnostic effects of implementing such an interview into the standard diagnostic procedure of a child psychiatric clinic. Therefore, we reviewed discharge diagnoses of psychiatric patients (age: 8-12 years; combined sample of inpatients and day hospital patients) over two intervals before and after implementing the semi-structured diagnostic interview K-SADS-PL as a diagnostic tool during intake. Each interval was a two year period spanning from 2009-2010 (pre sample; n=177) and from 2012-2013 (post sample; n=132). The number of diagnoses per patient and the co-morbidity rate increased significantly in the post sample. Furthermore, the percentage of children with a nonspecific diagnosis "other mixed disorders of conduct and emotions" (ICD-10: F92.8) decreased significantly after using the K-SADS-PL. Regarding the main diagnostic categories, a significant increase in the number of anxiety disorders and stress-related and somatoform disorders was found in the post sample. The results suggest that implementing a semi-structured interview into the daily routine of child psychiatry may have a substantial impact on discharge diagnoses. Practical implications are discussed and ideas for future research are given.

  3. Disability and Comorbidity: Diagnoses and Symptoms Associated with Disability in a Clinical Population with Panic Disorder

    Directory of Open Access Journals (Sweden)

    Caroline A. Bonham

    2014-01-01

    Full Text Available Background. Anxiety disorders are associated with considerable disability in the domains of (1 work, (2 social, and (3 family and home interactions. Psychiatric comorbidity is also known to be associated with disability. Methods. Data from the Cross-National Collaborative Panic Study was used to identify rates of comorbid diagnoses, anxiety and depression symptom ratings, and Sheehan disability scale ratings from a clinical sample of 1165 adults with panic disorder. Results. Comorbid diagnoses of agoraphobia, major depression, and social phobia were associated with disability across the three domains of work, social, and family and home interactions. The symptom of agoraphobic avoidance makes the largest contribution to disability but there is no single symptom cluster that entirely predicts impairment and disability. Limitations. The findings about the relative contributions that comorbid diagnoses make to disability only apply to a population with panic disorder. Conclusions. Although panic disorder is not generally considered to be among the serious and persistent mental illnesses, when it is comorbid with other diagnoses, it is associated with considerable impairment. In particular, the presence of agoraphobic avoidance should alert the clinician to the likelihood of important functional impairment. When measuring the functional impact of comorbid anxiety disorders, both the categorical and the dimensional approaches to diagnosis make valuable contributions.

  4. An automated clinical alert system for newly-diagnosed atrial fibrillation.

    Directory of Open Access Journals (Sweden)

    David A Cook

    Full Text Available Clinical decision support systems that notify providers of abnormal test results have produced mixed results. We sought to develop, implement, and evaluate the impact of a computer-based clinical alert system intended to improve atrial fibrillation stroke prophylaxis, and identify reasons providers do not implement a guideline-concordant response.We conducted a cohort study with historical controls among patients at a tertiary care hospital. We developed a decision rule to identify newly-diagnosed atrial fibrillation, automatically notify providers, and direct them to online evidence-based management guidelines. We tracked all notifications from December 2009 to February 2010 (notification period and applied the same decision rule to all patients from December 2008 to February 2009 (control period. Primary outcomes were accuracy of notification (confirmed through chart review and prescription of warfarin within 30 days.During the notification period 604 notifications were triggered, of which 268 (44% were confirmed as newly-diagnosed atrial fibrillation. The notifications not confirmed as newly-diagnosed involved patients with no recent electrocardiogram at our institution. Thirty-four of 125 high-risk patients (27% received warfarin in the notification period, compared with 34 of 94 (36% in the control period (odds ratio, 0.66 [95% CI, 0.37-1.17]; p = 0.16. Common reasons to not prescribe warfarin (identified from chart review of 151 patients included upcoming surgical procedure, choice to use aspirin, and discrepancy between clinical notes and the medication record.An automated system to identify newly-diagnosed atrial fibrillation, notify providers, and encourage access to management guidelines did not change provider behaviors.

  5. A case of Carpenter syndrome diagnosed in a 20-week-old fetus with postmortem examination.

    Science.gov (United States)

    Balci, S; Onol, B; Eryilmaz, M; Haytoglu, T

    1997-06-01

    Carpenter syndrome (acrocephalopolysyndactyly type II) is an autosomal recessive syndrome. The case we present was diagnosed prenatally at 20 weeks. Postmortem examination revealed severe central nervous system malformations. The central nervous system anomalies in this 23-week-old fetus merit emphasis, since these anomalies in such a young fetus may explain Carpenter syndrome cases, which do not improve in spite of early surgical intervention.

  6. Krukenberg tumors diagnosed during pregnancy simultaneously with advanced gastric cancer; A case report

    Energy Technology Data Exchange (ETDEWEB)

    You, Myung Won; Jung, Yoon Young; Shin, Jung Hwan; Hong, Young Ok [Eulji Hospital, Eulji University School of Medicine, Seoul (Korea, Republic of)

    2015-06-15

    Krukenberg tumors recognized during pregnancy are rarely reported. The preoperative diagnosis can be challenging because of the confusing morphological features and symptoms during pregnancy. Here, we report a case of a 29-year-old pregnant woman at 29 weeks gestation presenting with bilateral solid ovarian masses, which were later diagnosed as metastatic ovarian cancer originating from advanced gastric cancer. This case suggests that Krukenberg tumors should be considered when bilateral ovarian solid masses are encountered regardless of pregnancy.

  7. The phenotype of 45,X/46,XY mosaicism: an analysis of 92 prenatally diagnosed cases.

    OpenAIRE

    Chang, H.J.; Clark, R. D.; Bachman, H

    1990-01-01

    We undertook an international survey of prenatally diagnosed 45,X/46,XY mosaicism to ascertain the phenotypic spectrum of this condition. Ninety-two cases were obtained by means of a questionnaire sent to over 730 cytogenetic laboratories. Seventy-six cases (75 males and 1 female) had physical examinations after delivery or termination of pregnancy. Among these, there were four significant genital anomalies: three hypospadias and one female with clitoromegaly. Gonadal histology was abnormal i...

  8. An Adult Case of Unicommissural Unicuspid Aortic Valve Diagnosed Based on the Intraoperative Findings.

    Science.gov (United States)

    Yamanaka, Tetsuo; Fukatsu, Toru; Ichinohe, Yoshimaro; Komatsu, Hirotaka; Seki, Masahiro; Sasaki, Kenichi; Takai, Hideaki; Kunihara, Takashi; Hirata, Yasunobu

    2016-01-01

    We herein report an adult case of unicommissural unicuspid aortic valve (UAV). A 59-year-old man, who was noted to have a cardiac murmur at 31 years of age, was admitted to our hospital due to acute heart failure. Severe calcification in the aortic valve with severe low-flow/low-gradient aortic stenosis and moderate aortic regurgitation was observed and thought to be the cause of heart failure, however, the etiology of aortic valve dysfunction was not clear. Aortic valve replacement was subsequently performed, and unicommissural UAV was diagnosed according to the intraoperative findings. UAV is very rare congenital aortic valve disease which is rarely diagnosed preoperatively.

  9. Is there increase of STDs during Carnival? Time series of diagnoses in a STD clinic.

    Science.gov (United States)

    Passos, Mauro Romero Leal; Arze, Wilma Nancy Campos; Mauricio, Cagy; Barreto, Nero Araujo; Varella, Renata de Queiroz; Cavalcanti, Silvia Maria Baeta; Giraldo, Paulo Cesar

    2010-01-01

    Sexually transmitted diseases (STDs) are common reasons for seeking medical assistance. Media campaigns on STD/AIDS assume that exposure to risky sexual practices is greater during Carnival. The objective of this study was to analyze the temporal distribution of first appointments in a STD clinic from January 1993 to December 2005 to verify whether there is a seasonal increase in STD after Carnival. A total of 2,646 medical records with a diagnosis of gonorrhea, syphilis, or trichomoniasis were selected among patients seeking medical assistance in the STD Unit of Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil. Statistical analysis was performed using month-to-month and year-to-year standardized average number of appointments during 13 years, in addition to smoothed time-series data using the Lowess method and the deterministic moving average method. July and August exhibited the largest number of gonorrhea and syphilis diagnoses, and June and July of trichomoniasis diagnoses. Gonorrhea had its peak value in May, with a falling trend until August. A constant number of syphilis diagnoses was observed between May and August, with smaller numbers in January and February and peak values in November. The seasonal pattern for trichomoniasis diagnosis showed peak values in July, with a consistent falling trend until December and an increase from January on. Carnival has no influence on the increase in the occurrence of gonorrhea, syphilis, and trichomoniasis in patients attending a STD clinic in Niterói, Rio de Janeiro, Brazil.

  10. Delusional infestation is typically comorbid with other psychiatric diagnoses: review of 54 patients receiving psychiatric evaluation at Mayo Clinic.

    Science.gov (United States)

    Hylwa, Sara A; Foster, Ashley A; Bury, Jessica E; Davis, Mark D P; Pittelkow, Mark R; Bostwick, J Michael

    2012-01-01

    Delusional infestation, which encompasses both delusions of parasitosis and delusions of infestation with inanimate objects (sometimes called Morgellons disease), has been said to represent a distinct and encapsulated delusion, that is, a stand-alone diagnosis. Anecdotally, we have observed that patients with delusional infestation often have one or more psychiatric comorbid conditions and that delusional infestation should not be regarded as a stand-alone diagnosis. The purpose of this study was to identify whether patients with delusional infestation have psychiatric comorbid conditions. We therefore identified patients who had been formally evaluated in the Department of Psychiatry during their visit to Mayo Clinic. We retrospectively searched for and reviewed the cases of all patients with delusional infestation seen from 2001 through 2007 at Mayo Clinic, Rochester, Minnesota, and who underwent psychiatric evaluation. The diagnoses resulting from psychiatric evaluation were analyzed. During the 7-year study period, 109 patients seen for delusional infestation at Mayo Clinic were referred to the Department of Psychiatry, 54 (50%) of whom actually followed through with psychiatric consultation. Of these 54 patients, 40 (74%) received additional active psychiatric diagnoses; 14 patients (26%) had delusional infestation alone. Abnormal personality traits were rarely documented. Most patients with delusional infestation have multiple coexisting or underlying psychiatric disorders. Therefore, evaluation by a psychiatrist, when possible, is advised for all patients with delusional infestation. Copyright © 2012 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  11. A nomogram to predict Gleason sum upgrading of clinically diagnosed localized prostate cancer among Chinese patients

    Institute of Scientific and Technical Information of China (English)

    Jin-You Wang; Yao Zhu; Chao-Fu Wang; Shi-Lin Zhang; Bo Dai; Ding-Wei Ye

    2014-01-01

    Although several models have been developed to predict the probability of Gleason sum upgrading between biopsy and radical prostatectomy specimens, most of these models are restricted to prostate-specific antigen screening-detected prostate cancer. This study aimed to build a nomogram for the prediction of Gleason sum upgrading in clinical y diagnosed prostate cancer. The study cohort comprised 269 Chinese prostate cancer patients who underwent prostate biopsy with a minimum of 10 cores and were subsequently treated with radical prostatectomy. Of al included patients, 220 (81.8%) were referred with clinical symptoms. The prostate-specific antigen level, primary and secondary biopsy Gleason scores, and clinical T category were used in a multivariate logistic regression model to predict the probability of Gleason sum upgrading. The developed nomogram was validated internally. Gleason sum upgrading was observed in 90 (33.5%) patients. Our nomogram showed a bootstrap-corrected concordance index of 0.789 and good calibration using 4 readily available variables. The nomogram also demonstrated satisfactory statistical performance for predicting significant upgrading. External validation of the nomogram published by Chun et al. in our cohort showed a marked discordance between the observed and predicted probabilities of Gleason sum upgrading. In summary, a new nomogram to predict Gleason sum upgrading in clinically diagnosed prostate cancer was developed, and it demonstrated good statistical performance upon internal validation.

  12. Association between clinically diagnosed lumbar intervertebral disc prolapse and magnetic resonance image findings

    Directory of Open Access Journals (Sweden)

    Md. Habibur Rahman

    2016-09-01

    Full Text Available There are contradictory reports on the findings of magnetic resonance image (MRI in lumbar intervertebral disc prolapse. A study was conducted on 54 patients using 3 of 4 clinical criteria (low back pain with radiation down to the lower limbs, radicular pain along specific dermatomes, positive straight leg raising test, presence of neurological symptoms and signs e.g. motor or sensory deficit and MRI of lumbosacral spine of the respondent. Evaluation of MRI of lumbosacral spine was done based on extent of disc prolapse, disc degeneration, nerve root compression neural foramen compromise. The logistic regression analysis between the findings of MRI and the clinical features show that there was a significant association in the neural foramen or lateral recess (Odd's ratio 7.106, p<0.05, the root compression (p<0.01 as well as the disc extrusion (p<0.05. There was no statistical association between clinical levels and other MRI findings like disc protrusion and disc bulge (p value 0.21 and 0.14, respectively. The strength of agreement between clinical and MRI diagnosis level of disc prolapse was calculated using kappa statistics (k-value. The test revealed a very good agreement for L3/4 (k-value = 0.812 and good agreement for L4/5 and L5/SI  level (k-value 0.75 and 0.75 respectively between these two procedures, suggesting that level of disc prolapse could be correctly  diagnosed without MRI findings.  In conclusion, clinically diagnosed levels associate well with MRI levels, but all MRI abnormalities do not have any clinical significance. 

  13. Histopathologic features of melanoma in difficult-to-diagnose lesions: A case-control study.

    Science.gov (United States)

    Gonzalez, Manuel Lora; Young, Eric D; Bush, James; McKenzie, Katelyn; Hunt, Edgar; Tonkovic-Capin, Viseslav; Jacobs, Melissa; Kucenic, Michael; Fraga, Garth R

    2017-09-01

    Dermatopathology is considered the gold standard for melanoma diagnosis, but a subset of cases is difficult to diagnose by histopathology. The goals of this study were to measure the accuracy of histopathologic features in difficult-to-diagnose melanocytic tumors and the interobserver agreement of those features. This is a case-control study of histopathologic features of melanoma in 100 difficult-to-diagnose melanocytic neoplasms (40 melanomas and 60 nevi). Slides were blindly evaluated by 5 dermatopathologists. Frequencies, predictive values, and interobserver agreement were calculated. Univariate and multivariate logistic regression analyses were performed to identify the most influential features in arriving at a diagnosis of melanoma. Asymmetry, single-cell melanocytosis, solar elastosis, pagetoid melanocytosis, and broad surface diameter were most influential in arriving at a diagnosis of melanoma. Asymmetry and single-cell melanocytosis were most predictive of melanoma. Fleiss kappa was melanoma. This study is limited by the small sample size, selection bias, and binary classification of melanocytic lesions. Our results indicate histopathologic features of melanoma in difficult-to-diagnose lesions vary in accuracy and reproducibility. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  14. Refractory coeliac disease in a country with a high prevalence of clinically-diagnosed coeliac disease.

    Science.gov (United States)

    Ilus, T; Kaukinen, K; Virta, L J; Huhtala, H; Mäki, M; Kurppa, K; Heikkinen, M; Heikura, M; Hirsi, E; Jantunen, K; Moilanen, V; Nielsen, C; Puhto, M; Pölkki, H; Vihriälä, I; Collin, P

    2014-02-01

    Refractory coeliac disease (RCD) is thought to be a rare disorder, but the accurate prevalence is unknown. We aimed to identify the prevalence of and the risk factors for developing RCD in a Finnish population where the clinical detection rate of coeliac disease is high. The study involved 11 hospital districts in Finland where the number of treated RCD patients (n = 44), clinically diagnosed coeliac disease patients (n = 12 243) and adult inhabitants (n = 1.7 million) was known. Clinical characteristics at diagnosis of coeliac disease between the RCD patients and patients with uncomplicated disease were compared. The prevalence of RCD was 0.31% among diagnosed coeliac disease patients and 0.002% in the general population. Of the enrolled 44 RCD patients, 68% had type I and 23% type II; in 9% the type was undetermined. Comparing 886 patients with uncomplicated coeliac disease with these 44 patients that developed RCD later in life, the latter were significantly older (median 56 vs 44 years, P coeliac disease. Patients with evolving RCD had more severe symptoms at the diagnosis of coeliac disease, including weight loss in 36% (vs. 16%, P = 0.001) and diarrhoea in 54% (vs. 38%, P = 0.050). Refractory coeliac disease is very rare in the general population. Patients of male gender, older age, severe symptoms or seronegativity at the diagnosis of coeliac disease are at risk of future refractory coeliac disease and should be followed up carefully. © 2014 John Wiley & Sons Ltd.

  15. Analysis on Clinical Features of 2168 Patients with Lung Cancer Diagnosed by Bronchoscope

    Directory of Open Access Journals (Sweden)

    Yu Zhang

    2013-06-01

    Full Text Available Objective: To analyze the clinical features of lung cancer diagnosed by bronchoscopy. Methods: The clinical features of 2168 patients with lung cancer diagnosed by bronchoscopy were retrospectively analyzed, including gender, age, pathological type, diseased region, manifestations under bronchoscopy and methods of drawing materials. Results: The ratio of male/female was 4.8:1 and the peak onset age was 60 - 69 years old. The major pathological type was squamous cell carcinoma (44.5%, then adenocarcinoma (25.9% and small cell lung cancer (18.3%. The incidence of squamous cell carcinoma was the highest in males (50.6%, while that of adenocarcinoma in females (56.2%. The positive diagnostic rates of forceps biopsy, brush biopsy, bronchial alveolar lavage and transbronchial needle aspiration were 81.6%, 49.4%, 18.2% and 62.6%, respectively, whereas that of biopsy combined with brush biopsy came up to 89.0%. Conclusion: Bronchoscopy is an important method in diagnosis of lung cancer. Different ages and genders of patients with lung cancer have different onset, and the distribution of pathological types is diverse. Attaching more importance to bronchoscopy and improving biopsy technique can significantly improve the diagnostic rate and provide reliable evidences for clinical treatment.

  16. Analysis on Clinical Features of 2168 Patients with Lung Cancer Diagnosed by Bronchoscope

    Institute of Scientific and Technical Information of China (English)

    Zhang Yu; Yu Like; Xie Haiyan; Hu Weihua; Hao Keke; Xia Ning

    2013-01-01

    Objective: To analyze the clinical features of lung cancer diagnosed by bronchoscopy. Methods:The clinical features of2168 patients with lung cancer diagnosed by bronchoscopy were retrospectively analyzed, including gender, age, pathological type, diseased region, manifestations under bronchoscopy and methods of drawing materials. Results:The ratio of male/female was 4.8:1 and the peak onset age was 60~69 years old. The major pathological type was squamous cell carcinoma (44.5%), then adenocarcinoma (25.9%) and small cell lung cancer (18.3%). The incidence of squamous cell carcinoma was the highest in males (50.6%), while that of adenocarcinoma in females (56.2%). The positive diagnostic rates of forceps biopsy, brush biopsy, bronchial alveolar lavage and transbronchial needle aspiration were 81.6%, 49.4%, 18.2% and 62.6%, respectively, whereas that of biopsy combined with brush biopsy came up to 89.0%. Conclusion: Bronchoscopy is an important method in diagnosis of lung cancer. Different ages and genders of patients with lung cancer have different onset, and the distribution of pathological types is diverse. Attaching more importance to bronchoscopy and improving biopsy technique can signiifcantly improve the diagnostic rate and provide reliable evidences for clinical treatment.

  17. The Adequacy of the Q Methodology for Clinical Validation of Nursing Diagnoses Related to Subjective Foci.

    Science.gov (United States)

    Miguel, Susana; Caldeira, Sílvia; Vieira, Margarida

    2016-11-17

    This article describes the adequacy of the Q methodology as a new option for the validation of nursing diagnoses related to subjective foci. Discussion paper about the characteristics of the Q methodology. This method has been used in nursing research particularly related to subjective concepts and includes both a quantitative and qualitative dimension. The Q methodology seems to be an adequate and innovative method for the clinical validation of nursing diagnoses. The validation of nursing diagnoses related to subjective foci using the Q methodology could improve the level of evidence and provide nurses with clinical indicators for clinical reasoning and for the planning of effective interventions. Descrever a adequação da metodologia Q como uma nova opção para a validação clínica de diagnósticos de enfermagem relacionados com focos subjetivos. MÉTODOS: Artigo de discussão sobre as características da metodologia Q. Este método tem sido utilizado na pesquisa em enfermagem relacionada com conceitos subjetivos e inclui em simultâneo uma vertente qualitativa e quantitativa. CONCLUSÕES: A metodologia Q parece ser uma opção metodológica adequada para a validação clínica de diagnósticos de enfermagem. IMPLICAÇÕES PARA A PRÁTICA: A utilização da metodologia Q na validação clínica de diagnósticos de enfermagem relacionados com focos subjetivos pode melhorar o nível e evidência e facilitar o raciocínio clínico dos enfermeiros, ao providenciar indicadores clínicos também necessários ao desenvolvimento de intervenções efetivas. © 2016 NANDA International, Inc.

  18. Biosurveillance Using Clinical Diagnoses and Social Media Indicators in Military Populations

    Energy Technology Data Exchange (ETDEWEB)

    Corley, Courtney D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Volkova, Svitlana [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Rounds, Jeremiah [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Charles-Smith, Lauren E. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Harrison, Joshua J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Mendoza, Joshua A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Han, Keith S. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2017-02-23

    U.S. military influenza surveillance uses electronic reporting of clinical diagnoses to monitor health of military personnel and detect naturally occurring and bioterrorism-related epidemics. While accurate, these systems lack in timeliness. More recently, researchers have used novel data sources to detect influenza in real time and capture nontraditional populations. With data-mining techniques, military social media users are identified and influenza-related discourse is integrated along with medical data into a comprehensive disease model. By leveraging heterogeneous data streams and developing dashboard biosurveillance analytics, the researchers hope to increase the speed at which outbreaks are detected and provide accurate disease forecasting among military personnel.

  19. The Case of a Mother Who Was Also Diagnosed with Familial Mediterranean Fever Following Her Children s Diagnoses

    Directory of Open Access Journals (Sweden)

    Onur Ozturk

    2016-07-01

    Full Text Available Familial Mediterranean fever (FMF is an autosomal recessive disease that manifests itself with periodic fever, stomach ache, chest pain, and skin lesions such as erythema. Although it can be seen in adults, it is most often a childhood disease with symptoms generally occurring between 5-15 years of age. This study discusses a patient who had repeating fever, stomach ache, and leg pain attacks and was also diagnosed with FMF after her three children had received the same diagnosis.

  20. A human case of Echinostoma hortense (Trematoda: Echinostomatidae) infection diagnosed by gastroduodenal endoscopy in Korea

    Science.gov (United States)

    Cho, Chang-Min; Tak, Won-Young; Kweon, Young-Oh; Kim, Sung-Kook; Choi, Yong-Hwan; Kong, Hyun-Hee

    2003-01-01

    A human Echinostoma hortense infection was diagnosed by gastroduodenoscopy. An 81-year-old Korean male, living in Yeongcheon-shi, Gyeongsangbuk-do and with epigastric discomfort of several days duration, was subjected to upper gastrointestinal endoscopy. He was in the habit of eating fresh water fish. Two live worms were found in the duodenal bulb area and were removed using an endoscopic forcep. Based on their morphological characteristics, the worms were identified as E. hortense. The patient was treated with praziquantel 10 mg/kg as a single dose. The source of the infection in this case remains unclear, but the fresh water fish consumed, including the loach, may have been the source. This is the second case of E. hortense infection diagnosed by endoscopy in Korea. PMID:12815324

  1. [Proliferative diabetic retinopathy -- therapeutic approach (clinical case)].

    Science.gov (United States)

    Burcea, M; Muşat, Ovidiu; Mahdi, Labib; Gheorghe, Andreea; Spulbar, F; Gobej, I

    2014-01-01

    We present the case of a 54 year old pacient diagnosed with neglected insulin dependent diabetes and proliferative diabetic retinopathy. Surgery was recommended and we practiced posterior vitrectomy, endolaser and heavy silicone oil endotamponade. Post-operative evolution was favorable.

  2. MGMT inactivation and clinical response in newly diagnosed GBM patients treated with Gliadel.

    Science.gov (United States)

    Grossman, Rachel; Burger, Peter; Soudry, Ethan; Tyler, Betty; Chaichana, Kaisorn L; Weingart, Jon; Olivi, Alessandro; Gallia, Gary L; Sidransky, David; Quiñones-Hinojosa, Alfredo; Ye, Xiaobu; Brem, Henry

    2015-12-01

    We examined the relationship between the O(6)-methylguanine-methyltransferase (MGMT) methylation status and clinical outcomes in newly diagnosed glioblastoma multiforme (GBM) patients who were treated with Gliadel wafers (Eisai, Tokyo, Japan). MGMT promoter methylation has been associated with increased survival among patients with GBM who are treated with various alkylating agents. MGMT promoter methylation, in DNA from 122 of 160 newly diagnosed GBM patients treated with Gliadel, was determined by a quantitative methylation-specific polymerase chain reaction, and was correlated with overall survival (OS) and recurrence-free survival (RFS). The MGMT promoter was methylated in 40 (32.7%) of 122 patients. The median OS was 13.5 months (95% confidence interval [CI] 11.0-14.5) and RFS was 9.4 months (95% CI 7.8-10.2). After adjusting for age, Karnofsky performance score, extent of resection, temozolomide (TMZ) and radiation therapy (RT), the newly diagnosed GBM patients with MGMT methylation had a 15% reduced mortality risk, compared to patients with unmethylated MGMT (hazard ratio 0.85; 95% CI 0.56-1.31; p=0.46). The patients aged over 70 years with MGMT methylation had a significantly longer median OS of 13.5 months, compared to 7.6 months in patients with unmethylated MGMT (p=0.027). A significant difference was also found in older patients, with a median RFS of 13.1 versus 7.6 months for methylated and unmethylated MGMT groups, respectively (p=0.01). Methylation of the MGMT promoter in newly diagnosed GBM patients treated with Gliadel, RT and TMZ, was associated with significantly improved OS compared to the unmethylated population. In elderly patients, methylation of the MGMT promoter was associated with significantly better OS and RFS.

  3. Pelvic varices diagnosed with endorectal surface coil magnetic resonance imaging: case report

    Energy Technology Data Exchange (ETDEWEB)

    Gullo, G.; Russ, P.D. [Univ. of Colorado Health Sciences Center, Dept. of Radiology, Denver, Colorado (United States)

    2000-07-01

    Pelvic varices are a well-recognized cause of pain, especially in multiparous women, and are often associated with pelvic congestion syndrome. These dilated veins have been imaged using positive-contrast venography and ultrasonography (US). We present a case of painless pelvic varices that presented as an amorphous, non-specific-appearing parametrial and pericervical mass on computed tomography (CT), but which were diagnosed with magnetic resonance imaging (MRI) using an endorectal surface coil. (author)

  4. Comparison of clinical efficacy and safety of sitagliptin and metformin in the treatment of newly diagnosed T2MD patients with 30 cases respectively%西格列汀与二甲双胍治疗初诊T2MD患者各30例临床疗效及安全性比较

    Institute of Scientific and Technical Information of China (English)

    李晓钟

    2015-01-01

    Objective:To explore the clinical efficacy and safety of sitagliptin and metformin in the treatment of newly diagnosed T2MD patients.Methods:60 cases of newly diagnosed T2MD patients were selected.They were randomly divided into the treatment group and the control group.The treatment group were given sitagliptin,and the control group were given metformin,then we compared the therapeutic effect of the two groups.Results:After 12 weeks of treatment,compared with before treatment,FBG,2hPG, HbA1c,BMI of two groups of patients were decreased significantly(P0.05).After treatment,the two groups in blood lipids,blood routine,liver and kidney function,blood pressure,adverse reaction were no significant difference(P>0.05).Conclusion:Compared with metformin,sitagliptin was used to treat T2MD,the efficacy and safety were basically the same,but the price was more expensive,the cost performance was low.%目的:探讨西格列汀与二甲双胍对初诊 2 型糖尿病(T2DM)患者的临床疗效及安全性.方法:将 60 例初诊T2MD患者随机分为治疗组1和治疗组2,治疗组1口服西格列汀片,治疗组2口服二甲双胍片,比较两组治疗效果.结果:治疗12周后,两组患者的FBG、2 hPG、HbA1c、BMI比治疗前均有明显下降(P0.05).治疗后两组在血脂、血常规、血压、肝肾功能、不良反应等方面差异无统计学意义(P>0.05).结论:使用西格列汀治疗T2MD与二甲双胍比较,疗效、安全性基本相当,但其价格较贵,性价比较低.

  5. Isolation and Antibiogram of Clostridium tetani from Clinically Diagnosed Tetanus Patients.

    Science.gov (United States)

    Hanif, Hajra; Anjum, Awais; Ali, Naeem; Jamal, Asif; Imran, Muhammad; Ahmad, Bashir; Ali, Muhammad Ishtiaq

    2015-10-01

    Clostridium tetani, the etiologic agent of tetanus, produces a toxin that causes spastic paralysis in humans and other vertebrates. This study was aimed for isolation, identification, and determination of antimicrobial susceptibility of C. tetani from clinically diagnosed tetanus patients. Isolation was done from deep-punctured tissues of the foot and arm injuries of 80 clinically diagnosed tetanus patients from the Pakistan Institute of Medical Sciences hospital. We successfully screened out five C. tetani isolates out of 80 samples based on the strain-specific characteristics confirmed through biochemical testing and toxin production. A disc diffusion method was used for antimicrobial susceptibilities and C. tetani isolates showed susceptibility to cefoperazone, chloramphenicol, metronidazole, penicillin G, and tetracycline, but were found to be resistant to erythromycin and ofloxacin. During animal testing, all the infected mice developed symptoms of tetanus. The results showed that identification of C. tetani is possible using biochemical and molecular tools and that the strains of C. tetani isolated had not developed resistance against the antibiotics most often used for the treatment of tetanus.

  6. Guidelines and mindlines: why do clinical staff over-diagnose malaria in Tanzania? A qualitative study

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    Juma Kaseem

    2008-04-01

    Full Text Available Abstract Background Malaria over-diagnosis in Africa is widespread and costly both financially and in terms of morbidity and mortality from missed diagnoses. An understanding of the reasons behind malaria over-diagnosis is urgently needed to inform strategies for better targeting of antimalarials. Methods In an ethnographic study of clinical practice in two hospitals in Tanzania, 2,082 patient consultations with 34 clinicians were observed over a period of three months at each hospital. All clinicians were also interviewed individually as well as being observed during routine working activities with colleagues. Interviews with five tutors and 10 clinical officer students at a nearby clinical officer training college were subsequently conducted. Results Four, primarily social, spheres of influence on malaria over-diagnosis were identified. Firstly, the influence of initial training within a context where the importance of malaria is strongly promoted. Secondly, the influence of peers, conforming to perceived expectations from colleagues. Thirdly, pressure to conform with perceived patient preferences. Lastly, quality of diagnostic support, involving resource management, motivation and supervision. Rather than following national guidelines for the diagnosis of febrile illness, clinician behaviour appeared to follow 'mindlines': shared rationales constructed from these different spheres of influence. Three mindlines were identified in this setting: malaria is easier to diagnose than alternative diseases; malaria is a more acceptable diagnosis; and missing malaria is indefensible. These mindlines were apparent during the training stages as well as throughout clinical careers. Conclusion Clinicians were found to follow mindlines as well as or rather than guidelines, which incorporated multiple social influences operating in the immediate and the wider context of decision making. Interventions to move mindlines closer to guidelines need to take the

  7. The phenotype of 45,X/46,XY mosaicism: an analysis of 92 prenatally diagnosed cases.

    Science.gov (United States)

    Chang, H J; Clark, R D; Bachman, H

    1990-01-01

    We undertook an international survey of prenatally diagnosed 45,X/46,XY mosaicism to ascertain the phenotypic spectrum of this condition. Ninety-two cases were obtained by means of a questionnaire sent to over 730 cytogenetic laboratories. Seventy-six cases (75 males and 1 female) had physical examinations after delivery or termination of pregnancy. Among these, there were four significant genital anomalies: three hypospadias and one female with clitoromegaly. Gonadal histology was abnormal in three (27%) of 11 cases, all of whom had normal male external genitalia. Other anomalies were noted in five cases: one cystic hygroma in a male, two cardiac anomalies, one spina bifida with multiple other defects, and one intrauterine growth retardation. There was no relationship between the percent mosaicism and the presence or degree of abnormalities. We conclude that 95% of 45,X/46,XY fetuses will have normal male genitalia, although there will also be a significant risk (27%) for abnormal gonadal histology. Long-term follow-up studies of prenatally diagnosed cases of 45,X/46,XY mosaicism are needed to study, without ascertainment bias, stature, pubertal development, tumor risk, and fertility.

  8. Effect of montelukast on clinical score and cytokine levels of infants for clinically diagnosed acute bronchiolitis.

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    Tahan, Fulya; Celik, Serkan; Eke Gungor, Hatice

    2015-01-01

    Acute bronchiolitis comprises a major cause for morbidity in infants with viral infection which induces an immune inflammatory response that may produce long lasting harmful effects. Currently, there is no effective therapy for bronchiolitis. Our aim was to investigate the efficacy of five-day montelukast therapy in acute bronchiolitis management. The study included 50 infants with acute bronchiolitis. The infants with first episode of acute bronchiolitis were randomly assigned to receive daily montelukast dose of 4mg over five days after admission or no treatment. Plasma eotaxin, IL-4, IL-8 and IFN-gamma levels were evaluated before and after treatment by ELISA method. In the present study, the primary outcome measure was change in clinical severity score, whilst secondary outcome measures were changes in plasma eotaxin, IL-4, IL-8, IFN-gamma levels. No significant differences was found in clinical severity score with five-day montelukast treatment (p>0.05, Mann-Whitney U test). There were no significant differences in plasma eotaxin, IL-4, IL-8, IFN-gamma levels between the groups (p>0.05 Mann-Whitney U test). There was significant decrease in plasma IFN-gamma levels following five-day montelukast treatment (p=0.027, Wilcoxon). There were no significant differences in plasma IL-4, IL-8, IFN-gamma levels between the groups after five-day montelukast treatment (p>0.05, Wilcoxon). There was significant increase in eotaxin levels after five-day montelukast treatment (p=0.009, Wilcoxon). Our study showed that montelukast affected plasma IFN-gamma and eotaxin levels after five days of treatment. Further studies are needed to demonstrate effects of montelukast on chemokine levels in bronchiolitis. Copyright © 2014 SEICAP. Published by Elsevier Espana. All rights reserved.

  9. Unilateral pulmonary agenesis: a report of four cases, two diagnosed antenatally and literature review.

    Science.gov (United States)

    Kayemba-Kay's, S; Couvrat-Carcauzon, V; Goua, V; Podevin, G; Marteau, M; Sapin, E; Levard, G

    2014-03-01

    Pulmonary agenesis is a rare congenital malformation of lung development defined as complete absence of lung tissues, bronchi, and pulmonary vessels; it may be uni- or bilateral. The right-sided form carries the poorest prognosis due to severity of co-existent anomalies. Its diagnostic circumstances are variables: first reported cases were diagnosed at autopsy, but early postnatal as well as fortuitous discovery have been reported. In recent years, progress in obstetrical imaging has made antenatal diagnosis possible so that fetal ultrasound and MRI allow early diagnosis and refinement by permitting the elimination of differential diagnoses (diaphragmatic hernia, cystic adenomatoid malformation of the lung, giant lobar emphysema, and situs inversus). This anomaly is compatible with normal life provided co-existent malformations are thoroughly investigated and managed in a multidisciplinary setting. We report four cases of lung agenesis two of which were diagnosed antenatally at 23rd and 30th weeks of gestation respectively. Our aim is to describe the circumstances having led to diagnosis and report both follow-up and outcome of our patients.

  10. Munchausen syndrome in the emergency department mostly difficult, sometimes easy to diagnose: a case report and review of the literature

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    Vanderbruggen Nathalie

    2009-11-01

    Full Text Available Abstract Munchausen syndrome is a rare psychiatric disorder in which patients inflict on themselves an illness or injury for the primary purpose of assuming the sick role. Because these patients can present with many different complaints and clinical symptoms, diagnosis is often made at a later stage of hospitalisation. In contrast we report a case of a 40-year old woman very easy to diagnose with Munchausen syndrome. This trained nurse presented at our emergency department (ED complaining of abdominal pain. Interviewed by the medical trainee, she immediately confessed having put a knitting needle into her urethra four days earlier. She was not able to remove it anymore because it was beyond her reach. Abdominal X-ray confirmed the presence of the needle and a median laparotomy was performed to remove it. The diagnosis of Munchausen syndrome seemed immediately obvious in this case.

  11. A case of invasive Langerhans cell histiocytosis localizing only in the lung and diagnosed as pneumothorax in an adolescent female

    Science.gov (United States)

    Dejima, Hitoshi; Morita, Shigeki; Takahashi, Yusuke; Matsutani, Noriyuki; Iinuma, Hisae; Kondo, Fukuo; Kawamura, Masafumi

    2015-01-01

    In infants, Langerhans cell histiocytosis (LCH) is associated with poor clinical outcomes as Langerhans cells invade and damage multiple organs, a presentation that is different from that in adults. Here, we present a case of a 15-year-old female who visited ourclinic complaining of right chest pain and dyspnea. She was diagnosed with right pneumothorax by chest X-ray. Chest computed tomography showed multiple cystic changes in the bilateral lung. Additionally, bullous lesions occupying the upper lobe and multiple white tiny nodules on the surface of the lung were observed by thoracoscopy. These nodules comprised proliferating atypical CD1a/S-100-positive cells invading the pulmonary parenchyma, leading to the diagnosis of LCH. Because of the extensive invasion into the pulmonary parenchyma, chemotherapy was administered. This case of LCH was unique in that the age of onset was atypical and the tumor cells occupied a single organ, despite their malignant behavior. PMID:26045867

  12. Spreading the clinical window for diagnosing fetal-onset hypogonadism in boys

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    Rodolfo eRey

    2014-05-01

    Full Text Available In early fetal development, the testis secretes –independently of pituitary gonadotropins– androgens and anti-Müllerian hormone (AMH which are essential for male sex differentiation. In the second half of fetal life, the hypothalamic-pituitary axis gains control of testicular hormone secretion. FSH controls Sertoli cell proliferation, responsible for testis volume increase and AMH and inhibin B secretion, whereas LH regulates Leydig cell androgen and INSL3 secretion, involved in the growth and trophism of male external genitalia and in testis descent. This differential regulation of testicular function between early and late fetal periods underlies the distinct clinical presentations of fetal-onset hypogonadism in the newborn male: primary hypogonadism results in ambiguous or female genitalia when early fetal-onset whereas it becomes clinically undistinguishable from central hypogonadism when established later in fetal life. The assessment of the hypothalamic-pituitary-gonadal axis in the male has classically relied on the measurement of gonadotropin and testosterone levels in serum. These hormone levels normally decline 3-6 months after birth, thus constraining the clinical evaluation window for diagnosing male hypogonadism. The advent of new markers of gonadal function has spread this clinical window beyond the first 6 months of life. In this review, we discuss the advantages and limitations of old and new markers used for the functional assessment of the hypothalamic-pituitary-testicular axis in boys suspected of fetal-onset hypogonadism.

  13. Adult-onset Still's disease: Clinical cases

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    G. R. Imametdinova

    2014-01-01

    Full Text Available The annual incidence of adult-onset Still's disease (AOSD worldwide is 0.16 cases per 100,000 persons. Its leading symptoms are joint involvement, fever, skin rash, and neutrophilic leukocytosis in the absence of rheumatoid factor and anticyclic citrullinated peptide antibodies in serum and synovial fluid. In its initial stage, there may be monoarthritis more commonly of the wrist, hip, or knee. Then the lesion assumes the pattern of oligo- or polyarthritis. Musculoskeletal involvement appearing as arthralgia, arthritis, and myalgia is noted in all patients. In the majority of patients, articular involvement progresses and destructive polyarthritis develops. Symmetric involvement of the carpophalangeal and distal interphalangeal joints is frequently detected. Skin lesion manifests itself as maculopapular or roseolous rashes on the chest, back, shoulders, occasionally on the legs, or in the areas of mechanical irritation. A sore throat with the signs of pharyngitis is a characteristic early symptom of the disease. There may be involvements of the liver, cardiovascular system, lung, as well as lymphadenopathy, or splenomegaly. The chronic course of the disease is more frequently noted.The paper describes two cases of AOSD. One case demonstrates that the physician has no experience in diagnosing and managing patients with AOSD, resulting in the misinterpretation of the increase in disease activity when the subclinical doses of methotrexate (MT are used, which has been regarded as a therapeutic complication. The use of the adequate dose of MT could achieve a clinical and laboratory remission and discontinue glucocorticoids (GC.In the other case of recurrent AOSD and mild clinical symptoms, the unreasonable use of high GC doses gave rise to adverse reactions.

  14. Adult-onset Still's disease: Clinical cases

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    G. R. Imametdinova

    2014-12-01

    Full Text Available The annual incidence of adult-onset Still's disease (AOSD worldwide is 0.16 cases per 100,000 persons. Its leading symptoms are joint involvement, fever, skin rash, and neutrophilic leukocytosis in the absence of rheumatoid factor and anticyclic citrullinated peptide antibodies in serum and synovial fluid. In its initial stage, there may be monoarthritis more commonly of the wrist, hip, or knee. Then the lesion assumes the pattern of oligo- or polyarthritis. Musculoskeletal involvement appearing as arthralgia, arthritis, and myalgia is noted in all patients. In the majority of patients, articular involvement progresses and destructive polyarthritis develops. Symmetric involvement of the carpophalangeal and distal interphalangeal joints is frequently detected. Skin lesion manifests itself as maculopapular or roseolous rashes on the chest, back, shoulders, occasionally on the legs, or in the areas of mechanical irritation. A sore throat with the signs of pharyngitis is a characteristic early symptom of the disease. There may be involvements of the liver, cardiovascular system, lung, as well as lymphadenopathy, or splenomegaly. The chronic course of the disease is more frequently noted.The paper describes two cases of AOSD. One case demonstrates that the physician has no experience in diagnosing and managing patients with AOSD, resulting in the misinterpretation of the increase in disease activity when the subclinical doses of methotrexate (MT are used, which has been regarded as a therapeutic complication. The use of the adequate dose of MT could achieve a clinical and laboratory remission and discontinue glucocorticoids (GC.In the other case of recurrent AOSD and mild clinical symptoms, the unreasonable use of high GC doses gave rise to adverse reactions.

  15. Clinical and radiological analysis of a series of periapical cysts and periapical granulomas diagnosed in a Brazilian population

    Science.gov (United States)

    Tavares, Daniel-Petitet; Rodrigues, Janderson-Teixeira; dos Santos, Teresa-Cristina-Ribeiro-Bartholomeu; Armada, Luciana

    2017-01-01

    Background Periapical cysts (PC) and periapical granulomas (PG) are the two most common chronic inflammatory periapical diseases, but their clinicoradiological characteristics can vary depending on the methods employed in each study. The aim of the present work was to analyze the clinical and radiological profile of a series of PC and PG diagnosed in a Brazilian population. Material and Methods The files of two Oral Pathology laboratories were reviewed and all cases diagnosed as PG and PC were selected for the study. Clinical and radiological information were retrieved and data were tabulated and descriptively and comparatively analyzed. Results Final sample was composed by 647 inflammatory periapical lesions, including 244 PG (38%) and 403 PC (62%). The number of women affected by PG was significantly higher than the number of women affected by PC (p=0.037). Anterior region of the maxilla was the most common affected area for both entities (39% of the cases), but the most common anatomical location of PG (anterior maxilla and posterior maxilla) was different from PC (anterior maxilla and posterior mandible) (p<0.0001). Upper lateral incisor was the most affected tooth. The mean radiological size of the PC was larger than the mean radiological size of the PG (p<0.0001) and PC showed well-defined radiological images more frequently than PG (p<0.0001). Conclusions PC were more common than PG, both showed predilection for adult females, most lesions affected predominantly the anterior maxilla and PC presented larger mean radiological diameter and well-defined images when compared with PG. Key words:Periapical granuloma, periapical cyst, radicular cyst, diagnosis, Oral Pathology. PMID:28149477

  16. Pain in the Blood? Envisioning Mechanism-Based Diagnoses and Biomarkers in Clinical Pain Medicine

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    Emmanuel Bäckryd

    2015-03-01

    Full Text Available Chronic pain is highly prevalent, and pain medicine lacks objective biomarkers to guide diagnosis and choice of treatment. The current U.S. “opioid epidemic” is a reminder of the paucity of effective and safe treatment options. Traditional pain diagnoses according to the International Classification of Diseases are often unspecific, and analgesics are often prescribed on a trial-and-error basis. In contrast to this current state of affairs, the vision of future mechanism-based diagnoses of chronic pain conditions is presented in this non-technical paper, focusing on the need for biomarkers and the theoretical complexity of the task. Pain is and will remain a subjective experience, and as such is not objectively measurable. Therefore, the concept of “noci-marker” is presented as an alternative to “pain biomarker”, the goal being to find objective, measurable correlates of the pathophysiological processes involved in different chronic pain conditions. This vision entails a call for more translational pain research in order to bridge the gap between clinical pain medicine and preclinical science.

  17. Results of Mitochondrial DNA Sequence Analysis in Patients with Clinically Diagnosed Leber’s Hereditary Optic Neuropathy

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    Haluk Esgin

    2012-09-01

    Full Text Available Objective: To investigate possible mitochondrial DNA (mtDNA mutations in patients with Leber’s hereditary optic neuropathy (LHON in order to provide a precise diagnosis and genetic counseling.Material and Methods: Between 1982 and 2007, ten patients were clinically diagnosed with LHON and six of these patients agreed to be involved in this study. Six healthy individuals were also included as a control group. mtDNA was isolated from peripheral blood samples and polymerase chain reaction and mtDNA sequence analysis were performed. Results: In one of the six patients, a homoplasmic mutant m.11778G>A mutation was detected. All of the clinically diagnosed LHON patients and the control groups had the m.14212C>T and m.14580G>A single nucleotide polymorphisms (SNPs. The m.11719A>G SNP was detected in three of six patients and four of the controls. Two of the six patients had the m.3197T>C SNP and, in addition, the m.14258G>A SNP was found in one of these two patients, while neither of these mutations were present in the control group.Conclusion: The clinical diagnosis of LHON could be supported by molecular genetics only in one patient by the detection of one mutation. The m.3197T>C and m.14258G>A SNPs should be considered as potential mtDNA mutations due to the fact that they were detected in the patient group. These mutations should be investigated further in large case groups for suspected gene loci that could lead to optic neuropathy.

  18. Clinical Analysis of 48 Cases of Fetal Congenital Heart Disease Diagnosed by Color Doppler Ultrasound%彩色多普勒超声诊断48例胎儿先天性心脏病的临床分析

    Institute of Scientific and Technical Information of China (English)

    李蓉

    2015-01-01

    目的:探究分析彩色多普勒超声诊断在胎儿先天性心脏病中的临床效果。方法回顾性分析我院2014年2月~2015年3月拟诊有胎儿先天性心脏病的48例产妇超声诊断资料,同采用其他诊断方式进行对比分析。结果彩色多普勒超声共诊断出48例胎儿先天性心脏病,检出率为100%;其他诊断方法的综合检出率为75%,彩色多普勒超声诊断检出率高于其他诊断方式,数据之间差异显著(P<0.05)。结论彩色多普勒超声诊断胎儿先天性心脏病的检出率高,为早期诊断提供了真实可靠的依据。%Objective To explore the clinical effect of color Doppler ultrasound in the diagnosis of congenital heart disease in the fetus. MethodsA retrospective analysis of 48 cases of fetal congenital heart disease in our hospital from February 2014 to March 2015 were retrospectively analyzed.Results48 cases of fetal congenital heart disease were diagnosed by color Doppler ultrasound. The detection rate was 100%. The detection rate of other diagnostic methods was 75%. The diagnostic rate of color Doppler ultrasound was significantly higher than that of other diagnostic methods, and the difference was significant (P< 0.05).Conclusion Color Doppler ultrasound in the diagnosis of fetal congenital heart disease with high detection rate, which provides a reliable basis for early diagnosis of fetal congenital heart disease.

  19. Chronic pulmonary histoplasmosis in Brazil: report of two cases with cavitation diagnosed by transthoracic needle biopsy

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    SEVERO Luiz Carlos

    1997-01-01

    Full Text Available Two cases of Chronic Pulmonary Histoplasmosis are reported and other eleven cases, collected from Brazilian literature, are commented. After being clinically cured, one of our patients presented an Aspergillus fungus ball inside a cavitation in the wall of which H. capsulatum was disclosed. Comments are also done on the diagnosis of the mycosis

  20. 12-STEP FACILITATION FOR THE DUALLY DIAGNOSED: A RANDOMIZED CLINICAL TRIAL

    Science.gov (United States)

    Bogenschutz, Michael P.; Rice, Samara L.; Tonigan, J. Scott; Vogel, Howard S.; Nowinski, Joseph; Hume, Donald; Arenella, Pamela B.

    2014-01-01

    There are few clinical trials of 12-step treatments for individuals with serious mental illness and alcohol or drug dependence. This randomized trial assessed the effects of adding a 12-session 12-step facilitation therapy (TSF), adapted from that used in Project MATCH, to treatment as usual in an outpatient dual diagnosis program. Participants were 121 individuals dually diagnosed with alcohol dependence and a serious mental disorder, followed during 12 weeks of treatment and 36 weeks post-treatment. Participants receiving TSF had greater participation in 12-step programs, but did not demonstrate greater improvement in alcohol and drug use. However, considered dimensionally, greater participation in TSF was associated with greater improvement in substance use, and greater 12-step participation predicted decreases in frequency and intensity of drinking. Findings suggest that future work with TSF in this population should focus on maximizing exposure to TSF, and maximizing the effect of TSF on 12-step participation. PMID:24462479

  1. A late-diagnosed phenylketonuria case presenting with autism spectrum disorder in early childhood.

    Science.gov (United States)

    Mazlum, Betül; Anlar, Banu; Kalkanoğlu-Sivri, H Serap; Karlı-Oğuz, Kader; Özusta, Şeniz; Ünal, Fatih

    2016-01-01

    Phenylketonuria is one of the most prevalent autosomal recessive hereditary disorders in Turkey. If untreated, it results in severe brain damage and can also be associated with autism in certain patients. We present a three-year old boy who exhibited the symptoms of autism and was subsequently diagnosed with phenylketonuria. This case illustrates that because the majority of autism cases are idiopathic, an occasional patient with a metabolic disorder might be overlooked especially in the era of newborn screening. We also discuss the possible pathogenetic processes leading to autistic symptoms in phenylketonuria, and wish to draw attention to the possibility of cases missed in the screening program because of less than 100% coverage or insufficient food intake before blood sampling. Clinicians should keep in mind the possibility of treatable disorders in children with autism even when such disorders appear unlikely.

  2. Neuronal hypertrophy and mast cells in histologically negative, clinically diagnosed acute appendicitis: a quantitative immunophenotypical analysis.

    Science.gov (United States)

    Amber, Safeena; Mathai, Alka Mary; Naik, Ramadas; Pai, Muktha R; Kumar, Suneet; Prasad, Keerthana

    2010-03-01

    In about 20-25% of appendicectomies performed for clinically suspected acute appendicitis, definite morphological changes are lacking on histopathological examination. The present study was done to investigate whether any changes in neurons and mast cells could be detected in patients presenting with clinical acute appendicitis but found to have normal appendix at histopathology. A descriptive study was conducted on 50 appendix specimens which were categorized as histology-positive acute appendicitis (HPAA), clinically acute appendicitis but histologically negative (HNAA), appendices resected for other causes and appendices from forensic autopsy. A morphometric and quantitative evaluation of nerve fibers and ganglion plexus and its relation to mast cell density were studied. All sections were subjected to hematoxylin and eosin stain, toluidine blue stain, S 100 protein and neuron specific enolase (NSE) immunostaining and a quantitative image analysis system. Mucosal and submucosal neuronal components highlighted by NSE and S100 immunostaining observed in cases of HNAA were comparable to cases of HPAA. With S 100 immunostaining in HNAA cases, the increase in number and size of myentric neuronal plexus were mild in 40% (10/25) cases, moderate in 40% (10/25) and marked in 20% (5/25) cases as compared to 66.7% (10/15) cases of HPAA showing moderate and 33.3% (5/15) cases showing marked increase (p = 0.018). The mean mast cell count was highest in the HNAA cases (2.74) in all the four layers as compared to the HPAA (1.85) and control group (2.05). There was no difference in the relationship of the size of ganglion cells and the mast cell concentration. Neuronal hypertrophy and mast cells may play a role in the pathogenesis of appendicitis-like pain in patients with histologically normal appendices.

  3. The clinical challenge of SIADH - Three cases

    NARCIS (Netherlands)

    N. van der Lubbe (Nils); C. Thompson (Chris); R. Zietse (Bob); E.J. Hoorn (Ewout)

    2009-01-01

    textabstractThe syndrome of inappropriate antidiuretic hormone secretion (SIADH) remains a challenging disorder to diagnose and treat. Three cases are presented to illustrate these challenges. The first two cases had drug-induced SIADH secondary to a selective serotonin reuptake inhibitor (for depre

  4. Acute extensive ischemic enteritis in a young man diagnosed with wireless capsule endoscopy: a case report.

    Science.gov (United States)

    Jeong, Woo Seong; Song, Hyun Joo; Na, Soo Young; Boo, Sun Jin; Kim, Heung Up; Kim, Jinseok; Choi, Guk Myung

    2013-03-25

    Ischemic enteritis is caused by either the interruption or significant reduction of arterial inflow to the small intestine. Risk factors are old age, diabetes mellitus and cardiovascular disease. It is very rare in young patients. We experienced a 21-year-old man with recurrent acute ischemic enteritis who was diagnosed with capsule endoscopy. He had previously taken medications for pulmonary hypertension and obstruction of both carotid arteries, and about 20 months earlier, he had been admitted due to hematochezia. Two sessions of angiography did not reveal the cause of hematochezia. At that time, capsule endoscopy showed mucosal edema and erythema in the terminal ileum, suggesting healed ischemic enteritis. The patient was admitted again due to hematochezia. Abdominal computed tomography showed focal celiac trunk stenosis and diffuse wall thickening of the small intestine, suggesting ischemic enteritis. Capsule endoscopy showed multiple active ulcers and severe hemorrhage with exudate, extending from the proximal jejunum to the terminal ileum. Using capsule endoscopy, the patient was diagnosed with acute extensive ischemic enteritis. Because endoscopic images of ischemic enteritis have rarely been reported, we report a case of a 21-year-old man who was diagnosed acute extensive ischemic enteritis with capsule endoscopy.

  5. Analysis of diagnoses extracted from electronic health records in a large mental health case register

    Science.gov (United States)

    Kovalchuk, Yevgeniya; Stewart, Robert; Broadbent, Matthew; Hubbard, Tim J. P.; Dobson, Richard J. B.

    2017-01-01

    The UK government has recently recognised the need to improve mental health services in the country. Electronic health records provide a rich source of patient data which could help policymakers to better understand needs of the service users. The main objective of this study is to unveil statistics of diagnoses recorded in the Case Register of the South London and Maudsley NHS Foundation Trust, one of the largest mental health providers in the UK and Europe serving a source population of over 1.2 million people residing in south London. Based on over 500,000 diagnoses recorded in ICD10 codes for a cohort of approximately 200,000 mental health patients, we established frequency rate of each diagnosis (the ratio of the number of patients for whom a diagnosis has ever been recorded to the number of patients in the entire population who have made contact with mental disorders). We also investigated differences in diagnoses prevalence between subgroups of patients stratified by gender and ethnicity. The most common diagnoses in the considered population were (recurrent) depression (ICD10 codes F32-33; 16.4% of patients), reaction to severe stress and adjustment disorders (F43; 7.1%), mental/behavioural disorders due to use of alcohol (F10; 6.9%), and schizophrenia (F20; 5.6%). We also found many diagnoses which were more likely to be recorded in patients of a certain gender or ethnicity. For example, mood (affective) disorders (F31-F39); neurotic, stress-related and somatoform disorders (F40-F48, except F42); and eating disorders (F50) were more likely to be found in records of female patients, while males were more likely to be diagnosed with mental/behavioural disorders due to psychoactive substance use (F10-F19). Furthermore, mental/behavioural disorders due to use of alcohol and opioids were more likely to be recorded in patients of white ethnicity, and disorders due to use of cannabinoids in those of black ethnicity. PMID:28207753

  6. Blunt traumatic rupture of the pericardium with cardiac herniation: two cases diagnosed using computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Schir, F.; Thony, F.; Coulomb, M. [Dept. of Medical Imaging, Michallon Hospital, Grenoble (France); Chavanon, O.; Perez-Moreira, I.; Blin, D. [Dept. of Cardiac Surgery, Michallon Hospital, Grenoble (France)

    2001-06-01

    Traumatic ruptures of the pericardium with cardiac herniation are infrequent, and their radiological pattern little familiar, so that they are often missed preoperatively. Few reports have emphasised the use of a CT scan as a tool for diagnosis and CT scan signs have not been well documented. We report on two cases of traumatic herniation of the heart for which a CT scan brought a major contribution for diagnosis. We describe the presence of an empty pericardial sac on CT slices which allowed us to diagnose the cardiac herniation. These observations demonstrate that CT scans can contribute to the diagnosis of pericardial rupture with cardiac herniation. (orig.)

  7. A systematic review of clinical outcomes for patients diagnosed with skin cancer spinal metastases.

    Science.gov (United States)

    Goodwin, C Rory; Sankey, Eric W; Liu, Ann; Elder, Benjamin D; Kosztowski, Thomas; Lo, Sheng-Fu L; Fisher, Charles G; Clarke, Michelle J; Gokaslan, Ziya L; Sciubba, Daniel M

    2016-05-01

    of a neurological deficit, and nonambulatory status were associated with decreased survival in patients diagnosed with a primary skin cancer spinal metastasis. All other clinical or prognostic parameters were of low or insufficient strength. CONCLUSIONS Patients diagnosed with a primary skin cancer metastasis to the spine have poor overall survival with the exception of those with BCC. The median duration of survival for patients who received surgical intervention alone, medical management (chemotherapy and/or radiation) alone, or the combination of therapies was similar across interventions. Age, spinal region, and neurological status may be associated with poor survival following surgery.

  8. Eosinophilic funiculitis initially diagnosed as irreducible inguinal hernia: A case report.

    Science.gov (United States)

    Yamada, Kohei; Ikubo, Akashi; Ikeda, Shota; Koga, Satoko; Tsuru, Yasuhiro; Kuroki, Hideo; Koya, Naohiko; Samejima, Ryuichiro; Sakai, Masashi; Tabuchi, Masanobu; Yunotani, Seiji; Kido, Shinichi; Nishimura, Kazushige; Meiri, Hiroyuki

    2017-01-01

    Most groin masses are first suspected to be groin hernias. More than 80% of bulging groin lesions are reportedly diagnosed as hernias by ultrasonography. Establishment of the correct diagnosis of hernia among all differential diagnoses is not easy. We herein describe a very rare case of groin eosinophilic funiculitis that presented as an irreducible groin hernia. A 59-year-old man presented to our hospital with suspicion of a right groin hernia. He had a 1-week history of a painful right groin tumor. The tumor was about 4 cm without skin redness or warmth, irreducible even in the supine position, and associated with mild tenderness. Enhanced computed tomography showed that the mass seemed to be connected to the intra-abdominal structures. With time, the patient's pain did not increase, the inflammatory response did not worsen, and no ischemic signs were observed by enhanced computed tomography. Therefore, we diagnosed the tumor as an irreducible but not incarcerated hernia and performed elective surgery. Intraoperative examination revealed no hernia sac, and a 4-×3-cm tumor was observed around the spermatic cord. A malignant tumor was not completely ruled out. High orchiectomy was performed after consultation with the urologists. Pathological examination of the tumor showed no malignant features, and the final diagnosis was eosinophilic funiculitis with massive inflammatory changes and eosinophil invasion. Eosinophilic funiculitis is very rare; only three cases have been reported to date. We should always consider unusual causes of groin masses during a surgical approach to hernia-like lesions. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  9. EEG abnormalities in clinically diagnosed brain death organ donors in Iranian tissue bank.

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    Tavakoli, Seyed Amir Hossein; Khodadadi, Abbas; Azimi Saein, Amir Reza; Bahrami-Nasab, Hasan; Hashemi, Behnam; Tirgar, Niloufar; Nozary Heshmati, Behnaz

    2012-01-01

    Brain death is defined as the permanent, irreversible and concurrent loss of all brain and brain stem functions. Brain death diagnosis is based on clinical criteria and it is not routine to use paraclinical studies. In some countries, electroencephalogram (EEG) is performed in all patients for the determination of brain death while there is some skepticism in relying on EEG as a confirmatory test for brain death diagnosis. In this study, we assessed the validity of EEG and its abnormalities in brain death diagnosis. In this retrospective study, we used 153 EEGs from medical records of 89 brain death patients in organ procurement unit of the Iranian Tissue Bank admitted during 2002-2008. We extracted and analyzed information including EEGs, which were examined by a neurologist for waves, artifacts and EEG abnormalities. The mean age of the patients was 27.2±12.7 years. The most common cause of brain death was multiple traumas due to accident (65%). The most prevalent artifact was electrical transformer. 125 EEGs (82%) were isoelectric (ECS) and seven EEGs (5%) were depictive of some cerebral activity which upon repeat EEGs, they showed ECS patterns too. There was no relationship between cause of brain death and cerebral activity in EEGs of the patients. In this study, we could confirm ECS patterns in all brain death patients whose status had earlier been diagnosed clinically. Considering the results of this study, it seems sensible to perform EEG as a final confirmatory test as an assurance to the patients' families.

  10. Clinical and epidemiological profile of patients diagnosed with neurocysticercosis at two hospitals in Chiclayo, Peru

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    Giuseppe Rojas-Panta

    2017-01-01

    Full Text Available Objective: To describe the clinical and epidemiological profile of patients diagnosed with neurocysticercosis at two hospitals in Chiclayo, Peru. Materials and methods: A descriptive, cross-sectional and retrospective study was performed at the Almanzor Aguinaga Asenjo Hospital and Lambayeque Regional Hospital. Ninety-six (96 medical records of patients attended in 2014 with a diagnosis of neurocysticercosis were reviewed. Results: The mean age of the patients was 42.8 ± 18.8 years old, 52.1% were female, 26% came from Chiclayo and 54.2% received care for the first time. The most common symptom leading to medical consultation was headache. All patients underwent a diagnostic imaging method. The location of the parasite was mostly in the brain and the calcified stage was the most common one. The most widely used treatments were anticonvulsants and pain relievers. Conclusions: Neurocysticercosis mainly affects the economically active population, is more common in women and the most common clinical manifestation is headache

  11. Outcome of tuberculosis treatment in HIV-positive adults diagnosed through active versus passive case-finding

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    Taye T. Balcha

    2015-03-01

    Full Text Available Background: The World Health Organization strongly recommends regular screening for tuberculosis (TB in HIV-positive individuals. Objective: To compare the outcome of anti-tuberculosis treatment (ATT in HIV-positive adults diagnosed with TB through active case-finding (ACF or passive case-finding (PCF. Design: Antiretroviral therapy (ART-naïve adults diagnosed with TB were included from two prospective cohort studies conducted in Ethiopia between September 2010 and March 2013. The PCF cohort was based at out-patient TB clinics, whereas participants in the ACF cohort were actively screened for TB by bacteriological sputum testing (smear microscopy, Xpert MTB/RIF assay, and liquid culture without pre-selection on the basis of symptoms and signs. Outcomes of ATT were compared between participants in the two cohorts; characteristics at diagnosis and predictors of adverse outcomes were analysed. Results: Among 439 TB/HIV co-infected participants, 307 and 132 belonged to PCF and ACF cohorts, respectively. Compared with the ACF participants, hemoptysis, conjunctival pallor, bedridden status, and low mid upper-arm circumference (MUAC were significantly more common in participants identified through PCF. Sputum smear-positivity rates among pulmonary TB cases were 44.2% and 21.1% in the PCF and ACF cohorts, respectively (p<0.001. Treatment success was ascertained in 247 (80.5% of the participants in the PCF cohort and 102 (77.2% of the participants in the ACF cohorts (p=0.223. Low MUAC (p=0.001 independently predicted mortality in the participants in both cohorts. Conclusion: Although patients identified through ACF had less advanced TB disease, ATT outcome was similar to the patients identified through PCF. To achieve a better outcome, case management in ACF strategy should be strengthened through enhanced patient-centred counselling and adherence support.

  12. Decay kinetics of an interferon gamma release assay with anti-tuberculosis therapy in newly diagnosed tuberculosis cases.

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    Ifedayo M O Adetifa

    Full Text Available BACKGROUND: Qualitative and quantitative changes in IGRA response offer promise as biomarkers to monitor Tuberculosis (TB drug therapy, and for the comparison of new interventions. We studied the decay kinetics of TB-specific antigen T-cell responses measured with an in-house ELISPOT assay during the course of therapy. METHODS: Newly diagnosed sputum smear positive TB cases with typical TB chest radiographs were recruited. All patients were given standard anti-TB treatment. Each subject was followed up for 6 months and treatment outcomes were documented. Blood samples were obtained for the ESAT-6 and CFP-10 (EC ELISPOT at diagnosis, 1-, 2-, 4- and 6-months. Qualitative and quantitative reversion of the ELISPOT results were assessed with McNemar test, conditional logistic regression and mixed-effects hierarchical Poisson models. RESULTS: A total of 116 cases were recruited and EC ELISPOT was positive for 87% (95 of 109 at recruitment. There was a significant decrease in the proportion of EC ELISPOT positive cases over the treatment period (p<0.001. Most of the reversion occurred between the start and first month of treatment and at completion at 6 months. ESAT-6 had higher median counts compared to CFP-10 at all time points. Counts for each antigen declined significantly with therapy (p<0.001. Reverters had lower median SFUs at the start of treatment compared to non-Reverters for both antigens. Apart from the higher median counts for non-Reverters, no other risk factors for non-reversion were found. CONCLUSIONS: TB treatment induces qualitative and quantitative reversion of a positive in-house IGRA in newly diagnosed cases of active TB disease. As this does not occur reliably in the majority of cured individuals, qualitative and quantitative reversion of an IGRA ELISPOT has limited clinical utility as a surrogate marker of treatment efficacy.

  13. Three cases of systemic amyloidosis successfully diagnosed by subcutaneous fat tissue biopsy of the hip.

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    Arahata, Masahisa; Shimadoi, Shigeru; Yamatani, Satosi; Hayashi, Shin-Ichi; Miwa, Shigeharu; Asakura, Hidesaku; Nakao, Shinji

    2016-01-01

    Fine-needle aspiration biopsy of the abdominal fat pad is considered to be a minimally invasive procedure for diagnosing systemic amyloidosis. However, this procedure is sometimes difficult and can be dangerous for elderly patients whose abdominal fat layer is thin because of malnutrition. In such cases, alternative diagnostic methods are required. We report three elderly patients with heart failure complicated by malnutrition. In all cases, electrocardiogram showed low voltage in the limb leads and a pseudoinfarct pattern in the chest leads, and echocardiography showed left ventricular wall thickening with granular sparkling appearance. These patients were suspected of having amyloid cardiomyopathy but could not undergo myocardial biopsies because of their poor conditions. After failed attempts at biopsy of the abdominal fat pad or the other organs, subcutaneous fat tissue biopsy over the hip led to the diagnosis of systemic amyloidosis with cardiomyopathy. The resultant diagnosis guided us to choose the appropriate treatment for the patients. This article illustrates that subcutaneous fat tissue biopsy of the hip could be a useful procedure for diagnosing systemic amyloidosis in elderly patients, particularly when a fat tissue biopsy of the abdomen is associated with a high risk of complications because of malnutrition.

  14. Increasing frequency of feline cytauxzoonosis cases diagnosed in western Kentucky from 2001 to 2011.

    Science.gov (United States)

    Miller, Jean; Davis, Cheryl D

    2013-11-15

    Feline cytauxzoonosis is a rapidly progressing and usually fatal disease in domestic cats caused by the tick-borne pathogen, Cytauxzoon felis. The primary reservoir host for this protozoan parasite is the bobcat (Lynx rufus). In this retrospective study, we have examined the positive cases of feline cytauxzoonosis identified at Murray State University's Breathitt Veterinary Center, a regional diagnostic facility located in Hopkinsville, Kentucky, between January 2001 and December 2011. Center records reveal that there has been an increase in the rate of diagnosis of domestic feline infection with C. felis over that 10-year span with the majority of cases (75%) occurring between 2006 and 2011. The infection was diagnosed from March through October and showed a single peak in May, corresponding well with the questing period for the lone star tick, Amblyomma americanum, a known vector of C. felis.

  15. The clinical utility of pleural YKL-40 levels in diagnosing pleural effusions

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    Gumus, Aziz; Cinarka, Halit; Murat, Naci; Yilmaz, Adnan; Bedir, Recep; Sahin, Unal

    2013-01-01

    Background and objective Recent evidence suggests that YKL-40 is a relatively new biomarker of inflammation and it is involved in the pathogenesis of several pulmonary diseases. Details of serum and pleural YKL-40 in pleural effusions however, remain unknown. We aimed to assess whether serum and pleural YKL-40 is an accurate biomarker of pleural effusions. Methods This clinical study was prospective, observational and cross-sectional. The concentrations of serum and pleural fluid YKL-40 and conventional pleural marker levels were measured in 80 subjects with pleural effusions, including 23 transudates caused by congestive heart failure (CHF), and 57 exudates including 23 parapneumonic, 22 malignant and 12 tuberculous pleural effusions (TBPEs). Results Median pleural fluid YKL-40 levels were higher in exudates than in transudates (219.4 and 205.9 ng/mL, respectively, P215 ng/mL, yielded a 73% sensitivity, 73% specificity, likelihood ratio 2.8 for diagnosing exudate, with an area under the curve of 0.770 [95% confidence intervals (CI): 0.657-0.884]. Pleural YKL-40/serum YKL-40 ratio >1.5 yielded a 75% sensitivity, 72% specificity and likelihood ratio 2.6 for diagnosing TBPE, with an area under the curve of 0.825 (95% CI: 0.710-0.940). Conclusions High concentrations of pleural YKL-40 level may help to differentiate exudate from transudate and a high pleural YKL-40/serum YKL-40 ratio may be helpful in seperating TBPE from non-tuberculous effusions. PMID:24255777

  16. Early Onset Marfan Syndrome: Atypical Clinical Presentation of Two Cases

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    Ozyurt Abdullah

    2015-06-01

    Full Text Available Early onset Marfan Syndrome (eoMFS is a rare, severe form of Marfan Syndrome (MFS. The disease has a poor prognosis and most patients present with resistance to heart failure treatment during the newborn period. This report presents two cases of eoMFS with similar clinical features diagnosed in the newborn period and who died at an early age due to the complications related to the involvement of the cardiovascular system.

  17. Apicetomy or dental implant: Report of a clinical case.

    OpenAIRE

    Enrique Fernández-Bodereau; Patricia Tortolini

    2012-01-01

    We report a clinical case of a patient who underwent apicectomy on an upper premolar, presumably by endodontic done improperly, and have cast a bolt where the extraction run the risk of tooth fracture. Failed such treatment, an implant is performed, placed immediately after extraction, in which bone filling with xenograft and guided bone regeneration with resorbable collagen membrane was done. From this we deduce that the phase diagnosed is of paramount importance. Two months after functional...

  18. A clinical decision model identifies patients at risk for delayed diagnosed injuries after high-energy trauma.

    Science.gov (United States)

    Snoek, Anniek; Dekker, Maaike; Lagrand, Tjerk; Epema, Anniek; van der Ploeg, Tjeerd; van den Brand, J G H

    2013-06-01

    Tertiary trauma survey is widely implemented in trauma care to identify all injuries in trauma patients. However, various studies consistently show that some trauma patients have missed injuries. In this study, we developed a clinical decision model to identify patients who are at risk for delayed diagnosed injuries. During a period of 18 months, we collected the medical records of all the adult patients who presented after a high-energy trauma at the emergency department of a Dutch trauma centre. The type of trauma, patient characteristics, the radiology studies performed, Glasgow Coma Scale, Revised Trauma Score, and Injury Severity Score (ISS) were registered. We thoroughly screened all medical records for delayed diagnosed injuries. Stepwise logistic regression analysis was used to identify the variables associated with the outcome delayed diagnosed injuries and to develop a clinical prediction model. We included 475 patients. Thirteen (2.7%) patients with delayed diagnosed injuries were identified. Stepwise logistic regression analysis revealed several models with the ISS, ICU admittance, and CT-head as predictive variables. The model we proposed with the ISS could identify patients who are at a risk for delayed diagnosed injuries with a sensitivity of 92.3% and a specificity of 86.4%. Our newly developed clinical decision model can identify patients who are at a risk for delayed diagnosed injuries and who should undergo an intensified search for potential unidentified injuries.

  19. Clinical analysis of cases of neonatal Streptococcus agalactiae sepsis.

    Science.gov (United States)

    Zeng, S J; Tang, X S; Zhao, W L; Qiu, H X; Wang, H; Feng, Z C

    2016-06-17

    With the advent of antibiotic resistance, pathogenic bacteria have become a major threat in cases of neonatal sepsis; however, guidelines for treatment have not yet been standardized. In this study, 15 cases of neonatal Streptococcus agalactiae sepsis from our hospital were retrospectively analyzed. Of these, nine cases showed early-onset and six cases showed late-onset sepsis. Pathogens were characterized by genotyping and antibiotic sensitivity tests on blood cultures. Results demonstrated that in cases with early-onset sepsis, clinical manifestations affected mainly the respiratory tract, while late-onset sepsis was accompanied by intracranial infection. Therefore, we suggest including a cerebrospinal fluid examination when diagnosing neonatal sepsis. Bacterial genotyping indicated the bacteria were mainly type Ib, Ia, and III S. agalactiae. We recommend treatment with penicillin or ampicillin, since bacteria were resistant to clindamycin and tetracycline. In conclusion, our results provide valuable information for the clinical treatment of S. agalactiae sepsis in neonatal infants.

  20. Chronic kidney disease in Nigeria: an evaluation of the spatial accessibility to healthcare for diagnosed cases in Edo State

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    Osaretin Oviasu

    2016-05-01

    Full Text Available Chronic kidney disease (CKD is a growing problem in Nigeria, presenting challenges to the nation’s health and economy. This study evaluates the accessibility to healthcare in Edo State of CKD patients diagnosed between 2006 and 2009. Using cost analysis techniques within a geographical information system, an estimated travel time to the hospital was used to examine the spatial accessibility of diagnosed patients to available CKD healthcare in the state. The results from the study indicated that although there was an annual rise in the number of diagnosed cases, there were no significant changes in the proportion of patients that were diagnosed at the last stage of CKD. However, there were indications that the travel time to the hospital for CKD treatment might be a contributing factor to the number of diagnosed CKD cases. This implies that the current structure for CKD management within the state might not be adequate.

  1. Examining the Stability of Experts' Clinical Case Processing: An Experimental Manipulation

    Science.gov (United States)

    De Bruin, Anique B. H.; Van De Wiel, Margaretha W. J.; Rikers, Remy M. J. P.; Schmidt, Henk G.

    2005-01-01

    The present study was undertaken to examine the hypothesis that the intermediate effect in clinical case recall is partly explained by experts' lower motivation to write down "everything" they remember when asked for free recall. Medical experts and students were presented with two clinical cases, which they had to read, diagnose, and recall.…

  2. Dedifferentiated Liposarcoma in the Spermatic Cord Finally Diagnosed at 7th Resection of Recurrence: A Case Report and Bibliographic Consideration

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    Kento Morozumi

    2017-08-01

    Full Text Available Liposarcoma in the spermatic cord is infrequent, and accurate diagnosis of histopathological subtype is often difficult in spite of the importance of differential diagnosis for adequate treatment. A 54-year-old man underwent left-sided high orchiectomy with inguinal lymphadenectomy for a spermatic cord tumor in July 2006. The initial histopathological report diagnosed leiomyosarcoma in the spermatic cord. He then underwent surgeries for repeated recurrences a further 6 times between July 2008 and May 2014. Pathological finding at the 7th resection of the recurrent tumor was osteosarcoma, which was uncommon in the spermatic cord. With a thorough overview of all specimens, the histopathological diagnosis was finally confirmed as dedifferentiated liposarcoma because of a biphasic pattern in the specimen of high orchiectomy at the first resection. A biphasic pattern represents high-grade sarcoma like osteosarcoma and well-differentiated liposarcoma, and is characteristic of dedifferentiated liposarcoma. Although the dedifferentiated type is one of poor prognosis, the diagnosing of liposarcoma histopathologically was found to be difficult throughout this case. In this report we discuss the accurate histopathological diagnosis of liposarcoma in the spermatic cord in order to prevent repeated recurrences based on a review of the literature, as well as the difficulty in recognizing dedifferentiated liposarcoma macroscopically and morphologically. Our experience suggests that, after much difficulty, accurate histopathological diagnosis of liposarcoma in the spermatic cord is still clinically challenging.

  3. Family Functioning and Maternal Anxiety Among Cases Diagnosed With Adhd: A Comparison Study

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    Gonca OZYURT

    2015-10-01

    Full Text Available Aim: Attention Deficit Hyperactivity Disorder (ADHD is one of the most common childhood neurodevelopmental disorders. Factors related with parents affect family functioning and make changes in ADHD symptoms. We aimed to evaluate maternal anxiety and family functioning in children with ADHD comparing with controls and their mothers. Method: The study group consisted of 62 children (6-12 years old diagnosed with Attention Deficit Hyperactivity Disorder. The control group (62 children comprised patients of other clinics at hospital and was matched for gender and age to the ADHD patients. The Kiddie Schedule for Affective Disorders and Schizophrenia for School Aged Children- Present and Lifetime Version (K-SADS-PL was used to diagnose ADHD and allowed comorbidities. All patients were treatment-naive. DuPaul Attention Deficit and Hyperactivity Disorder-Rating Scale -IV Inventory for ADHD symptoms, Family Assessment Device (FAD for family functioning, State Trait Anxiety Inventory for maternal anxiety were used. Results: There was no significant difference between sociodemographic data of two groups. The families of children with ADHD had more family dysfunction in roles, behavioral control, affective involvement subscales. Mothers of children with ADHD had higher scores than controls in State and Trait Anxiety Inventory forms. Conclusion: ADHD generally continues into adolescence and adulthood, and multiple functional impairments can occur due to ADHD. If the relationship between maternal anxiety; family functioning, and ADHD is understood well, treatment of ADHD will be provided more effectively.

  4. AGENESIS OF GALL BLADDER DIAGNOSED INTRA-OPERATIVEL Y: A CASE REPORT

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    Somorjit Singh

    2013-04-01

    Full Text Available ABSTRACT : BACKGROUND : Congenital absence of GB is a rare anomaly occurrin g in less than 1 in 1000 population. These patients’ complaints of tho se of more common biliary conditions and routine radiological and biochemical investigat ion makes difficult to diagnose preoperatively and patients undergo unnecessary operat ive intervention. MATERIALS AND METHODS : A 18 years old female with clinical features of Ch olecystitis diagnosed by USG as Contracted GB with Cholelithiasis was operated for O pen Cholecystectomy. Intra-operatively, the GB could not be seen even after thorough dissec tion. Post operative MRCP confirmed the diagnosis of absence of GB. RESULTS: The patient having the classical features of Gall St one disease with the routine investigative reports, had undergone Operation .As the gall bladder was not found , the procedure was terminated and post operative MRCP confirmed the diagnosis of absence of GB. CONCLUSION: The rare congenital anomaly of absence of GB may have common biliary conditions, and so patients may undergo unnecessary operative procedures. With the newer minimally invasive radiol ogic techniques, this situation can largely be avoided if awareness of this condition is improve d.

  5. 613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review

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    Aubrey-Bassler F

    2012-08-01

    Full Text Available Abstract Background Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. Methods Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. Results We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143, haematologic (n = 84 and non-haematologic neoplasms (n = 48. Amyloidosis (n = 24, internal trauma such as cough or vomiting (n = 17 and rheumatologic diseases (n = 10 are less frequently reported. Colonoscopy (n = 87 was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6, infarction (n = 6 and hamartomata (n = 5. Medications associated with rupture include anticoagulants (n = 21, thrombolytics (n = 13 and recombinant G-CSF (n = 10. Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm

  6. Urothelial carcinoma of the upper urinary tract diagnosed via FGFR3 mutation detection in urine: a case report

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    Silverberg Daniel M

    2012-08-01

    Full Text Available Abstract Background Upper urinary tract cancer is typically diagnosed with urine cytology and imaging techniques. These assays can be limited by sensitivity, specificity, or technical issues making some diagnoses difficult. Case presentation A 73-year old man presented to the clinic with a right renal pelvis filling defect that was detected by a CT-scan performed for unrelated reasons. Urine cytology was negative. Cystoscopy, retrograde pyelogram, and partial ureteroscopy were unable to visualize the lesion resulting in an indeterminate diagnosis. A subsequent CT scan confirmed the renal lesion which appeared to have become larger and was consistent with urothelial carcinoma. A urine based genetic assay was used to test for the presence of urothelial carcinoma. This assay evaluates the presence of mutations in fibroblast growth factor receptor 3 (FGFR3. Mutations in FGFR3 are known to be associated with urothelial carcinoma and have a positive predictive value of 95% when detected in patients with no history of TCC. A mutation in exon 10 (Y375C of FGFR3 was identified. Nephroureterectomy was performed and the subsequent pathology confirmed urothelial carcinoma. In addition, PCR analysis on isolated tumor tissue indicated the tumor carried the same FGFR3 mutation as that of the DNA isolated from urine, consistent with the tumor being the origin of the mutant DNA. Conclusion This study indicates that the FGFR3 urine assay, which was originally developed to monitor bladder cancer, is also a useful tool for diagnosing upper urinary tract cancer in a real-life setting.

  7. A Case of Intestinal Obstruction in Pregnancy Diagnosed by MRI and Treated by Intravenous Hyperalimentation

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    Atsushi Daimon

    2016-01-01

    Full Text Available Intestinal obstruction in pregnancy is rare and is mainly caused by prior pelvic surgery. We herein report a case of intestinal obstruction in a pregnant female with a history of laparoscopic myomectomy, who presented with hypogastric pain, abdominal distension, and vomiting at 26 weeks of gestation. A simple intestinal obstruction was diagnosed by MRI. Conservative treatments, including intravenous hyperalimentation and the placement of an ileus tube, were provided and her abdominal symptoms improved for 14 days. After restarting oral intake, she had no abdominal symptoms. She gave birth to a 2,146 g female infant by caesarean section at 37 weeks and 1 day of gestation. Although an area of cicatrization, which was thought to have been the starting point of the occlusion that caused the intestinal obstruction, was found, the excision of the small intestine was not necessary. Her postoperative course was uneventful. Intestinal obstruction requires a prompt diagnosis and aggressive intervention may be necessary to minimize the morbidity and mortality associated with this rare complication of pregnancy. MRI can be safely used during pregnancy to diagnose intestinal obstruction and intravenous hyperalimentation may improve the maternal and fetal prognoses.

  8. Two diagnoses become one? Rare case report of anorexia nervosa and Cushing’s syndrome

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    Sawicka N

    2013-03-01

    Full Text Available Nadia Sawicka,* Maria Gryczyńska,* Jerzy Sowiński, Monika Tamborska-Zedlewska, Marek Ruchała Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland*These authors contributed equally to this workAbstract: Hypothalamic-pituitary-adrenal axis impairment in anorexia nervosa is marked by hypercortisolemia, and psychiatric disorders occur in the majority of patients with Cushing’s syndrome. Here we report a patient diagnosed with anorexia nervosa who also developed Cushing’s syndrome. A 26-year-old female had been treated for anorexia nervosa since she was 17 years old, and also developed depression and paranoid schizophrenia. She was admitted to the Department of Endocrinology, Metabolism, and Internal Medicine with a preliminary diagnosis of Cushing’s syndrome. Computed tomography revealed a 27 mm left adrenal tumor, and she underwent laparoscopic adrenalectomy. She was admitted to hospital 6 months after this procedure, at which time she did not report any eating or mood disorder. This is a rare case report of a patient with anorexia nervosa in whom Cushing’s syndrome was subsequently diagnosed. Diagnostic difficulties were caused by the signs and symptoms presenting in the course of both disorders, ie, hypercortisolemia, osteoporosis, secondary amenorrhea, striae, hypokalemia, muscle weakness, and depression.Keywords: anorexia nervosa, Cushing’s syndrome, adrenalectomy, osteoporosis

  9. Diagnosing postpartum depression in a mother of developmentally delayed infant: a case report

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    Genco Usta

    2015-12-01

    Full Text Available Postpartum depression is the most common clinical entity of childbirth. Although there are conflicting results about the influence of postpartum depression on the children, the consequences of the illness might extend to preschool age or further. Because physicians encounter mothers at the same time with the babies in the examination room, it might be of particular importance to have the knowledge of symptoms of maternal depression and pay attention to the mental and physical well-being of both the mother and the baby. In this article we would like to present an 18 month old child who presented with psychomotor retardation with a mother diagnosed as postpartum depression. [Int J Reprod Contracept Obstet Gynecol 2015; 4(6.000: 2056-2058

  10. Psychiatric disorders in individuals diagnosed with infantile autism as children: a case control study

    DEFF Research Database (Denmark)

    Mouridsen, Svend Erik; Rich, Bente; Isager, Torben

    2008-01-01

    Psychiatric Central Register. The average observation time was 32.5 years, and mean age at follow-up was 40.6 years (range 25-55 years). Of the 118 individuals with IA, 57 (48.3%) had been in contact with psychiatric hospitals (inpatient hospitalization or outpatient visits) during the follow-up period......The objective of this study was to compare the prevalence and types of psychiatric disorders in a clinical sample of 118 individuals diagnosed as children with infantile autism (IA) with psychiatric disorders in 336 matched controls from the general population using data from the nationwide Danish......, compared with 20/336 (6.0%) in the control group (p IA. Of the 118 individuals in the IA group, 20 individuals (17%) had been given a comorbid...

  11. Psychiatric disorders in individuals diagnosed with infantile autism as children: A case control study

    DEFF Research Database (Denmark)

    Mouridsen, S.E.; Rich, B.; Isager, T.

    2008-01-01

    Psychiatric Central Register. The average observation time was 32.5 years, and mean age at follow-up was 40.6 years (range 25-55 years). Of the 118 individuals with IA, 57 (48.3%) had been in contact with psychiatric hospitals (inpatient hospitalization or outpatient visits) during the follow-up period......The objective of this study was to compare the prevalence and types of psychiatric disorders in a clinical sample of 118 individuals diagnosed as children with infantile autism (IA) with psychiatric disorders in 336 matched controls from the general population using data from the nationwide Danish......, compared with 20/336 (6.0%) in the control group (p IA. Of the 118 individuals in the IA group, 20 individuals (17%) had been given a comorbid...

  12. Gender differences in disease activity and clinical features in newly diagnosed systemic lupus erythematosus patients.

    Science.gov (United States)

    Muñoz-Grajales, C; González, L A; Alarcón, G S; Acosta-Reyes, J

    2016-10-01

    The objective of this paper is to compare disease activity and clinical features at diagnosis in male and female patients with systemic lupus erythematosus (SLE). This was a cross-sectional study in which every male patient (n = 40) was matched with three female patients of the same age (±5 years) and racial/ethnic group; disease activity as per the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and disease manifestations at the time of diagnosis were compared. Alopecia and anti-Ro antibodies were more frequent in female patients. No statistically significant difference in any other disease characteristics was found. However, male gender was associated with a risk of severe disease activity at the time of diagnosis (as determined by SLEDAI ≥12 score) independent of age, racial/ethnic group, anti-Ro positivity or time to criteria accrual (OR: 3.11 95% CI, 1.09-8.92; p = 0.035). In newly diagnosed SLE patients, male gender is associated with higher disease activity despite the fact that male and female patients seem to experience similar overall disease manifestations. © The Author(s) 2016.

  13. Clinical value of MRI and acute madopar responsiveness test in diagnosing progressive supranuclear palsy

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    LI Xiao-hong

    2013-07-01

    Full Text Available Objective To investigate the MRI abnormalities and acute madopar responsiveness test in diagnosing progressive supranuclear palsy (PSP and Parkinson's disease (PD. Methods Seventeen patients with PSP and 17 gender and age matched patients with PD were studied with cranial MRI examinations and results of acute madopar responsiveness test, and the clinical manifestations of PSP were summarized. Results The atrophy of the midbrain tegmentum and hummingbird sign was demonstrated in all of the PSP patients in our study, but was not observed in the PD patients. The areas of the midbrain on mid-sagittal MRI in PSP patients [(77.35 ± 15.30 mm2] were significantly smaller than that in those with PD [(142.35 ± 31.49 mm2]. The average ratio of the area of the midbrain to the area of pons in the patients with PSP [(14.31 ± 2.47%] was significantly smaller than that in those with PD [(24.08 ± 4.73%; P = 0.000, for all]. According to the result of acute madopar responsiveness test, the maximum Unified Parkinson's Disease Rating Scale (UPDRS Ⅲ improvement rate of 2 patients with PSP and 16 patients with PD was more than 30% (χ2 = 23.142, P = 0.000. Conclusion The assessment of the mid-sagittal MRI and acute madopar responsiveness test may be a useful method to differentiate PSP from PD.

  14. [Report on 16 cases of small intestine ascariasis diagnosed by capsule endoscopy].

    Science.gov (United States)

    Wang, Pu; Li, Rong-Zhi; Huang, Zhi-Yin; Tang, Cheng-Wei

    2013-06-01

    The clinical data and capsule endoscopy image of 16 adult patients with small intestine ascariasis were reviewed and analyzed retrospectively from June 2006 to June 2012 in West China Hospital. Among the 16 patients, 15 cases manifested as gastrointestinal bleeding, 15 cases showed anemia (3 severe, 10 moderate, and 2 mild), 2 had hypoalbuminemia, 1 had peripheral blood eosinophilia. All the cases were found to be fecal occult blood positive, but no Ascaris eggs found in the feces. Capsule endoscopy showed they were infected with Ascaris worms. The worms were found in the proximal small intestine in 14 patients and 2 in the distal intestine. Mucosal erythema and erosions around the worm were observed in 3 cases, and 7 cases were found with active bleeding or old haemorrhage in small intestine.

  15. Reporting of clinically diagnosed dementia on death certificates: retrospective cohort study

    Science.gov (United States)

    Perera, Gayan; Stewart, Robert; Higginson, Irene J.; Sleeman, Katherine E.

    2016-01-01

    Background: mortality statistics are a frequently used source of information on deaths in dementia but are limited by concerns over accuracy. Objective: to investigate the frequency with which clinically diagnosed dementia is recorded on death certificates, including predictive factors. Methods: a retrospective cohort study assembled using a large mental healthcare database in South London, linked to Office for National Statistics mortality data. People with a clinical diagnosis of dementia, aged 65 or older, who died between 2006 and 2013 were included. The main outcome was death certificate recording of dementia. Results: in total, 7,115 people were identified. Dementia was recorded on 3,815 (53.6%) death certificates. Frequency of dementia recording increased from 39.9% (2006) to 63.0% (2013) (odds ratio (OR) per year increment 1.11, 95% CI 1.07–1.15). Recording of dementia was more likely if people were older (OR per year increment 1.02, 95% CI 1.01–1.03), and for those who died in care homes (OR 1.89, 95% CI 1.50–2.40) or hospitals (OR 1.14, 95% CI 1.03–1.46) compared with home, and less likely for people with less severe cognitive impairment (OR 0.95, 95% CI 0.94–0.96), and if the diagnosis was Lewy body (OR 0.30, 95% CI 0.15–0.62) or vascular dementia (OR 0.79, 95% CI 0.68–0.93) compared with Alzheimer's disease. Conclusions: changes in certification practices may have contributed to the rise in recorded prevalence of dementia from mortality data. However, mortality data still considerably underestimate the population burden of dementia. Potential biases affecting recording of dementia need to be taken into account when interpreting mortality data. PMID:27146301

  16. Bayesian comparison of cost-effectiveness of different clinical approaches to diagnose coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Patterson, R.E.; Eng, C.; Horowitz, S.F.; Gorlin, R.; Goldstein, S.R.

    1984-08-01

    The objective of this study was to compare the cost-effectiveness of four clinical policies (policies I to IV) in the diagnosis of the presence or absence of coronary artery disease. A model based on Bayes theorem and published clinical data was constructed to make these comparisons. Effectiveness was defined as either the number of patients with coronary disease diagnosed or as the number of quality-adjusted life years extended by therapy after the diagnosis of coronary disease. The following conclusions arise strictly from analysis of the model and may not necessarily be applicable to all situations. As prevalence of coronary disease in the population increased, it caused a linear increase in cost per patient tested, but a hyperbolic decrease in cost per effect, that is, increased cost-effectiveness. Thus, cost-effectiveness of all policies (I to IV) was poor in populations with a prevalence of disease below 10%. Analysis of the model also indicates that at prevalences less than 80%, exercise thallium scintigraphy alone as a first test (policy II) is a more cost-effective initial test than is exercise electrocardiography alone as a first test (policy I) or exercise electrocardiography first combined with thallium imaging as a second test (policy IV). Exercise electrocardiography before thallium imaging (policy IV) is more cost-effective than exercise electrocardiography alone (policy I) at prevalences less than 80%. 4) Noninvasive exercise testing before angiography (policies I, II and IV) is more cost-effective than using coronary angiography as the first and only test (policy III) at prevalences less than 80%. 5) Above a threshold value of prevalence of 80% (for example patients with typical angina), proceeding to angiography as the first test (policy III) was more cost-effective than initial noninvasive exercise tests (policies I, II and IV).

  17. [Congenital retinal folds in different clinical cases].

    Science.gov (United States)

    Munteanu, M

    2005-01-01

    We present 12 clinical cases of congenital retinal folds with different etiologies: posterior primitive vitreous persistency and hyperplasia (7 cases),retinocytoma (1 case). retinopathy of prematurity (1 case), astrocytoma of the retina (1 case), retinal vasculitis (1 case), Goldmann-Favre syndrome (1 case). Etiopathogenic and nosological aspects are discussed; the congenital retinal folds are interpreted as a symptom in a context of a congenital or acquired vitreo-retinal pathology.

  18. THE ROLE OF AUTOPSY IN MEDICAL INTENSIVE CARE UNIT: COMPARISON OF CLINICAL AND POSTMORTEM DIAGNOSES

    Directory of Open Access Journals (Sweden)

    Vandana Tukaram

    2016-03-01

    Full Text Available BACKGROUND Autopsy is an essential auditing tool in clinical practice. The autopsy teaches us not only what is killing people right now, but points to what will kill us in the near future. This is the first autopsy study in Medical Intensive Care Unit (MICU in India as per our knowledge. METHODS Retro-prospective study of total of 141 medical autopsies of MICU deaths performed in the Department of Pathology during a period of three years. A meticulous study was performed to compare ante-mortem clinical diagnosis and post-mortem final cause of death. Cases showing a discrepancy between the clinical diagnosis and post-mortem final cause of death were categorized into IV classes according to Goldman classification. RESULTS Maximum autopsies were performed in 21-40 years (58.15%. Female preponderance noted. Non-infectious aetiology was most common cause of death (50%, of which lesions of respiratory system were the most common (33.8%. Amongst the infections, pneumonia was the most common cause of death (29.23%. Discrepancies between ante-mortem and post-mortem were noted in 63 cases (44.68%. Class I and class II discrepancies were 49.21% and 44.45%, respectively. CONCLUSION Our study stresses that routine autopsy is still very useful in MICU and emphasis must be placed on autopsy evaluation for the improvement of quality of patient care.

  19. Nine (9) marker chromosomes diagnosed prenatally in 6,234 cases and their outcome

    Energy Technology Data Exchange (ETDEWEB)

    Raghunathan, L.; Demarest, A.; Wisniewski, L. [Medical Genetics Emanuel Hospital & Health Center, Portland, OR (United States)] [and others

    1994-09-01

    Marker chromosomes have a frequency of 0.06-0.08 per 1000 in prenatal diagnosis specimens and often pose a dilemma in counseling because of an inability in most cases to identify the marker chromosome cytogenetically. An attempt is made in this study to characterize the marker chromosomes we found in our prenatal diagnosis from 1991-1993. We diagnosed 9 cases of marker chromosomes out of 6,234 prenatal diagnostic studies. Eight cases were patients referred because of advanced maternal age and one (GS) was referred after abnormal ultrasound findings. Six cases were mosaic for a marker. Seven of these patients continued their pregnancies, one patient had a dizygotic twin pregnancy (CM) where the co-twin had normal chromosome complement. Parental chromosomes on all of these cases were normal (in one couple the wife (VA) had a 46,XX/47,XXX karyotype). Special staining methods used for identifying the markers were DAPI/DA, NOR, C, R and FISH. Of the seven pregnancies that were continued, two babies were born with complications, and one of them (GS) subsequently died at six months of age. The marker in this baby was identified as chromosome 14 in origin by FISH. The other (LM) baby was born with extrophy of the bladder. The marker in the dizygotic twin (CM) was identified as chromosome 13 in origin by FISH. The rest of the pregnancies with a marker chromosome had a normal outcome with phenotypically normal babies without any complications. By parental report, babies were developing normally at 1 day (VA), 4 months (CM), 8 months (CL), 9 months (KP) and 22 months (EN) of age. Results of FISH studies on these cases will be presented along with a detailed table.

  20. Time trend in Alzheimer diagnoses and the association between distance to an Alzheimer clinic and Alzheimer diagnosis

    DEFF Research Database (Denmark)

    Jørgensen, Terese Sara Høj; Torp-Pedersen, Christian; Gislason, Gunnar H.

    2015-01-01

    BACKGROUND: Centralization of specialized health care in Denmark has caused increased geographical distance to health-care providers, which may be a barrier for Alzheimer patients to seek health care. We examined the incidence of Alzheimer diagnosis in Denmark between 2000 and 2009 and investigated...... the association between patients' distance to Alzheimer clinics and Alzheimer diagnoses. METHODS: Data of all individuals aged 65+ years were collected from Danish national registers. Incidences of Alzheimer diagnoses were analysed with joinpoint regression and hazard ratios (HRs) for Alzheimer diagnoses were...... analysed with Cox regressions. RESULTS: The annual incidence of Alzheimer diagnoses increased with 32.5% [95% confidence interval (CI): 7.1-63.8] among individuals aged 65-74 years from 2000 to 2002 and with 29.1% (95% CI: 11.0-50.2) among individuals aged 75+ years from 2000 to 2003. For both groups...

  1. Ossifying fibromyxoid tumor of the breast mimicking fibroadenoma: a case report and differential diagnoses.

    Science.gov (United States)

    Asirvatham, Jaya Ruth; Shah, Anand; Carreon, Chrystalle Katte; Bhuiya, Tawfiqul A; Kahn, Leonard B; Kostroff, Karen; Morgenstern, Nora J

    2014-08-01

    An 80-year-old woman presented with a palpable mass in the right breast. Mammographic findings were consistent with calcified fibroadenoma. An ultrasound was performed that showed a solid nodule with peripheral calcification. A core biopsy was obtained that revealed a spindle cell proliferation with a shell of mature bone. The histologic features, in combination with immunohistochemical studies, were those of an ossifying fibromyxoid tumor. Complete excision of the specimen further confirmed the diagnosis. To the best of our knowledge, this is the first reported case of ossifying fibromyxoid tumor occurring in the breast. We review the current literature on ossifying fibromyxoid tumor and discuss the differential diagnoses when confronted with bland spindle cells on a core biopsy of the breast.

  2. An easy method for diagnosing macro-aspartate aminotransferase: a case series.

    Science.gov (United States)

    Beşer, Omer Faruk; Laçinel, Sibel; Gülcü, Didem; Kutlu, Tufan; Cullu Çokuğraş, Fügen; Erkan, Tülay

    2014-10-01

    Macro-aspartate transaminase (macro-AST) must be considered when the aspartate transaminase (AST) level is chronically high without any liver, cardiac, or muscle disease. Many specialized laboratory techniques have been recommended for diagnosing macro-AST, including the polyethylene glycol immune precipitate technique, which is simple. This study presents a considerably easier method based on the studies of Davidson and Watson and Castiella et al. Our method is based on the decrease in the plasma AST level after storage of the macroenzyme at 2-8 °C for 5 days, and has the advantages of low cost, reliability, and practicality at any health center. In our eight cases of macro-AST, the AST activity at day 6 had decreased by more than 50% from day 1. This method is practical for primary healthcare facilities because of its easy application and accurate results, and obviated the need for unnecessary tests after diagnosis.

  3. Three cases of systemic amyloidosis successfully diagnosed by subcutaneous fat tissue biopsy of the hip

    Directory of Open Access Journals (Sweden)

    Arahata M

    2016-08-01

    Full Text Available Masahisa Arahata,1 Shigeru Shimadoi,1 Satosi Yamatani,1 Shin-ichi Hayashi,2 Shigeharu Miwa,2 Hidesaku Asakura,3 Shinji Nakao4 1Department of Internal Medicine, Nanto Municipal Hospital, Nanto, 2Department of Diagnostic Pathology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, 3Department of Internal Medicine (III, 4Department of Cellular Transplantation Biology, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan Abstract: Fine-needle aspiration biopsy of the abdominal fat pad is considered to be a minimally invasive procedure for diagnosing systemic amyloidosis. However, this procedure is sometimes difficult and can be dangerous for elderly patients whose abdominal fat layer is thin because of malnutrition. In such cases, alternative diagnostic methods are required. We report three elderly patients with heart failure complicated by malnutrition. In all cases, electrocardiogram showed low voltage in the limb leads and a pseudoinfarct pattern in the chest leads, and echocardiography showed left ventricular wall thickening with granular sparkling appearance. These patients were suspected of having amyloid cardiomyopathy but could not undergo myocardial biopsies because of their poor conditions. After failed attempts at biopsy of the abdominal fat pad or the other organs, subcutaneous fat tissue biopsy over the hip led to the diagnosis of systemic amyloidosis with cardiomyopathy. The resultant diagnosis guided us to choose the appropriate treatment for the patients. This article illustrates that subcutaneous fat tissue biopsy of the hip could be a useful procedure for diagnosing systemic amyloidosis in elderly patients, particularly when a fat tissue biopsy of the abdomen is associated with a high risk of complications because of malnutrition. Keywords: systemic amyloidosis, amyloid cardiomyopathy, fine-needle aspiration biopsy, subcutaneous fat tissue, hip

  4. Hepatosplenic T Cell Lymphoma in an Immunocompetent Female Diagnosed using Flow Cytometry: A Rare Clinical Entity.

    Science.gov (United States)

    Dorwal, Pranav; Sachdev, Ritesh; Pande, Amit; Jain, Dharmendra; Jha, Bhawna; Raina, Vimarsh

    2016-08-01

    Hepatosplenic T-cell lymphoma is a rare haematopoietic malignancy that comprises less than 1% of Non-Hodgkin lymphomas. We are reporting a case of a 26-year-old female, who presented with pallor, weight loss, jaundice, pancytopenia and hepatosplenomegaly. The bone marrow examination showed infiltration by lymphoid cells. These cells on flow cytometric evaluation showed the phenotype of hepatosplenic T cell lymphoma. The cells were positive for CD3, CD8, CD56 and TCR γδ and negative for CD5, CD4, CD8, CD16, CD57, TCRαβ along with B cell markers. This case is reported for being a rare clinical entity and its presence in an immunocompetent female making it rarer.

  5. [Vertical fractures: apropos of 2 clinical cases].

    Science.gov (United States)

    Félix Mañes Ferrer, J; Micò Muñoz, P; Sánchez Cortés, J L; Paricio Martín, J J; Miñana Laliga, R

    1991-01-01

    The aim of the study is to present a clinical review of the vertical root fractures. Two clinical cases are presented to demonstrates the criteria for obtaining a correct diagnosis of vertical root fractures.

  6. High IFIT1 expression predicts improved clinical outcome, and IFIT1 along with MGMT more accurately predicts prognosis in newly diagnosed glioblastoma.

    Science.gov (United States)

    Zhang, Jin-Feng; Chen, Yao; Lin, Guo-Shi; Zhang, Jian-Dong; Tang, Wen-Long; Huang, Jian-Huang; Chen, Jin-Shou; Wang, Xing-Fu; Lin, Zhi-Xiong

    2016-06-01

    Interferon-induced protein with tetratricopeptide repeat 1 (IFIT1) plays a key role in growth suppression and apoptosis promotion in cancer cells. Interferon was reported to induce the expression of IFIT1 and inhibit the expression of O-6-methylguanine-DNA methyltransferase (MGMT).This study aimed to investigate the expression of IFIT1, the correlation between IFIT1 and MGMT, and their impact on the clinical outcome in newly diagnosed glioblastoma. The expression of IFIT1 and MGMT and their correlation were investigated in the tumor tissues from 70 patients with newly diagnosed glioblastoma. The effects on progression-free survival and overall survival were evaluated. Of 70 cases, 57 (81.4%) tissue samples showed high expression of IFIT1 by immunostaining. The χ(2) test indicated that the expression of IFIT1 and MGMT was negatively correlated (r = -0.288, P = .016). Univariate and multivariate analyses confirmed high IFIT1 expression as a favorable prognostic indicator for progression-free survival (P = .005 and .017) and overall survival (P = .001 and .001), respectively. Patients with 2 favorable factors (high IFIT1 and low MGMT) had an improved prognosis as compared with others. The results demonstrated significantly increased expression of IFIT1 in newly diagnosed glioblastoma tissue. The negative correlation between IFIT1 and MGMT expression may be triggered by interferon. High IFIT1 can be a predictive biomarker of favorable clinical outcome, and IFIT1 along with MGMT more accurately predicts prognosis in newly diagnosed glioblastoma.

  7. Scoring clinical signs can help diagnose canine visceral leishmaniasis in a highly endemic area in Brazil

    Science.gov (United States)

    da Silva, Kleverton Ribeiro; de Mendonça, Vitor Rosa Ramos; Silva, Kellen Matuzzy; do Nascimento, Leopoldo Fabrício Marçal; Mendes-Sousa, Antonio Ferreira; de Pinho, Flaviane Alves; Barral-Netto, Manoel; Barral, Aldina Maria Prado; Cruz, Maria do Socorro Pires e

    2017-01-01

    Canine visceral leishmaniasis (CVL) diagnosis is still a challenge in endemic areas with limited diagnostic resources. This study proposes a score with the potential to distinguish positive CVL cases from negative ones. We studied 265 dogs that tested positive for CVL on ELISA and parasitological tests. A score ranging between 0 and 19 was recorded on the basis of clinical signs. Dogs with CVL had an overall higher positivity of the majority of clinical signs than did dogs without CVL or with ehrlichiosis. Clinical signs such as enlarged lymph nodes (83.93%), muzzle/ear lesions (55.36%), nutritional status (51.79%), bristle condition (57.14%), pale mucosal colour (48.21%), onychogryphosis (58.93%), skin lesion (39.28%), bleeding (12.50%), muzzle depigmentation (41.07%), alopecia (39.29%), blepharitis (21.43%), and keratoconjunctivitis (42.86%) were more frequent in dogs with CVL than in dogs with ehrlichiosis or without CVL. Moreover, the clinical score increased according to the positivity of all diagnostic tests (ELISA, p < 0.001; parasite culture, p = 0.0021; and smear, p = 0.0003). Onychogryphosis (long nails) [odds ratio (OR): 3.529; 95% confidence interval (CI): 1.832-6.796; p < 0.001], muzzle depigmentation (OR: 4.651; 95% CI: 2.218-9.750; p < 0.001), and keratoconjunctivitis (OR: 5.400; 95% CI: 2.549-11.441; p < 0.001) were highly associated with CVL. Interestingly, a score cut-off value ≥ 6 had an area under the curve of 0.717 (p < 0.0001), sensitivity of 60.71%, and specificity of 73.64% for CVL diagnosis. The clinical sign-based score for CVL diagnosis suggested herein can help veterinarians reliably identify dogs with CVL in endemic areas with limited diagnostic resources. PMID:28076469

  8. The clinical application value of glycosylated hemoglobin(HbA1c) plus fasting plasma glucose in diagnosing diabetes

    Institute of Scientific and Technical Information of China (English)

    程多智

    2012-01-01

    Objective To evaluate clinical application value of HbA1c plus fasting plasma glucose(FPG) in diagnosing diabetes mellitus(DM).Methods 681 patients with DM were enrolled in this study. The level of HbA1c by Bio-RAD-10 glycated hemoglobin analyzer,FPG by OLYMPUS

  9. Diagnosing Borderline Personality Disorder: Examination of How Clinical Indicators Are Used by Professionals in the Health Setting

    Science.gov (United States)

    Treloar, Amanda Jane Commons; Lewis, Andrew J.

    2009-01-01

    This paper reviews the history of the recognition of borderline personality disorder as a clinical disorder, followed by a review of the contemporary practice of diagnosing borderline personality disorder in psychiatric settings. Many researchers have cautioned against the conflation of difficult patients with the diagnostic category of borderline…

  10. Skin and Environmental Contamination in Patients Diagnosed With Clostridium difficile Infection but Not Meeting Clinical Criteria for Testing.

    Science.gov (United States)

    Kundrapu, Sirisha; Sunkesula, Venkata; Tomas, Myreen; Donskey, Curtis J

    2015-11-01

    Of 134 patients diagnosed with Clostridium difficile infection, 30 (22%) did not meet clinical criteria for testing because they lacked significant diarrhea or had alternative explanations for diarrhea and no recent antibiotic exposure. For these patients, skin and/or environmental contamination was common only in those with prior antibiotic exposure.

  11. Contribution of laboratory methods in diagnosing clinically suspected ocular toxoplasmosis in Brazilian patients.

    Science.gov (United States)

    Mattos, Cinara C B; Meira, Cristina S; Ferreira, Ana I C; Frederico, Fábio B; Hiramoto, Roberto M; Almeida, Gildásio C; Mattos, Luiz C; Pereira-Chioccola, Vera L

    2011-07-01

    This prospective study evaluated the value of laboratorial diagnosis in ocular toxoplasmosis analyzing peripheral blood samples from a group of Brazilian patients by immunologic and molecular methods. We analyzed blood samples from 184 immunocompetent patients with ocular disorders divided into 2 groups: Group I, composed of samples from 49 patients with ocular toxoplasmosis diagnosed by clinical features; Group II, samples from 135 patients with other ocular diseases. Samples were assayed by conventional polymerase chain reaction (cnPCR), real-time PCR (qPCR) for Toxoplasma gondii, indirect immunofluorescence reaction (IF), avidity test (crude tachyzoite lysate as antigen), and excreted-secreted tachyzoite proteins as antigen (ESA-ELISA). cnPCR and qPCR profiles were concordant in all samples. Positive PCR was shown in 40.8% of group I patients. The majority of the positive blood samples (75%) were taken from patients with toxoplasmic retinochoroiditis scars, and the others (25%), from patients with retinal exudative lesions. Despite that 86 of the 135 patients from Group II had asymptomatic toxoplasmosis, all DNA blood samples had negative PCR. Concordant results were shown in the data obtained by serologic methods. Around 24% of the patients with ocular toxoplasmosis had high antibody titers determined by ESA-ELISA and IF. Anti-ESA antibodies are shown principally in patients with active infection. Collectively, these data demonstrate the presence of tachyzoites in the blood of patients with chronic infection, supporting the idea of recurrent disease. Circulating parasites in blood of immunocompetent individuals may be associated with the reactivation of the ocular disease.

  12. Clinical diagnoses in 216 insomnia patients using the International Classification of Sleep Disorders (ICSD), DSM-IV and ICD-10 categories: a report from the APA/NIMH DSM-IV Field Trial.

    Science.gov (United States)

    Buysse, D J; Reynolds, C F; Kupfer, D J; Thorpy, M J; Bixler, E; Manfredi, R; Kales, A; Vgontzas, A; Stepanski, E; Roth, T

    1994-10-01

    Three diagnostic classifications for sleep disorders have been developed recently: the International Classification of Sleep Disorders (ICSD), the Diagnostic and Statistical Manual, 4th edition (DSM-IV), and the International Classification of Diseases, 10th edition (ICD-10). No data have yet been published regarding the frequency of specific diagnoses within these systems or how the diagnostic systems relate to each other. To address these issues, we examined clinical sleep disorder diagnoses (without polysomnography) in 257 patients (216 insomnia patients and 41 medical/psychiatric patients) evaluated at five sleep centers. A sleep specialist interviewed each patient and assigned clinical diagnoses using ICSD, DSM-IV and ICD-10 classifications. "Sleep disorder associated with mood disorder" was the most frequent ICSD primary diagnosis (32.3% of cases), followed by "Psychophysiological insomnia" (12.5% of cases). The most frequent DSM-IV primary diagnoses were "Insomnia related to another mental disorder" (44% of cases) and "Primary insomnia" (20.2% of cases), and the most frequent ICD-10 diagnoses were "Insomnia due to emotional causes" (61.9% of cases) and "Insomnia of organic origin" (8.9% of cases). When primary and secondary diagnoses were considered, insomnia related to psychiatric disorders was diagnosed in over 75% of patients. The more narrowly defined ICSD diagnoses nested logically within the broader DSM-IV and ICD-10 categories. We found substantial site-related differences in diagnostic patterns. These results confirm the importance of psychiatric and behavioral factors in clinicians' assessments of insomnia patients across all three diagnostic systems. ICSD and DSM-IV sleep disorder diagnoses have similar patterns of use by experienced clinicians.

  13. A Case of Pulmonary Cryptococcosis in an Immunocompetent Male Patient Diagnosed by a Percutaneous Supraclavicular Lymph Node Biopsy.

    Science.gov (United States)

    Sung, Ji Hee; Kim, Do Hoon; Oh, Mi-Jung; Lee, Kyoung Ju; Bae, Young A; Kwon, Kye Won; Lee, Seung Min; Kang, Ho Joon; Choi, Jinyoung

    2015-07-01

    Cryptococcal pneumonia usually occurs in immunocompromised patients with malignancy, acquired immune deficiency syndrome, organ transplantations, immunosuppressive chemotherapies, catheter insertion, or dialysis. It can be diagnosed by gaining tissues in lung parenchyma or detecting antigen in blood or bronchoalveolar lavage fluid. Here we report an immunocompetent 32-year-old male patient with diabetes mellitus diagnosed with cryptococcal pneumonia after a ultrasound-guided percutaneous supraclavicular lymph node core needle biopsy. We treated him with fluconazole at 400 mg/day for 9 months according to the guideline. This is the first case that cryptococcal pneumonia was diagnosed from a percutaneous lymph node biopsy in South Korea.

  14. Clinical Analysis of 45 Cases of Caesarean Scar Pregnancy

    Institute of Scientific and Technical Information of China (English)

    Hong SHI; Ai-hua FANG; Qin-fang CHEN

    2008-01-01

    Objective To summarize the clinical characteristics of caesarean scar pregnancy and to investigate its treatment.Methods Clinical case records of 45 cases of caesarean scar pregnancy from June 2003 to September 2007 were reviewed.The characteristics and management of cases were analyzed.Results The women's average age was 32.8±5.1 years.All cases had amenorrhoea.and 27 cases had vaginal bleeding from spotting to morderate.Seven cases were misdiagnosed as normal early intrauterine pregnancy or inevitable miscarriage before dilation and curettage(D & C).In case of massive bleeding,caesarean scar pregnancy was diagnosed after D & C.Bleeding was controlled and uterus was conserved in 6 cases,and 1 case underwent hysterectomy because of uncontrollable bleeding.The remaining 38 cases had ultrasound scan,which indicated scar pregnancy before primary treatment.Eight cases were primarily treated with dilation and curettage,in which only 2 cases had slight bleeding in the operation and no further treatment.Nineteen cases were primarily treated with dilation and curettage after uterine artery embolization.in which 17 cases needed no further treatment and had no complications.The success rate was 89.4%(17/19).Eleven cases were primarity treated with trichosanthin 1.2 mg intramuscular.No one encountered massive bleeding,but 7 cases of these 11 cases needed extra treatment.Conclusion Caesarean scar pregnancy must be cautious of,especially in cases of inevitable miscarriage.Dilation and curettage followed uterine artery embolization can be used as the primary treatment for caesarean scar pregnancy.

  15. Rare case of monozygotic twins diagnosed with klinefelter syndrome during evaluation for infertility.

    Science.gov (United States)

    Barazani, Yagil; Sabanegh, Edmund

    2015-01-01

    Although neither Klinefelter syndrome nor monozygotic twins are particularly rare (1/667 male births and 3-4/1000 live births, respectively), the occurrence of both in the same pregnancy (ie, identical twins with Klinefelter syndrome) is exceedingly rare and has only been reported three times previously in the literature. This report describes the fourth ever reported case of monozygotic twins with Klinefelter syndrome (who presented to our male fertility clinic with failure to conceive) and sheds interesting light on the reproductive concordance observed with this rare clinical entity. To our knowledge, this is the first reported case of monozygotic twins with Klinefelter syndrome that describes the infertility workup and outcomes of microsurgical testicular sperm extraction.

  16. Clinical classification and gene mutation of Chinese probands with Charcot-Marie-Tooth disease Analysis of 57 cases

    Institute of Scientific and Technical Information of China (English)

    Ruxu Zhang; Xiaobo Li; Xiaohong Zi; Shunxiang Huang; Fufeng Zhang; Kun Xia; Qian Pan; Beisha Tang

    2011-01-01

    Charcot-Mafie-Tooth (CMT) disease is the most common inherited peripheral neuropathic disorder.CMT is clinically and genetically heterogeneous. To date, 27 genes associated with the disease have been cloned. The present study carried out clinical classification according to clinical,electrophysiological and pathological features, conducted inheritance classification according to inheritance patterns, and performed mutation analysis of 13 CMT disease genes (PMP22, CX32,HSPB1, MNF2, MPZ, HSPB8, GDAP1, NFL, EGR2, SIMPLE, RAB7, LMNA, MTMR2) in 57 Chinese probands with CMT. Five cases of AD-CMT1 and 13 cases of sporadic CMT1 were diagnosed as CMT1A; five cases of X-CMT1, one case of X-CMT2 and one case of sporadic CMT1 were diagnosed as CMTX1; four cases of AD-CMT2 were diagnosed as CMT2F; one case of AD-CMT2 and one case of sporadic CMT2 were diagnosed as CMT2A2; one case of AD-CMT2 was diagnosed as CMT2L; one case of AD-CMT2 was diagnosed as CMT2J; one case of AR-CMT1 was diagnosed as CMT4A. Among the 57 CMT probands, seven genotypes were determined among 34 patients, with a detection rate of 59.6%. The results indicated that the clinical classification and inheritance classification are indispensable for selecting potential disease genes for mutation detection, and for efficient molecular diagnosis.

  17. Meckel's diverticulum bleeding diagnosed with magnetic resonance enterography: a case report.

    Science.gov (United States)

    Zhou, Fu-Run; Huang, Liu-Ye; Xie, Hai-Zhu

    2013-05-07

    Although the introduction of double-balloon enteroscopy has greatly improved the diagnostic rate, definite diagnosis of Meckel's diverticulum far from the ileocecal valve is still impossible in most cases. We explored the role of magnetic resonance (MR) enterography in detecting bleeding from Meckel's diverticulum that can not be confirmed via double-balloon enteroscopy. This study describes a case of male patient with bleeding from Meckel's diverticulum diagnosed with MR enterography of the small intestine. No bleeding lesion was found via colonoscopy, anal enteroscopy, or oral colonoscopy. MR enterography of the small intestine revealed an occupying lesion of 3.0 cm in the lower segment of the ileum. The patient was transferred to the Department of Abdominal Surgery of our hospital for surgical treatment. During surgery, a mass of 3 cm × 2 cm was found 150 cm from the ileocecal valve, in conjunction with congestion and edema of the corresponding mesangium. Intraoperative diagnosis was small bowel diverticulum with bleeding. The patient underwent partial resection of the small intestine. Postoperative pathology showed Meckel's diverticulum containing pancreatic tissues. He was cured and discharged 7 d after operation. We conclude that MR enterography of the small intestine has greatly improved the diagnosis rate of Meckel's diverticulum, particularly in those patients with the disease which can not be confirmed via double-balloon enteroscopy.

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

    Science.gov (United States)

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

    2017-01-01

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

  19. Diagnosing and Managing Primary Aldosteronism in Hypertensive Patients: a Case-Based Approach.

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    Carey, Robert M

    2016-10-01

    Primary aldosteronism with a prevalence of 8 % of hypertension and 20 % of pharmacologically resistant hypertension is the most common secondary cause of hypertension. Yet, the diagnosis is missed in the vast majority of patients. Current clinical practice guidelines recommend screening for primary aldosteronism in patients with sustained elevation of blood pressure (BP) ≥150/100 mmHg if possible prior to initiation of antihypertensive therapy, and in patients with resistant hypertension, spontaneous or diuretic-induced hypokalemia, adrenal incidentaloma, obstructive sleep apnea, a family history of early onset of hypertension or cerebrovascular accident Clinical and laboratory methods of screening, confirmatory testing, subtype classification, and medical and surgical management are systematically reviewed and illustrated with a clinical case.

  20. Evaluation of the MEFV gene mutations and clinical symptoms in186 patients diagnosed as familial Mediterranean fever

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    Mahmut Abuhandan

    2015-03-01

    Full Text Available Objective: This retrospective study aimed to evaluate the clinical symptoms and the MEFV mutation ratios of the 186 patients diagnosed as Familial Mediterranean Fever. Methods: Age, sex, admission symptoms, family history, and the MEFV mutation test cases of the 186 patients followed as Familial Mediterranean Fever were evaluated retrospectively. MEFV gene was analyzed with DNA sequence analysis after amplifying the exons 1.-10. using PCR method. Results: There were 84 male and 102 female in the study, and the mean age was 9.45 ± 4.40 years. 26.9% of the patients had close relationship between the parents, and 25.8% had a family history of AAA. The most common symptoms were abdominal pain (92.5%, fever (89.2%, and arthralgia (24.2% respectively. The most common mutations were R202Q (33.3%, M694V (22.6%, E148Q (22%, V726A (7.5%, R761H (4.3%, M680I (3.8%, and the others (6.5% respectively. 21.5% homozygous, 67.7% heterozygous, and 10.8% compound heterozygous mutations of AAA were detected. Conclusion: FMF is a common disease in our country and has difficulties in the differential diagnosis. In recent years molecular genetically methods are considered more commonly for the diagnosis. The results of this study showed that our AAA patients have a wide range of mutations, and supported the heterogeneity of MEFV gene mutations in AAA.

  1. Geographic variation of clinically diagnosed mood and anxiety disorders in Christchurch after the 2010/11 earthquakes.

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    Hogg, Daniel; Kingham, Simon; Wilson, Thomas M; Griffin, Edward; Ardagh, Michael

    2014-11-01

    The 22nd February 2011 Christchurch earthquake killed 185 people, injured over 8000, damaged over 100,000 buildings and on-going aftershocks maintained high anxiety levels. This paper examines the dose of exposure effect of earthquake damage assessments, earthquake intensity measures, liquefaction and lateral spreading on mood and anxiety disorders in Christchurch after this event. We hypothesise that such disorders are more likely to develop in people who have experienced greater exposure to these impacts within their neighborhood than others who have been less exposed, but also live in the city. For this purpose, almost all clinically diagnosed incident and relapsed cases in Christchurch in a 12 months period after the 2011 earthquake were analysed. Spatio-temporal cluster analysis shows that people living in the widely affected central and eastern parts after the 2010/11 earthquakes have a 23% higher risk of developing a mood or anxiety disorder than people living in other parts of the city. Generally, mood and anxiety-related disorders increase with closer proximity to damage from liquefaction and moderate to major lateral spreading, as well as areas that are more likely to suffer from damage in future earthquakes.

  2. Towards optimal clinical and epidemiological registration of haematological malignancies: Guidelines for recording progressions, transformations and multiple diagnoses.

    Science.gov (United States)

    Gavin, Anna; Rous, Brian; Marcos-Gragera, Rafael; Middleton, Richard; Steliarova-Foucher, Eva; Maynadie, Marc; Zanetti, Roberto; Visser, Otto

    2015-06-01

    Haematological malignancies (HM) represent over 6% of the total cancer incidence in Europe and affect all ages, ranging between 45% of all cancers in children and 7% in the elderly. Thirty per cent of childhood cancer deaths are due to HM, 8% in the elderly. Their registration presents specific challenges, mainly because HM may transform or progress in the course of the disease into other types of HM. In the context of cancer registration decisions have to be made about classifying subsequent notifications on the same patient as the same tumour (progression), a transformation or a new tumour registration. Allocation of incidence date and method of diagnosis must also be standardised. We developed European Network of Cancer Registries (ENCR) recommendations providing specific advice for cancer registries to use haematology and molecular laboratories as data sources, conserve the original date of incidence in case of change of diagnosis, make provision for recording both the original as well as transformed tumour and to apply precise rules for recording and counting multiple diagnoses. A reference table advising on codes which reflect a potential transformation or a new tumour is included. This work will help to improve comparability of data produced by population-based cancer registries, which are indispensable for aetiological research, health care planning and clinical research, an increasing important area with the application of targeted therapies.

  3. Asperger's Syndrome: A Comparison of Clinical Diagnoses and Those Made According to the ICD-10 and DSM-IV

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    Woodbury-Smith, Marc; Klin, Ami; Volkmar, Fred

    2005-01-01

    The diagnostic criteria for Asperger Syndrome (AS) according to ICD-10 and DSM-IV have been criticized as being too narrow in view of the rules of onset and precedence, whereby autism takes precedence over AS in a diagnostic hierarchy. In order to investigate this further, cases from the DSM-IV multicenter study who had been diagnosed clinically…

  4. Description of six autochthonous cases of canine visceral leishmaniasis diagnosed in Pedregulho (São Paulo, Brazil

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    Cássia Regina de Abreu

    Full Text Available Visceral leishmaniasis is an infectious disease of chronic, emerging and zoonotic nature that presents various degrees of severity. In Brazil, this illness is caused by Leishmania infantum (Leishmania chagasi, which is transmitted by the bite of the sand fly Lutzomyia longipalpis, and dogs are its main reservoir. Given the increasing spread of this disease across Brazil, the aim of this study was to report on six cases of canine visceral leishmaniasis, diagnosed in June 2013, in the city of Pedregulho, State of São Paulo, considered to be a non-endemic area and free of phlebotomine sand flies. The diagnosis was based on clinical signs of the patients and additional tests (serological and parasitological. It was concluded that the diagnosis of leishmaniasis is complex because the clinical signs are similar to other systemic diseases, thus justifying the importance of parasitological test of bone marrow, considered "gold standard", in the confirmation of the disease. In addition, the area was not, until now, considered risk place, despite notification.

  5. A Retrospectively Diagnosed Case of IgG4-Related Tubulointerstitial Nephritis Showing Good Renal Outcome and Pathological Progress

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    Qiong Wu

    2013-01-01

    Full Text Available A 74-year-old man was hospitalized for diabetic nephropathy evaluation and assessment of the effect of treatment on his tubulointerstitial nephritis (TIN. When he was 62 years old, he developed polyarthralgia and had superficial lymph node swelling, mildly increased serum creatinine concentration, hypergammaglobulinemia, hypocomplementemia, high serum IL-2R level, and positive titer of antinuclear antibody. Several tissues were biopsied. Mild chronic sialadenitis and reactive lymphadenitis were identified. Renal specimen showed mild glomerular ischemia, extensive storiform fibrosis, and abundant infiltrating monocytes and plasma cells. He was treated with oral prednisolone and cyclophosphamide. After the treatment, most of his clinical parameters quickly returned to within the reference range. However, he developed diabetes mellitus soon after steroid therapy. At the time of rebiopsy, a high level of serum IgG4 was detected. The second renal biopsy showed diabetic nephropathy without any tubulointerstitial damage. The first biopsied tissues were retrospectively investigated. Large numbers of IgG4-positive plasma cells were detected in the kidneys and lymph nodes. A retrospective diagnosis of IgG4-related TIN with lymph node involvement was made. In conclusion, this paper describes a retrospectively diagnosed case of IgG4-related TIN with lymph node involvement, showing good clinical and pathological prognosis.

  6. Sociodemographic Characteristics and Diagnoses of Individuals Referred to a Child and Adolescent Psychiatry Outpatient Clinic of a University Hospital

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    Sevcan Karakoç Demirkaya

    2015-04-01

    Full Text Available OBJECTIVE: The aim of this study is to evaluate the sociodemographic characteristics, complaints, and diagnoses of individuals who were admitted to a child and adolescent psychiatry outpatient clinic. MATERIALS AND METHODS: Medical charts of the patients who were admitted to the child and adolescent psychiatry unit of Adnan Menderes University between February 1st and July 31st, 2014 were retrospectively studied. RESULTS: The rate of girls and boys from a total of 832 cases who were referred to the child and adolescent psychiatry outpatient clinic in the six month period was 41.8% and 58.2%, respectively. The mean age of the girls and boys was 10.8±4.9 and 8.5±4.7 years, respectively. The most common age range was between 12 and 18 years. The proportion of patients who lived with both parents was 81.1%; however, the proportion of individuals brought in by institutional caregivers was 0.8%. The proportion of consanguineous marriages was 13.7%. The education level of mothers and fathers was mostly a primary school degree (47% and 45.6%, respectively. A positive psychiatric history was present in 13.7% of the mothers and 7.6% of the fathers. Reasons for child psychiatric assessments were as follows: 21.9% for disability report, 13.8% for forensic evaluation, 11.2% for consultation, and 52.9% for general psychiatric evaluation. Referral complaints were irritability/anger (15.7%, attention deficit/hyperactivity (14.8%, delay in speech (10.5%, fear/anxiety (5.9%, and poor school performance (5.7%. The diagnoses were as follows: attention deficit hyperactivity disorder (ADHD (20.6%, other disruptive behaviors (12.4%, and anxiety disorder (10.2%. CONCLUSION: We revealed that the most common referring complaint was irritability/anger and that the most common diagnosis was ADHD in our patient group, which was similar to previous studies. Our results showed that a low parental educational level and a positive history for parental psychopathology were

  7. Recurrent peroneal neuropathy in adolescent: clinical case

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    V. A. Bulanova

    2012-01-01

    Full Text Available The clinical case of hereditary neuropathy with liability to pressure palsies (HNPP confirmed the results of DNA diagnostics is described. Clinical and electrophysiological features of the course of HNPP in adolescent is analyzed. Many various illnesses require exclusion in case of the foot extensor paresis.

  8. Recurrent peroneal neuropathy in adolescent: clinical case

    OpenAIRE

    V. A. Bulanova; D. S. Druzhinin

    2012-01-01

    The clinical case of hereditary neuropathy with liability to pressure palsies (HNPP) confirmed the results of DNA diagnostics is described. Clinical and electrophysiological features of the course of HNPP in adolescent is analyzed. Many various illnesses require exclusion in case of the foot extensor paresis.

  9. Baseline CD4 cell counts of newly diagnosed HIV cases in China: 2006-2012.

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    Houlin Tang

    Full Text Available BACKGROUND: Late diagnosis of HIV infection is common. We aim to assess the proportion of newly diagnosed HIV cases receiving timely baseline CD4 count testing and the associated factors in China. METHODS: Data were extracted from the Chinese HIV/AIDS Comprehensive Response Information Management System. Adult patients over 15 years old who had been newly diagnosed with HIV infection in China between 2006 and 2012 were identified. The study cohort comprised individuals who had a measured baseline CD4 count. RESULTS: Among 388,496 newly identified HIV cases, the median baseline CD4 count was 294 cells/µl (IQR: 130-454, and over half (N = 130,442, 58.8% were less than 350 cells/µl. The median baseline CD4 count increased from 221 (IQR: 63-410 in 2006 to 314 (IQR: 159-460 in 2012. A slight majority of patients (N = 221,980, 57.1% received baseline CD4 count testing within 6 months of diagnosis. The proportion of individuals who received timely baseline CD4 count testing increased significantly from 20.0% in 2006 to 76.9% in 2012. Factors associated with failing to receiving timely CD4 count testing were: being male (OR: 1.17, 95% CI: 1.15-1.19, age 55 years or older (OR:1.03, 95% CI: 1.00-1.06, educational attainment of primary school education or below (OR: 1.30, 95% CI: 1.28-1.32, infection with HIV through injection drug use (OR: 2.07, 95% CI: 2.02-2.12 or sexual contact and injection drug use (OR: 1.87, 95% CI: 1.76-1.99, diagnosis in a hospital (OR: 1.91, 95% CI: 1.88-1.95 or in a detention center (OR: 1.75, 95% CI: 1.70-1.80, and employment as a migrant worker (OR:1.55, 95% CI:1.53-1.58. CONCLUSION: The proportion of newly identified HIV patients receiving timely baseline CD4 testing has increased significantly in China from 2006-2012. Continued effort is needed for further promotion of early HIV diagnosis and timely baseline CD4 cell count testing.

  10. [Amyand hernia--a rare anatomic and clinical entity diagnosed intraoperatively].

    Science.gov (United States)

    Grecu, F; Filip, B; Moţoc, I; Andriescu, Nadia; Lăpuşneanu, A; Ursaru, Manuela

    2010-01-01

    The Amyand hernia is an uncommon variant of the inguinal hernia, rarely recognised before the surgical treatment because of the confusion with a strangled hernia. In spite of this, the clinical presentation seems to follow a well determined pathway, so it is possible to state that the uncorrect diagnosis is to be attributed to the ignorance of this variant of hernia. We present two consecutive case reports of acute appendicitis founded in an inguinal hernia sac. The clinical presentation depended on the inflammation extension inside the hernia sac and the presence or not of peritoneal contamination. The patients were admitted for a painful pseudotumor in the inguinal region with irreducibility, mimicking strangled inguinal hernia with acute inflammatory syndrome. Intraoperatively we have found a hernia sac with a phlegmonous/gangrenous appendix inside. Appendectomy was performed, followed by hernioplasty (retrofunicular technique) without prosthetic material). The operation followings were favorable. We conclude that amyand hernia must be considered as differential diagnosis of apparently strangled inguinal hernias. Technical precautions and antibioprophylaxy applied during surgery may prevent septic complications after hernioplasty. The hernia repair must be performed without prosthetic material and using exclusively resorbable sutures.

  11. Retrospective Analysis of Discrepancies between Clinical and Histopathological Diagnoses in Head and Neck Lesions: An Institutional Study with 10 Years Database

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    Ketki P Kalele

    2016-01-01

    Full Text Available Introduction: Oral and maxillofacial lesions present a wide spectrum of clinical manifestations ranging from an asympto - matic small lesion to a large destructive one. Several lesions mimic each other in their clinical presentation posing a diag - nostic dilemma. Due to interoperator subjectivity and lack of defined objective diagnostic criteria, histopathological investi - gation, most of the times, plays a vital role in final diagnosis. Many studies have reported the concordance rates among the clinical and histopathological diagnoses of oral lesions, however, there are very few studies which have highlighted the discrepancies in them that have led to drastic changes in the lines of diagnoses and treatment. This institutional retro - spective descriptive study intended to highlight this lacuna by going through histopathological registry to study such cases with discrepancies in clinical and histopathological diagnoses in last 10 years. The aim of this study was to systematically analyze the discrepancies in clinical and histopathological diagnoses of various oral lesions with an emphasis on malig - nant and nonmalignant groups so as to stress the importance of histopathological examination to ultimately minimize the risk of inadvertent inappropriate treatment. Materials and methods: A total of 1570 cases that were reported to our institute over a period of 10 years were evaluated from the histopathology registry. Out of these, 1300 cases met our inclusion criteria. Discrepancies were charted as major and minor discrepancies and discrepancy indices were calculated. Lesions were divided into malignan t and nonmalignant groups and were subjected to d i agnostic-screening test evaluation to assess the discrepancies. Results: Total discrepancy value (discrepancy index obtained was 12.9%, out of which 9.23% showed major discrepancies and 3.69% showed minor discrepancies. Ninety-five percent confidence interval (CI was calculated, and was found in

  12. OPPORTUNITIES TO DIAGNOSE ACTIVE TUBERCULOSIS IN THE PATIENTS WITH CLINICALLY CURED RESPIRATORY TUBERCULOSIS

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    G. S. Balasanyants

    2017-01-01

    Full Text Available Goal of the study: to evaluate the test with tuberculous recombinant allergen (TRA in the patients with effective treatment course due to tuberculosis, to investigate the impact of clinical, epidemiological and social factors on persistence of active tuberculosis.Materials and methods. Patients were divided into 2 groups basing on time period after completion of the main treatment course. Group I – 32 patients (up to 6 months, group II – 63 patients (more than 6 months.Results of the study. Results of TRA tests in Group I remained positive in 34.4% of patients and in Group II - 23.8%. The average size of the induration in Group I made 10 mm(95% CI 6.5-13.3, in Group II – 13 mm (95% CI 8.4-19.7 Patients from Group I had positive results of TRA test more often in case of initial infiltrate form of pulmonary tuberculosis and bacillary excretion. In patients from Group II the positive TRA results correlated with presence of concurrent conditions and exposure to a tuberculosis case in the past. Positive results were confidently more often observed in lonely patients in both groups. TRA test can be a valuable tool to evaluate the risk of tuberculosis relapse after completion of the main treatment course. 

  13. Discrepancies between diagnoses of methanol and ethylene glycol intoxication based on determinations performed in the regional clinical toxicology centre and in the department of forensic medicine

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    Tomasz Cywka

    2014-08-01

    Full Text Available The situations in which autopsy blood toxicology results do not confirm methanol and/or ethylene glycol intoxications diagnosed during patients` hospitalizations are frequently observed in the Department of Forensic Medicine in Lublin. Material and methods: In order to verify inconsistent findings, serum samples of 18 individuals, routinely stored in the regional clinical toxicology centre after testing, were re-examined using the specific method of gas chromatography (GC. Results: None of the fatal methanol intoxications was confirmed; toxic concentration of glycol was detected only in one case whereas the remaining determinations were negative or revealed “congeneric” concentrations. In cases of negative results of chromatographic re-analyses, the difference between hospital analysis and GC results were on average 29.6 mg% (max. 127.7 mg% for glycol and 31.8 mg% (max. 80.0 mg% for methanol. Severe metabolic acidosis was found in all hospitalized patients. In the hospital setting, “intoxications” were diagnosed even when low concentrations of methanol or glycol (below the cut-off values were detected with spectrophotometry, which is the method still used in the hospital laboratory. The diagnosis of methanol intoxication in a car accident victim was particularly bizarre; as were the methanol intoxication diagnoses established in cases of acute diabetes-associated complications (4, pancreatitis (1, pneumonia (2 and peritonitis (1, gastrointestinal haemorrhage (1, and decompensated hepatic cirrhosis (1. The therapeutic management based on those diagnoses was incorrectly targeted at the non-existing intoxication that was considered the cause of patient’s deteriorating condition. Conclusions : Our findings indicate inadequate knowledge of physicians to interpret and critically verify toxicological results. Moreover, low cost and speed of spectrophotometric analysis should not veil its significant limitations: mainly low specificity and

  14. Variety of genotypes in males diagnosed as dichromatic on a conventional clinical anomaloscope.

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    Neitz, Maureen; Carroll, Joseph; Renner, Agnes; Knau, Holger; Werner, John S; Neitz, Jay

    2004-01-01

    The hypothesis that dichromatic behavior on a clinical anomaloscope can be explained by the complement and arrangement of the long- (L) and middle-wavelength (M) pigment genes was tested. It was predicted that dichromacy is associated with an X-chromosome pigment gene array capable of producing only a single functional pigment type. The simplest case of this is when deletion has left only a single X-chromosome pigment gene. The production of a single L or M pigment type can also result from rearrangements in which multiple genes remain. Often, only the two genes at the 5' end of the array are expressed; thus, dichromacy is also predicted to occur if one of these is defective or encodes a defective pigment, or if both of them encode pigments with identical spectral sensitivities. Subjects were 128 males who accepted the full range of admixtures of the two primary lights as matching the comparison light on a Neitz or Nagel anomaloscope. Strikingly, examination of the L and M pigment genes revealed a potential cause for a color-vision defect in all 128 dichromats. This indicates that the major component of color-vision deficiency could be attributed to alterations of the pigment genes or their regulatory regions in all cases, and the variety of gene arrangements associated with dichromacy is cataloged here. However, a fraction of the dichromats (17 out of 128; 13%) had genes predicted to encode pigments that would result in two populations of cones with different spectral sensitivities. Nine of the 17 were predicted to have two pigments with slightly different spectral peaks (usually dichromats, others test as anomalous trichromats. The discrepancy is probably partly attributable to testing method differences and partly to a difference in performance not perception, but it seems there must also be cases in which other factors, for example, cone ratio, contribute to a person's ability to extract a color signal from a small spectral difference.

  15. A Case for Conservative Management: Characterizing the Natural History of Radiographically Diagnosed Rathke Cleft Cysts.

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    Culver, Silas A; Grober, Yuval; Ornan, David A; Patrie, James T; Oldfield, Edward H; Jane, John A; Thorner, Michael O

    2015-10-01

    Rathke cleft cysts (RCCs) are benign embryonic remnants of the Rathke's pouch found in 13% to 33% of the general population. When symptomatic, they manifest themselves by compressing adjacent structures, causing pressure effects such as headache, visual disturbance, or pituitary hormone deficits. Most RCCs are asymptomatic, and their management remains controversial. Surgical resection has generally been indicated to treat symptomatic RCCs but carries the risk of complications. Our objective was to better characterize the outcomes for patients with presumed RCCs undergoing conservative management. This was a retrospective cohort study. The setting was a pituitary program at a university medical center. The participants were 75 patients with radiographically diagnosed RCCs. All brain magnetic resonance imaging (MRI) scans performed at the University of Virginia from 2006 through 2013 were searched for the words "Rathke cleft cyst," and pituitary clinic notes from 2007 to 2012 were reviewed for patients identified as probably having an RCC. Images for all patients were reviewed by the interpreting neuroradiologist, and those patients with at least 2 MRI scans were included. The dimensions of each cyst were assessed by the same neuroradiologist, and the volume of each cyst was analyzed as a function of the time from the first image obtained. A total of 75 patients (4-76 years old) met our inclusion criteria. The length of follow-up was 1 to 126 months (median 24 months). In 43 patients (57%) no detectable change in the size of their cysts was seen, in 21 patients (28%) cysts increased in size, and in 11 patients (15%) cysts decreased in size. The predicted mean cyst growth rate was not significantly different from 0. The increasingly prevalent use of brain imaging modalities such as MRI has resulted in an increase in the incidental discovery of pituitary lesions. Our study demonstrates that the majority of radiologically diagnosed RCCs remain unchanged or decrease in

  16. A case of lupus vulgaris with rare localization diagnosed 30 years after onset.

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    Laudańska, H; Reduta, T; Zalewski, G; Chodynicka, B

    2011-01-01

    Cutaneous tuberculosis (tuberculosis cutis) is one of the extrapulmonary forms of tuberculosis, which may affect the skin only or co-exist with tuberculosis of other organs, particularly the lungs. We describe a case of lupus vulgaris in a 72-year-old male patient with a single lesion localized on his lower extremity, developing for 30 years before correct diagnosis and previously treated with topical steroids. Bacillus infection in other organs was not detected. Diagnosis of tuberculosis was made based on personal history, clinical picture, hypersensitivity to tuberculin, histopathology and polymerase chain reaction. A multidrug therapy with rifampicin, isoniazid and pyrazinamide resulted in regression of the lesion. The common lack of knowledge about the clinical picture of cutaneous tuberculosis causes its late diagnosis and treatment.

  17. Three cases of hematologic malignancies in pregnancy: Still difficult to diagnose and hard to treat

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    Özlem Bozoklu Akkar

    2016-06-01

    Full Text Available The hematologic malignancies during pregnancy are rare and there is often a delay in diagnosis because of the similarity of symptoms to those of pregnancy. Therefore the management of disease necessitates many medical, psychological, social, and ethical problems for the patient and physician to deal with and a multidisciplinary approach of a medical team consisting of hematologist, obstetrician and pediatrician. Here, we present three cases of hematologic malignancies during pregnancy; acute myeloid leukemia, acute lymphoblastic leukemia, and B-cell non-Hodgkin’s lymphoma that were admitted to our clinic with different clinical presentation. There is a need for measures to increase the awareness of health workers related to hematologic malignancies during antenatal care.

  18. Concordance between patient self-reports and claims data on clinical diagnoses, medication use, and health system utilization in Taiwan.

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    Chi-Shin Wu

    Full Text Available PURPOSE: The aim of this study was to evaluate the concordance between claims records in the National Health Insurance Research Database and patient self-reports on clinical diagnoses, medication use, and health system utilization. METHODS: In this study, we used the data of 15,574 participants collected from the 2005 Taiwan National Health Interview Survey. We assessed positive agreement, negative agreement, and Cohen's kappa statistics to examine the concordance between claims records and patient self-reports. RESULTS: Kappa values were 0.43, 0.64, and 0.61 for clinical diagnoses, medication use, and health system utilization, respectively. Using a strict algorithm to identify the clinical diagnoses recorded in claims records could improve the negative agreement; however, the effect on positive agreement and kappa was diverse across various conditions. CONCLUSION: We found that the overall concordance between claims records in the National Health Insurance Research Database and patient self-reports in the Taiwan National Health Interview Survey was moderate for clinical diagnosis and substantial for both medication use and health system utilization.

  19. USE OF A NOVEL BOARD GAME IN A CLINICAL ROTATION FOR LEARNING THORACIC DIFFERENTIAL DIAGNOSES IN VETERINARY MEDICAL IMAGING.

    Science.gov (United States)

    Ober, Christopher P

    2017-03-01

    When confronted with various findings on thoracic radiographs, fourth-year veterinary students often have difficulty generating appropriate lists of differential diagnoses. The purpose of this one-group, pretest, posttest experimental study was to determine if a game could be used as an adjunct teaching method to improve students' understanding of connections between imaging findings and differential diagnoses. A novel board game focusing on differential diagnoses in thoracic radiography was developed. One hundred fourth-year veterinary students took a brief pretest, played the board game, and took a brief posttest as a part of their respective clinical radiology rotations. Pretest results were compared to posttest results using a paired t-test to determine if playing the game impacted student understanding. Students' mean scores on the posttest were significantly higher than mean pretest scores (P game resulted in improved short-term understanding of thoracic differential diagnoses by fourth-year students, and use of the board game on a clinical rotation seems to be a beneficial part of the learning process. © 2016 American College of Veterinary Radiology.

  20. Using Disguised Clinical Case Material

    Science.gov (United States)

    Kantrowitz, Judy L.

    2010-01-01

    When, why, and how clinicians decide to write about clients are ethical concerns. There are risks and potential clinical ramifications as well as responsibilities for how these decisions are made. On the basis of 141 interviews with psychoanalysts who have published in 3 major national and international psychoanalytic journals, the author explores…

  1. PRNP and SPRN genes polymorphism in atypical bovine spongiform encephalopathy cases diagnosed in Polish cattle.

    Science.gov (United States)

    Gurgul, Artur; Polak, Mirosław Paweł; Larska, Magdalena; Słota, Ewa

    2012-08-01

    Polymorphisms in the coding region of the prion protein gene (PRNP) have been associated with the susceptibility and incubation period of prion diseases in humans and sheep. However, polymorphisms in this part of the bovine PRNP gene do not affect the classical bovine spongiform encephalopathy (BSE) susceptibility in cattle. Studies carried out in Germany have shown that insertion/deletion-type polymorphisms located in the promoter region of the bovine prion gene are possible genetic factors modulating BSE susceptibility by changing the level of PRNP expression. No such association was observed for atypical BSE cases; however, due to the rare nature of the disease, these results should be confirmed. Additionally, a single nonsynonymous mutation in PRNP codon 211 (E211K) was described in one H-type BSE case in the USA; however, it was not found in any other cases. Here, we performed genetic characterization of PRNP promoter indel variations and determined the polymorphism of open reading frames (ORFs) of PRNP and bovine prion-like Shadoo (SPRN) genes in six Polish atypical BSE cases and compared these results to the population of clinically healthy Polish Holstein cattle. No potentially pathogenic mutations were found in the PRNP ORF in atypical BSE-affected cattle, but our study showed a high frequency of deletions at the indel loci of PRNP promoter in these animals. Additionally, a rare sequence variation in the SPRN protein-coding sequence was found in one L-type atypical BSE-affected animal.

  2. Estimation of the true incidence of lactic acidosis within the Lighthouse Clinic cohort, and the likely magnitude of missed diagnoses in the region

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    Colin Speight

    2014-11-01

    Full Text Available Introduction: Lactic acidosis is one of the most serious side effects associated with ART, most commonly associated with stavudine. Clinical features are non-specific and specialist laboratory capabilities are essential to confirm the diagnosis, making under-diagnosis likely in resource-constrained settings. Lighthouse Trust is a tertiary referral ART centre with over 23,500 patients on ART. The adjacent University of North Carolina Project laboratory, also serving Kamuzu Central Hospital, has been the only site processing lactate tests in Central Zone for many years. Our objective was to quantify the true incidence within our cohort, and estimate the likely degree of historical missed diagnoses from less central ART clinics. Methods: All high lactate results between June 2010 and June 2013 were treated as cases, and cross referenced with the Lighthouse database. Patients transferring in to Lighthouse within one month prior to diagnosis were assumed to have been referred due to their lactic acidosis, and moved to the Central Zone cohort to avoid referral bias. Routinely collected quarterly ART cohort data for both Lighthouse and the entire Central Zone were analyzed. Results: Over the three-year period, from within the Lighthouse cohort, there were 138 cases: 74% were female, median duration on ART was 14 months (IQR 10–26, and 98.5% were attributable to stavudine (only two cases to zidovudine. Over this period, the average number of patients taking stavudine at Lighthouse was 10,960 (3,600 on zidovudine. For the whole Central Zone (minus Lighthouse patients there were 61,000 on stavudine (4,830 on zidovudine, yet only 124 cases of lactic acidosis were apparently diagnosed from within this cohort. Conclusions: Although cases may, of course, also have been missed at Lighthouse, as a tertiary referral centre the rate observed is likely to be closer to the true incidence. Over the three years, with 138 cases from the 10,960 patients taking

  3. Aspergillus thyroiditis: first antemortem case diagnosed by fine-needle aspiration culture in a pediatric stem cell transplant patient.

    Science.gov (United States)

    Badawy, S M; Becktell, K D; Muller, W J; Schneiderman, J

    2015-12-01

    Aspergillus thyroiditis (AT) has historically been considered a postmortem diagnosis in immunocompromised patients; most have disseminated disease. This report summarizes the clinical challenge of diagnosing AT. It also highlights the value of the early use of thyroid fine-needle aspiration culture and the need for a high index of suspicion to reach the final diagnosis before disease dissemination.

  4. Pseudobulbar Paralysis Treated by Acupuncture - Clinical Observation in 36 Cases

    Institute of Scientific and Technical Information of China (English)

    杜琳

    2001-01-01

    @@Pseudobulbar paralysis is a kind of common clinical syndromes of cerebral vascular diseases, which is manifested as dyslalia, dysphagia and choking. By several-year clinical observations, 36 cases were treated with satisfactory therapeutic effects as reported in the following. Clinical Data Of 36 in-patients, there were 24 males and 12 females, aged from 44 to 81 years, averaging 64.92 years. Of 36 cases, 24 were at the acute stage and 12 at the recovery stage. All the cases were diagnosed as cerebral vascular diseases by cranial CT scan and MRI, of which, 4 were cerebral infarction, 26 lacunar cerebral infarction, 5 cerebral hemorrhage and 1 mixed type. Of 36 cases, 15 were the first attack of wind-stroke, 15 the second attack, 5 the third attack and 1 the forth attack. There were 26 patients with hypertension among 36 cases, of which, 8 patients suffered from hypertension within 10 years, 6 for more than 10 years, 9 for more than 20 years and 3 for more than 30 years. All the 36 cases were associated with dysphagia and agreeable to Standard on Diagnosis and Evaluation of Therapeutic Effects of Wind-stroke issued by the State Scientific Committee 85-919-01-01, 1995.

  5. Registration of symptoms and diagnoses in patients of a Belarussian-Dutch outpatient clinic in Gomel, October 1991 - September 1993

    Energy Technology Data Exchange (ETDEWEB)

    Van Oostrum, I.E.A.; Svalkoul, T.J.F. [National Poison Control Centre, RIVM, Bilthoven (Netherlands); Joore, J.C.A. [Department of Intensive Care and Clinical Toxicology, AZU, Utrecht (Netherlands); Volkova, G.V.; Savkova, M.I.; Derzhitski, V.E. [Gomel Regional Specialized Dispensary, Gomel (Belarus); Bootsma, P.A. [Bureau for International Cooperation, RIVM, Bilthoven (Netherlands)

    1995-09-01

    The results of a survey of the medical consumption of 4,500 patients at the Belarussian-Dutch Outpatient Clinic in Gomel during 1991-1993 are presented and discussed. Analysis of the patient registration data was focused on complaints related to possible enhanced radiation exposure of the patients since the reactor incident at Chernobyl in 1986. The pattern of complaints and diagnoses was comparable to the situation in a Dutch outpatient clinic, except for a higher number of goitre, gastritis, gastric and duodenal ulcers. Diagnoses that could be attributed to increased radiation exposure were not enhanced compared to the pattern in a Dutch population of similar size, except for a higher number of thyroid disease. 19 refs.

  6. Stenting:84 Cases of Clinical Application

    Institute of Scientific and Technical Information of China (English)

    GUANG Yongsong

    2002-01-01

    Objective To evaluate clinical application of therapeutic stenting. Methods 84 cases were managed with stents clinically, 136 procedures of intervention in all. The cases were suffering from portal hypertension of cirrhosis, stricture of inferior vana cava, superior vana cava syndrome, post- operative esophageal stricture, narrowig of femoral, common carotid, renal, superior mesentery arteries and biliary tract, etc. Results Therapeutic stenting achieves clinical effects completely different from conventional intemal medicine and surgery. Conclusion Therapeutic stenting is clinically unique, dramatically effective, with minor risks and worthy promoting.

  7. Influenza-like-illness and clinically diagnosed flu: disease burden, costs and quality of life for patients seeking ambulatory care or no professional care at all.

    Science.gov (United States)

    Bilcke, Joke; Coenen, Samuel; Beutels, Philippe

    2014-01-01

    This is one of the first studies to (1) describe the out-of-hospital burden of influenza-like-illness (ILI) and clinically diagnosed flu, also for patients not seeking professional medical care, (2) assess influential background characteristics, and (3) formally compare the burden of ILI in patients with and without a clinical diagnosis of flu. A general population sample with recent ILI experience was recruited during the 2011-2012 influenza season in Belgium. Half of the 2250 respondents sought professional medical care, reported more symptoms (especially more often fever), a longer duration of illness, more use of medication (especially antibiotics) and a higher direct medical cost than patients not seeking medical care. The disease and economic burden were similar for ambulatory ILI patients, irrespective of whether they received a clinical diagnosis of flu. On average, they experienced 5-6 symptoms over a 6-day period; required 1.6 physician visits and 86-91% took medication. An average episode amounted to €51-€53 in direct medical costs, 4 days of absence from work or school and the loss of 0.005 quality-adjusted life-years. Underlying illness led to greater costs and lower quality-of-life. The costs of ILI patients with clinically diagnosed flu tended to increase, while those of ILI patients without clinically diagnosed flu tended to decrease with age. Recently vaccinated persons experienced lower costs and a higher quality-of-life, but this was only the case for patients not seeking professional medical care. This information can be used directly to evaluate the implementation of cost-effective prevention and control measures for influenza. In particular to inform the evaluation of more widespread seasonal influenza vaccination, including in children, which is currently considered by many countries.

  8. Clinical Applications of Successive Spot Radiographs in Esophagography for Diagnosing the Early Esophageal Cancer

    Institute of Scientific and Technical Information of China (English)

    TANGLi-jun; KONGFan-fu; WANGDe-hang

    2004-01-01

    To introduce primary experience of clinical applications of successive spot radiographs in esophagography for the din mlosis of early esoplmgeal cancer (EEC). Methods: Six patients with EEC were examined and doagnosed dlaarmsed by a digital X-ray machine. According to the routine double contrast study of esophagus, the patient gulped a barimn suspension in the upright position when the successive films were taken by 2 frmnes per second lasting for about 10 seconds. Various phases were obtained including barimn-filled views,mucosal relief views and double contrast views. Results: Functional changes and abnormal mucosal folds of esophagus were present on successive spot radiographs of esophagography in patients with EEC and those patients with EEC were confirmed by endoscopic and pathologic findings. Four patients had mild loss of distensibility, 2 patients had spasmodic contraction and 1 patient had barium retention. Thickened or interrupted folds were found in all cases.Little niches were detected in 5 of 6 patients. Conctusion: Evidence presented in barimn studies of esophagus is more comprehensive and intact for the diagnosis of EEC when successive spot radiographs are employed. Functional changes of esophagus are more evident with this approach.

  9. Exploring the Clinical Utility of the Development and Well-Being Assessment (DAWBA) in the Detection of Hyperkinetic Disorders and Associated Diagnoses in Clinical Practice

    Science.gov (United States)

    Foreman, David; Morton, Stephanie; Ford, Tamsin

    2009-01-01

    Background: The clinical diagnosis of ADHD is time-consuming and error-prone. Secondary care referral results in long waiting times, but primary care staff may not provide reliable diagnoses. The Development And Well-Being Assessment (DAWBA) is a standardised assessment for common child mental health problems, including attention…

  10. [Astrocytoma and epilepsy. Clinical case].

    Science.gov (United States)

    Moreno-Jiménez, Sergio; Miranda-Fernández, Karen Alejandra; García Gutiérrez, Mónica; Vázquez-Estrada, Norma; Müller-Grohmann, Stephanie; Flores-Vázquez, Fabiola

    2016-07-11

    Pilocytic astrocytoma is a rare tumour, usually occurring in paediatric ages, and mainly located in the posterior fossa. It can cause hydrocephalus and intracranial hypertension and, less frequently, seizures, or a focal neurological deficit. The main imaging study by magnetic resonance imaging, which shows a tumour with solid and cystic components without peri-lesional swelling. The election treatment is surgical, and the patient is considered cured if a total resection is accomplished. The case is presented of 22-year-old female patient with a supratentorial pilocytic astrocytoma and epilepsy. Histopathology reported a low grade glial proliferation, with an extensive fibrillar matrix, small cells without atypia, extensive calcifications and piloid areas consisting of bipolar fusiform cells, and some Rosenthal fibres. There were also spongiotic areas consisting of multipolar cells and associated microcysts. The final report was a pilocytic astrocytoma. Pilocytic astrocytoma is more frequent in paediatric patients and in the posterior fossa. The case presented is of a young female adult with supratentorial location, making it a special case. The surgery achieved a total resection. The long-term prognosis is good, but it is necessary to perform a follow-up, particularly in adult patients because of a higher risk of recurrence. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  11. A Case of Enterocutaneous Fistula Diagnosed with Tc-99m DTPA Fistulography Using Hybrid SPECT/CT.

    Science.gov (United States)

    Choi, Hongyoon; Paeng, Jin Chul; Chun, In Kook; Baik, Kyung Don; Kang, Keon Wook; Chung, June-Key; Lee, Dong Soo

    2012-06-01

    Enterocutaneous fistula (ECF) is a communication between the bowel lumen and the skin, which especially occurs post-operatively and is associated with significant morbidity and mortality. Correct diagnosis and anatomical information of ECF are crucial for a patient's management. Here, we present a case of ECF clearly diagnosed by hybrid single-photon emission computed tomography/computed tomography (SPECT/CT). A 61-year-old man was admitted to our hospital with persistent pus discharge from a surgical wound of previous cystectomy and ileal conduit formation. Initially, he was assessed with fistulography, and ECF was suspected by intraluminal contrast media. As clinical symptom and signs were not definitely matched with ECF, Tc-99m diethylene triamine pentaacetic acid (DTPA) SPECT/CT was performed for the evaluation of fistular tract as an alternative method. On the SPECT/CT after injection of Tc-99m DTPA to the putative fistular opening, fistular as well as intraluminal radioactivity was clearly visualized. SPECT/CT is a sensitive and safe diagnostic imaging tool for ECF.

  12. Simultaneous acute shoulder arthritis and multiple mononeuropathy in a newly diagnosed type 2 diabetes patient - First case report.

    Science.gov (United States)

    Kotlęga, Dariusz; Gołąb-Janowska, Monika; Zaborowski, Grzegorz; Ciećwież, Sylwester; Nowacki, Przemysław

    Diabetes is a common disorder that leads to the musculoskeletal symptoms such as the shoulder arthritis. The involvement of peripheral nervous system is one of the troublesome for the patients as it provokes chronic sensory symptoms, lower motor neuron involvement and autonomic symptoms. In the course of the disease there has been several types of neuropathies described. A 41-year-old male patient was admitted to the internal medicine department because of the general weakness, malaise, polydypsia and polyuria since several days. The initial blood glucose level was 780mg/dl. During the first day the continuous insulin infusion was administered. On the next day when he woke up, the severe pain in the right shoulder with limited movement, right upper extremity weakness and burning pain in the radial aspect of this extremity appeared. On examination right shoulder joint movement limitation was found with the muscle weakness and sensory symptoms in the upper limbs. The clinical picture indicated on the right shoulder arthritis and the peripheral nervous system symptoms such as the right musculocutaneous, supraspinatus, right radial nerve and left radial nerve damage. We present a first case report of simultaneous, acute involvement of the shoulder joint and multiple neuropathy in a patient with newly diagnosed type 2 diabetes, presumably in the state of ketoacidosis.

  13. Meralgia paresthetica: clinical and electrophysiological diagnosis in 120 cases.

    Science.gov (United States)

    Seror, P; Seror, R

    2006-05-01

    We report the results of clinical and electrophysiological examinations in 131 cases of meralgia paresthetica (MP) among 120 unselected patients, 69 men and 51 women, aged 15-81 years. All patients experienced permanent or intermittent pain, and all but one had permanent sensory impairment of the thigh. The lateral aspect of the thigh was solely involved in 88 cases and the anterior aspect was also or exclusively involved in 32 cases. The right thigh was involved 62 times and the left 58 times. Symptom duration varied from 2 weeks to 20 years. The initial diagnosis was meralgia paresthetica in 47 cases (39%), root disease in 35 cases, and osteoarthritis in 6 cases; no diagnosis was proposed in the 32 remaining cases. Two cases had undergone previous spine surgery for disk herniation, with no benefit. A precise cause could explain the lateral femoral cutaneous nerve (LFCN) lesion in 46 cases, the other 74 cases being considered idiopathic (25% of patients were obese). Only one case required surgery to relieve symptoms. LFCN conduction was studied orthodromically, distally from the anterior superior iliac spine. The side-to-side amplitude ratio (ssRatio) was greater than 2.3 in 118 of 120 patients (98.3%) and was a better index to confirm a lesion of the LFCN than SNAP amplitude, which was abnormal (less than 3 microV) in 88 cases (73.3%). Only two of the 11 bilateral cases had an ssRatio lower than 2.3 (they were both 2.0). An ssRatio of 2.3 or more and a SNAP amplitude lower than 3 microV provided a specificity of 98.75% or more. The mean axonal loss was 88%. These clinical and electrophysiological data highlight the central role the neurophysiologist should play in diagnosing MP by means of an LFCN conduction study.

  14. Right pulmonary artery agenesis with patent ductus arteriosus and Eisenmenger syndrome: a rare case diagnosed during the postpartum period.

    Science.gov (United States)

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

    2014-01-01

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

  15. A case of disseminated histoplasmosis diagnosed after oral presentation in an old HIV-negative patient in Sweden.

    Science.gov (United States)

    Mota de Almeida, Fernando J; Kivijärvi, Kristina; Roos, Göran; Nylander, Karin

    2015-09-01

    Histoplasmosis is an endemic disease in various regions such as North America and South-East Asia but remains rare in Europe. Disseminated histoplasmosis is unusual in HIV-negative patients. Here, we describe a case of disseminated histoplasmosis in an HIV-negative patient diagnosed after oral presentation.

  16. Gonorrhoea diagnoses in a network of STI clinics in Spain during the period 2006–2010: differences by sex and transmission route

    Science.gov (United States)

    2013-01-01

    Background Gonorrhoea infection is one of the most common bacterial sexually transmitted infections and an important cause of morbidity and serious complications. The objectives of this paper are: a) to describe gonorrhoea cases diagnosed in a network of 15 (out of 16) STI clinics in Spain during 2006–2010; b) to analyse differences among men who have sex with men (MSM), men who have sex exclusively with women (MSW) and women; and c) to evaluate factors associated to with HIV co-infection. Methods All gonorrhoea cases diagnosed in the network were included (25.7% of total cases notified in Spain). Data were collected by clinical staff. Descriptive/bivariate analyses were carried out stratifying by sex and transmission category; association and trends were evaluated using the chi-square test. Factors associated with HIV co-infection were estimated using a logistic regression model. Results 2385 cases were included: 55.3% among MSM, 31.3% among MSW and 13.3% among females; cases among MSM increased from 55.8% in 2006 to 62.9% in 2010 while no trends were found among the other two groups. Most MSM cases were Spaniards (72%), aged 25–34 years (46%), 49% reported previous STI and 25% concurrent STI (excluding HIV); casual partners were the commonest source of infection, and 21% of cases had rectal gonorrhoea. MSW cases did not differ from MSM by age, origin or source of infection, but frequencies of prior or concurrent STI were lower. Female cases were younger than male, were mostly foreigners (58%), and 41% were sex workers; concurrent STI (other than HIV) were diagnosed in 30%; 20.4% had symptoms (72.5% and 89.2% in MSM and MSW), and pharyngeal location was present in 30%. HIV co-infection was highest in MSM (20.9%). Co-infection was associated with age > 35 years, low educational level, being Western European or Latin-American, being MSM, having previous or concurrent STI and reporting contact with an HIV-infected partner; it was inversely associated with

  17. Prognosis for patients diagnosed with pregnancy-associated breast cancer: a paired case-control study

    Directory of Open Access Journals (Sweden)

    Wagner Brant Moreira

    Full Text Available CONTEXT AND OBJECTIVE: Previous studies have suggested that the occurrence of pregnancy concomitantly with a diagnosis of breast cancer may affect the evolution of the neoplasia. The present study aimed to compare pregnancy-associated breast cancer (PABC patients with non-pregnant cancer patients (controls in relation to the time taken to diagnose the disease, tumor characteristics and mortality. DESIGN AND SETTING: A retrospective, paired case-control study was conducted at the Hospital da Santa Casa de Misericórdia and Centro de Quimioterapia Antiblástica e Imunoterapia in Belo Horizonte, Brazil. METHODS: The study involved 87 PABC and 252 control patients. The influence of covariables (interval between first symptoms and diagnosis, tumor histology, size of primary tumor, distant metastasis, grade of malignancy, hormone receptor status and axillary lymph node involvement and the pregnancy variable on overall survival was investigated using univariate and multivariate analyses. RESULTS: The median overall survival for PABC patients of 30.1 months (95% confidence interval, CI: 19.4-40.9 months was significantly different (P = 0.005 from that of the control group (53.1 months; 95% CI: 35.1-71.0 months. The cumulative overall survivals after five and ten years were, respectively, 29.7 and 19.2% for PABC patients, and 47.3 and 34.8% for control patients (P = 0.005. Tumor size, grade of malignancy, distant metastasis and pregnancy were independent factors that significantly modified disease prognosis. CONCLUSIONS: Pregnancy was an independent prognostic factor. The overall survival of PABC patients was shorter than that of non-pregnant patients.

  18. Association of heteromorphism of chromosome 9 and recurrent abortion (ultrasound diagnosed blighted ovum): A case report

    National Research Council Canada - National Science Library

    Baghbani, Fatemeh; Mirzaee, Salmeh; Hassanzadeh-Nazarabadi, Mohammad

    2014-01-01

    ... no. 9 heteromorphism and recurrent abortion, chromosomal analysis was performed on the basis of G-banding technique at high resolution for a couple with the history of 4 ultrasound diagnosed blighted...

  19. Cardiac autonomic testing and diagnosing heart disease. “A clinical perspective”

    OpenAIRE

    Nicholas L. DePace; Joy P. Mears; Michael Yayac; Joseph Colombo

    2014-01-01

    Background Coronary heart disease (CHD) is a major health concern, affecting nearly half the middle-age population and responsible for nearly one-third of all deaths. Clinicians have responsibilities beyond diagnosing CHD, including risk stratification of patients for major adverse cardiac events (MACE), modifying the risks and treating the patient. In this first of a two-part review, identifying risk factors is reviewed, including more potential benefit from autonomic testing. Methods...

  20. Clinically Diagnosed Acute Diverticulitis in Outpatients: Misdiagnosis in Patients with Irritable Bowel Syndrome.

    Science.gov (United States)

    Longstreth, George F; Tieu, Ryan S

    2016-02-01

    Physicians often diagnose diverticulitis and prescribe antibiotics in outpatients with abdominal pain and tenderness without other evidence. We investigated the misattribution of irritable bowel syndrome (IBS) symptoms to diverticulitis in outpatients. In patients diagnosed with diverticulitis and dispensed antibiotics in an integrated healthcare system, we retrospectively compared 15,846 outpatients managed without computed tomography (CT) versus 3750 emergency department/inpatients who had CT. We assessed demographics and past history, including 17 symptom-based somatic and 11 mental disorders and three somatic-mental comorbidity pairs (dyads) coded over 3 years and seven drug classes dispensed over 1 year before diagnosis. Univariate analysis showed small intergroup demographic differences. Outpatients had increases in prior diverticulitis, including outpatient-managed episodes, total somatic diagnoses (p Hispanic white race/ethnicity, less Charlson comorbidity, diverticulitis history, IBS, chest pain, dyspepsia, fibromyalgia, low back pain, migraine, acute reaction to stress, and antispasmodic and anxiolytic dispensing and negatively associated with non-dependent drug abuse and opioid dispensing (p ≤ .0226). Multiple types of indirect and concordant evidence suggest misattribution of IBS pain to diverticulitis and unnecessary antibiotic therapy in outpatients.

  1. Clinical and pathological analysis of 20 cases of hemochromatosis

    Directory of Open Access Journals (Sweden)

    Li LIANG

    2011-01-01

    Full Text Available Objective To investigate the clinical and pathological characteristics of hemochromatosis(HC,and provide references for HC diagnosis and treatment.Methods Liver specimens were obtained via needle biopsy from 20 cases of HC.Histological specimens were stained with haematoxylin eosin.Pathological changes of liver tissues were analyzed together with the clinical data.Results Ten cases of hereditary hemochromatosis(HHC and 10 cases of secondary hemochromatosis(SHC were randomly selected.Fatigue(18/20,hepatomegalia(18/20 and splenomegalia(17/20were the common clinical manifestations.The 20 HC cases characterized by iron overload and fibrosis may be divided into HHC type(17 cases and non-HHC type(3 cases according to the region of iron deposition.All the 10 cases of HHC showed HHC type,while 7 of the 10 SHC cases showed HHC type,and the other 3 SHC cases showed non-HHC type.Steatosis,eosinophile granulocyte infiltration and vacuolus nucleus were also observed frequently in the liver tissues of HC,and their distribution coincided with the region of iron deposition.Statistically,fibrosis was significantly associated with iron deposition and serum iron in HHC patients(P < 0.05,but not associated with steatosis and duration of HHC.Additionally,fibrosis was not associated with iron deposition,serum iron,steatosis and duration of SHC in SHC patients.Conclusions The final diagnosis of HC depends mainly on histological changes in liver tissues.Meanwhile,it is necessary to distinguish HHC from SHC according to case history and biochemical detection.HHC might be a metabolic disease with multi-organ damage due to the disruption of homeostasis by iron overload.To avoid multi-organ failure,patients with HHC should be diagnosed and treated as early as possible.

  2. ATYPICAL CELIAC DISEASE: A CLINICAL CASE

    Directory of Open Access Journals (Sweden)

    E. A. Roslavtseva

    2012-01-01

    Full Text Available Celiac disease has traditionally been associated with severe malabsorption syndrome. Recent years it was shown that among children of preschool and school-age mild cases with atypical clinical picture were dominated that leads to diagnostic difficulties. Here we are citing an example of an atypical clinical/latent celiac disease course in a child aged 4.5 years.

  3. Dual cusped protostylid: Case report and clinical significance

    Directory of Open Access Journals (Sweden)

    Preeti Bhattacharya

    2016-01-01

    Full Text Available Protostylids are superstructures on maxillary or mandibular molars, which have rarely been reported in literature, and the significance of their presence has also been underestimated. The dental practitioners may easily misdiagnose a tooth, with such conical tubercles as malformed tooth. Interestingly, this is neither a malformation nor an anomaly but rather an important morphological trait of an individual. Once in a while, one may come across such a distinct morphological trait without being able to diagnose. To the authors' best knowledge, only one similar case has been reported previously, and the second such case internationally. Bearing all such facts in mind, the authors attempt to educate the readers towards the existence of such a trait so that it can be identified and studied in larger numbers. Hence, it is the authors' endeavor to report an unusual case of dual cusped maxillary protostylid along with its clinical significance.

  4. Single Nucleotide Variants Associated With Polygenic Hypercholesterolemia in Families Diagnosed Clinically With Familial Hypercholesterolemia.

    Science.gov (United States)

    Lamiquiz-Moneo, Itziar; Pérez-Ruiz, María Rosario; Jarauta, Estíbaliz; Tejedor, María Teresa; Bea, Ana M; Mateo-Gallego, Rocío; Pérez-Calahorra, Sofía; Baila-Rueda, Lucía; Marco-Benedí, Victoria; de Castro-Orós, Isabel; Cenarro, Ana; Civeira, Fernando

    2017-09-14

    Approximately 20% to 40% of clinically defined familial hypercholesterolemia cases do not show a causative mutation in candidate genes, and some of them may have a polygenic origin. A cholesterol gene risk score for the diagnosis of polygenic hypercholesterolemia has been demonstrated to be valuable to differentiate polygenic and monogenic hypercholesterolemia. The aim of this study was to determine the contribution to low-density lipoprotein cholesterol (LDL-C) of the single nucleotide variants associated with polygenic hypercholesterolemia in probands with genetic hypercholesterolemia without mutations in candidate genes (nonfamilial hypercholesterolemia genetic hypercholesterolemia) and the genetic score in cascade screening in their family members. We recruited 49 nonfamilial hypercholesterolemia genetic hypercholesterolemia families (294 participants) and calculated cholesterol gene scores, derived from single nucleotide variants in SORT1, APOB, ABCG8, APOE and LDLR and lipoprotein(a) plasma concentration. Risk alleles in SORT1, ABCG8, APOE, and LDLR showed a statistically significantly higher frequency in blood relatives than in the 1000 Genomes Project. However, there were no differences between affected and nonaffected members. The contribution of the cholesterol gene score to LDL-C was significantly higher in affected than in nonaffected participants (P = .048). The percentage of the LDL-C variation explained by the score was 3.1%, and this percentage increased to 6.9% in those families with the highest genetic score in the proband. Nonfamilial hypercholesterolemia genetic hypercholesterolemia families concentrate risk alleles for high LDL-C. Their contribution varies greatly among families, indicating the complexity and heterogeneity of these forms of hypercholesterolemias. The gene score explains a small percentage of LDL-C, which limits its use in diagnosis. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All

  5. [Herpetic encephalitis: a clinical case].

    Science.gov (United States)

    Dryhant, L P; Sereda, V H; Kushpiĭ, O V; Tkachenko, V V; Kravchuk, N A; Inhula, N I; Sizina, A V; Sachko, Iu Iu; Andrusenko, A S; Tytenko, Iu I; Babirad, A M

    2012-01-01

    An example of diagnostics and treatment of patient is in-process made with herpetic encephalitis. It is well-proven in researches, that a herpetic encephalitis is 11.5% among sharp encephalitises. Morbidity is sporadic, some researchers specify on an increase its spring. An infection can be passed tiny and pin a way. Seasonal vibrations are not incident to the herpetic encephalitis. Two peaks of morbidity are on 5-30 years and age more senior 50 years. More than in 95% cases the virus of simple herpes of type serves as an exciter of herpetic encephalitis 1. A characteristic triad of herpetic encephalitis is the sharp feverish beginning, development of cramps of dzheksonovskogo type and violation of consciousness, developing usually after a brief respirator infection. Sometimes sudden development of cramps and loss of consciousness is preceded a fever. Example of such development of disease is made an in our work.

  6. Disseminated cysticercosis incidentally diagnosed in a patient of low backache:A case report and concise review of literature

    Institute of Scientific and Technical Information of China (English)

    Mohammad Nasim Akhtar; Sharat Agarwal

    2012-01-01

    ABSTRACT Disseminated cysticercosis is an uncommon presentation of a common disease.Asymptomatic disseminated cysticercosis is rarely reported in literature.Here, we are reporting a case of asymptomatic disseminated cysticercosis incidentally diagnosed in a patient of low backache. Magnetic resonance imaging of lumbosacral spine and neuroimaging done subsequently during the course of evaluation revealeddiffuse cysticercosis involving abdominal, paraspinal, pelvic and gluteal muscles along with neurocysticercosis.Such a disseminated cysticercosis was diagnosed incidentally in this patient of low backache with right sciatica and radiculopathy atL5-S1 prolapsed intervertebral disc and was subsequently managed byL5-S1 interlaminar fenestration and discectomy.

  7. [A case of Wilson's disease in an elderly patient initially diagnosed with NASH].

    Science.gov (United States)

    Seishima, Jun; Sakai, Yoshio; Kitahara, Noriaki; Kitamura, Kazuya; Arai, Kuniaki; Kagaya, Takashi; Yamashita, Tatsuya; Mizukoshi, Eishiro; Honda, Masao; Kaneko, Shuichi

    2015-02-01

    A 62-year-old female was admitted to our hospital for examination of icterus and thrombocytopenia. She had a history of diabetes mellitus (under treatment), and liver cirrhosis was evident on abdominal CT. Because she was clinically obese and had no past history of alcohol consumption, the initial diagnosis was NASH. However, subsequent MRI findings and normal serum transaminase levels were not consistent with this diagnosis. We then performed additional examinations, including liver biopsy, measurements of serum Cu and ceruloplasmin concentrations, and measurement of urinary Cu secretion, which resulted in a diagnosis of Wilson's disease. It is necessary to include Wilson's disease in the differential diagnosis of NASH in cases of unidentified liver disease even among elderly patients.

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    BACKGROUND: In our clinical work, we treat refugees who have been exposed to trauma and who subsequently develop psychotic symptoms. However, the literature does not address the relationship between refugees with depression, post-traumatic stress disorder (PTSD) and psychotic symptoms. Therefore...... Centre Gentofte in Copenhagen during 2009. RESULTS: Our cases were all characterized by having severe symptoms of depression and PTSD. Before treatment start they had a score on the Harvard Trauma Questionnaire between 2.9 and 3.8 (cut-off: 2.5), and a score on the Hopkins Symptom Checklist-25 between 2...... into the prevalence of psychotic symptoms among refugees with depression and PTSD, including the qualitative dimensions of the symptoms in order to optimize diagnosis and treatment among this group of psychiatric patients....

  9. Use of DSM paraphilia diagnoses in sexually violent predator commitment cases.

    Science.gov (United States)

    First, Michael B; Halon, Robert L

    2008-01-01

    There is legitimate concern in the psychiatric community about the constitutionality of sexually violent predator (SVP) commitment statutes. Such constitutionality depends on the requirement that a sexual offender have a mental abnormality that makes him commit violent predatory sex offenses and reflects almost exclusively a concern for public safety, with little regard for notions of clinical sensibility or diagnostic accuracy. However, given that mental health experts' diagnostic opinions are, and will continue to be, important to the triers of fact in regard to the application of the SVP statutes, we describe valid means of making a DSM-IV-TR paraphilic diagnosis. We also provide a three-step approach for the judicious application of the diagnosis in the context of SVP commitment evaluations that emphasizes the importance of not making a paraphilia diagnosis based solely on the sexual offenses themselves. Finally, we discuss the appropriate use of a paraphilia NOS diagnosis in SVP cases.

  10. A clinical comparative study on treatment of severe newly diagnosed immune thrombocytopenia by recombinant human thrombopoietin combined with glucocorticoid

    Institute of Scientific and Technical Information of China (English)

    顾史洋

    2013-01-01

    Objective To evaluate the efficacy and safety of recombinant human thrombopoietin (rhTPO) combined with glucocorticoid in treatment of severe newly diagnosed primary immune thrombocytopenia (ITP) .Methods From June 2009 to December 2012,24 male patients and 38female patients with the diagnosis of severe primary ITP in our hospital were randomized into trial group (31cases) or control group (31 cases) ,the median age was 50 years (range:21-84 years) .Trial group was treated with rhTPO combined with glucocorticoid,and control group was

  11. Evaluation of NANDA nursing diagnoses of healthcare college final year students during the clinical application of the mental health and disease nursing course

    Directory of Open Access Journals (Sweden)

    Gülay Taşdemir

    2013-01-01

    Full Text Available The aim of this descriptive study was to evaluate the NANDA nursing diagnoses of Pamukkale University Denizli Healthcare College final year students for the patients they undertook the care of and to determine the aims and interventions relevant to these diagnoses.The study universe consisted of all Pamukkale University Denizli Healthcare College final year students who were continuing their education during the 2009-2010 educational year and took the Mental Health and Disease Nursing course (84. The universe was studied before selecting a sample. The internal medicine, surgery, cardiovascular surgery, chest disease, orthopedics-urology, and physical treatment and rehabilitation clinics were chosen for the consultation liaison psychiatry (CLP while the AMATEM Center of the Denizli State Hospital and the Pamukkale University Psychiatry clinics were chosen as the student clinical application areas. The data were collected by evaluating the 136 nursing care plans prepared by the students and the data collection forms the students had used for nursing care during the 2009-2010 autumn semester. The nursing care was evaluated according to the symptom, etiology and problem (SEP format, using the diagnostic list containing the NANDA diagnoses that had previously been provided to the students, and the number and percentage distributions were determined.The patients cared for at the CLP clinics by the students included in the study had been admitted for surgical interventions at a rate of 29.8% and cancer at 28.6% while those in the psychiatry clinics had been admitted for psychosis or alcohol-substance abuse at a rate of 16.7%. The students included in the study had determined 36 nursing diagnoses in 136 cases. The 6 most common diagnoses were infection risk at 34.5%, disturbance of sleep pattern at 33.3%, anxiety at 25.0%, activity intolerance at 20.2%, inadequate personal coping at 16.7% and trauma risk at 13.1% at the CLP clinics, and disturbed sleep

  12. Secondary breast lymphoma diagnosed by vacuum-assisted breast biopsy: a case report

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    Zagouri Flora

    2007-10-01

    Full Text Available Abstract Introduction Breast lymphoma, either as a manifestation of primary extranodal disease or as secondary involvement, is a rare malignancy, and its diagnosis, prognosis, and treatment have not been clearly defined. On the other hand, Vacuum-assisted breast biopsy (VABB is a minimally invasive technique with ever-growing use for the diagnosis of mammographically detected, non-palpable breast lesions. Case presentation A symptom-free, 56-year-old woman presented with a non-palpable BI-RADS 4B lesion without microcalcifications. She had a positive family history for breast cancer and a history of atypical ductal hyperplasia in the ipsilateral breast four years ago. She reported having been treated for non-Hodgkin lymphoma 12 years ago. With the suspicion of breast cancer, mammographically guided VABB with 11-gauge probe (on the stereotactic Fisher's table was performed. VABB made the diagnosis of a non-Hodgkin, grade II, B-cell germinal-center lymphoma. VABB yielded enough tissue for immunohistochemistry/WHO classification. Conclusion This is the first case in the literature demonstrating the successful diagnosis of breast lymphoma by VABB, irrespectively of the level of clinical suspicion. It should be stressed that VABB was able to yield enough tissue for WHO classification. In general, lymphoma should never be omitted in the differential diagnosis, since no pathognomonic radiologic findings exist for its diagnosis.

  13. Mobile teledermatopathology: using a tablet PC as a novel and cost-efficient method to remotely diagnose dermatopathology cases.

    Science.gov (United States)

    Speiser, Jodi J; Hughes, Ian; Mehta, Vikas; Wojcik, Eva M; Hutchens, Kelli A

    2014-01-01

    : Dermatopathology has relatively few studies regarding teledermatopathology and none have addressed the use of new technologies, such as the tablet PC. We hypothesized that the combination of our existing dynamic nonrobotic system with a tablet PC could provide a novel and cost-efficient method to remotely diagnose dermatopathology cases. 93 cases diagnosed by conventional light microscopy at least 5 months earlier by the participating dermatopathologist were retrieved by an electronic pathology database search. A high-resolution video camera (Nikon DS-L2, version 4.4) mounted on a microscope was used to transmit digital video of a slide to an Apple iPAD2 (Apple Inc, Cupertino, CA) at the pathologist's remote location via live streaming at an interval time of 500 ms and a resolution of 1280/960 pixels. Concordance to the original diagnosis and the seconds elapsed to reaching the diagnosis were recorded. 24.7% (23/93) of cases were melanocytic, 70.9% (66/93) were nonmelanocytic, and 4.4% (4/93) were inflammatory. About 92.5% (86/93) of cases were diagnosed on immediate viewing (<5 seconds), with the average time to diagnosis at 40.2 seconds (range: 10-218 seconds). Of the cases diagnosed immediately, 98.8% (85/86) of the telediagnoses were concordant with the original. Telepathology performed via a tablet PC may serve as a reliable and rapid technique for the diagnosis of routine cases with some diagnostic caveats in mind. Our study established a novel and cost-efficient solution for those institutions that may not have the capital to purchase either a dynamic robotic system or a virtual slide system.

  14. Severe Tricuspid Regurgitation Diagnosed 13 Years after a Car Accident: A Case Report

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    Burak Acar

    2015-10-01

    Full Text Available Blunt chest traumas mostly occur due to car accidents and can cause many cardiac complications such as septal rupture, free-wall rupture, coronary artery dissection or thrombosis, heart failure, arrhythmias, and chordae and papillary muscle rupture. One of the most serious complication is tricuspid regurgitation (TR, which can be simply diagnosed by physical examination and confirmed by echocardiography. We describe a 48-year-old female patient, diagnosed with severe TR 13 years after a blunt chest trauma due to a car accident. TR was diagnosed with transthoracic echocardiography and three dimensional transthoracic echocardiography had defined the exact pathology of the tricuspid valve. The patient underwent successful surgery with bioprosthetic valve implantation and was discharged at 6th postoperative day without any complication. The patient had no problem according to the follow-up one month and six months after operation

  15. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity.

    Science.gov (United States)

    Carroccio, Antonio; Mansueto, Pasquale; Iacono, Giuseppe; Soresi, Maurizio; D'Alcamo, Alberto; Cavataio, Francesca; Brusca, Ignazio; Florena, Ada M; Ambrosiano, Giuseppe; Seidita, Aurelio; Pirrone, Giuseppe; Rini, Giovanni Battista

    2012-12-01

    Non-celiac wheat sensitivity (WS) is considered a new clinical entity. An increasing percentage of the general population avoids gluten ingestion. However, the real existence of this condition is debated and specific markers are lacking. Our aim was thus to demonstrate the existence of WS and define its clinical, serologic, and histological markers. We reviewed the clinical charts of all subjects with an irritable bowel syndrome (IBS)-like presentation who had been diagnosed with WS using a double-blind placebo-controlled (DBPC) challenge in the years 2001-2011. One hundred celiac disease (CD) patients and fifty IBS patients served as controls. Two hundred and seventy-six patients with WS, as diagnosed by DBPC challenge, were included. Two groups showing distinct clinical characteristics were identified: WS alone (group 1) and WS associated with multiple food hypersensitivity (group 2). As a whole group, the WS patients showed a higher frequency of anemia, weight loss, self-reported wheat intolerance, coexistent atopy, and food allergy in infancy than the IBS controls. There was also a higher frequency of positive serum assays for IgG/IgA anti-gliadin and cytometric basophil activation in "in vitro" assay. The main histology characteristic of WS patients was eosinophil infiltration of the duodenal and colon mucosa. Patients with WS alone were characterized by clinical features very similar to those found in CD patients. Patients with multiple food sensitivity were characterized by clinical features similar to those found in allergic patients. Our data confirm the existence of non-celiac WS as a distinct clinical condition. We also suggest the existence of two distinct populations of subjects with WS: one with characteristics more similar to CD and the other with characteristics pointing to food allergy.

  16. Case of Rapid Progression of Hemiatrophy on the Face: A New Clinical Entity?

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    Hisashi Nomura

    2015-01-01

    Full Text Available A lot of diseases, including lupus profundus, morphea, lipodystrophy, and Parry-Romberg syndrome, may manifest progressive hemifacial atrophy. These diseases usually progress slowly and rapid progression of atrophy is extremely rare. We report a case of elderly-onset rapid progression of hemifacial atrophy only in three weeks. Our case did not meet variable differential diagnoses. We discuss the clinical character of the patient against the past of literature and suppose it may be a new clinical entity.

  17. Fine needle aspiration cytology findings in cases diagnosed as oropharyngeal tularemia lymphadenitis (Erratum was published in Vol 24 Number 1, 2008

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    Banu DOĞAN GÜN

    2007-01-01

    Full Text Available Francisella tularensis is a gram-negative coccobacilus that causes zoonotic disease tularemia. Histopathological examination of lymph node biopsy in tularemia reveals suppurative granulomatous inflammation potentially associated caseous necrosis. Diagnosis is mainly made on the evidence of elevated agglutinating antibodies against F. Tularensis. In this study we aimed to evaluate the cytological features of ulceroglandular tularemia cases and to demonstrate the role of fine needle aspiration cytology in the diagnosis of tularemia.Fine needle aspiration cytology findings of six cervical lymphadenopaties that had established diagnoses of tularemia both clinically and serologically, were evaluated and the cytomorphological features were described.All of the cases revealed suppurative inflammation and some caseous necrosis and in four cases epithelioid histiocytes and multinuclear giant cells were observed additionally.The differential diagnosis of tularemia principally from tuberculosis and other types of bacterial lymphadenitis was made and the place of fine needle aspiration cytology among other diagnostic laboratory tests for tularemia was evaluated.

  18. The Validity of Psychiatric Diagnoses: The Case of "Specific" Developmental Disorders

    Science.gov (United States)

    Dyck, Murray J.; Piek, Jan P.; Patrick, Jeff

    2011-01-01

    We tested whether developmental coordination disorder (DCD) and mixed receptive expressive language disorder (RELD) are valid diagnoses by assessing whether they are separated from each other, from other childhood disorders, and from normality by natural boundaries termed zones of rarity. Standardized measures of intelligence, language, motor…

  19. The EXIT for Prenatally Diagnosed Cervical Cystic Teratoma: A Case Report

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    Sabri Cansaran

    2015-03-01

    Full Text Available The Ex-utero intrapartum treatment (EXIT is a procedure performed during caesarean section while on fetal-placental circulation. We present a prenatally diagnosed cervical cystic mass causing tracheal compression which was managed successfully with the EXIT procedure.

  20. Boron neutron capture therapy for newly diagnosed glioblastoma multiforme: An assessment of clinical potential

    Energy Technology Data Exchange (ETDEWEB)

    Hopewell, J.W., E-mail: john.hopewell@gtc.ox.ac.uk [Green Templeton College and Particle Therapy Cancer Research Institute, University of Oxford, Oxford (United Kingdom); Gorlia, T. [Data Center, EORTC, Brussels (Belgium); Pellettieri, L. [Hammercap Medical AB, Stockholm (Sweden)] [Department of Neurosurgery, Goeteborg University, Goeteborg (Sweden); Giusti, V. [Hammercap Medical AB, Stockholm (Sweden)] [Department of Mechanical, Nuclear and Production Engineering, University of Pisa, Pisa (Italy); H-Stenstam, B. [Nykoeping Hospital, County of Sormland (Sweden); Skoeld, K. [Hammercap Medical AB, Stockholm (Sweden)

    2011-12-15

    The purpose of this analysis was to assess the potential of BNCT, with L-boronophenylalanine (L-BPA), as first line radiotherapy for glioblastoma multiforme (GBM). The survival of patients with newly diagnosed GBM from a phase II BNCT study was compared with those from the two arms of a phase III study with conventional radiotherapy (RT) vs. RT plus concomitant and adjuvant medication with temozolomide (TMZ). A small subgroup, for which the methylation status of the O{sup 6}-methylguanine-DNA methyltransferase (MGMT) DNA-repair gene was known, was also considered. The results indicated that the use of BNCT with BPA should be explored in a stratified randomized phase II trial in which patients with the unmethylated MGMT DNA-repair gene are offered BNCT vs. RT plus TMZ.

  1. FENO measurement and sputum analysis for diagnosing asthma in clinical practice.

    Science.gov (United States)

    Schneider, Antonius; Schwarzbach, Johannes; Faderl, Bernhard; Welker, Lutz; Karsch-Völk, Marlies; Jörres, Rudolf A

    2013-02-01

    To determine the diagnostic accuracy of fractional exhaled nitric oxide (FENO) measurement in pneumologists routine diagnostic work-up; and to determine the impact of the inflammatory pattern on diagnostic accuracy. Prospective diagnostic study in 393 patients attending a private practice of pneumologists with complaints suspicious of obstructive airway disease (OAD). Index test was FENO measurement. Reference standard was the Tiffeneau ratio (FEV(1)/VC) or airway resistance as assessed by whole body plethysmography, with additional bronchoprovocation or bronchodilator testing. Morning sputum was analysed with smear slides which were prepared and stained by Giemsa. 154 patients were diagnosed as having asthma (145 diagnoses based on bronchial provocation, 9 based on bronchodilator results), 5 had COPD. For the whole group, asthma could be ruled in at FENO > 71 ppb (PPV 80%; 95% CI 63-90%) and ruled out at FENO ≤ 9 ppb (NPV 82%; 95% CI 67-91%) (area under the curve (AUC) = 0.656; 95% CI 0.600-0.712; p ppb (sd 48.9) in patients with predominant eosinophilic inflammation, 18.5 ppb with neutrophilic inflammation, and 23.1 ppb in others (p = 0.003). Diagnostic accuracy of FENO increased when patients with neutrophilic inflammation were omitted from analysis (AUC = 0.745; 95% CI 0.651-0.838; p  31 ppb (PPV 82%; 95% CI 63-92%) and ruled out at FENO ≤ 12 ppb (NPV 81%; 95% CI 62-91%). FENO measurement can be useful as an additional diagnostic tool in pneumologists' practice. The diagnostic value of FENO could be improved when inflammatory patterns are taken into account. Copyright © 2012. Published by Elsevier Ltd.

  2. [Factors associated with marital status among spouse after diagnosed in newly reported HIV cases in China, 2014].

    Science.gov (United States)

    Li, J; Xu, J; Tang, H L; Han, J; Mao, Y R

    2017-02-10

    Objective: To analyze the factors associated with divorce or separation when one of the spouse diagnosed and newly reported as HIV positive, in China. Methods: Data from the Chinese HIV/AIDS Comprehensive Response Information Management System, by December 31, 2015 were used for collection on newly reported HIV cases regarding their baseline information in 2014 and follow-up within one year, among couples and above 18 year olds. HIV cases were divided into divorce/separation group and married group according to their marriage dynamics in one year after being diagnosed as HIV positive. Multivariate logistic regressions were used to analyze potential factors associated with divorce or separation after the diagnoses made. Results: A total of 31 708 HIV cases were included in this study. 22.5% (7 134/31 708) of them got divorced or separated in one year after diagnose being made. 81.6% (25 864/31 708) of them had couples tested in one year after diagnose made and 10.0% (2 599/25 864) of them got divorced or separated. Among 18.4% (5 844/31 708) of the HIV cases who did not have their couples tested in one year after the diagnoses, 77.6% (4 535/5 844) got divorced or separated. For those who did not have their couples tested in one year after the diagnose. Data from the multivariate logistic regression analysis showed that factors as those who were older than 45 (46-60 yr.: OR=1.28, 95%CI: 1.03-1.58; ≥61 yr.: OR=1.83, 95%CI: 1.41-2.37), with Han ethnicity (OR=1.56, 95%CI: 1.34-1.83), with high school education or above (OR=1.55, 95%CI: 1.27-1.90), non-farmers or non-rural laborers (OR=1.34, 95%CI: 1.17-1.54), infected through injecting drug use (OR=1.33, 95% CI: 1.03-1.71), men who had sex with men (OR=1.49, 95% CI: 1.20-1.86), or with childless (OR=2.35, 95%CI: 1.78-3.09) etc. were more likely to be divorced or separated after the diagnoses being made, among those who had their couples tested in one year after the diagnoses. Results from the multivariate logistic

  3. Diagnosing developmental dyscalculia on the basis of reliable single case FMRI methods: promises and limitations.

    Directory of Open Access Journals (Sweden)

    Philipp Johannes Dinkel

    Full Text Available FMRI-studies are mostly based on a group study approach, either analyzing one group or comparing multiple groups, or on approaches that correlate brain activation with clinically relevant criteria or behavioral measures. In this study we investigate the potential of fMRI-techniques focusing on individual differences in brain activation within a test-retest reliability context. We employ a single-case analysis approach, which contrasts dyscalculic children with a control group of typically developing children. In a second step, a support-vector machine analysis and cluster analysis techniques served to investigate similarities in multivariate brain activation patterns. Children were confronted with a non-symbolic number comparison and a non-symbolic exact calculation task during fMRI acquisition. Conventional second level group comparison analysis only showed small differences around the angular gyrus bilaterally and the left parieto-occipital sulcus. Analyses based on single-case statistical procedures revealed that developmental dyscalculia is characterized by individual differences predominantly in visual processing areas. Dyscalculic children seemed to compensate for relative under-activation in the primary visual cortex through an upregulation in higher visual areas. However, overlap in deviant activation was low for the dyscalculic children, indicating that developmental dyscalculia is a disorder characterized by heterogeneous brain activation differences. Using support vector machine analysis and cluster analysis, we tried to group dyscalculic and typically developing children according to brain activation. Fronto-parietal systems seem to qualify for a distinction between the two groups. However, this was only effective when reliable brain activations of both tasks were employed simultaneously. Results suggest that deficits in number representation in the visual-parietal cortex get compensated for through finger related aspects of number

  4. Diagnosing developmental dyscalculia on the basis of reliable single case FMRI methods: promises and limitations.

    Science.gov (United States)

    Dinkel, Philipp Johannes; Willmes, Klaus; Krinzinger, Helga; Konrad, Kerstin; Koten, Jan Willem

    2013-01-01

    FMRI-studies are mostly based on a group study approach, either analyzing one group or comparing multiple groups, or on approaches that correlate brain activation with clinically relevant criteria or behavioral measures. In this study we investigate the potential of fMRI-techniques focusing on individual differences in brain activation within a test-retest reliability context. We employ a single-case analysis approach, which contrasts dyscalculic children with a control group of typically developing children. In a second step, a support-vector machine analysis and cluster analysis techniques served to investigate similarities in multivariate brain activation patterns. Children were confronted with a non-symbolic number comparison and a non-symbolic exact calculation task during fMRI acquisition. Conventional second level group comparison analysis only showed small differences around the angular gyrus bilaterally and the left parieto-occipital sulcus. Analyses based on single-case statistical procedures revealed that developmental dyscalculia is characterized by individual differences predominantly in visual processing areas. Dyscalculic children seemed to compensate for relative under-activation in the primary visual cortex through an upregulation in higher visual areas. However, overlap in deviant activation was low for the dyscalculic children, indicating that developmental dyscalculia is a disorder characterized by heterogeneous brain activation differences. Using support vector machine analysis and cluster analysis, we tried to group dyscalculic and typically developing children according to brain activation. Fronto-parietal systems seem to qualify for a distinction between the two groups. However, this was only effective when reliable brain activations of both tasks were employed simultaneously. Results suggest that deficits in number representation in the visual-parietal cortex get compensated for through finger related aspects of number representation in

  5. Identification of the c.2448-25G>A Polymorphism in Patients Clinically Diagnosed with Wilson's Disease

    Directory of Open Access Journals (Sweden)

    Yulia Clark Feoktistova

    2015-11-01

    Full Text Available Background: Wilson's disease is characterized by copper accumulation in the liver, brain and cornea. It is caused by mutations in the ATP7B gene. Several polymorphisms in the ATP7B gene have been reported in the literature.Objective: to identify conformational changes in the fragment comprising intron 9-exon 10 for detecting the c.2448-25G> A polymorphism in the ATP7B gene of Cuban patients clinically diagnosed with Wilson's disease.Methods: a descriptive study including 100 patients with clinical diagnosis of Wilson's disease was conducted at the National Medical Genetics Center from 2008 to 2012. The polymerase chain reaction was used to amplify the fragment of interest and the single-strand conformation polymorphism was applied in the intron 9-exon 10 region of the ATP7B gene to identify conformational changes. Presence of the c.2448-25G> A polymorphism was detected by sequencing this fragment.Results: the conformational change called b corresponded to the c.2448-25G> A polymorphism in heterozygous state. The allele frequency of the c.2448-25G> A polymorphism in 100 Cuban patients clinically diagnosed with Wilson's disease was 8.5%. The most common manifestations in patients with this polymorphism were related to the liver.Conclusion: the c.2448-25G> A polymorphism was identified in Cuba for the first time, which will enable molecular studies by indirect methods.

  6. TCT联合阴道镜宫颈活检和LEEP诊治宫颈病变200例临床分析%Clinical analysis on 200 cases with cervical lesions diagnosed and treated by TCT combined with cervical biopsy under colposcope and LEEP

    Institute of Scientific and Technical Information of China (English)

    张敦兰; 雷燕; 周丽敏

    2011-01-01

    目的:探讨TCT联合阴道镜检查诊断官颈病变的准确率和LEEP术诊治官颈病变的效果.方法:对TCT联合阴道镜宫颈活检初步诊断为官颈疾病者200例采用LEEP术治疗,切除组织行病理检查.结果:TCT联合阴道镜官颈活检结果与LEEP术后病理结果的诊断符合率为97.00%,两者无显著性差异;LEEP术并发症发生率为8.9%.结论:TCT联合阴道镜宫颈活检与LEEP术后病理诊断无显著性差异,是宫颈上皮内瘤变及癌前病变筛查的较好方法;LEEP术是一种较好的确诊和治疗官颈病变的方法.%Objective: To explore the accurate rate of TCT combined with colposcopy for diagnosis of cervical lesions and the effi-cacy of loop electrosurgical excision procedure (LEEP) for diagnosis and treatment of cervical lesions. Methods; 200 cases who were diag-nosed as cervical lesions by TCT combined with cervical biopsy under colposcope were treated with LEEP, then the excised tissue samples were collected for pathological examination. Results: The diagnostic accordance rate of TCT combined with cervical biopsy under colposcope and pathological examination after LEEP was 97.00% , there was no significant difference between the two methods; the incidence of compli-cations after LEEP was 8. 9%. Conclusion: There is no significant difference in the accurate rate for diagnosis of cervical lesions between TCT combined with cervical biopsy under colposcope and pathological examination after LEEP, TCT combined with cervical biopsy under col-poscope is a good method to screen cervical intraepithelial neoplasia and precancerous lesion of cervix; LEEP is a good method for definite di-agnosis and treatment of cervical lesions.

  7. [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.

  8. Travel-related leptospirosis in Japan: a report on a series of five imported cases diagnosed at the National Center for Global Health and Medicine.

    Science.gov (United States)

    Kutsuna, Satoshi; Kato, Yasuyuki; Koizumi, Nobuo; Yamamoto, Kei; Fujiya, Yoshihiro; Mawatari, Momoko; Takeshita, Nozomi; Hayakawa, Kayoko; Kanagawa, Shuzo; Ohmagari, Norio

    2015-03-01

    Leptospirosis is one of the most common travel-related infections. We report 5 cases of travel-related leptospirosis who presented at our clinic between January 2008 and December 2013. Patients were included in the study if they presented with a clinical profile that was compatible with the disease within 21 days of their return from traveling, which were laboratory-diagnosed as leptospirosis by blood culture, rise in antibody titers in paired sera using the microscopic agglutination test (MAT), and/or DNA detection using flaB-nested PCR. Five leptospirosis cases were evaluated, all of which contracted the disease after exposure to fresh water in Southeast Asian countries. All of the cases had fevers, headaches, conjunctival injections, and relative bradycardia. The pertinent laboratory findings included elevated C-reactive protein levels, elevated creatinine levels, and sterile pyuria. All 5 cases had serum MAT titers that increased by ≥ 4 times in the interval between specimens taken during the acute phase and those taken during the convalescence phase, and leptospiral DNA was detected in plasma and/or urine specimens in 4 cases. Leptospira interrogans was isolated from one patient's blood sample. Patients were treated with penicillin G, minocycline, or doxycycline. One case was cured without antibiotics. A diagnosis of leptospirosis should be considered for febrile travelers who return from Southeast Asian countries to Japan after being exposed to freshwater while traveling.

  9. Integrated case learning: teaching clinical reasoning.

    Science.gov (United States)

    Radomski, Natalie; Russell, John

    2010-05-01

    Learning how to 'think like doctors' can be difficult for undergraduate medical students in their early clinical years. Our model of collaborative Integrated Case Learning (ICL) and simulated clinical reasoning aims to address these issues. Taking a socio-cultural perspective, this study investigates the reflective learning interactions and practices of clinical thinking that emerged in the ICL environment. We also explore how third year medical students perceived their ICL experiences in relation to the clinical situations encountered in the hospital setting. The context for the inquiry is a rural Clinical School in North West Victoria, Australia. We used a qualitative case study methodology following eight third-year medical students over an academic year. Individual and group interviews were conducted, together with observations and document/artefact analysis. Data was analysed using content and narrative methods. The ICL program was well received. Findings suggest that the group-based, simulated clinical reasoning process appears to help undergraduate medical students to rehearse, articulate and question their clinical decision-making pathways. We argue that the ICL process offers a professionally challenging, but supportive group learning 'space' for students to practise what it might mean to 'think', 'talk' and 'perform' like doctors in real settings. The ICL environment also appears to create a connective bridge between the 'classroom' and clinical practice.

  10. Apicetomy or dental implant: Report of a clinical case.

    Directory of Open Access Journals (Sweden)

    Enrique Fernández-Bodereau

    2012-07-01

    Full Text Available We report a clinical case of a patient who underwent apicectomy on an upper premolar, presumably by endodontic done improperly, and have cast a bolt where the extraction run the risk of tooth fracture. Failed such treatment, an implant is performed, placed immediately after extraction, in which bone filling with xenograft and guided bone regeneration with resorbable collagen membrane was done. From this we deduce that the phase diagnosed is of paramount importance. Two months after functional load of the implant is made with a cemented ceramic crown. One of the factors that influenced the positive outcome of this case, where immediately implants are placed to the tooth extraction is ultra microtextured surface of the used implant, besides being the bone table of these dental elements of thicker vestibular.

  11. Maxillary First Molars with Six Canals Diagnosed with the Aid of Cone Beam Computed Tomography: A Report of Two Cases

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    Mamta Kaushik

    2013-01-01

    Full Text Available The case reports present the endodontic management of two maxillary first molars with six canals. The diagnosis of morphology of multiple canal systems was identified under magnification of the dental operating microscope and was confirmed with the help of cone beam computed tomography. This paper discusses the variations in the canal morphology and the use of the latest adjuncts in successfully diagnosing and treating unusual canal anatomy.

  12. Hashimoto thyroiditis is more frequent than expected when diagnosed by cytology which uncovers a pre-clinical state

    Directory of Open Access Journals (Sweden)

    Staii Anca

    2010-12-01

    Full Text Available Abstract Background Our Thyroid-Multidisciplinary Clinic is a large referral site for thyroid diseases. Thyroid biopsies are mainly performed for thyroid cancer screening. Yet, Hashimoto thyroiditis (HT is being too frequently diagnosed. The prevalence of HT is reported as 0.3-1.2% or twice the prevalence of type 1 diabetes. However, the prevalence of HT confirmed by cytology is still uncertain. To evaluate different aspects of thyroid physiopathology including prevalence of Hashimoto's, a database of clinical features, ultrasound images and cytology results of patients referred for FNA of thyroid nodules was prospectively developed. Methods We retrospectively studied 811 consecutive patients for whom ultrasound guided thyroid FNA biopsies were performed at our clinic over 2.5 year period (Mar/2006-Sep/2008. Results The analysis of our database revealed that from 761 patients, 102 (13.4% had HT, from whom 56 (7.4% were euthyroid or had sub-clinical (non-hypothyroid disease, and 46 (6% were clinically hypothyroid. Conclusions This is the first study to show such a high prevalence of HT diagnosed by ultrasound-guided FNA. More strikingly, the prevalence of euthyroid HT, appears to be >5% similar to that of type 2 diabetes. Based on our results, there might be a need to follow up on cytological Hashimoto's to monitor for thyroid failure, especially in high risk states, like pregnancy. The potential risk for thyroid cancer in patients with biopsy-proven inflammation of thyroid epithelium remains to be established prospectively. However, it may explain the increased risk for thyroid cancer observed in patients with elevated but within normal TSH.

  13. Fetal outcome of trisomy 18 diagnosed after 22 weeks of gestation: Experience of 123 cases at a single perinatal center.

    Science.gov (United States)

    Nagase, Hiromi; Ishikawa, Hiroshi; Toyoshima, Katsuaki; Itani, Yasufumi; Furuya, Noritaka; Kurosawa, Kenji; Hirahara, Fumiki; Yamanaka, Michiko

    2016-01-01

    To investigate the pregnancy outcome of the fetuses with trisomy 18, we studied 123 cases of trisomy 18 who were born at our hospital from 1993 to 2009. Among them, 95.9% were diagnosed with trisomy 18 prenatally. Prenatal ultrasound findings showed fetal growth restriction in 77.2%, polyhydramnios in 63.4% and congenital heart defects in 95.1%. For 18 cases, cesarean section (C-section) was chosen, and for 75 cases, transvaginal delivery was chosen. Premature delivery occurred in 35.5%. Stillbirths occurred in 50 cases (40.7%). Fetal demise before onset of labor occurred in 30 cases and fetal demise during labor occurred in 20 cases which was 26.7% of vaginal deliveries. Among the 73 live-born infants, the survival rate for 24 h, 1 week, 1 month and 1 year were 63%, 43%, 33% and 3%. The median survival time was 3.5 days. There was no significant difference between the survival time of C-section and that of vaginal delivery. However, for the births involving breech presentation, the survival time of C-section was significantly longer than that of vaginal delivery. When the fetus is diagnosed with trisomy 18, the parents have to make many choices. These findings constitute critical information in prenatal counseling to the couples whose fetuses have been found to have trisomy 18, especially when they choose palliative approaches in the perinatal management.

  14. The process of recovery for people diagnosed with personality disorder: a case study of The Haven

    OpenAIRE

    Castillo, Heather

    2010-01-01

    The study investigates the process of recovery for people diagnosed with personality disorder. This is related to the application of the new meaning of recovery from mental illness as explored by members of The Haven which, as the service setting for the study, addresses the problems of a client group that suffers significant social exclusion, known to impact on demand for health and other public services. It aims to examine efforts which attempt to reverse this social exclusion as an aspect ...

  15. Selective, reliable blood and milk bio-markers for diagnosing clinical and subclinical bovine mastitis.

    Science.gov (United States)

    Sadek, Kadry; Saleh, Ebeed; Ayoub, Mousa

    2017-02-01

    Mastitis is positioned as the most vital ailment in dairy cows in light of conventional cost examinations. The aim of the present study was to evaluate the diagnostic value of different acute phase proteins (APPs), pro-inflammatory cytokines, and oxidative stress biomarkers in healthy cows and in those with clinical or subclinical mastitis and to localize APP gene expression in the milk of mastitic cows. Therefore, 20 subclinical mastitic cows with positive California Mastitis Test (CMT) results and no clinical signs of mastitis, 15 clinically mastitic cows, and 15 healthy cows with negative CMT results and somatic cell count (SCC) of mastitis, except for total protein, albumin, and GSH levels and the TAC, which were significantly (p mastitis, while Fb expression was absent. The present study demonstrates that APPs, pro-inflammatory cytokines, and indicators of oxidative stress may serve as biomarkers of clinical and subclinical mastitis. Interestingly, the expression of SAA and Hp indicates the local de novo synthesis of these APPs within the mammary glands. Furthermore, the presence of SAA and Hp transcripts in milk cells derived from pathogen-free mammary glands proved their constitutive expression. However, future studies with more extensive baseline sampling are still needed to establish and validate the reference values for APPs, cytokines, and oxidative stress markers in cows.

  16. Crescentic glomerulonephritis: A clinical and histomorphological analysis of 46 cases

    Directory of Open Access Journals (Sweden)

    Ruchika Gupta

    2011-01-01

    Full Text Available Background: Crescentic glomerulonephritis (CrGN, defined as crescents involving more than 50% of the glomeruli, includes pauci-immune, immune complex-mediated and anti-glomerular basement membrane disease. Objectives: The present study was aimed at evaluating the various clinical, biochemical and histological parameters in CrGN with respect to these categories and clinical outcome. Materials and Methods: Renal biopsies diagnosed as CrGN between Jan 2008 and Feb 2010 were included. Clinical and laboratory parameters were retrieved along with the therapeutic approach and clinical outcome, wherever available. Renal biopsy slides were evaluated for various glomerular, tubulo-interstitial and arteriolar features. Appropriate statistical tests were applied for significance. Results: A total of 46 cases of CrGN were included; majority (71.7% of cases were pauci-immune (PI while 28.3% were immune complex-mediated (IC. Among clinical features, gender ratio was significantly different between PI and IC groups (P = 0.006. The various histological parameters, including proportion of cellular crescents, tuft necrosis and Bowman′s capsule rupture, were similar in both the groups. Four unusual associations, including idiopathic membranoproliferative glomerulonephritis (MPGN, multibacillary leprosy, acute lymphoblastic leukemia and C1q nephropathy were detected. Adequate follow-up information was available in 21 (46% of the patients. Of these, 11 (52.4% were dialysis-dependent at the last follow-up. Adult patients required renal replacement therapy more frequently than pediatric cases (P = 0.05. Presence of arteriolar fibrinoid necrosis also showed association with poor clinical outcome (P = 0.05. Conclusions: Crescentic glomerulonephritis remains one of the main causes of acute renal failure with histological diagnosis. Immunohistologic examination is essential for accurate classification into one of the three categories. This condition should be considered

  17. Women's views of their sexual difficulties: agreement and disagreement with clinical diagnoses.

    Science.gov (United States)

    King, Michael; Holt, Victoria; Nazareth, Irwin

    2007-04-01

    There is controversy about how to conceptualize sexual problems in women. Our purpose in this study was to compare ICD-10 diagnoses of sexual dysfunction in women with whether or not the woman perceived she had a sexual problem, her views on its origins, and its impact on her life. Participants (N = 401, M age, 37.8 years) were consecutive attendees to general practices in London, England. Our main measures were an ICD-10 diagnosis of sexual dysfunction and the woman's own perception of a sexual problem. Based on reported symptoms and behavior, 38% of women had at least one ICD-10 diagnosis of sexual dysfunction. Prevalence fell to 18% in women who also perceived they had a problem and to 6% in women who regarded the problem as moderate or severe. A total of 73 (18%) women were assigned an ICD-10 diagnosis and agreed that they had a problem, 80 (20%) were assigned a diagnosis but reported no problem, 78 (19%) had no diagnosis but reported a sexual problem, and 170 (42%) had no diagnosis and reported no problem. For women with sexual partners, reported sexual satisfaction was lowest in those assigned an ICD-10 diagnosis who also perceived they had a problem and highest in those with no diagnosis and no perceived problem. Relationship and emotional difficulties were the most common perceived causes of sexual difficulties, whether or not an ICD-10 diagnosis was assigned. There were three aspects to sexual difficulties in women. The first concerned symptoms and behavior that clinicians used to make a diagnosis, the second was the woman's own perception that she had a sexual difficulty, and the third was her level of sexual satisfaction. All three appear to be important and may explain why published prevalence rates of sexual dysfunction and associated factors are so conflicting.

  18. Clinical efficacy and safety of lamotrigine monotherapy in newly diagnosed pediatric patients with epilepsy

    Directory of Open Access Journals (Sweden)

    Ji Hye Han

    2010-04-01

    Full Text Available Purpose : To verify the efficacy and safety of lamotrigine (LTG monotherapy in newly diagnosed children with epilepsy. Methods : We prospectively enrolled 148 children who had undergone LTG monotherapy at our institution between September 2002 and June 2009. Twenty-nine patients were excluded: 19 due to incomplete data and 10 were lost to follow up. The data of the remaining 119 patients was analyzed. Results : We enrolled 119 pediatric epilepsy patients (aged 2.8-19.3 years; 66 males and 53 females in this study. Out of 119 patients, 29 (25.2% had generalized epilepsy and 90 (74.8% had partial epilepsy. The responses of seizure reduction were as follows: Seizure freedom (no seizure attack for at least 6 months in 87/111 (78.4%, n=111 patients; partial response (reduced seizure frequency compared to baseline in 13 (11.7% patients; and persistent seizure in 11 (9.9% patients. The seizure freedom rate was in 81.6% in patients with partial seizure (75.9% for complex partial seizure and 90.9% for benign rolandic epilepsy and 44.8% in patients with generalized epilepsy (30.0% for absence seizure, 35.7% for juvenile myoclonic epilepsy patients, and 100.0% for idiopathic generalized epilepsy patients. Adverse reactions were reported in 17 (14.3% patients, and 8 patients (6.7% discontinued LTG because of rash and tic. No patient experienced severe adverse reaction such as Stevens-Johnson syndrome. Conclusion : LTG showed excellent therapeutic response and had few significant adverse effects. Our findings report may contribute in promoting the use of LTG monotherapy in epileptic children.

  19. The relationship between carers' report of autistic traits and clinical diagnoses of autism spectrum disorders in adults with intellectual disability.

    Science.gov (United States)

    Bhaumik, Sabyasachi; Tyrer, Freya; Barrett, Mary; Tin, Nyunt; McGrother, Catherine W; Kiani, Reza

    2010-01-01

    It is often difficult to determine the triad of impairments and whether autistic features are the consequence of intellectual impairment or autism spectrum disorders in people with intellectual disability (ID). The aim of the current study was to investigate the relationship between carer-reported autistic traits and independent diagnoses of autism spectrum disorders (ASD). Data were collected on carers' subjective report of autistic traits and clinical diagnoses of ASD. Of 1145 adults with ID identified, 220 (19%) individuals had a diagnosis of ASD, and 778 (68%) individuals had at least one autistic trait. Optimal sensitivity and specificity were achieved with two or more autistic traits (sensitivity 63%; specificity 79%) and the positive predictive value increased substantially as the number of autistic traits increased. However, a significant proportion of individuals with ID who did not have a diagnosis of ASD also displayed autistic traits. Our findings suggest that in the absence of other measures, the presence of autistic traits can serve as a useful proxy measure for ASD in research (and/or clinical settings). However, although information on autistic traits may help healthcare practitioners to identify people with possible ASD, it cannot be used alone to make a formal diagnosis.

  20. Goodpasture Syndrome Diagnosed One Year And A Half after the Appearance of the First Symptoms (Case Report).

    Science.gov (United States)

    Stojkovikj, Jagoda; Zejnel, Sead; Gerasimovska, Biljana; Gerasimovska, Vesna; Stojkovic, Dragana; Trajkovski, Martin; Angelovska, Irina; Debreslioska, Angela; Jovanovski, Smilko

    2016-12-15

    Goodpasture syndrome was originally described as an association of alveolar haemorrhage and glomerulonephritis. It occurs when the immune system attacks and destroys healthy body tissue. We are presenting a patient with a clinical picture of pulmonary haemorrhage and glomerulonephritis, which is diagnosed by renal biopsy. His illness began a year and a half before being diagnosed. In that period he had occasional exacerbations. He was received at our Clinic in extremely serious condition, and after stabilisation of his medical condition, there was made a biopsy of the kidney. The p-ANCA was 8.93 U/ml (neg 5 U/ml). Histopathological diagnosis of biopsy of the kidney was: Glomerulonephritis extra capillaries focalis, segmentalis et globalis. Based on this he was diagnosed with Goodpasture syndrome. He received corticosteroid therapy and cyclophosphamide, with good response to treatment, and he is currently in a stable condition, receiving only corticosteroid therapy. Goodpasture syndrome is a severe illness caused by the formation of antibodies to the glomerular basement membrane and alveolus with consequential damage to renal and pulmonary function. With current therapy, long-term survival is more than 50%.

  1. Generating Evidence for Clinical Benefit of PET/CT in Diagnosing Cancer Patients

    DEFF Research Database (Denmark)

    Vach, Werner; Høilund-Carlsen, Poul Flemming; Gerke, Oke

    2011-01-01

    of PET/CT in cancer patients: replacement of an invasive procedure, improved accuracy of initial diagnosis, improved accuracy of staging for curative versus palliative treatment, improved accuracy of staging for radiation versus chemotherapy, response evaluation, and acceleration of clinical decisions...... to assess the benefit expected from the use of PET/CT. Only if decision modeling does not allow definitive conclusions should randomized controlled trials be planned....

  2. Catatonia: Etiopathological diagnoses and treatment response in a tertiary care setting: A clinical study

    Directory of Open Access Journals (Sweden)

    Santosh Ramdurg

    2013-01-01

    Full Text Available Aim: Catatonia is caused by a variety of psychiatric and organic conditions. The onset, clinical profile, and response to treatment may vary depending on the underlying cause. The study is an attempt to explore clinical profile, possible etiological correlates with neurotic/psychotic spectrum illnesses, and response to treatment and outcome in patients of catatonia. Materials and Methods: Retrospective chart analysis by using semistructured data sheet for the analysis of sociodemographic data, clinical profile, precipitating event, and response to treatment in patients with catatonic symptoms admitted to IHBAS (Institute of Human Behaviour and Allied Sciences, New Delhi, India from January 2009 to December 2010 was undertaken. Results: Catatonia was commonly observed in patients with the following profile - late twenties, female, Hindu religion, urban background, and housewives. Psychotic spectrum disorder (57%, N=35 was the most commonly entertained diagnosis and affective disorder (18%, N=11 being the second common. Thirty four percent of the subjects responded to lorazepam treatment and rest required modified electroconvulsive therapy (MECT. Conclusion: Catatonia is more likely to be associated with Schizophrenia and Other Psychotic Disorders in Indian settings. Majority of patients responded to therapy either by lorazepam alone or to its augmentation with modified ECT. The study being a retrospective one, the sample being representative of the treatment seeking group only, and unavailability of the follow up data were the limitations of the study

  3. [Autopsy case of a patient with Charcot-Marie-Tooth disease type 1A and suspected chronic inflammatory demyelinating polyradiculoneuropathy, which was later diagnosed as amyotrophic lateral sclerosis].

    Science.gov (United States)

    Higuchi, Yujiro; Sakiyama, Yusuke; Nishihira, Yasushi; Endo, Kazuhiro; Suwazono, Shugo; Suehara, Masahito

    2012-01-01

    We report an autopsy case of a 74-year-old man with late onset Charcot-Marie-Tooth disease type 1A (CMT1A) diagnosed by genetic screening, later associated with amyotrophic lateral sclerosis (ALS). At the age of 70 years, the patient was admitted to our hospital because of progressive weakness and dysesthesia in the right upper limb. In the early stages of the illness, he was diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), and transient improvement was achieved with intravenous immunoglobulin. However, the symptoms progressively worsened and became refractory. Gene analysis revealed PMP22 gene duplication, which confirmed CMT1A. On sural nerve biopsy, severe demyelinating neuropathy and abundant onion-bulb formations with endoneurial infiltration of inflammatory cells were observed. Thereafter, pseudo-bulbar palsy and respiratory muscle weakness developed insidiously and progressed rapidly along with muscle weakness in the limbs and trunk. The patient died about four years after the onset of this disease. Postmortem examination showed moderate neuronal cell loss, Bunina bodies, and TDP-43-positive inclusions in the anterior horn cells. The spinal cord revealed axonal loss and extensive macrophage permeation in the corticospinal tracts. On the basis of these findings, the final neuropathological diagnosis was ALS. This is the first report of an autopsy case of CMT1A complicated with ALS. We here discuss the significant clinical and neuropathological findings of this case.

  4. Four cases of supposed multiple personality disorder: evidence of unjustified diagnoses.

    Science.gov (United States)

    Freeland, A; Manchanda, R; Chiu, S; Sharma, V; Merskey, H

    1993-05-01

    Four cases are presented in which an unjustified diagnosis of multiple personality disorder was made. These cases are used to illustrate the concern that some cases of multiple personality disorder may be the result of misdiagnosis by both patients and clinicians.

  5. Case Managers' Attitudes toward the Use of Homework for People Diagnosed with a Severe Psychiatric Disability

    Science.gov (United States)

    Kelly, Peter J.; Deane, Frank P.; Kazantzis, Nikolaos; Crowe, Trevor P.

    2007-01-01

    The study examined mental health case managers' attitudes toward the use of homework and explored the relationship between clinician attitudes and systematic homework administration practices. A survey examining attitudes toward the use of homework was completed by 122 Australian mental health case managers. Case managers who held more positive…

  6. The prevalence of neovascularity in patients clinically diagnosed with rotator cuff tendinopathy

    Directory of Open Access Journals (Sweden)

    Raza Syed A

    2009-12-01

    Full Text Available Abstract Background Shoulder dysfunction is common and pathology of the rotator cuff tendons and subacromial bursa are considered to be a major cause of pain and morbidity. Although many hypotheses exist there is no definitive understanding as to the origin of the pain arising from these structures. Research investigations from other tendons have placed intra-tendinous neovascularity as a potential mechanism of pain production. The prevalence of neovascularity in patients with a clinical diagnosis of rotator cuff tendinopathy is unknown. As such the primary aim of this pilot study was to investigate if neovascularity could be identified and to determine the prevalence of neovascularity in the rotator cuff tendons and subacromial bursa in subjects with unilateral shoulder pain clinically assessed to be rotator cuff tendinopathy. The secondary aims were to investigate the association between the presence of neovascularity and pain, duration of symptoms, and, neovascularity and shoulder function. Methods Patients with a clinical diagnosis of unilateral rotator cuff tendinopathy referred for a routine diagnostic ultrasound (US scan in a major London teaching hospital formed the study population. At referral patients were provided with an information document. On the day of the scan (on average, at least one week later the patients agreeing to participate were taken through the consent process and underwent an additional clinical examination prior to undergoing a bilateral grey scale and colour Doppler US examination (symptomatic and asymptomatic shoulder using a Philips HDI 5000 Sono CT US machine. The ultrasound scans were performed by one of two radiologists who recorded their findings and the final assessment was made by a third radiologist blinded both to the clinical examination and the ultrasound examination. The findings of the radiologists who performed the scans and the blinded radiologist were compared and any disagreements were resolved

  7. [Phenotypic variability in 47, XXX patients: Clinical report of four new cases].

    Science.gov (United States)

    Goldschmidt, Ernesto; Márquez, Marisa; Solari, Andrea; Ziembar, María I; Laudicina, Alejandro

    2010-08-01

    The 47, XXX karyotype has a frequency of 1 in 1000 female newborns. However, this karyotype is not usually suspected at birth or childhood. These patients are usually diagnosed during adulthood when they develop premature ovarian failure or infertility, because the early phenotype doesn t have any specific features. The study describes four cases and the clinical variability of the 47, XXX karyotype.

  8. Art Therapy for an Individual with Late Stage Dementia: A Clinical Case Description

    Science.gov (United States)

    Tucknott-Cohen, Tisah; Ehresman, Crystal

    2016-01-01

    This article describes the healing benefits of art therapy for an individual with dementia of the Alzheimer's type. In this clinical case description, a woman diagnosed with Alzheimer's disease received individual art therapy for 17 weeks. The treatment concerns that arose, altered view of reality, agitation, and retrogenesis provide insight on…

  9. Art Therapy for an Individual with Late Stage Dementia: A Clinical Case Description

    Science.gov (United States)

    Tucknott-Cohen, Tisah; Ehresman, Crystal

    2016-01-01

    This article describes the healing benefits of art therapy for an individual with dementia of the Alzheimer's type. In this clinical case description, a woman diagnosed with Alzheimer's disease received individual art therapy for 17 weeks. The treatment concerns that arose, altered view of reality, agitation, and retrogenesis provide insight on…

  10. Marketing and clinical trials: a case study.

    Science.gov (United States)

    Francis, David; Roberts, Ian; Elbourne, Diana R; Shakur, Haleema; Knight, Rosemary C; Garcia, Jo; Snowdon, Claire; Entwistle, Vikki A; McDonald, Alison M; Grant, Adrian M; Campbell, Marion K

    2007-11-20

    Publicly funded clinical trials require a substantial commitment of time and money. To ensure that sufficient numbers of patients are recruited it is essential that they address important questions in a rigorous manner and are managed well, adopting effective marketing strategies. Using methods of analysis drawn from management studies, this paper presents a structured assessment framework or reference model, derived from a case analysis of the MRC's CRASH trial, of 12 factors that may affect the success of the marketing and sales activities associated with clinical trials. The case study demonstrates that trials need various categories of people to buy in - hence, to be successful, trialists must embrace marketing strategies to some extent. The performance of future clinical trials could be enhanced if trialists routinely considered these factors.

  11. Most lobular carcinoma in situ and atypical lobular hyperplasia diagnosed on core needle biopsy can be managed clinically with radiologic follow-up in a multidisciplinary setting.

    Science.gov (United States)

    Middleton, Lavinia P; Sneige, Nour; Coyne, Robin; Shen, Yu; Dong, Wenli; Dempsey, Peter; Bevers, Therese B

    2014-06-01

    We evaluated the efficacy of using standard radiologic and histologic criteria to guide the follow-up of patients with lobular carcinoma in situ (LCIS), lobular neoplasia (LN), or atypical lobular hyperplasia (ALH). Patients with high-risk benign lesions diagnosed on biopsy were presented and reviewed in a multidisciplinary clinical management conference from 1 November 2003 through September 2011. Associations between patient characteristics and rates of upgrade were determined by univariate and multivariate logistic models, and times to diagnosis carcinoma were calculated. Of 853 cases reviewed, 124 (14.5%) were lobular neoplasms. In all, 104 patients were clinically and/or radiographically monitored. In 20 patients, who were found to have LN on core biopsy and were recommended to have immediate surgical excision, a more significant lesion was identified in 8 (40%) of the excised specimens. Factors associated with a more significant lesion on excisional biopsy included whether the lobular lesion had been targeted for biopsy and whether the extent of disease involved three or more terminal duct lobular units. Of the 104 patients radiographically and clinically monitored, the median follow-up time was 3.4 years with a range of 0.44-8.6 years. Five patients under surveillance were subsequently diagnosed with breast malignancy (three of the five at a site unrelated to the initial biopsy). Patients with incidental lobular lesions identified on percutaneous core needle biopsy have a small risk of upgrade and may not require an excisional biopsy. Clinical management of low-volume lobular lesions in a multidisciplinary setting is an efficacious alternative to surgical excision when radiologic and histologic characteristics are well-defined.

  12. Resolving clinical diagnoses for syndromic cleft lip and/or palate phenotypes using whole-exome sequencing.

    Science.gov (United States)

    Pengelly, R J; Upstill-Goddard, R; Arias, L; Martinez, J; Gibson, J; Knut, M; Collins, A L; Ennis, S; Collins, A; Briceno, I

    2015-11-01

    Individuals from three families ascertained in Bogota, Colombia, showing syndromic phenotypes, including cleft lip and/or palate, were exome-sequenced. In each case, sequencing revealed the underlying causal variation confirming or establishing diagnoses. The findings include very rare and novel variants providing insights into genotype and phenotype relationships. These include the molecular diagnosis of an individual with Nager syndrome and a family exhibiting an atypical incontinentia pigmenti phenotype with a missense mutation in IKBKG. IKBKG mutations are typically associated with preterm male death, but this variant is associated with survival for 8-15 days. The third family exhibits unusual phenotypic features and the proband received a provisional diagnosis of Pierre Robin sequence (PRS). Affected individuals share a novel deleterious mutation in IRF6. Mutations in IRF6 cause Van der Woude and popliteal pterygium syndrome and contribute to nonsyndromic cleft lip phenotypes but have not previously been associated with a PRS phenotype. Exome sequencing followed by in silico screening to identify candidate causal variant(s), and functional assay in some cases offers a powerful route to establishing molecular diagnoses. This approach is invaluable for conditions showing phenotypic and/or genetic heterogeneity including cleft lip and/or palate phenotypes where many underlying causal genes have not been identified. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Type F Congenital Quadricuspid Aortic Valve: A Very Rare Case Diagnosed by 3-dimenional Transoesophageal Echocardiography

    Science.gov (United States)

    Garg, Pankaj; Kamaruddin, Hazlyna; Orme, Rachel; Watt, Victoria

    2014-01-01

    Congenital quadricuspid aortic valve (QAV) is a rare cardiac anomaly. Several different anatomical variations of a quadricuspid aortic valve have been described. Aortic regurgitation is the predominant valvular dysfunction associated with QAV and patients tend to present in their 5th or 6th decade of life. This anomaly is rarely picked up by transthoracic echocardiogram (TTE). A comprehensive transoesophageal echocardiography (TOE) study is more likely to diagnose it. We describe a very rare type of QAV – Type F in a 52-year-old lady who presented with symptoms of shortness of breath and pre-syncope. We include TOE images and intra-operative valve images. PMID:24707324

  14. The value of double balloon enteroscopy in diagnosing blue rubber bleb naevus syndrome: a case report.

    LENUS (Irish Health Repository)

    O'Kelly, Fardod

    2010-01-01

    Blue rubber bleb naevus syndrome is a rare vascular disorder associated with multiple gastrointestinal haemangiomas that have the potential for life-threatening haemorrhage. These may be difficult to diagnose, and have classically been described using computed tomographic studies and\\/or mesenteric angiography. Resected surgical specimens of these lesions, especially in the small bowel, have often been extensive and poorly localized. The recent advent and progressive development of double balloon enteroscopy has allowed the direct visualization and marking of these enteric lesions and serves as a valuable adjunct not only in diagnosis but also planning prior to surgery to allow accurate estimate of the extent of resection.

  15. [Individualised care plan during extracorporeal membrane oxygenation. A clinical case].

    Science.gov (United States)

    Call Mañosa, S; Pujol Garcia, A; Chacón Jordan, E; Martí Hereu, L; Pérez Tejero, G; Gómez Simón, V; Estruga Asbert, A; Gallardo Herrera, L; Vaquer Araujo, S; de Haro López, C

    2016-01-01

    An individualised care plan is described for a woman diagnosed with pneumonia, intubated, and on invasive mechanical ventilation, who was admitted to the Intensive Care Unit for extracorporeal membrane oxygenation (ECMO). A nursing care plan was designed based on Marjory Gordon functional patterns. The most important nursing diagnoses were prioritised, using a model of clinical reasoning model (Analysis of the current status) and NANDA taxonomy. A description is presented on, death anxiety, impaired gas exchange, decreased cardiac output, dysfunctional gastrointestinal motility, risk for disuse syndrome, infection risk, and bleeding risk. The principal objectives were: to reduce the fear of the family, achieve optimal respiratory and cardiovascular status, to maintain gastrointestinal function, to avoid immobility complications, and to reduce the risk of infection and bleeding. As regards activities performed: we gave family support; correct management of the mechanical ventilation airway, cardio-respiratory monitoring, skin and nutritional status; control of possible infections and bleeding (management of therapies, care of catheters…). A Likert's scale was used to evaluate the results, accomplishing all key performance indicators which were propose at the beginning. Individualised care plans with NNN taxonomy using the veno-venous ECMO have not been described. Other ECMO care plans have not used the same analysis model. This case can help nurses to take care of patients subjected to veno-venous ECMO treatment, although more cases are needed to standardise nursing care using NANDA taxonomy.

  16. Sweet syndrome: Clinical and Laboratory Findings of 31 Cases

    Directory of Open Access Journals (Sweden)

    Serap Güneş Bilgili

    2013-03-01

    Full Text Available Background and Design: Sweet syndrome is an inflammatory disease characterized by the abrupt onset of pain, red papules and plaques, fever, neutrophilic leukocytosis, and dermal neutrophilic infiltrate. There are not enough data about Sweet syndrome in Turkey. In this article, we studied clinical, laboratory, histopathological, and epidemiological characteristics of patients, who presented to our clinic, and compared the findings with the literature. Materials and Methods: All patients diagnosed with Sweet syndrome in our clinic between 2005 and 2011 were included in the study. The epidemiological, clinical, and laboratory findings were retrospectively evaluated. Results: A total of 31 patients with Sweet’s syndrome - 24 female (77.4%, 7 male (22.6%; aged 23-82 years – included in the study. The average age of the patients was 48 years. Cutaneous lesions were most frequently localized in the upper extremity. Conjunctivitis was the common systemic manifestation, followed by fever, arthralgia, and myalgia. The most common trigger factor was infections of the upper respiratory tract. In histopathological evaluations of skin biopsies, dense neutrophil infiltration compatible with Sweet syndrome was detected in the dermis. Also, findings of vasculitis were determined in 3 patients. Discussion: The clinical and laboratory findings in our study are mostly similar to those reported in the literature. We found evidence of vasculitis in 10% of cases, therefore, we think the presence of vasculitis does not necessarily rule out the diagnosis of Sweet syndrome

  17. Giant Cavernous Hepatic Hemangioma Diagnosed Incidentally in a Perimenopausal Obese Female with Endometrial Adenocarcinoma: A Case Report.

    Science.gov (United States)

    Bara, Tivadar; Gurzu, Simona; Jung, Ioan; Muresan, Mircea; Szederjesi, Janos; Bara, Tivadar

    2016-02-01

    Hemangiomas are the most common benign tumors of the liver, considered giant when they exceed 50-100 mm in diameter. In the present report, we present a case of a 5.2-kg hemangioma of the right hepatic lobe, with hemangiomatous foci in the left lobe, which was incidentally diagnosed in a 53-year-old obese female hospitalized for uterine bleeding. The computed tomographic scan and physical examination revealed a giant abdominal tumor and hepatic hemangioma of the right hepatic lobe was suspected. Right hepatectomy and total hysterectomy with bilateral ovariectomy was performed. The histological examination of the surgical specimens confirmed the extremely giant cavernous hepatic hemangioma, and a synchronous pT1a endometrioid endometrial adenocarcinoma was also diagnosed. The patient remains alive without postoperative disorders, 6 months after surgery. To our knowledge, this is the first reported case of such huge hemangioma incidentally diagnosed in an obese female, with a synchronous endometrial adenocarcinoma of the uterus. Because obesity may cause hyperestrogenism, it might both increase the growth rate of hemangioma and the genesis of endometrial cancer in perimenopausal females. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  18. Intravascular Large B-Cell Lymphoma Diagnosed on Prostate Biopsy: A Case Report

    Directory of Open Access Journals (Sweden)

    Nazan Özsan

    2014-12-01

    Full Text Available Intravascular large B-cell lymphoma (IVLBCL is a very rare type of non-Hodgkin lymphoma, usually affecting elderly patients and characterized by selective infiltration of neoplastic cells within blood vessels’ lumina. IVLBCL diagnosed with prostatic involvement is extremely rare. We report a patient of 65 years old, having mostly neurological complaints but diagnosed with IVLBCL upon histopathological examination of transurethral prostate resection material, which revealed large neoplastic cell infiltration totally limited within the lumens of small vessels. By immunohistochemistry, neoplastic cell infiltration was positive with MUM1, bcl-6, and bcl-2 and negative with ALK1, CD10, and CD30, with a high Ki-67 proliferation index. CD34 and CD31 staining showed expression in endothelial cells, highlighting the intravascular nature of neoplastic infiltrate. The patient unfortunately refused to receive treatment and died of the disease 8 months after the diagnosis. IVLBCL, though very rare, should be considered in differential diagnosis of all organ biopsies with intravascular infiltration. Further improvements in the understanding of the pathogenesis and biology of this rare type of lymphoma are mandatory.

  19. The challenge of diagnosing Plasmodium ovale malaria in travellers: report of six clustered cases in french soldiers returning from West Africa

    Directory of Open Access Journals (Sweden)

    Deparis Xavier

    2010-12-01

    Full Text Available Abstract Background Plasmodium ovale is responsible for 5% of imported malaria in French travellers. The clinical and biological features of six clustered cases of P. ovale malaria in an army unit of 62 French soldiers returning from the Ivory Coast are reported. Case report All patients were symptomatic and developed symptoms on average 50 days after their return and 20 days after the end of chemoprophylaxis (doxycycline. Clinical features included fever (6/6, mostly tertian (4/6, aches (6/6, nausea (3/6, abdominal pain (2/6, diarrhoea (2/6, or cough (2/6. Thrombocytopaenia was lower than 100,000/mm3 in half the cases only, and the haemoglobin count was normal for all patients. The diagnosis was made after at least three thick and thin blood smear searches. Parasitaemia was always lower than 0.5%. All rapid diagnostic tests were negative for HRP2 and pLDH antigens. Discussion Plasmodium ovale malaria is currently a problem to diagnose in travellers, notably in French soldiers returning from the Ivory Coast. Early attempts at diagnosis are difficult due to the lack of specific clinical features, the rarity of biological changes and the poor sensitivity of diagnostic tools to detect low parasitaemia. Thus, the diagnosis is commonly delayed or missed. Physicians should be aware of this diagnostic challenge to avoid relapses and provide prompt and adequate treatment with chloroquine and radical cure with primaquine.

  20. [THE COMPARATIVE ANALYSIS OF INFORMATION VALUE OF MAIN CLINICAL CRITERIA USED TO DIAGNOSE OF BACTERIAL VAGINOSIS].

    Science.gov (United States)

    Tsvetkova, A V; Murtazina, Z A; Markusheva, T V; Mavzutov, A R

    2015-05-01

    The bacterial vaginosis is one of the most frequent causes of women visiting gynecologist. The diagnostics of bacterial vaginosis is predominantly based on Amsel criteria (1983). Nowadays, the objectivity of these criteria is disputed more often. The analysis of excretion of mucous membranes of posterolateral fornix of vagina was applied to 640 women with clinical diagnosis bacterial vaginosis. The application of light microscopy to mounts of excretion confirmed in laboratory way the diagnosis of bacterial vaginosis in 100 (15.63%) women. The complaints of burning and unpleasant smell and the Amsel criterion of detection of "key cells" against the background of pH > 4.5 were established as statistically significant for bacterial vaginosis. According study data, the occurrence of excretions has no statistical reliable obligation for differentiation of bacterial vaginosis form other inflammatory pathological conditions of female reproductive sphere. At the same time, detection of "key cells" in mount reliably correlated with bacterial vaginosis.

  1. Diagnosing malignant melanoma in ambulatory care: a systematic review of clinical prediction rules

    Science.gov (United States)

    Harrington, Emma; Clyne, Barbara; Wesseling, Nieneke; Sandhu, Harkiran; Armstrong, Laura; Bennett, Holly; Fahey, Tom

    2017-01-01

    Objectives Malignant melanoma has high morbidity and mortality rates. Early diagnosis improves prognosis. Clinical prediction rules (CPRs) can be used to stratify patients with symptoms of suspected malignant melanoma to improve early diagnosis. We conducted a systematic review of CPRs for melanoma diagnosis in ambulatory care. Design Systematic review. Data sources A comprehensive search of PubMed, EMBASE, PROSPERO, CINAHL, the Cochrane Library and SCOPUS was conducted in May 2015, using combinations of keywords and medical subject headings (MeSH) terms. Study selection and data extraction Studies deriving and validating, validating or assessing the impact of a CPR for predicting melanoma diagnosis in ambulatory care were included. Data extraction and methodological quality assessment were guided by the CHARMS checklist. Results From 16 334 studies reviewed, 51 were included, validating the performance of 24 unique CPRs. Three impact analysis studies were identified. Five studies were set in primary care. The most commonly evaluated CPRs were the ABCD, more than one or uneven distribution of Colour, or a large (greater than 6 mm) Diameter (ABCD) dermoscopy rule (at a cut-point of >4.75; 8 studies; pooled sensitivity 0.85, 95% CI 0.73 to 0.93, specificity 0.72, 95% CI 0.65 to 0.78) and the 7-point dermoscopy checklist (at a cut-point of ≥1 recommending ruling in melanoma; 11 studies; pooled sensitivity 0.77, 95% CI 0.61 to 0.88, specificity 0.80, 95% CI 0.59 to 0.92). The methodological quality of studies varied. Conclusions At their recommended cut-points, the ABCD dermoscopy rule is more useful for ruling out melanoma than the 7-point dermoscopy checklist. A focus on impact analysis will help translate melanoma risk prediction rules into useful tools for clinical practice. PMID:28264830

  2. Malignant peripheral nerve sheath tumors: Clinicopathological profile of 63 cases diagnosed at a tertiary cancer referral center in Mumbai, India

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    Rekhi Bharat

    2010-10-01

    Full Text Available Background: A malignant peripheral nerve sheath tumor (MPNST is a rare sarcoma, characterized by an aggressive course and forms a diagnostic challenge, in view of its varied histomorphology. The present study is a comprehensive analysis, including histopathological spectrum of 63 MPNSTs that forms a substantial study from an Indian perspective. Materials and Methods: Clinicopathological features of 63 MPNSTs, diagnosed during a period from January 2002 to December 2006, at a tertiary cancer referral center in Mumbai, India, were analyzed. Statistical analysis was carried out using SPSS (version 14 and STRATA. Difference in events was noted in 50 cases with selected variables. Disease free survival (DFS was calculated by Kaplan-Meir analysis at the end of 1 year. Results: More cases were identified in > 30 years age (36 cases, 57.14% group; in men (46 cases, 73%, and were deep-seated (38, 60.3%. Ten cases (15.9% showed stigmata of multiple neurofibromatosis type 1. Average tumor (T size was 9.9 cm, with 72.9% cases having T size > 5 cm. More cases were of high grade (56, 88.8% and high stage (22, 34.9%. Histopathologically, most cases showed hypo- and hypercellular areas (marbleized appearance of doubly indented spindle cells. Two cases showed epithelioid differentiation. Heterologous elements in the form of osteoid, chondroid, pigmented neuroectodermal (1 case, glandular (1 case and rhabdomyoblastic differentiation (1 case were identified in 14 cases (22.2%. S-100 protein positivity was noted in 38/54 cases (70.3%. Maximum cases (45, 71.4% underwent surgery, including wide excisions and amputations (R0 in 20 cases, marginal excisions (R1 in 4, and intracapsular excision (R2 in 1 case. Nineteen cases underwent adjuvant treatment. A total of 29 cases (46% showed recurrences and 22 (34.9% showed multifocality and/or metastasis. Four patients succumbed to the disease in 1 year. The DFS was 53.1%. Cases ≤30 years of age (P- value = 0.007, T size

  3. [Dengue with unusual clinical features in an infant. Case report].

    Science.gov (United States)

    Méndez-Domínguez, Nina; Achach-Medina, Kikey; Morales-Gual, Yareni María; Gómez-Carro, Salvador

    2016-07-01

    The state of Yucatan, in Mexico, is an endemic area for dengue. During 2015, there was an unpredicted increase in the number of expected cases of dengue fever. To describe and analyse the clinical presentation, progress, and management of a case of dengue infection with non-specific clinical manifestations in an infant which resulted in a dengue shock syndrome. One month old infant admitted to hospital with a generalised rash and a history of being bitten by an insect. He was diagnosed with anaphylaxis based on clinical manifestations and anamnesis. While in hospital, he developed hypotension, tachycardia, anaemia, and respiratory distress. He was transferred to the intensive care unit, but died on the fifth day. He tested positive to dengue virus in the PCR test and for IgG antibodies using Elisa. The basic cause of death was dengue shock syndrome. Dengue fever in young infant infections may be afebrile, so it is important to suspect them appropriately in the presence of a generalised rash, tachycardia, and hypotension, in order to avoid the deadly consequences of dengue shock. Copyright © 2016 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Escitalopram in Preschool-Age Children Diagnosed with ‎Obsessive ‎Compulsive‏ ‏Disorder: A Case Report‎

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    Kemal Utku Yazici

    2016-02-01

    Full Text Available When a literature review on pediatric obsessive-compulsive disorder (OCD is ‎performed, it is observed that there is a dearth of research on preschool period OCD ‎cases. Although cognitive behavioral therapy is recommended as the first line of ‎treatment in preschool OCD cases when patients do not show adequate response to ‎CBT, psychopharmacological treatment offers an alternative. The first line used in ‎psychopharmacological treatment is selective serotonin reuptake inhibitors (SSRI’s. ‎However, no SSRI’s (or any other drug group have been approved by the FDA for this ‎age group. Moreover, studies related to psychopharmacology in preschool OCD are very ‎limited in the literature, consisting mostly of case reports related to sertraline and ‎fluoxetine. In those studies, it is reported that sertraline and fluoxetine are effective in ‎preschool OCD and generally well-tolerated. In this paper, we discussed the treatment ‎and six-month follow-up period of a 3.5 year-old (42 months female diagnosed with ‎OCD and for whom escitalopram was used. In the literature, there is a retrospective case ‎series related to this subject consisting of eleven cases, where improvement in symptoms ‎is reported with escitalopram treatment in the five of six cases diagnosed with OCD. As ‎far as we could find in literature, our paper is the second report on this subject. Our case ‎also included the youngest patient to receive escitalopram for preschool period OCD ‎and report its benefits.‎

  5. Clinical diagnosis analysis in 21 cases of spinal cord disease

    Institute of Scientific and Technical Information of China (English)

    ZHANG Hong

    2000-01-01

    21 cases of spinal cord disease were clinically analyzed of which 14 cases were male. 7 female, aged from 30 to 69, weraged 50.9. This group contained 2 cases of consciusness dysfunction. 2l of sensational dysfunction. 19 of morion dysrunction, 11 of aotonomic nerve dysrunction, 2 of, sexual dysfunction. 2 of Brown-Sequrd syndrome. llhad been chrmcally sympromatic for more than two months. the other were of acute for sub acute onset. The segments of the diseases were found mainly at cervical and thoracic ones. to which more attention should be pazd clincally. The incidences of intramedullary lesions were a bit more than that of extramedullary ones. Of the 11 extramendullary cases, 8 arised srorn verteoral body (72.7%), of which 6 cases arisen form the intervertebral dies, or 75%. On which emphasis should be laid clinically Foci in brain and spinal cord were found synchronically in 5 cases (23.8%). They were Wernick cerebral disease, metastetic cerebral tumor, cerebral infarction, polioencephalomyelitis. So possibility of brain disease should also be considerod when diagnosing spinai cord disease, especially in stenosis of cervical canal. Oppressed spinal cord was accodiated with cerebellopontine angle tumor. Disease in brain was negiected because of concermng spinal cord disease and cerehellopontine angie giant meningiona was discovered 5 yeas laaer. There are several methods to diagnose spinal cord disease, including X-rays photography, CSF test, CT, and MRI, etc. X-rays photography should be used for involved vertebral body in lateral and P-A position at first when to suspect spinal cord disease. It should be avoided that neglecting X-rays photography and using CT or MRIfirst. It should be noted when taking segments examination by CT or MRI, thut the actual vertebral body is usually located 7'- 14 segments below the spinal cord involved. Otherwise, misdiagnosis would be resulted. 4 c ases of oppressive spinal cord disease of this group were treated with operating

  6. Histopathological and clinical traps in lichen sclerosus: a case report.

    Science.gov (United States)

    Brănişteanu, Daciana Elena; Brănişteanu, Daniel Constantin; Stoleriu, Gabriela; Ferariu, Dan; Voicu, Cătălina Maria; Stoica, Loredana Elena; Căruntu, Constantin; Boda, Daniel; Filip-Ciubotaru, Florina Mihaela; Dimitriu, Andreea; Radu, Cezar Doru

    2016-01-01

    Lichen sclerosus et atrophicus and limited systemic scleroderma (acrosclerosis) are inflammatory skin diseases that ultimately evolve into two distinct modes of atrophic scar formation, but which can easily be confused clinically. They are very rarely associated. The literature has reported cases in which lichen sclerosus was associated with various forms of scleroderma, but often with localized morphea. The characteristic histopathological picture of lichen sclerosus includes a thin epidermis, with orthohyperkeratosis and vascular degeneration in the basal layer, loss of elastic fibers, and band-like inflammatory infiltrate in the papillary dermis, while systemic sclerosis is characterized by excessive deposition of collagen in the dermis, accompanied by reduction in adnexal structures and their entrapment in collagen, and the presence of perivascular lymphocytic inflammatory infiltrate. We present the case of a 40-year-old female patient clinically diagnosed with systemic scleroderma and lichen sclerosus involving the genital mucosa. Physical examination in conjunction with laboratory findings (elevated antinuclear, anti-Scl-70, anti-SSA antibodies and immunogram) induced the supposition of the coexistence of lichen sclerosus and systemic scleroderma, fact confirmed by pathological examination. Systemic therapy with corticosteroids, immunosuppressive and phlebotropic drugs, peripheral vasodilators and other tropic adjuvants and topically potent topical corticosteroids was initiated. The course was favorable under therapy, the hardened skin slightly regaining elasticity, relief of itching and disappearance of lichen sclerosus lesions. Our case reaffirms the uncommon association of these two disorders. The importance of history, physical and laboratory examinations in making a diagnosis of certainty in emphasized.

  7. Epidemiological and clinical studies on aseptic meningitis in 377 cases, 3. A study on brain CT scan in acute phase

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Masaaki; Kondo, Tomio; Takashima, Akira; Kono, Shinya; Yamashina, Manabu (Ogaki Shimin Hospital, Gifu (Japan))

    1984-02-01

    Brain CT scan performed in the acute phase of aseptic meningitis in 88 cases revealed abnormal findings in 5 consisting of 2 of cerebral edema, 2 of subdural hygroma and one of cerebral atrophy. Clinical findings showed no particular relation to the age, but cerebral edema was observed in the cases of possible cephalomeningitis diagnosed on the basis of accompanying convulsion and disturbance of consciousness. Abnormal findings were associated with 25% of symptoms diagnosed more than 4 days after onset.

  8. Dentine in a capsule: Clinical case reports

    Directory of Open Access Journals (Sweden)

    Mallikarjuna Kenchappa

    2015-01-01

    Full Text Available Biodentine TM , a calcium silicate based material has been popular now and can be used as an alternative to mineral trioxide aggregate (MTA due to superior physical and biologic properties. It has been known by several terms as Biodentine, dentin substitute, and RD 94. It has varied clinical applications such as apexification, apexogenesis, pulpotomy, internal resorption, root perforation repair, retrograde filling, pulp capping procedure, and dentin replacement. This article describes the clinical case reports using Biodentine in apexification, apexogenesis, pulpotomy, and root perforation repair.

  9. Case report of clival tuberculoma. Difficult to diagnose by means of a CT scan

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    Ichikawa, F.; Tachibana, S.; Miyasaka, Y.; Suwa, T.; Iida, H.; Kan, S.; Matsuda, Y.

    1987-02-01

    A patient with tuberculoma at the skull base was reported. Twenty-two years old, she had complained for ten years of amenorrhea, headache, and visual disturbance. On neurological examination, bitemporal hemianopsia, bilateral sixth nerve palsy, and recent right-side facial palsy were demonstrated. On radiological examination, a destructive lesion was found at the clivus. CT and MRI demonstrated, a space-taking lesion expanding to the floor of the third ventricle anteriorly, to the cerebello-pontine angle superiorly, and to the epipharynx inferiorly, and a marked swelling of the cerebellum, though no confirmative diagnosis could be obtained without a biopsy of the epipharyngeal tumor. The histological examination revealed that the tumor was tuberculoma. Medical treatment with INH, RFP, and steroids was effective. Although tuberculoma involving the skull base is very rare and rather difficult to diagnose, the authors would like to stress that early accurate diagnosis is very important because the lesion is curable with appropriate medical treatment.

  10. Late Diagnosed Type II Autoimmune Polyglandular Failure Syndrome: A Case Report

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    Mehtap Evran

    2014-03-01

    Full Text Available Autoimmune polyglandular syndrome (APS type II is the term descibing a group of diseases with two or more concurrent endocrine disorders. It is more prevalent in female gender. The most common pathologies include primary adrenal insufficiency (Addison’s disease, autoimmune thyroid diseases (Graves’ disease, Hashimoto’s thyroiditis, type 1 diabetes mellitus (DM and primary hypogonadism. Replacement of deficient hormone is the basis of treatment. The present paper discussed autoimmune polyglandular syndrome based on the symptoms in a 25-year-old female patient who was followed in the intensive care unit because of impaired consciousness considered to have resulted from potential drug/substance addiction. Antidepressant therapy was recommended for the patient and she was diagnosed with APS on further evaluation. Turk Jem 2014; 1: 13-16

  11. A Case of Acute Q Fever Hepatitis Diagnosed by F-18 FDG PET/CT

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    Beak, Sora [Hallym Univ. College of Medicine, Seoul (Korea, Republic of); Oh, Minyoung; Lee, Sand-Oh; Yu, Eunsil; Ryu Jin-Sook [Univ. of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2012-06-15

    A 53-year-old man with fever of unknown origin underwent F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) as a workup for a fever of unknown origin. On presentation, he complained of fever, chills, and myalgia. The F-18 FDG PET/CT scan showed diffusely increased uptake of the liver with mild hepatomegaly. A liver biopsy then revealed fibrin-ring granulomas typically seen in Q fever. The patient was later serologically diagnosed as having acute Q fever as the titers for C. IgM and IgG were 64:1 and -16:1, respectively. He recovered completely following administration of doxycycline. This indicates that F-18 FDG PET/CT may be helpful for identifying hepatic involvement in Q fever as a cause of fever of unknown origin.

  12. Trichuris trichiura infection diagnosed by colonoscopy: case reports and review of literature.

    Science.gov (United States)

    Ok, Kyung-Sun; Kim, You-Sun; Song, Jung-Hoon; Lee, Jin-Ho; Ryu, Soo-Hyung; Lee, Jung-Hwan; Moon, Jeong-Seop; Whang, Dong-Hee; Lee, Hye-Kyung

    2009-09-01

    Trichuris trichiura, commonly referred to as a whipworm, has a worldwide distribution, particularly among countries with warm, humid climates. In Korea, trichuriasis was a highly prevalent soil-transmitted helminthiasis until the 1970s. However, the nationwide prevalence decreased to 0.02% in 2004 as a result of national control activities and improvement in the socioeconomic status of Koreans. Most infected individuals have no distinct symptoms, if lightly infected. The diagnosis is typically confirmed by detection of T. trichiura eggs on examination of a stool sample; few reports have described detection of the parasite during colonoscopy. Recently, we managed 4 patients with trichuriasis who were diagnosed by detection of the parasite on colonoscopy, and we reviewed the literature on the colonoscopic diagnosis of T. trichiura in Korea. We suggest that colonoscopy might be a useful diagnostic tool, especially when infected by only a few male worms with no eggs in the stool.

  13. A case of acquired hemophilia A diagnosed after percutaneous endoscopic gastrostomy.

    Science.gov (United States)

    Okamura, Takuma; Komatsu, Michiharu; Ito, Akihiro; Ito, Tetsuya; Suga, Tomoaki; Arakura, Norikazu; Sakai, Hitoshi; Tanaka, Eiji

    2015-10-01

    A 65-year-old male with no personal or familial history of bleeding disorders underwent percutaneous endoscopic gastrostomy (PEG) for neurogenic dysphagia due to subarachnoid hemorrhage. On postoperative day 6, continuous oozing of venous blood was observed at the stoma. Prothrombin time was within normal range, but activated partial thromboplastin time was prolonged. Cross-mixing test results indicated the existence of an inhibitor, and laboratory findings revealed decreased factor VIII activity and high levels of factor VIII inhibitor. The patient was diagnosed as having acquired hemophilia A, for which steroid monotherapy was effective. Acquired hemophilia A is a rare but potentially fatal disease. Clinicians should be aware of this condition in patients presenting with sudden hemorrhage after PEG or other endoscopic treatments, even in those with no apparent history of bleeding.

  14. Renovascular Hypertension: Clinical Features, Differential Diagnoses and Basic Principles of Treatment

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    Petrovic Dejan

    2016-09-01

    Full Text Available Renovascular hypertension is caused by renal artery stenosis. Its prevalence in populations of hypertensive patients is 1-8%, and in populations of patients with resistant hypertension, it is up to 20%. The two main causes of stenosis are atherosclerosis and fibromuscular dysplasia of the renal artery. The main clinical consequences of renal artery stenosis include renovascular hypertension, ischemic nephropathy and “flash” acute pulmonary oedema. Unilateral stenosis of the renal artery causes angiotensin II-dependent hypertension, and bilateral stenosis of the renal arteries produces volume-dependent hypertension. Renovascular aetiology of hypertension should be questioned in patients with resistant hypertension, hypertension with a murmur identified upon auscultation of the renal arteries, and a noticeable side-to-side difference in kidney size. Non-invasive diagnostic tests include the determination of concentrations of peripheral vein plasma renin activity, the captopril test, captopril scintigraphy, colour Doppler ultrasonography, computed tomography angiography, and nuclear resonance angiography. Renovasography represents the gold standard for the diagnosis of renovascular hypertension. The indications for revascularization of the renal artery include haemodynamically significant renal artery stenosis (with a systolic pressure gradient at the site of stenosis of - ΔP ≥ 20 mmHg, along with the ratio of the pressure in the distal part of the renal artery (Pd and aortic pressure (Pa less than 0.9 (Pd/Pa 0.8, chronic kidney disease (GFR <30 ml/min/1.73 m2 and negative captopril scintigraphy (lack of lateralization.

  15. Extended high frequency audiometry can diagnose sub-clinic involvement in a seemingly normal hearing systemic lupus erythematosus population.

    Science.gov (United States)

    Lasso de la Vega, Mar; Villarreal, Ithzel María; López Moya, Julio; García-Berrocal, José Ramón

    2017-02-01

    Sensorineural hearing loss must be considered within the clinical picture of systemic lupus erythematosus. The results confirm the usefulness of extended high-frequency audiometry in the audiologic testing of these patients, enabling the possibility of modifying or applying a preventive treatment for a possible hearing loss. Hearing involvement is usually under-diagnosed with routine auditory examination. This study proposes the use of extended high-frequency audiometry to achieve a correct detection of a possible asymptomatic hypoacusis in early stages of the disease. The aim of this study is to analyze the hearing levels in extended high-frequencies in these patients and to correlate the hearing loss with the severity of the disease and the immunological parameters. A descriptive cross-sectional study was performed. Fifty-five patients with systemic lupus erythematosus were included in the study. The control group consisted of 71 patients paired by age and sex with the study population. Both a pure tone audiometry and an extended high-frequency audiometry (8-18 KHz) were performed. In total, 70% were diagnosed with sensorineural hearing loss with extended high-frequency audiometry, overcoming the results obtained with pure tone audiometry (30.9%). Statistically significant correlations were found within the patients regarding sensorineural hearing loss related with age, disease activity and cryoglobulinemia.

  16. Prevalence and predictors of infertility-specific stress in women diagnosed with primary infertility: A clinic-based study

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    Ansha Patel

    2016-01-01

    Full Text Available BACKGROUND: According to the existing literature on infertility, stress appears to be inevitably associated with infertility diagnosis and treatment in sub-fertile individuals. The epidemiological data on the prevalence and predictors of infertility-specific stress in cultural specific scenario are scarce. The objective of the present study was to estimate the prevalence of infertility-specific stress and identify predictors of infertility-specific stress in women diagnosed with primary infertility. MATERIALS AND METHODS: This cross-sectional study was conducted on 300 infertile married women, diagnosed with primary infertility. The tools used for the assessment were “semi-structured questionnaire ” compiled by the authors, “ICD-10 Classification of Mental and Behavioral Disorders (Clinical Descriptions and Diagnostic Guidelines, ” and “Psychological Evaluation Test for infertility. ” STATISTICAL ANALYSIS: Data were analyzed using SPSS (version 15. Chi-square test was used for univariate analysis followed by multiple logistic regressions between stress and the predictor variables. RESULTS AND DISCUSSION: The prevalence of stress among women was 80%. Univariate analysis revealed that predictors of stress were years of marital life, duration of infertility, infertility type, history of gynecological surgery, cycles of ovulation induction with timed intercourse and intra-uterine inseminations, present and past psychiatric morbidity, coping difficulties, gynecological diagnosis, and severity of premenstrual dysphoria. Multivariate analysis showed leading associations of stress with infertility type and coping difficulties.

  17. Doença de Chagas aguda: vias de transmissão, aspectos clínicos e resposta à terapêutica específica em casos diagnosticados em um centro urbano Acute Chagas' disease: transmission mechanisms, clinical features and specific therapeutic response in cases diagnosed in an urban center

    Directory of Open Access Journals (Sweden)

    M.A. Shikanai-Yasuda

    1990-02-01

    . The following transmission routes were involved: triatominae in 7 cases, blood transfusion in 9, kidney transplantation and/or blood transfusion in 4, accidental in 1, oral route in 3, probably breast feeding in 1, congenital or breast feeding in 1, and congenital or blood transfusion in 1. Six patients infected by triatominae acquired the disease between 1974 and 1980 and one in 1987. The blood transfusion infected patients acquired the disease in Greater São Paulo, seven of whom after 1983. The acute phase Chagas' disease was oligosymptomatic in 4 patients: three of such patients being immunocompromised by drugs or other diseases. Another two adult immunocompromised patients developed myocarditis and congestive heart failure. Clinical features were severe in 5 from 6 children under two years, irrespective of the transmission route. Evaluation of the acute phase patients treated with benznidazol (4-10 mg/kg/day showed: therapeutic failure in 4/16 (25.0%; possible cure in 9/16 (53.2% and inconclusive results in 3/16 (18.8%. The antibody and complement-mediated lysis reaction was in keeping with the xenodiagnosis in 18/22 cases, having shown negative results after treatment earlier than classical serological reactions. One aplastic anaemia patient receiving corticosteroid presented lymphoproliferative disease 6 years after being treated with benznidazol for acute Chagas' disease.

  18. Interested Cases Encountered in the Breast Clinic

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    Kwak, Jin Young; Lee, Seung Hee; Jung, Hae Kyoung; Kwon, Tae Hee [CHA General Hospital, Pochon CHA University College of Medicine, Pocheon (Korea, Republic of); Chung, Sun Yang [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2005-09-15

    Many patients present to the breast clinic with variable symptoms. The degree of palpability is the important symptom for patients and clinicians. Both mammography and ultrasonography play an important role in the diagnosis of breast diseases by indicating the cause of the symptoms and aiding in the selection of treatment for the disease. Sometimes, however, we meet unexpected results. In this paper, we will illustrate the ultrasonographic and mammographic findings of interesting, unusual or perplexing breast cases in order to familiarize ourselves with these breasts through these cases and thereby assist in future diagnosis

  19. Graves Disease And Down Sindrome : Clinical Case

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    Scrinic Olesea

    2015-08-01

    Full Text Available Introduction: Pacients with Down’s syndrome present an increase revalence of autoimune endocrine disorders. We communicate the case of 14 years and 6 months old pacient known with Down syndrome admitted in Endocrinology department with suspicion of hyperthyroidism, the diagnosis being confirmed by hormonal dosage. The particularity of the case consists in: symptomatology onset during puberty, clinical evolution with mild symptoms, without ocular involvement, morphological and functional remission obtained relatively soon after the initiation of antithyroid therapy, lack of posttherapy side effects, favorabile evolution under the “block and replace” therapy

  20. Asymptomatic early acute appendicitis initiated and diagnosed during colonoscopy: A case report

    Institute of Scientific and Technical Information of China (English)

    Michelle Petro; Anil Minocha

    2005-01-01

    Colonoscopic diagnosis of asymptomatic early acute appendicitis is exceedingly rare. Although obstruction of the lumen due to various causes is believed to be the most common physiologic mechanism of acute appendicitis, all of the previously documented cases in the literature have only shown a patent appendiceal lumen with pus flowing into the cecum. We present the case of a patient undergoing colonoscopy for colorectal cancer evaluation with no abdominal symptoms. An obstructed, swollen appendix was seen. The process was probably initiated during the colonoscopy, documenting perhaps the earliest stage of acute appendicitis for the first time. Endoscopic, CT and microscopic documentation of the case is also presented.

  1. [Laryngeal amyloidosis: a clinical case and review of literature].

    Science.gov (United States)

    Fries, S; Pasche, P; Brunel, C; Schweizer, V

    2015-09-30

    Amyloidosis consists of different forms of systemic or isolated organ lesions characterised by fibrillary protein deposits in extra-cellular tissue. The isolated involvement of the larynx is the most frequent form in the ENT sphere. We present a clinical case of a 67 year-old woman addressed for a sub-acute laryngitis resistant to conservative treatment, and finally diagnosed with laryngeal amyloidosis. We reviewed its physiopathology, the scientific literature as well as the different possibilities of management. Laryngeal amyloidosis is rare. A thorough additional work-up for the research of multifocal or systemic forms is highly recommended. The treatment aims at a minimal invasive endoscopic surgery with functional organ preservation.

  2. Failing to diagnose and failing to treat an addicted client: Two potentially life-threatening clinical errors.

    Science.gov (United States)

    Liese, Bruce S; Reis, Daniel J

    2016-09-01

    Psychotherapists risk making 2 types of errors with clients who struggle with addictive behaviors: failure to addictive behaviors and failure to effectively addictive behaviors. Given the high prevalence of addictive behaviors in clinical populations, therapists are in a unique position to assist individuals with these problems. It is assumed that therapists possess general diagnostic and treatment skills and yet many do not diagnose or do not treat addictive behaviors. Reasons for making these errors include prohibitive beliefs and limited knowledge about addictive behaviors. We offer specific recommendations to reduce these psychotherapy errors. These include: (a) more deliberate screening and diagnosis of addictive behaviors, (b) increased application of empirically supported addiction treatments, (c) required education and training in addictive behaviors, (d) modification of prohibitive attitudes about addressing addictive behaviors, and (e) increased attention paid to the addictive behaviors by professional psychotherapy organizations. (PsycINFO Database Record

  3. Eosinophilic funiculitis initially diagnosed as irreducible inguinal hernia: A case report

    Directory of Open Access Journals (Sweden)

    Kohei Yamada

    2017-01-01

    Conclusion: Eosinophilic funiculitis is very rare; only three cases have been reported to date. We should always consider unusual causes of groin masses during a surgical approach to hernia-like lesions.

  4. [Solitary hepatic cyst. Presentation of a case diagnosed in neonatal period].

    Science.gov (United States)

    Ruíz Jiménez, J I; Cuenca Burgos, M J; Vera Lorente, M; Espejo García, M P; Zambudio, G

    1992-10-01

    We reported one case of hepatic solitary cyst, in an infant seven days old. The precocious diagnostic was supported by the presence of an abdominal cyst mass in prenatal period. Different diagnostic and therapeutic consideration are made.

  5. A rare localization in right-sided endocarditis diagnosed by echocardiography: A case report

    Directory of Open Access Journals (Sweden)

    Beaufils Philippe

    2003-08-01

    Full Text Available Abstract Background Right-sided endocarditis occurs predominantly in intravenous drug users, patients with pacemakers or central venous lines and with congenital heart diseases. The vast majority of cases involve the tricuspid valve. Case presentation A case of a 31-year-old woman with intravenous drug abuse who had a right-sided vegetation attached to the muscular bundle of the right ventricle is presented. Transthoracic echocardiography revealed a vegetation in the right ventricular outflow tract. Transesophageal echocardiography clearly showed that the 1.8 cm vegetation was not adherent to the pulmonary valve but attached to a muscular bundle. Conclusions Our case points to an unusual location of right-sided endocarditis in intravenous drug users. It confirms that TTE remains an easy and highly sensitive first-line examination for the diagnosis of right-sided endocarditis.

  6. [The role of fetal echocardiography in the prenatal diagnosis of aneuploidy based upon prenatally diagnosed patau syndrome fetuses (case analysis)].

    Science.gov (United States)

    Janiak, Katarzyna; Kaczmarek, Piotr; Krasoń, Aneta; Nowicki, Grzegorz; Piotrowicz, Małgorzata; Respondek-Liberska, Maria

    2002-07-01

    Assessment of usefulness of the fetal echocardiography and genetic sonography in prenatal diagnosis trisomy 13 (retrospective analysis). Between 1994-1999 at the Department for Diagnosis of Congenital Malformation at the Institute of PPMH in 11 fetuses with Patau Syndrome ultrasound and echocardiography examination were performed. In our study the most of cases come from low risk of pregnant women. Fetal heart defect was the most common anomaly diagnosed prenatally in fetuses with Patau Syndrome (7/11), the second one were central nervous system anomalies (6/11) and genitourinary system anomalies (6/11).

  7. DNA quantification as prognostic factor in a case of acinar cell carcinoma of the parotid gland, diagnosed by FNA.

    Science.gov (United States)

    Azúa-Romeo, Javier; Sánchez-Garnica, Juan Carlos; Azúa-Blanco, Javier; Tovar-Lázaro, Mayte

    2005-01-01

    Hereby we present a case of a 43-years-old male who complained of a three years history preauricular painful mass. Fine needle aspiration cytology was performed, diagnosing of compatible with acinar cell carcinoma, thus DNA quantification by image cytometry was carried out. Biological parameters studied (ploidy, S-phase, 5-c exceeding rate) showed that it is a low grade of malignancy lesion. Total parotidectomy conservative of facial nerve was recommended, without regional lymphadenectomy. Patient remains, one year later, asymptomatic and free of disease.

  8. [Bouveret Syndrome. First case diagnosed in Santa Maria del Socorro, Ica, Peru].

    Science.gov (United States)

    Hernández Garcés, Héctor Rubén; Andrain Sierra, Yudit; del Rio-Mendoza, Jeny R; Gutierrez Revatta, Eddy; Moutary, Issufo

    2014-01-01

    We are presenting an case of a patient with upper gastrointestinal bleeding presented as hematemesis preceded by profuse vomiting secondary to a duodenal obstruction, caused by an impacted giant biliary stone in the duodenal bulb (Bouveret syndrome). The diagnosis was made during an upper gastrointestinal endoscopy and confirmed by surgery. We report and discuss this case as it is the first presentation in our institution.

  9. MR elastography of the liver at 3.0 T in diagnosing liver fibrosis grades; preliminary clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Yoshimitsu, Kengo; Mitsufuji, Toshimichi; Shinagawa, Yoshinobu; Fujimitsu, Ritsuko; Morita, Ayako; Urakawa, Hiroshi; Takano, Koichi [Fukuoka University, Department of Radiology, Fukuoka (Japan); Hayashi, Hiroyuki [Fukuoka University, Department of Pathology, Faculty of Medicine, Fukuoka (Japan)

    2016-03-15

    To clarify the usefulness of 3.0-T MR elastography (MRE) in diagnosing the histological grades of liver fibrosis using preliminary clinical data. Between November 2012 and March 2014, MRE was applied to all patients who underwent liver MR study at a 3.0-T clinical unit. Among them, those who had pathological evaluation of liver tissue within 3 months from MR examinations were retrospectively recruited, and the liver stiffness measured by MRE was correlated with histological results. Institutional review board approved this study, waiving informed consent. There were 70 patients who met the inclusion criteria. Liver stiffness showed significant correlation with the pathological grades of liver fibrosis (rho = 0.89, p < 0.0001, Spearman's rank correlation). Areas under the receiver operating characteristic curve were 0.93, 0.95, 0.99 and 0.95 for fibrosis score greater than or equal to F1, F2, F3 and F4, with cut-off values of 3.13, 3.85, 4.28 and 5.38 kPa, respectively. Multivariate analysis suggested that grades of necroinflammation also affected liver stiffness, but to a significantly lesser degree as compared to fibrosis. 3.0-T clinical MRE was suggested to be sufficiently useful in assessing the grades of liver fibrosis. (orig.)

  10. Sudden infant death syndrome in Korea: a retrospective analysis of autopsy-diagnosed cases.

    Science.gov (United States)

    Yoo, Seong Ho; Kim, Angela Julie; Kang, Shin-Mong; Lee, Han Young; Seo, Joong-Seok; Kwon, Tae Jung; Yang, Kyung-Moo

    2013-03-01

    This study aimed to elucidate the demographic and sleeping environmental factors associated with sudden infant death syndrome (SIDS) in Korea. The autopsy reports of all SIDS cases reported to the National Forensic Service and Seoul National University College of Medicine between 1996 and 2008 were reviewed for data collection and analysis to identify the risk factors for SIDS. Analysis of the 355 SIDS cases reported within the study period revealed that of the 168 (47.3%) cases for which sleeping position before death had been reported, 75 (44.7%) cases had occurred after placement in prone or side position. Of the 204 (57.5%) cases for which bed-sharing situation had been reported, 121 (59.3%) deaths had occurred during bed-sharing, of which 54 (44.6%) infants were under 3 months of age, a significantly younger age than that of the non-bed-sharing cases (P = 0.0279). Analysis of the results indicated no tendency toward an increase or decrease in the use of a prone or side position. Rather, there was a statistically significant increasing trend for bed-sharing over the study period (OR, 1.087; 95% CI, 1.004-1.177; P = 0.04). These findings indicate the need for nationwide educational programs promoting a safe sleeping environment to enhance SIDS prevention.

  11. Clinical crown lengthening - a case report.

    Science.gov (United States)

    Lipska, Weronika; Lipski, Marcin; Lisiewicz, Małgorzata; Gala, Andrzej; Gronkiewicz, Krzysztof; Darczuk, Dagmara; Chomyszyn-Gajewska, Maria

    2015-01-01

    Maintaining healthy parodontium during teeth restoration procedures is an indispensable condition for obtain- ing regular functionning and esthetics. Thus, the knowledge of correct anatomy and the influence of filling and complement on paradontium tissue is vital. Difficulty in maintaining appropriate gingival biological width (GBW) is a frequent problem encountered in this type of reconstruction. Preservation of unchanged biological width conditions predictible treatment result and, what is more, lack of inflammatory lesions in marginal parodontium. The ideal situation for parodontium is localizing the filling/complement border supragingivaly, which is at least 3 mm from alveolar process edge. In the case, when the above conditions are impossible to fulfil, elongation of clinical crown is a metod of choice. The effect is possible to achieve by surgical treatment or combined orthodontic - surgical treatment. Surgical treatment is faster and preferred procedure for indirect reconstruction, where achieving high clinical crown is necessary. Three clinical cases of performing method of surgical clinical crown elongation were presented in the article. Performing the described procedure enables correct tooth crown reconstruction and, what is most important, keeping individual toothing.

  12. The validity of psychiatric diagnoses: the case of 'specific' developmental disorders.

    Science.gov (United States)

    Dyck, Murray J; Piek, Jan P; Patrick, Jeff

    2011-01-01

    We tested whether developmental coordination disorder (DCD) and mixed receptive expressive language disorder (RELD) are valid diagnoses by assessing whether they are separated from each other, from other childhood disorders, and from normality by natural boundaries termed zones of rarity. Standardized measures of intelligence, language, motor skills, social cognition, and executive functioning were administered to children with DCD (n = 22), RELD (n = 30), autistic disorder (n = 30), mental retardation (n = 24), attention deficit/hyperactivity disorder (n = 53) and to a representative sample of children (n = 449). Discriminant function scores were used to test whether there were zones of rarity between the DCD, RELD, and other groups. DCD and RELD were reliably distinguishable only from the mental retardation group. Cluster and latent class analyses both resulted in only two clusters or classes being identified, one consisting mainly of typical children and the other of children with a disorder. Fifty percent of children in the DCD group and 20% in the RELD group were clustered with typical children. There was no evidence of zones of rarity between disorders. Rather, with the exception of mental retardation, the results imply there are no natural boundaries between disorders or between disorders and normality.

  13. Patterns of Somatic Diagnoses in Older People with Intellectual Disability: A Swedish Eleven Year Case-Control Study of Inpatient Data

    Science.gov (United States)

    Sandberg, Magnus; Ahlström, Gerd; Kristensson, Jimmie

    2017-01-01

    Background: Knowledge about diagnoses patterns in older people with intellectual disabilities is limited. Methods: The case group (n = 7936) comprised people with intellectual disabilities aged 55 years and older. The control group (n = 7936) was age matched and sex matched. Somatic inpatient diagnoses (2002-2012) were collected retrospectively.…

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

    DEFF Research Database (Denmark)

    Norredam, Marie; Jensen, Mette; Ekstrøm, Morten

    2011-01-01

    In our clinical work, we treat refugees who have been exposed to trauma and who subsequently develop psychotic symptoms. However, the literature does not address the relationship between refugees with depression, post-traumatic stress disorder (PTSD) and psychotic symptoms. Therefore the aim...

  15. A case of abdominal pain with dyslipidemia: difficulties diagnosing cholesterol ester storage disease.

    Science.gov (United States)

    Cameron, S J; Daimee, U; Block, R C

    2015-01-01

    Cholesterol ester storage disease is an exceptionally rare dyslipidemia with less than 150 cases reported in the medical literature. The diagnosis of Cholesterol Ester Storage Disease is often missed by virtue of the fact that the symptoms mimic both inborn metabolic defects and hepatic steatosis. Patients with Cholesterol Ester Storage Disease usually present with atypical complaints including abdominal pain from altered gut motility. Blood analysis typically reveals abnormal liver function tests with coincident dyslipidemia. We present a case of a young woman with Cholesterol Ester Storage Disease who was followed over two decades. We discuss issues common to her initial protracted diagnosis with management options over time.

  16. Syringomyelia following tuberculous meningitis. Report of three cases diagnosed by MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Tsuchiya, Kazuhiro; Takeshita, Koji; Makita, Kozo; Furui, Shigeru; Takenaka, Eiichi

    1988-11-01

    We present three cases with syringomyelia after tuberculous meningitis. The MR findings suggested the syrinx was formed by blockage of the CSF flow at the outlets of the fourth ventricle. We consider this complication is not a rare condition following tuberculous meningitis.

  17. Chronic endocarditis due to Legionella anisa: a first case difficult to diagnose

    Directory of Open Access Journals (Sweden)

    F. Compain

    2015-11-01

    Full Text Available Endocarditis due to Legionella spp. is uncommon but presumably underestimated given the prevalence of Legionellae in the environment. We report a first and unusual case of chronic native valve endocarditis due to L. anisa and advocate that the diagnosis of endocarditis be made collaboratively between the cardiologist, surgeon, microbiologist and pathologist.

  18. Gaucher disease diagnosed after bone marrow trephine biopsy — a report of two cases

    Directory of Open Access Journals (Sweden)

    Bożena Sokołowska

    2011-07-01

    Full Text Available The hematologist is at the forefront of specialists to whom patients with Gaucher disease presentbecause of cytopenia and hepatosplenomegaly. Usually, patients with such symptoms have undergone trephinebiopsy. We present the cases of two patients in whom Gaucher disease was suspected because of the discovery ofGaucher cells in trephine biopsy, and subsequently confirmed via enzymatic and molecular investigations.

  19. Chronic endocarditis due to Legionella anisa: a first case difficult to diagnose

    Science.gov (United States)

    Compain, F.; Bruneval, P.; Jarraud, S.; Perrot, S.; Aubert, S.; Napoly, V.; Ramahefasolo, A.; Mainardi, J.-L.; Podglajen, I.

    2015-01-01

    Endocarditis due to Legionella spp. is uncommon but presumably underestimated given the prevalence of Legionellae in the environment. We report a first and unusual case of chronic native valve endocarditis due to L. anisa and advocate that the diagnosis of endocarditis be made collaboratively between the cardiologist, surgeon, microbiologist and pathologist. PMID:26693025

  20. Patients newly diagnosed with clinical type 2 diabetes mellitus but presenting with HbA1c within normal range: 19-year mortality and clinical outcomes

    DEFF Research Database (Denmark)

    Veloso, A.G.; Siersma, V.; Heldgaard, P.E.;

    2013-01-01

    AIMS: To investigate whether long-term mortality or clinical outcomes differed between patients diagnosed with type 2 diabetes mellitus and presenting with HbA1c within or above normal range at time of diagnosis. METHODS: Data were from a population-based sample of 1136 individuals with newly...... diagnosed type 2 diabetes mellitus. The diagnosis was confirmed with a single fasting whole blood/plasma glucose ≥7.0/8.0mmol/l. The median time from day of diagnosis until end of follow up was 18.8years. Patients were grouped according to normal HbA1c and elevated HbA1c at diagnosis. The effect of elevated...... HbA1c on a number of clinical outcomes and all-cause mortality was assessed in Cox regression models. RESULTS: At diagnosis, 97 patients (8.5%) had an HbA1c level within normal range. Age (mean (SD)) at diagnosis was 64.5 (11.5) years. Both unadjusted and adjusted hazard ratios for the effect of HbA1...

  1. Integrated Source Case Investigation for Tuberculosis (TB) and HIV in the Caregivers and Household Contacts of Hospitalised Young Children Diagnosed with TB in South Africa: An Observational Study.

    Science.gov (United States)

    Lala, Sanjay G; Little, Kristen M; Tshabangu, Nkeko; Moore, David P; Msandiwa, Reginah; van der Watt, Martin; Chaisson, Richard E; Martinson, Neil A

    2015-01-01

    Contact tracing, to identify source cases with untreated tuberculosis (TB), is rarely performed in high disease burden settings when the index case is a young child with TB. As TB is strongly associated with HIV infection in these settings, we used source case investigation to determine the prevalence of undiagnosed TB and HIV in the caregivers and household contacts of hospitalised young children diagnosed with TB in South Africa. Caregivers and household contacts of 576 young children (age ≤7 years) with TB diagnosed between May 2010 and August 2012 were screened for TB and HIV. The primary outcome was the detection of laboratory-confirmed, newly-diagnosed TB disease and/or HIV-infection in close contacts. Of 576 caregivers, 301 (52·3%) self-reported HIV-positivity. Newly-diagnosed HIV infection was detected in 63 (22·9%) of the remaining 275 caregivers who self-reported an unknown or negative HIV status. Screening identified 133 (23·1%) caregivers eligible for immediate anti-retroviral therapy (ART). Newly-diagnosed TB disease was detected in 23 (4·0%) caregivers. In non-caregiver household contacts (n = 1341), the prevalence of newly-diagnosed HIV infection and TB disease was 10·0% and 3·2% respectively. On average, screening contacts of every nine children with TB resulted in the identification of one case of newly-diagnosed TB disease, three cases of newly diagnosed HIV-infection, and three HIV-infected persons eligible for ART. In high burden countries, source case investigation yields high rates of previously undiagnosed HIV and TB infection in the close contacts of hospitalised young children diagnosed with TB. Furthermore, integrated screening identifies many individuals who are eligible for immediate ART. Similar studies, with costing analyses, should be undertaken in other high burden settings-integrated source case investigation for TB and HIV should be routinely undertaken if our findings are confirmed.

  2. Diagnosing cellular defects in an unexplained case of total fertilization failure.

    Science.gov (United States)

    Combelles, Catherine M H; Morozumi, Kazuto; Yanagimachi, Ryuzo; Zhu, Liben; Fox, Janis H; Racowsky, Catherine

    2010-07-01

    Despite the advent of ICSI, cases of total fertilization failure (TFF) often lead to cycle cancellation with limited diagnostic and therapeutic strategies currently available. We report on the case of an infertile couple who failed to conceive after repeated IVF and ICSI. Sperm of the husband were morphologically normal and passed a functional test assessing their ability to activate mouse oocytes. Whether oocytes were activated artificially with calcium ionophore after injection of husband's or with donor sperm, all oocytes failed to fertilize. Multiple polar bodies and two disorganized spindle structures were predominantly observed, pointing towards a cytoplasmic defect in the oocytes as the primary cause of the couple's infertility. In fact, injection of husband's sperm into donor oocytes resulted in the delivery of healthy twins. This report describes a course of action that may be applied for couples with TFF after both IVF and ICSI.

  3. Variants Within TSC2 Exons 25 and 31 Are Very Unlikely to Cause Clinically Diagnosable Tuberous Sclerosis.

    Science.gov (United States)

    Ekong, Rosemary; Nellist, Mark; Hoogeveen-Westerveld, Marianne; Wentink, Marjolein; Panzer, Jessica; Sparagana, Steven; Emmett, Warren; Dawson, Natalie L; Malinge, Marie Claire; Nabbout, Rima; Carbonara, Caterina; Barberis, Marco; Padovan, Sergio; Futema, Marta; Plagnol, Vincent; Humphries, Steve E; Migone, Nicola; Povey, Sue

    2016-04-01

    Inactivating mutations in TSC1 and TSC2 cause tuberous sclerosis complex (TSC). The 2012 international consensus meeting on TSC diagnosis and management agreed that the identification of a pathogenic TSC1 or TSC2 variant establishes a diagnosis of TSC, even in the absence of clinical signs. However, exons 25 and 31 of TSC2 are subject to alternative splicing. No variants causing clinically diagnosed TSC have been reported in these exons, raising the possibility that such variants would not cause TSC. We present truncating and in-frame variants in exons 25 and 31 in three individuals unlikely to fulfil TSC diagnostic criteria and examine the importance of these exons in TSC using different approaches. Amino acid conservation analysis suggests significantly less conservation in these exons compared with the majority of TSC2 exons, and TSC2 expression data demonstrates that the majority of TSC2 transcripts lack exons 25 and/or 31 in many human adult tissues. In vitro assay of both exons shows that neither exon is essential for TSC complex function. Our evidence suggests that variants in TSC2 exons 25 or 31 are very unlikely to cause classical TSC, although a role for these exons in tissue/stage specific development cannot be excluded.

  4. On a Diagnosed Case of Multiple Personality Disorder -A Supplementary Report with Special Reference to Psychotherapy-

    OpenAIRE

    藤田, 裕司

    2000-01-01

    As a supplement of the study on a dignosed case of MPD (Multiple Personality Disorder), the effect of the psychotherapy was discussed. The patient was a twenty-four-year-old woman suspected of an attempted murder. In this article, continued from the previous one reporting the process of a series of ten psychotherapeutic interviews with her, the general comment on that was made, and the merits and demerits of the psychotherapy were clarified.

  5. Gaucher disease diagnosed after bone marrow trephine biopsy — a report of two cases

    Directory of Open Access Journals (Sweden)

    Anna Dmoszyńska

    2011-07-01

    Full Text Available The hematologist is at the forefront of specialists to whom patients with Gaucher disease present because of cytopenia and hepatosplenomegaly. Usually, patients with such symptoms have undergone trephine biopsy. We present the cases of two patients in whom Gaucher disease was suspected because of the discovery of Gaucher cells in trephine biopsy, and subsequently confirmed via enzymatic and molecular investigations. (Folia Histochemica et Cytobiologica 2011; Vol. 49, No. 2, pp. 352–356

  6. Jejunal diverticulitis with localized perforation diagnosed by ultrasound: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kelekis, Alexis D.; Poletti, Pierre A. [Department of Radiology, Geneva University Hospital, 24 Rue Michelli-du-Crest, 1208 Geneva (Switzerland)

    2002-07-01

    A rare case of a proximal jejunal diverticulitis is presented. The diagnosis was initially suggested by US and confirmed by CT. Ultrasound detected a hypoechoic irregular lesion continuous with the jejunum suggestive of the presence of diverticula. The presence of peridiverticular hyperechoic fat, associated with US signs of extraluminal air, evoked the diagnosis of a proximal jejunal diverticulitis, which was spontaneously walled-off. The diagnosis was confirmed by CT. The patient recovered after conservative treatment. (orig.)

  7. Clinical Description of Metastatic Cutaneous Hemangiosarcoma (HSA in a Greyhound Dog: Clinical Case Study

    Directory of Open Access Journals (Sweden)

    Romy Marie Weinborn Astudillo

    2015-09-01

    Full Text Available Hemangiosarcoma (HSA is a type of cancer that has different clinical presentations and therefore different effects, since, depending on each case, different treatment options will exist. While in the case of cutaneous HSA the first line of treatment is always surgical removal of the tumor, metastatic foci should be sought and then perform chemotherapy, despite them having a low metastatic potential. Moreover, the low survival that exists in this type of cancer is a factor that should be communicated to those responsible for the pets, so that, with all available information, they can make a free and informed choice about the treatment they want for their pet, considering the financial commitment, survival time and quality of life associated with chemotherapy. This article describes the clinical case of a female greyhound dog of eight years of age that was brought to consultation for a skin tumor on the right hind limb in the distal tibia. She was diagnosed with noninvasive cutaneous HSA through histopathology, reason why the owners chose not to do the chemotherapy; however, 10 months later she presented recurrent skin lesions and a popliteal lymph node corresponding to hemangiosarcoma and hemangioma respectively, and three weeks later the patient developed cardiac tamponade due to a cardiac mass with associated spill, which resulted in her euthanasia.

  8. Asteroid hyalosis: clinical review of 58 cases

    Directory of Open Access Journals (Sweden)

    José Nuno Vargas Galveia

    2013-10-01

    Full Text Available OBJECTIVE: Understand the behavior, functional repercussion and relationship with epidemiological factors of asteroid hyalosis (AH and retrospective observational case series. METHODS: Fifty-eight patients diagnosed with AH (24 women and 34 men were studied. All patients were submitted to a thorough ophthalmological examination. RESULTS: We observed a statistical association between the presence of AH and male sex (p=0,042. An increase in prevalence of this pathology was observed with increasing age. We determined an odds ration of 5,24 of a patient over 50 years old having AH, when compared to patients bellow this threshold. Eighty-six percent of patients had unilateral vitreous deposits. We measured a lower IOP in the affected eye, with the difference being in average 2,68 ± 1,45 mmHg (p=0,037. We observed no statistical association between AH and age related macular degeneration, diabetes or glaucoma. Five eyes were submitted to facoemulsification combined with pars plana vitrectomy with an average gain of 7 lines (Snellen in visual acuity (p=0,03. CONCLUSION: In our sample a clear association between AH, ageing and male sex was observed. The majority of patients had unilateral vitreous deposits. Vitrectomy in association with facoemulsification is a safe and effective intervention in this group of patients.

  9. Gestalt Therapy Applied: A Case Study with an Inpatient Diagnosed with Substance Use and Bipolar Disorders.

    Science.gov (United States)

    Aiach Dominitz, Valerie

    2017-01-01

    The aim of the present paper is to open the discourse regarding the unmet needs of specific patients, especially those with substance use disorder and/or personality disorder where 'multimorbidities', and/or 'overdiagnosis' and/or 'diagnosis overlap' are frequent. An additional aim is to review the main therapeutic purpose and concepts of Gestalt therapy which might be appropriate in the treatment of these patients often characterized by their difficulties in being aware and in contact in the 'here and now'. I first start with an overview of Gestalt therapy concepts. Then, I illustrate Gestalt's 'here and now' and awareness concepts applied during 18 sessions with an inpatient diagnosed with substance use and bipolar disorders. In addition, the patient had to face an open criminal charge, was regarded as having an antisocial personality disorder and argued suffering from post-traumatic stress disorder. After this two-month therapy period, the patient entered for the first time a daily rehabilitation program in the community, where he was doing well (this after a few prior hospitalizations). The awareness development in the 'here and now' through which different contact styles and cycles of experiences are experienced is a process that allowed the patient to start experiencing contact with himself, his true needs and his environment. This contributed to his well-being improvement, led and supported his rehabilitation and reinsertion within the society and decrease his relapses, either with drugs or criminal activities. Copyright © 2016 John Wiley & Sons, Ltd. People with substance use disorder (where 'multimorbidities', 'overdiagnosis' or 'diagnosis overlap' are frequent), people with personality disorder(s) or people who have difficulties in defining what really disturbs them are the same people who could benefit of GT encouraging awareness and contact development in the 'here and now'. Gestalt therapy should not be regarded as a practitioner's toolbox but as a

  10. Maternal clinical diagnoses and hospital variation in the risk of cesarean delivery: analyses of a National US Hospital Discharge Database.

    Directory of Open Access Journals (Sweden)

    Katy B Kozhimannil

    2014-10-01

    Full Text Available BACKGROUND: Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. METHODS AND FINDINGS: Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project--a 20% sample of US hospitals--we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals. The outcome was cesarean (versus vaginal delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status. The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1% among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15. The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]. A limitation is that these data, while nationally representative, did not contain information on parity or gestational age. CONCLUSIONS: Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These

  11. Nail apparatus melanoma initially diagnosed as nail matrix blue nevus: a case report with dermatoscopy and dermatopathology

    Science.gov (United States)

    Akay, Bengu Nisa; Heper, Aylin Okcu; Thomas, Luc; Balme, Brigitte; Clark, Simon; Rosendahl, Cliff

    2017-01-01

    We present a case of nail apparatus melanoma in a 50-year-old woman presenting as new and changing longitudinal melanonychia of the right thumb. Very heavy melanin pigmentation involving both the epidermis and dermis interfered with dermatopathological assessment, which initially leads to a diagnosis of nail matrix blue nevus. After consultation with a specialist multidisciplinary clinic the diagnosis was revised to invasive melanoma, a diagnosis consistent with the clinical and dermatoscopic assessment. PMID:28243499

  12. Clinical status of a cohort of patients with type 1 diabetes diagnosed more than 2 decades before. Results of a specific clinical follow-up program.

    Science.gov (United States)

    Amor, Antonio J; Cabrer, Maria; Giménez, Marga; Vinagre, Irene; Ortega, Emilio; Conget, Ignacio

    2016-01-01

    The clinical course of type 1 diabetes mellitus (T1DM) has changed in recent decades. The aim of our study was to assess the long-term (> 20 years) clinical status of a patient cohort with T1DM under a specific treatment and follow-up program. A single center, observational, cross-sectional study was conducted of a patient cohort diagnosed with T1DM in the 1986-1994 period at our tertiary university hospital. Clinical characteristics, metabolic parameters, and occurrence of chronic complications and comorbidities after > 20 years of follow-up were collected. All subjects entered our specific program for patients with newly-diagnosed T1D and were followed up using the same clinical protocol. Data are shown as mean (standard deviation) or as number of patients and percentage. The appropriate test was used to compare quantitative and qualitative data. A P value <0.05 was considered statistically significant. A total of 279 patients were recorded, of whom 153 (53.6% women; mean age 46.6±8.6 years; age at onset 23.3±8.8 years; disease duration, 23.3±2.6 years) continued to attend our diabetes unit at the time of the analysis. Of these patients, 24.8% were administered continuous subcutaneous insulin infusion (CSII). Mean HbA1c in the past 5 years and in the last year were7.8±0.9% and 7.7±1.1% respectively (7.3±1.5% in those given CSII). Smoking was reported by 19.6% of patients, while 15.7% had high blood pressure and 37.9% dyslipidemia. Diabetic retinopathy was diagnosed in 20.4%, and 11.3% of the total cohort had nephropathy. Only 1.3% of our patients had a history of CVD. Data collected from a cohort of patients with T1DM for more than 2 decades regularly followed up with a specific program in a tertiary university hospital suggest a remarkably low prevalence of diabetic complications. Copyright © 2016 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. The clinical case for proton beam therapy

    Directory of Open Access Journals (Sweden)

    Foote Robert L

    2012-10-01

    Full Text Available Abstract Over the past 20 years, several proton beam treatment programs have been implemented throughout the United States. Increasingly, the number of new programs under development is growing. Proton beam therapy has the potential for improving tumor control and survival through dose escalation. It also has potential for reducing harm to normal organs through dose reduction. However, proton beam therapy is more costly than conventional x-ray therapy. This increased cost may be offset by improved function, improved quality of life, and reduced costs related to treating the late effects of therapy. Clinical research opportunities are abundant to determine which patients will gain the most benefit from proton beam therapy. We review the clinical case for proton beam therapy. Summary sentence Proton beam therapy is a technically advanced and promising form of radiation therapy.

  14. Clinical observations of odontomas in Japanese children: 39 cases including one recurrent case.

    Science.gov (United States)

    Tomizawa, M; Otsuka, Y; Noda, T

    2005-01-01

    Retrospective investigations of odontomas in Japanese children and one recurrent case were carried out. Thirty-nine cases of odontoma in 38 children were treated in the Paediatric Dentistry Clinic of Niigata University Dental Hospital between September 1979 and December 2002. The patients consisted of 23 males and 15 females and their ages ranged from 1 year 2 months to 14 years old. The chief complaints were delayed tooth eruption in 19 cases (five: primary teeth, 14: permanent teeth), retention of primary teeth in 11, incidentally found on the radiographic examination in eight cases, and swelling of the jaw in one case. Thirty-four cases (87%) were associated with tooth eruption disturbances. The most frequently affected region was the maxillary anterior region. Treatment consisted of surgical removal of odontomas in all cases, after which if the impacted teeth did not erupt, exposure of the crown and/or orthodontic traction was performed. Pathological diagnoses were compound odontoma in 30 cases, complex odontoma (n = 7), and compound and complex odontoma (n = 2). A retrospective study of the radiographs revealed the developing process of odontomas in four cases and odontoma disturbed tooth eruption since the early uncalcified developing stage. A recurrent case was a boy aged 6 years 5 months in whom the first surgical removal of odontoma was performed at the age of 1 year 8 months. Recurrence of an odontoma is very rare, but in very young children odontomas are in the early developing stages, containing uncalcified portions, so it is important to perform periodical observations until the succedaneous teeth erupt.

  15. Screening detected celiac disease in children with type 1 diabetes mellitus: Effect on the clinical course - (A case control study)

    NARCIS (Netherlands)

    Rami, B.; Sumnik, Z.; Schober, E.; Waldhor, T.; Battelino, T.; Bratanic, N.; Kurti, K.; Lebl, J.; Limbert, C.; Madacsy, L.; Odink, R.J.H.; Paskova, M.; Soltesz, G.

    2005-01-01

    Objective: To investigate clinical and metabolic characteristics of diabetic children with screening detected celiac disease in a multicenter case-control study. Methods: Cases: 98 diabetic patients were diagnosed as having silent celiac disease by screening with endomysial antibodies and subsequent

  16. Screening detected celiac disease in children with type 1 diabetes mellitus : Effect on the clinical course - (A case control study)

    NARCIS (Netherlands)

    Rami, B; Sumnik, Z; Schober, E; Waldhor, T; Battelino, T; Bratanic, N; Kurti, K; Lebl, J; Limbert, C; Madacsy, L; Odink, RJH; Paskova, M; Soltesz, G

    Objective: To investigate clinical and metabolic characteristics of diabetic children with screening detected celiac disease in a multicenter case-control study. Methods: Cases: 98 diabetic patients were diagnosed as having silent celiac disease by screening with endomysial antibodies and subsequent

  17. Screening detected celiac disease in children with type 1 diabetes mellitus : Effect on the clinical course - (A case control study)

    NARCIS (Netherlands)

    Rami, B; Sumnik, Z; Schober, E; Waldhor, T; Battelino, T; Bratanic, N; Kurti, K; Lebl, J; Limbert, C; Madacsy, L; Odink, RJH; Paskova, M; Soltesz, G

    2005-01-01

    Objective: To investigate clinical and metabolic characteristics of diabetic children with screening detected celiac disease in a multicenter case-control study. Methods: Cases: 98 diabetic patients were diagnosed as having silent celiac disease by screening with endomysial antibodies and subsequent

  18. Segmental omental infarction in childhood: a typical case diagnosed by CT allowing successful conservative treatment

    Energy Technology Data Exchange (ETDEWEB)

    Coulier, Bruno [Clinique St. Luc, Department of Diagnostic Radiology, Bouge (Belgium)

    2006-02-01

    Segmental omental infarction (SOI) is an uncommon cause of right lower quadrant pain in children that is often misdiagnosed as appendicitis. During the last decade, imaging findings of SOI have proved to be sufficiently typical to avoid unnecessary surgery in the majority of reported adult patients. The condition has a spontaneous favourable evolution under medical treatment. In children the surgical option remains controversial. We report a typical case of SOI in a 10-year-old boy. The diagnosis was suspected by sonography, unambiguously confirmed by multidetector CT and successfully treated conservatively. This report emphasizes the use of CT in selected acute abdominal situations, peculiarly in obese children, to avoid unnecessary surgery. (orig.)

  19. A Case of Fetal Herpes Simplex Encephalitis Diagnosed Prenatally by Ultrasonography in the Third Trimester

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Mi Bum; Kim, Yu Ri; Hwang, Han Sung; Park, Yong Won; Kim, Young Han [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2007-12-15

    Almost all reported incidences of herpes simplex virus (HSV) infection in newborns result as a complication of rupture of the amniotic membranes or the delivery of the baby, but infection via the placenta and amniotic membranes is rare. Ventriculomegaly was detected at 36 weeks of gestation by prenatal ultrasonography, and an emergency cesarean section was then performed at 36 weeks of gestation. We report a case of herpes simplex encephalitis detected at 36 weeks of gestation by prenatal ultrasonography, which was confirmed by a postnatal serologic test and CSF test with a brief review of literature

  20. A Case of Transient ST Elevation and Polymorphic Tachycardia without Angina Diagnosed by Holter Monitoring.

    Science.gov (United States)

    Farooq, Ali; Alqahtani, Fahad; Trabulsi, Almoutassim; Kawsara, Akram; Alkhouli, Mohamad

    2017-05-25

    We report the case of 52-year-old female with recurrent episodes of palpitations and dizziness. Holter monitoring revealed transient ST elevations followed by episodes of polymorphic ventricular tachycardia associated with episodes of palpitations and dizziness. Coronary angiography revealed mildly irregular right coronary artery with 90% stenosis. The patient underwent percutaneous coronary intervention with successful placement of a stent to the mid-right coronary artery. The patient has been followed closely over a period of 12 months. There haven't been any recorded episodes of tachycardia, and the patient has remained symptom-free.

  1. A case of hepatopulmonary syndrome diagnosed by {sup 99m}Tc-MAA perfusion lung scan

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Hyung Tae; Lee, Moo Yong; Song, Il Han; Park, Seok Gun [College of Medicine, Dankook Univ., Cheonan (Korea, Republic of)

    2002-06-01

    In patients with chronic liver disease, hepatopulmonary syndrome, the right to left shunt without previous pulmonary and cardiac disease, can develope and cause respiratory distress. Tools to prove shunt are contrast echocardiography, pulmonary angiography, and {sup 99m}Tc-MAA perfusion lung scan. Among them, {sup 99m}Tc-MAA scan is a simple and safe method detecting the right to left shunt. At the same time, quantitation of shunt amount is possible by this method. We report a case of hepatopulmonary syndrome confirmed by {sup 99m}Tc-MAA scan and contrast echocardiography with review of literatures.

  2. Cheilitis glandularis and actinic cheilitis: differential diagnoses - report of three unusual cases.

    Science.gov (United States)

    Andrade, Emanuel Sávio Souza; Sobral, Ana Paula Veras; Laureano Filho, José Rodrigues; Santos, Marconi Eduardo Sousa Maciel; Camargo, Igor Batista

    2009-01-15

    A variety of pathological conditions of diverse etiologies may involve the lips. Cheilitis glandularis (CGL) is a rare disorder of unknown etiology characterized by inflammation of the minor salivary glands of the lower lip. The aim of this paper is to compare the diagnosis and treatment of two cases of CGL at an early age (one in a child and the other in a young adult with mental retardation) with the diagnosis and treatment of actinic cheilitis, which is much more prevalent than CGL in tropical countries.

  3. Acquired auditory agnosia in childhood and normal sleep electroencephalography subsequently diagnosed as Landau-Kleffner syndrome: a report of three cases.

    Science.gov (United States)

    van Bogaert, Patrick; King, Mary D; Paquier, Philippe; Wetzburger, Catherine; Labasse, Catherine; Dubru, Jean-Marie; Deonna, Thierry

    2013-06-01

      We report three cases of Landau-Kleffner syndrome (LKS) in children (two females, one male) in whom diagnosis was delayed because the sleep electroencephalography (EEG) was initially normal.   Case histories including EEG, positron emission tomography findings, and long-term outcome were reviewed.   Auditory agnosia occurred between the age of 2 years and 3 years 6 months, after a period of normal language development. Initial awake and sleep EEG, recorded weeks to months after the onset of language regression, during a nap period in two cases and during a full night of sleep in the third case, was normal. Repeat EEG between 2 months and 2 years later showed epileptiform discharges during wakefulness and strongly activated by sleep, with a pattern of continuous spike-waves during slow-wave sleep in two patients. Patients were diagnosed with LKS and treated with various antiepileptic regimens, including corticosteroids. One patient in whom EEG became normal on hydrocortisone is making significant recovery. The other two patients did not exhibit a sustained response to treatment and remained severely impaired.   Sleep EEG may be normal in the early phase of acquired auditory agnosia. EEG should be repeated frequently in individuals in whom a firm clinical diagnosis is made to facilitate early treatment. © The Authors. Developmental Medicine & Child Neurology © 2012 Mac Keith Press.

  4. Ruptured Cystic Mesothelioma Diagnosed after Blunt Trauma; Case Report and Literature Review

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    Francisco Igor B. Macedo

    2016-10-01

    Full Text Available The majority of blunt trauma is secondary to motor vehicle crashes,especially in those wearing seatbelts or sitting in the front or passenger seat location.Hollow viscus gastrointestinal injuries occur more frequently in small bowel, followed by colorectal, duodenum, stomach and appendix. A 25-year-old male presents after being involved in a motor vehicle accident. Initialworkup was significant for moderate amount of pelvic free fluid and curvilinear,cystic­like structures in the pelvis. He subsequently developed peritonitis and underwentdiagnostic laparoscopy, which revealed multiple cystic nodules arising from theperitoneum. Pathology demonstrated benign cystic mesothelioma (BCM. BCM is a very rarecondition of mesothelial­lined, variably sized, fluid­filled cysts that arises from theserous, pericardial or peritoneal lining. Due to the scarcity of cases, its management and prognosis are not fully established. This singular case highlights the necessity for a clinician to have a widedifferential forunusual causes of free pelvic fluid after blunt abdominaltrauma.

  5. [Aphasia, prosopagnosia and mania: a case diagnosed with right temporal variant semantic dementia].

    Science.gov (United States)

    Turan, Çetin; Kesebir, Sermin; Meteris, Handan; Ülker, Mustafa

    2013-01-01

    Neurologic disorders can produce "secondary" mania, and clinicians must distinguish secondary mania from bipolar disorders (BD). Patients with new and late onset mania require an evaluation that includes a thorough history, a neurologic examination, neuroimaging, and other selected tests. Neurologic causes of mania include strokes in the right basotemporal or inferofrontal region, strokes or tumors in the perihypothalamic region, Huntington's disease and other movement disorders, multiple sclerosis and other white matter diseases, head trauma, infections such as neurosyphilis and Creutzfeldt-Jakob disease, and frontotemporal lobar degeneration. The term Frontotemporal Lobar Degeneration (FTLD) is suggested for neurodegenerative diseases characterized by focal degeneration such as Primer Progressive Aphasia (PPA), Frontal Lobe Dementia, PPA- Amyotrophic Lateral Sclerosis (ALS), and Corticobasal Degeneration. In this article, we report a frontotemporal dementia (FTD) case that referred with manic symptoms. The female patient was 46 years old, married, graduated from primary school, and had been admitted with complaints of hyperactivity, excessive talking, and decreased sleep for one week. She presented first with complaints that began three years ago that included the inability to remember names, recognize faces, use household appliances, and follow rules. She had also been repeating the same words and behaviors. Prosopagnosia, aphasia, and a positive family history of ALS were discussed with related index in our case.

  6. Equine-Assisted Intervention in a child diagnosed with autism spectrum disorder: a case report.

    Science.gov (United States)

    Cerino, Stefania; Borgi, Marta; Fiorentini, Ilaria; Correale, Cinzia; Lori, Alessia; Cirulli, Francesca

    2016-01-01

    An increasing number of studies have shown the beneficial effects of both recreational and therapeutic interventions assisted by animals for children with Autism Spectrum Disorders (ASD). The observed effects are believed to be mainly due to the ability of some animals to positively engage people, thus potentially counteracting the social withdrawal characterizing these subjects. Here we report the case of a child with high-functioning autism who has been included in an Equine-Assisted Intervention (EAI) program for 2 years. In particular, the relationship with the animal was used to encourage child’s narrative abilities as a primary means of improving cognition and communication. This case represents a first attempt to theorize the role of human-animal interaction as an adjunct to classic therapeutic strategies in ASD. During the intervention, the child appeared to gradually abandon his attitude to avoid the contact with the present and to hide in imaginative past and future. We propose animal-assisted interventions as complementary approaches capable to facilitate the verbalization of the patient’s internal states and to promote psychological well-being through the development of a bond with the animal.

  7. Diagnosing the SAPHO syndrome: a report of three cases and review of literature.

    Science.gov (United States)

    Kundu, Bijit Kumar; Naik, Ananta Kumar; Bhargava, Shrinath; Srivastava, Dinesh

    2013-08-01

    SAPHO, an acronym for synovitis, acne, pustulosis, hyperostosis and osteitis, is a heterogeneous entity with myriad presentations and features overlapping with other entities. It is a differential in patients presenting with skin and bone symptoms, either singly or in combination. Often misdiagnosed radiologically as a malignancy or infection, the diagnosis is seldom thought of. We present three cases referred to us for evaluation of findings unrelated to the presenting symptoms. After evaluation, a (99)Tc bone scan was ordered, which showed the 'bull's head sign' in all the three cases, confirming the diagnosis. We review the literature for SAPHO. It has a few features which point to its diagnosis and can help us to distinguish it from other seronegative arthritis. The clinician should be aware of this entity and should not hesitate to order a (99)Tc bone scan. We conclude that SAPHO is not rare, but rather, it is underdiagnosed. High index of suspicion is necessary for diagnosis. A (99)Tc bone scan is diagnostic and should be ordered in patients having any of the presenting features of the syndrome. We put forward the suggestion of using (99)Tc bone scintigraphy to define a 'pre-MRI' stage of ankylosing spondylitis.

  8. Clinical features and diagnosis for Chinese cases with malignant hyperthermia: a case cluster from 2005 to 2007

    Institute of Scientific and Technical Information of China (English)

    WANG Ying-lin; LUO Ai-lun; TAN Gang; CUI Xu-lei; GUO Xiang-yang

    2010-01-01

    Background Malignant hyperthermia (MH), manifesting as MH crisis during and/or after general anesthesia, is a potentially fatal disorder in response to volatile anesthetics and depolarizing muscle relaxants.Though typical features of MH episode can provide clues for clinical diagnosis, MH susceptibility is confirmed by in vitro caffeine-halothane contracture test (CHCT) in western countries.It is traditionally thought that MH has less incidence and fewer typical characteristics in Chinese population than their western counterparts because of the different genetic background.In this study, we investigated the clinical features of MH in Chinese cases and applied the clinical grading scale and CHCT for diagnosis of MH.Methods A cluster of three patients with MH, from January 2005 to December 2007, were included in the study.Common clinical presentations and the results of some lab examinations were reported in detail.The method of the clinical grading scale of diagnosis of MH was applied to estimate the qualitative likelihood of MH and predict MH susceptibility.Muscle fibers of femoral quadriceps of the patients were collected and CHCT was performed to confirm the diagnosis of MH.Results The clinical grading scales of diagnosis of the disease for these cases were all ranked grade D6, suggesting almost diagnosed ones.And the results of caffeine test were positive correspondingly, indicating that the patients should be diagnosed as MH susceptibility (MHS) according to diagnostic criteria of the North America MH group, which were already confirmed by clinical presentations and biochemical results.Conclusions These Chinese cases manifest as MH crisis.The clinical grading scale of diagnosis of MH may provide clues for clinical diagnosis.CHCT can also be used in confirming diagnosis of MH in Chinese cases though they have different genetic background from their western counterparts.

  9. Cytodiagnosis of alveolar soft part sarcoma: Report of two cases with special emphasis on the first orbital lesion diagnosed by aspiration cytology

    Directory of Open Access Journals (Sweden)

    K Majumdar

    2013-01-01

    Full Text Available Alveolar soft part sarcoma (ASPS is a rare neoplasm of uncertain cell of origin. Known to occur in adolescents and young adults, this tumor usually involves the muscles and deep soft tissues of the extremities and trunk. Orbital localization is rare and not yet subjected to cytological assessment, as per our literature search. We present here two cases of ASPS diagnosed by aspiration cytology, one in the orbit and the other in the lower extremity. The cells displayed abundant clear to finely vacuolated cytoplasm, often with disrupted margins and flowing of the cytoplasmic material; prominent nucleoli and scattered bare nuclei were also seen in the background. Two close cytological differential diagnoses include metastatic renal cell carcinoma and paraganglioma. Intracytoplasmic periodic acid schiff (PAS positive, diastase-resistant, needle-shaped crystals and corresponding rhomboid crystals with regular lattice pattern on ultrastructure are the hallmarks of this neoplasm. Due to its slowly progressive clinical course and poor outcome, preoperative diagnosis of ASPS through fine-needle aspiration cytology may be essential for deciding therapy, especially in rare and difficult locations like orbit, where adjuvant radiation may not be possible.

  10. Clinical Approach in Orbital Cellulitis Cases: Case Series

    Directory of Open Access Journals (Sweden)

    Altan Atakan Özcan

    2012-07-01

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

  11. Appendicitis Diagnosed by Emergency Physician Performed Point-of-care Transvaginal Ultrasound: Case Series

    Directory of Open Access Journals (Sweden)

    Robert Bramante

    2013-09-01

    Full Text Available Lower abdominal pain in females of reproductive age continues to be a diagnostic dilemma for the emergency physician (EP. Point-of-care ultrasound (US allows for rapid, accurate, and safe evaluation of abdominal and pelvic pain in both the pregnant and non-pregnant patient. We present 3 cases of females presenting with right lower quadrant and adnexal tenderness where transvaginal ultrasonography revealed acute appendicitis. The discussion focuses on the use of EP-performed transvaginal US in gynecologic and intra-abdominal pathology and discusses the use of a staged approach to evaluation using US and computed tomography, as indicated. [West J Emerg Med. 2013;14(5:415-418.

  12. Primary ciliary dyskinesia diagnosed by electron microscopy in one case of Kartagener syndrome.

    Science.gov (United States)

    Rugină, Aniela Luminiţa; Dimitriu, Alexandru Grigore; Nistor, Nicolai; Mihăilă, Doina

    2014-01-01

    Primary ciliary dyskinesia (PCD) is associated with abnormalities in the structure of a function of motile cilia, causing impairment of muco-ciliary clearence, with bacterial overinfection of the upper and lower respiratory tract (chronic oto-sino-pulmonary disease), heterotaxia (situs abnormalities), with/without congenital heart disease, abnormal sperm motility with male infertility, higher frequency of ectopic pregnancy and female subfertility. The presence of recurrent respiratory tract infections in the pediatric age requires differentiation between primary immunodeficiency, diseases with abnormal mucus (e.g., cystic fibrosis) and abnormal ciliary diseases. This case was hospitalized for recurrent respiratory tract infections and total situs inversus at the age of five years, which has enabled the diagnosis of Kartagener syndrome. The PCD confirmation was performed by electron microscopy examination of nasal mucosa cells through which were confirmed dynein arms abnormalities. The diagnosis and early treatment of childhood PCD allows a positive development and a good prognosis, thus improving the quality of life.

  13. Diagnosing HIV “window phase” in routine laboratory: a teaching case

    Directory of Open Access Journals (Sweden)

    Roberta Valentina Marotta

    2011-12-01

    Full Text Available Human immunodeficiency virus (HIV is the causative agent of acquired immunodeficiency syndrome (AIDS. It is a retrovirus that inserts itself into the host’s DNA and use the host – cell’s replication mechanisms for its own perpetuation. Two distinct species of HIV (HIV 1 and HIV 2 have been identified and they have a different global distribution. In this paper we describe a case of HIV early infection in an italian man of fourty years old. From this example we want to stress the importance to consider with high attention the validation of a negative index of HIV antibodies.We advise to follow this procedure that allows to avoid the risk to report a false negative.

  14. Characterization of PRNP and SPRN coding regions from atypical scrapie cases diagnosed in Poland.

    Science.gov (United States)

    Piestrzyńska-Kajtoch, Agata; Gurgul, Artur; Polak, Mirosław P; Smołucha, Grzegorz; Zmudziński, Jan F; Rejduch, Barbara

    2012-03-01

    Scrapie, a fatal transmissible spongiform encephalopathy (TSE) occurs in two phenotypes: classical and atypical. Many authors point out that the polymorphism of three codons (136, 154, 171) of the PRNP (PrP gene) is associated with a sheep susceptibility to classical scrapie. Until now, only one PRNP gene variant coding phenylalanine at codon 141 has been found to be associated with atypical scrapie. Another recently identified and interesting candidate gene for scrapie susceptibility in sheep is an SPRN gene coding for Shadoo protein (Sho). Sho is a highly interspecies conserved protein and an insertion/deletion (indel) found in a sheep Sho gene was associated with classical scrapie occurrence. Here we determined the polymorphism of PRNP and SPRN genes in nine atypical scrapie cases (six in native born sheep and three in imported sheep) and compared these results with a control group of healthy animals comprising six corresponding Polish sheep breeds. In atypical scrapie cases five PRNP diplotypes were identified: A(136)R(154)Q(171)/ARQ, AHQ/ARQ, ARR/ARQ, ARR/AHQ and AHQ/AHQ. The ARR/AHQ diplotype was found only in imported sheep. A previously unobserved SNP in PRNP (E224K) was also found in both atypical scrapie and in a few control animals. In the ORF of the SPRN gene, six SNPs and one indel were identified. None of these variations was exclusive for scrapie animals and they were probably, naturally occurring polymorphisms. Special attention was given to the 6-bp indel SPRN polymorphism which was previously associated with classical scrapie occurrence.

  15. Assessment of horse owners' ability to recognise equine laminitis: A cross-sectional study of 93 veterinary diagnosed cases in Great Britain.

    Science.gov (United States)

    Pollard, D; Wylie, C E; Verheyen, K L P; Newton, J R

    2017-05-22

    Use of owner-reported data could further epidemiological knowledge of equine laminitis. However, owner recognition of laminitis has not previously been assessed. The primary objective was to establish whether cases of owner-suspected laminitis would be confirmed as laminitis by the attending veterinary surgeon. Secondary objectives were to compare owner- and veterinary-reported information from veterinary-confirmed cases of equine laminitis. Cross-sectional study. Twenty-five British veterinary practices were invited to submit laminitis reporting forms (LRFs) for active laminitis cases attended between January 2014 and October 2015; detailing 27 clinical signs, 5 underlying conditions and 7 risk factors associated with laminitis. Owners were invited to independently complete a modified LRF if reason for the veterinary visit was suspicion of laminitis. Differences between paired veterinary and owner LRFs, and between cases where owners did and did not recognise laminitis, were assessed using McNemar's and Fisher's Exact tests, respectively. Veterinary LRFs were received for 93 veterinary-diagnosed laminitis cases. All 51 owner-suspected cases were confirmed by veterinary diagnosis, with the remaining 42 (45.2%) not recognised as laminitis by owners. Undefined lameness, foot abscesses, colic and stiffness were common reasons for owner-requested veterinary visits in owner-unrecognised cases. 'Divergent growth rings' (prevalence difference: +27.3%, P = 0.01) and 'breed type' (prevalence difference: +21.2%, P = 0.04) were more commonly reported by veterinary surgeons in owner-recognised compared to owner-unrecognised cases. 'Difficulty turning', 'shifting weight' and risk factor 'body condition' were more frequently reported by veterinary surgeons whilst 'increased hoof temperature' was reported more frequently by owners. The limited clinical data restricted statistical inferences regarding the secondary objectives. All owner-suspected laminitis cases were confirmed

  16. Physiotherapy Management of People Diagnosed with de Quervain's Disease: A Case Series

    Science.gov (United States)

    Israeli, Tomer; Kozol, Zvi

    2015-01-01

    ABSTRACT Purpose: To report the outcomes of a physiotherapy management approach for de Quervain's disease (DQD), a common hand disorder for which evidence for physiotherapy management is lacking, in 4 consecutive patients with DQD. Methods: Participants underwent a median of eight treatment sessions, consisting of mobilizations with movement, eccentric muscle training, and high-voltage electrical stimulation. Outcomes were assessed with an 11-point numeric pain rating scale (NPRS; range 1–10) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH; range 0%–100%). Results: Median NPRS and DASH scores decreased from a baseline of 5 and 48, respectively, to 2.8 and 19 after treatment; at 6-month follow-up, all participants reported minimal pain and disability, but one participant required a corticosteroid injection shortly after discharge from physiotherapy. Conclusions: Overall outcome was considered successful for three of four patients, comparable to the success rate previously reported for corticosteroid injections. A randomized clinical trial evaluating the efficacy of this intervention seems warranted. PMID:26839455

  17. Implementing the semi-structured interview Kiddie-SADS-PL into an in-patient adolescent clinical setting: impact on frequency of diagnoses

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    Ferrari Pierre

    2008-07-01

    Full Text Available Abstract Background Research is needed to establish the utility of diagnostic interviews in clinical settings. Studies comparing clinical diagnoses with diagnoses generated with structured instruments show generally low or moderate agreement and clinical diagnostic assignment (e.g. admission or chart diagnoses are often considered to underdiagnose disorders. The objective of this study was to evaluate the impact of implementing the Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (Kiddie-SADS-PL into an in-patient adolescent clinical setting. Methods Participants were all adolescents admitted through the years 2001–2004 (N = 333 admissions, age 12–17 years. The authors reviewed the charts of the previous three years of consecutive admissions, patients being evaluated using routine psychiatric evaluation, before the Kiddie-SADS-PL was introduced. They then reviewed the charts of all consecutive admissions during the next twelve months, patients being evaluated by adding the instrument to routine practice. Results The rates of several main diagnostic categories (depressive, anxiety, bipolar and disruptive disorders increased considerably, suggesting that those disorders were likely underreported when using non-structured routine assessment procedures. The rate of co-morbidity increased markedly as the number of diagnoses assigned to each patient increased. Conclusion The major differences in diagnostic assignment rates provide arguments for the utility of diagnostic interviews in inpatient clinical settings but need further research, especially on factors that affect clinical diagnostic assignment in "real world" settings.

  18. Aortopulmonary window:a case diagnosed and surgery confirmed by ultra-fast computed tomography

    Institute of Scientific and Technical Information of China (English)

    张希; 吴钟凯; 姚尖平; 孙培吾

    2004-01-01

    @@ Aortopulmonary window (APW) is a rare congenital defect, found in 0.2% of patients with congenital heart disease, in which a communication exists between the ascending aorta and the pulmonary artery trunk with normal separation of the aortic and pulmonary valves.1 APW is classified into three types according to proximal, distal or total defects. Up to 50% of APW patients have patent ductus arteriosus (PDA), ventricular septal defects (VSD), aortic atresia, aortic valve stenosis, atrial septal defect, pulmonary valve stenosis, complete atrioventricular septal defect or tetralogy of Fallot.1-3 APW allows a large left to right shunt that causes pulmonary hypertension and chronic heart failure. Irreversible pulmonary vascular disease may occur at an early age. Cardiac catheterization and retrograde aortography confirm the diagnosis and the associated disorders. Prompt operative treatment achieves excellent long-term results.4 A ratio of pulmonary vascular resistance to systemic vascular resistance exceeding 0.4 is the main risk factor.5 We report the first case of APW confirmed by ultra-fast computed tomography (UFCT) before surgery following failure of transaortic patch closure due to aortic narrowing. UFCT after surgery confirmed its success.

  19. Molecular and histological tools to diagnose an imported case of American cutaneous leishmaniasis in Cuba.

    Science.gov (United States)

    Montalvo, Ana M; De Armas, Yaxsier; Fraga, Jorge; Blanco, Orestes; Menéndez, Reinaldo; Montoto, Vicente; Capó de Paz, Virginia

    2015-10-01

    Leishmaniasis represents a polymorphous group of diseases caused by around 20 different species of Leishmania parasite. Increases in the number of cases of leishmaniasis reported as a consequence of the growth in travel and migration are of concern to epidemiologists and are diagnostically challenging in non-endemic areas. Molecular and histological analyses of a paraffin-embedded skin biopsy were used in parallel to detect Leishmania parasites in a Cuban woman with suspicious lesions arriving in Cuba from Venezuela. Primers based on the 18S fragment of ribosomal ribonucleic acid (rRNA) and heat shock protein 70 genes (hsp70) were used for molecular detection. Histological studies detected the presence of the parasite. A small fragment of Leishmania DNA was amplified by polymerase chain reaction (PCR) targeting the 18S fragment using, for the first time, nucleic acid obtained from paraffin-embedded tissue as a template. Amplification of a larger fragment from the hsp70 gene did not occur. The detection of Leishmania DNA from paraffin-embedded tissue by means of 18S-targeted PCR is a feasible approach to diagnosis. In combination with classical methods such as histology, the molecular detection of the parasite was demonstrated to be useful in confirming Leishmania infection in a traveler. © 2015 The International Society of Dermatology.

  20. A retrospective review of cases preoperatively diagnosed by radiologic imaging as cavernous venous malformations.

    Science.gov (United States)

    Jayaram, Anupam; Cohen, Liza M; Lissner, Gary S; Karagianis, Achilles G

    2017-04-03

    The purpose of this study is to examine orbital lesions identified on preoperative radiologic imaging as cavernous venous malformations (CVMs), identify their imaging characteristics, and determine if these may help differentiate CVMs from other intraorbital masses. An IRB-approved retrospective chart review over 30 years was undertaken identifying lesions "consistent with cavernous hemangioma" on radiologic studies, which were subsequently surgically resected with a tissue diagnosis. All radiologic images (CT and MRI) obtained preoperatively were re-reviewed by a single masked neuroradiologist. The pattern of contrast enhancement on sequential MRI views was used to determine whether the enhancing characteristics helped identify CVMs compared to other intraorbital masses. Fifty-seven orbital lesions consistent with a CVM were identified on imaging. Fourteen (25%) of them were resected, of which nine (64%) were found to be CVMs on pathologic examination. Five (36%) were found to be a different lesion, most commonly schwannoma (21%). On imaging, CVMs tended to display heterogeneous progressive enhancement, whereas other tumors, in particular schwannomas, enhanced at their maximum level immediately. Based on these characteristics, on re-review, the masked neuroradiologist was able to differentiate a CVM versus other tumors for all 14 imaging cases. This study suggests that examining the pattern of contrast enhancement may help to correctly differentiate a CVM from other isolated, encapsulated orbital lesions on CT/MR imaging.

  1. A case of severe pseudomembranous colitis diagnosed by colonoscopy after Helicobacter pylori eradication.

    Science.gov (United States)

    Sato, Satoshi; Chinda, Daisuke; Yamai, Kiyonori; Satake, Ryu; Soma, Yasushi; Shimoyama, Tadashi; Fukuda, Shinsaku

    2014-06-01

    A 65-year-old male was admitted for hemorrhagic gastric ulcer. Since anti-Helicobacter pylori-immunoglobulin G antibody tested positive, eradication therapy was administered using rabeprazole, amoxicillin, and clarithromycin. During hospitalization, colonoscopy showed normal colonic mucosa except for a polyp of the sigmoid colon. He was discharged 4 days after finishing eradication therapy, but fever up and diarrhea appeared on the following day. After re-admission, colonoscopy revealed multiple yellowish-white, small circular membranous elevations, and a diagnosis of pseudomembranous colitis was made. He was successfully treated by oral administration of vancomycin. Concomitant use of antibiotics and a proton pump inhibitor for a hospitalized patient is a risk for pseudomembranous colitis. However, H. pylori eradication therapy should be started at re-introduction of oral feeding in cases of bleeding ulcers because rebleeding can be mortal in patients in 'poor general condition'. Physicians should consider pseudomembranous colitis as a diagnosis for the patients with diarrhea and high fever following H. pylori eradication therapy.

  2. Clinical-epidemiological features of HIV-infected patients diagnosed at age of 50 years or older

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    V Fink

    2012-11-01

    Full Text Available HIV/AIDS prevention and care efforts are directed to individuals of reproductive age (15–49 yrs. With the extension of sexual life of older people, they became a growing population at risk of HIV infection, usually not included in prevention strategies. In order to evaluate clinical profile of HIV/AIDS pts diagnosed at 50 yrs or older assisted in an HIV outpatient center in Buenos Aires, we retrospectively assessed clinical records of pts initiating care between Jan 1986 and Dec 2011. Age, CD4 cells and viral load (pVL at HIV diagnosis and most recent value, opportunistic infections (OIs, co-morbidities and antiretroviral therapy (ARV were recorded. Of 10,998 pts assisted in the 26-yr period, 495 (4.5% were≥50 yrs old at HIV diagnosis; median annual diagnoses: 18.5 (IQR 3.3–30.3 without significant changes in the last 20 yrs. Demographics: median age 54.7 yrs (IQR 51.8–59.2, rank 50–80, 76.6% male. Risk behavior: HTX 61.4%, MSM 34.1%, others 4.4%. 55.4% of HIV diagnoses occurred during hospitalization or simultaneously with acute OIs. One third (n=176 had AIDS at diagnosis, 24% had history of STDs. HCV co-infection 5.7%, past HBV infection 28.1% and chronic HBV infection 5.1%. Median CD4 cells at HIV diagnosis: 223.5 (13.7% (IQR 98.8–420.3, initial pVL 60,000 cp/mL (IQR 9,995.5–208,391. 69.3% of pts started ARV therapy during follow-up (FU, and the median time between diagnosis and treatment initiation was 3.4 mo (IQR 0.7–14; 56.9% of them started a non-nucleoside-based regimen (ZDV/3TC/EFV, 28.3% a PI-based regimen (ZDV/3TC/IDV and 14.6% a nucleoside-based regimen (ZDV/ddI pre-HAART era. After a year (±6 mo, 63.8% pts achieved undetectable pVL and gained 136 CD4 cells from BSL (IQR 83–204. After 40.6 mo of FU (IQR 6.7-89.8, 66.3% are alive, 7.1% died (68.6% of HIV-related diseases and 26.7% are lost to FU. Co-morbidities were present in 125 (25.3%, mainly hypertension, increased lipids, CVD and DBT. Among treated pts, 70

  3. Analysis of CT diagnose for fungal sinusitis in 100 cases%CT诊断真菌性鼻窦炎100例分析

    Institute of Scientific and Technical Information of China (English)

    李春晖

    2012-01-01

    Objective To summarize the fungal sinusitis of fungal sinusitis retrospectively and to analyze the clinical value of CT diagnose for fungal sinusitis. Methods The data of 100 patients with fungal sinusitis and the clinical examination results were compared with CT diagnose. Bone window and soft - tissue window scans were performed for sinus CT scans. Results 100 cases suffered unilateral nasal sinusitis disease. There were 34 cases of fungus ball, 4 cases of chronic invasive fungal sinusitis, and 28 cases of allergic fungal sinusitis. The characteristics of imaging showed that there were well-distributed high density frosted glass shadow, or extremely irregular linar, there are decentralization calcification spots distribute in the sinuses. And accompany different degree bone resorption or the structures were unclearly. There were 15 cases of sinus wall bone erosion, lesions extended to adjacent structures in 3 cases, extended to eye socket in 1 case and 2 cases with bone absorption of lateral skull base. The mucin in nasal or sinus were in accord with the high density of ground-glass opacity which showed by CT scan. Conclusion The imaging of CT of these patients' representations were different with others paranasal sinusitis. It can aid accurate diagnose the fungal sinusitis.%目的 回顾性总结真菌性鼻窦炎CT影像表现,并结合临床,探讨CT检查对诊断真菌性鼻窦炎的临床价值.方法 收集100例确诊为真菌性鼻窦炎的病人资料并结合临床检查结果,与CT检查进行分析比较.鼻窦CT扫描采用骨窗和软组织窗扫描.结果 100例患者均为单侧鼻窦发病,其中真菌球型68例,慢性侵袭性真菌性鼻窦炎4例,变应性真菌性鼻窦炎28例.CT扫描影像特点为鼻窦腔散在较均匀毛玻璃特征或极不规则的线状,有星状分布的钙化点;伴不同程度骨质吸收或结构不清;窦壁骨质侵蚀15例.病变延伸到邻近结构3例,其中1例累及眼眶.有2例侧颅底骨质吸收.

  4. Clinical applications of CO2 lasers: clinical cases

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    Sinibaldi, Kenneth R.

    1994-09-01

    The most common surgery performed in our clinic with the CO2 laser is the cutting and vaporization of neoplasms associated with the head and neck, in particular, the squamous cell carcinoma in the cat. A majority of the tumors are malignant and 50% are metastatic at the time of presentation for surgery. Experience has taught us that early detection and removal with the CO2 laser affords the best prognosis. To date, roughly 100 cases have been treated with the CO2 laser. The success rate in the dog is not as rewarding as in the cat. Most cases were done with 5 - 10 watts of power continuous or pulsed wave, using a 125 mm or 50 mm handpiece. The laser beam was focused or defocused to adjust for cutting, vaporization, and coagulation. No post-op care of the wounds was recommended. Other small neoplasms in and around the ears, head, and neck can also be removed easily with the CO2 laser.

  5. A clinical case of pseudotumorous chronic parainfectious limbic encephalitis

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    N. A. Shnaider

    2014-01-01

    Full Text Available Parainfectous limbic encephalitis (PILE associated with viruses of the Herpesviridae family is one of the forms of chronic herpes encephalitis characterized by limbic system dysfunction and a prolonged course with frequent exacerbations. There are two types of the course of the disease: latent autoimmune limbic encephalitis (LE progressing to mesial temporal sclerosis and pseudotumorous granulomatous LE. The latter (inflammatory pseudotumor or granuloma is characterized by the formation of a polymorphic inflammatory infiltrate with the elements of fibrosis, necrosis, and a granulomatous reaction and by myofibroblast cells. This is a slowly growing benign pseudotumor that contains much more plasma cells than inflammatory ones. The diagnosis of pseudotumorous LE is difficult and requires the participation of a neurologist, an immunologist, an oncologist, and a neurosurgeon. Perfusion computed tomography, magnetic resonance imaging, and magnetic resonance spectroscopy give proof to the adequacy of the term inflammatory pseudotumor because it is histologically difficult to characterize the lesion as a tumor or inflammation. When a chronic lesion in the central nervous system is lately diagnosed, the prognosis of the disease may be poor and complicated by the development of resistant symptomatic focal epilepsy and emotional, volitional, and cognitive impairments. It was differentially diagnosed from brain tumors (astrocytic, oligodendroglial, and mixed gliomas, ependymal, neuronal, neuroglial, and embryonal tumors, meningiomas, cholesteatomas, dermoid cysts, teratomas, and cysts, other reactive and inflammatory processes (leukemic infiltrations, systemic lupus erythematosus, multiple sclerosis, encephalomyelitis, hypoparathyroidism, Addison's disease, vitamin A intoxication, and the long-term use of glucocorticoids and contraceptives. The authors describe a clinical case of the pseudotumorous course of chronic PILE in a 28-year-old woman

  6. CHARGE-like presentation, craniosynostosis and mild Mowat-Wilson Syndrome diagnosed by recognition of the distinctive facial gestalt in a cohort of 28 new cases.

    Science.gov (United States)

    Wenger, Tara L; Harr, Margaret; Ricciardi, Stefania; Bhoj, Elizabeth; Santani, Avni; Adam, Margaret P; Barnett, Sarah S; Ganetzky, Rebecca; McDonald-McGinn, Donna M; Battaglia, Domenica; Bigoni, Stefania; Selicorni, Angelo; Sorge, Giovanni; Monica, Matteo Della; Mari, Francesca; Andreucci, Elena; Romano, Silvia; Cocchi, Guido; Savasta, Salvatore; Malbora, Baris; Marangi, Giuseppe; Garavelli, Livia; Zollino, Marcella; Zackai, Elaine H

    2014-10-01

    Mowat-Wilson syndrome (MWS) is characterized by moderate to severe intellectual disability and distinctive facial features in association with variable structural congenital anomalies/clinical features including congenital heart disease, Hirschsprung disease, hypospadias, agenesis of the corpus callosum, short stature, epilepsy, and microcephaly. Less common clinical features include ocular anomalies, craniosynostosis, mild intellectual disability, and choanal atresia. These cases may be more difficult to diagnose. In this report, we add 28 MWS patients with molecular confirmation of ZEB2 mutation, including seven with an uncommon presenting feature. Among the "unusual" patients, two patients had clinical features of charge syndrome including choanal atresia, coloboma, cardiac defects, genitourinary anomaly (1/2), and severe intellectual disability; two patients had craniosynostosis; and three patients had mild intellectual disability. Sixteen patients have previously-unreported mutations in ZEB2. Genotype-phenotype correlations were suggested in those with mild intellectual disability (two had a novel missense mutation in ZEB2, one with novel splice site mutation). This report increases the number of reported patients with MWS with unusual features, and is the first report of MWS in children previously thought to have CHARGE syndrome. These patients highlight the importance of facial gestalt in the accurate identification of MWS when less common features are present. © 2014 Wiley Periodicals, Inc.

  7. The Added Value of Eye-tracking in Diagnosing Dyscalculia: A Case Study

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    Sietske eVan Viersen

    2013-10-01

    Full Text Available The present study compared eye movements and performance of a nine-year-old girl with Developmental Dyscalculia (DD on a series of number line tasks to those of a group of typically developing (TD children (n = 10, in order to answer the question whether eye-tracking data from number line estimation tasks can be a useful tool to discriminate between TD children and children with a number processing deficit. Quantitative results indicated that the child with dyscalculia performed worse on all symbolic number line tasks compared to the control group, indicated by a low linear fit (R2 and a low accuracy measured by mean percent absolute error. In contrast to the control group, her magnitude representations seemed to be better represented by a logarithmic than a linear fit. Furthermore, qualitative analyses on the data of the child with dyscalculia revealed more unidentifiable fixation patterns in the processing of multi-digit numbers and more dysfunctional estimation strategy use in one third of the estimation trials as opposed to approximately 10% in the control group. In line with her dyscalculia diagnosis, these results confirm the difficulties with spatially representing and manipulating numerosities on a number line, resulting in inflexible and inadequate estimation or processing strategies. It can be concluded from this case study that eye-tracking data can be used to discern different number processing and estimation strategies in TD children and children with a number processing deficit. Hence, eye-tracking data in combination with number line estimation tasks might be a valuable and promising addition to current diagnostic measures.

  8. The added value of eye-tracking in diagnosing dyscalculia: a case study.

    Science.gov (United States)

    van Viersen, Sietske; Slot, Esther M; Kroesbergen, Evelyn H; Van't Noordende, Jaccoline E; Leseman, Paul P M

    2013-01-01

    The present study compared eye movements and performance of a 9-year-old girl with Developmental Dyscalculia (DD) on a series of number line tasks to those of a group of typically developing (TD) children (n = 10), in order to answer the question whether eye-tracking data from number line estimation tasks can be a useful tool to discriminate between TD children and children with a number processing deficit. Quantitative results indicated that the child with dyscalculia performed worse on all symbolic number line tasks compared to the control group, indicated by a low linear fit (R (2)) and a low accuracy measured by mean percent absolute error. In contrast to the control group, her magnitude representations seemed to be better represented by a logarithmic than a linear fit. Furthermore, qualitative analyses on the data of the child with dyscalculia revealed more unidentifiable fixation patterns in the processing of multi-digit numbers and more dysfunctional estimation strategy use in one third of the estimation trials as opposed to ~10% in the control group. In line with her dyscalculia diagnosis, these results confirm the difficulties with spatially representing and manipulating numerosities on a number line, resulting in inflexible and inadequate estimation or processing strategies. It can be concluded from this case study that eye-tracking data can be used to discern different number processing and estimation strategies in TD children and children with a number processing deficit. Hence, eye-tracking data in combination with number line estimation tasks might be a valuable and promising addition to current diagnostic measures.

  9. Birth Order and Sibling Gender Ratio of a Clinical Sample of Children and Adolescents Diagnosed with Attention Deficit Hyperactivity Disorder

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    Ahmad Ghanizadeh

    2012-09-01

    Full Text Available Objective: It is not clear whether sibling’s gender ratio is associated with attention deficit hyperactivity disorder (ADHD. This study examines whether inattentiveness severity and hyperactivity/impulsivity severity are associated with birth order of children with ADHD.Method: Participants are a clinical sample of 173 children and adolescents with ADHD and 43 ones without ADHD. Diagnoses were made using Diagnostic and Statistical Manual of Mental Disorders forth edition-Text Revision (DSM-IV-TR, diagnostic criteria according to face-to-face interview with the children and their parents. ADHD DSM-IV checklist was used to measure inattentiveness and hyperactivity/impulsivity scores.Results: The association of birth order and diagnosis of ADHD was not statistically significant after adjusting for covariate factors. The gender ratio of siblings is not associated with ADHD.Conclusion: Birth order and siblings gender ratio are independent of ADHD diagnosis. The results of this study support the fact that genetic factors rather than environmental factor of birth order is associated with ADHD. Moreover, contrary to autism, the current results do not suggest the androgen theory for ADHD.

  10. Prolonged survival of a woman with lung cancer diagnosed and treated with chemotherapy during pregnancy. Review of cases reported.

    Science.gov (United States)

    Garrido, M; Clavero, J; Huete, A; Sánchez, C; Solar, A; Alvarez, M; Orellana, E

    2008-05-01

    Lung cancer is the most common cause of cancer death in women in the US, diagnosis during pregnancy is rare and has been reported 34 times. We report a case of a 34-year-old woman with stage III locally advanced lung cancer diagnosed during the 27th week of pregnancy. Chest X-ray and thorax MRI revealed a 9cmx7cm mass in the upper right lung lobe. CT guided FNA biopsy indicated adenocarcinoma. Neoadjuvant chemotherapy was administered with vinorelvine (Navelbine) and cisplatin for three cycles with partial response. At 39 weeks, she delivered a healthy baby. Right upper lobectomy with complete lymphadenectomy was performed 3 weeks later. Final pathology was reported as an adenocarcinoma of 7.5cmx6.2cm with involvement of 16/30 lymph nodes. She received three additional cycles of chemotherapy and radiotherapy. Follow-up with CT scan after 11 months did not show recurrence.

  11. Clinical Presentation of a Patient with Localized Acquired Cutis Laxa of Abdomen: A Case Report

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    Tugomir Gverić

    2010-01-01

    Objective. The aim of this case report was to present our patient suffering from CL, and to evaluate clinical presentation, diagnostic and therapeutic difficulties in this rare condition. Case Report. A 30-year-old female patient was admitted to our Hospital due to localized loose and sagging skin of abdomen, induced by prior cesarean section 6 years ago. CL has been diagnosed based on the clinical picture and pathohistological appearance. Conclusion. Reconstructive surgery provides a dramatic cosmetic improvement with significant psychosocial benefit. Repeated surgical procedures may be required to correct the lax skin, which worsens with age.

  12. High Accuracy of Common HIV-Related Oral Disease Diagnoses by Non-Oral Health Specialists in the AIDS Clinical Trial Group.

    Directory of Open Access Journals (Sweden)

    Caroline H Shiboski

    Full Text Available Many studies include oral HIV-related endpoints that may be diagnosed by non-oral-health specialists (non-OHS like nurses or physicians. Our objective was to assess the accuracy of clinical diagnoses of HIV-related oral lesions made by non-OHS compared to diagnoses made by OHS.A5254, a cross-sectional study conducted by the Oral HIV/AIDS Research Alliance within the AIDS Clinical Trial Group, enrolled HIV-1-infected adults participants from six clinical trial units (CTU in the US (San Francisco, New York, Chapel Hill, Cleveland, Atlanta and Haiti. CTU examiners (non-OHS received standardized training on how to perform an oral examination and make clinical diagnoses of specific oral disease endpoints. Diagnoses by calibrated non-OHS were compared to those made by calibrated OHS, and sensitivity and specificity computed.Among 324 participants, the majority were black (73%, men (66%, and the median CD4+ cell count 138 cells/mm(3. The overall frequency of oral mucosal disease diagnosed by OHS was 43% in US sites, and 90% in Haiti. Oral candidiasis (OC was detected in 153 (47% by OHS, with erythematous candidiasis (EC the most common type (39% followed by pseudomembranous candidiasis (PC; 26%. The highest prevalence of OC (79% was among participants in Haiti, and among those with CD4+ cell count ≤ 200 cells/mm(3 and HIV-1 RNA > 1000 copies/mL (71%. The sensitivity and specificity of OC diagnoses by non-OHS were 90% and 92% (for EC: 81% and 94%; PC: 82% and 95%. Sensitivity and specificity were also high for KS (87% and 94%, respectively, but sensitivity was < 60% for HL and oral warts in all sites combined. The Candida culture confirmation of OC clinical diagnoses (as defined by ≥ 1 colony forming unit per mL of oral/throat rinse was ≥ 93% for both PC and EC.Trained non-OHS showed high accuracy of clinical diagnoses of OC in comparison with OHS, suggesting their usefulness in studies in resource-poor settings, but detection of less common

  13. Semiconductor Whole Exome Sequencing for the Identification of Genetic Variants in Colombian Patients Clinically Diagnosed with Long QT Syndrome.

    Science.gov (United States)

    Burgos, Mariana; Arenas, Alvaro; Cabrera, Rodrigo

    2016-08-01

    Inherited long QT syndrome (LQTS) is a cardiac channelopathy characterized by a prolongation of QT interval and the risk of syncope, cardiac arrest, and sudden cardiac death. Genetic diagnosis of LQTS is critical in medical practice as results can guide adequate management of patients and distinguish phenocopies such as catecholaminergic polymorphic ventricular tachycardia (CPVT). However, extensive screening of large genomic regions is required in order to reliably identify genetic causes. Semiconductor whole exome sequencing (WES) is a promising approach for the identification of variants in the coding regions of most human genes. DNA samples from 21 Colombian patients clinically diagnosed with LQTS were enriched for coding regions using multiplex polymerase chain reaction (PCR) and subjected to WES using a semiconductor sequencer. Semiconductor WES showed mean coverage of 93.6 % for all coding regions relevant to LQTS at >10× depth with high intra- and inter-assay depth heterogeneity. Fifteen variants were detected in 12 patients in genes associated with LQTS. Three variants were identified in three patients in genes associated with CPVT. Co-segregation analysis was performed when possible. All variants were analyzed with two pathogenicity prediction algorithms. The overall prevalence of LQTS and CPVT variants in our cohort was 71.4 %. All LQTS variants previously identified through commercial genetic testing were identified. Standardized WES assays can be easily implemented, often at a lower cost than sequencing panels. Our results show that WES can identify LQTS-causing mutations and permits differential diagnosis of related conditions in a real-world clinical setting. However, high heterogeneity in sequencing depth and low coverage in the most relevant genes is expected to be associated with reduced analytical sensitivity.

  14. Unemployment among patients with newly diagnosed first-episode psychosis: prevalence and clinical correlates in a U.S. sample.

    Science.gov (United States)

    Ramsay, Claire E; Stewart, Tarianna; Compton, Michael T

    2012-05-01

    Although it is well established that people with schizophrenia have markedly high rates of unemployment, less is known about the prevalence and clinical correlates of unemployment in patients newly diagnosed with first-episode psychosis. This analysis documented the prevalence of unemployment and examined previously reported clinical correlates of unemployment in patients with first-episode psychosis hospitalized in an urban, public-sector setting in the southeastern US. Participants (n = 181) were assessed as part of an overarching study of first-episode psychosis using a variety of standardized research instruments. The rate of unemployment was compared to that documented in the general population according to US census data. Bivariate tests of associations between employment status and a number of variables of interest were followed by a multiple logistic regression model based on a previous study from Dublin, Ireland. Some 65.0% of first-episode patients were unemployed in the month prior to hospital admission, which is substantially higher than the rate of unemployment during the same period in the two counties in which recruitment took place. In bivariate tests, unemployment was associated with younger age, fewer years of educational attainment, lower global functioning scores, and more severe negative symptoms. In the logistic regression model, only age and global functioning were independently significant correlates. The remarkably high rate of unemployment in this young, first-episode sample, and the evidence of associations between unemployment, greater symptomatology, and poorer functioning, argue for further research and development on supported employment programs for such patients.

  15. A rare case of myxoid liposarcoma of the adult foot diagnosed using fine needle aspiration cytology (FNAC

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    Kure S

    2014-12-01

    Full Text Available Shoko Kure,1 Wei-Xia Peng,1 Mitsuhiro Kudo,1 Miyuki Matsubara,2 Takashi Tsunoda,3 Zenya Naito1,21Department of Integrated Diagnostic Pathology, Nippon Medical School, 2Department of Pathology, Nippon Medical School Hospital, 3Department of Orthopedics, Nippon Medical School Department of Orthopedics, Nippon Medical School, Tokyo, JapanAbstract: Liposarcoma is categorized as a soft tissue sarcoma that most commonly appears in the lower extremities during adulthood, but rarely in the feet. We present a rare case of a primary myxoid liposarcoma in the foot of a 63-year-old man that was diagnosed by fine needle aspiration cytology (FNAC. The patient presented to our hospital with a 10-year history of a slow-growing mass on the left lateral ankle. On physical examination, the 60 mm ×60 mm mass, was found to be soft and elastic, causing poor mobility without pain. Magnetic resonance imaging of the mass revealed high signal intensity on T1-weighted images and heterogeneously high signal intensity on T2-weighted images without fat suppression. As a result of the physical examination and imaging, the mass was suspected to be a lipoma or ganglion cyst. However, the FNAC procedure revealed atypical small, round, short spindle cells, or foamy cells with a myxoid background, suggesting myxoid liposarcoma. Histology using an open biopsy showed a proliferation of atypical spindle and asteroid cells with a few foamy lipoblasts in a capillary-rich and myxoid background. The atypical lipoblasts were slightly positive for S-100. These findings were consistent with myxoid liposarcoma. The patient was treated with a resection of the mass. Liposarcoma is considered to be the second most common soft-tissue sarcoma. It usually involves the lower extremities, particularly the thigh, and is very rare in the adult foot. Our case was a rare occurrence of myxoid liposarcoma of the foot diagnosed preoperatively using FNAC.Keywords: myxoid liposarcoma, foot, fine needle

  16. Does naftifine have anti-inflammatory properties? A double-blind comparative study with 1% clotrimazole/1% hydrocortisone in clinically diagnosed fungal infection of the skin.

    Science.gov (United States)

    Evans, E G; James, I G; Seaman, R A; Richardson, M D

    1993-10-01

    In a multicentre, double-blind, randomized, parallel group study in general practice, 269 patients with clinically diagnosed fungal infection of the skin were treated with either naftifine (Exoderil) or 1% clotrimazole plus 1% hydrocortisone (CHC; Canesten HC) applied twice daily for 4 weeks. Only 115 patients were shown subsequently to have a fungal infection by laboratory tests; the others had inflammatory disease of unknown aetiology. In those with fungal disease, both treatments were equally effective in terms of mycological cure (negative microscopy and culture). Clinical results for all 265 patients showed no clinically identifiable difference between the two preparations in terms of resolution of the disease, indicating that naftifine does have anti-inflammatory activity at least equal to CHC. This study suggests that there is no clinical advantage in treating patients with clinically diagnosed fungal infection of the skin with an antimycotic/corticosteroid combination as opposed to naftifine alone.

  17. Discovering treatment pattern in Traditional Chinese Medicine clinical cases by exploiting supervised topic model and domain knowledge.

    Science.gov (United States)

    Yao, Liang; Zhang, Yin; Wei, Baogang; Wang, Wei; Zhang, Yuejiao; Ren, Xiaolin; Bian, Yali

    2015-12-01

    In Traditional Chinese Medicine (TCM), the prescription is the crystallization of clinical experience of doctors, which is the main way to cure diseases in China for thousands of years. Clinical cases, on the other hand, describe how doctors diagnose and prescribe. In this paper, we propose a framework which mines treatment patterns in TCM clinical cases by exploiting supervised topic model and TCM domain knowledge. The framework can reflect principle rules in TCM and improve function prediction of a new prescription. We evaluate our method on 3090 real world TCM clinical cases. The experiment validates the effectiveness of our method.

  18. Tibial bone metastasis as an initial presentation of endometrial carcinoma diagnosed by fine-needle aspiration cytology: A case report and review of the literature

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    Sarag Aboujafar Boukhar

    2015-01-01

    Full Text Available Endometrial cancer is the most common gynecologic malignancy in the United States. However, bony metastasis is infrequent and exceptionally rare as the initial presentation. We report a case of a 77-year-old female with a clinically silent endometrial carcinoma who presented with a left tibial metastasis as the first manifestation of her disease. Ours is only the third case diagnosed by fine-needle aspiration (FNA cytology, and the first to detail the cytomorphologic features of metastatic endometrial cancer to bone. These microscopic findings, including three-dimensional cohesive clusters with cellular overlapping and cuboidal to columnar cells exhibiting low nuclear: cytoplasmic ratios and partially vacuolated cytoplasm, differ significantly from those of endometrial carcinoma on a Papanicolaou test. The tumor bore similarity to the more commonly encountered metastatic colon cancer, but immunohistochemical staining enabled reliable distinction between these entities. A review of osseous metastases of endometrial cancer demonstrates a predilection for bones of the lower extremity and pelvis with a predominance of the endometrioid histologic subtype. In about a quarter of the cases, the bony metastasis was the first manifestation of the cancer. FNA was an effective diagnostic modality for this unusual presentation of a common malignancy. Awareness of this entity and its differential diagnosis is essential for accurate and timely diagnosis.

  19. Clinical-histopathological correlation in a case of Coats' disease

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    Zajdenweber Moyses E

    2006-08-01

    Full Text Available Abstract Background Coats' disease is a non-hereditary ocular disease, with no systemic manifestation, first described by Coats in 1908. It occurs more commonly in children and has a clear male predominance. Most patients present clinically with unilateral decreased vision, strabismus or leukocoria. The most important differential diagnosis is unilateral retinoblastoma, which occurs in the same age group and has some overlapping clinical manifestations. Case presentation A 4 year-old girl presented with a blind and painful right eye. Ocular examination revealed neovascular glaucoma, cataract and posterior synechiae. Although viewing of the fundus was impossible, computed tomography disclosed total exsudative retinal detachment in the affected eye. The eye was enucleated and subsequent histopathological evaluation confirmed the diagnosis of Coats' disease. Conclusion General pathologists usually do not have the opportunity to receive and study specimens from patients with Coats' disease. Coats' disease is one of the most important differential diagnoses of retinoblastoma. Therefore, It is crucial for the pathologist to be familiar with the histopathological features of the former, and distinguish it from the latter.

  20. [Assessment of individual clinical outcomes: regarding an electroconvulsive therapy case].

    Science.gov (United States)

    Iraurgi, Ioseba; Gorbeña, Susana; Martínez-Cubillos, Miren-Itxaso; Escribano, Margarita; Gómez-de-Maintenant, Pablo

    2015-01-01

    Evaluation of therapeutic results and of the efficacy and effectiveness of treatments is an area of interest both for clinicians and researchers. In general, randomized controlled trial designs have been used as the methodology of choice in which intergroup comparisons are made having a minimum of participants in each arm of treatment. However, these procedures are seldom used in daily clinical practice. Despite this fact, the evaluation of treatment results for a specific patient is important for the clinician in order to address if therapeutic goals have been accomplished both in terms of statistical significance and clinical meaningfulness. The methodology based on the reliable change index (Jacobson y Truax)1 provides an estimate of these two criteria. The goal of this article is to propose a procedure to apply the methodology with a single case study of a woman diagnosed with major depression and treated with electroconvulsive therapy. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

  1. A case of eosinophilic pneumonia simultaneously diagnosed in a patient and a tame cat: a case report

    OpenAIRE

    Tsuji,Takao; Kondo, Mitsuko; Kikuchi, Ryota; Tagaya, Etsuko; Tamaoki, Jun

    2014-01-01

    Introduction Chronic eosinophilic pneumonia is an idiopathic disorder of unknown etiology. Corticosteroid treatment provides a good response but recurrence frequently occurs after tapering of corticosteroid. Chronic eosinophilic pneumonia occurs predominantly in middle-aged women and non-cigarette smokers, which leads to the speculation that environmental antigens, particularly in the home, contribute to the etiology. Case presentation A 66-year-old Japanese woman was given a diagnosis of chr...

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

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    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.

  3. Recognizing the clinical manifestations of acromegaly: case studies.

    Science.gov (United States)

    Iuliano, Sherry L; Laws, Edward R

    2014-03-01

    To present case studies of a 36-year-old woman and a 73-year-old man who presented with the syndrome of acromegaly, and to provide primary care nurse practitioners (NPs) with the understanding of the clinical and laboratory features needed for early recognition and treatment of this fascinating disease. A comprehensive review of published literature on acromegaly is presented. The findings discussed include the history, physical examination, and diagnostic studies of two patients presenting in different ways. They both saw multiple healthcare providers, and had symptoms and signs eventually leading to the diagnosis of acromegaly. Acromegaly is the result of excessive amounts of growth hormone (GH) and insulin-like growth factor type 1 (IGF-1), almost always caused by a benign adenoma of the pituitary gland. This leads to coarse facial features, soft tissue swelling (including the tongue), enlargement of the hands and feet, respiratory problems, hypertension, diabetes mellitus, carpal tunnel syndrome, and osteoarthritis. Early recognition and appropriate referral can reverse some of the signs and symptoms over time, and lead to decreased mortality and a markedly improved quality of life. These cases exemplify the challenges faced by NPs and other healthcare providers in diagnosing patients with acromegaly. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

  4. Cushing syndrome and adrenal carcinoma: a clinical case.

    Science.gov (United States)

    Candela, Giancarlo; Varriale, Sergio; Manetta, Fiorenza; Di Libero, Lorenzo; Giordano, Marco; Santini, Luigi

    2009-01-01

    A 21-year-old girl arrived at our hospital with a short history of hirsutism, facial pletora, amenorrhea, progressive weight gain and hypertension. The clinically suspected Cushing syndrome was then confirmed through chemical pathology. In fact, the results from hemato-chemical exams were: 45.5 Ig/dl cortisol, a DHEA sulphate >8000 ng/ml, 7.2 pg/ml ACTH, 17OH-Progesterone 10.66 ng/ml, Delta-4 Androstenedione 5.2 ng/ml, UFC (Urine Free Cortisol) >1000 mg/24h, FSH 0.8 mUI/ml, LH < 0.1 mUI/ml, Prolactin 13, 17, estradiol 96 pg/ml, and a bonded hypokalaemia, K+ 2,4 mEq/L. The echogram of the complete abdomen reveals, near the superior pole of the left kidney, the presence of a solid mass, not independent from the pole itself about 9.5 centimetres long, diagnosis confirmed to the TC abdomen and pelvis too, with or without mdc. This removed mass resulted, from the histological exam, in an adrenal carcinoma with a general and trabecular structure. Primal adrenal tumours are responsible for about 10% of Cushing syndrome cases. They present an annual incidence of 0.5 - 2.0 cases per million of inhabitants. The prognosis of adrenal ca remains low, with 5 year survival rate for 38% of diagnosed patients.

  5. The Tophus That Damages Hand Joint in a Female Patient Diagnosed with Premenopausal Gout: A Case Report

    Directory of Open Access Journals (Sweden)

    Selçuk Sayılır

    2016-08-01

    Full Text Available Gout is a disease cauising severe and sudden pain, tenderness, rash, edema and temperature rise in the joints. Although it appears generally in males, it can also be seen especially in postmenopausal women and it can rise in the joints except toe joint. It should be kept in mind for differential diagnosis and clinical approach in chronic hand arthritis. Sixty-one years old female patient admitted to our clinic with swelling and pain in the right second finger existing for several months. She had hypertension and was on 5 mg/day amlodipin and she was diagnosed with gout 9 years ago and was on colchicine 1 mg/day, allopruinol 300 mg/day. There were gray color changing, swelling, movement restriction and pain on 2. distal interphalengeal joint. Body mass index of the patient was 38 kg/m2. Blood analyses values were normal and uric acid level was detected 6.2 mg/dL (normal 4.2-5.4 mg/dL. There were subchondral osteopenia, severe intraarticular narrowing and degenerative changes at X-ray examination. The medical treatment of patient was planned and she was consulted for surgery to orthopedics clinic. Uric acid crystals cumulate in joints and their environment in chronic gout patients. These accumulations are called tophus when they get together abundantly. They occur under the skin as swelling. Tophuses generally located at affected joints and their environment, on fingers, on elbows or external ear. Tophuses can damage joints. Although it appears generally in males, it can also be seen especially in postmenopausal obese women and it can rise in the joints except toe joint. It should be kept in mind for clinical approach, treatments and preventing unnecessary surgeries chronic gout arthritis.

  6. Acute calcific tendinopathy of the popliteus tendon: a rare case diagnosed using a multimodality imaging approach and treated conservatively

    Energy Technology Data Exchange (ETDEWEB)

    Doucet, Cedric; Gotra, Akshat; Reddy, Santhosh Mauvva Venkatesh; Boily, Mathieu [McGill University, Royal Victoria Hospital, Department of Radiology, Montreal, QC (Canada)

    2017-07-15

    Acute calcific tendinopathy of the popliteus tendon is a rare medical entity associated with significant patient discomfort. We present the case of a previously healthy 48-year-old female who presented to the emergency department with acute onset of left knee pain. Initial radiographs revealed calcifications within the posterolateral compartment of the knee. Ultrasound imaging demonstrated a swollen and hypoechoic popliteus tendon with an increased color Doppler signal at the periphery of the tendon as well as calcification in the tendon and adjacent soft tissues. Subsequently performed MRI revealed a thickened and heterogeneous popliteus tendon near its femoral attachment with marked edematous changes surrounding the tendon. Local ultrasound-guided glucocorticoid injection had successful clinical results with no recurrence at 8-month follow-up. In this case report we review the literature for similar previously reported cases. This case report of popliteus tendon calcific tendinopathy provides comprehensive multimodality imaging findings and a description of its non-surgical management. (orig.)

  7. Differences in clinical and epidemiological features between tuberculosis cases notified in primary and tertiary health care

    Directory of Open Access Journals (Sweden)

    Pâmela Curbani

    2014-04-01

    Full Text Available Objective: To compare, on the basis of clinical, radiological and epidemiological aspects, all cases of tuberculosis (TB diagnosed in the tertiary healthcare services to those diagnosed at the primary healthcare providers in the municipality of Vitória-ES. Methods: Cross- sectional, retrospective study, with analysis of the SINAN’s database, to identify all cases among residents of the municipality of Vitória-ES and diagnosed with TB in 2006 and 2007. Patients were divided into two groups: cases diagnosed in Primary Health Care (PHC and those diagnosed in Tertiary Health Care (THC. For statistical analysis, it was used the software STATA CORP 9.0. Results: 338 patients were identified; 207 (61.24% of these were diagnosed in PHC and 131 (38.76% in THC. The pulmonary form was predominant in both groups. However, the extrapulmonary form presented higher frequency in the THC group. When analyzing the results of sputum smear, the positivity was found in 114 (55.07% patients of the PHC and in 57 (43.51% of THC. Regarding the positive cultures, 119 (57.48% patients diagnosed in PHC and only 38 (29% in THC tested positive. Conclusion: There is evidence of high proportion of patients with TB communicated as “new cases” in THC in the city and it was observed a predominance of the pulmonary form in both groups - PHC and THC, although the extrapulmonary form was more frequent in the latter. doi:10.5020/18061230.2013.p251

  8. Clinical analysis of abdominal wall endometriosis in 101 cases

    Institute of Scientific and Technical Information of China (English)

    Cheng Ning-hai; Zhu Lan; Lang Jing-he; Liu Zhu-feng; Sun Da-wei; Leng Jin-hua

    2006-01-01

    Objective: To review the clinical characteristics, treatment and prognoses of abdominal wall endometriosis(AWE).Methods: A retrospective study of 101 cases of AWE from 1992 to 2005 at Obstetric and Gynecologic Department of Peking Union Medical College Hospital was performed. Ninety-eight patients had a history of caesarean section. The mean age of the patients was (33.3±4.8) years and the average size of the mass was 1.5 cm. Abdominal wall mass associated pain during the menstrual cycle was noticed in 89.8% of the patients. The occurrence of AWE after caesarean section was 0.05% at our hospital. In patients without pelvic endometriosis or adenomyosis, 20.5% were presented with high CA125 >35 U/ml and the highest one was 93.4 U/ml. 92.1% of patients were diagnosed before surgery. 4 patients were administrated first in General Surgical Department with painless abdominal mass. Medication was adopted in 16 cases pre-operatively and 14 cases post-operatively.Results: The mean size of the resected mass was 4.2 cm, significantly larger than the estimation with palpation or ultrasonography, which was 0.8-1.2 cm (P=0.006, P<0.001). Pelvic endometriosis or adenomyosis was detected during the operation in 13 patients. One patient was diagnosed as atypical endometriosis by pathological examination in the beginning but transformed to be sarcoma finally. Ten patients recurred after surgery. 2 of them received medication and 5 of them received second operation.Conclusions: Ultrasonography can be used to evaluate the size of the mass and the infiltrative scope pre-operation. The serum CA125 is not specific for diagnosis of AWE. Complete eradication of the lesion with at least 1 cm beyond the edge of the mass is recommended as the primary treatment. Eradication should be considered also in recurrent cases. It may transform to malignant lesions after multiple recurrence.

  9. Challenges in diagnosing hepatic encephalopathy.

    Science.gov (United States)

    Weissenborn, K

    2015-02-01

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

  10. Multimodality imaging in cranial blastomycosis, a great mimicker: Case-based illustration with review of clinical and imaging findings

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    Puneet S Kochar

    2016-01-01

    Full Text Available We describe the clinical, laboratory, and imaging data of three patients who are proven cases of blastomycosis with cranial involvement. In this review, we discuss the imaging features of cranial blastomycosis with relevant clinical case examples including computed tomography (CT, magnetic resonance imaging (MRI, and advanced MR imaging techniques like magnetic resonance spectroscopy (MRS and MR perfusion. Literature is reviewed for modern-day diagnosis and treatment of this fatal intracranial infection, if not diagnosed promptly and managed effectively.

  11. First case of chancroid in 14 years at the largest STI clinic in Paris, France.

    Science.gov (United States)

    Fouéré, Sébastien; Lassau, François; Rousseau, Clotilde; Bagot, Martine; Janier, Michel

    2016-08-01

    We report the first case of chancroid seen at our clinic in 14 years. It was diagnosed by nuclear acid amplification test in a male patient returning from Madagascar. Although the disease is considered on the verge of disappearance even in tropical countries, its real potential for reemergence - due to new strains of Haemophilus ducreyi, underreporting and a lack of widespread use of molecular testing - could be underestimated.

  12. Concomitant HIV infection in newly diagnosed multiple myeloma ...

    African Journals Online (AJOL)

    HIV-positive MM patients with unusual clinical presentations and aggressive ... fatigue, weight loss, bone marrow plasmacytosis, renal insufficiency ... cell transplantation. ... HIV was newly diagnosed during the work-up of MM in eight cases.

  13. Functional Fitness and Self-Reported Quality of Life of Older Women Diagnosed with Knee Osteoarthrosis: A Cross-Sectional Case Control Study

    OpenAIRE

    Paula Andréa Malveira Cavalcante; Márcio Roberto Doro; Frank Shiguemitsu Suzuki; Roberta Luksevicius Rica; Andrey Jorge Serra; Francisco Luciano Pontes Junior; Alexandre Lopes Evangelista; Aylton José Figueira Junior; Julien Steven Baker; Danilo Sales Bocalini

    2015-01-01

    Aim. Utilizing a cross-sectional case control design, the aim of this study was to evaluate the functional fitness and self-reported quality of life differences in older people diagnosed with knee osteoarthrosis (O) who participated in health promotion groups. Methods. Ninety older women were distributed into two groups: control without O of the knee (C, n = 40) and a group diagnosed with primary and secondary knee O with grade II or higher, with definite osteophytes (OA, n = 50). Functional ...

  14. Recurrent Lower Gastrointestinal Bleeding: Ileal GIST Diagnosed by Video Capsule Endoscopy—A Case Report and Literature Review

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    Jie Ling

    2013-01-01

    Full Text Available Introduction. Gastrointestinal stromal tumor (GIST in the ileum is an extremely rare cause of recurrent lower gastrointestinal bleeding (GIB. Case Report. An 89-year-old man was admitted with melana. He had extensive PMH of CAD post-CABG/AICD, AAA repair, chronic anemia, myelodysplastic syndrome, lung cancer after resection, and recurrent GIB. Prior EGDs, colonoscopies, and upper device-assisted enteroscopy showed duodenal ulcer, A-V malformation s/p cauterization, and angioectasia. On admission, Hb was 6.0 g/dL. An endoscopic capsule study showed an ulcerated tumor in the ileum. CT showed no distant metastasis. The lesion was resected successfully and confirmed as a high-grade GIST. The patient was discharged with no further bleeding. Discussion. Early diagnosis for patients with ileal GIST is often challenging. Video capsule endoscopy and double balloon enteroscopy could be useful diagnostic tools. Surgical removal is the first line for a resectable GIST. Imatinib has become the standard therapy. Conclusion. This is a unique case of an ileal GIST in a patient with recurrent GIB which was diagnosed by video capsule. Complicated medical comorbidities often lead to a significant delay in diagnosis. Therefore, we recommend that if GIB does not resolve after appropriate treatments for known causes, the alternative diagnosis for occult GIB must be considered, including malignancy such as GIST.

  15. A case of juvenile acromegaly that was initially diagnosed as severe congestive heart failure from acromegaly-induced dilated cardiomyopathy.

    Science.gov (United States)

    Sue, Mariko; Yoshihara, Aya; Okubo, Yoichiro; Ishikawa, Mayumi; Ando, Yasuyo; Hiroi, Naoki; Shibuya, Kazutoshi; Yoshino, Gen

    2010-01-01

    Acromegaly is characterized by chronic hypersecretion of growth hormone (GH) and is associated with increased mortality rate because of the potential complications such as cardiovascular disease, respiratory disease, or malignancy, which are probably caused by the long-term exposure of tissues to excess GH, for at least 10 years, before diagnosis and treatment. A 22-year-old man with a 2-month history of fatigue was admitted to our hospital because of chest discomfort, dyspnea, and pitting edema of the lower limbs experienced over a 1-month period. On admission, his height and body weight were 186 cm and 138.5 kg, respectively, with a BMI of 39.8 kg/m(2). He showed acromegalic features and elevated serum GH and IGF-1 levels, which were 11.5 ng/mL and 960 ng/mL, respectively. There was no GH suppression in the 75-g oral glucose tolerance test. Pituitary magnetic resonance imaging (MRI) revealed microadenoma. Chest X-ray revealed cardiomegaly, and echocardiogram showed dilated left ventricular (LV) cavity and diffuse hypokinesis with extremely decreased ejection fraction (EF). He was diagnosed as having acromegaly with congestive heart failure from diastolic cardiomyopathy. After the successful transsphenoidal resection of the pituitary adenoma, the level of GH was normalized. However, the cardiac dysfunction did not show any improvement even after the administration of β-blockers, angiotensin-converting enzyme inhibitor (ACE-I), or diuretics. The patient was re-hospitalized, and he died of cardiac failure at the age of 25 years. Patients with acromegaly have been reported to have about 30% higher mortality rate, and cardiovascular disease accounts for 60% of the deaths. We report a case of a patient with juvenile acromegaly who was diagnosed with severe cardiac failure at the time of diagnosis and failed to recover cardiac function even after the successful resection of the pituitary adenoma. Immediate diagnosis and treatment are required for better control of

  16. Inverse Association of Plasma Chromium Levels with Newly Diagnosed Type 2 Diabetes: A Case-Control Study

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    Sijing Chen

    2017-03-01

    Full Text Available Chromium has long been known as an enhancer of insulin action. However, the role of chromium in the development of type 2 diabetes mellitus (T2DM in humans remains controversial. The current study aimed to examine the associations of plasma chromium levels with T2DM and pre-diabetes mellitus (pre-DM. We conducted a case-control study involving 1471 patients with newly diagnosed T2DM, 682 individuals with newly diagnosed pre-DM, and 2290 individuals with normal glucose tolerance in a Chinese population from 2009 to 2014. Plasma chromium was measured by inductively coupled plasma mass spectrometry. Plasma chromium levels were lower in the T2DM and pre-DM groups than in the control group (median: 3.68 μg/L, 3.61 μg/L, 3.97 μg/L, respectively, p < 0.001. After adjustment for potential confounding factors, the odds ratios (95% confidence interval for T2DM across increasing quartiles of plasma chromium levels were 1 (referent, 0.67 (0.55–0.83, 0.64 (0.51–0.79, and 0.58 (0.46–0.73, respectively (p for trend <0.001. The corresponding odds ratios (95% confidence interval for pre-DM were 1 (referent, 0.70 (0.54–0.91, 0.67 (0.52–0.88, and 0.58 (0.43–0.78, respectively (p for trend < 0.001. Our results indicated that plasma chromium concentrations were inversely associated with T2DM and pre-DM in Chinese adults.

  17. Inverse Association of Plasma Chromium Levels with Newly Diagnosed Type 2 Diabetes: A Case-Control Study

    Science.gov (United States)

    Chen, Sijing; Jin, Xiaoling; Shan, Zhilei; Li, Shuzhen; Yin, Jiawei; Sun, Taoping; Luo, Cheng; Yang, Wei; Yao, Ping; Yu, Kaifeng; Zhang, Yan; Cheng, Qian; Cheng, Jinquan; Bao, Wei; Liu, Liegang

    2017-01-01

    Chromium has long been known as an enhancer of insulin action. However, the role of chromium in the development of type 2 diabetes mellitus (T2DM) in humans remains controversial. The current study aimed to examine the associations of plasma chromium levels with T2DM and pre-diabetes mellitus (pre-DM). We conducted a case-control study involving 1471 patients with newly diagnosed T2DM, 682 individuals with newly diagnosed pre-DM, and 2290 individuals with normal glucose tolerance in a Chinese population from 2009 to 2014. Plasma chromium was measured by inductively coupled plasma mass spectrometry. Plasma chromium levels were lower in the T2DM and pre-DM groups than in the control group (median: 3.68 μg/L, 3.61 μg/L, 3.97 μg/L, respectively, p < 0.001). After adjustment for potential confounding factors, the odds ratios (95% confidence interval) for T2DM across increasing quartiles of plasma chromium levels were 1 (referent), 0.67 (0.55–0.83), 0.64 (0.51–0.79), and 0.58 (0.46–0.73), respectively (p for trend <0.001). The corresponding odds ratios (95% confidence interval) for pre-DM were 1 (referent), 0.70 (0.54–0.91), 0.67 (0.52–0.88), and 0.58 (0.43–0.78), respectively (p for trend < 0.001). Our results indicated that plasma chromium concentrations were inversely associated with T2DM and pre-DM in Chinese adults. PMID:28304331

  18. Impact of vitamin D deficiency on the clinical presentation and prognosis of patients with newly diagnosed multiple myeloma.

    Science.gov (United States)

    Ng, Alvin C; Kumar, Shaji K; Rajkumar, S Vincent; Drake, Matthew T

    2009-07-01

    Vitamin D is a fundamental mediator of skeletal metabolism. It also has important nonskeletal actions. We hypothesized that vitamin D deficiency may play an important role in skeletal morbidity and clinical outcomes in MM. We studied 148 newly diagnosed MM patients from January 1, 2004 through December 31, 2008 who had a serum 25-hydroxyvitamin D [25(OH)D] obtained within 14 days of diagnosis. Subjects with vitamin D deficiency [25(OH)D level less than 50 nmol/L (20 ng/mL)] had higher mean values of serum C-reactive protein (CRP) (2.40 mg/L vs. 0.84 mg/L, P = 0.02) and creatinine (1.75 mg/dL vs. 1.24 mg/dL, P = 0.03) and lower serum albumin values (3.12 g/dL vs. 3.39 g/dL, P = 0.003) compared to subjects without vitamin D deficiency. The prevalence of vitamin D deficiency increased in parallel with International Staging System (ISS): 16% of subjects in Stage I, 20% in Stage II, and 37% in Stage III (P = 0.03) were vitamin D deficient. No differences were detected between the two groups in terms of skeletal morbidity. Association of vitamin D deficiency with higher serum CRP, serum creatinine and ISS stage at time of diagnosis suggests that vitamin D deficiency may portend poorer outcomes in subjects with MM. Am. J. Hematol. 2009. (c) 2009 Wiley-Liss, Inc.

  19. A 5 year retrospective study of biopsied jaw lesions with the assessment of concordance between clinical and histopathological diagnoses

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    Elif Peker

    2016-01-01

    Full Text Available Introduction: The jaw can be affected by several lesions that manifest in the oral cavity, but little is known about their distribution patterns in various populations. Aims and Objectives: This study presents the frequency and distribution of biopsied jaw lesions recorded in Faculty of Dentistry and gathers the information including provisional and final diagnosis of the lesions. Material and Methods: Biopsy of 1938 lesions (2008-2013 was reviewed and 1473 lesions were included in this study. The provisional diagnosis and histopathological validations of lesions were compared. Data on the location of the lesion, as well as patient demographics, were also evaluated. The lesions were divided into three major groups as 1 - developmental/reactive and inflammatory lesions of the jaw, 2 - cystic lesion and 3 - tumor and tumor-like lesions. Statistical Analysis: The variables were recorded and analysed using descriptive statistics. Results and Observations: Three hundred and ninety-six lesions were in Group 1 and periapical granuloma was the most frequent diagnosis. Seven hundred and eighty-nine lesions were in Group 2 and the radicular cyst was the most frequent diagnosis. Two hundred and eighty-eight lesions were in Group 3 and the keratocystic odontogenic tumor was the most frequent. Two hundred and ninety-one biopsied lesions were in disagreement with respect to the diagnoses on clinical and histopathological examination. Conclusion: Consequently, a provisional diagnosis of some of the malignant lesions was reactive, inflammatory, cystic or benign lesions, therefore the importance of evaluation of the specimen is emphasized.

  20. Clinical and Electrophysiological Report of a Unilateral Retinitis Pigmentosa Case

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    Sedaghat MR

    2014-04-01

    Full Text Available Introduction: To describe clinical and electrophysiological features of a patient with unilateral Retinitis Pigmentosa (RP. Case: A 29-year-old female with a long history of progressive visual disturbance in the right eye has undergone multiple eye examinations during the past eight years. There was nothing noticeable in her past medical and ocular history. Comprehensive eye examinations were done in the first visit. All data was suggestive of right eye RP. Posterior segment fundal examination findings were: a pallor waxy disc, vessel attenuation, and extended pigmentary degeneration of the mid-peripheral retina. The left eye examination was normal. Comparing the automated 60 degree and 30 degree visual fields of both eyes obviously showed significant defects in the right eye visual field but normal in the left eye.  All of the probable infectious agents, which can cause similar ocular manifestations, were ruled out by serological tests. The standard photopic and scotopic electroretinographies were significantly reduced in amplitude in the right eye; however, they were normal in the left eye. Also, the standard Electro-Oculography (EOG results were the same as the Electro-Retinography (ERG ones in both eyes. Eye examinations were normal in other family members. Over an eight-year follow-up period, progressive deteriorating vision has gradually become more noticeable in the right eye. The left eye has been completely normal since.  This data was compatible with the Francois and Verriesr unilateral RP diagnostic criteria. Conclusion: Clinical signs and symptoms, a minimum of a five-year follow-up period, and confirmatory ERG and EOG are very helpful to diagnose andaffirm the case of unilateral RP.

  1. A case of familial Mediterranean fever who complained of periodic fever and abdominal pain diagnosed by MEFV gene analysis.

    Science.gov (United States)

    Ogita, Chie; Matsui, Kiyoshi; Kisida, Dai; Kakudou, Mariko; Yazaki, Masahide; Nakamura, Akinori; Azuma, Kouta; Tsuboi, Kazuyuki; Abe, Takeo; Yokoyama, Yuichi; Furukawa, Tetsuya; Maruoka, Momo; Tamura, Masao; Yoshikawa, Takahiro; Saito, Atsushi; Nishioka, Aki; Sekiguchi, Masahiro; Azuma, Naoto; Kitano, Masayasu; Tsunoda, Shinichiro; Hashimoto-Tamaoki, Tomoko; Sano, Hajime

    2016-01-01

      Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease caused by Mediterranean FeVergene (MEFV) mutations on Chromosome 16, and characterized by periodic fever of and serositis. FMF is the result of gain-of-function mutations in pyrin that lead to interleukin-1β activation. FMF can be classified as "typical" and "atypical" types based on clinical finding and genetic screening. Although MEFV genotyping has enabled FMF to be confirmed in some cases, the diagnosis remains predominantly clinical since genotyping has shown that the disease is characterized by variable manifestations in Japanese. In 1976, the first report performed on the case of Japanese FMF with periodic fever of and serositis. Since 2002, genetic analyses are performed on Japanese FMF patients by K. Shiozaki et al. and N. Tomiyama et al. In our case, she was a 25-year-old Japanese woman with at periodic fever and abdominal pain. MEFV gene analysis demonstrated a heterozygous mutation of variant M694I, leading to a diagnosis of FMF. After the increase dose (up to 3 mg/day) of colchicine, periodic fever and abdominal pain disappeared. It is the important candidate of FMF for differential diagnosis with unexplained periodic fever and serositis, such as our case.

  2. Thimerosal exposure and increased risk for diagnosed tic disorder in the United States: a case-control study

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    Geier David A.

    2015-06-01

    Full Text Available A hypothesis testing, case-control study evaluated automated medical records for exposure to organic-Hg from Thimerosal-containing hepatitis B vaccines (TM-HepB administered at specific intervals in the first six-months-of-life among cases diagnosed with a tic disorder (TD or cerebral degeneration (CD (an outcome not biologically plausibly linked to TM exposure in comparison to controls; both cases and controls were continuously enrolled from birth (born from 1991–2000 within the Vaccine Safety Datalink (VSD database. TD cases were significantly more likely than controls to have received increased organic-Hg from TM-HepB administered within the first month-of-life (odds ratio (OR=1.59, p<0.00001, first two-months-of-life (OR=1.59, p<0.00001, and first six-months-of-life (OR=2.97, p<0.00001. Male TD cases were significantly more likely than male controls to have received increased organic-Hg from TM-HepB administered within the first month-of-life (OR =1.65, p<0.0001, first two-months-of-life (OR=1.64, p<0.0001, and first six months-of-life (OR=2.47, p<0.05, where as female TD were significantly more likely than female controls to have received increased organic-Hg from TM-HepB administered within the first six-months-of-life (OR=4.97, p<0.05. By contrast, CD cases were no more likely than controls to have received increased organic-Hg exposure from TM-HepB administered at any period studied within the first six-months-of-life. Although routine childhood vaccination is considered an important public health tool to combat infectious diseases, the present study associates increasing organic-Hg exposure from TM-HepB and the subsequent risk of a TD diagnosis.

  3. Case of 7p22.1 Microduplication Detected by Whole Genome Microarray (REVEAL in Workup of Child Diagnosed with Autism

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    Veronica Goitia

    2015-01-01

    Full Text Available Introduction. More than 60 cases of 7p22 duplications and deletions have been reported with over 16 of them occurring without concomitant chromosomal abnormalities. Patient and Methods. We report a 29-month-old male diagnosed with autism. Whole genome chromosome SNP microarray (REVEAL demonstrated a 1.3 Mb interstitial duplication of 7p22.1 ->p22.1 arr 7p22.1 (5,436,367–6,762,394, the second smallest interstitial 7p duplication reported to date. This interval included 14 OMIM annotated genes (FBXL18, ACTB, FSCN1, RNF216, OCM, EIF2AK1, AIMP2, PMS2, CYTH3, RAC1, DAGLB, KDELR2, GRID2IP, and ZNF12. Results. Our patient presented features similar to previously reported cases with 7p22 duplication, including brachycephaly, prominent ears, cryptorchidism, speech delay, poor eye contact, and outburst of aggressive behavior with autism-like features. Among the genes located in the duplicated segment, ACTB gene has been proposed as a candidate gene for the alteration of craniofacial development. Overexpression of RNF216L has been linked to autism. FSCN1 may play a role in neurodevelopmental disease. Conclusion. Characterization of a possible 7p22.1 Duplication Syndrome has yet to be made. Recognition of the clinical spectrum in patients with a smaller duplication of 7p should prove valuable for determining the minimal critical region, helping delineate a better prediction of outcome and genetic counseling

  4. Ameloblastoma: Our clinical experience with 68 cases

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    Benjamin Fomete

    2014-01-01

    Full Text Available Introduction: In this environment, previous workers have reported on the challenges of managing large sized ameloblastoma of the jaws with less than adequate facilities. The aim of this review is to present the management of 68 cases of ameloblastoma with emphasis on surgical care. Materials and Methods: Retrospective survey of case notes of patients with histopathologic diagnosis of ameloblastoma (using the criteria of Barnes et al., 2005 seen between January 2006 and August 2010 at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Nigeria was undertaken. Data collected includes histopathological diagnosis, age, gender, clinical information on site of lesion, form of intubation and surgical procedure performed. Results: Out of 94 patients, 68 with histological diagnosis of ameloblastoma (59 mandibular and 9 maxillary were operated within the study period. The remainder (26 was not treated in hospital. Among 68 patients treated, more were males (38 than females (30, giving a male to female ratio of 1.3:1. The age range was between 14 and 74 years (mean-standard deviation. The duration of the symptoms ranged from 7 months to 24 years, most were follicular ameloblastoma (n = 13 followed by acanthomatous type (n = 7. Endotracheal intubation was the most common (n = 55 followed by fiber optic laryngoscopy (n = 8. The surgical approach most used was extended Risdon with intraoral (n = 24 followed by extended Risdon with lip split and intraoral (n = 17. Segmental resection (en block formed the bulk of our procedures (n = 22 followed by subtotal mandibulectomy (n = 16. Conclusion: The treatment of ameloblastoma remains controversial. Its destructive nature has left patients with wide defects difficult to reconstruct.

  5. Concepts of Causality in Psychopathology: Applications in Clinical Assessment, Clinical Case Formulation and Functional Analysis

    NARCIS (Netherlands)

    Haynes, S.H.; O'Brien, W.H.; Kaholokula, J.K.; Witteman, C.L.M.

    2012-01-01

    This paper discusses and integrates concepts of causality in psychopathology, clinical assessment, clinical case formulation and the functional analysis. We propose that identifying causal variables, relations and mechanisms in psychopathology and clinical assessment can lead to more powerful and e

  6. Analysis on clinical characteristics of intracranial Arachnoid Cysts in 488 pediatric cases.

    Science.gov (United States)

    Huang, Jian-Huang; Mei, Wen-Zhong; Chen, Yao; Chen, Jian-Wu; Lin, Zhi-Xiong

    2015-01-01

    To summarize the clinical characteristics of intracranial arachnoid cysts (IACs) in pediatric cases. A retrospective analysis was carried out on clinical characteristics of IACs in 488 pediatric cases who were treated at our hospital from January 2003 to September 2013. There were 342 males and 146 females (male-to-female ratio, 2.34:1), aged 5.61±3.25 years on average. 221 cases (45.29%) were diagnosed accidentally, 267 cases had clinical complaints (54.71%), among which relationships between clinical complaints and IACs were identified in 123 (46.07%). Simple IACs occurred in 364 cases (4.59%), and concurrent congenital abnormalities occurred in 124 cases (4.59%). In terms of location, 355 had IACs in middle cranial fossa (72.75%), 82 cases in posterior cranial fossa (16.80%), 20 cases in anterior cranial fossa (4.10%), 12 cases in dorsolateral surface (2.46%), 7 cases in suprasellar cistern (1.43%), 5 cases in cerebral ventricle (1.02%), 5 cases in quadrigeminal cistern (1.02%), and 2 cases in interhemispheric region (0.41%). There were 449 cases with single IAC (92.01%) and 39 cases with multiple IACs (7.99%). On MRI, the cysts produced tension in 127 cases (26.02%), but not in the remaining 361 cases (73.98%). Surgery was performed on 76 of 488 cases (15.57%), while conservative observation was accepted in 412 cases (84.43%). For the former, the symptoms and the cyst volume were improved to varying extent; for the latter, the follow-up lasting for 3-72 months (average 32.43±8.92 months) showed that the cyst volume remained stable in 407 cases (98.78%), enlarged with aggravated symptoms in 3 cases (0.73%), and shrank in 2 cases (0.49%). Clinical complaints of IACs varied in pediatric cases, and the relationships between clinical complaints and IACs were established only partially. Some pediatric cases were combined with other congenital abnormalities. The cyst volume largely remained stable during the disease course, and surgery was required for only a few

  7. Has universal screening with Xpert® MTB/RIF increased the proportion of multidrug-resistant tuberculosis cases diagnosed in a routine operational setting?

    Science.gov (United States)

    Dunbar, Rory; Caldwell, Judy; Lombard, Carl; Beyers, Nulda

    2017-01-01

    Setting Primary health services in Cape Town, South Africa where the introduction of Xpert® MTB/RIF (Xpert) enabled simultaneous screening for tuberculosis (TB) and drug susceptibility in all presumptive cases. Study aim To compare the proportion of TB cases with drug susceptibility tests undertaken and multidrug-resistant tuberculosis (MDR-TB) diagnosed pre-treatment and during the course of 1st line treatment in the previous smear/culture and the newly introduced Xpert-based algorithms. Methods TB cases identified in a previous stepped-wedge study of TB yield in five sub-districts over seven one-month time-points prior to, during and after the introduction of the Xpert-based algorithm were analysed. We used a combination of patient identifiers to identify all drug susceptibility tests undertaken from electronic laboratory records. Differences in the proportions of DST undertaken and MDR-TB cases diagnosed between algorithms were estimated using a binomial regression model. Results Pre-treatment, the probability of having a DST undertaken (RR = 1.82)(p<0.001) and being diagnosed with MDR-TB (RR = 1.42)(p<0.001) was higher in the Xpert-based algorithm than in the smear/culture-based algorithm. For cases evaluated during the course of 1st-line TB treatment, there was no significant difference in the proportion with DST undertaken (RR = 1.02)(p = 0.848) or MDR-TB diagnosed (RR = 1.12)(p = 0.678) between algorithms. Conclusion Universal screening for drug susceptibility in all presumptive TB cases in the Xpert-based algorithm resulted in a higher overall proportion of MDR-TB cases being diagnosed and is an important strategy in reducing transmission. The previous strategy of only screening new TB cases when 1st line treatment failed did not compensate for cases missed pre-treatment. PMID:28199375

  8. Using Clinical Gait Case Studies to Enhance Learning in Biomechanics

    Science.gov (United States)

    Chester, Victoria

    2011-01-01

    Clinical case studies facilitate the development of clinical reasoning strategies through knowledge and integration of the basic sciences. Case studies have been shown to be more effective in developing problem-solving abilities than the traditional lecture format. To enhance the learning experiences of students in biomechanics, clinical case…

  9. 医学生辅助诊断能力的培养%Medical ethics education in clinic practice: Training medicos to envisage the effects of high- tech instruments in diagnoses of diseases

    Institute of Scientific and Technical Information of China (English)

    韦怀新; 蔡绍曦

    2005-01-01

    It belongs to the ethics that depending to much on high - tech instruments in diagnoses of diseases and overlooking medical examination and clinical history. In clinic educations, we should train medicos to envisage the effects of high - tech instruments in diagnoses of diseases, and strengthen their feeling of responsibihty and training of clinic basic shills.

  10. A case of a superficial spreading melanoma in situ diagnosed via digital dermoscopic monitoring with high dynamic range conversion

    Science.gov (United States)

    Sato, Toshitsugu; Tanaka, Masaru

    2014-01-01

    A 48-year-old woman presented with a 3 mm, pigmented macule at her first visit to our clinic. The macule, which showed complete symmetry and a typical network, was tentatively diagnosed as a Clark nevus; a 6-month follow-up was recommended, and the patient returned 7 months later. At the second visit, the lesion had enlarged to a diameter of 5 mm, and dermoscopy revealed that it had maintained its typical pigment network. At this point, evidence-based monitoring would have led to excision but the decision was made to continue monitoring. Owing to poor compliance, the patient went another 2 years without follow-up. When we assess small lesions, such as this, the usefulness of dermoscopy is apparent. Additionally, we examined the benefits and drawbacks of high dynamic range (HDR) conversion of the dermoscopy images and their helpfulness for inspecting small lesions. Although the delicate structures present in the lesion can be recognized by a dermoscopy expert and HDR image conversion has a capacity to highlight important structures, there is also a risk that HDR image conversion may mask some of the structural changes. However, a comparison of the original dermoscopy images with the HDR-converted images provides newly trained dermoscopists the opportunity to recognize new findings and to distinguish the differences in the findings between both the types of images. Therefore, such comparisons might be useful for obtaining an accurate diagnosis by using dermoscopy and HDR image conversion. PMID:25396087

  11. [Neonatal Dengue. Presentation of clinical cases].

    Science.gov (United States)

    Romero-Santacruz, Edith; Lira-Canul, Janeth Jaqueline; Pacheco-Tugores, Fredy; Palma-Chan, Adolfo Gonzalo

    2015-05-01

    Dengue is an infectious disease caused by a flavivirus, with four serotypes, transmitted by the mosquito Aedes aegypti. In Mexico it is a public health problem, especially in the region of central and southeast of the country. The disease can be asymptomatic or present serious forms and even death. It is confirmed by detection of the NS1 Antigen; IgM antibodies, polymerase chain reaction and virus isolation. The vertical transmission to de newborn has been little studied. 7 cases in neonates from November to December 2011 are reported. All patients were male, obtained by caesarean section between 34 and 40 weeks of gestation, whose mothers were enrolled with fever and symptoms associated with dengue disease and serology positive for dengue. Six with positive AgNS1 and one positive IgM; one mother died. All the newborns had positive serology for dengue, 4 with positive AgNS1 and 3 positive IgM. The clinical features of the newborn ranged from asymptomatic to one serious dengue fever, shock and hemorrhage. The symptomatic 6 attended with thrombocytopenia, changes in temperature and unspecific disturbance. The severity of mothers conditioned disrepair product at birth, but not with subsequent gravity of the new born. Vertical trasmission of dengue should be suspected in risk areas, to maintain vigilance and to give early treatment. Also is neccesary promote the realization of specific diagnostic and therapeutic guidelines to the neonatal period.

  12. Clinical and pathological study on 10 cases of cerebral lobe hemorrhage related with cerebral amyloid angiopathy

    Directory of Open Access Journals (Sweden)

    Xiao-qi LI

    2015-07-01

    Full Text Available Objective To summarize the clinical data and pathological features of 10 cases of cerebral lobar hemorrhage related with cerebral amyloid angiopathy (CAA diagnosed pathologically, thereby to improve the knowledge and diagnosis of the disease. Methods The clinical data of 10 cases of cerebral lobar hemorrhage related with CAA, collected in the General Hospital of Shenyang Command from 1983 up to now, were retrospectively analyzed, and the clinical and neuropathological features of these cases were summarized. Results Of the 10 patients, 2 suffered from single lobar hemorrhage and 8 multiple lobar hemorrhage, all of them were confirmed pathologically to have ruptured into the subarachnoid space. Pathological examination revealed microaneurysm in 2 cases, "double barrel" change in 4 cases, multiple arteriolar clusters in 5 cases, obliterative onion-liked intima change in 4 cases, and fibrinoid necrosis of vessel wall in 7 cases. In addition, neurofibrillary tangles were found in 8 cases, and senile plaque was observed in 5 cases. Conclusions Cerebral lobar hemorrhage related with CAA is mainly located in the parietal, temporal and occipital lobes, readily breaking into the subarachnoid space, and it is often multiple and recurrent. The CAA associated microvasculopathy was found frequently in the autopsy sample of CAA related cerebral lobar hemorrhage, and it may contribute to the pathogenesis of cerebral hemorrhage. DOI: 10.11855/j.issn.0577-7402.2015.07.04

  13. In newly diagnosed breast cancer, screening MRI of the contralateral breast detects mammographically occult cancer, even in elderly women: the mayo clinic in Florida experience.

    Science.gov (United States)

    Bernard, Johnny Ray; Vallow, Laura A; DePeri, Elizabeth R; McNeil, Rebecca B; Feigel, Deborah G; Amar, Surabhi; Buskirk, Steven J; Perez, Edith A

    2010-01-01

    The role of magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer is somewhat controversial. The purpose of this study was to evaluate the prevalence of synchronous, occult contralateral breast cancer detected by MRI but not by mammography or clinical breast examination in women with newly diagnosed breast cancer, including those aged 70 years or older at our institution. MRI results for women with newly diagnosed breast cancer who underwent bilateral breast MRI after negative mammography and clinical examination between February 2003 and November 2007 at Mayo Clinic in Florida were reviewed. The prevalence of pathologically confirmed contralateral carcinoma diagnosed solely by MRI was determined and analyzed in the context of age, family history, menopausal status, breast density, and primary-tumor characteristics. Logistic regression was used to explore the association between contralateral carcinoma and potential patient risk factors. A total of 425 women were evaluated, of whom 129 (30%) were aged 70 years or older. A contralateral biopsy was recommended and performed solely on the basis of MRI in 72 of the 425 women (17%). Sixteen of these 72 women (22%) had pathologically confirmed carcinoma, including seven in the older subgroup. The prevalence of clinically and mammographically occult contralateral carcinoma detected by MRI was 3.8% (16/425) overall and 5.4% (7/129) in the group of older women. When potential risk factors for contralateral breast cancer were evaluated, postmenopausal status was the only significant predictor of contralateral cancer detected by MRI (p = 0.016). We concluded that contralateral breast screening with MRI should be considered in postmenopausal women with newly diagnosed breast cancer, even those aged 70 years or older at diagnosis.

  14. Sheehan syndrome: clinical and laboratory evaluation of 20 cases.

    Science.gov (United States)

    Ozkan, Yusuf; Colak, Ramis

    2005-06-01

    Sheehan syndrome (SS) or post-partum pituitary necrosis is a pituitary insufficiency secondary to excessive post-partum blood losses. SS is a very significant cause of maternal morbidity and mortality in developing countries although it is a rarity in developed countries in which obstetrical care has been improved. In this study, we reviewed 20 cases retrospectively who were diagnosed as SS in our clinic. The patients aged 40 to 65 years with a mean age of 51.12 +/- 9.44 years (mean +/- SD). Time to make a definitive diagnosis of the disease ranged between 5 and 25 years with a mean of 16.35 +/- 4.74 years. Three of our patient (15%) had a previous diagnosis of SS. Three patients (15%) were referred to emergency service for hypoglycemia, three patients (15%) for hypothyroidism and one patient (5%) for hyponatremia. Dynamic examination of the pituitary revealed GH, Prolactin, FSH, TSH and ACTH insufficiency in all of the patients. One of our patients had a sufficient LH response to LHRH challenge. All of the patients were imaged with pituitary MRI. Eleven patients had empty sella and 9 patients had partial empty sella. SS is still a common problem in our country, especially in rural areas. Considering the duration of disease, important delays occur in diagnosis and treatment of the disease.

  15. How Is Pelvic Pain Diagnosed?

    Science.gov (United States)

    ... Information Clinical Trials Resources and Publications How is pelvic pain diagnosed? Skip sharing on social media links Share ... needed to help diagnose the cause of the pelvic pain. These tests or procedures may include 1 , 2 : ...

  16. How Is Lactose Intolerance Diagnosed?

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    ... Information Clinical Trials Resources and Publications How is lactose intolerance diagnosed? Skip sharing on social media links ... people think that they or their children are lactose intolerant without being tested or diagnosed. 1 As ...

  17. A 5-year-old girl with a congenital ganglioneuroma diagnosed by fine needle aspiration biopsy: a case report

    Directory of Open Access Journals (Sweden)

    Ponce-Camacho Marco

    2008-01-01

    Full Text Available Abstract Introduction Ganglioneuroma is a rare, benign, neuroblastic tumor arising mainly from the central or peripheral autonomic nervous system, especially the sympathetic system. The most affected anatomical sites are the posterior mediastinum, retroperitoneum, adrenal gland and head and neck soft tissue. In the current literature, reports of ganglioneuroma diagnosed by fine-needle aspiration and its cytological appearance are scarce. Case Presentation A 5-year-old girl presented with a mass in the cervical region since birth. Laboratory routine tests were within normal limits, ultrasonography demonstrated a solid and well-circumscribed lesion in the soft tissues of the cervical region. Fine needle aspiration biopsy was carried out, and the obtained smears showed a mixture of mature ganglion cells and groups of spindle cells suggestive of schwann cell origin. A diagnosis of ganglioneuroma was suggested. Core biopsy and surgical resection confirmed this diagnosis. Conclusion Congenital ganglioneuroma of the cervical region is an uncommon soft tissue benign neoplasm of neuroblastic origin, and it should be considered in the differential diagnosis of head and neck pediatric soft tissue tumors. Fine needle aspiration biopsy technique is a reliable method that can be used with confidence when dealing with pediatric soft tissue tumors.

  18. Breast Cancer with Cartilaginous and/or Osseous Metaplasia Diagnosed by Lymph Nodal Metastasis:A Case Report

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    Nakahara,Saki

    2009-12-01

    Full Text Available Breast cancer with cartilaginous and/or osseous metaplasia is a type of metaplastic carcinomas and is a rare disease. We report the case of a 49 year-old female who underwent right mastectomy for a large breast tumor. Histological examinations revealed a mixed tumor with both stromal and epithelial elements;the stroma showed poor differentiated spindle-shape and multiform cells with a massive osseous matrix, and atypical epithelial cells, which mainly existed on the surface of the cysts, showed nucleic atypia. The tumor was diagnosed as a malignant phyllodes tumor with osteosarcomatous differentiation;it was not identified as a metaplastic carcinoma because of the lack of proof of a cancerous component. Two years after a mastectomy, swelling of the axillary lymph nodes was found and a biopsy was performed. Histological findings for the lymph node indicated a metastasis of the invasive ductal carcinoma. The primary tumor was re-examined and was considered to be the origin of the lymph nodal metastasis. Lymph nodal metastasis of cancer proved that the primary tumor had cancerous potential, and the pathological diagnosis was altered to a breast cancer with cartilaginous and/or osseous metaplasia.

  19. Quantitative appraisal of ventricular cerebrospinal fluid biomarkers in neuropathologically diagnosed Parkinson's disease cases lacking Alzheimer's disease pathology.

    Science.gov (United States)

    Maarouf, Chera L; Beach, Thomas G; Adler, Charles H; Malek-Ahmadi, Michael; Kokjohn, Tyler A; Dugger, Brittany N; Walker, Douglas G; Shill, Holly A; Jacobson, Sandra A; Sabbagh, Marwan N; Roher, Alex E

    2013-01-01

    Identifying biomarkers that distinguish Parkinson's disease (PD) from normal control (NC) individuals has the potential to increase diagnostic sensitivity for the detection of early-stage PD. A previous proteomic study identified potential biomarkers in postmortem ventricular cerebrospinal fluid (V-CSF) from neuropathologically diagnosed PD subjects lacking Alzheimer's disease (AD) neuropathology. In the present study, we assessed these biomarkers as well as p-tau(181), Aβ42, and S100B by ELISA in PD (n = 43) and NC (n = 49) cases. The p-tau(181)/Aβ42 ratio and ApoA-1 showed statistically significant differences between groups. Multiple regression analysis demonstrated that p-tau(181)/Aβ42 had a significant odds ratio: OR = 1.42 (95% confidence interval [CI], 1.12-1.84), P = 0.006. Among the molecules investigated, intriguing correlations were observed that require further investigation. Our results suggest coexistent AD CSF biomarkers within the PD group notwithstanding that it was selected to minimize AD neuropathological lesions.

  20. Etiology of newly-diagnosed cases of chronic liver disease in Southern Italy: results of a prospective multicentric study

    Directory of Open Access Journals (Sweden)

    Antonio Ascione