Chorioretinal Lesions Presumed Secondary to Zika Virus Infection in an Immunocompromised Adult.

Science.gov (United States)

Henry, Christopher R; Al-Attar, Luma; Cruz-Chacón, Alexis M; Davis, Janet L

2017-04-01

Zika virus has spread rapidly throughout the Americas since 2015. The public health implications of Zika virus infection lend special importance to identifying the virus in unsuspected hosts. To describe relevant imaging studies and clinical features of chorioretinal lesions that are presumably associated with Zika virus and that share analogous features with chorioretinal lesions reported in cases of Dengue fever and West Nile virus. This is a case report from an academic referral center in Miami, Florida, of a woman in her 60s from Guaynabo, Puerto Rico, who presented with reduced visual acuity and bilateral diffuse, subretinal, confluent, placoid, and multifocal chorioretinal lesions. The patient was observed over a 5-month period. Visual acuity, clinical course, and multimodal imaging study results. Fluorescein angiography revealed early hypofluorescence and late staining of the chorioretinal lesions. Optical coherence tomography demonstrated outer retinal disruption in the placoid macular lesions. Zika RNA was detected in a plasma sample by real-time reverse transcription polymerase chain reaction testing and was suspected to be the cause of chorioretinal lesions after other viral and infectious causes were ruled out. Three weeks after the onset of symptoms, the patient's visual acuity had improved to 20/60 OD and 20/25 OS, with intraocular pressures of 18 mm Hg OD and 19 mm Hg OS. In 6 weeks, the chorioretinal lesions had healed and visual acuity had improved to 20/25 OD and 20/20 OS. Follow-up optical coherence tomography demonstrated interval recovery of the outer retina and photoreceptors. Acute-onset, self-resolving, placoid, or multifocal nonnecrotizing chorioretinal lesions may be a feature of active Zika virus chorioretinitis, as reported in other Flavivirus infections in adults. Similar findings in potentially exposed adults suggest that clinicians should consider IgM antibody or polymerase chain reaction testing for Zika virus as well as diagnostic

Light distribution in diffractive multifocal optics and its optimization.

Science.gov (United States)

Portney, Valdemar

2011-11-01

To expand a geometrical model of diffraction efficiency and its interpretation to the multifocal optic and to introduce formulas for analysis of far and near light distribution and their application to multifocal intraocular lenses (IOLs) and to diffraction efficiency optimization. Medical device consulting firm, Newport Coast, California, USA. Experimental study. Application of a geometrical model to the kinoform (single focus diffractive optical element) was expanded to a multifocal optic to produce analytical definitions of light split between far and near images and light loss to other diffraction orders. The geometrical model gave a simple interpretation of light split in a diffractive multifocal IOL. An analytical definition of light split between far, near, and light loss was introduced as curve fitting formulas. Several examples of application to common multifocal diffractive IOLs were developed; for example, to light-split change with wavelength. The analytical definition of diffraction efficiency may assist in optimization of multifocal diffractive optics that minimize light loss. Formulas for analysis of light split between different foci of multifocal diffractive IOLs are useful in interpreting diffraction efficiency dependence on physical characteristics, such as blaze heights of the diffractive grooves and wavelength of light, as well as for optimizing multifocal diffractive optics. Disclosure is found in the footnotes. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Pneumonia eosinofílica aguda com evolução para síndroma de dificuldade respiratória aguda: caso clínico

OpenAIRE

J.P.F. Baptista; P.C. Casanova; J.P.A. Sousa; P.J. Martins; A. Simões; V. Fernandes; J. Souto; J.J. Costa; A. Rebelo; L. Carvalho; J. Pimentel

2004-01-01

RESUMO: Os autores apresentam um caso de pneumonia eosinofílica aguda (PEA) associada a síndroma de dificuldade respiratória aguda grave num adolescente previamente saudável, medicado com nitrofurantoína. A PEA deve ser incluída no diagnóstico diferencial da pneumonia adquirida na comunidade, bem como na lista das patologias causadoras de síndroma de dificuldade respiratória aguda, e o seu diagnóstico deve ser sugerido pela presença de alveolite eosinofílica no líquido de lavagem broncoalveol...

Drug-induced progressive multifocal leukoencephalopathy

DEFF Research Database (Denmark)

Vermeer, N S; Straus, S M J M; Mantel-Teeuwisse, A K

2015-01-01

Progressive multifocal leukoencephalopathy (PML) has been identified as a serious adverse drug reaction (ADR) of several immunomodulatory biologicals. In this study, we contrasted the reporting patterns of PML for two biologicals for which the risk was identified at different points in their life......Progressive multifocal leukoencephalopathy (PML) has been identified as a serious adverse drug reaction (ADR) of several immunomodulatory biologicals. In this study, we contrasted the reporting patterns of PML for two biologicals for which the risk was identified at different points...

Comparison of the visual and intraocular optical performance of a refractive multifocal IOL with rotational asymmetry and an apodized diffractive multifocal IOL.

Science.gov (United States)

Alió, Jorge L; Plaza-Puche, Ana B; Javaloy, Jaime; Ayala, María José

2012-02-01

To compare the visual outcomes and intraocular optical quality observed postoperatively in patients implanted with a rotationally asymmetric multifocal intraocular lens (IOL) and an apodized diffractive multifocal IOL. Seventy-four consecutive eyes of 40 cataract patients (age range: 36 to 79 years) were divided into two groups: zonal refractive group, 39 eyes implanted with a rotationally asymmetric multifocal IOL (Lentis Mplus LS-312 IOL, Oculentis GmbH); and diffractive group, 35 eyes implanted with an apodized diffractive multifocal IOL (ReSTOR SN6AD3, Alcon Laboratories Inc). Distance and near visual acuity outcomes, contrast sensitivity, intraocular optical quality, and defocus curves were evaluated during 3-month follow-up. Calculation of the intraocular aberrations was performed by subtracting corneal aberrations from total ocular aberrations. Uncorrected near visual acuity and distance-corrected near visual acuity were better in the diffractive group than in the zonal refractive group (P=.01), whereas intermediate visual acuity (defocus +1.00 and +1.50 diopters) was better in the zonal refractive group. Photopic contrast sensitivity was significantly better in the zonal refractive group (P=.04). Wavefront aberrations (total, higher order, tilt, primary coma) were significantly higher in the zonal refractive group than in the diffractive group (P=.02). Both multifocal IOLs are able to successfully restore visual function after cataract surgery. The zonal refractive multifocal IOL provides better results in contrast sensitivity and intermediate vision, whereas the diffractive multifocal IOL provides better near vision at a closer distance. Copyright 2012, SLACK Incorporated.

Pancreatitis aguda grave asociada a gangrena vesicular

OpenAIRE

Arroyo-Sánchez, Abel S; Aguirre-Mejía, Rosa Y; Echenique-Martínez, Sergio E

2014-01-01

Se presenta el caso un paciente diabético que desarrolló un cuadro de pancreatitis aguda grave asociada a gangrena vesicular, en el que se evaluó la aplicabilidad de los criterios de clasificación y manejo de la hoja de ruta para pancreatitis aguda, así mismo se proponen algunos tópicos que pudieran ser investigados a futuro We present a diabetic patient who developed severe acute pancreatitis associated to gallbladder gangrene, in this case we assessed the applicability of classification ...

VIH: Infeccion aguda, pesquisa y manejo

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Cortés S. Esteban, Dr.

2014-05-01

Si bien existe una relativa facilidad para realizar el diagnóstico de un paciente con la infección crónica por VIH, existe por otro lado una relativa dificultad para realizar el diagnóstico de la infección aguda en etapas tempranas de la infección. Esta situación es de importancia desde el punto de vista de la Salud Pública por cuanto en la infección aguda es cuando se producen las viremias más elevadas y por tanto la mayor facilidad para que el sujeto sea infectante y disemine la infección viral.

Multi-focal Vision and Gaze Control Improve Navigation Performance

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Kolja Kuehnlenz

2008-11-01

Full Text Available Multi-focal vision systems comprise cameras with various fields of view and measurement accuracies. This article presents a multi-focal approach to localization and mapping of mobile robots with active vision. An implementation of the novel concept is done considering a humanoid robot navigation scenario where the robot is visually guided through a structured environment with several landmarks. Various embodiments of multi-focal vision systems are investigated and the impact on navigation performance is evaluated in comparison to a conventional mono-focal stereo set-up. The comparative studies clearly show the benefits of multi-focal vision for mobile robot navigation: flexibility to assign the different available sensors optimally in each situation, enhancement of the visible field, higher localization accuracy, and, thus, better task performance, i.e. path following behavior of the mobile robot. It is shown that multi-focal vision may strongly improve navigation performance.

Bilateral implantation of +2.5 D multifocal intraocular lens and contralateral implantation of +2.5 D and +3.0 D multifocal intraocular lenses: Clinical outcomes

NARCIS (Netherlands)

Nuijts, Rudy M. M. A.; Jonker, Soraya M. R.; Kaufer, Robert A.; Lapid-Gortzak, Ruth; Mendicute, Javier; Martinez, Cristina Peris; Schmickler, Stefanie; Kohnen, Thomas

2016-01-01

To assess the clinical visual outcomes of bilateral implantation of Restor +2.5 diopter (D) multifocal intraocular lenses (IOLs) and contralateral implantation of a Restor +2.5 D multifocal IOL in the dominant eye and Restor +3.0 D multifocal IOL in the fellow eye. Multicenter study at 8

Resultados do tratamento da pancreatite aguda grave

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Franz Robert Apodaca-Torrez

Full Text Available OBJETIVO: Avaliar os resultados do Protocolo de Atendimento de pacientes com diagnóstico de pancreatite aguda grave. MÉTODOS: Foram analisados, consecutivamente, a partir de janeiro de 2002, idade, sexo, etiologia, tempo de internação, tipo de tratamento e mortalidade de 37 pacientes portadores de pancreatite aguda grave. RESULTADOS: A idade dos pacientes variou de 20 a 88 anos (média de 50 anos; 27% foram do sexo feminino e 73% do masculino. O tempo médio global de internação foi 47 dias. Treze pacientes foram tratados cirurgicamente; a média de operações realizadas foi duas por paciente. Ocorreram seis óbitos dentre os pacientes submetidos ao tratamento cirúrgico (46% e dois óbitos no grupo submetido somente ao tratamento clínico (8,3%. A mortalidade global foi 21% CONCLUSÃO: Após a modificação na forma de abordagem dos pacientes com pancreatite aguda grave, houve diminuição da mortalidade e uma tendência para a conduta expectante.

Three-dimensional vectorial multifocal arrays created by pseudo-period encoding

Science.gov (United States)

Zeng, Tingting; Chang, Chenliang; Chen, Zhaozhong; Wang, Hui-Tian; Ding, Jianping

2018-06-01

Multifocal arrays have been attracting considerable attention recently owing to their potential applications in parallel optical tweezers, parallel single-molecule orientation determination, parallel recording and multifocal multiphoton microscopy. However, the generation of vectorial multifocal arrays with a tailorable structure and polarization state remains a great challenge, and reports on multifocal arrays have hitherto been restricted either to scalar focal spots without polarization versatility or to regular arrays with fixed spacing. In this work, we propose a specific pseudo-period encoding technique to create three-dimensional (3D) vectorial multifocal arrays with the ability to manipulate the position, polarization state and intensity of each focal spot. We experimentally validated the flexibility of our approach in the generation of 3D vectorial multiple spots with polarization multiplicity and position tunability.

Comparison of outcomes with multifocal intraocular lenses: a meta-analysis

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Béatrice Cochener

2011-01-01

Full Text Available Béatrice Cochener1, Antoine Lafuma2, Babak Khoshnood2, Laurène Courouve2, Gilles Berdeaux3,41Centre Hospitalier Universitaire Brest, Brest, France; 2Cemka Eval, Bourg la Reine, France; 3Alcon France, Rueil-Malmaison, France; 4Conservatoire National des Arts et Métiers, Paris, FrancePurpose: To compare the clinical outcome of different multifocal intraocular lenses (IOLs based on information reported in the international literature.Methods: All comparative clinical trials that involved implanting at least one multifocal IOL in patients with cataract or presbyopia were extracted from the literature. Clinical outcomes included uncorrected near visual acuity, uncorrected distance visual acuity, visual acuity, spectacle independence, and halos. Random effects meta-analyses were conducted to compare outcomes for the different IOL types.Results: Twenty papers were identified describing 11 monofocal IOLs and 35 multifocal IOLs (19 diffractive, including 12 ReSTOR®, 14 refractive, and two accommodative patient cohorts. Multifocal and monofocal uncorrected distance visual acuity was 0.165 (0.090–0.240 and 0.093 (0.088–0.098, respectively. Compared with monofocal IOLs, multifocal IOLs produced better uncorrected near visual acuity (0.470 [0.322–0.618] versus 0.141 [0.131–0.152]; P < 0.0001, resulting in higher spectacle independence (incidence rate ratio [IRR] 3.62 [2.90–4.52]; P < 0.0001. Compared with refractive multifocal IOLs, diffractive multifocal IOLs produced a similar uncorrected distance visual acuity (0.105 [0.098–0.111] versus 0.085 [0.029–0.140]; P ≤ 0.78, not significant and better uncorrected near visual acuity (0.217 [0.118–0.317] versus 0.082 [0.067–0.098]; P < 0.0001 resulting in higher spectacle independence (IRR 1.75 [1.24–2.48]; P < 0.001. Compared with other multifocal IOLs, ReSTOR produced a better uncorrected distance visual acuity (0.067 [0.059–0.076] versus 0.093 [0.088–0.098]; P < 0.0001 and better

Multifocal versus monofocal intraocular lenses after cataract extraction

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Daniel Calladine

Full Text Available BACKGROUND: Good unaided distance visual acuity is now a realistic expectation following cataract surgery and intraocular lens (IOL implantation. Near vision, however, still requires additional refractive power, usually in the form of reading glasses. Multiple optic (multifocal IOLs are available which claim to allow good vision at a range of distances. It is unclear whether this benefit outweighs the optical compromises inherent in multifocal IOLs. OBJECTIVES: The objective of this review was to assess the effects of multifocal IOLs, including effects on visual acuity, subjective visual satisfaction, spectacle dependence, glare and contrast sensitivity, compared to standard monofocal lenses in people undergoing cataract surgery. METHODS: Search methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register, The Cochrane Library 2012, Issue 2, MEDLINE (January 1946 to March 2012, EMBASE (January 1980 to March 2012, the metaRegister of Controlled Trials (mRCT (www.controlled-trials.com, ClinicalTrials.gov (www.clinicaltrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP (www.who.int/ictrp/search/en. We did not use any date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 6 March 2012. We searched the reference lists of relevant articles and contacted investigators of included studies and manufacturers of multifocal IOLs for information about additional published and unpublished studies. Selection criteria: All randomised controlled trials comparing a multifocal IOL of any type with a monofocal IOL as control were included. Both unilateral and bilateral implantation trials were included. Data collection and analysis: Two authors collected data and assessed trial quality. Where possible, we pooled data from the individual studies using a random-effects model, otherwise we tabulated data. MAIN RESULTS: Sixteen completed trials

Nefrite Intersticial Aguda Após Exposição a Losartan

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Letícia Schwerz Weinert

2007-07-01

Full Text Available Nefrite intersticial aguda é uma causa comum de perda aguda de função renal. Exposição a drogas é o fator desencadeante mais freqüentemente relatado, porém auto-imunidade e infecções também estão associadas. Os inibidores da enzima de conversão da angiotensina têm sido relatados como possíveis agentes, porém não há relato na literatura de nefrite intersticial com uso de losartan. Descrevemos então, o caso de perda aguda de função renal após exposição a losartan, em paciente com dano renal prévio por nefropatia diabética, cuja biópsia renal diagnosticou nefrite intersticial aguda.

[Incremental cost effectiveness of multifocal cataract surgery].

Science.gov (United States)

Pagel, N; Dick, H B; Krummenauer, F

2007-02-01

Supplementation of cataract patients with multifocal intraocular lenses involves an additional financial investment when compared to the corresponding monofocal supplementation, which usually is not funded by German health care insurers. In the context of recent resource allocation discussions, however, the cost effectiveness of multifocal cataract surgery could become an important rationale. Therefore an evidence-based estimation of its cost effectiveness was carried out. Three independent meta-analyses were implemented to estimate the gain in uncorrected near visual acuity and best corrected visual acuity (vision lines) as well as the predictability (fraction of patients without need for reading aids) of multifocal supplementation. Study reports published between 1995 and 2004 (English or German language) were screened for appropriate key words. Meta effects in visual gain and predictability were estimated by means and standard deviations of the reported effect measures. Cost data were estimated by German DRG rates and individual lens costs; the cost effectiveness of multifocal cataract surgery was then computed in terms of its marginal cost effectiveness ratio (MCER) for each clinical benefit endpoint; the incremental costs of multifocal versus monofocal cataract surgery were further estimated by means of their respective incremental cost effectiveness ratio (ICER). An independent meta-analysis estimated the complication profiles to be expected after monofocal and multifocal cataract surgery in order to evaluate expectable complication-associated additional costs of both procedures; the marginal and incremental cost effectiveness estimates were adjusted accordingly. A sensitivity analysis comprised cost variations of +/- 10 % and utility variations alongside the meta effect estimate's 95 % confidence intervals. Total direct costs from the health care insurer's perspective were estimated 3363 euro, associated with a visual meta benefit in best corrected visual

Apendicitis Aguda

OpenAIRE

Jorge Fallas González

2012-01-01

La apendicitis aguda, descrita desde 1886, es la emergencia quirúrgica más común. Tiene su mayor incidencia durante la adultez joven y su menor incidencia en niños y adultos mayores. Su diagnóstico se basa en una historia clínica completa, un examen físico bien orientado y en una adecuada interpretación de los exámenes de laboratorio y gabinete. A pesar de ser una entidad de resolución quirúrgica, su tratamiento engloba diferentes aspectos médicosAcute appendicitis, described since 1886, is t...

Does multifocal papillary micro-carcinoma require radioiodine ablation?

International Nuclear Information System (INIS)

Punda, A.; Markovic, V.; Eterovic, D.

2015-01-01

Full text of publication follows. Background: the thyroid carcinomas smaller than 1 cm (micro-carcinomas) comprise a significant fraction of papillary carcinomas. Excluding clinical micro-carcinomas, which present as metastatic disease, the micro-carcinomas diagnosed by ultrasound/FNAC or incidentally have very good prognosis. However, whether or not these papillary micro-carcinomas require post-surgical radioiodine ablation remains a matter of debate. Hypothesis: multi-focality is present in majority of clinical papillary micro-carcinomas and this characteristic can be used to identify the subset of non-clinical micro-carcinomas with greater malignant potential. Methods: the data on types of differentiated thyroid carcinomas diagnosed in the period 2008-2011 in the University Hospital Split were collected. Results: there were 359 patients with thyroid carcinoma, 329 (92%) of which had papillary carcinoma. About 61% (202/329) of papillary carcinomas were micro-carcinomas; most of them were diagnosed by ultrasound/FNAC (134/202= 66%), the rest were incidentalomas (48/202=24%) and clinical micro carcinomas (20/202=10%). Sixty percent (12/20) of patients with clinical micro-carcinoma and 23 patients with non-clinical micro-carcinoma (23/182=13%) had multifocal disease. Conclusion: multifocal disease is a frequent characteristic of clinical papillary thyroid micro-carcinomas, suggesting that multi-focality presents an early stage of non-clinical micro-carcinomas with more aggressive behaviour. Thus multifocal, but not uni-focal papillary micro-carcinomas may require radioiodine ablation. (authors)

Gingivitis ulceronecrosante aguda

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Eduardo de la Teja-Ángeles

2015-11-01

Full Text Available La gingivitis ulcerativa necrosante, conocida por sus siglas en inglés como GUN (anteriormente se le conocía como enfermedad de Vincent o “boca de trinchera” por afectar a soldados en guerra, es una enfermedad poco frecuente.1-6 Se caracteriza por ser una infección aguda y dolorosa en la que las encías sangran, hay necrosis de las papilas interdentales y ataque al estado general.

Bilateral implantation of +2.5 D multifocal intraocular lens and contralateral implantation of +2.5 D and +3.0 D multifocal intraocular lenses: Clinical outcomes.

Science.gov (United States)

Nuijts, Rudy M M A; Jonker, Soraya M R; Kaufer, Robert A; Lapid-Gortzak, Ruth; Mendicute, Javier; Martinez, Cristina Peris; Schmickler, Stefanie; Kohnen, Thomas

2016-02-01

To assess the clinical visual outcomes of bilateral implantation of Restor +2.5 diopter (D) multifocal intraocular lenses (IOLs) and contralateral implantation of a Restor +2.5 D multifocal IOL in the dominant eye and Restor +3.0 D multifocal IOL in the fellow eye. Multicenter study at 8 investigative sites. Prospective randomized parallel-group patient-masked 2-arm study. This study comprised adults requiring bilateral cataract extraction followed by multifocal IOL implantation. The primary endpoint was corrected intermediate visual acuity (CIVA) at 60 cm, and the secondary endpoint was corrected near visual acuity (CNVA) at 40 cm. Both endpoints were measured 3 months after implantation with a noninferiority margin of Δ = 0.1 logMAR. In total, 103 patients completed the study (53 bilateral, 50 contralateral). At 3 months, the mean CIVA at 60 cm was 0.13 logMAR and 0.10 logMAR in the bilateral group and contralateral group, respectively (difference 0.04 logMAR), achieving noninferiority. Noninferiority was not attained for CNVA at 40 cm; mean values at 3 months for bilateral and contralateral implantation were 0.26 logMAR and 0.11 logMAR, respectively (difference 0.15 logMAR). Binocular defocus curves suggested similar performance in distance vision between the 2 groups. Treatment-emergent ocular adverse events rates were similar between the groups. Bilateral implantation of the +2.5 D multifocal IOL resulted in similar distance as contralateral implantation of the +2.5 D multifocal IOL and +3.0 D multifocal IOL for intermediate vision (60 cm), while noninferiority was not achieved for near distances (40 cm). Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Pneumonia aguda fibrinosa e organizante

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Cláudia Santos

2010-07-01

Full Text Available Resumo: O padrão histológico de Pneumonia Aguda Fibrinosa e Organizante (AFOP – Acute Fibrinous And Organizing Pneumonia, descrito por Beasley em 2002, caracteriza-se pela existência de fibrina intra-alveolar sob a forma de bolas de fibrina e pneumonia organizativa difusa. A apresentação clínica desta doença intersticial pulmonar pode ser aguda ou subaguda, diferindo no entanto dos outros padrões histológicos habitualmente associados a lesão pulmonar aguda – Lesão Alveolar Difusa (DAD, Pneumonia Organizativa (OP e Pneumonia Eosinofílica (EP.A propósito deste tema, os autores fazem uma revisão da literatura e descrevem o caso clínico de um doente de 44 anos, com aspectos imagiológicos e evolução pouco habituais. Abstract: The histologic pattern of Acute Fibrinous and Organizing Pneumonia (AFOP, described by Beasley in 2002, is characterized by the existence of intra alveolar fibrin in the form of fibrin “balls” and diffuse organizing pneumonia. Presenting symptoms of this interstitial pulmonary disease can be acute or subacute. However, it differs from the well-recognized histologic patterns of acute pulmonary lesion – Diffuse Alveolar Damage (DAD, Organizing Pneumonia (OP and Eosinophilic Pneumonia (EP.The authors carry out a review of the literature concerning this topic and describe the clinical case of a 44-year-old patient with unusual imaging features and outcome. Palavras-chave: AFOP, bolas de fibrina, pneumonia organizativa, Key-word: AFOP, fibrin balls, organizing pneumonia

Insuficiencia respiratoria aguda

OpenAIRE

Gutiérrez Muñoz, Fernando R.

2010-01-01

La función respiratoria básica es el intercambio gaseoso de oxígeno y dióxido carbono; lo que implica un perfecto equilibrio y control entre los componentes del sistema respiratorio. a insuficiencia respiratoria aguda (IRA) es la incapacidad del sistema respiratorio de cumplir su función básica, que es el intercambio gaseoso de oxígeno y dióxido de carbono. Basic respiratory function is gas exchange of oxygen and carbon dioxide, which implies a perfect balance and control between the compo...

Multifocal Epithelial Hyperplasia.

Science.gov (United States)

Agnew, Caitlin; Alexander, Sherene; Prabhu, Neeta

2017-01-15

Multifocal epithelial hyperplasia is a rare disease associated with human papilloma virus types 13 and 32. Diagnosis is based on clinical and histopathological findings, and most lesions are asymptomatic and regress spontaneously with time. The purpose of this paper is to describe a five-year-old girl who presented with multiple intraoral lesions on the buccal mucosa and tongue, which regressed spontaneously in 15 months.

MULTIFOCAL CHOROIDITIS IN DISSEMINATED SPOROTRICHOSIS IN PATIENTS WITH HIV/AIDS.

Science.gov (United States)

Biancardi, Ana L; Freitas, Dayvison F S; Valviesse, Vitor R G de A; Andrade, Hugo B; de Oliveira, Manoel M E; do Valle, Antonio C F; Zancope-Oliveira, Rosely M; Galhardo, Maria C G; Curi, Andre L L

2017-01-01

In this article, the authors describe multifocal choroiditis related to disseminated sporotrichosis in patients with HIV/AIDS. We conducted a retrospective observational study of three patients infected with HIV who presented with disseminated sporotrichosis characterized by cutaneous lesions, multifocal choroiditis, and other manifestations, including osteomyelitis and involvement of the bone marrow, larynx, pharynx, and nasal and oral mucosa. Five eyes of three patients with HIV/AIDS showed multifocal choroiditis related to disseminated sporotrichosis. The CD4 counts ranged from 25 to 53 mm. All patients were asymptomatic visually. The ocular disease was bilateral in two patients. The lesion size ranged from 1/3 to 2 disc diameters. None of the patients had vitritis. Of the 12 lesions, 9 were localized in the posterior pole (Zone 1) and 3 were localized in the mild periphery (Zone 2). Multifocal choroiditis due to disseminated sporotrichosis can occur in profoundly immunosuppressed patients with HIV/AIDS.

Microcristais biliares na pancreatite aguda idiopática: indício para etiologia biliar oculta subjacente

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CHEBLI Júlio Maria Fonseca

2000-01-01

Full Text Available As principais causas de inflamação pancreática no mundo são a litíase biliar e o alcoolismo crônico. Admite-se que 10 a 30% das pancreatites agudas sejam idiopáticas. Sugere-se que parte destas são causadas por microlitíase ou barro biliar, identificados pela presença de microcristais no sedimento biliar. Neste estudo, realizou-se análise microscópica da bile obtida por colangiopancreatografia endoscópica, em pacientes com pancreatite aguda idiopática, pancreatite aguda biliar e pancreatite crônica alcoólica - 20 em cada grupo. Pacientes com pancreatite aguda idiopática e microcristais na bile foram submetidos a colecistectomia. Naqueles inaptos à cirurgia efetuou-se esfincterotomia endoscópica ou tratamento com ácido ursodesoxicólico. Pacientes com pancreatite aguda idiopática sem cristais não receberam tratamento específico. A prevalência de microcristais biliares em pacientes com pancreatite aguda idiopática (75% e pancreatite aguda biliar (90% foi significativamente maior que naqueles com pancreatite crônica alcoólica (15%. A detecção de microcristais apresentou sensibilidade de 90%, especificidade de 85%, valor preditivo positivo de 85,7%, valor preditivo negativo de 89,4% e acurácia de 87,5% em identificar pancreatite de origem biliar. Nos pacientes com pancreatite aguda idiopática recurrente, cursando com microcristais, houve redução significante dos episódios de pancreatite após tratamento específico. No seguimento deste grupo durante 23,3 meses, recidiva ocorreu apenas naqueles que apresentavam "fator biliar persistente" (coledocolitíase ou microcristais. Todos os pacientes com pancreatite aguda idiopática submetidos a colecistectomia apresentavam colecistite crônica, e microlitíase foi observada em um paciente. No seguimento ultra-sonográfico, colelitíase foi detectada em um dos casos. No subgrupo de cinco pacientes com pancreatite aguda idiopática sem microcristais houve uma recidiva. Estudo

Efectividad de la magnetoterapia como tratamiento en pacientes con lumbalgia aguda

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Raidel González Rodríguez

2015-05-01

Full Text Available Son numerosos los pacientes aquejados de algias vertebrales, tanto lumbares como dorsales y cervicales. Se realizó esta investigación con el objetivo de determinar la efectividad de la magnetoterapia como tratamiento en la lumbalgia aguda, en pacientes atendidos en el policlínico universitario “Raúl Sánchez” de la provincia de Pinar del Río, Cuba. Se realizó un estudio descriptivo, prospectivo, de corte transversal en pacientes con lumbalgia aguda, pertenecientes a dicha área de salud. La muestra quedó conformada por 68 pacientes de ambos sexos con lumbalgia aguda, diagnosticados clínicamente y mayores de 17 años de edad. En la investigación predominó el sexo femenino (67,6 % y el rango de edad estuvo entre 40 y 49 años. El esfuerzo físico fue el principal factor desencadenante (47,1 %. Con el tratamiento de la magnetoterapia aplicado a los pacientes se redujeron los estadios del dolor. La mayoría de los pacientes presentaron una respuesta clínica excelente y mejoraron los síntomas entre los siete y diez días (61,8 %. No se reportaron efectos adversos. La magnetoterapia resultó efectiva en el tratamiento de pacientes aquejados de lumbalgia aguda

Refractive outcomes after multifocal intraocular lens exchange.

Science.gov (United States)

Kim, Eric J; Sajjad, Ahmar; Montes de Oca, Ildamaris; Koch, Douglas D; Wang, Li; Weikert, Mitchell P; Al-Mohtaseb, Zaina N

2017-06-01

To evaluate the refractive outcomes after multifocal intraocular lens (IOL) exchange. Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Retrospective case series. Patients had multifocal IOL explantation followed by IOL implantation. Outcome measures included type of IOL, surgical indication, corrected distance visual acuity (CDVA), and refractive prediction error. The study comprised 29 patients (35 eyes). The types of IOLs implanted after multifocal IOL explantation included in-the-bag IOLs (74%), iris-sutured IOLs (6%), sulcus-fixated IOLs with optic capture (9%), sulcus-fixated IOLs without optic capture (9%), and anterior chamber IOLs (3%). The surgical indication for exchange included blurred vision (60%), photic phenomena (57%), photophobia (9%), loss of contrast sensitivity (3%), and multiple complaints (29%). The CDVA was 20/40 or better in 94% of eyes before the exchange and 100% of eyes after the exchange (P = .12). The mean refractive prediction error significantly decreased from 0.22 ± 0.81 diopter (D) before the exchange to -0.09 ± 0.53 D after the exchange (P exchange to 0.23 D after the exchange (P exchange can be performed safely with good visual outcomes using different types of IOLs. A lower refractive prediction error and a higher likelihood of 20/40 or better vision can be achieved with the implantation of the second IOL compared with the original multifocal IOL, regardless of the final IOL position. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Comparison between OPD-Scan results and visual outcomes of monofocal and multifocal intraocular lenses Comparação dos resultados do OPD-Scan e performance visual das lentes intraoculares monofocal e multifocal

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Wilson Takashi Hida

2009-08-01

Full Text Available PURPOSE: To compare the visual outcome, contrast sensitivity and wavefront analysis of patients that underwent cataract surgery and implantation of AcrySof SN60D3 multifocal intraocular lens with those who received the AcrySof SN60AT monofocal IOL. METHODS: This was a prospective clinical trial of forty eyes that received the multifocal IOL and thirty-two eyes that received the monofocal IOL after phacoemulsification. RESULTS: Values for total and spherical aberrations in the multifocal group were statistically lower than in the monofocal group. In the monofocal group, 75% achieved uncorrected intermediate visual acuities between Jaeger 1 and 6. In the multifocal group, 75% of the eyes achieved more than Jaeger 6. At least 87.5% of the multifocal group and 6.3% of the monofocal group achieved monocular uncorrected near acuity of 20/30 (J2, N5 or better. And 90.0% of the eyes in the multifocal group and 37.5% in the monofocal group achieved an uncorrected near acuity of 20/40 (J3, N6 or better. The mean spherical error was 0.11 D in the multifocal group and -0.18 D in the monofocal group (p=0.0379. The SN60D3 group compared to SN60AT group had low contrast sensitivity (log units with statistically significant differences in 6.0 cpd in photopic conditions (p=0.014 and the SN60D3 group compared to SN60AT group had higher contrast sensitivity (log units under mesopic conditions (p=0.044. CONCLUSION: The multifocal IOLs induced less spherical aberration than monofocal IOLs and predictably good uncorrected distance and uncorrected near acuities. However, contrast sensitivity was lower in the multifocal group.OBJETIVO: Comparar a performance visual, sensibilidade ao contraste e de wavefront com OPD-Scan em pacientes submetidos a cirurgia de facoemulsificação com implante de lente intraocular AcrySof SN60D3 multifocal e AcrySof SA60AT monofocal. MÉTODOS: Quarenta olhos com a lente intraocular multifocal e trinta e dois olhos com a lente intraocular

Multifocal choroiditis following simultaneous hepatitis A, typhoid, and yellow fever vaccination

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Escott S

2013-02-01

Full Text Available Sarah Escott, Ahmad B Tarabishy, Frederick H DavidorfHavener Eye Institute, The Ohio State University, Columbus, OH, USAAbstract: The paper describes the first reported case of multifocal choroiditis following simultaneous hepatitis-A, typhoid, and yellow fever vaccinations. A 33-year-old male developed sudden onset of flashing lights and floaters in his right eye 3 weeks following hepatitis A, typhoid, and yellow fever vaccinations. Fundus examination and angiography confirmed the presence of multiple peripheral chorioretinal lesions. These lesions demonstrated characteristic morphologic changes over a period of 8 weeks which were consistent with a diagnosis of self-resolving multifocal choroiditis. Vaccine-induced intraocular inflammation has been described infrequently. We demonstrate the first case of self-resolving multifocal choroiditis following simultaneous administration of hepatitis A, yellow fever, and typhoid immunizations.Keywords: multifocal choroiditis, vaccination, hepatitis A, typhoid, yellow fever

Serie de 8 casos de parotiditis supurada aguda neonatal

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Manuel Díaz Álvarez

Full Text Available La parotiditis supurada aguda es una infección poco frecuente en la práctica del pediatra y neonatólogo. El objetivo es mostrar nuestra experiencia en la atención de serie de casos con parotiditis supurada aguda en el período neonatal, y describir sus características de presentación. Se presentan los hallazgos clínicos en 8 pacientes con parotiditis supurativa neonatal, quienes estuvieron ingresados en el Servicio de Neonatología del Hospital Pediátrico Universitario "Juan Manuel Márquez", durante el período de 22 años (desde el año 1992 hasta el año 2013, y se contrasta con los reportes publicados en la literatura internacional. Las características de presentación de la parotiditis aguda supurada de nuestros casos concuerdan con la literatura revisada en muchos aspectos, y se demuestra que es, además, una infección poco frecuente en el período neonatal. Es la primera publicación sobre esta entidad en neonatos en Cuba, y la mayor serie de casos en el ámbito latinoamericano.

Autorefraction versus subjective refraction in a radially asymmetric multifocal intraocular lens

NARCIS (Netherlands)

van der Linden, Jan Willem; Vrijman, Violette; Al-Saady, Rana; El-Saady, Rana; van der Meulen, Ivanka J.; Mourits, Maarten P.; Lapid-Gortzak, Ruth

2014-01-01

To evaluate whether the automated refraction (AR) correlates with subjective manifest (MR) refraction in eyes implanted with radially asymmetric multifocal intraocular lens (IOLs). This retrospective study evaluated 52 eyes (52 patients) implanted with a radially asymmetric multifocal IOL (LS-312

Multifocal hyperfunctioning thyroid carcinoma without metastases.

Science.gov (United States)

Nishida, Akiko T; Hirano, Shigeru; Asato, Ryo; Tanaka, Shinzo; Kitani, Yoshiharu; Honda, Nobumitsu; Fujiki, Nobuya; Miyata, Kouji; Fukushima, Hideyuki; Ito, Juichi

2008-09-01

Hyperthyroidism due to thyroid carcinoma is rare, and most cases are caused by hyperfunctioning metastatic thyroid carcinoma rather than primary carcinoma. Among primary hyperfunctioning thyroid carcinoma, multifocal thyroid carcinoma is exceedingly rare, with the only one case being reported in the literature. Here, we describe the case of a 62-year-old woman with multifocal functioning thyroid carcinoma. Technetium-99m (99m Tc) scintigraphic imaging showed four hot areas in the thyroid gland. Histopathological examination of all four nodules revealed papillary carcinoma, corresponding to hot areas in the 99m Tc scintigram. DNA sequencing of the thyrotropin receptor (TSH-R) gene from all nodules revealed no mutation, indicating that activation of TSH-R was unlikely in the pathophysiogenesis of hyperfunctioning thyroid carcinoma in the present case.

A rare case of a medullary, multifocal lesion in the distal radius

Science.gov (United States)

Aktas, Birol; Ozturan, Burak; Kilic, Bulent; Ozkan, Korhan

2017-01-01

In multifocal findings, the possibility of multifocal osteoid osteomas should be considered and this case helps us to be attentive for the unusual radiographical presentation of osteoid osteoma. PMID:28748099

Incidencia de la enfermedad diarreica aguda en menores de cinco años

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Mayelín Ávila Labrada

2015-05-01

Full Text Available La enfermedad diarreica aguda es motivo frecuente de consulta pediátrica, representando un problema grave de salud pública. Los agentes infecciosos son causa frecuente de diarrea aguda. Se realizó un estudio descriptivo, retrospectivo sobre la prevalencia de la enfermedad diarreica aguda en menores de cinco años, atendidos en la clínica “Simón Bolívar” en la ciudad de Mariara del municipio Diego Ibarra, Carabobo, Venezuela; en el periodo comprendido entre enero de 2008 y diciembre de 2012, lo cual ofreció información de cinco años completos. La prevalencia de la enfermedad diarreica aguda disminuyó significativamente en el intervalo 2009-2011, sin embargo, se caracterizó por tener la mayor prevalencia en los años extremos, 2012 y 2008, por ese orden. Los varones y los del grupo de uno a cuatro años fueron los que más incidieron en cada uno de los años estudiados

Multifocal osteosarcoma as second tumor after childhood retinoblastoma

International Nuclear Information System (INIS)

Potepan, P.; Laffranchi, A.; Danesini, G.M.; Spagnoli, I.; Luksch, R.; Sozzi, G.; Testi, A.; Parafioriti, A.; Giardini, R.

1999-01-01

We present a case of multifocal osteosarcoma (MFOS) arising 11.5 years after successful treatment of bilateral retinoblastoma. The clinical, imaging and pathological findings at onset, after therapy, and during follow-up are described. Fluorescent in situ hybridization did not reveal a deletion of the RB-1 retinoblastoma gene, although the presence of an inactivating mutation invisible to this method cannot be ruled out. The MFOS may have been a second multifocal tumor associated with the original retinoblastoma or a post-irradiation sarcoma with extensive metastases. (orig.)

Notas sobre apendicitis aguda

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Martín Méndez S.

1933-04-01

apendicitis aguda y sin embargo, es necesario decirlo claro, nada hay tan complicado y en ocasiones tan oscuro. Sin duda, a medida que los conocimientos clínicos se extienden, se va iluminando el campo, antes inexplorado, de la cirugía apendicular, y hoy día casi todos los médicos y cirujanos tienen un criterio científico muy bien formado para lograr hacer un buen diagnóstico y aconsejar o llevar a cabo una intervención quirúrgica.

Hepatitis viral aguda

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Héctor Rubén Hernández Garcés

1998-10-01

Full Text Available Se realizó una revisión bibliográfica de las hepatitis virales agudas sobre aspectos vinculados a su etiología. Se tuvieron en cuenta además algunos datos epidemiológicos, las formas clínicas más importantes, los exámenes complementarios con especial énfasis en los marcadores virales y el diagnóstico positivoA bibliographical review of acute viral hepatitis was made taking into account those aspects connected with its etiology. Some epidemiological markers, the most important clinical forms, and the complementary examinations with special emphasis on the viral markers and the positive diagnosis were also considered

Scleral fixation of a single-piece multifocal intraocular lens.

Science.gov (United States)

Can, Ertugrul; Basaran, M Resat; Gül, Adem

2013-01-01

We describe an ab interno technique for injector implantation of a one-piece multifocal intraocular lens (IOL). Transscleral fixation of multifocal posterior chamber IOL implantation using an injector with ab interno technique was performed in an eye of a 9-year-old girl who had undergone pars plana lensectomy 2 years before for bilateral lens subluxation with unknown etiology. No major complications were encountered during a 3-month follow-up of the patient and excellent centration was observed during the follow-up period. Her preoperative best spectacle-corrected distance visual acuity of 20/32 improved to uncorrected distance visual acuity of 20/25. Closed-loop design of IOL served the function of eyelets and position of the IOL was provided using only a 2-point fixation. Intraoperative position adjustment of the IOL provided an excellent centralization of multifocal IOL.

A multifocal collimator with circularly distributed focal points for SPECT imaging

International Nuclear Information System (INIS)

Guillemaud, R.; Grangeat, P.

1994-01-01

The authors propose a new circular multifocal collimator which has multiple axial focal points distributed on a transverse circle. This distribution provides a strong focusing at the center of the detector like a cone-beam collimator, with a good sensitivity, and a weak transverse focusing at the periphery, to ensure acquisition of sufficient data, in order to prevent truncation artifacts. For a circular acquisition trajectory, each projection set of the multifocal geometry is equivalent to a virtual cone-beam projection set with a larger detector. Due to this equivalence, the authors derive a first solution for an analytical multifocal reconstruction algorithm: to rebin the projection set from multifocal to cone-beam geometry, then to use a 3D cone-beam reconstruction algorithm. The authors propose to use the Grangeat algorithm in order to deal with a large cone-beam aperture. Finally, the authors present results on simulated data for heart phantom, for a Defrise phantom and for a MTF study. The conclusion is that, from a multifocal projection set, objects are reconstructed without truncation artifacts, with a good precision at their center and with a loss of resolution at the periphery. In addition, the 3D cone-beam artifacts are reduced with the use of the Grangeat algorithm for the reconstruction step

Algunas observaciones sobre la apendicitis aguda en los niños

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Luis Piñeros Suárez

1940-03-01

Full Text Available La apendicitis aguda en los niños, presenta actitudes particulares que diferencian de la apendicitis aguda del adulto y que vienen a formar grupos clínicos casi exclusivamente de la infancia. De una manera general, las formas más graves, las formas fulminantes de la apendicitis aguda se encuentran especialmente en la infancia y en estas formas graves llama poderosamente la atención, la falta de relación entre los signos clínicos observados y la importancia de las lesiones encontradas en el apéndice y el peritoneo, pues en los niños con signos de intensidad media y sin que se hayan presentado los síntomas que en el adulto caracterizan las formas graves de apendicitis, podemos encontrar en las operaciones practicadas en las primeras 24 a 36 horas, peritonitis generalizadas, formas de apendicitis gangrenosas, que no son frecuentes en el adulto y mucho menos en un lapso de tiempo tan corto.

An Unusual Case of Unilateral Multifocal Choroiditis in a Young Male

African Journals Online (AJOL)

Multifocal choroiditis is a vision‑threatening disease causing inflammation at the level of retinal pigment epithelium and outer retina. We present a unique case of unilateral multifocal choroiditis in a young nonmyopic male and its subsequent course. The patient developed visual loss due to the sub‑retinal neovascular ...

Estado oxidante e antioxidante de crianças com bronquiolite aguda

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Rusen Dundaroz

2013-08-01

Full Text Available OBJETIVO: O estresse oxidativo demonstrou contribuir para a patogênese de doenças pulmonares inflamatórias agudas e crônicas. Nosso objetivo foi avaliar o estado oxidante/antioxidante de crianças com bronquiolite aguda por meio de mensuração da capacidade antioxidante total do plasma, estado oxidante total e índice de estresse oxidativo. MÉTODOS: As crianças com bronquiolite aguda encaminhadas para o Departamento de Emergência Pediátrica do hospital universitário entre janeiro e abril 2012 foram comparadas a controles saudáveis de mesma idade. Os pacientes com bronquiolite aguda tiveram essa doença classificada como leve e moderada. O estado oxidante e antioxidante foi avaliado pela mensuração da capacidade antioxidante total do plasma, estado oxidante total e índice de estresse oxidativo. RESULTADOS: Foram incluídas 31 crianças com bronquiolite aguda com idade de três meses a dois anos e 37 crianças saudáveis. O estado oxidante total (EOT foi maior em pacientes com bronquiolite aguda do que no grupo de controle (5,16±1,99 µmol H2O2 em comparação a 3,78±1,78 µmol H2O2 [p = 0,004]. A capacidade antioxidante total (CAT foi significativamente menor em crianças com bronquiolite que no grupo de controle (2,51±0,37 µmol Trolox equivalente/L em comparação a 2,75±0,39 µmol Trolox Eqv/L (p = 0,013. Os pacientes com bronquiolite moderada apresentaram níveis de EOT mais elevados que os com bronquiolite leve e os do grupo de controle (p = 0,03, p < 0,001. Os pacientes com bronquiolite moderada apresentaram níveis de IEO mais elevados que os do grupo de controle (p = 0,015. O nível de saturação de oxigênio de pacientes com bronquiolite foi inversamente correlacionado ao nível de EOT (r = -0,476, p < 0,05. CONCLUSÃO: O equilíbrio entre os sistemas oxidante e antioxidante é interrompido em crianças com bronquiolite moderada, indicando que o fator de estresse poderá ter um papel na patogênese da doença.

Otomastoidite Aguda em Criança

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João Araújo

2017-09-01

Full Text Available Criança de 2 anos, sexo masculino, diagnóstico de otite média aguda bilateral, medicada inicialmente com amoxicilina + clavulanato 90 mg/kg/dia desde há 7 dias, internada por agravamento do quadro à esquerda, com edema e eritema retroauricular, apagamento do sulco retroauricular [...] Recebido: 07/09/2015 · Aceite: 7/01/2016

Leucemia congénita aguda Acute congenital leukemia

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Nilvia Esther González García

2011-06-01

Full Text Available La leucemia aguda durante el período neonatal es poco frecuente de evolución rápida y pronóstico sombrío. Sus características clínicas y biológicas difieren de las encontradas en niños de mayor edad, y su inicio se caracteriza por afectación cutánea, hepatoesplenomegalia, hiperleucocitosis e infiltración del sistema nervioso central. Se han observado pacientes con formas tanto mieloides como linfoides, pero la leucemia mieloide aguda parece predominar en esta etapa de la vida. Se presenta el caso de un paciente con leucemia congénita clasificada morfológicamente, con aparición de manifestaciones clínicas de enfermedad hematológica desde el nacimiento y diagnóstico de leucemia linfoblástica aguda congénita.Acute leukemia during neonatal period is not frequent, of a fast course and gloomy prognosis. Its clinical and biological features differ of that present in older children and it onset is characterized by cutaneous affection, hepatosplenomegaly, hyperleukocytosis and infiltration of central nervous system (CNS. There are patients presenting with myeloid and lymphoid types, but the acute leukemia seems to predominate in this stage of life. This is the case of a patient with acute leukemia morphologically classified, with appearance of clinical manifestations of hematologic disease from birth and a diagnosis of congenital acute lymphoblastic leukemia.

[Multifocal Electroretinography in Patients with Poppers Maculopathy].

Science.gov (United States)

Pahlitzsch, Milena; Salchow, Daniel; Rossel, Mirjam; Bergholz, Richard

2017-10-12

Background Maculopathy is a potential side effect of amyl nitrite or "poppers" abuse. It is characterized by a sudden, painless decrease in visual acuity. While the funduscopic changes are subtle, optical coherence tomography shows alterations of the outer retinal layers in the fovea. However, the extent of retinal dysfunction remains poorly understood. Materials/Methods We compared the multifocal electroretinogram of 6 patients with poppers maculopathy to that of a control group consisting of 6 healthy subjects. Response densities and implicit times of N1 and P1 were analyzed. Results Response densities and implicit times of both N1 and P1 were lower in the patients with poppers maculopathy than in the control group, particularly in ring 1 and rings 4 and 5. The only statistically significant finding, however, was a reduced N1 response density of one hexagon in the patient group. No significant differences were found considering the sum response or the averaged rings 1 to 5. Conclusion Compared to a healthy control group, the multifocal electroretinogram of patients with poppers maculopathy shows no relevant impairment. This contrasts the marked effect of the disease on visual acuity. In clinical practice, poppers maculopathy cannot be diagnosed by multifocal electroretinography. Georg Thieme Verlag KG Stuttgart · New York.

Multifocal, chronic osteomyelitis of unknown etiology

International Nuclear Information System (INIS)

Kozlowski, K.; Beluffi, G.; Feltham, C.; James, M.; Nespoli, L.; Tamaela, L.; Pavia Univ.; Municipal Hospital, Nelson; Medical School, Jakarta

1985-01-01

Four cases of multifocal osteomyelitis of unknown origin in childhood are reported. The variable clinical and radiographic appearances of the disease are illustrated and the diagnostic difficulties in the early stages of the disease are stressed. (orig.) [de

Progressive multifocal leukoencephalopathy in transplant recipients

NARCIS (Netherlands)

Mateen, Farrah J.; Muralidharan, RajaNandini; Carone, Marco; van de Beek, Diederik; Harrison, Daniel M.; Aksamit, Allen J.; Gould, Mary S.; Clifford, David B.; Nath, Avindra

2011-01-01

Transplant recipients are at risk of developing progressive multifocal leukoencephalopathy (PML), a rare demyelinating disorder caused by oligodendrocyte destruction by JC virus. Reports of PML following transplantation were found using PubMed Entrez (1958-July 2010). A multicenter, retrospective

Foot clearance and variability in mono- and multifocal intraocular lens users during stair navigation.

Science.gov (United States)

Renz, Erik; Hackney, Madeleine; Hall, Courtney

2016-01-01

Intraocular lenses (IOLs) provide distance and near refraction and are becoming the standard for cataract surgery. Multifocal glasses increase variability of toe clearance in older adults navigating stairs and increase fall risk; however, little is known about the biomechanics of stair navigation in individuals with multifocal IOLs. This study compared clearance while ascending and descending stairs in individuals with monofocal versus multifocal IOLs. Eight participants with multifocal IOLs (4 men, 4 women; mean age = 66.5 yr, standard deviation [SD] = 6.26) and fifteen male participants with monofocal IOLs (mean age = 69.9 yr, SD = 6.9) underwent vision and mobility testing. Motion analysis recorded kinematic and custom software-calculated clearances in three-dimensional space. No significant differences were found between groups on minimum clearance or variability. Clearance differed for ascending versus descending stairs: the first step onto the stair had the greatest toe clearance during ascent, whereas the final step to the floor had the greatest heel clearance during descent. This preliminary study indicates that multifocal IOLs have similar biomechanic characteristics to monofocal IOLs. Given that step characteristics are related to fall risk, we can tentatively speculate that multifocal IOLs may carry no additional fall risk.

Application of diffractive aspheric multifocal intraocular lens in the Uighur in phacoemulsification

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Nuersimanguli·Mijiti

2016-05-01

Full Text Available AIM:To research the efficacy and safety of diffractive aspheric multifocal intraocular lens(MIOLin the Uighur in phacoemulsification to provide guidance for the clinical treatment of cataracts patients in Xinjiang region. METHODS:Two hundred and twenty-eight Uygur patients(280 eyesreceived phacoemulsification from April 2012 to March 2013 were randomly divided into multifocal group(106 cases with 146 eyesand monofocal group(122 cases with 134 eyes. Patients were followed up for 3mo. The intraocular pressure(IOP, uncorrected distance visual acuity, uncorrected near vision, best-corrected distance visual acuity and best corrected near vision were measured. The delensed rate, visual quality, and satisfaction for lenses in the form of questionnaires were compared. RESULTS:Multifocal group was better on the uncorrected near vision than monofocal group(PP>0.05. The contrast sensitivity of multifocal group under scotopia at spatial frequency 3c/d was lower than that of monofocal group(PP>0.05. Delensed rate of multifocal group was higher than that of monofocal group(PP>0.05.CONCLUSION:MIOL with phacoemulsification can provide patient good full range vision, especially on good near vision. The patients with MIOL implanted have a higher delensed rate, less postoperative adverse symptoms, quicker recovery and satisfaction.

Power profiles of single vision and multifocal soft contact lenses.

Science.gov (United States)

Wagner, Sandra; Conrad, Fabian; Bakaraju, Ravi C; Fedtke, Cathleen; Ehrmann, Klaus; Holden, Brien A

2015-02-01

The purpose of this study was to investigate the optical zone power profile of the most commonly prescribed soft contact lenses to assess their potential impact on peripheral refractive error and hence myopia progression. The optical power profiles of six single vision and ten multifocal contact lenses of five manufacturers in the powers -1.00 D, -3.00 D, and -6.00 D were measured using the SHSOphthalmic (Optocraft GmbH, Erlangen, Germany). Instrument repeatability was also investigated. Instrument repeatability was dependent on the distance from the optical centre, manifesting unreliable data for the central 1mm of the optic zone. Single vision contact lens measurements of -6.00 D lenses revealed omafilcon A having the most negative spherical aberration, lotrafilcon A having the least. Somofilcon A had the highest minus power and lotrafilcon A the biggest deviation in positive direction, relative to their respective labelled powers. Negative spherical aberration occurred for almost all of the multifocal contact lenses, including the centre-distance designs etafilcon A bifocal and omafilcon A multifocal. Lotrafilcon B and balafilcon A seem to rely predominantly on the spherical aberration component to provide multifocality. Power profiles of single vision soft contact lenses varied greatly, many having a negative spherical aberration profile that would exacerbate myopia. Some lens types and powers are affected by large intra-batch variability or power offsets of more than 0.25 dioptres. Evaluation of power profiles of multifocal lenses was derived that provides helpful information for prescribing lenses for presbyopes and progressing myopes. Copyright © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Bioptics in sutureless intrascleral multifocal posterior chamber intraocular lens fixation.

Science.gov (United States)

Pavlidis, Mitrofanis; de Ortueta, Diego; Scharioth, Gabor B

2011-05-01

To present a technique for sutureless fixation of a three-piece, multifocal, posterior chamber intraocular lens (IOL) in the ciliary sulcus. A 24-year-old woman presented with bilateral subluxation of the crystalline lens. Two straight sclerotomies were prepared with a 24-gauge cannula 2.0 mm from the limbus 180° apart from each other. The cannula was used to create a 2.0- to 3.0-mm tunnel parallel to the limbus starting from the sclerotomies. The leading haptic of the multifocal IOL was grasped at its tip with end-gripping, 25-gauge forceps and pulled through the sclerotomy. The forceps was used to introduce the IOL haptic into the scleral tunnel parallel to the limbus. Multifocal posterior chamber IOLs were stable and well centered. No postoperative complications occurred in the 16-month follow-up period. Preoperative astigmatism was corrected after IOL implantation with corneal wavefront-guided laser epithelial keratomileusis. Sutureless fixation of multifocal posterior chamber IOL haptics in a scleral tunnel parallel to the limbus can be successful, resulting in long-term centration and three-dimensional axial stability for optimal refractive results. If necessary, postoperative wavefront-guided refractive correction can be performed to optimize final refraction. Copyright 2011, SLACK Incorporated.

Taxonomy of multi-focal nematode image stacks by a CNN based image fusion approach.

Science.gov (United States)

Liu, Min; Wang, Xueping; Zhang, Hongzhong

2018-03-01

In the biomedical field, digital multi-focal images are very important for documentation and communication of specimen data, because the morphological information for a transparent specimen can be captured in form of a stack of high-quality images. Given biomedical image stacks containing multi-focal images, how to efficiently extract effective features from all layers to classify the image stacks is still an open question. We present to use a deep convolutional neural network (CNN) image fusion based multilinear approach for the taxonomy of multi-focal image stacks. A deep CNN based image fusion technique is used to combine relevant information of multi-focal images within a given image stack into a single image, which is more informative and complete than any single image in the given stack. Besides, multi-focal images within a stack are fused along 3 orthogonal directions, and multiple features extracted from the fused images along different directions are combined by canonical correlation analysis (CCA). Because multi-focal image stacks represent the effect of different factors - texture, shape, different instances within the same class and different classes of objects, we embed the deep CNN based image fusion method within a multilinear framework to propose an image fusion based multilinear classifier. The experimental results on nematode multi-focal image stacks demonstrated that the deep CNN image fusion based multilinear classifier can reach a higher classification rate (95.7%) than that by the previous multilinear based approach (88.7%), even we only use the texture feature instead of the combination of texture and shape features as in the previous work. The proposed deep CNN image fusion based multilinear approach shows great potential in building an automated nematode taxonomy system for nematologists. It is effective to classify multi-focal image stacks. Copyright © 2018 Elsevier B.V. All rights reserved.

Heterogeneity of DNA methylation in multifocal prostate cancer.

Science.gov (United States)

Serenaite, Inga; Daniunaite, Kristina; Jankevicius, Feliksas; Laurinavicius, Arvydas; Petroska, Donatas; Lazutka, Juozas R; Jarmalaite, Sonata

2015-01-01

Most prostate cancer (PCa) cases are multifocal, and separate foci display histological and molecular heterogeneity. DNA hypermethylation is a frequent alteration in PCa, but interfocal heterogeneity of these changes has not been extensively investigated. Ten pairs of foci from multifocal PCa and 15 benign prostatic hyperplasia (BPH) samples were obtained from prostatectomy specimens, resulting altogether in 35 samples. Methylation-specific PCR (MSP) was used to evaluate methylation status of nine tumor suppressor genes (TSGs), and a set of selected TSGs was quantitatively analyzed for methylation intensity by pyrosequencing. Promoter sequences of the RASSF1 and ESR1 genes were methylated in all paired PCa foci, and frequent (≥75 %) DNA methylation was detected in RARB, GSTP1, and ABCB1 genes. MSP revealed different methylation status of at least one gene in separate foci in 8 out of 10 multifocal tumors. The mean methylation level of ESR1, GSTP1, RASSF1, and RARB differed between the paired foci of all PCa cases. The intensity of DNA methylation in these TSGs was significantly higher in PCa cases than in BPH (p epigenetic profile of recurrent tumors can be inferred from our data.

Lúpus eritematoso sistêmico e pancreatite aguda: relato de dois casos

OpenAIRE

Azevedo, Ana Beatriz Cordeiro de; Brito, Fabiano Almeida; Santos, Flávia Patrícia Sena Teixeira; Ferreira, Gilda Aparecida; Carvalho, Marco Antônio Parreiras de

2003-01-01

A pancreatite aguda é uma manifestação incomum do lúpus eritematoso sistêmico (LES) e a freqüência desta associação não é conhecida. Contudo, a pancreatite aguda é um diagnóstico diferencial importante na avaliação da dor abdominal em pacientes com LES. Os pacientes, normalmente, apresentam dor de intensidade variável, algumas vezes simulando abdome agudo. Vários fatores têm sido implicados na patogênese desta condição, tais como fenômenos autoimunes, vasculite, anticorpos antifosfolípides e ...

Whole body MRI in the diagnosis of chronic recurrent multifocal osteomyelitis.

LENUS (Irish Health Repository)

Kennedy, M T

2012-06-01

Chronic recurrent multifocal osteomyelitis (CRMO) is a diagnosis of exclusion primarily in children and adolescents. As part of the essential criteria for the diagnosis of CRMO, multifocal lesions must be identified. We present the case of an 11-year-old boy with CRMO, whose diagnosis was facilitated by the use of whole body magnetic resonance imaging (WBMR), but not isotope bone scanning.

Multifocal necrotizing fasciitis following Hirshsprung's disease ...

African Journals Online (AJOL)

Multifocal necrotizing fasciitis following Hirshsprung's disease surgery away from the surgical wound site. Ahmed A. Haseeb, Shadi Okasha and Atef Elbarawi. Necrotizing fasciitis (NF) is a life-threatening infection with rapidly progressive necrosis. Escherichia coli is rarely reported as causative agent of type 2 NF.

Suscetibilidade genética na lesão pulmonar aguda e síndrome da angústia respiratória aguda Genetic susceptibility in acute lung injury and acute respiratory distress syndrome

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Fernando Suparregui Dias

2009-12-01

Full Text Available A lesão pulmonar aguda e sua forma mais grave, a síndrome da angústia respiratória aguda, são o denominador comum de várias doenças que podem provocar uma inflamação exagerada nos pulmões. Nos últimos anos, essa variabilidade tem sido atribuída, pelo menos em parte, a fatores genéticos. O presente estudo tem por objetivos revisar o papel dos principais genes envolvidos na suscetibilidade, morbidade e mortalidade na lesão pulmonar aguda e na síndrome da angústia respiratória aguda. Através de pesquisa nas bases de dados PubMed e LiLACS, empregando-se os unitermos lesão pulmonar aguda, síndrome da angústia respiratória aguda e síndrome da angústia respiratória do adulto em combinação com polimorfismos genéticos, foram selecionados 69 artigos, dos quais 38 foram incluídos nesta revisão. Foram também considerados artigos relevantes extraídos das referências bibliográficas nos artigos selecionados das bases de dados. Os polimorfismos genéticos são variantes gênicas presentes em pelo menos 1% da população. A presença destas variantes genéticas pode influenciar a expressão de mediadores da resposta inflamatória, afetando diretamente a suscetibilidade à lesão pulmonar aguda, a intensidade da inflamação no parênquima pulmonar, a evolução e o desfecho destes pacientes. Estudos de associação com grandes populações e passíveis de reprodução permitirão de modo definitivo a inclusão da genômica no arsenal diagnóstico, prognóstico e terapêutico de pacientes com lesão pulmonar aguda/síndrome da angústia respiratória agudaAcute lung injury and its most severe presentation, acute respiratory distress syndrome, are a common denominator for several diseases which can lead to exaggerated lung inflammation. In the last years this variability has been ascribed, at least partially, to genetic issues. This study aims to review the role of the main genes involved in acute lung injury and acute respiratory

Esofagitis necrosante aguda: análisis retrospectivo Acute esophageal necrosis: a retrospective case series

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R. Ramos

2008-09-01

Full Text Available Introducción: la esofagitis necrosante aguda es una entidad rara. Se reconoce por el aspecto negro difuso del esófago a la endoscopia. Su incidencia e patogénesis se desconoce. Pacientes y métodos: se analizaron retrospectivamente 11 pacientes con esofagitis necrosante aguda desde el punto de vista de los datos clínicos, de laboratorio y endoscopicos en 2 años. Resultados: se analizaron las endoscopias realizadas a 3.976 pacientes, observándose esofagitis necrosante aguda en 11 pacientes. El estado nutricional era malo en 6 pacientes. La resolución completa de la esofagitis se observó en cuatro pacientes. Durante el seguimiento se observó una estenosis en un paciente y un nuevo episodio de esofagitis necrosante aguda en otro paciente. Siete pacientes fallecieron, pero esta elevada mortalidad parece deberse a las enfermedades de base y no es atribuible a las lesiones de la esofagitis necrosante. Conclusiones: la incidencia de esofagitis necrosante aguda en nuestra serie fue 0,28%. La esofagitis necrosante aguda tiene una elevada mortalidad.Background: acute esophageal necrosis has been considered a rare event. It is defined as the presence of diffuse dark pigmentation of the esophagus on upper endoscopy. Its incidence has not yet been established. The pathogenesis remains unknown. Patients and methods: a retrospective analysis of clinical, laboratory, endoscopic, and histological data, and of the clinical course of 11 patients with acute necrotizing esophagitis was carried out over a 2-year period. Results: among 3,976 patients who underwent upper endoscopy, 11 (0.28% with acute esophageal necrosis were identified. Nutritional status was poor for 6 patients. Complete resolution of acute esophageal necrosis without further recurrence was observed in 4. One stricture appeared during follow-up and other patient developed new-onset acute esophageal necrosis. Seven patients died, but no death was directly related to acute esophageal necrosis

[Multifocal phakic intraocular lens implant to correct presbyopia].

Science.gov (United States)

Baikoff, G; Matach, G; Fontaine, A; Ferraz, C; Spera, C

2005-03-01

Presbyopic surgery is considered as the new frontier in refractive surgery. Different solutions are proposed: myopization of one eye, insertion of an accommodative crystalline lens, scleral surgery, the effects of which are still unknown, and finally multifocal phakic implants. We therefore decided to undertake a prospective study under the Huriet law to determine its efficacy and specify the conditions required for an anterior chamber multifocal phakic implant. Fifty-five eyes of 33 patients received an anterior chamber foldable multifocal phakic implant. Twenty-one females and 12 males underwent surgery. Initial refraction was between -5D and +5D. The implant's single addition was +2.50. Recuperating a distant uncorrected visual acuity of 0.6 or better and near uncorrected vision of Parinaud 3 or better can be considered a very good postoperative result. Average follow-up was 42.6+/-18 weeks. Mean postoperative refraction was -0.12+/-0.51 D. Mean postoperative uncorrected visual acuity was 0.78+/-0.20. Postoperative uncorrected visual acuity was Parinaud 2.3+/-0.6. Eighty-four percent of eyes operated on recuperated 0.6 or better without correction and Parinaud 3 or better without correction. Lenses in four eyes were explanted for different reasons, essentially optical, and no severe anatomical complications were observed. Placing an anterior chamber multifocal phakic implant to correct presbyopia is an effective technique with good predictability and has the advantage of being reversible in case of intolerance, optical parasite effects or undesired complications. Considering the particularity of this surgery, it is imperative to respect very strict inclusion criteria: anterior chamber depth equal to or above 3.1 mm, open angle, endothelial cell count equal to or above 2000 cells/mm2, absence of an incipient cataract or the slightest evidence of macular alteration.

Retreatments after multifocal intraocular lens implantation: an analysis

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Gundersen KG

2016-03-01

Full Text Available Kjell Gunnar Gundersen,1 Sarah Makari,2 Steffen Ostenstad,1 Rick Potvin2 1Ifocus Eye Clinic, Haugesund, Norway; 2Science in Vision, Akron, NY, USA Purpose: To determine the incidence and etiology of required retreatment after multifocal intraocular lens (IOL implantation and to evaluate the methods and clinical outcomes of retreatment.Patients and methods: A retrospective chart review of 416 eyes of 209 patients from one site that underwent uncomplicated cataract surgery with multifocal IOL implantation. Biometry, the IOL, and refractive data were recorded after the original implantation, with the same data recorded after retreatment. Comments related to vision were obtained both before and after retreatment for retreated patients.Results: The multifocal retreatment rate was 10.8% (45/416 eyes. The eyes that required retreatment had significantly higher residual refractive astigmatism compared with those who did not require retreatment (1.21±0.51 D vs 0.51±0.39 D, P<0.01. The retreatment rate for the two most commonly implanted primary IOLs, blended bifocal (10.5%, 16/152 and bilateral trifocal (6.9%, 14/202 IOLs, was not statistically significantly different (P=0.12. In those requiring retreatment, refractive-related complaints were most common. Retreatment with refractive corneal surgery, in 11% of the eyes, and piggyback IOLs, in 89% of the eyes, was similarly successful, improving patient complaints 78% of the time.Conclusion: Complaints related to ametropia were the main reasons for retreatment. Residual astigmatism appears to be an important determinant of retreatment rate after multifocal IOL implantation. Retreatment can improve symptoms for a high percentage of patients; a piggyback IOL is a viable retreatment option. Keywords: piggyback IOL, Sulcoflex, toric, STAAR, symptoms, astigmatism

Intoxicaciones agudas en pediatría

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Yalena Prado Vizcaíno

2011-12-01

Full Text Available Introducción: las intoxicaciones han sido en los últimos años una importante causa de aumento de la morbilidad y mortalidad en edades pediátricas. Objetivo: determinar el comportamiento clínico de las intoxicaciones agudas en la etapa de enero de 2005 a diciembre de 2009 en el Hospital Pediátrico "William Soler". Métodos: el estudio se realizó en el Hospital "William Soler". Se revisaron las historias clínicas, los registros de intoxicaciones agudas y las tarjetas de codificación de egresos hospitalarios por intoxicaciones de los pacientes llegados al hospital en esta etapa. Resultados: se recibieron en el hospital 886 pacientes. El grupo de mayor frecuencia de intoxicaciones fue el de 1 a 5 años, con predominio del sexo masculino, aunque sin diferencias significativas con respecto al sexo femenino. Las intoxicaciones más frecuentes fueron por medicamentos, fundamentalmente psicofármacos y antibióticos, seguido por alimentos y por productos químicos del hogar. El 30,2 % de los casos fueron ingresados. Conclusiones: estos resultados nos hacen pensar en la necesidad de estar alertas y crear acciones encaminadas a proteger o evitar las intoxicaciones en edades tan vulnerables.

Bases moleculares de las leucemias agudas

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G. Martínez Antuña

2006-04-01

Full Text Available El gran desarrollo de la biología molecular en los últimos años ha contribuido a un importante avance en los conocimientos relacionados con las bases moleculares de las leucemias agudas (LA. Ademas de profundizar en la biología de estas enfermedades y conocer las bases moleculares, ha renido también gran impacto en mejorar el resultado de los tratamientos y disminuir la toxicidad de las terapias.

NGAL urinária em pacientes sem e com lesão renal aguda em unidade de terapia intensiva

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Mirian Watanabe

2014-12-01

Full Text Available Objetivo: Avaliar a eficácia diagnóstica e prognóstica da lipocalina associada à gelatinase neutrofílica urinária em pacientes de unidade de terapia intensiva. Métodos: Estudo do tipo coorte, prospectivo, longitudinal desenvolvido em uma unidade de terapia intensiva clínica especializada em cardiologia. Os pacientes foram estratificados segundo os grupos sem e com lesão renal aguda, acompanhados a partir das primeiras 24 horas de internação até a alta hospitalar ou óbito. A creatinina sérica, o fluxo urinário e a lipocalina associada à gelatinase neutrofílica urinária foram coletadas em dois períodos: 24 horas e 48 horas de admissão. Resultados: Foram avaliados 83 pacientes clínicos da unidade de terapia intensiva, com predomínio do gênero masculino (57,8%. Os pacientes foram agrupados em sem lesão renal aguda (N=18, com lesão renal aguda (N=28 ou com lesão renal aguda grave (N=37. Entre os pacientes com lesão renal aguda e lesão renal aguda grave, foram prevalentes os portadores de doenças crônicas, em uso de ventilação mecânica e em terapia de substituição renal, além daqueles com maiores taxas de permanência na unidade de terapia intensiva e hospitalar, e maior mortalidade. O grupo com lesão renal aguda não apresentou alteração significativa da creatinina sérica nas primeiras 24 horas na unidade de terapia intensiva, apesar dos níveis elevados de lipocalina associada à gelatinase neutrofilica urinária demonstrados nos grupos com lesão renal aguda e lesão renal aguda grave (p<0,001. Níveis elevados de lipocalina associada à gelatinase neutrofílica urinária na amostra foram associados ao óbito. Conclusão: A elevação nos níveis de lipocalina associada à gelatinase neutrofílica urinária antecede as variações da creatinina sérica em pacientes com lesão renal aguda e pode ser associada ao óbito.

Contactin-1 and Neurofascin-155/-186 Are Not Targets of Auto-Antibodies in Multifocal Motor Neuropathy.

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Kathrin Doppler

Full Text Available Multifocal motor neuropathy is an immune mediated disease presenting with multifocal muscle weakness and conduction block. IgM auto-antibodies against the ganglioside GM1 are detectable in about 50% of the patients. Auto-antibodies against the paranodal proteins contactin-1 and neurofascin-155 and the nodal protein neurofascin-186 have been detected in subgroups of patients with chronic inflammatory demyelinating polyneuropathy. Recently, auto-antibodies against neurofascin-186 and gliomedin were described in more than 60% of patients with multifocal motor neuropathy. In the current study, we aimed to validate this finding, using a combination of different assays for auto-antibody detection. In addition we intended to detect further auto-antibodies against paranodal proteins, specifically contactin-1 and neurofascin-155 in multifocal motor neuropathy patients' sera. We analyzed sera of 33 patients with well-characterized multifocal motor neuropathy for IgM or IgG anti-contactin-1, anti-neurofascin-155 or -186 antibodies using enzyme-linked immunosorbent assay, binding assays with transfected human embryonic kidney 293 cells and murine teased fibers. We did not detect any IgM or IgG auto-antibodies against contactin-1, neurofascin-155 or -186 in any of our multifocal motor neuropathy patients. We conclude that auto-antibodies against contactin-1, neurofascin-155 and -186 do not play a relevant role in the pathogenesis in this cohort with multifocal motor neuropathy.

Effect of multizone refractive multifocal contact lenses on standard automated perimetry.

Science.gov (United States)

Madrid-Costa, David; Ruiz-Alcocer, Javier; García-Lázaro, Santiago; Albarrán-Diego, César; Ferrer-Blasco, Teresa

2012-09-01

The aim of this study was to evaluate whether the creation of 2 foci (distance and near) provided by multizone refractive multifocal contact lenses (CLs) for presbyopia correction affects the measurements on Humphreys 24-2 Swedish interactive threshold algorithm (SITA) standard automated perimetry (SAP). In this crossover study, 30 subjects were fitted in random order with either a multifocal CL or a monofocal CL. After 1 month, a Humphrey 24-2 SITA standard strategy was performed. The visual field global indices (the mean deviation [MD] and pattern standard deviation [PSD]), reliability indices, test duration, and number of depressed points deviating at P0.5% on pattern deviation probability plots were determined and compared between multifocal and monofocal CLs. Thirty eyes of 30 subjects were included in this study. There were no statistically significant differences in reliability indices or test duration. There was a statistically significant reduction in the MD with the multifocal CL compared with monfocal CL (P=0.001). Differences were not found in PSD nor in the number of depressed points deviating at P0.5% in the pattern deviation probability maps studied. The results of this study suggest that the multizone refractive lens produces a generalized depression in threshold sensitivity as measured by the Humphreys 24-2 SITA SAP.

Comportamento da síndrome coronariana aguda: resultados de um registro brasileiro

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Leopoldo Soares Piegas

2013-06-01

Full Text Available FUNDAMENTO: O Brasil carece de registros multicêntricos publicados de síndrome coronariana aguda. OBJETIVO: O Registro Brasileiro de Síndrome Coronariana Aguda é um estudo multicêntrico nacional com objetivo de apresentar dados representativos das características clínicas, e manejo e evolução hospitalares dessa síndrome. MÉTODOS: Participaram 23 hospitais de 14 cidades. Foram elegíveis pacientes que se apresentaram com suspeita de síndrome coronariana aguda nas primeiras 24 horas, com quadro clínico sugestivo, associado a alterações eletrocardiográficas compatíveis e/ou marcadores de necrose. O seguimento foi realizado até o óbito ou a alta hospitalar. RESULTADOS: Entre os anos de 2003 e 2008, foram incluídos 2.693 pacientes com diagnóstico de síndrome coronariana aguda, sendo 864 (32,1% mulheres. O diagnóstico final foi de angina instável para 1.141 (42,4% pacientes, com mortalidade de 3,06% deles; de infarto agudo do miocárdio sem supradesnível de ST para 529 (19,6% pacientes, com mortalidade de 6,8% deles; e de infarto agudo do miocárdio com supradesnível de ST para 950 (35,3% pacientes, com mortalidade de 8,1% deles; tiveram diagnóstico não confirmado 73 (2,7% pacientes, com mortalidade de 1,36% deles. A mortalidade global foi de 5,53%. O modelo de regressão logística múltipla identificou o gênero feminino (OR=1,45, o diabetes melito (OR=1,59, o índice de massa corporal (OR=1,27 e a intervenção coronariana percutânea (OR=0,70 como fatores de risco de óbito, para demografia e intervenções. Um modelo para óbito por complicações maiores identificou choque cardiogênico/Edema Agudo de Pulmão (OR=4,57, reinfarto (OR=3,48, acidente vascular cerebral (OR=21,56, sangramento grave (OR=3,33, parada cardiorrespiratória (OR=40,27 e classe funcional de Killip (OR=3,37. CONCLUSÃO: Os dados do Registro Brasileiro de Síndrome Coronariana Aguda não diferem de outros coletados fora do país. Seus achados poder

Reading ability with pseudophakic monovision and with refractive multifocal intraocular lenses: comparative study.

Science.gov (United States)

Ito, Misae; Shimizu, Kimiya

2009-09-01

To the compare the reading ability after bilateral cataract surgery in patients who had pseudophakic monovision achieved by monofocal intraocular lens (IOL) implantation and patients who had refractive multifocal IOL implantation. Department of Ophthalmology, Kitasato University Hospital, Kanagawa, Japan. This study evaluated patients who had bilateral cataract surgery using the monovision method with monofocal IOL implantation to correct presbyopia (monovision group) or who had bilateral cataract surgery with refractive multifocal IOL implantation (multifocal group). In the monovision group, the dominant eye was corrected for distance vision and the nondominant eye for near vision. The maximum reading speed, critical character size, and reading acuity were measured binocularly without refractive correction using MNREAD-J acuity charts. The monovision group comprised 38 patients and the multifocal group, 22 patients. The mean maximum reading speed was 350.5 characters per minute (cpm) +/- 62.3 (SD) in the monovision group and 355.0 +/- 53.3 cpm in the multifocal group; the difference was not statistically significant. The mean critical character size was 0.24 +/- 0.12 logMAR and 0.40 +/- 0.16 logMAR, respectively (P<.05). The mean reading acuity was 0.05 +/- 0.12 logMAR and 0.19 +/- 0.11 logMAR, respectively (P<.01). The monovision group had better critical character size and reading acuity results. The monovision method group had better reading ability; however, careful patient selection is essential.

Multifocal tenosynovial giant cell tumors in a child with Noonan syndrome

Energy Technology Data Exchange (ETDEWEB)

Meyers, Arthur B. [Children' s Hospital of Wisconsin, Department of Radiology, Milwaukee, WI (United States); Nemours Children' s Health System/Nemours Children' s Hospital, Department of Radiology, Orlando, FL (United States); Awomolo, Agboola O. [Children' s Hospital of Wisconsin, Department of Radiology, Milwaukee, WI (United States); Szabo, Sara [Medical College of Wisconsin and Children' s Hospital of Wisconsin, Department of Pathology, Milwaukee, WI (United States); Cincinnati Children' s Hospital Medical Center, Division of Pathology and Laboratory Medicine, Cincinnati, OH (United States)

2017-03-15

Noonan syndrome is a genetic disorder with variable expression of distinctive facial features, webbed neck, chest deformity, short stature, cryptorchidism and congenital heart disease. The association of Noonan syndrome and giant cell granulomas of the mandible is widely reported. However, Noonan syndrome may also be associated with single or multifocal tenosynovial giant cell tumors, also referred to as pigmented villonodular synovitis. We report a child with Noonan syndrome, giant cell granulomas of the mandible and synovial and tenosynovial giant cell tumors involving multiple joints and tendon sheaths who was initially misdiagnosed with juvenile idiopathic arthritis. It is important for radiologists to be aware of the association of Noonan syndrome and multifocal giant cell lesions, which can range from the more commonly described giant cell granulomas of the mandible to isolated or multifocal intra- or extra-articular tenosynovial giant cell tumors or a combination of all of these lesions. (orig.)

Multifocal tenosynovial giant cell tumors in a child with Noonan syndrome.

Science.gov (United States)

Meyers, Arthur B; Awomolo, Agboola O; Szabo, Sara

2017-03-01

Noonan syndrome is a genetic disorder with variable expression of distinctive facial features, webbed neck, chest deformity, short stature, cryptorchidism and congenital heart disease. The association of Noonan syndrome and giant cell granulomas of the mandible is widely reported. However, Noonan syndrome may also be associated with single or multifocal tenosynovial giant cell tumors, also referred to as pigmented villonodular synovitis. We report a child with Noonan syndrome, giant cell granulomas of the mandible and synovial and tenosynovial giant cell tumors involving multiple joints and tendon sheaths who was initially misdiagnosed with juvenile idiopathic arthritis. It is important for radiologists to be aware of the association of Noonan syndrome and multifocal giant cell lesions, which can range from the more commonly described giant cell granulomas of the mandible to isolated or multifocal intra- or extra-articular tenosynovial giant cell tumors or a combination of all of these lesions.

Multifocal tenosynovial giant cell tumors in a child with Noonan syndrome

International Nuclear Information System (INIS)

Meyers, Arthur B.; Awomolo, Agboola O.; Szabo, Sara

2017-01-01

Noonan syndrome is a genetic disorder with variable expression of distinctive facial features, webbed neck, chest deformity, short stature, cryptorchidism and congenital heart disease. The association of Noonan syndrome and giant cell granulomas of the mandible is widely reported. However, Noonan syndrome may also be associated with single or multifocal tenosynovial giant cell tumors, also referred to as pigmented villonodular synovitis. We report a child with Noonan syndrome, giant cell granulomas of the mandible and synovial and tenosynovial giant cell tumors involving multiple joints and tendon sheaths who was initially misdiagnosed with juvenile idiopathic arthritis. It is important for radiologists to be aware of the association of Noonan syndrome and multifocal giant cell lesions, which can range from the more commonly described giant cell granulomas of the mandible to isolated or multifocal intra- or extra-articular tenosynovial giant cell tumors or a combination of all of these lesions. (orig.)

Tratamiento quirúrgico de las colecciones agudas y crónicas del pericardio

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Orestes Noel Mederos Curbelo

Full Text Available Introducción: las colecciones agudas o crónicas del pericardio con frecuencia producen una compresión del corazón que en los casos crónicos conlleva invalidez y, en los agudos, peligro de muerte por taponamiento cardíaco. Objetivo: caracterizar a los pacientes intervenidos quirúrgicamente en el Hospital Universitario "Comandante Manuel Fajardo" entre 1995 y 2012 a causa de colecciones pericárdicas. Métodos: se realizó un estudio descriptivo transversal con los pacientes atendidos quirúrgicamente en dicha institución por colecciones del pericardio. Constituyeron el universo 24 pacientes: 22 con colecciones agudas y 2 con colecciones crónicas. Resultados: la causa más frecuente de los derrames agudos fue la pericarditis aguda idiopática (25 %. Las colecciones crónicas fueron por pericarditis fibrosa de causa idiopática en el 100 % de los enfermos. La intervención realizada fue la resección del pericardio y el drenaje de las colecciones agudas mediante toracotomía izquierda o por vía preperitoneal subxifoidea. En las colecciones de origen maligno se realizó la resección pericárdica con fines paliativos y, en los derrames por lesión traumática del corazón, la sutura de este órgano fue el tratamiento quirúrgico empleado en todos los casos. En las pericarditis constrictivas, la pericardiectomía radical fue el tratamiento empleado en el 100 % de los casos. Conclusiones: el tratamiento quirúrgico en las colecciones agudas y crónicas del pericardio permite drenar el contenido por una ventana pericárdica obtenida por toracoscopia o por vía preperitoneal subxifoidea, mientras que la toracotomía izquierda es útil en las emergencias. En los derrames crónicos con fibrosis y síntomas de insuficiencia cardíaca, la pericardiectomía radical mediante esternotomía media ofrece los mejores resultados.

Multifocal chronic osteomyelitis of unknown etiology

International Nuclear Information System (INIS)

Kozlowski, K.; Masel, J.; Harbison, S.; Yu, J.; Royal Brisbane Children Hospital; Regional Hospital Bowral

1983-01-01

Five cases of chronic, inflammatory, multifocal bone lesions of unknown etiology are reported. Although bone biopsy confirmed osteomyelitis in each case in none of them were organisms found inspite of an extensive work up. Different clinical course of the disease reflects different aetiology in respective cases. These cases present changing aspects of osteomyelitis emerging since introduction of antibiotics. (orig.)

Nutrição na pancreatite aguda : monografia : Nutrition in acute pancreatitis

OpenAIRE

Oliveira, Joana da Silva

2009-01-01

Resumo da tese:A pancreatite aguda (PA) é uma doença inflamatória aguda do pâncreas de etiologia multifactorial e pode ter atingimento local (PA ligeira a moderada) ou sistémico (PA grave). A magnitude da lesão pancreática, a presença e extensão da necrose e de infecção determinam o grau de gravidade. Prever a gravidade é fundamental para direccionar antecipadamente a terapêutica médica e nutricional. Na sua maioria, os episódios de PA são ligeiros a moderados, de resolução espontânea, enquan...

A circular multifocal collimator for 3D SPECT imaging

International Nuclear Information System (INIS)

Guillemaud, R.; Grangeat, P.

1993-01-01

In order to improve sensitivity of 3D Single Photon Emission Tomography (SPECT) image, a cone-beam collimator can be used. A new circular multifocal collimator is proposed. The multiple focal points are distributed on a transaxial circle which is the trajectory of the focal points during the circular acquisition. This distribution provides a strong focusing at the center of the detector like a cone-beam collimator, with a good sensitivity, and a weak transaxial focusing at the periphery. A solution for an analytical multifocal reconstruction algorithm has been derived. Grangeat algorithm is proposed to use for this purpose in order to reconstruct with a good sensitivity the region of interest. (R.P.) 3 refs

Multifocal epithelioid hemangioendothelioma of the phalanges of the hand

International Nuclear Information System (INIS)

Bruegel, Melanie; Waldt, Simone; Woertler, Klaus; Rummeny, Ernst J.; Weirich, Gregor

2006-01-01

Epithelioid hemangioendothelioma (EH) of bone is a rare vascular neoplasm characterized by epithelioid endothelial cells and a variable biologic behaviour. The principal sites of occurrence of this osteolytic tumor are the lower extremity and the axial skeleton. Approximately half of the cases present with multifocal disease. The latter feature can be helpful in suggesting the diagnosis of a vascular tumor; on the other hand, it strengthens the need for a skeletal survey or whole-body MRI/CT. We report on the clinical, histologic and radiologic features - including CT and MRI findings - of EH in a case of multifocal disease of the phalanges of the hand, a very uncommon anatomic site of affliction. (orig.)

Research advances on multifocal electroretinogram in primary open angle glaucoma

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Feng-Fei Mo

2013-10-01

Full Text Available Primary open angle glaucoma is a chronic and progressive optic neuropathy. It can lead to serious damage of visual impairment, and it is an important eye disease of blindness. Multifocal electroretinogram is a new way to measure visual electrophysiology. It can measure electroretinogram of the whole visual field of many small parts in a relatively short period of time, and it can reflect the function of regional retina. It has an extremely important value for early diagnosis of primary open angle glaucoma. The research advances on multifocal electroretinogram in diagnosing primary open angle glaucoma were summarized in this paper.

Classificação de gravidade na pancreatite aguda

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Tercio De Campos

Full Text Available De acordo com a Classificação de Atlanta a pancreatite aguda pode ser dividida, baseado em sua severidade, em uma forma leve ou grave. Uma série de aspectos têm sido discutidos nos últimos anos, tais como, quantas categorias de gravidade devem ser consideradas; se o doente com falência orgânica é igual ao doente com necrose infectada; qual o papel da falência orgânica transitória; e como avaliar a falência orgânica. A reunião de revista"Telemedicina Baseada em Evidência - Cirurgia do Trauma e Emergência" (TBE-CiTE realizou uma avaliação crítica de artigos relacionados a este tema, considerando três artigos recentes que delinearam duas grandes revisões publicadas nos últimos meses. Estes artigos sugerem a classificação de gravidade em três ou quatro categorias, ao invés de pancreatite aguda leve ou grave, além de discutir qual o melhor escore para avaliar a falência orgânica. As seguintes recomendações foram propostas: (1 A pancreatite aguda deve ser classificada em quatro categorias: leve, moderada, grave e crítica, o que permite uma melhor determinação das características dos doentes; (2 Avaliação de falência orgânica com um escore de gravidade, preferencialmente algum que avalie diretamente cada falência orgânica, tais como o SOFA e o MODS (Marshall. O SOFA parece ter maior acurácia, mas o MODS tem melhor aplicabilidade devido à facilidade de uso.

Multifocal fibrosclerosis: a new case report and review of the literature

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Oguz, Kader Karli; Oguz, Oguzhan; Cila, Aysenur; Oto, Aytekin [Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara (Turkey); Kiratli, Hayyam [Department of Ophthalmology, Faculty of Medicine, Hacettepe University, Ankara (Turkey); Gokoz, Aytac [Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara (Turkey)

2002-05-01

A case of multifocal fibrosclerosis is presented with MR images. Bilateral sclerosing orbital pseudotumor invading cavernous sinuses were the presenting disorder. Magnetic resonance imaging showed involvement of paranasal sinuses bilaterally and multiple supratentorial dural masses. Retroperitoneal fibrosis was associated with the condition. Multifocal involvement should be considered in patients with sclerosing orbital pseudotumor and an imaging approach should be performed on the appropriate clinical condition to document possible coexistence of other disorders including retroperitoneal fibrosis, mediastinal fibrosis, sclerosing cholangitis, and Riedel's thyroiditis (orig.)

Detección molecular de las translocaciones más comunes en Leucemia aguda mediante RT-PCR

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L. García

2001-07-01

Full Text Available Evaluar la incidencia de las translocaciones t(4;11, t(1;19, t(9;22 y t(12;21 en leucemia linfoide aguda (LLA y t(15;17, t(8;21 e Inv.(16 en leucemia mieloide aguda (LMA. Correlacionar los resultados obtenidos con el diagnóstico morfológico y citogenético.

Multifocality as a prognostic factor in breast cancer patients registered in Danish Breast Cancer Cooperative Group (DBCG) 1996-2001

DEFF Research Database (Denmark)

Joergensen, L.E.; Gunnarsdottir, K.A.; Lanng, C.

2008-01-01

The purpose of this study was to investigate the prognostic influence of multifocality in breast cancer patients. In a cohort of 7196 patients there were 945 patients with multifocality. We found no prognostic influence of multifocality on overall survival when controlling for known prognostic......, Gunnarsdottir KA, Rasmussen BB, Moeller S, Lanng C. The prognostic influence of multifocality in breast cancer patients. Breast 2004;13:188-193]....... factors. We found a small but significant influence on disease-free survival (HR=1.16 [1.03-1.31]) and a strong correlation between multifocality and known prognostic factors. This was in accordance with an earlier study done on a smaller population and in a different period of time [Pedersen L...

MULTIFOCAL RETINAL INFILTRATES WITH PHLEBITIS AND OPTIC NEUROPATHY IN AN HIV-POSITIVE PEDIATRIC PATIENT.

Science.gov (United States)

Kasi, Sundeep K; Vora, Robin A; Martin, Taliva; Cunningham, Emmett T

2015-01-01

To describe an unusual presentation of bilateral HIV-associated multifocal retinal infiltrates with phlebitis and optic neuropathy in a pediatric patient from Zimbabwe, Africa. Retrospective case report of a 15-year-old boy from Zimbabwe, Africa. The patient was found to have bilateral vitritis, multifocal retinitis with phlebitis, and optic neuropathy in the setting of previously unrecognized HIV infection. Vision improved and the clinical findings resolved after treatment with intravenous corticosteroids and highly active retroviral therapy (HAART). The authors describe the occurrence and treatment of bilateral, HIV-associated multifocal retinal infiltrates with phlebitis and HIV-associated optic neuropathy in a pediatric patient from Zimbabwe, Africa.

Long-Term Visual Prognosis of Peripheral Multifocal Chorioretinitis

NARCIS (Netherlands)

Ossewaarde-van Norel, J; ten Dam-van Loon, NH; de Boer, JH; Rothova, A.

2015-01-01

Purpose To report on the clinical manifestations, complications, and long-term visual prognosis of patients with peripheral multifocal chorioretinitis and to search for predictors for a lower visual outcome. Design Retrospective consecutive observational case series. Methods setting: Institutional.

A Rare Case of Multifocal Prostatic Blue Nevus

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Elias J. Farran

2018-01-01

Full Text Available Prostatic blue nevus is a rare benign pathologic diagnosis most commonly diagnosed incidentally on many different types of prostate specimens. Blue nevus is the deposition of stromal melanin characterized by spindle cells within the fibromuscular stroma which stains positive for melanin-specific stains Fontana-Masson and S100 and stains negative for CD68, HMB45, and iron stains. We report the case of a multifocal and bilateral blue nevus in a 52-year-old Hispanic male who presented with an elevated prostate-specific antigen of 4.3 and mild obstructive lower urinary tract symptoms, found by transrectal ultrasound-guided prostate needle biopsy. The biopsy also revealed benign prostatic tissue with postatrophic hyperplasia and chronic inflammation. This is the 35th reported case of prostatic blue nevus and the third to show multifocal blue nevus.

Falla cardíaca aguda

OpenAIRE

Sénior Sánchez, Juan Manuel; Gándara Ricardo, Jairo Alfonso

2015-01-01

Se presenta el caso clínico de una mujer de 26 años de edad, que acudió al Hospital Universitario San Vicente Fundación (Medellín) con síntomas y signos de falla cardíaca aguda y diagnóstico previo de falla cardíaca crónica con fracción de expulsión disminuida, de origen no claro, tromboembolismo pulmonar y ataque cerebrovascular isquémico, sin modulación neurohormonal óptima. Ingresó a la institución con hallazgos clínicos de sobrecarga hídrica y baja perfusión tisular, con requerimiento de ...

Abdomen agudo ocasionado por apendicitis aguda de probable origen tuberculoso. Informe de un caso

OpenAIRE

Montiel-Jarquín, Álvaro José; Alvarado-Ortega, Iván; Romero-Figueroa, María del Socorro; Rodríguez-Pérez, Fabiola; Rodríguez-Lima, Felipe; Loria-Castellanos, Jorge

2017-01-01

RESUMEN Antecedentes: la apendicitis aguda tuberculosa es una enfermedad rara, constituye de 0,001 % a 0,01 % de las formas clínicas de tuberculosis. Se presenta un caso de apendicitis aguda probablemente tuberculosa como causa de abdomen agudo quirúrgico. Caso clínico: hombre de 29 años con cuadro de dolor abdominal leve a moderado que se intensificó y localizó en el hemiabdomen derecho, claudicación, febrícula, vómito, mal estado general, leucocitosis de 11 300/µL y neutrofilia de 91 %....

Intoxicaciones agudas graves en un servicio de medicina intensiva durante doce años

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Palazón Sánchez C

2000-01-01

Full Text Available Fundamento: Conocer la epidemiología de las intoxicaciones agudas graves en un servicio de medicina intensiva y evaluar el pronóstico de la PCR y mortalidad asociada a los distintos tóxicos Métodos: Estudio retrospectivo realizado en el servicio de medicina intensiva polivalente de 10 camas, ubicado en un Hospital General de adultos. Período de estudio 12 años. Revisión de las historias clínicas de las personas ingresadas en el servicio de medicina intensiva por intoxicaciones agudas graves. Se recogieron datos demográficos, existencia de PCR al ingreso, necesidad de VM, complicaciones de las intoxicaciones agudas graves y mortalidad de la serie. Se realizó un análisis global y por año de estudio. El tratamiento estadístico de los datos se realizó con el paquete SPSS mediante la "t" de Student o la "chi" cuadrado, considerando valores significativos si p<0,05 Resultados: Se han incluido 233 sujetos, de los que 130 fueron varones. La estancia media fue de 4 días. El 63% de los pacientes fueron menores de 40 años (p<0,05. La intoxicación más frecuente fue la medicamentosa debida a un solo producto (72%. La supervivencia tras la PCR fue del 40% (4/10. La mortalidad global se situó en el 5,6% (n=13, habiendo precisado el 92% de los sujetos que posteriormente murieron, VM en algún momento de su ingreso en la unidad de cuidados intensivos. Conclusiones: En nuestro medio, la intoxicación más frecuente es la medicamentosa. La mortalidad se muestra dependiente del carácter de voluntariedad, pero independiente del tipo de tóxico (medicamentoso o no. La PCR asociada a las intoxicaciones agudas graves tiene, en nuestra serie, un mejor pronostico que la asociada a otras patologías. La VM asociada a las intoxicaciones agudas graves tiene una mortalidad baja (15,7%

Dor aguda no joelho do paciente idoso Acute knee pain in elderly patients

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Gilberto Luís Camanho

2008-09-01

Full Text Available A dor aguda no joelho de pacientes idosos é freqüente, sendo caracterizada por seu aparecimento súbito, sem causa aparente, com exame radiográfico dentro dos padrões da normalidade, na maioria dos casos. A etiologia da dor aguda no joelho é decorrente de insuficiência das estruturas, e seu quadro clínico difere completamente daquele determinado pela osteoartrose, sendo sempre unilateral e ocorre na grande maioria em pacientes do sexo feminino, após a quinta década de vida, e na região medial do joelho (local de maior carga. Com o propósito de analisar as possíveis etiologias para a dor aguda do joelho de pacientes acima de 60 anos de idade, suas características e tratamento, os autores discutem as etiologias relacionadas à dor aguda: lesão meniscal, fratura por fadiga e osteonecrose idiopática.Acute knee pain in elderly patients is not uncommon, and is characterized by a sudden onset, no apparent cause, and by normal radiographic findings in most cases. The etiology of acute knee pain is the result of insufficient structures, and clinical symptoms are totally different from the symptoms seen in osteoarthrosis. This acute pain in the knee is always unilateral and in the medial region of the knee joint (site with the heaviest load, predominantly in females after the fifth decade of live. In order to consider the possible etiologies for acute knee joint pain in patients older than 60 years, its characteristics and treatment, the authors discuss etiologies related to acute pain: lesion of the meniscus, stress fracture, and idiopathic osteonecrosis.

Carambola como causa de lesão renal aguda

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Karilla Lany Scaranello

2014-04-01

Full Text Available A carambola pertence à família das Oxalidáceas, espécie Averrhoa carambola. É rica em sais minerais, vitaminas A, C, complexo B e ácido oxálico. Estudos recentes demonstram que a toxicidade da fruta difere entre os indivíduos e pode ser explicada pelas respostas biológicas individuais como idade, quantidade da ingestão, neurotoxinas em cada tipo de fruta. Adicionalmente, a nefrotoxicidade causada pela fruta é dose dependente, podendo levar ao desenvolvimento de lesão renal aguda pela deposição de cristais de oxalato de cálcio intratubular, assim como por lesão direta das células epiteliais tubulares, levando à apoptose das mesmas. Relatamos o caso de uma paciente que, após a ingestão do suco da fruta e fruta in natura, desenvolveu lesão renal aguda, necessitando de terapia dialítica, evoluindo com desfecho favorável e recuperação da função renal.

Ataxia cerebelar aguda na criança

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Valeriana Moura Ribeiro

1968-03-01

Full Text Available São relatados os casos de 6 crianças com ataxia cerebelar aguda. Admitem os autores a presença de um fator etiológico de caráter viral comum a todos êles, discutindo os mecanismos patogênicos com base nos casos da literatura. A evolução foi favorável em todos os pacientes, com regressão completa da sintomatologia, dentro do período de 6 a 60 dias.

Relación entre las infecciones respiratorias agudas altas y el asma bronquial

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Verónica Soler Fonseca

Full Text Available Introducción: la infección respiratoria es la enfermedad más frecuente en los seres humanos, pues es responsable de la mitad de todas las enfermedades agudas. En Cuba al igual que en el resto del mundo, el asma bronquial constituye un importante problema de salud con incidencia relevante en los niños. Se señala que las infecciones virales están involucradas en la patogénesis del asma, sobre todo en el paciente pediátrico. Objetivo: identificar la influencia de las Infecciones Respiratorias Agudas Altas en la aparición y exacerbación de las crisis de asma bronquial. Métodos: se realizó un estudio descriptivo, transversal y prospectivo de los pacientes ingresados con asma bronquial en el servicio de enfermedades respiratorias del Hospital Pediátrico Docente de San Miguel del Padrón, durante todo el año 2008. Resultados: el tiempo de evolución de la IRAA más frecuente que desencadenó la crisis de asma bronquial fue de más de 7 días, con un 54,8 %. Un total de 188 pacientes presentaron rinofaringitis aguda catarral relacionada con la aparición de la crisis de asma bronquial, lo que representó el 82,4 % del total de la muestra. Conclusiones: predominó el grupo de 1 a 4 años con manifestaciones respiratorias altas de posible etiología viral sin diferencias apreciables en relación con el sexo. La mayoría de los pacientes que participaron en el estudio presentaron IRAA de etiología viral (Rinofaringitis, que precedieron la aparición y exacerbación de las crisis agudas de asma bronquial.

Evaluation of refractive correction for standard automated perimetry in eyes wearing multifocal contact lenses

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Kazunori Hirasawa

2017-10-01

Full Text Available AIM: To evaluate the refractive correction for standard automated perimetry (SAP in eyes with refractive multifocal contact lenses (CL in healthy young participants. METHODS: Twenty-nine eyes of 29 participants were included. Accommodation was paralyzed in all participants with 1% cyclopentolate hydrochloride. SAP was performed using the Humphrey SITA-standard 24-2 and 10-2 protocol under three refractive conditions: monofocal CL corrected for near distance (baseline; multifocal CL corrected for distance (mCL-D; and mCL-D corrected for near vision using a spectacle lens (mCL-N. Primary outcome measures were the foveal threshold, mean deviation (MD, and pattern standard deviation (PSD. RESULTS: The foveal threshold of mCL-N with both the 24-2 and 10-2 protocols significantly decreased by 2.2-2.5 dB CONCLUSION: Despite the induced mydriasis and the optical design of the multifocal lens used in this study, our results indicated that, when the dome-shaped visual field test is performed with eyes with large pupils and wearing refractive multifocal CLs, distance correction without additional near correction is to be recommended.

Aspectos disautonômicos da porfiria aguda intermitente: a propósito de seis casos

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Charles P. Tilbery

1979-06-01

Full Text Available Foram estudados seis casos de porfiria aguda intermitente, sendo enfocados os aspectos disautonômicos apresentados durante a longa permanência hospitalar dos doentes (média de 64 dias. Foram observados taquicardia sinusal e hipertensão arterial (4 casos, parada cardíaca (3 casos e depressão respiratória (5 casos. Os autores tecem comentários a propósito da fisiopatologia destas alterações e chamam a atenção sobre o prognóstico sombrio da porfiria aguda intermitente.

O mosaico patogênico da pancreatite aguda grave

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Márcio Cavalcante Carneiro

Full Text Available A pancreatite aguda tem sido alvo de grandes discussões que vão desde o entendimento de sua fisiopatologia até a investigação de novas modalidades terapêuticas. Reconhece-se que a necrose pancreática e a falência orgânica múltipla - mormente associadas à infecção - representam os principais fatores determinantes da evolução para o óbito, mas, apesar dos grandes avanços em seu estudo, a doença permanece como um desafio para o clínico e o cirurgião. Deste modo, um melhor conhecimento dos mecanismos envolvidos em sua fisiopatologia pode ser a chave para um tratamento mais eficaz, principalmente em relação às formas graves, cuja letalidade ainda encontra-se substancialmente elevada. Baseado nestas considerações, o presente trabalho tem por objetivo a revisão bibliográfica da fisiopatologia, dos fatores patogênicos envolvidos na história natural da pancreatite aguda grave e dos eventos associados à síndrome da resposta inflamatória sistêmica e à sepse, esboçando-se assim o mosaico patogênico desta importante condição.

Caracterización epidemiológica de la descompensación aguda del asma bronquial

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Yanin Arteaga Prado

2013-08-01

Full Text Available Introducción: el asma bronquial tiene una compleja fisiopatología que involucra la presencia en el paciente de factores genéticos de atopia, mecanismos inmunológicos disfuncionales. Objetivo: caracterizar la asociación de diversos aspectos epidemiológicos con la aparición de descompensaciones agudas del asma bronquial. Material y método: se realizó un estudio descriptivo y transversal a 118 pacientes del área de dos consultorios médicos del Policlínico Universitario "Hermanos Cruz" de la Ciudad de Pinar del Río durante el primer trimestre del 2012. Se comparó el grupo de pacientes que presentaron descompensaciones de la enfermedad con el grupo de pacientes que no se descompensó. Se aplicó un cuestionario para explorar las variables de interés. Para verificar la asociación entre variables se utilizó el estadígrafo ji cuadrado para un valor de significación estadística á=0.05. Resultados: las descompensaciones agudas fueron casi dos veces más frecuentes en el sexo femenino. De manera muy significativa (Z=3,26 p<0,01 una tercera parte de los asmáticos de su enfermedad; las amas de casa y los estudiantes fueron los más afectados. Solo el 38,1 % de los asmáticos tuvo un adecuado seguimiento por un especialista (clínico, pediatra, alergólogo o inmunólogo y de estos solo el 11,1 % presentaron descompensaciones agudas, en tanto se descompensó un 39,7 % de los que no tienen seguimiento especializado. Conclusiones: la degradación de las condiciones de la vivienda favoreció la aparición de descompensaciones agudas del asma. En tres cuartas partes de las casas había animales domésticos, existiendo una fuerte asociación entre esta condición y la aparición de descompensaciones agudas del paciente asmático.

Evaluation of rotation and visual outcomes after implantation of monofocal and multifocal toric intraocular lenses.

Science.gov (United States)

Garzón, Nuria; Poyales, Francisco; de Zárate, Begoña Ortíz; Ruiz-García, Jose Luis; Quiroga, Juan Antonio

2015-02-01

To evaluate rotational stability and its influence on postoperative visual acuity of different monofocal and multifocal toric intraocular lenses (IOLs). A prospective interventional study was designed. Ninety-one patients with a mean age of 71.65 ± 11.82 years were implanted with toric IOLs after phacoemulsification. Three monofocal toric IOLs (the Lentis LT [Oculentis, Berlin, Germany], enVista [Bausch & Lomb, Rochester, NY], and AcrySof IQ [Alcon Laboratories, Inc., Fort Worth, TX]) and one multifocal toric IOL (AcrySof IQ ReSTOR; Alcon Laboratories, Inc.) were implanted. Preoperative and postoperative images were taken to calculate the misalignment due to the marking method. To evaluate rotation in the different follow-up visits, another photograph was taken 1 hour and 1, 7 and 30 days postoperatively. Refraction, uncorrected distance visual acuity (UDVA), and corrected distance visual acuity were measured 30 days postoperatively. Postoperative UDVA was 0.1 logMAR or better in 64.6% of eyes implanted with monofocal IOLs and 46.4% of eyes implanted with multifocal IOLs. The enVista toric IOL showed the best UDVA compared to the other monofocal IOLs, with 81% of eyes with 0.1 logMAR or better. The mean misalignment in the total group studied was 0.07° ± 0.60°; 69.6% of monofocal IOLs and 67.9% of multifocal IOLs showed less than 5° of rotation. A correlation was found between postoperative UDVA and rotation in the monofocal and multifocal IOLs implanted (r = 0.439 [P < .011] and = 0.787 [P = .001], respectively). At 1 month postoperatively, UDVA was slightly more affected by IOL rotation in multifocal than monofocal toric IOLs. The marking method was also effective. Copyright 2015, SLACK Incorporated.

Validity of automated refraction after segmented refractive multifocal intraocular lens implantation.

Science.gov (United States)

Albarrán-Diego, César; Muñoz, Gonzalo; Rohrweck, Stephanie; García-Lázaro, Santiago; Albero, José Ricardo

2017-01-01

To evaluate the clinical utility of automated refraction (AR) and keratometry (KR) compared with subjective or manifest refraction (MR) after cataract or refractive lens exchange surgery with implantation of Lentis Mplus X (Oculentis GmbH) refractive multifocal intraocular lens (IOL). Eighty-six eyes implanted with the Lentis Mplus X multifocal IOL were included. MR was performed in all patients followed by three consecutive AR measurements using the Topcon KR-8000 autorefractor. Assessment of repeatability of consecutive AR before and after dilation with phenylephrine 10%, and comparison of the AR and KR with MR using vector analysis were performed at 3mo follow-up. Analysis showed excellent repeatability of the AR measurements. Linear regression of AR versus MR showed good correlation for sphere and spherical equivalent, whereas the correlation for astigmatism was low. The mean difference AR-MR was -1.28±0.29 diopters (D) for sphere. Astigmatism showed better correlation between KR and MR. We suggest AR sphere plus 1.25 D and the KR cylinder as the starting point for MR in eyes with a Lentis Mplus X multifocal IOL. If AR measurements are equal to MR, decentration of the IOL should be suspected.

Sertralina e pancreatite aguda: relato de caso Sertraline and acute pancreatitis: a case-report

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André Malbergier

2004-03-01

Full Text Available A pancreatite aguda é uma patologia grave e com considerável morbidade e mortalidade. Vários fatores são apontados como possíveis causas de pancreatite aguda. Neste relato, será apresentado um caso de pancreatite aguda com possível associação causal com um inibidor seletivo de recaptura de serotonina: sertralina. Após um mês de tratamento com sertralina, uma paciente do sexo feminino, 55 anos, desenvolveu forte dor abdominal e elevação da amilase sérica. Após internação e retirada da sertralina, seus sintomas remitiram e os níveis de amilase voltaram ao normal. Pela potencial gravidade do quadro e pelo amplo uso desta medicação, tal associação deve ser lembrada em investigações de casos de pancreatite aguda.Acute pancreatitis is a severe disease with considerable morbidity and mortality. Many risk factors are causally related to acute pancreatitis. In this report, a case of acute pancreatitis with possible causal relationship with the use of a selective serotonin reuptake inhibitor, sertraline, will be discussed. After one month of treatment with sertraline, a female patient, 55 years-old, developed a severe abdominal pain and showed a serum amylase elevation. She was admitted to the hospital and the use of sertraline was interrupted. After that, the symptoms remitted and the serum amylase level returned to normal. Because of the potential severity of this disease and the widespread use of sertraline, this association should be reminded when investigating possible causes for acute pancreatitis.

Multifocal peritoneal splenosis in Tc-99m-labeled heat-denatured red blood cell scintigraphy

Energy Technology Data Exchange (ETDEWEB)

Yoon, Min Ki; Hwang, Kyung Hoon; Choe, Won Sick [Gachon University Gil Medical Center, Incheon (Korea, Republic of)

2006-06-15

A 44-year-old man with a past medical history of splenectomy came to hospital because of epigastric pain abdominopelvic computed tomography(CT) showed a soft tissue mass and multifocal variable-sized nodules as well as finding suggestive of cholecystitis. Subsequently, he underwent Tc-99m-labeled heat- denatured red blood cell(RBC) scintigraphy to evaluate the mass and nodules. The scintigraphy confirmed multifocal peritoneal splenosis in the abdominopelvic cavity.

Soporte nutricional en la insuficiencia renal aguda

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O. Cristina Olivos, Dra.

2010-07-01

Full Text Available La insuficiencia renal aguda (IRA se presenta frecuentemente en distintas condiciones clínicas y es especialmente frecuente en unidades de cuidados intensivos. La presencia de IRA se considera como un factor de riesgo independiente de morbilidad y mortalidad hospitalaria. De ahí la importancia de evaluar los diversos factores determinantes de su evolución, entre los que cuenta la desnutrición calórico-proteica. El propósito de esta revisión es analizar la literatura más relevante hasta la actualidad en este tema.

The Clinical and Molecular Characteristics of Adenocarcinoma Presented 
by Multi-focal GGO

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Yang SONG

2018-03-01

Full Text Available Due to emphasis on early screening for lung cancer, the detection rate of multiple ground glass opacities (GGOs on computed tomography (CT image increases in recent years, and research on multifocal adenocarcinomas presented by GGOs has been thriving. It is more common in women and non-smokers and has excellent prognosis both in patients with natural history and after surgery. These clinical features suggest that it is likely to be a distinct disease entity. From the perspective of molecular genetics, lesions in the same individual are likely to have distinct clonal features. Therefore, genetic heterogeneity is the most prominent feature of multifocal pulmonary adenocarcinomas with GGOs. The genetic heterogeneity is expected to assist the diagnosis of multifocal pulmonary adenocarcinoma and intrapulmonary metastasis, and also suggests that genetic testing of the GGO lesions is of great therapeutic significance. Some GGO lesions may harvest the similar clonal feature, which provide new evidence for the theory of spread through air spaces (STAS.

[The Clinical and Molecular Characteristics of Adenocarcinoma Presented 
by Multi-focal GGO].

Science.gov (United States)

Song, Yang; Liang, Naixin; Li, Shanqing

2018-03-20

Due to emphasis on early screening for lung cancer, the detection rate of multiple ground glass opacities (GGOs) on computed tomography (CT) image increases in recent years, and research on multifocal adenocarcinomas presented by GGOs has been thriving. It is more common in women and non-smokers and has excellent prognosis both in patients with natural history and after surgery. These clinical features suggest that it is likely to be a distinct disease entity. From the perspective of molecular genetics, lesions in the same individual are likely to have distinct clonal features. Therefore, genetic heterogeneity is the most prominent feature of multifocal pulmonary adenocarcinomas with GGOs. The genetic heterogeneity is expected to assist the diagnosis of multifocal pulmonary adenocarcinoma and intrapulmonary metastasis, and also suggests that genetic testing of the GGO lesions is of great therapeutic significance. Some GGO lesions may harvest the similar clonal feature, which provide new evidence for the theory of spread through air spaces (STAS).
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TOXICIDAD AGUDA DE Aleurites moluccana POR VIA ORAL EN RATAS SPRAGUE-DAWLEY

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Laura Rocío Orellana-Cuéllar

2014-12-01

Full Text Available Objetivo: Determinar la toxicidad aguda por Aleurites moluccana por administración oral en ratas Sprague-Dawley. Metodología: Estudio experimental realizado en el Instituto de Patología de la Facultad de Medicina-UNMSM. Se usaron treinta ratas Sprague-Dawley, hembras y machos, de 6 semanas de edad. Se formaron aleatoriamente tres grupos de diez ratas: grupo A1, recibió 8,2 mg/Kg de peso de A. moluccana; grupo  A2, recibió 2000 mg/Kg de peso de A. moluccana; grupo control, recibió agua ad libitum. Se evaluaron los signos clínicos de toxicidad, los pesos, variables bioquímicas y las características histopatológicas de hígado, riñón, corazón, intestino, bazo y gónadas. Se consideró significativo un p0,05. Los grupos  A1 y A2 presentaron signos clínicos de toxicidad y la muerte de tres ratas; células hepáticas binucleadas y regenerativas en el hígado; y hemorragia glomerular en el riñón. Conclusiones: Las variables clínicas e histopatológicas en hígado y riñón demostraron que la Aleurites moluccana produce toxicidad aguda, las variables bioquímicas no demostraron este efecto. Palabras Claves: Aleurites moluccana, Toxicidad aguda, Ratas Sprague-Dawley.

Síndrome coronariana aguda em paciente jovem com sintomas atípicos

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Gustavo Daher

2012-08-01

Full Text Available O diagnóstico da dor torácica aguda no setor de emergência pode ser difícil e desafiador, incluindo diversos diagnósticos diferenciais, dentre eles: causas benignas a causas potencialmente fatais. O diagnóstico na maioria das vezesé estabelecido através do quadro clínico e de exames complementares como: marcadores de necrose miocárdica, eletrocardiograma e radiografia de tórax.A angiotomografia coronariana tem sido utilizada nos casos de dor torácica aguda com baixa ou intermediária probabilidade de síndrome coronariana aguda, permitindo sua exclusão e conseqüente alta precoce dos pacientes. Apresentamosrelato de caso de uma paciente jovem com dor precordial atípica e marcadores de necrose miocárdica discretamente elevados. Considerando-se a epidemiologia e o quadro clínico da paciente, foi feita hipótese diagnóstica inicial de miocardite. A angiotomografia cardíaca com pesquisa de realce tardiofoi solicitada. Apesar do escore de cálcio ter sido zero, foi diagnosticada lesão estenosante grave no terço médio da artéria coronária descendente anterior com realce tardio na parede anterior do ventrículo esquerdo, compatível comnecrose miocárdica. A paciente foi submetida a cateterismo com angioplastia da lesão.

Determining the origin of synchronous multifocal bladder cancer by exome sequencing

International Nuclear Information System (INIS)

Acar, Ömer; Özkurt, Ezgi; Demir, Gulfem; Saraç, Hilal; Alkan, Can; Esen, Tarık; Somel, Mehmet; Lack, Nathan A.

2015-01-01

Synchronous multifocal tumours are commonly observed in urothelial carcinomas of the bladder. The origin of these physically independent tumours has been proposed to occur by either intraluminal migration (clonal) or spontaneous transformation of multiple cells by carcinogens (field effect). It is unclear which model is correct, with several studies supporting both hypotheses. A potential cause of this uncertainty may be the small number of genetic mutations previously used to quantify the relationship between these tumours. To better understand the genetic lineage of these tumours we conducted exome sequencing of synchronous multifocal pTa urothelial bladder cancers at a high depth, using multiple samples from three patients. Phylogenetic analysis of high confidence single nucleotide variants (SNV) demonstrated that the sequenced multifocal bladder cancers arose from a clonal origin in all three patients (bootstrap value 100 %). Interestingly, in two patients the most common type of tumour-associated SNVs were cytosine mutations of TpC* dinucleotides (Fisher’s exact test p < 10 −41 ), likely caused by APOBEC-mediated deamination. Incorporating these results into our clonal model, we found that TpC* type mutations occurred 2-5× more often among SNVs on the ancestral branches than in the more recent private branches (p < 10 −4 ) suggesting that TpC* mutations largely occurred early in the development of the tumour. These results demonstrate that synchronous multifocal bladder cancers frequently arise from a clonal origin. Our data also suggests that APOBEC-mediated mutations occur early in the development of the tumour and may be a driver of tumourigenesis in non-muscle invasive urothelial bladder cancer. The online version of this article (doi:10.1186/s12885-015-1859-8) contains supplementary material, which is available to authorized users

Cerebelite aguda causada por vírus Epstein-Barr: relato de caso

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Teive Hélio A.G.

2001-01-01

Full Text Available A cerebelite aguda pode ocorrer em associação a infecção pelo vírus da varicela-zoster, enterovirus, caxumba, micoplasma e outros agentes infecciosos. A cerebelite aguda é uma complicação rara da infecção pelo vírus Epstein-Barr (EBV. Relatamos o caso de uma mulher de 21 anos com história de 12 dias de evolução com náuseas, vômitos, ataxia de marcha e membros, tremor cefálico e de membros, opsoclono, mioclonias e rash cutâneo. Sorologia para EBV foi positiva. A infecção pelo EBV, com complicações neurológicas, pode não se apresentar com os sinais e sintomas clássicos da mononucleose infeciosa.

Insuficiencia renal aguda en pacientes de la Unidad de Cuidados Intensivos, Hospital Regional de Cuilapa, Santa Rosa, Guatemala

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Ronald J. Ajcalon

2017-03-01

Full Text Available La insuficiencia renal aguda, es una condición común en la Unidad de Cuidados Intensivos de Adultos (UCIA y probablemente una consecuencia de la enfermedad crítica que se asocia a resultados clínicos adversos, altos costos y una mortalidad de más del 50%, sobre todo si se requiere tratamiento de reemplazo renal. El objetivo fue determinar la incidencia de insuficiencia renal aguda en pacientes ingresados a la UCIA. El estudio fue prospectivo, longitudinal, observacional, en 101 pacientes ingresados en la UCIA del Hospital Regional de Cuilapa. Se diagnosticaron 101 pacientes durante el periodo de estudio con insuficiencia renal aguda represento el 27.4% del total de pacientes internados (368 en el servicio en un año. La incidencia de mortalidad en pacientes que requieren terapia de reemplazo renal y se encuentran en ventilación mecánica es del 100%. Del total de pacientes estudiados, según la escala Akin, se encontró que el 49.5% de los pacientes correspondían a grado II, aunque el grado I también fue frecuente (29%, y que el 22 % de los pacientes correspondían a grado III. La patología que mayormente se asoció al desarrollo de insuficiencia renal aguda fue sepsis grave con un 31%, seguido de pacientes sometidos a cirugía mayor e hipovolemia con el 21 y 18% respectivamente. Se halló una incidencia aumentada de insuficiencia renal aguda comparado con estadísticas internacionales, cuya etiología fue mayormente causada por procesos sépticos.

Unusually high incidence of multifocal epithelial hyperplasia in children of the Nahuatl population of Mexico.

Science.gov (United States)

Ledesma-Montes, Constantino; Mendez-Mendoza, Amilcar

2017-01-01

Multifocal epithelial hyperplasia is an uncommon disease of the oral mucosa caused by the human papilloma virus. To study the clinical and pathological findings of multifocal epithelial hyperplasia detected during an oral examination of 343 Mexican Nahuatl children from a single primary school in El Paso de Cupilco, Mexico. A thorough oral examination was performed in all children and clinical data (age, gender, location and number of lesions) were documented and analyzed. Multifocal epithelial hyperplasia was diagnosed in 110 of the 343 children (32.3%). The ages of the children varied from 5 to 15 years, and of these, 56.3% were girls. The lesions were asymptomatic, 0.2 to 3.0 cm in diameter, soft, round to oval, smooth surfaced, sessile papulonodules, similar in colour to that of the surrounding mucosa. The lesions were commonly seen on the buccal mucosa and tongue, and most affected children (85%) had less than 5 lesions. Children in the 7 to 10 years age group were most often affected. Human papillomavirus typing was not done owing to a lack of facilities. There is a high incidence of multifocal epithelial hyperplasia in Nahuatl children with a predilection for females.

Basic characterization of normal multifocal electroretinogram

International Nuclear Information System (INIS)

Fernandez Cherkasova, Lilia; Rojas Rondon, Irene; Castro Perez, Pedro Daniel; Lopez Felipe, Daniel; Santiesteban Freixas, Rosaralis; Mendoza Santiesteban, Carlos E

2008-01-01

A scientific literature review was made on the novel multifocal electroretinogram technique, the involved cell mechanisms and some of the factors modifying its results together with the form of presentation. The basic characteristics of this electrophysiological record obtained from several regions of the retina of normal subjects is important in order to create at a small scale a comparative database to evaluate pathological eye tracing. All this will greatly help in early less invasive electrodiagnosis of localized retinal lesions. (Author)

Optical implementation of multifocal programmable lens with single and multiple axes

Energy Technology Data Exchange (ETDEWEB)

Romero, Lenny A; Millan, Maria S; Perez-Cabre, Elisabet, E-mail: lenny.alexandra.romero@upc.edu [Optics and Optometry Dep. Technical University of Catalonia Violinista Vellsola 37, 08222 Terrassa (Spain)

2011-01-01

In this work we analyse the generation of a diffractive optical element (DOE) consisting of a multifocal Fresnel lens by means of an LCoS (liquid cristal on silicon) spatial light modulator (SLM). The multifocal lens is composed of a set of lenses of different focal length that share a common optical axis (coaxial combination) or have different axes in parallel (multi-axis combination). For both configurations, we present several ways to combine the phase distributions for three lenses with different focal lengths (f1, f2, f3), into a single-phase distribution addressed to the SLM. Numerical simulations were carried out along with the experimental analysis to corroborate the results.

Effect of hyperthermia on experimental acute pancreatitis Efeito da hipertermia na pancreatite aguda experimental

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José Luiz Jesus de Almeida

2006-12-01

Full Text Available BACKGROUD: Recent studies indicate that hyperthermia can change inflammatory mechanisms and protect experimental animals from deleterious effects of secretagogue-induced acute pancreatitis AIM: To evaluate the effects of hyperthermia post-treatment on cerulein-induced acute pancreatitis in rats METHODS: Twenty animals were divided in two groups: group I (n = 10, rats with cerulein-induced acute pancreatitis undergone hyperthermia, and group II (n = 10, animals with cerulein-induced acute pancreatitis that were kept normothermic. In all groups, amylase serum levels, histologic damage, vascular permeability and pancreatic water content were assessed. Acute pancreatitis was induced by administration of two cerulein injections (20 mcg/kg. A single dose of Evans' blue dye was administered along with the second dose of cerulein. All animals also received a subcutaneous injection of saline solution. After this process, animals undergone hyperthermia were heated in a cage with two 100 W lamps. Body temperature was increased to 39.5ºC and maintained at that level for 45 minutes. Normothermia rats were kept at room temperature in a second cage RESULTS: Control animals had typical edema, serum amylase activity and morphologic changes of this acute pancreatitis model. Hyperthermia post-treatment ameliorated the pancreatic edema, whereas the histologic damage and the serum amylase level remained unchanged CONCLUSIONS: The findings suggest a beneficial effect of the thermal stress on inflammatory edema in experimental acute pancreatitis.RACIONAL: Estudos recentes indicam que a hipertermia pode modificar mecanismos inflamatórios e proteger animais experimentais dos efeitos deletérios da pancreatite aguda induzida por secretagogos OBJETIVO: Avaliar a eficácia da hipertermia como tratamento da pancreatite aguda induzida por ceruleína em ratos MÉTODOS: Vinte animais foram divididos em dois grupos: grupo I (n = 10, ratos com pancreatite aguda induzida por

Clinical and patient-reported outcomes of bilateral implantation of a +2.5 diopter multifocal intraocular lens.

Science.gov (United States)

Maxwell, Andrew; Holland, Edward; Cibik, Lisa; Fakadej, Anna; Foster, Gary; Grosinger, Les; Moyes, Andrew; Nielsen, Stephen; Silverstein, Steven; Toyos, Melissa; Weinstein, Arthur; Hartzell, Scott

2017-01-01

To assess the effectiveness and safety of a multifocal intraocular lens (IOL) with +2.5 diopter (D) additional power compared with a monofocal IOL. Fifteen sites in the United States. Prospective randomized patient- and observer-masked clinical trial. Randomized patients received multifocal or monofocal IOLs bilaterally. Visual acuity (33 cm, 40 cm, 53 cm, 60 cm, 4 m) was measured; safety was assessed through adverse event rates. Patient-reported visual outcomes were evaluated using the Visual Tasks questionnaire. The frequency and severity of visual disturbances were evaluated using the Assessment of Photic Phenomena and Lens EffectS questionnaire. The multifocal IOL (n = 155) provided better corrected distance visual acuity at 53 cm than the monofocal IOL (n = 165) (0.322 versus 0.512 logMAR; between-group difference, -0.190 logMAR; P < .0001) and 40 cm but not at 4 m. Ocular adverse event rates were less than 3.84% in both groups. Serious adverse event rates were comparable between the 2 IOL types. Patients with multifocal IOLs reported less difficulty with near tasks (with and without correction) and intermediate tasks (without correction). Difficulty with extended-intermediate and distance tasks was similar between groups. The most frequently reported self-rated severe phenomena were halos, starbursts, and glare. Most patients (monofocal ≥72%; multifocal ≥73%) reported never experiencing blurred, distorted, or double vision. The +2.5 D multifocal IOL provided better vision at 40 cm and 53 cm and similar vision at 4 m compared with the monofocal IOL. Safety profiles and visual phenomena were comparable between groups. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

A Rare Multifocal Pattern of Type 2 Autoimmune Pancreatitis with Negative IgG4: A Potential Diagnostic Pitfall That May Mimic Multifocal Pancreatic Adenocarcinoma

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Partha Hota

2018-02-01

Full Text Available Autoimmune pancreatitis (AIP is an increasingly recognized form of acute pancreatitis characterized by obstructive jaundice with a rapid and dramatic treatment response to steroid therapy. Recently, AIP has been divided into two distinct phenotypes: lymphoplasmocytic sclerosing pancreatitis AIP (type 1 and idiopathic duct-centric pancreatitis AIP (type 2; each of which have their own distinct demographics, diagnostic criteria, and histopathological features. We report, to the best of our knowledge, the first case of a multifocal pattern of type 2 AIP characterized with both CT and MR imaging. This rare imaging pattern of AIP may mimic the appearance of more worrisome malignant etiologies such as multifocal pancreatic adenocarcinoma or lymphoma, with overlapping imaging characteristics potentially complicating or delaying diagnosis. Therefore, recognition of this atypical pattern of AIP and avoidance of this potential diagnostic pitfall is crucial.

Multifocal Langerhans cell sarcoma involving epidermis: a case report and review

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Wang Changsong

2012-08-01

Full Text Available Abstract Objective To study the clinico-pathological characteristics of Langerhans cell sarcoma (LCS which involving epidermis. Methods A case of primary multifocal LCS was analyzed in histopathology and immunophenotype. Results A 41-year-old man with multifocal cutaneous LCS involving the inguina and waist was reported. Clinical and pathology data were available. Neoplastic cells with markedly malignant cytological features were observed. Tumor cells exhibited irregular shape with abundant and eosinophilic red staining cytoplasm; large, irregular-shaped, showing lobulated or dented nucleus and some cells with a longitudinal nuclear groove and prominent nucleoli. The tumor cells expressed CD1a, Langerin (CD207, S-100 protein, CD68 and vimentin, and did not express pan-T or B cell markers and epithelial markers. The patient died less than 1 year after diagnosis due to local recurrence and metastasis to the lung, despite the administration of local radiation and chemotherapy. Conclusions LCS is a tumor with markedly malignant cytological features that originates from Langerhans cells. Primary multifocal neoplasms involving epidermis is even rare. Accurate diagnosis is based on the histopathological and immunohistochemical of the tumor cells. Virtual slide The virtual slide(s for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1182345104754765.

Validity of automated refraction after segmented refractive multifocal intraocular lens implantation

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César Albarrán-Diego

2017-11-01

Full Text Available AIM: To evaluate the clinical utility of automated refraction (AR and keratometry (KR compared with subjective or manifest refraction (MR after cataract or refractive lens exchange surgery with implantation of Lentis Mplus X (Oculentis GmbH refractive multifocal intraocular lens (IOL. METHODS: Eighty-six eyes implanted with the Lentis Mplus X multifocal IOL were included. MR was performed in all patients followed by three consecutive AR measurements using the Topcon KR-8000 autorefractor. Assessment of repeatability of consecutive AR before and after dilation with phenylephrine 10%, and comparison of the AR and KR with MR using vector analysis were performed at 3mo follow-up. RESULTS: Analysis showed excellent repeatability of the AR measurements. Linear regression of AR versus MR showed good correlation for sphere and spherical equivalent, whereas the correlation for astigmatism was low. The mean difference AR-MR was -1.28±0.29 diopters (D for sphere. Astigmatism showed better correlation between KR and MR. CONCLUSION: We suggest AR sphere plus 1.25 D and the KR cylinder as the starting point for MR in eyes with a Lentis Mplus X multifocal IOL. If AR measurements are equal to MR, decentration of the IOL should be suspected.

Indocyanine Green Angiographic and Multifocal Electroretinographic Features in the Diffuse and Regional Form of Bietti′s Crystalline Retinopathy

Institute of Scientific and Technical Information of China (English)

Libin Jiang; Feng Wen; Lezheng Wu; Hong Yan; Shixing Hu

2002-01-01

Prpose: To observe different features of indocyanine green angiography(ICGA) andtifocal electroretinography (ERG) in the diffuse and regional type of Bieti′sc stalline retinopathy (BCR). Thods: ICGA and the multifocal ERG were performed in two cases of the diffuse andregional type of BCR respectively. These data were compared with fluoresceinangiography (FA), standard Ganzfeld ERG, and visual field testing. Results: In the regional case, ICGA revealed reduced perfusion of the choroidalcirculation in the early phase and multiple hypofluorescent spots in the posterior pole in the late phase, due to choriocapillaris filling defect; the extent of choroiocapillaris losswas shown in early phase of ICGA and there were multifocal hyperfluorescent dotssurrounding hypofluorescent spots in late phase in the diffuse case. The multifocal ERGshowed that the central responses were markedly depressed, corresponding to the visualfield defects, while the findings of Ganzfeld ERG were normal in the regional BCR;however, both the multifocal ERG and Ganzfeld ERG were severely subnormal in thediffuse case.Conclusions: The features of ICGA and multifocal ERG are different between the diffuseand regional BCR. In the meantime, the two tools are also useful to differentiate the typeand assess the extentof evolution in BCR.

Miopia aguda induzida por topiramato: relato de dois casos

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Kathy Dadam Sgrott

2011-06-01

Full Text Available RESUMO A miopia aguda pode ser desencadeada pelo uso de medicações sistêmicas, dentre elas, o anticonvulsivante topiramato. Este trabalho descreve dois casos de pacientes jovens com quadro agudo bilateral de miopia induzida por terapia com topiramato para controle de síndrome depressiva, fazendo relação com casos semelhantes descritos na literatura e revisão bibliográfica pertinente.

Infarto esplénico secundario a pancreatitis aguda Splenic infarction secondary to acute pancreatitis

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J. J. Arenal Vera

2008-05-01

Full Text Available Fundamento y objetivo: la estrecha relación anatómica del páncreas con los vasos esplénicos y el bazo es responsable de complicaciones esplénicas en el curso de la pancreatitis aguda. El objetivo es presentar dos casos clínicos de pancreatitis aguda grave que sufrieron infarto esplénico como complicación de la enfermedad pancreática. Pacientes, participantes: en un periodo de tres meses, dos pacientes fueron diagnosticados de infarto esplénico secundario a pancreatitis aguda. En ambos casos el diagnóstico y seguimiento evolutivo del infarto esplénico se hizo a través de tomografía axial computerizada. Resultados: en el primer paciente, las imágenes muestran de forma inequívoca la afectación de la arteria esplénica por el proceso inflamatorio pancreático. En el segundo, no se pudo demostrar afectación de los vasos esplénicos, por lo que la única posible explicación etiológica es un incremento de coagulabilidad intravascular. Conclusiones: sería recomendable añadir las complicaciones esplénicas al conjunto de complicaciones graves extrapancreáticas de la pancreatitis aguda. La tomografía axial computerizada es de gran utilidad para la detección y seguimiento de las complicaciones esplénicas de la pancreatitis aguda.Background and objective: the close anatomic relationship of the pancreas with the splenic vessels and the spleen is responsible for splenic complications in the course of acute pancreatitis. Our objective was to report two cases of severe acute pancreatitis complicated by splenic infarction. Patients: in a three-month period of time two patients were diagnosed with splenic infarction secondary to acute pancreatitis. In both cases splenic infarction diagnosis and follow-up were carried out using computed tomography. Results: in the first case images clearly showed a narrowing of the splenic artery due to the inflammatory pancreatic condition. In the second case no involvement of the splenic vessels could

Predictability of uncontrollable multifocal seizures - towards new treatment options

Science.gov (United States)

Lehnertz, Klaus; Dickten, Henning; Porz, Stephan; Helmstaedter, Christoph; Elger, Christian E.

2016-04-01

Drug-resistant, multifocal, non-resectable epilepsies are among the most difficult epileptic disorders to manage. An approach to control previously uncontrollable seizures in epilepsy patients would consist of identifying seizure precursors in critical brain areas combined with delivering a counteracting influence to prevent seizure generation. Predictability of seizures with acceptable levels of sensitivity and specificity, even in an ambulatory setting, has been repeatedly shown, however, in patients with a single seizure focus only. We did a study to assess feasibility of state-of-the-art, electroencephalogram-based seizure-prediction techniques in patients with uncontrollable multifocal seizures. We obtained significant predictive information about upcoming seizures in more than two thirds of patients. Unexpectedly, the emergence of seizure precursors was confined to non-affected brain areas. Our findings clearly indicate that epileptic networks, spanning lobes and hemispheres, underlie generation of seizures. Our proof-of-concept study is an important milestone towards new therapeutic strategies based on seizure-prediction techniques for clinical practice.

Imaging manifestations of progressive multifocal leukoencephalopathy

International Nuclear Information System (INIS)

Shah, R.; Bag, A.K.; Chapman, P.R.; Cure, J.K.

2010-01-01

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease caused by reactivation of JC virus in immunosuppressed patients. The diagnosis is usually suggested on imaging and confirmed by cerebrospinal fluid polymerase chain reaction (PCR) for JC virus DNA. In this article, we review the imaging manifestations of PML on computed tomography (CT), magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), MR spectroscopy, single photon-emission computed tomography (SPECT) and positron-emission tomography (PET), and outline the role of imaging in follow-up and prognostication.

[Clinical results after implantation of a new segmental refractive multifocal intraocular lens].

Science.gov (United States)

Thomas, B C; Auffarth, G U; Philips, R; Novák, J; Blazek, J; Adamkova, H; Rabsilber, T M

2013-11-01

The aim of the study was a clinical evaluation of an intraocular lens (IOL) with a segmental multifocal optic design and near addition of + 3.0 D as part of a CE approval study. In a multicenter study the LENTIS Mplus LS-312 MF IOL (Oculentis) was implanted in 134 eyes of 79 patients with a mean age of 68 ± 12 years. The multifocality is achieved by implementation of a distance part and a segmented near sector. Three months after surgery, uncorrected and best corrected distance visual acuity (UCDVA and BCDVA, respectively), near visual acuity (UCNVA and BCNVA, respectively), contrast vision and patient satisfaction (questionnaire) were evaluated. The IOLs were implanted uneventfully either unilaterally or bilaterally and 3 months postoperatively (n = 86 eyes) the following mean visual acuities were obtained (logMAR): UCDVA = 0.05, BCDVA = - 0.01, UCNVA = 0.09 and BCNVA = 0.02. Contrast sensitivity (n = 25 eyes) was within normal limits. Of the 66 questioned patients 10.6% spontaneously reported halos and 3% glare. This new innovative multifocal IOL concept showed very good functional results as well as high patient satisfaction.

Chest wall resection for multifocal osseous haemangioma.

Science.gov (United States)

Weinandt, Marthe; Legras, Antoine; Mordant, Pierre; Le Pimpec Barthes, Françoise

2016-02-01

Intraosseous haemangioma is a rare and benign primary tumour of the bone. We report the case of a 76-year old woman who presented the exceptional condition of multifocal cavernous haemangiomas involving the spine and the ribs, requiring spinal and chest wall resections to confirm the diagnosis and treat the symptoms. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

N-3 Polyunsaturated Fatty Acids of Marine Origin and Multifocality in Human Breast Cancer.

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Lobna Ouldamer

Full Text Available The microenvironment of breast epithelial tissue may contribute to the clinical expression of breast cancer. Breast epithelial tissue, whether healthy or tumoral, is directly in contact with fat cells, which in turn could influence tumor multifocality. In this pilot study we investigated whether the fatty acid composition of breast adipose tissue differed according to breast cancer focality.Twenty-three consecutive women presenting with non-metastatic breast cancer underwent breast-imaging procedures including Magnetic Resonance Imaging prior to treatment. Breast adipose tissue specimens were collected during breast surgery. We established a biochemical profile of adipose tissue fatty acids by gas chromatography. We assessed whether there were differences according to breast cancer focality.We found that decreased levels in breast adipose tissue of docosahexaenoic and eicosapentaenoic acids, the two main polyunsaturated n-3 fatty acids of marine origin, were associated with multifocality.These differences in lipid content may contribute to mechanisms through which peritumoral adipose tissue fuels breast cancer multifocality.

N-3 Polyunsaturated Fatty Acids of Marine Origin and Multifocality in Human Breast Cancer.

Science.gov (United States)

Ouldamer, Lobna; Goupille, Caroline; Vildé, Anne; Arbion, Flavie; Body, Gilles; Chevalier, Stephan; Cottier, Jean Philippe; Bougnoux, Philippe

2016-01-01

The microenvironment of breast epithelial tissue may contribute to the clinical expression of breast cancer. Breast epithelial tissue, whether healthy or tumoral, is directly in contact with fat cells, which in turn could influence tumor multifocality. In this pilot study we investigated whether the fatty acid composition of breast adipose tissue differed according to breast cancer focality. Twenty-three consecutive women presenting with non-metastatic breast cancer underwent breast-imaging procedures including Magnetic Resonance Imaging prior to treatment. Breast adipose tissue specimens were collected during breast surgery. We established a biochemical profile of adipose tissue fatty acids by gas chromatography. We assessed whether there were differences according to breast cancer focality. We found that decreased levels in breast adipose tissue of docosahexaenoic and eicosapentaenoic acids, the two main polyunsaturated n-3 fatty acids of marine origin, were associated with multifocality. These differences in lipid content may contribute to mechanisms through which peritumoral adipose tissue fuels breast cancer multifocality.

Nonsyndromic Synchronous Multifocal Central Giant Cell Granulomas of the Maxillofacial Region: Report of a Case.

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Anita Munde

2015-04-01

Full Text Available Central giant cell granuloma (CGCG is a benign proliferation of fibroblasts and multinucleated giant cells that almost exclusively occurs in the jaws. It commonly occurs in young adults showing a female predilection in the anterior mandible. Multifocal CGCGs in maxillofacial region are very rare and suggestive of systemic diseases such as hyperparathyroidism, an inherited syndrome such as Noonan-like multiple giant cell lesion syndrome or other disorders. Only 10 cases of multifocal CGCGs in the maxillofacial region without any concomitant systemic disease have been reported in the English literature. Here, we report an unusual case of 36 year-old female presented with non-syndromic synchronous, multifocal CGCGs in the left posterior mandible and left posterior maxilla without any concomitant systemic disease. Relevant literature is reviewed and the incidence, clinical features, radiological features, differential diagnosis and management of CGCGs are discussed.

Multifocal Synchronous Granular Cell Tumors of the Gastrointestinal Tract

OpenAIRE

Lipkin-Moore, Zachary; Thomas, Rebecca M.; Rothstein, Robin D.

2014-01-01

Granular cell tumors (GCT) are rare and unusual tumors, which are usually benign and asymptomatic. Only 5?10% of cases involve the gastrointestinal tract, most commonly as singular, non-cancerous lesions in the esophagus. We report a rare case of symptomatic, multifocal, synchronous GCT involving the esophagus, stomach, and cecum.

The multifocal electroretinogram (mfERG) in the pig

DEFF Research Database (Denmark)

Voss Kyhn, Maria; Kiilgaard, Jens Folke; Lopez, Ana Garcia

2007-01-01

To establish a method allowing multifocal electroretinography (mfERG) recording with simultaneous fundus monitoring on anaesthetized pigs. In addition we characterize the peaks of the porcine mfERG trace, and compare the visual streak area with the optic nerve head, a known non-response area....... Finally we illustrate the feasibility of the method by performing mfERG after an induced laser burn in the visual streak....

A case of osseous scintigraphy showing focuses of multifocal tuberculosis

International Nuclear Information System (INIS)

Faurous-Vanaud, R.; Faurous, P.; Kalfa, G.; Collet, H.; Couty, H.; Artus, J.C.

1997-01-01

Incidence of tuberculosis in developed countries presents in the last years a spectacular boost. However, the osteo-articular system is afflicted by tuberculosis only in a few percent of cases and the multifocal character represents less than 5% of osseous tuberculosis. It is presented here a case of multifocal osseous tuberculosis only to stress its rarity. A woman 28 years old from Djibouti presents since 8 months an asthenia and dorsal pains long thought as psychalgia. The examination has shown a major vertebral stiffness and limitation of right haunch. The radiographs showed a scoliosis centered on D8 with modifications. The biologic data are VS = 90, CRP = 124 and the hemogram is normal. The intradermal reaction (10 U of tuberculin) is phlyctenular. The TDM indicates lytic vertebral extension on D7 - D8, the osseous scintigraphy with MDP - 99 mTc indicates no anomaly in the vascular arrival time; a few minutes after injection: dorsal and upper and of right femur hyperactivity; 2 h after injection: hyper-fixation of D7 to D9 and of the upper end of right femur. The IRM indicates para-vertebral abscess of D7 to D9 with epidural abscess; abscess in the upper part of the loge of right adductors with osseous affliction of the femur's upper end; a bacillary infectious process was a priori evoked. The patient was then placed under quadruple antibiotic-therapy anti-tuberculous care. In case of anomalous multifocal osseous scintigraphy the tuberculous affliction is part of the differential diagnosis, particularly in the immigrant populations or in HIV+ persons

Inmunofenotipos aberrantes en leucemias agudas en una población hospitalaria de Buenos Aires

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Viviana Novoa

2013-02-01

Full Text Available La citometría de flujo multiparamétrica es el método de elección para la caracterización inmunofenotípica de las células hematopoyéticas clonales presentes en los distintos procesos leucémicos agudos. El objetivo fue analizar la expresión de antígenos de membrana y evaluar la presencia de fenotipos aberrantes en los blastos de pacientes con diagnóstico de leucemia aguda, que permiten el monitoreo de la respuesta al tratamiento. Se revisaron los inmunofenotipos de 364 muestras de pacientes adultos derivadas a nuestro laboratorio en un período de 7 años. El inmunofenotipo se realizó por citometría de flujo con un amplio panel de anticuerpos monoclonales con el que se evaluó la expresión de antígenos de linaje linfoide, mieloide y también antígenos de maduración. De las 364 muestras estudiadas, 60.2% presentaron un fenotipo compatible con leucemia mieloide aguda (LMA, 28.8% con leucemia linfoblástica B (LLA-B, 6.6% con leucemia linfoblástica T (LLA-T y 4.4% con leucemias agudas poco frecuentes. La presencia de fenotipos aberrantes se observó en 89% de los casos, los fenotipos aberrantes identificados fueron: 1 infidelidad de linaje: LMA (54%, LLA-B (40%, LLA-T (29%; 2 ausencia de expresión antigénica: LMA (21%, LLA-B (35%, LLA-T (70%; 3 alteración de la expresión antigénica: LMA (67%, LLA-B (66%, LLA-T (84%; 4 asincronismo madurativo: LMA (26%, LLA-B (37% y 5 fenotipo ectópico: LLA-T 96%. El análisis por citometría de flujo multiparamétrica de las leucemias agudas permitió la identificación de fenotipos aberrantes en la mayoría de nuestros pacientes, que son de utilidad para el monitoreo de la respuesta al tratamiento.

Multifocal Intraocular Lens Results in Correcting Presbyopia in Eyes After Radial Keratotomy.

Science.gov (United States)

Kim, Kyeong Hwan; Seok, Kyung-Won; Kim, Wan Soo

2017-11-01

To report results of multifocal intraocular lens (IOL) implantation in 2 patients with refractive error and presbyopia after previous radial keratotomy (RK). A refractive multifocal IOL with rotational asymmetry (LS313-MF30; Oculentis, Berlin, Germany) was implanted. The first patient was a 60-year-old man with myopia who underwent unilateral RK 20 years before. His uncorrected distance visual acuity (UDVA) was 20/400, and his distance corrected near vision was J9 in both eyes. Six months after bilateral surgery, his binocular UDVA and uncorrected near visual acuity (UNVA) improved to 20/20 and J1, respectively, although he experienced diurnal fluctuation. The second patient was a 55-year-old woman with hyperopia who underwent bilateral RK 18 years before. Uncorrected distance visual acuity was 20/25 in both eyes, but UNVA was between J9 and J10. Three months after unilateral surgery, UDVA and UNVA of the postsurgical eye improved to 20/20 and J1, respectively. Neither patient reported any significant photic phenomena, and both were satisfied with the results of treatment. The desirable clinical outcomes and levels of satisfaction expressed by these patients indicate that surgery using this particular multifocal IOL may benefit presbyopic patients with previous RK.

Coréia aguda na gravidez

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Walter C. Pereira

1967-12-01

Full Text Available São apresentados doze casos de coréia aguda observados entre 150.000 gestantes (1/12.500. A maioria dos surtos ocorreu no segundo trimestre da primeira gravidez. A duração média dos sintomas foi de três meses, não tendo sido registrado caso algum de óbito materno. Todos os partos foram espontâneos e normais. Houve apenas um óbito fetal conseqüente a choque hemorrágico. São tecidas considerações a propósito dos aspectos clínico, laboratorial e prognóstico da coréia gravídica, sendo focalizado mais pormenorizadamente o problema fisiopatogênico dessa afecção.

Chronic multifocal non-bacterial osteomyelitis in hypophosphatasia mimicking malignancy

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Warmuth-Metz Monika

2007-01-01

Full Text Available Abstract Background Hypophosphatasia (HP is characterized by a genetic defect in the tissue-nonspecific alkaline phosphatase (TNSALP gene and predominantly an autosomal recessive trait. HP patients suffer from reduced bone mineralization. Biochemically, elevated concentrations of substrates of TNSALP, including pyridoxal-5'-phosphate and inorganic pyrophosphate occur in serum, tissues and urine. The latter has been associated with chronic inflammation and hyperprostaglandinism. Case presentation We report on 2 affected children presenting with multifocal inflammatory bone lesions mimicking malignancy: A 6 years old girl with short stature had been treated with human growth hormone since 6 months. Then she started to complain about a painful swelling of her left cheek. MRI suggested a malignant bone lesion. Bone biopsy, however, revealed chronic inflammation. A bone scan showed a second rib lesion. Since biopsy was sterile, the descriptive diagnosis of chronic non-bacterial osteomyelitis (CNO was established. The diagnostic tests related to growth failure were repeated and subsequent analyses demonstrated a molecular defect in the TNSALP gene. The second girl (10 years old complained about back pain after she had fallen from her bike. X rays of her spine revealed compressions of 2 thoracic vertebrae. At first these were considered trauma related, however a bone scan did show an additional lesion in the right 4th rib. A biopsy of this rib revealed a sterile lympho- plasmocytoid osteomyelitis suggesting multifocal CNO. Further analyses did show a decreased TNSALP in leukocytes and elevated pyridoxal phosphate in plasma, suggesting a heterozygous carrier status of HP. Conclusion Chronic bone oedema in adult HP and chronic hyper-prostaglandinism in childhood HP do suggest that in some HP patients bone inflammation is present in conjunction with the metabolic defect. Sterile multifocal osteomyelitis could be demonstrated. Non-steroidal anti

Outcomes of excimer laser enhancements in pseudophakic patients with multifocal intraocular lens

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Schallhorn SC

2016-04-01

Full Text Available Steven C Schallhorn,1–3 Jan A Venter,2 David Teenan,2 Julie M Schallhorn,3 Keith A Hettinger,2 Stephen J Hannan,2 Martina Pelouskova2 1Department of Ophthalmology, University of California, San Francisco, CA, USA; 2Optical Express, Glasgow, UK; 3Department of Ophthalmology, University of Southern California, Los Angeles, CA, USA Purpose: The aim of this study was to assess visual and refractive outcomes of laser vision correction (LVC to correct residual refraction after multifocal intraocular lens (IOL implantation. Patients and methods: In this retrospective study, 782 eyes that underwent LVC to correct unintended ametropia after multifocal IOL implantation were evaluated. Of all multifocal lenses implanted during primary procedure, 98.7% were refractive and 1.3% had a diffractive design. All eyes were treated with VISX STAR S4 IR excimer laser using a convectional ablation profile. Refractive outcomes, visual acuities, patient satisfaction, and quality of life were evaluated at the last available visit. Results: The mean time between enhancement and last visit was 6.3±4.4 months. Manifest spherical equivalent changed from -0.02±0.83 D (-3.38 D to +2.25 D pre-enhancement to 0.00±0.34 D (-1.38 D to +1.25 D post-enhancement. At the last follow-up, the percentage of eyes within 0.50 D and 1.00 D of emmetropia was 90.4% and 99.5%, respectively. Of all eyes, 74.9% achieved monocular uncorrected distance visual acuity 20/20 or better. The mean corrected distance visual acuity remained the same before (-0.04±0.06 logMAR [logarithm of the minimum angle of resolution] and after LVC procedure (-0.04±0.07 logMAR; P=0.70. There was a slight improvement in visual phenomena (starburst, halo, glare, ghosting/double vision following the enhancement. No sight-threatening complications related to LVC occurred in this study. Conclusion: LVC in pseudophakic patients with multifocal IOL was safe, effective, and predictable in a large cohort of

Case report: multifocal subchondral stress fractures of the femoral heads and tibial condyles in a young military recruit.

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Yoon, Pil Whan; Yoo, Jeong Joon; Yoon, Kang Sup; Kim, Hee Joong

2012-03-01

Subchondral stress fractures of the femoral head may be either of the insufficiency-type with poor quality bone or the fatigue-type with normal quality bone but subject to high repetitive stresses. Unlike osteonecrosis, multiple site involvement rarely has been reported for subchondral stress fractures. We describe a case of multifocal subchondral stress fractures involving femoral heads and medial tibial condyles bilaterally within 2 weeks. A 27-year-old military recruit began having left knee pain after 2 weeks of basic training, without any injury. Subsequently, right knee, right hip, and left hip pain developed sequentially within 2 weeks. The diagnosis of multifocal subchondral stress fracture was confirmed by plain radiographs and MR images. Nonoperative treatment of the subchondral stress fractures of both medial tibial condyles and the left uncollapsed femoral head resulted in resolution of symptoms. The collapsed right femoral head was treated with a fibular strut allograft to restore congruity and healed without further collapse. There has been one case report in which an insufficiency-type subchondral stress fracture of the femoral head and medial femoral condyle occurred within a 2-year interval. Because the incidence of bilateral subchondral stress fractures of the femoral head is low and multifocal involvement has not been reported, multifocal subchondral stress fractures can be confused with multifocal osteonecrosis. Our case shows that subchondral stress fractures can occur in multiple sites almost simultaneously.

Progressive multifocal leukoencephalopathy: new concepts

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Marco A. Lima

2013-09-01

Full Text Available Progressive multifocal leukoencephalopathy (PML is a demyelinating disease of the CNS caused by reactivation of JC virus (JCV in a setting of cellular immunosuppression. Originally, PML was observed in patients with advanced HIV infection, lymphoproliferative disorders and transplant recipients. However, the widespread use of HIV antiretroviral drugs and the new selective immunomodulatory and immunosuppressive medications, such as Rituximab and Natalizumab, has recently modified the epidemiology, clinical presentation and prognosis of PML. Herein, we discuss the new concepts on PML, emphasizing the recent modification in the epidemiology; the impact of new immunomodulatory treatments in the disease, PML-IRIS (Immune reconstitution inflammatory síndrome, new treatment strategies and other JCV related CNS diseases.

Fatores técnicos intervenientes na realização do exame de eletrorretinograma multifocal (ERGmf Technical factors that influence multifocal electroretinogram (mfERG recording

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Maria Kiyoko Oyamada

2007-08-01

Full Text Available OBJETIVO: Descrever os principais fatores intervenientes observados durante a aquisição e análise do exame de eletrorretinograma multifocal (ERGmf, que afetam o registro gráfico das ondas obtidas e portanto sua análise. MÉTODOS: Análise dos fatores de erro observados durante a aquisição de 100 exames seqüenciais de eletrorretinograma multifocal, realizados com o Reti System da Roland Consult, no período de maio a julho de 2005. Os exames de eletrorretinograma multifocal foram realizados conforme recomendações internacionais, respeitando-se os parâmetros preestabelecidos do equipamento, com 61 elementos, e ângulo visual de 30º. Todos os pacientes foram submetidos à avaliação oftalmológica completa, excluindo-se aqueles com transparência inadequada de meios, córneas planas e os incapazes de visualizar as linhas de fixação. RESULTADOS: Os fatores intervenientes, que poderiam causar erros na interpretação dos resultados obtidos, observados e corrigidos durante a realização dos exames foram: fixação excêntrica, movimentação dos olhos, contração do orbicular, contração da musculatura cervical, não-correção adequada, não-transparência adequada do eletrodo corneano, deslocamento do eletrodo em geral para baixo, descentralização do suporte da lente corretora, distância inadequada paciente-monitor em pacientes com alta ametropia, altura inadequada dos olhos em relação ao centro da tela, ruído na freqüência de 60 HZ (rede elétrica e de campo eletromagnético, impedâncias elevadas. No processamento das ondas, a utilização excessiva de filtros para remoção de ruídos dos registros obtidos, pode interferir na análise dos resultados obtidos. CONCLUSÕES: Cuidados simplesmente observacionais durante a aquisição dos sinais são de importância significativa para a obtenção de registros com boa morfologia e baixo nível de ruído. Permitindo, por meio de sua pronta correção, a análise correta e

Unusual multifocal granulomatous disease caused by actinomycetous bacteria in a nestling Derbyan parrot (Psittacula derbiana).

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Park, F J; Jaensch, S

2009-01-01

A nestling Derbyan parrot (Psittacula derbiana) was presented with unusual subcutaneous swellings of the thigh regions, and poor growth. Histological examination revealed actinomycetous bacteria associated with multifocal systemic granulomas. The clinical and pathological findings of the case are presented, and some relevant aspects of actinomycetous bacterial infections in mammals and birds are discussed. Although granulomatous disease is encountered at times in avian species, the actinomycetous bacteria (Nocardia and Actinomyces spp.) have rarely been reported in association with multifocal granulomatous disease in birds.

Efecto de la restitución temprana de la nutrición oral en la pancreatitis aguda leve

OpenAIRE

Vega Sandoval, Carlos Andres; Isaza Restrepo, Andres; Moscoso Daza, Alejandro

2010-01-01

Aunque el manejo nutricional de los pacientes con Pancreatitis Aguda Severa ha sido bien establecido por la evidencia disponible, el inicio de la vía oral en Pancreatitis Leve no ha sido igualmente estudiado. El objetivo de este estudio es evaluar el efecto del inicio temprano de la nutrición por vía oral en estos pacientes. Métodos: Realizamos un descriptivo serie de comparación de casos en los cuales comparamos la evolución y resultados del manejo de los pacientes con pancreatitis aguda ant...

The Mathematical Theory of Multifocal Lenses

Institute of Scientific and Technical Information of China (English)

Jacob RUBINSTEIN

2017-01-01

This paper presents the fundamental optical concepts of designing multifocal ophthalmic lenses and the mathematical methods associated with them.In particular,it is shown that the design methodology is heavily based on differential geometric ideas such as Willmore surfaces.A key role is played by Hamilton's eikonal functions.It is shown that these functions capture all the information on the local blur and distortion created by the lenses.Along the way,formulas for computing the eikonal functions are derived.Finally,the author lists a few intriguing mathematical problems and novel concepts in optics as future projects.

Optimizing outcomes with multifocal intraocular lenses

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Gitansha Shreyas Sachdev

2017-01-01

Full Text Available Modern day cataract surgery is evolving from a visual restorative to a refractive procedure. The advent of multifocal intraocular lenses (MFIOLs allows greater spectacle independence and increased quality of life postoperatively. Since the inception in 1980s, MFIOLs have undergone various technical advancements including trifocal and extended depth of vision implants more recently. A thorough preoperative workup including the patients' visual needs and inherent ocular anatomy allows us to achieve superior outcomes. This review offers a comprehensive overview of the various types of MFIOLs and principles of optimizing outcomes through a comprehensive preoperative screening and management of postoperative complications.

Sumário de atualização da II Diretriz Brasileira de Insuficiência Cardíaca Aguda 2009/2011

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Marcelo Westerlund Montera

2012-05-01

Full Text Available Nos últimos dois anos, observamos diversas modificações na abordagem diagnóstica e terapêutica dos pacientes com Insuficiência Cardíaca aguda (IC aguda, o que nos motivou quanto à necessidade da realização de um sumário de atualização da II Diretriz Brasileira de Insuficiência Cardíaca Aguda de 2009. Na avaliação diagnóstica, o fluxograma diagnóstico foi simplificado e foi fortalecido o papel da avaliação clínica e ecocardiograma. Na avaliação clínico-hemodinâmica admissional, o ecocardiograma hemodinâmico ganhou destaque no auxilio da definição dessa condição no paciente com IC aguda na sala de emergência. Na avaliação prognóstica, os biomarcadores tiveram seu papel mais bem estabelecido, e a síndrome cardiorrenal teve seus critérios e valor prognóstico mais bem definidos. Os fluxogramas de abordagem terapêutica foram revistos, tornando-se mais simples e objetivos. Dentre os avanços na terapêutica medicamentosa destacam-se a segurança e a importância da manutenção ou introdução dos betabloqueadores na terapêutica admissional. A anticoagulação, de acordo com as novas evidências, ganha um espectro maior de indicações. O edema agudo de pulmão tem bem estabelecido os seus modelos hemodinâmicos de apresentação com suas distintas formas de abordagens terapêuticas, com novos níveis de indicação e evidência. No tratamento cirúrgico da IC aguda, a revascularização miocárdica, a abordagem das lesões mecânicas e o transplante cardíaco foram revistos e atualizados. Este sumário de atualização fortalece a II Diretriz Brasileira de Insuficiência Cardíaca Aguda por mantê-la atualizada e rejuvenescida. Todos os clínicos cardiologistas que lidam com pacientes com IC aguda encontrarão na diretriz e em seu sumário de atualização importantes instrumentos no auxílio da prática clínica para o melhor diagnóstico e tratamento de seus pacientes.

Renal Function Outcomes for Multifocal Renal Neoplasms Managed by Radiofrequency Ablation

Energy Technology Data Exchange (ETDEWEB)

Gupta, Pushpender, E-mail: pugupta@wakehealth.edu; Allen, Brian C., E-mail: bcallen2@wakehealth.edu; Chen, Michael Y., E-mail: mchen@wakehealth.edu; Childs, David D., E-mail: dchilds@wakehealth.edu; Kota, Gopi, E-mail: gkota@wakehealth.edu; Zagoria, Ronald J., E-mail: rzagoria@wakehealth.edu [Wake Forest University School of Medicine, Department of Radiology (United States)

2013-10-15

Purpose: To evaluate renal function changes related to radiofrequency ablation (RFA) for the treatment of multifocal renal neoplasms. Methods: This is an institutional review board-approved, Health Insurance Portability and Accountability Act compliant retrospective study of all patients treated with computed tomography guided RFA for multifocal renal neoplasms at one institution. Fifty-seven subjects, mean age 70 (range 37-88) years, underwent RFA of 169 renal neoplasms (average size 2.0 cm). Subjects had between 2 and 8 (mean 2.96) neoplasms ablated. Estimated glomerular filtration rate (eGFR) was measured before and after RFA. Complications related to RFA were recorded. Results: eGFR decreased on average of 4.4 % per tumor treated and 6.7 % per ablation session (average 1.76 tumors treated per session). For subjects with the largest neoplasm measuring >3 cm, eGFR decreased an average of 14.5 % during the course of their treatment. If the largest neoplasm measured 2-3 cm, eGFR decreased an average of 7.7 %, and if the largest neoplasm measured <2 cm, eGFR decreased an average of 3.8 %. Subjects with reduced baseline renal function were more likely to have a greater decline in eGFR after RFA. There was a minor complication rate of 6.3 % (6 of 96 sessions), none of which required treatment, and a major complication rate of 4.2 % (4 of 96 sessions). Conclusion: RFA for the treatment of multifocal renal neoplasms results in mild decline of renal function.

Autorefraction versus subjective refraction in a radially asymmetric multifocal intraocular lens

NARCIS (Netherlands)

Linden, J.W.M. van der; Vrijman, V.; El-Saady, R.; Meulen, I.J. van der; Mourits, M.P.; Lapid-Gortzak, R.

2014-01-01

PURPOSE: To evaluate whether the automated refraction (AR) correlates with subjective manifest (MR) refraction in eyes implanted with radially asymmetric multifocal intraocular lens (IOLs). METHODS: This retrospective study evaluated 52 eyes (52 patients) implanted with a radially asymmetric

Effect of Unifocal versus Multifocal Lenses on Cervical Spine Posture in Patients with Presbyopia.

Science.gov (United States)

Abbas, Rami L; Houri, Mohamad T; Rayyan, Mohammad M; Hamada, Hamada Ahmad; Saab, Ibtissam M

2018-04-04

There are many environmental considerations which may or may not lead to the development of faulty cervical mechanics. The design of near vision lenses could contribute to the development of such cervical dysfunction and consequently neck pain. Decision making regarding proper type of lens prescription seems important for presbyopic individuals. To investigate the effect of unifocal and multifocal lenses on cervical posture. Thirty subjects (18 females and 12 males) participated in the study with an age range from 40 to 64 years. Each subject wore consequently both unifocal and multifocal lenses randomly while reading. Then lateral cervical spine X-ray films were taken for each subject during each lens wearing. X-ray films were analyzed with digital software (Autocad software, 2 D) to measure segmental angles of the cervical vertebrae (Occiput/C1, C1/C2, C2/C3, C3/C4, C4/C5, C5/C6, C6/C7, C3/C7, C0/C3, and occiput/C7). Higher significant extension angle in the segments C0/C7, C1/C2, C5/C6, C6/C7, and C3/C7 (p<0.05) during multifocal lenses wearing were observed in contrast with higher flexion angle between C3/C4 and C4/C5 (p<0.05) with unifocal lenses wear. Multifocal lens spectacles produces increased extension in the cervical vertebrae angles when compared with the use of unifocal lenses.

Respostas cardiovasculares agudas em ambiente virtualmente simulado pelo Nintendo Wii

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Renato Aparecido de Souza

2013-01-01

Full Text Available DOI: http://dx.doi.org/10.5007/1980-0037.2013v15n1p60 Recentemente, tem sido verificada a utilização do Nintendo Wii no contexto da saúde. O objetivo do presente estudo foi analisar as respostas cardiovasculares agudas monitoradas por meio do comportamento da frequência cardíaca, pressão arterial sistólica, pressão arterial diastólica e duplo produto, em ambiente virtualmente simulado pelo console Nintendo Wii. A amostra foi composta por 18 universitários saudáveis, com média de idade de 22,07 ± 1,34 anos. As variáveis foram observadas com uso de deltas (valor final - inicial após 25 arremessos de basquetebol em duas situações experimentais: (I com o voluntário sentado e, (II com o voluntário saltando verticalmente. Os resultados sugerem que a prática de atividade física em ambiente virtual emulado pelo Nintendo Wii é capaz de alterar as respostas cardiovasculares agudas, especialmente, quando realizada em associação a saltos verticais. Assim, os resultados sustentam a viabilidade do uso do Nintendo Wii em programas de treinamento e favorecem sua indicação de forma mais segura.

Premature epiphyseal fusion and degenerative arthritis in chronic recurrent multifocal osteomyelitis

International Nuclear Information System (INIS)

Piddo, C.; Reed, M.H.; Black, G.B.

2000-01-01

A 9-year-old boy was diagnosed with chronic recurrent multifocal osteomyelitis affecting multiple sites. During an 8-year follow-up he developed premature closure of a distal radial epiphysis and degenerative changes in the adjacent radiocarpal joint. (orig.)

Multifocal gastrointestinal stromal tumor (GIST) of the stomach in an 11-year-old girl

International Nuclear Information System (INIS)

Park, Jin; Rubinas, Tara C.; Fordham, Lynn A.; Phillips, J.D.

2006-01-01

A previously healthy 11-year-old girl presented with an 8-month history of anemia and left upper quadrant abdominal pain. US examination demonstrated a 9-cm cystic mass with a fluid-fluid level in the left upper quadrant with unclear organ of origin. Abdominal MR imaging demonstrated a complex cystic mass, likely arising from the stomach. Additional T2 hyperintense submucosal lesions were identified in the gastric wall. Surgical excision confirmed the diagnosis of multifocal gastric gastrointestinal stromal tumor (GIST). MR imaging was helpful in suggesting a gastric origin of the primary mass and in demonstrating multifocal disease within the stomach. (orig.)

Intoxicaciones agudas graves en un servicio de medicina intensiva durante doce años

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César Palazón Sánchez

2000-01-01

Full Text Available Conocer 12 epidemiología de las u~tux~- aciones agudas graves en un servicio de medicina intensiva y evaluar el pronóstico de la PCR y mortalidad asociada a los distintos tóxicos.

Leucemia linfoblástica aguda em lactentes: 20 anos de experiência

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Amanda Ibagy

2013-02-01

Full Text Available OBJETIVO: Analisar pacientes com menos de dois anos de idade com leucemia linfoblástica aguda atendidos no período de 1990 a 2010, em um centro de referência estadual. MÉTODOS: Estudo clínico, epidemiológico, transversal, descritivo e observacional. Pacientes incluídos tinham menos de dois anos de idade, com leucemia linfoblástica aguda, tratados no período de 1990 a 2010 na unidade de oncologia pediátrica de um centro de referência estadual, totalizando 41 casos. RESULTADOS: Todos os pacientes eram Caucasianos e 60,9% eram do sexo feminino. Com relação à idade, 24,38% tinham menos de seis meses, 17,07% tinham entre seis meses e um ano e 58,53% mais do que um ano de idade. A idade de seis meses foi estatisticamente significante para o desfecho de óbito. Os sinais e sintomas predominantes foram febre, hematomas e petéquias. Uma contagem de leucócitos superior a 100.000 foi observada em 34,14% dos casos; hemoglobina inferior a 11 em 95,13% e contagem de plaquetas inferior a 100.000, em 75,61% dos casos. Infiltração do sistema nervoso central estava presente em 12,91% dos pacientes. Em relação à linhagem, a linhagem B predominou (73%, mas a linhagem de células T foi estatisticamente significativa para o óbito. Trinta e nove por cento dos pacientes tiveram recorrência da doença. Em relação ao estado vital, 70,73% dos pacientes morreram, sendo choque séptico a principal causa. CONCLUSÕES: leucemia linfoblástica aguda em crianças tem uma alta taxa de mortalidade, principalmente em crianças menores de um ano e linhagem derivada de células T.

Multifocal fibrosing thyroiditis: report of 55 cases of a poorly recognized entity.

Science.gov (United States)

Fellegara, Giovanni; Rosai, Juan

2015-03-01

During the course of our consultation activity, we have recognized a peculiar form of thyroiditis in which multiple foci of fibrosis, most of which were associated with reactive atypia of the surrounding follicles, are present. We have referred to this condition, both in our consultation reports and in the third series of A.F.I.P. Fascicle on Tumors of the Thyroid Gland, as "multifocal fibrosing thyroiditis" or (less frequently) "multifocal sclerosing thyroiditis," which are descriptive terms that highlight the benign/inflammatory nature of the process, its multiplicity, and its unknown pathogenesis. The aim of this study is to better define the morphologic features of this process and correlate it with some clinical data. With this purpose, the consultation files of one of the authors (J.R.) were searched for cases coded as multifocal fibrosing thyroiditis or multifocal sclerosing thyroiditis in a 20-year period ranging from January 1989 to December 2009. A total of 55 cases were identified that displayed the above-listed features. There were 51 (93%) female and 4 (7%) male patients (F/M=12.75), with ages ranging between 15 and 71 years (mean age, 47.03 y; median age, 44.5 y). Microscopically, multiple foci of fibrosis were identified in all cases, their number ranging from 2 to 51 per case (mean number, 16), with a mean diameter of 3 mm (range: 0.36 to 15.1 mm). Although heterogenous in shape and size, the individual foci were rather similar to each other in composition, being characterized by a fibrotic poorly cellular center that merged with a cellular peripheral zone. Some of the follicular structures present at the periphery of the scar and-to a lesser extent-those entrapped inside it underwent complex reactive and regenerative (atypical) changes that simulated malignancy. We discuss the differential diagnosis with other benign and malignant thyroid conditions and speculate about its pathogenesis and possible relationship with papillary thyroid microcarcinoma.

Exploring the methods of data analysis in multifocal visual evoked potentials

DEFF Research Database (Denmark)

Malmqvist, Lasse; Santiago de Abreu, Lucimar; Fraser, C.

2016-01-01

Purpose: The multifocal visual evoked potential (mfVEP) provides a topographical assessment of visual function, which has already shown potential for use in patients with glaucoma and multiple sclerosis. However, the variability in mfVEP measurements has limited its broader application. The purpo...

Insuficiencia renal aguda inducida por mordedura de serpiente Bothrops

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Gustavo A. Aroca Martínez

2014-01-01

Full Text Available Mujer de 58 años de edad, remitida a urgencias por presentar cuadro clínico de insuficiencia renal aguda (IRA secundaria a mordedura de serpiente (Bothrops Atrox. Ingresa hipotensa con elevación de azoados e hiperkalemia, ecografía renal dentro de parámetros normales. Se maneja terapia dialítica con lo cual presenta mejoría clínica. En este reporte se detallan aspectos del diagnóstico, manejo clínico y posibles mecanismos fisiopatológicos que explican el daño renal.

Upper Extremity Multifocal Neuropathy in a 10-Year-Old Boy Associated With NS6S Disaccharide Antibodies.

Science.gov (United States)

Edelman, Frederick; Naddaf, Elie; Waclawik, Andrew J

2015-06-01

We present a 10-year-old boy with a predominantly motor multifocal neuropathy with demyelinating and axonal changes with sensory involvement, affecting only one upper extremity. Laboratory studies revealed an elevated titer of immunoglobulin M (IgM) antibodies against the NS6S antigen. He responded to treatment with high dose intravenous immunoglobulins. Focal or multifocal immune-mediated neuropathies are not common in children and may be underdiagnosed. © The Author(s) 2014.

Influence of Near-Segment Positioning in a Rotationally Asymmetric Multifocal Intraocular Lens.

Science.gov (United States)

Song, In Seok; Yoon, Sam Young; Kim, Jae Yong; Kim, Myoung Joon; Tchah, Hungwon

2016-04-01

To compare visual performance and higher order aberrations (HOAs) based on the position of the near segment in eyes with rotationally asymmetric multifocal intraocular lenses (IOLs). Asymmetric multifocal IOLs (Lentis Mplus LS-313; Oculentis Optikgeräte GmbH, Wetzlar, Germany) were implanted with the near segment positioned either inferiorly, superiorly, or temporally. Uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuity, corrected distance visual acuity (CDVA), and distance-corrected intermediate (DCIVA) and near (DCNVA) visual acuity, contrast sensitivity, HOAs, and subjective symptom questionnaires were compared at 1 month postoperatively. Forty-five eyes from 45 patients were evaluated (n = 25, 9, and 11 eyes in the inferior, superior, and temporal groups, respectively). No significant differences in UDVA, UIVA, UNVA, CDVA, DCIVA, or DCNVA were found between the three groups (P > .05). The temporal group showed the best results in UDVA, CDVA, and DCNVA, but the inferior group showed the best results in DCIVA and UNVA and the superior group showed the best results in UIVA. Contrast sensitivity and the subjective symptom questionnaire also did not demonstrate any significant differences (P > .05). Total HOA and spherical aberration did not demonstrate any statistically significant differences (P > .05), but vertical coma and horizontal coma demonstrated significant differences based on near segment position (P < .001). The position of the near segment in eyes with rotationally asymmetric multifocal IOLs demonstrates no significant effect on visual performance. Copyright 2016, SLACK Incorporated.

Isquemia aguda de miembros inferiores secundaria a ergortismo

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Franco J. Vallejo, MD

2011-11-01

Full Text Available Paciente de género femenino, de 21 años de edad, quien ingresó por dolor progresivo e intenso en miembros inferiores, y refirió antecedente reciente de ingestión de derivados del ergot. Al examen físico se observó ausencia de pulsos en ambos miembros inferiores. Por angiotomografia se documentó disminución severa, generalizada y bilateral, del calibre de los vasos arteriales de miembros inferiores. Se diagnosticó isquemia arterial aguda secundaria a ergotismo y se inició tratamiento con vasodilatadores y calcio-antagonistas, que resolvió los síntomas en su totalidad.

Caracterización del comportamiento clínico-quirúrgico de la pancreatitis aguda en una unidad hospitalaria de Pinar del Río

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Eduardo Rogelio García Noguera

2015-08-01

Full Text Available Introducción: la pancreatitis aguda es una enfermedad que produce diversos grados de inflamación en el órgano y puede llegar hasta la necrosis glandular. Objetivo: caracterizar el comportamiento clínico-quirúrgico en los pacientes con pancreatitis aguda en el Hospital General Docente "Abel Santamaría Cuadrado" de Pinar del Rio, en el periodo de 2009-2012. Material y método: se realizó una investigación observacional, descriptiva, longitudinal, retrospectiva, en pacientes con diagnóstico de pancreatitis aguda, ingresados en el Hospital General Docente "Abel Santamaría Cuadrado", de Pinar del Río, entre el 2009 y el 2012. Resultados: el 53,3% de los pacientes ingresó en el Servicio de Cirugía y el resto en la Unidad de Cuidados Intensivos. El 77,8% de los pacientes fueron intervenidos quirúrgicamente antes de transcurrir 48 horas desde el ingreso. Existió un predominio notable de enfermos complicados que ingresaron en las salas de cirugía, prevaleciendo en estos las complicaciones agudas o sistémicas. En los pacientes operados la mortalidad se elevó considerablemente un 42,1%. Conclusiones: para llevar a cabo una conducta adecuada en los pacientes ingresados con pancreatitis aguda, y de esta manera reducir las complicaciones y fallecimiento por esta causa, se deben ingresar desde el inicio en una sala de cuidados intensivos; además de incrementar el empleo de investigaciones como la TAC abdominal y disminuir los casos intervenidos quirúrgicamente.

Calcio sérico total y calcio corregido como predictores de severidad en pancreatitis aguda

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A.A. Gutiérrez-Jiménez

2014-01-01

Conclusiones: El CT y CCA tomados en las primeras 24 h son útiles como predictores de severidad en pancreatitis aguda, con valores de S y predictivos comparables o superiores a los de las escalas pronósticas tradicionales.

Primeiro consenso brasileiro do tratamento da fase aguda do acidente vascular cerebral

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2001-01-01

Full Text Available Este texto apresenta a síntese das conclusões do Iº Consenso Brasileiro do Tratamento da Fase Aguda do Acidente Vascular Cerebral (AVC. Tratou-se de reunião patrocinada e coordenada pela Sociedade Brasileira de Doenças Cerebrovasculares, com neurologistas especializados nas doenças cerebrovasculares, que analisaram os principais itens da conduta dos AVC.

Asma aguda em adultos na sala de emergência: o manejo clínico na primeira hora

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DALCIN PAULO DE TARSO ROTH

2000-01-01

Full Text Available Asma é doença com alta prevalência em nosso meio e ao redor do mundo. Embora novas opções terapêuticas tenham sido recentemente desenvolvidas, parece haver aumento mundial na sua morbidade e mortalidade. Em muitas instituições, as exacerbações asmáticas ainda constituem emergência médica muito comum. As evidências têm demonstrado que a primeira hora no manejo da asma aguda na sala de emergência concentra decisões cruciais que podem determinar o desfecho desta situação clínica. Nesta revisão não-sistemática, os autores enfocaram a primeira hora da avaliação e tratamento do paciente com asma aguda na sala de emergência, descrevendo uma estratégia apropriada para o seu manejo. São consideradas as seguintes etapas: diagnóstico, avaliação da gravidade, tratamento farmacológico, avaliação das complicações e decisão sobre onde se realizará o tratamento adicional. Espera-se que estas recomendações contribuam para que o médico clínico tome a decisão apropriada na primeira hora do manejo da asma aguda.

The Effects of Hashimoto Thyroiditis on Lymph Node Metastases in Unifocal and Multifocal Papillary Thyroid Carcinoma

Science.gov (United States)

Zhu, Feng; Shen, Yi Bin; Li, Fu Qiang; Fang, Yun; Hu, Liang; Wu, Yi Jun

2016-01-01

Abstract The purpose of this study was to investigate the risk factors for central and lateral neck lymph node metastases in papillary thyroid carcinoma (PTC) and multifocal papillary thyroid carcinoma (MPTC), particularly when associated with Hashimoto thyroiditis (HT). A retrospective analysis of 763 consecutive patients who underwent total thyroidectomy with bilateral central neck dissection in the First Affiliated Hospital, College of Medicine, Zhejiang University between October 2011 and October 2014 was conducted. All patients had formal histological diagnoses of HT. Multivariable logistic regression analysis was performed to identify risk factors of neck lymph node metastases. Our study identified 277 PTC patients with HT and showed comparatively low rates of central lymph node metastases (CLNM) compared with the PTC patients without HT (37.2% versus 54.7%, P thyroid peroxidase antibody >140 IU/mL was established as the most sensitive and specific level for the prediction of MPTC based on receiver operating characteristic curve analyses. Thyroid peroxidase antibody, age, tumor size, and multifocality exhibited the ability to predict CLNM in PTC with HT patients with an area under the curve of 81.1% based on a multivariate model. Hashimoto thyroiditis was associated with increased prevalences of multifocality and capsular invasion. In contrast, HT was associated with a reduced risk of CLNM in PTC and MPTC patients, which indicated a potential protective effect. We found that the prognostic prediction model was applicable for predicting multifocality and CLNM in PTC patients with HT. PMID:26871795

Incidencia y factores de riesgo para adquirir diarrea aguda en una comunidad rural de la selva peruana

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César Henríquez Camacho

2002-04-01

Full Text Available Objetivo: Determinar la incidencia y factores de riesgo para adquirir diarrea aguda en una comunidad rural localizada en la selva del departamento de San Martín, Perú. Material y métodos: Una cohorte de 119 personas fue seleccionada al azar entre la población de 446 habitantes y seguida diariamente por un mes entre enero y febrero de 1999, buscando casos de diarrea aguda, definida como tres ó más cámaras de deposiciones al día por no más de 3 días. Un estudio caso control pareado fue diseñado para determinar los factores de riesgo para adquirir diarrea. Resultados: Fueron observados 18 casos de diarrea aguda; la incidencia fue 15.1 casos por 100 personas-mes (IC 95%: 9.45-23.12. La edad media de los casos fue de 10.7 años (rango: 1-34 años y 66% de los casos fueron niños menores de 10 años de edad. Los factores de riesgo para adquirir diarrea fueron: consumo de alimentos crudos, RR: 2.2 (IC 95%: 1.12-4.33, consumo de alimentos no lavados, RR: 4.47 (IC 95%: 1.56-12.82, falta de lavado de manos antes de alimentarse, RR: 9.61 (95% IC: 1.44-64.16, consumo de agua no hervida, RR: 4.52 (IC 95%: 1.23-16.65 y alimentación fuera de casa, RR: 2.2 (IC 95%: 1.51-3.20. La diferencia en el número promedio (DE de personas que vivían por casa entre casos y controles fue de 4.38 (1.03 vs. 3.22 (0.54, p=0.0003, respectivamente. No hubo diferencia en el tiempo de residencia en la comunidad entre casos y controles, media de 5.61 ( 5.04 años vs. 8.83 (9.79, p=0.5747. Conclusiones: Diarrea aguda es un problema de salud pública en la selva de San Martín. Hacinamiento, carencia de saneamiento y pobres prácticas higiénicas son los responsables para adquirir diarrea aguda en esta comunidad de bajo nivel socioeconómico. Campañas educativas y mejora en las condiciones sanitarias son claramente necesarias para superar este problema.

Primary multifocal tuberculous osteomyelitis with involvement of the ribs

Energy Technology Data Exchange (ETDEWEB)

Chang, D.S. [New York University School of Medicine, New York, New York (United States); Rafii, M.; McGuinness, G. [Department of Radiology, NYU Medical Center, New York, NY (United States); Jagirdar, J.S. [Department of Pathology, NYU Medical Center, New York, New York (United States)

1998-11-01

Two cases of primary multifocal tuberculous osteomyelitis with involvement of the rib cage are presented. The lungs were normal and the appearance of the skeletal lesions did not suggest tuberculosis. These lesions were predominantly lytic, with minimal soft tissue involvement. Tuberculosis should be high in the differential diagnosis of multiple destructive bone lesions, especially in patients from regions where tuberculosis is endemic. (orig.) With 5 figs., 21 refs.

Mielopatia transversa em adulto portador de leucemia aguda linfoblástica: relato de caso

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Brito José Correia de Farias

2001-01-01

Full Text Available Relatamos um caso de mielopatia transversa aguda em paciente masculino de 31 anos de idade, branco, portador de leucemia aguda linfoblástica, subtipo L3 (LLA-L3. Esta é uma forma grave de leucemia e compromete mais crianças em relação aos adultos. Menos de 1% dos pacientes leucêmicos apresentam complicações espinais. No paciente em estudo, a sintomatologia instalou-se de modo abrupto e com as seguintes características: dores nas costas, paraplegia crural flácida e perda das funções sensitivas e vegetativas abaixo do segmento afetado. O diagnóstico etiológico foi estabelecido após a realização dos seguintes exames: hemograma, mielograma, análise do líquido cefalorraqueano e ressonância magnética de coluna dorsal. Foi instituído tratamento específico, que não interferiu com a evolução fatal da doença.

Bilateral implantation of +3.0 D multifocal toric intraocular lenses: results of a US Food and Drug Administration clinical trial.

Science.gov (United States)

Lehmann, Robert; Modi, Satish; Fisher, Bret; Michna, Magda; Snyder, Michael

2017-01-01

The purpose of this study was to evaluate the clinical outcomes of apodized diffractive +3.0 D multifocal toric intraocular lens (IOL) implantations in subjects with preoperative corneal astigmatism. This was a prospective cohort study conducted at 21 US sites. The study population consisted of 574 subjects, aged ≥21 years, with preoperative astigmatism 0.75-2.82 D, and potential postoperative visual acuity (VA) ≥0.2 logMAR, undergoing bilateral cataract removal by phacoemulsification. The intervention was bilateral implantation of aspheric apodized diffractive +3.0 D multifocal toric or spherical multifocal nontoric IOLs. The main outcome measures were monocular uncorrected near and distance VA and safety at 12 months. A total of 373/386 and 182/188 subjects implanted with multifocal toric and nontoric IOLs, respectively, completed 12-month follow-up after the second implantation. Toric IOLs were nonin-ferior in monocular uncorrected distance (4 m) and near (40 cm) VA but had >1 line better binocular uncorrected intermediate VA (50, 60, and 70 cm) than nontoric IOLs. Toric IOLs reduced cylinder to within 0.50 D and 1.0 D of target in 278 (74.5%) and 351 (94.1%) subjects, respectively. Mean ± standard deviation (SD) differences between intended and achieved axis orientation in the first and second implanted eyes were 5.0°±6.1° and 4.7°±4.0°, respectively. Mean ± SD 12-month IOL rotations in the first and second implanted eyes were 2.7°±5.8° and 2.2°±2.7°, respectively. No subject receiving toric IOLs required secondary surgical intervention due to optical lens properties. Multifocal toric IOLs were noninferior to multifocal nontoric IOLs in uncorrected distance and near VAs in subjects with preexisting corneal astigmatism and effectively corrected astigmatism of 0.75-2.82 D.

The effect of high- to low-altitude adaptation on the multifocal electroretinogram

DEFF Research Database (Denmark)

Kofoed, Peter Kristian; Sander, Birgit; Zubieta-Calleja, Gustavo

2009-01-01

PURPOSE: To examine variations in retinal electrophysiology assessed by multifocal electroretinogram (mfERG) during acclimatization of native highlanders to normobaric normoxia at sea level. METHODS: Eight healthy residents of the greater La Paz area in Bolivia (3600 m above sea level) were...

Multifocal oral melanoacanthoma associated with Addison's disease and hyperthyroidism: a case report.

Science.gov (United States)

Dantas, Thinali Sousa; Nascimento, Isabelly Vidal do; Verde, Maria Elisa Quezado Lima; Alves, Ana Paula Negreiros Nunes; Sousa, Fabrício Bitu; Mota, Mário Rogério Lima

2017-01-01

Oral melanoacanthoma is a mucocutaneous, pigmented, rare, benign, and probably reactive lesion. This paper reports for the first time in the literature a case of multifocal oral melanoacanthoma in a patient diagnosed with Addison's disease and concomitant Graves' disease with hyperthyroidism. The patient presented with oral pigmented lesions, which were hypothesized to be mucosal pigmentation associated with Addison's disease. Due to their unusual clinical pattern, these oral lesions were biopsied and diagnosed as oral melanoacanthoma on histopathology and immunohistochemistry for HMB-45. At the moment of this report, the patient was being treated for her systemic conditions, but the lesions had not regressed. Reactive hyperpigmentation of the skin and mucous membranes may be found in Addison's disease and hyperthyroidism. This case reinforces the hypothesis of a reactive nature for oral melanoacanthoma and highlights the need for investigation of endocrine disorders in patients with multifocal oral melanoacanthoma.

Acidosis láctica severa y leucemia aguda

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David Loja

2004-03-01

Full Text Available Reportamos el caso de una paciente de 27 años de edad con leucemia linfoblástica aguda, quien presentó acidosis láctica severa como complicación metabólica. Ella acudió con desnutrición severa, anemia marcada y síndrome consuntivo. No había compromiso del sistema reticuloendotelial y un mielograma inicial fue normal. Estos factores retardaron el diagnóstico y obligaron a ampliar el diagnóstico diferencial. La sospecha de neoplasia hematológica asociada a acidosis láctica sin causa aparente permitió reevaluar el caso con un nuevo mielograma y establecer el diagnóstico.

Amigdalitis aguda recurrente bacteriana: Estudio prospectivo, comparativo y controlado de sus características clínicas y microbiológicas

OpenAIRE

Der M,Carolina; Iñiguez C,Rodrigo; Guzman D,Ana Maria; Jofré P,David; Iñiguez C,Armando; Labarca L,Jaime

2007-01-01

Introducción: La amigdalitis aguda recurrente es una patología de frecuente consulta, es una de las indicaciones de amigdalectomía. No se sabe con exactitud el origen de esta patología. Objetivo: Identificar la microbiología y patrones de susceptibilidad de las bacterias en la amigdalitis aguda recurrente bacteriana (AARB) a los antimicrobianos más comúnmente en el medio nacional, usados en su tratamiento. Material y método: Se planificó un estudio prospectivo, controlado y ciego. Se evaluaro...

Glomerulonefritis aguda post-infecciosa asociada a neumonía neumocócica Acute post infectious glomerulonephritis associated to pneumococcal pneumonia

OpenAIRE

S. Fernández de Miguel; E. de Goicoechea Manzanares; M. Gaboli; J.M. Sánchez Granados; V. Murga Herrera

2009-01-01

Presentamos un niño de 6 años con insuficiencia renal aguda secundaria a glomerulonefritis asociada a neumonía neumocócica. El paciente presentó en primer lugar un síndrome nefrítico con hematuria, proteinuria, oliguria, edemas y deterioro de la función renal, siendo diagnosticado a continuación de neumonía con derrame pleural. La función renal se normalizó tras 72 horas, persistiendo una hipertensión arterial que precisó tratamiento en la fase aguda. El cuadro se resolvió sin secue...

Autorefraction versus subjective refraction in a radially asymmetric multifocal intraocular lens.

Science.gov (United States)

van der Linden, Jan Willem; Vrijman, Violette; Al-Saady, Rana; El-Saady, Rana; van der Meulen, Ivanka J; Mourits, Maarten P; Lapid-Gortzak, Ruth

2014-12-01

To evaluate whether the automated refraction (AR) correlates with subjective manifest (MR) refraction in eyes implanted with radially asymmetric multifocal intraocular lens (IOLs). This retrospective study evaluated 52 eyes (52 patients) implanted with a radially asymmetric multifocal IOL (LS-312 MF30, Oculentis, Germany). At 3 months postoperatively, the AR and MR values were compared to determine the correlation between the sphere (S), the spherical equivalent (SE) and the astigmatic components J0 and J45. The difference of mean spherical measurement was +0.98D ± 0.62, with the AR measuring more myopic. The difference of the mean spherical equivalent was +1.11D ± 0.57, again with AR being more myopic. Both these differences were statistically significant (p < 0.001). The astigmatic components showed less differences, with the mean difference of the J0 being -0.09D ± 0.43, and the J45 of +0.04D ± 0.47, which were both not statistically significant (p = 0.123 and p = 0.531, respectively). Correlation analysis of the refractive parameters showed r(2) = 0.067, r(2) = 0.078, r(2) = 0.018 and r(2) = 0.015, respectively, all of which point to a low correlation between the AR and the MR. Autorefraction shows poor correlation to manifest subjective refraction with these radially asymmetric multifocal IOLs. The autorefraction systematically underestimates the spherical and spherical equivalent power, while the correlation between the astigmatic components was also low. Autorefraction seems not a valid starting point for manifest subjective refraction with these types of lenses, unless a corrective factor of about +1 dioptre is used. © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Uso do sulfato de magnésio venoso para tratamento da asma aguda grave da criança no pronto-socorro

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Tânia Mara Baraky Bittar

2012-03-01

Full Text Available A asma aguda grave é uma emergência médica que deve ser diagnosticada e tratada rapidamente. O tratamento inicial inclui broncodilatadores e corticosteróides sistêmicos. Em casos graves, com fraca resposta ao tratamento padrão, o sulfato de magnésio venoso surge como opção terapêutica. O objetivo deste artigo foi revisar a literatura sobre o uso do sulfato de magnésio venoso na asma aguda em crianças no pronto-socorro no que se refere a eficácia, indicação, dosagem, efeitos adversos e contraindicações. Realizada revisão narrativa por meio das Bases de dados Medline, Lilacs e Cochrane Database of Systmatic Reviews, entre 2000 e 2010. Utilizados os descritores: asthma, children, emergency, magnesium sulfate. Incluídos oito ensaios clínicos controlados, três meta-análises, um estudo retrospectivo, oito artigos de revisão e um estudo transversal. A eficácia do magnésio venoso em crianças foi observada por vários autores, com raros efeitos adversos. Seu uso foi indicado para os pacientes com asma aguda moderada e grave que não responderam ao tratamento inicial com broncodilatador e corticosteróide. As contraindicações em pediatria são poucas. Entre elas estão insuficiência renal e bloqueio atrioventricular. Existem poucos relatos da interação do magnésio com drogas de uso pediátrico. Apesar da segurança, na prática, o magnésio venoso é pouco usado na asma aguda em pediatria. Na maioria das vezes, é indicado tardiamente para impedir falência respiratória e internação na unidade de cuidados intensivos. Os estudos demonstram que o magnésio venoso é uma droga eficaz e segura na criança com asma aguda grave, porém o seu uso no pronto-socorro ainda é limitado.

Radioembolization After Portal Vein Embolization in a Patient with Multifocal Hepatocellular Carcinoma

International Nuclear Information System (INIS)

Burgmans, Mark C.; Irani, Farah G.; Chan, Wan Ying; Teo, Terence K.; Kao, Yung Hsiang; Goh, Anthony S.W.; Chow, Pierce K.; Lo, Richard H.

2012-01-01

Radioembolization is an effective locoregional therapy for patients with intermediate or advanced stage hepatocellular carcinoma (HCC). It has been shown that radioembolization is safe in patients with portal vein thrombosis. This case report describes safe radioembolization after portal vein embolization in a patient with multifocal HCC.

Multifocal amelanotic conjunctival melanoma and acquired melanosis sine pigmento.

Science.gov (United States)

Paridaens, A D; McCartney, A C; Hungerford, J L

1992-03-01

Clinical and histopathological features of four cases of multifocal amelanotic malignant melanoma of the conjunctiva in association with 'acquired melanosis sine pigmento' are reported. The absence of conjunctival pigmentation in this extremely rare combination of lesions prevented early diagnosis and clinical monitoring. As a result orbital exenteration was required in three cases. This multicentric non-pigmented variety of conjunctival malignant melanoma tends to present later than pigmented forms and may require exenteration of the orbit as a primary procedure.

Crisis aguda de Asma Bronquial. Diagnóstico y tratamiento estandarizado

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Anelia de la Caridad Rojas-Pérez

2013-01-01

Full Text Available Se realizó un estudio prospectivo de intervención en 150 pacientes con diagnóstico de Asma Bronquial que acudieron con crisis aguda al Servicio de Urgencias del Hospital Pediátrico de Holguín, de Enero del 2009 hasta Diciembre del 2010; para evaluar la evolución de los mismos después de la aplicación de Guías de Buenas Prácticas. Se aplicó tratamiento a los pacientes según lo establecido, observando su respuesta. Predominó el grupo de 4 a 8 años del sexo masculino, el 52 % de los pacientes presentaron crisis ligeras, buena respuesta al uso de broncodilatadores en aerosol, se aplicó la Prednisona por vía oral en la mayoría de los casos que lo requirieron, el 68,7 % realizó tratamiento domiciliario con respuestas controladas y solo en el 31,3 % se decidió ingreso hospitalario lo que permitió arribar a la siguiente conclusión: Con la aplicación de Guías de Buenas Prácticas Clínicas par a el manejo de la exacerbación aguda del Asma Bronquial se logró una clasificación adecuada de la severidad de la misma, buena respuesta a los tratamientos utilizados y disminución de los ingresos hospitalarios.

Nutrición parenteral total en una paciente gestante con pancreatitis aguda e hipertrigliceridemia por déficit de lipoproteín lipasa

OpenAIRE

Contreras-Bolívar, Victoria; González-Molero, Inmaculada; Valdivieso, Pedro; Olveira, Gabriel

2015-01-01

Presentamos un caso de pancreatitis aguda severa inducida por hipertrigliceridemia secundaria a déficit de lipoproteín lipasa (LPL) en una paciente gestante con diabetes gestacional, manejada inicialmente con dieta, siendo necesario posteriormente llevar a cabo medidas de soporte nutricional artificial: nutrición parenteral total. El déficit de LPL causa hipertrigliceridemia severa y, frecuentemente, pancreatitis aguda de repetición, situación de difícil manejo y de importante gravedad durant...

Aféresis en el tratamiento de pancreatitis aguda hipertrigliceridémica: Reporte de caso y revisión de la literatura

OpenAIRE

Zaragoza, José J.; Villa, Gianluca; Borbolla-Arizti, Juan Pablo; Salgado-Hernández, Turmalina; Cerón-Díaz, Ulises

2015-01-01

La hipertrigliceridemia severa está asociada con varias patologías incluyendo pancreatitis aguda. Las opciones de tratamiento para la pancreatitis aguda hipertrigliceridémica incluyen insulina, glucosa y heparina en infusión, así como muchos tipos de aféresis. Los pacientes se pueden beneficiar del uso temprano de recambio plasmático para reducir los niveles de lípidos en sangre. El tiempo de inicio y el tipo de terapia juegan un papel importante para conseguir los beneficios completos del pr...

Primeras experiencias con drenaje biliar percutáneo de urgencia en la colangitis aguda

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José Luis González González

Full Text Available Introducción: la obstrucción biliar es motivo frecuente de morbilidad en los pacientes con metástasis hepáticas, adenopatías periportales y cáncer hepatobiliopancreático. La colangitis aguda es la complicación más temida, debido a su mortalidad. En este trabajo se presentan los primeros abordajes percutáneos realizados por cirujanos del Hospital Clínicoquirúrgico "Hermanos Ameijeiras" como herramienta para el tratamiento urgente de esta entidad. Objetivo: caracterizar el drenaje percutáneo transparietohepático de urgencia en pacientes con colangitis aguda e ictericia obstructiva. Métodos: se realizó un estudio descriptivo, prospectivo y aplicado con 30 pacientes atendidos de esta forma en dicha institución entre enero de 2008 y diciembre de 2010. Resultados: el diagnóstico etiológico preponderante fue el de tumor maligno de la cabeza del páncreas. La localización baja de la lesión duplicó a la localización alta. La mejoría clínica de la ictericia se evidenció en la mayoría de los pacientes después de una semana tras el procedimiento: el drenaje percutáneo constituyó el método definitivo en el 73,3 % de los pacientes. Las edades medias para los distintos diagnósticos etiológicos exhibieron diferencias estadísticamente significativas. No hubo complicaciones ni mortalidad relacionadas con el procedimiento. Conclusiones: el drenaje biliar percutáneo guiado por ultrasonido es una herramienta útil y segura para el tratamiento de urgencia de la colangitis aguda. Es un método que pueden realizar los cirujanos generales con entrenamiento adecuado y específico, y tiene asociadas pocas complicaciones.

Correction to: Progressive multifocal leukoencephalopathy in rituximab-treated rheumatic diseases: a rare event.

Science.gov (United States)

Berger, Joseph R; Malik, Vineeta; Lacey, Stuart; Brunetta, Paul; Lehane, Patricia B

2018-04-10

The article "Progressive multifocal leukoencephalopathy in rituximab-treated rheumatic diseases: a rare event," written by Joseph R. Berger, Vineeta Malik, Stuart Lacey, Paul Brunetta, and Patricia B. Lehane 3 , was originally published electronically on the publisher's internet portal (currently SpringerLink).

Multifocal choroiditis as the first sign of systemic sarcoidosis associated with pembrolizumab

Directory of Open Access Journals (Sweden)

Qu-Knafo Lise

2017-04-01

Conclusions and importance: Pembrolizumab is an immune checkpoint inhibitor therapy used in the treatment of metastatic melanoma. We report a pembrolizumab-associated sarcoidosis revealed by a panuveitis with multifocal choroiditis. Physicians should be aware of the potential inflammatory and autoimmune disease that may be induced by immunomodulatory therapies.

Optical design of soft multifocal contact lens with uniform optical power in center-distance zone with optimized NURBS.

Science.gov (United States)

Vu, Lien T; Chen, Chao-Chang A; Yu, Chia-Wei

2018-02-05

This study aims to develop a new optical design method of soft multifocal contact lens (CLs) to obtain uniform optical power in large center-distance zone with optimized Non-Uniform Rational B-spline (NURBS). For the anterior surface profiles of CLs, the NURBS design curves are optimized to match given optical power distributions. Then, the NURBS in the center-distance zones are fitted in the corresponding spherical/aspheric curves for both data points and their centers of curvature to achieve the uniform power. Four cases of soft CLs have been manufactured by casting in shell molds by injection molding and then measured to verify the design specifications. Results of power profiles of these CLs are concord with the given clinical requirements of uniform powers in larger center-distance zone. The developed optical design method has been verified for multifocal CLs design and can be further applied for production of soft multifocal CLs.

Características clínico epidemiologicas de los pacientes con Leucemia Aguda del Servicio de Hematologia del Hospital Almanzor Aguinaga Asenjo

OpenAIRE

Polo-Capuñay, Ana María; Universidad de San Martín de Porres; León-Seminario, Carlos Alberto; Universidad de San Martín de Porres; Pérez-Villena, Joan Flaubert; Universidad de San Martín de Porres; Yovera-Merino, Jhonny David; Universidad de San Martín de Porres; Barraza-Chavesta, Omar; Universidad de San Martín de Porres; Torres-Anaya, Victor; Universidad de San Martín de Porres; Diaz-Vélez., Cristian; Universidad de San Martín de Porres

2014-01-01

OBJETIVOIdentificar las características clínico-epidemiológicas de los pacientes con leucemia en el área de Hematología del H.A.A.A.MATERIAL Y MÉTODOEstudio retrospectivo, transversal y descriptivo. Se revisaron 55 historias clínicas de pacientes con diagnóstico de Leucemia Aguda, tomadas de la oficina de registro del HNAAA, durante el periodo de Enero 2005 a Marzo 2010.RESULTADOSEn el periodo de estudio, se diagnosticaron 142 casos de Leucemia, 105 (73.94%) correspondieron a Leucemia aguda. De...

NECESSIDADES BÁSICAS DAS ESPOSAS DE PACIENTES INFARTADOS, NA FASE AGUDA DO TRATAMENTO

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Edna Ikumi Umebayashi Takahashi

Full Text Available Trata-se de um estudo exploratório que teve por finalidade identificar as necessidades básicas das esposas de pacientes infartados, na fase aguda do tratamento. Foi utilizado como referencial para análise os conceitos de Necessidades Básicas de Maslow. Os resultados permitiram identificar como principais necessidades afetadas das esposas: segurança, amor e gregária, estima.

Power Profiles of Commercial Multifocal Soft Contact Lenses.

Science.gov (United States)

Kim, Eon; Bakaraju, Ravi C; Ehrmann, Klaus

2017-02-01

To evaluate the optical power profiles of commercially available soft multifocal contact lenses and compare their optical designs. The power profiles of 38 types of multifocal contact lenses-three lenses each-were measured in powers +6D, +3D, +1D, -1D, -3D, and -6D using NIMO TR1504 (Lambda-X, Belgium). All lenses were measured in phosphate buffered saline across 8 mm optic zone diameter. Refractive index of each lens material was measured using CLR 12-70 (Index Instruments, UK), which was used for converting measured power in the medium to in-air radial power profiles. Three basic types of power profiles were identified: center-near, center-distance, and concentric-zone ring-type designs. For most of the lens types, the relative plus with respect to prescription power was lower than the corresponding spectacle add. For some lens types, the measured power profiles were shifted by up to 1D across the power range relative to their labeled power. Most of the lenses were designed with noticeable amounts of spherical aberration. The sign and magnitude of spherical aberration can either be power dependent or consistent across the power range. Power profiles can vary widely between the different lens types; however, certain similarities were also observed between some of the center-near designs. For the more recently released lens types, there seems to be a trend emerging to reduce the relative plus with respect to prescription power, include negative spherical aberration, and keep the power profiles consistent across the power range.

Progressive Multifocal Leukoencephalopathy: Recent Advances and a Neuro-Ophthalmological Review.

Science.gov (United States)

Sudhakar, Padmaja; Bachman, David M; Mark, Alexander S; Berger, Joseph R; Kedar, Sachin

2015-09-01

Progressive multifocal leukoencephalopathy (PML) is a severe often fatal opportunistic infection of the central nervous system caused by reactivation of a ubiquitous polyoma virus, JC virus. Although typically characterized by multifocal asymmetric subcortical white matter lesions, it may be monofocal and affect the cortical gray matter. Among the broad spectrum of clinical manifestations that occurs with PML, visual complaints are common. Combination of representative personally observed cases of PML and comprehensive review of case series of PML from 1958 through 2014. Neuro-ophthalmic signs and symptoms were reported in approximately 20%-50% of patients with PML and can be the presenting manifestation in half of these. A majority of these presentations occur from damage to cerebral visual pathways resulting in visual field defects, cortical blindness, and other disorders of visual association. Given the decreased frequency of infratentorial and cerebellar involvement, ocular motility disorders are less common. Visual complaints occur in patients with PML and are often the presenting sign. Awareness of this condition is helpful in avoiding unnecessary delays in the diagnosis of PML and management of the underlying condition. Recent guidelines have established criteria for diagnosis of PML in the high-risk patient population and strategies to mitigate the risk in these populations.

Wide-field two-dimensional multifocal optical-resolution photoacoustic computed microscopy

Science.gov (United States)

Xia, Jun; Li, Guo; Wang, Lidai; Nasiriavanaki, Mohammadreza; Maslov, Konstantin; Engelbach, John A.; Garbow, Joel R.; Wang, Lihong V.

2014-01-01

Optical-resolution photoacoustic microscopy (OR-PAM) is an emerging technique that directly images optical absorption in tissue at high spatial resolution. To date, the majority of OR-PAM systems are based on single focused optical excitation and ultrasonic detection, limiting the wide-field imaging speed. While one-dimensional multifocal OR-PAM (1D-MFOR-PAM) has been developed, the potential of microlens and transducer arrays has not been fully realized. Here, we present the development of two-dimensional multifocal optical-resolution photoacoustic computed microscopy (2D-MFOR-PACM), using a 2D microlens array and a full-ring ultrasonic transducer array. The 10 × 10 mm2 microlens array generates 1800 optical foci within the focal plane of the 512-element transducer array, and raster scanning the microlens array yields optical-resolution photoacoustic images. The system has improved the in-plane resolution of a full-ring transducer array from ≥100 µm to 29 µm and achieved an imaging time of 36 seconds over a 10 × 10 mm2 field of view. In comparison, the 1D-MFOR-PAM would take more than 4 minutes to image over the same field of view. The imaging capability of the system was demonstrated on phantoms and animals both ex vivo and in vivo. PMID:24322226

Multifocal Visual Evoked Potential in Eyes With Temporal Hemianopia From Chiasmal Compression: Correlation With Standard Automated Perimetry and OCT Findings.

Science.gov (United States)

Sousa, Rafael M; Oyamada, Maria K; Cunha, Leonardo P; Monteiro, Mário L R

2017-09-01

To verify whether multifocal visual evoked potential (mfVEP) can differentiate eyes with temporal hemianopia due to chiasmal compression from healthy controls. To assess the relationship between mfVEP, standard automated perimetry (SAP), and Fourier domain-optical coherence tomography (FD-OCT) macular and peripapillary retinal nerve fiber layer (RNFL) thickness measurements. Twenty-seven eyes with permanent temporal visual field (VF) defects from chiasmal compression on SAP and 43 eyes of healthy controls were submitted to mfVEP and FD-OCT scanning. Multifocal visual evoked potential was elicited using a stimulus pattern of 60 sectors and the responses were averaged for the four quadrants and two hemifields. Optical coherence tomography macular measurements were averaged in quadrants and halves, while peripapillary RNFL thickness was averaged in four sectors around the disc. Visual field loss was estimated in four quadrants and each half of the 24-2 strategy test points. Multifocal visual evoked potential measurements in the two groups were compared using generalized estimated equations, and the correlations between mfVEP, VF, and OCT findings were quantified. Multifocal visual evoked potential-measured temporal P1 and N2 amplitudes were significantly smaller in patients than in controls. No significant difference in amplitude was observed for nasal parameters. A significant correlation was found between mfVEP amplitudes and temporal VF loss, and between mfVEP amplitudes and the corresponding OCT-measured macular and RNFL thickness parameters. Multifocal visual evoked potential amplitude parameters were able to differentiate eyes with temporal hemianopia from controls and were significantly correlated with VF and OCT findings, suggesting mfVEP is a useful tool for the detection of visual abnormalities in patients with chiasmal compression.

Acuidade visual em implantes bilaterais de lentes intra-oculares monofocais e multifocais Visual acuity of bilateral implants of monofocal and multifocal intraocular lenses

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Leonardo Akaishi

2003-01-01

Full Text Available OBJETIVO: Comparar a acuidade visual de longe e perto de pacientes submetidos à facoemulsificação binocular não simultânea com implante de lentes multifocais ou monofocais. MÉTODOS: Foram selecionados 20 pacientes com lentes multifocais bilaterais e outros 20 pacientes com lentes monofocais também bilaterais, com acuidade visual sem correção melhor ou igual a 0,63 (20/30, medidos separadamente, nos três primeiros meses de pós-operatório. Foi medida a acuidade visual para longe e perto com e sem correção e testes de sensibilidade ao contraste e ofuscamento. RESULTADOS: A acuidade visual sem correção para longe no grupo das monofocais teve média de 0,82 (DP± 0,16 e no grupo das multifocais, 0,94 (DP±0,12, valor de p 0,001. Os dois grupos de lentes tiveram visão com correção para longe igual a 1. No grupo das multifocais, 75% tiveram J1 e 100% tiveram J3 ou melhor sem correção. No grupo das lentes monofocais, 10% tiveram J1 e 70% tiveram J3 ou melhor sem correção. Não houve diferença significante na avaliação com o teste de sensibilidade ao contraste entre os grupos pesquisados. No teste de ofuscamento, os dois grupos tiveram redução da visão, que foi mais acentuada no grupo dos pacientes com lentes multifocais. CONCLUSÃO: A acuidade visual para longe com correção nos pacientes com implante multifocal foi semelhante a dos pacientes com implantes monofocais, embora a acuidade visual para perto no grupo em que foi implantado lente multifocal foi bastante superior ao grupo da lente monofocal. A sensibilidade ao contraste manteve-se semelhante nos dois grupos, já o ofuscamento ("glare test" no grupo multifocal foi maior que no grupo monofocal.PURPOSE: To compare distant and near visual acuity between patients submitted to bilateral nonsimultaneous facoemulsification and implantation of multifocal or monofocal intraocular lenses (IOL. METHODS: Twenty patients with bilateral multifocal IOL and 20 patients with

Chronic recurrent multifocal osteomyelitis (CRMO)

International Nuclear Information System (INIS)

Schilling, F.

1998-01-01

Chronic recurrent multifocal osteomyelitis (CRMO) is an unusual clinical entity. More than 200 cases are described in the literature and it is presented here with special reference to its radiological aspects. It is an acquired disease of the skeleton which occurs predominantly during childhood and adolescence. About ten per cent of cases begin in early or, rarely, in later adult life. This variant is described here for the first time and is discussed as 'adult CRMO'. The underlying pathology is a bland, predominantly lympho-plasma cellular osteomyelitis which is self-limiting and leads to bone sclerosis (Garre). It probably involves an abnormal immune process which follows an infection but remains clinically latent and remains aseptic and sterile. In a quarter of cases there is an association with pustulosis palmo-plantaris and its relationship with psoriatic arthropathy is discussed. The clinical, histopathological and imaging features (radiological and particularly MRT) and the bone changes are described. (orig./AJ) [de

Primary Disseminated Multifocal Ewing Sarcoma: Results of the Euro-EWING 99 Trial

NARCIS (Netherlands)

Ladenstein, Ruth; Pötschger, Ulrike; Le Deley, Marie Cécile; Whelan, Jeremy; Paulussen, Michael; Oberlin, Odile; van den Berg, Henk; Dirksen, Uta; Hjorth, Lars; Michon, Jean; Lewis, Ian; Craft, Alan; Jürgens, Heribert

2010-01-01

Purpose To improve the poor prognosis of patients with primary disseminated multifocal Ewing sarcomas (PDMES) with a dose-intense treatment concept. Patients and Methods From 1999 to 2005, 281 patients with PDMES were enrolled onto the Euro-EWING 99 R3 study. Median age was 16.2 years (range, 0.4 to

Late hemodynamic failure following percutaneous transluminal angioplasty for long and multifocal femoropopliteal stenoses

DEFF Research Database (Denmark)

Jørgensen, B; Tønnesen, K H; Holstein, P

1991-01-01

separate segments were dilated. Following 98% initial technical success, 3-year patency was 68% for single short stenoses, as opposed to 20% for long and multifocal stenoses (p = 0.05, logrank test). Antiplatelet therapy with acetylsalicyclic acid was not found to influence occurrence of restenosis...

Multifocal dystonia, Clinical feature of Hallervorden-Spatz

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Ghelichkhani H

1998-09-01

Full Text Available Hallervorden-spatz disease is an inherited metabolic disorder with autosomal recessive trait. Onset is in late childhood or early adolescence. Clinical manifestation is variable but pyramidal and extrapyramidal signs are often prominent. Many of patients show progressive dementia and extrapyramidal symptoms. Ataxia or myoclonus is reported in the course of the disease in individual cases. Focal dystonias including tongue, eyelids (blepharospasm and optic atrophy, retinitis pigmentosa, rarely familial parkinsonism are also reported. Pathologically pigmentary degeneration of globus pallidus, substantia nigra (pars reticular and red nucleus is characteristic. In our case the main clinical feature was multifocal dystonia without obvious pyramidal or other extrapyramidal symptoms, and diagnosis was based on clinical and MRI findings.

Evaluation of refractive correction for standard automated perimetry in eyes wearing multifocal contact lenses.

Science.gov (United States)

Hirasawa, Kazunori; Ito, Hikaru; Ohori, Yukari; Takano, Yui; Shoji, Nobuyuki

2017-01-01

To evaluate the refractive correction for standard automated perimetry (SAP) in eyes with refractive multifocal contact lenses (CL) in healthy young participants. Twenty-nine eyes of 29 participants were included. Accommodation was paralyzed in all participants with 1% cyclopentolate hydrochloride. SAP was performed using the Humphrey SITA-standard 24-2 and 10-2 protocol under three refractive conditions: monofocal CL corrected for near distance (baseline); multifocal CL corrected for distance (mCL-D); and mCL-D corrected for near vision using a spectacle lens (mCL-N). Primary outcome measures were the foveal threshold, mean deviation (MD), and pattern standard deviation (PSD). The foveal threshold of mCL-N with both the 24-2 and 10-2 protocols significantly decreased by 2.2-2.5 dB ( P correction without additional near correction is to be recommended.

Insuficiencia renal aguda obstructiva: Estudio de 42 pacientes

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Isabel Caravia Pubillones

1997-04-01

Full Text Available Se revisaron las historias clínicas de 42 pacientes ingresados en el Servicio de Cuidados Intensivos del Instituto de Nefrología con el diagnóstico de insuficiencia renal aguda obstructiva (IRAO, con 1 ó 2 riñones funcionantes. Los pacientes estudiados estaban entre la 5ta y la 7ma década de la vida, con una mayor incidencia en el sexo masculino. La causa más frecuente de IRAO fue la litiasis renal (47,62 %, seguida por las enfermedades tumorales que infiltraban los uréteres (28,57 %. Se empleó tratamiento médico en 9 pacientes y el resto (33 fueron sometidos a tratamiento quirúrgico. Las principales complicaciones fueron sépticas con un franco predominio de las infecciones del tractus urinario (38,5 %. Hubo 3 fallecidos, 2 de ellos por complicaciones cardiovasculares. Del total de insuficiencias renales agudas que se atendieron en nuestro Centro, el 10,6 % correspondió a IRAO. La efectividad del tratamiento quirúrgico empleado fue del 94,4 % de curación en los pacientes atendidosMedical records of 42 patients admitted to the Intensive Care Unit of the Institute of Nephrology diagnosed as having acute obstructive renal failure with 1 or 2 kidneys functioning, were revised. Patients studied ware at the 5th and 7th decade of life with a greater incidence in males. The most frequent cause of acute obstructive renal failure was renal lithiasis (47.62 %, followed by tumor diseases which were infiltrating the ureters (28.57 %. Medical treatment was employed in 9 patients and the remaining (33 were submitted to surgical treatment. The main complications were septic with predominance of urinary tract infections (38.5 %. Three patients died, 2 of them as a result of cardiovascular complications. Of the total number of cases presenting with acute renal failure and treated in our center, 10.6 % had an acute obstructive renal failure. The effectiveness of the surgical treatment performed was 94.4 % of healing in patients treated for this

Epidemia de infección respiratoria aguda observaciones hospitalarias

OpenAIRE

Chavarría Milanés, José Fernando; Mata, Leonardo; Mohs Villalta, Edgar; Ramírez, Giselle; Lizano, Lucía

1985-01-01

artículo -- Universidad de Costa Rica. Instituto de Investigaciones en Salud, 1985 Se describe la clínica, tratamiento y complicaciones de 81 niños lactantes con infección respiratoria aguda. Los niños provenían del cantón central de San José y fueron admitidos en el Hospital Nacional de Niños del 10 de noviembre al 15 de diciembre de 1983. Se encontró un 57% de varones y un 43% de mujeres; los más afectados fueron los niños menores de 3 meses. Más de la mitad de los niños egresó con el di...

Leucemia Linfoblástica Aguda Caso clínico

OpenAIRE

Jiménez Navarro, Nuria

2017-01-01

El cáncer es una de las segundas causas de muerte de nuestra población considerándose también la segunda causa de muerte entre los 0-14 años de edad. Es una enfermedad multifactorial que consigue deteriorar al paciente tanto física como psíquicamente. La leucemia linfoblástica aguda es el cáncer más relevante en niños, constituyendo el 80% de los casos. Está localizado en las células sanguíneas, normalmente en los glóbulos blancos, de la médula ósea, afectando a la función inmunológica. Debid...

Toxicidade aguda e risco ambiental do antibiótico oxitetraciclina para tilápia ( Oreochromis niloticus , Daphnia magna e Lemna minor

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A.A. Machado

Full Text Available RESUMO O objetivo deste estudo foi classificar o antibiótico Terramicina(r de acordo com a toxicidade aguda e o risco de intoxicação ambiental para Oreochromis niloticus, Daphnia magna e Lemna minor, com base no seu ingrediente ativo oxitetraciclina (OTC. Além disso, observou-se a ocorrência de sinais de intoxicação aguda em peixes e o efeito da diluição do antibiótico sobre as variáveis de qualidade de água. Alevinos, neonatos e frondes foram expostos a concentrações de OTC. De acordo com os resultados dos testes de toxicidade aguda, a Terramicina(r foi classificada pela toxicidade aguda e pelo risco de intoxicação ambiental. Para O. niloticus, a CL(I50; 48h calculada foi de 6,92 mg L-1, para D. magna a CE(I50; 48h foi de 0,17mg.L-1, enquanto para L. minor a CI(I50;7d foi de 0,68 mg L-1. A Terramicina(r foi classificada como muito tóxica para O. niloticus e extremamente tóxica para D. magna e L. minor e causa risco de intoxicação ambiental para os três organismos testados. Concentrações de 7,5 e 8,0 mg L-1 de OTC reduziram a concentração de oxigênio dissolvido na água. De acordo com este estudo, a Terramicina(r não deve ser utilizada na aquicultura, pois é altamente tóxica e causa risco de intoxicação ambiental aos organismos teste.

[Follow-up on MEWDS by fundus perimetry and multifocal ERG with the SLO].

Science.gov (United States)

Bültmann, S; Martin, M; Rohrschneider, K

2002-09-01

Most conventional techniques for examination such as perimetry or ERG may not be sensitive enough to detect functional alterations due to MEWDS precisely. We report on a follow-up performed by fundus perimetry and the new technique of multifocal ERG using the scanning laser ophthalmoscope. A 24-year-old female patient (VA 0.2/0.8) was followed up for 7 weeks with these techniques as well as Octopus perimetry, fluorescence angiography, Ganzfeld ERG and biomicroscopy. Multifocal ERG stimulation (mfERG, Retiscan) was performed with the SLO. Visual acuity improved from 0.2 to 0.8 and the central relative scotoma disappeared while a relevant increase of P1-wave amplitudes in mfERG could be observed. Combining objective measurements from the fundus controlled SLO-mfERG and results from fundus perimetry enable good correlation of morphology and results, even for minor alterations of the macula only accessible by few established clinical examinations.

Multifocal ERG wavelet packet decomposition applied to glaucoma diagnosis

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Rodríguez-Ascariz José M

2011-05-01

Full Text Available Abstract Background Glaucoma is the second-leading cause of blindness worldwide and early diagnosis is essential to its treatment. Current clinical methods based on multifocal electroretinography (mfERG essentially involve measurement of amplitudes and latencies and assume standard signal morphology. This paper presents a new method based on wavelet packet analysis of global-flash multifocal electroretinogram signals. Methods This study comprised twenty-five patients diagnosed with OAG and twenty-five control subjects. Their mfERG recordings data were used to develop the algorithm method based on wavelet packet analysis. By reconstructing the third wavelet packet contained in the fourth decomposition level (ADAA4 of the mfERG recording, it is possible to obtain a signal from which to extract a marker in the 60-80 ms time interval. Results The marker found comprises oscillatory potentials with a negative-slope basal line in the case of glaucomatous recordings and a positive-slope basal line in the case of normal signals. Application of the optimal threshold calculated in the validation cases showed that the technique proposed achieved a sensitivity of 0.81 and validation specificity of 0.73. Conclusions This new method based on mfERG analysis may be reliable enough to detect functional deficits that are not apparent using current automated perimetry tests. As new stimulation and analysis protocols develop, mfERG has the potential to become a useful tool in early detection of glaucoma-related functional deficits.

Efecto de los inotrópicos sobre la mortalidad en falla cardiaca aguda. Metaanálisis en red de ensayos clínicos

OpenAIRE

Juan M. Sénior; Edison Muñoz; James Díaz

2017-01-01

Introducción: en pacientes con falla cardiaca aguda es necesario el uso de inotrópicos para lograr su estabilización. Objetivo: definir cuál de los medicamentos inotrópicos se asocia con menor mortalidad. Metodología: se realizó un metaanálisis en red con la aproximación frecuentista. La búsqueda sistemática incluyó PUBMED, EMBASE, CENTRAL, DARE, Epistemonikos, SieELO, LILACS y OpenGray. Se incluyeron ensayos clínicos con asignación aleatoria en pacientes con falla cardiaca aguda que re...

Spectacle Independence after Cataract Extraction in Post-Radial Keratotomy Patients Using Hybrid Monovision with ReSTOR® Multifocal and TECNIS® Monofocal Intraocular Lenses

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Isha Gupta

2014-05-01

Full Text Available Background: We report 2 patients who have undergone radial keratotomy (RK preceding ReSTOR® multifocal intraocular lens (IOL; Alcon, Fort Worth, Tex., USA implantation in their nondominant eyes and TECNIS® monofocal IOL (Abbott Medical Optics, Abbott Park, Ill., USA in their dominant eyes. Methods: Retrospective review of 2 patients who underwent hybrid monovision with ReSTOR® multifocal and TECHNIS® monofocal IOLs at the time of cataract surgery after a remote history of RK. Results: Implantation of the ReSTOR® multifocal and the TECHNIS® monofocal IOLs was successful, with no reported adverse events. The patients were able to achieve spectacle freedom. Conclusion: We report a novel technique for the management of post-RK patients to optimize their chances for spectacle independence.

Infección respiratoria aguda en niños que acuden a un centro de desarrollo infantil

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Nandí-Lozano Eugenia

2002-01-01

Full Text Available Objetivo. Establecer la incidencia de infección respiratoria y los patrones de colonización faríngea en niños que asisten a guarderías. Material y métodos. Se realizó un estudio de cohorte en niños menores de cuatro años de edad, de uno u otro sexo, asistentes a la guardería del Hospital Infantil de México Federico Gómez, de la Ciudad de México, durante abril a octubre de 1999. Se registró la presencia de infección de vías aéreas superiores cada semana, y de colonización cada tres meses, mediante un exudado nasofaríngeo. Se hizo estadística descriptiva de las variables analizadas. Se determinaron tasas de infección respiratoria aguda. Resultados. Se estudiaron 85 niños, 40 del sexo femenino (47% y 45 del sexo masculino (53% durante un total de 9 090 niños/día de seguimiento. Tres niños tenían antecedentes de atopia (3.52%, seis niños antecedentes de asma (7.05%, y 39 eran expuestos a tabaquismo pasivo (45.88%. Se diagnosticaron 246 rinofaringitis (95.3%, nueve otitis media aguda (3.48%, tres bronquiolitis (1.16%, para un total de 258 eventos de infección respiratoria aguda. La tasa de incidencia global fue de 10.35 infecciones por niño/año de observación (IC 95% 8.7-12.0. La incidencia de otitis y bronquiolitis fue de 0.36 y 0.12 eventos por niño/año de observación. Se tomaron cultivos nasofaríngeos con una prevalencia de colonización para S. pneumoniae de 20.4%, H. influenzae no tipificable 13.1% y Moraxella catarrhalis 8.1%. Conclusiones. Los resultados no sólo demuestran una alta prevalencia de colonización debido a cepas invasivas, sino que también revelan una tasa de incidencia de infección respiratoria aguda del doble de lo reportado en estudios de comunidad. Estos resultados ayudan a caracterizar un problema pobremente documentado en nuestro país.

Osteoblastomatosis of bone. A benign, multifocal osteoblastic lesion, distinct from osteoid osteoma and osteoblastoma, radiologically simulating a vascular tumor

International Nuclear Information System (INIS)

Kyriakos, Michael; El-Khoury, Georges Y.; McDonald, Douglas J.; Buckwalter, Joseph A.; Sundaram, Murali; DeYoung, Barry; O'Brien, Michael P.

2007-01-01

Two adult patients are described with multifocal osteolytic lesions radiologically simulating a vascular tumor. One patient had multiple bones involved. Histologically, the individual lesions had the features of the nidus of osteoid osteoma/osteoblastoma. A review of the English language medical literature yielded only one other reported case with similar features. The process is designated as osteoblastomatosis to indicate its bone-forming character, prominent osteoblast proliferation, and multiplicity. The cases are distinguished from multifocal/multicentric osteoid osteoma and osteoblastoma, and from benign and malignant vascular tumors. (orig.)

An adult multifocal medulloblastoma with diffuse acute postoperative cerebellar swelling: immunohistochemical and molecular genetics analysis.

Science.gov (United States)

Balik, Vladimir; Trojanec, Radek; Holzerova, Milena; Tuckova, Lucie; Sulla, Igor; Megova, Magdalena; Vaverka, Miroslav; Hrabalek, Lumir; Ehrmann, Jiri

2015-01-01

Medulloblastoma (MB), the most common malignant tumor typically affecting children, occurs only exceptionally in adults. Multifocal presentation of this malignancy in adulthood is even much rarer—only four cases with favorable postoperative course have been reported, so far. The study illustrates a very rare rapid postoperative clinical deterioration due to diffuse cerebellar swelling (DCS) in an adult multifocal MB (MMB). To the best of their knowledge, authors for the first time performed genetic analysis of MMB and demonstrated expression patterns of selected markers that put the patient within the sonic hedgehog (SHH) molecular subgroup and at least partially explain her unsatisfactory clinical course. Herein, authors summarized the relevant literature concerning this issue with the aim to determine features that would facilitate diagnosis and therapy of such a scarce clinical entity.

Infecciones respiratorias agudas en los niños. Posibles medidas de control

OpenAIRE

Mohs Villalta, Edgar

1985-01-01

Artículo científico -- Universidad de Costa Rica. Instituto de Investigaciones en Salud, 1985 Las infecciones respiratorias agudas que representan el 50% aproximadamente, de los casos de enfermedades que deben notificarse a las autoridades y de las consultas pediátricas de pacientes ambulatorios en los países en desarrollo, son también una de las principales causas de las enfermedades contraídas en los hospitales y de mortalidad por enfermedades nosocomiales. En 1982, por *mph:), fueron la...

Objective perimetry using a four-channel multifocal VEP system: correlation with conventional perimetry and thickness of the retinal nerve fibre layer.

Science.gov (United States)

Horn, Folkert K; Kaltwasser, Christoph; Jünemann, Anselm G; Kremers, Jan; Tornow, Ralf P

2012-04-01

There is evidence that multifocal visual evoked potentials (VEPs) can be used as an objective tool to detect visual field loss. The aim of this study was to correlate multifocal VEP amplitudes with standard perimetry data and retinal nerve fibre layer (RNFL) thickness. Multifocal VEP recordings were performed with a four-channel electrode array using 58 stimulus fields (pattern reversal dartboard). For each field, the recording from the channel with maximal signal-to-noise ratio (SNR) was retained, resulting in an SNR optimised virtual recording. Correlation with RNFL thickness, measured with spectral domain optical coherence tomography and with standard perimetry, was performed for nerve fibre bundle related areas. The mean amplitudes in nerve fibre related areas were smaller in glaucoma patients than in normal subjects. The differences between both groups were most significant in mid-peripheral areas. Amplitudes in these areas were significantly correlated with corresponding RNFL thickness (Spearman R=0.76) and with standard perimetry (R=0.71). The multifocal VEP amplitude was correlated with perimetric visual field data and the RNFL thickness of the corresponding regions. This method of SNR optimisation is useful for extracting data from recordings and may be appropriate for objective assessment of visual function at different locations. This study has been registered at http://www.clinicaltrials.gov (NCT00494923).

The multifaceted presentation of chronic recurrent multifocal osteomyelitis

DEFF Research Database (Denmark)

Girschick, Hermann; Finetti, Martina; Orlando, Francesca

2018-01-01

Objectives: Chronic non-bacterial osteomyelitis (CNO) or chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disorder characterized by sterile bone osteolytic lesions. The aim of this study was to evaluate the demographic data and clinical, instrumental and therapeutic features...... with glucocorticoids, 61 with bisphosphonates, 58 with MTX, 47 with SSZ, 26 with anti-TNF and 4 with anakinra, with a variable response. Conclusion: This is the largest reported case series of CNO patients, showing that the range of associated clinical manifestations is rather heterogeneous. The study confirms...... that the disease usually presents with an early teenage onset, but it may also occur in adults, even in the absence of mucocutaneous manifestations....

Perfiles clínicos y hemodinámicos en pacientes con falla cardiaca aguda

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Luis Eduardo Calderón

2017-09-01

Conclusiones: la falla cardíaca aguda descompensada es el perfil de presentación clínica más común en nuestra población con dos tercios del total de casos. El perfil hemodinámico más frecuente fue el “caliente y húmedo” (Stevenson B, resultados que concuerdan con lo observado en estudios locales y registros internacionales.

Necessidades básicas das esposas de pacientes infartados na fase aguda do tratamento

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Edna Ikumi Umebayashi Takahashi

1990-12-01

Full Text Available Trata-se de um estudo exploratório que teve por finalidade as necessidades básicas das esposas de pacientes infartados, na fase aguda do tratamento. Foi utlizado como referencial para análise os conceitos de Nacessidades Básicas de MASLOW. Os resultados permitiram identificar como principais necessidades afetadas das esposas: segurança, amor e gregária, estima.

Necessidades básicas das esposas de pacientes infartados na fase aguda do tratamento

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Edna Ikumi Umebayashi Takahashi

Full Text Available Trata-se de um estudo exploratório que teve por finalidade as necessidades básicas das esposas de pacientes infartados, na fase aguda do tratamento. Foi utlizado como referencial para análise os conceitos de Nacessidades Básicas de MASLOW. Os resultados permitiram identificar como principais necessidades afetadas das esposas: segurança, amor e gregária, estima.

Peripheral refraction with dominant design multifocal contact lenses in young myopes

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Daniela Lopes-Ferreira

2013-04-01

Conclusion: It is possible to induce significant changes in the pattern of relative peripheral refraction in the myopic direction with commercially available dominant design multifocal contact lenses. The higher add (+3.00 D induced an significantly higher effect than the +2.00 D add lens, although an increase of 1 D in add power does not correspond to the same amount of increase in RPRE.

Multifocal demyelinating motor neuropathy and hamartoma syndrome associated with a de novo PTEN mutation.

Science.gov (United States)

Bansagi, Boglarka; Phan, Vietxuan; Baker, Mark R; O'Sullivan, Julia; Jennings, Matthew J; Whittaker, Roger G; Müller, Juliane S; Duff, Jennifer; Griffin, Helen; Miller, James A L; Gorman, Grainne S; Lochmüller, Hanns; Chinnery, Patrick F; Roos, Andreas; Swan, Laura E; Horvath, Rita

2018-05-22

To describe a patient with a multifocal demyelinating motor neuropathy with onset in childhood and a mutation in phosphatase and tensin homolog ( PTEN ), a tumor suppressor gene associated with inherited tumor susceptibility conditions, macrocephaly, autism, ataxia, tremor, and epilepsy. Functional implications of this protein have been investigated in Parkinson and Alzheimer diseases. We performed whole-exome sequencing in the patient's genomic DNA validated by Sanger sequencing. Immunoblotting, in vitro enzymatic assay, and label-free shotgun proteomic profiling were performed in the patient's fibroblasts. The predominant clinical presentation of the patient was a childhood onset, asymmetric progressive multifocal motor neuropathy. In addition, he presented with macrocephaly, autism spectrum disorder, and skin hamartomas, considered as clinical criteria for PTEN-related hamartoma tumor syndrome. Extensive tumor screening did not detect any malignancies. We detected a novel de novo heterozygous c.269T>C, p.(Phe90Ser) PTEN variant, which was absent in both parents. The pathogenicity of the variant is supported by altered expression of several PTEN-associated proteins involved in tumorigenesis. Moreover, fibroblasts showed a defect in catalytic activity of PTEN against the secondary substrate, phosphatidylinositol 3,4-trisphosphate. In support of our findings, focal hypermyelination leading to peripheral neuropathy has been reported in PTEN-deficient mice. We describe a novel phenotype, PTEN-associated multifocal demyelinating motor neuropathy with a skin hamartoma syndrome. A similar mechanism may potentially underlie other forms of Charcot-Marie-Tooth disease with involvement of the phosphatidylinositol pathway. Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Embolectomía en una embolia pulmonar aguda masiva

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Manuel Carnero Alcázar

2007-07-01

Full Text Available Presentamos el caso de un varón de 57 años que, en el seno de un meningioma microcítico, padece una tromboembolia pulmonar masiva aguda con inestabilidad hemodinámica. Dado el riesgo de hemorragia por el tumor craneal, se contraindica la terapia fibrinolítica y se procede a practicar embolectomía pulmonar. Ésta se realiza bajo anestesia general, con canulación convencional y bajo hipotermia moderada. Se extrae émbolo en el tronco de la arteria pulmonar y con catéter de Fogarty se extraen émbolos en ramas lobares y segmentarias. Discutimos la asociación de enfermedad tromboembólica con determinadas neoplasias y el tratamiento de la tromboembolia pulmonar

Colesterol y triglicéridos como marcadores bioquímicos del estado de la enfermedad del paciente con leucemia linfocítica aguda

OpenAIRE

Marco Guzmán; Miguel Sandoval

2004-01-01

Objetivo: Determinar la relación de los niveles séricos de colesterol y triglicéridos con el estado de respuesta al tratamiento quimioterápico de inducción de pacientes con leucemia linfocítica aguda. Material y Métodos: La muestra la conforman 25 pacientes de 2 a 18 años de edad, admitidos al Instituto de Enfermedades Neoplásicas con un diagnóstico reciente de leucemia linfocítica aguda; determinándose en ellos sus concentraciones séricas de colesterol total, colesterol-HDL, colesterol-LDL y...

Application of serum natalizumab levels during plasma exchange in MS patients with progressive multifocal leukoencephalopathy

NARCIS (Netherlands)

Vennegoor, A.; Rispens, T.; van Oosten, B.W.; Wattjes, M.P.; Wondergem, M.J.; Teunissen, C.E.; van der Kleij, D.; Uitdehaag, B.M.J.; Polman, C.H.; Killestein, J.

2015-01-01

Progressive multifocal leukoencephalopathy (PML) is a severe complication of natalizumab treatment. Restoring immune function by plasmapheresis/immunoadsorption (PLEX/IA) is important for the outcome of PML. We report on four multiple sclerosis (MS) patients whom developed PML during natalizumab

Caracterización inmunofenotípica de pacientes con leucemia mieloide aguda

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Daily Pino Blanco

Full Text Available Introducción: la leucemia mieloide aguda incluye un grupo heterogéneo de neoplasias caracterizadas por una expansión clonal de mieloblastos, cuya clasificación involucra varios criterios, incluidos los inmunológicos. Objetivo: caracterizar el inmunofenotipo de los pacientes con leucemia mieloide aguda evaluados en el Instituto de Hematología e Inmunología. Métodos: se realizó un estudio descriptivo transversal de los pacientes diagnosticados con este tipo de leucemia, cuyas muestras de sangre fueron procesadas en el Departamento de Inmunología en el período 2008-2012. Se usó un ultramicrométodo inmunocitoquímico que utiliza un panel de anticuerpos monoclonales específicos de antígenos mieloides y linfoides. Las variables analizadas fueron: edad, sexo, subtipo de leucemia y expresión de marcadores inmunológicos, cuyas asociaciones fueron analizadas con los estadígrafos Chi-cuadrado y coeficiente de correlación de Spearman. Resultados: se estudiaron 58 pacientes, 28 del sexo femenino y 30 del masculino. El grupo de edad predominante fue de 0 a 9 años con una mediana de 26 años. El subtipo M4 resultó el más frecuente (30,4 %. Los subtipos M4 y M7 predominaron en niños, mientras que el M0, predominó en adultos, con diferencias estadísticamente significativas (p d»0,05. La combinación de los antígenos panmieloides CD13 y CD33 se presentó en el 91 % de los enfermos. Las combinaciones de CD13/CD33, CD14/CD15, CD33/CD14 y CD33/CD15 mostraron correlación significativa. En el 20,6 % de los pacientes evaluados, fueron detectados, además, antígenos linfoides. No se encontraron diferencias significativas en cuanto al sexo y la edad. El antígeno CD7 fue el más expresado, seguido de los antígenos: CD3, CD20, CD22 y CD79, en igual proporción. Conclusiones: el inmunofenotipaje celular demostró ser un procedimiento útil para confirmar el diagnóstico morfológico y clínico de la leucemia mieloide aguda.

Multifocal fibrosclerosis presenting as Grave's orbitopathy. Bilateral exophthalmos associated with retroperitoneal and sellar fibrosis

NARCIS (Netherlands)

van der Pol, R.; Nieuwenhuis, M. G.; Mourits, M. P.

1999-01-01

BACKGROUND: Multifocal fibrosclerosis (MF) is a rare disease that may be misdiagnosed as Graves' orbitopathy. The combination of localisations of MF presented here has not been reported before. CASE REPORT: A 44-year-old man was referred with progressive bilateral exophthalmos. CT of his chest and

Multifocal epithelial hyperplasia in a community in the Mayan area of Mexico.

Science.gov (United States)

González-Losa, Maria R; Suarez-Allén, Rosa E; Canul-Canche, Jaqueline; Conde-Ferráez, Laura; Eljure-Lopez, Nixma

2011-03-01

Multifocal epithelial hyperplasia is a pathology of the oral mucosa which has been reported in diverse ethnic groups. Human papillomavirus (HPV) types 13 and 32 DNA has been detected in these lesions. The aims of this paper are to describe the epidemiological and clinical characteristics of an outbreak in a rural community in the Mayan area of Mexico and to identify a possible route of transmission through saliva. A cross-sectional study was conducted in Chemax (Yucatan, Mexico). Clinical and epidemiological data were obtained through direct interviews. Samples of oral cells and saliva were taken. HPV 13 and 32 were identified by polymerase chain reaction using specific primers. A total of 57 patients were studied, of whom 79.1% were aged jugal mucosa, and more frequently, the tongue. HPV 13 was found in all the patients and HPV 32 in none. A total of 42 saliva samples were positive for HPV 13. Human papillomavirus type 13 is involved in multifocal epithelial hyperplasia among the Mexican Mayan population. The presence of HPV 13 in cells from saliva, combined with poor hygiene behaviors, may explain the familial distribution of the pathology. © 2011 The International Society of Dermatology.

Multifocal fibrosclerosis and IgG4-related disease involving the cardiovascular system

International Nuclear Information System (INIS)

Ishizaka, Nobukazu; Terasaki, Fumio; Sakamoto, Aiko; Imai, Yasushi; Nagai, Ryozo

2012-01-01

The cardiovascular system may be involved as a target organ of multifocal fibrosclerosis, which may manifest as idiopathic retroperitoneal fibrosis, inflammatory aortic aneurysm, inflammatory periarteritis, and inflammatory pericarditis. These pathological conditions can sometimes occur concomitantly. Idiopathic retroperitoneal fibrosis and inflammatory abdominal aortic aneurysm are both characterized by the presence of fibro-inflammatory tissue around the abdominal aorta expanding into the surrounding retroperitoneal structures, and together they may be termed 'chronic periaortitis'. Cardiovascular fibrosclerosis has become non-uncommonly encountered condition since imaging modalities have made its diagnosis more feasible. In addition, recent studies have demonstrated that a certain fraction, but not all, of cardiovascular fibrosclerosis may have a link with immunoglobulin-G4 (IgG4)-related sclerosing disease (IgG4-SD). IgG4-SD is histologically characterized by dense fibrosclerosis and infiltration of lymphocytes and IgG4-positive plasma cells, and these histopathologic findings seem to be essentially similar regardless of the organs involved. In this mini review, we summarize what is known so far about multifocal fibrosclerosis of the cardiovascular system and its association with IgG4-SD, and what remains to be clarified in future investigations. (author)

Light-distortion analysis as a possible indicator of visual quality after refractive lens exchange with diffractive multifocal intraocular lenses.

Science.gov (United States)

Brito, Pedro; Salgado-Borges, José; Neves, Helena; Gonzalez-Meijome, José; Monteiro, Manuel

2015-03-01

To study the perception of light distortion after refractive lens exchange (RLE) with diffractive multifocal intraocular lenses (IOLs). Clínica Oftalmológica das Antas, Porto, Portugal. Retrospective comparative study. Refractive lens exchange was performed with implantation of an AT Lisa 839M (trifocal) or 909MP (bifocal toric) IOL, the latter if corneal astigmatism was more than 0.75 diopter (D). The postoperative visual and refractive outcomes were evaluated. A prototype light-distortion analyzer was used to quantify the postoperative light-distortion indices. A control group of eyes in which a Tecnis ZCB00 1-piece monofocal IOL was implanted had the same examinations. A trifocal or bifocal toric IOL was implanted in 66 eyes. The control IOL was implanted in 18 eyes. All 3 groups obtained a significant improvement in uncorrected distance visual acuity (UDVA) (P refractive cylinder was less than 1.00 D in 86.7% of cases with the toric IOL. The mean light-distortion index was significantly higher in the multifocal IOL groups than in the monofocal group (P light-distortion index and CDVA. The multifocal IOLs provided excellent UDVA and functional UNVA despite increased light-distortion indices. The light-distortion analyzer reliably quantified a subjective component of vision distinct from visual acuity; it may become a useful adjunct in the evaluation of visual quality obtained with multifocal IOLs. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Relação lipase/amilase nas pancreatites agudas de causa biliar e nas pancreatites agudas/crônicas agudizadas de causa alcoólica Lipase/amylase ratio in biliary acute pancreatitis and alcoholic acute/acutized chronic pancreatitis

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Ricardo Custódio Pacheco

2007-03-01

Full Text Available RACIONAL: Pancreatites agudas de causas alcoólica ou biliar podem necessitar de abordagens terapêuticas diferentes. OBJETIVO: Verificar a validade da relação lipase/amilase em diferenciar as causas alcoólica ou biliar na pancreatite aguda/pancreatite crônica agudizada. MÉTODOS: Foram avaliados nove pacientes com pancreatite aguda/pancreatite crônica agudizada alcoólica, todos homens, com idade média (desvio padrão de 39,8 ± 7,0 anos (grupo I e 29 com pancreatite aguda biliar, sendo 8 homens e 21 mulheres, com idade média de 43,6 ± 19,9 anos (grupo II. As amilasemias e lipasemias foram determinadas em pacientes com sintomatologia há, no máximo, 48 horas. A relação lipase/amilase foi calculada utilizando-se valores de amilasemia e lipasemia expressas como múltiplos de seus respectivos valores superiores de referência. RESULTADOS: As médias das lipasemias (4.814 ± 3.670 U/L e amilasemias (1.282 ± 777 U/L no grupo I foram semelhantes às do grupo II (2.697 ± 2.391 e 1.878 ± 1.319 U/L, respectivamente, mas a média das relações lipase/amilase foi significantemente maior no grupo I (4,4 ± 3,6 do que no grupo II (2,2 ± 2,2. Relação lipase/amilase >3 foi significantemente mais freqüente no grupo I (66,7% do que no grupo II (24,1% e diferenciou os dois grupos com sensibilidade de 67% e especificidade de 76%. CONCLUSÕES: 1 as amilasemias e lipasemias não diferenciaram os dois grupos avaliados; 2 relação lipase/amilase >3 é mais freqüente na pancreatite aguda/pancreatite crônica agudizada alcoólica do que na pancreatite aguda biliar, e pode ser útil na diferenciação destas duas causas de pancreatite.BACKGROUND: Alcoholic or biliary acute pancreatitis may need different therapeutic approaches. AIM: Assessing the validity of lipase/amylase ratio in differentiating biliary from alcoholic acute pancreatitis/acutized chronic pancreatitis. METHODS: Nine male patients (mean age and standard deviation: 39.8 ± 7.0 years

Progressive multifocal leukoencephalopathy limited to the brain stem

Energy Technology Data Exchange (ETDEWEB)

Kastrup, O.; Maschke, M.; Diener, H.C. [Neurologische Universitaetsklinik, University of Essen (Germany); Wanke, I. [Department of Neuroradiology, University of Essen (Germany)

2002-03-01

Progressive multifocal leukoencephalopathy (PML) is a subacute demyelinating slow-virus encephalitis caused by the JC polyomavirus in 2-5% of patients with AIDS. MRI typically shows multiple lesions in the cerebral hemispheres. We present a rare case of rapidly evolving and lethal PML with a severe bulbar syndrome and spastic tetraparesis in a patient with AIDS. MRI showed high-signal lesions on T2-weighted images confined to the brain stem, extending from the medulla oblongata to the midbrain. JC virus polymerase chain reaction in cerebrospinal fluid was positive, and neuropathology showed the findings of PML. This case was also notable because of the rapid progression despite improved immune status with antiretroviral therapy. (orig.)

Early Magnetic Resonance Detection of Natalizumab-Related Progressive Multifocal Leukoencephalopathy in a Patient with Multiple Sclerosis

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Guglielmo Manenti

2013-01-01

Full Text Available Diagnosis of progressive multifocal leukoencephalopathy is usually based on the clinical presentation, on the demonstration of the brain lesions at the magnetic resonance imaging examination, and on the detection of the JC virus DNA in the cerebrospinal fluid with high sensitive polymerase chain reaction. The role of magnetic resonance imaging specifically in natalizumab-associated progressive multifocal leukoencephalopathy is strengthening, and it is gaining importance not only as an irreplaceable diagnostic tool but also as a surveillance and risk stratifying tool in treated patients. While other imaging techniques such as computed tomography lack sensitivity and specificity, magnetic resonance performed with morphological and functional sequences offers clinicians the possibility to early identify the stage of the disease and the emergence of an immune reconstitution inflammatory syndrome after natalizumab blood removal plasmapheresis.

Retinopatia de Purtscher-like e pancreatite aguda Purtscher-like retinopathy and acute pancreatitis

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Kelly Fernandes de Paula Rodrigues

2008-04-01

Full Text Available Retinopatia de Purtscher-like é uma baixa súbita da visão associada à imagem de múltiplas áreas branco-amareladas (manchas algodonosas e hemorragias no pólo posterior de ambos os olhos. O exato mecanismo da injúria ainda não é claro, mas provavelmente seria de natureza embólica.Tem sido descrita em uma variedade de condições, incluindo pancreatite aguda, síndrome de embolia gordurosa, insuficiência renal, nascimento (parto e pós-parto, desordens do tecido conectivo, entre outras. Serão relatados três casos de pancreatite aguda confirmada pelos exames laboratoriais e história clínica, associadas a alterações no exame do fundo de olho, compatíveis com esta retinopatia.Purtscher-like retinopathy is acute loss of vision associated image of the multiple areas of retinal whitening and hemorrhage in the posterior pole of both eyes. The exact mechanism of injury remains unclear, current evidence suggests that it is embolic in nature. In a variety of conditions are been described including acute pancreatitis, fat embolism syndrome, renal failure, childbirth, and connective tissue disorders. Will are related three cases of the acute pancreatitis which was confirmed by complementary laboratory studies and clinical history, associated from exam of the fundus of the eye, similar is this retinopathy.

Sarcoidosis aguda: Variante de Síndrome de Löfgren sin eritema nodoso

OpenAIRE

Pérez, Gerardo; Facal, Jorge

2014-01-01

El síndrome de Löfgren, es una variante aguda de la sarcoidosis, que se caracteriza por fiebre, eritema nodoso, adenomegalias hiliares pulmonares y artritis. En general, tiene un curso benigno y autolimitado, que contrasta con las formas crónicas que requieren uso de corticoides y tienen tendencia a la recidiva. Se describe aquí el caso clínico de un paciente joven, de sexo masculino, con artritis pero sin eritema nodoso, lo que dificultó el planteo diagnóstico de síndrome de Löfgren. Se real...

The value of local treatment in patients with primary, disseminated, multifocal Ewing sarcoma (PDMES)

NARCIS (Netherlands)

Haeusler, Julia; Ranft, Andreas; Boelling, Tobias; Gosheger, Georg; Braun-Munzinger, Gabriele; Vieth, Volker; Burdach, Stefan; van den Berg, Henk; Juergens, Heribert; Dirksen, Uta

2010-01-01

The value of local treatment in patients with primary, disseminated, multifocal Ewing sarcoma (PDMES) was investigated. We analyzed 120 patients registered into the European Ewing Tumor Working Initiative of National Groups (EURO-E.W.I.N.G. 99) trial at the trial center of Muenster from 1998 to

Particularidades del síndrome de dificultad respiratoria aguda en edades pediátricas

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Valentín Santiago Rodríguez Moya

Full Text Available Desde las primeras descripciones del síndrome de dificultad respiratoria aguda los pediatras intensivistas reconocieron que posee particularidades que la hacen diferente en la población pediátrica. El objetivo de este trabajo es divulgar la definición específica en el modelo infantil, aunque existen similitudes en la fisiopatología del síndrome de dificultad respiratoria en adultos y niños. Se revisaron los conceptos vigentes sobre el síndrome de dificultad respiratoria aguda desde su descripción, a través de los diferentes consensos (desde el de 1994 hasta el de 2015 y se señalaron las recomendaciones en el tratamiento y seguimiento de esta entidad. Los tópicos que se trataron fueron: concepto; prevalencia y epidemiología; fisiopatología, severidad y enfermedades asociadas; soporte ventilatorio; tratamientos secundarios específicos sobre el pulmón; tratamientos concomitantes; monitoreo general y pulmonar; soporte ventilatorio no invasivo; terapia extracorpórea y el seguimiento a largo plazo. Las recomendaciones propuestas en la última conferencia de consenso para el tratamiento del síndrome de dificultad respiratoria en edades pediátricas permiten optimizar el tratamiento e identificar necesidades futuras de investigación del tema.

Esofagitis necrotizante aguda: Una entidad inusual

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Silvana E. Pramparo

2010-12-01

Full Text Available La esofagitis necrotizante aguda (ENA, también denominada esófago negro, es una rara enfermedad poco descripta en la literatura médica. Describimos el caso de un hombre de 80 años, con hemorragia digestiva alta quien desarrolló un esófago negro luego de un episodio de hipotensión. La necrosis fue confirmada histológicamente. Los pacientes se presentan con hematemesis y melena en más del 70% de los casos. Los hallazgos endoscópicos muestran una coloración negruzca de la mucosa esofágica. El diagnóstico se realiza con endoscopia y confirmación histológica. La mortalidad es alta (más del 50% aunque relacionada a las enfermedades de base del paciente. Por último, podemos decir que la sospecha es muy importante en el diagnóstico de ENA, particularmente en pacientes ancianos con enfermedades asociadas y evidencia de hemorragia digestiva alta. En este trabajo describimos las características clínicas, endoscópicas e histopatológicas de un paciente con ENA.

Efecto del calcio sobre la toxicidad aguda de aluminio en alevines de trucha arcoiris (Oncorhynchus mykiss expuestos en aguas de diferente pH

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Rolando Vega

2015-05-01

Full Text Available En la producción de alevines de salmón de la región de la Araucanía (sur de Chile se presentan importantes eventos de mortalidad aguda sin rasgos patológicos aparentes. El problema se focaliza en ejemplares de 0,2 a 1 g y las causas apuntan a procesos de acidificación del pH del agua y a la presencia de ciertos metales pesados, entre los cuales destaca el aluminio, que alcanza concentraciones más allá de los rangos de tolerancia de los peces. La información científica indica que concentraciones de 5 mg Ca L-1 en el afluente son suficientes para mantener a salvo los peces del efectos tóxico del aluminio. Sin embargo, los problemas en la producción de alevines de salmón indican que se requiere un mayor conocimiento científico y evidencia experimental que soporte el desarrollo de procesos y tecnologías para el tratamiento de los afluentes de las pisciculturas chilenas. En este trabajo se evaluó el efecto de cuatro concentraciones de calcio (0, 5, 10 y 20 mg Ca L-1 sobre la toxicidad aguda de 500 μg Al L-1 en alevines de trucha arcoiris (Oncorhynchus mykiss de 0,1 g en agua de cultivo a pH 5, 6 y 7. El objetivo del trabajo fue determinar la dosis de calcio que reduce la toxicidad aguda de aluminio y los tiempos mínimos de reacción que podrían disponer los piscicultores para tomar medidas preventivas ante una concentración aguda de aluminio en el agua de cultivo. Los resultados indican que antes de 8 h de exposición a una concentración tóxica de aluminio los piscicultores deberían asegurar en el agua de cultivo una dosis superior a 10 mg Ca L-1 y un pH >6 como medida remedial para reducir el efecto de intoxicación aguda causada por aluminio.

Proteinograma sérico, com ênfase em proteínas de fase aguda, de bovinos sadios e bovinos portadores de enfermidade aguda de ocorrência natural

OpenAIRE

Simplício,K.M.M.G.; Sousa,F.C.; Fagliari,J.J.; Silva,P.C.

2013-01-01

Nas últimas décadas, as proteínas de fase aguda (PFAs) tornaram-se biomarcadores de escolha em medicina humana para identificação e monitoração de doenças. Não há razão para imaginar que tais pesquisas clínicas não sejam igualmente úteis na medicina veterinária. Com o objetivo de verificar a importância das PFAs como biomarcadores de doenças inflamatórias em bovinos, determinou-se o proteinograma sérico, por meio da técnica de eletroforese SDS-PAGE, com interesse especial nas PFAs. Foram util...

Prevalência de toxoplasmose aguda em gestantes, incidência de toxoplasmose congênita e desempenho de testes diagnósticos em toxoplasmose congênita

OpenAIRE

Ivana Rosângela dos Santos Varella

2007-01-01

Introdução: A infecção aguda pelo Toxoplasma gondii em gestantes pode determinar infecção fetal através de passagem transplacentária. As crianças afetadas podem desenvolver coriorretinite e déficit neurológico, na ausência de tratamento adequado. Objetivos: Estimar a prevalência de toxoplasmose aguda em gestantes atendidas na maternidade do Hospital Nossa Senhora da Conceição, avaliando possíveis diferenças nas freqüências ao longo do período estudado; medir a incidência de toxoplasmose congê...

Strategy in Regulatory Decision-Making for Management of Progressive Multifocal Leukoencephalopathy

DEFF Research Database (Denmark)

Segec, A; Keller-Stanislawski, B; Vermeer, N S

2015-01-01

Progressive multifocal leukoencephalopathy (PML) has been observed after the use of several medicines, including monoclonal antibodies. As these drugs play important roles in the therapeutic armamentarium, it is important to address the challenges that this severe adverse reaction poses to the safe...... use of medicines. Considering the need for consistent outcomes of regulatory decisions, the European Medicines Agency Pharmacovigilance Risk Assessment Committee (PRAC) used PML as an example to develop a systematic approach to labeling and risk minimization....

The spatial resolution of the porcine multifocal electroretinogram for detection of laser-induced retinal lesions

DEFF Research Database (Denmark)

Kyhn, Maria Voss; Kiilgaard, Jens Folke; Scherfig, Erik

2008-01-01

This study aimed to investigate the spatial resolution of a porcine multifocal electroretinogram (mfERG) protocol by testing its ability to detect laser-induced retinal lesions. Furthermore, we wanted to describe time-dependent changes in implicit time and amplitude of the different mfERG peaks...

Subjective evaluation of uncorrected vision in patients undergoing cataract surgery with (diffractive multifocal lenses and monovision

Directory of Open Access Journals (Sweden)

Stock RA

2017-07-01

Full Text Available Ricardo Alexandre Stock, Thaís Thumé, Luan Gabriel Paese, Elcio Luiz Bonamigo Universidade do Oeste de Santa Catarina, Rua Getúlio Vargas, Joaçaba, Santa Catarina, Brazil Purpose: To analyze patient satisfaction and difficulties with bilateral multifocal intraocular lenses (IOLs implantation and aspheric monofocal IOLs implantation using monovision, after cataract surgery.Materials and methods: A total of 61 participants were included in the study, 29 with monovision and 32 with multifocal lenses. The inclusion criteria were patients undergoing phacoemulsification for bilateral visual impairment due to cataracts and presenting with postoperative visual acuity of 20/30 or better for distance and line J3 or better for near vision.Results: The 2 groups had similar results regarding difficulties with daily activities such as distance vision, near vision, watching television, reading, cooking, using a computer or cellphone, shaving/putting on makeup and shopping. There were differences in responses between the groups regarding difficulty with night vision (P=0.0565 and night driving (P=0.0291. Degree of satisfaction in terms of distance vision without glasses was statistically significantly better in monovision group (P=0.0332, but not for near (P=0.9101.Conclusion: Both techniques yielded satisfactory results regarding visual acuity for different activities without the need to use glasses. Multifocal lenses are a good option for patients with the exception of night driving, and who desire independence from glasses. Keywords: cataract extraction, aphakia, postcataract, patient satisfaction, night vision

Paracoccidioidomicose crônica multifocal tendo como primeira manifestação o envolvimento palpebral: relato de caso Chronical and multifocal paracoccidioidomycosis having the lid involvement as the first sign: case report

Directory of Open Access Journals (Sweden)

Tiago Nelson de Oliveira Rassi

2009-12-01

Full Text Available O acometimento ocular da paracoccidioidomicose é raro e quando ocorre é geralmente secundário à disseminação hematogênica. Descrição de um caso de paracococcidioidomicose multifocal em homem de 73 anos com história de trauma contuso no olho direito por pedaço de madeira e que teve como primeira manifestação clínica lesão palpebro-conjuntival. Interroga-se possível infecção primária ocular por contiguidade e alerta-se para a manifestação da doença em idade mais avançada.Ocular involvement of paracoccidioidomycosis is rare and when it occurs it is usually secondary to hematogenic dissemination. A case of multifocal paracoccidioidomycosis in a 73 year-old male after history of blunt trauma in the right eye with a stick of wood that presented as the first clinical sign a lid-conjunctival lesion is described. The possible primary ocular infection spreading by contiguity is argued and the disease manifestation in an advanced age is highlighted.

Multifocal osteolysis following limb-sparing procedures: imaging findings and a review of the literature

International Nuclear Information System (INIS)

Kaste, S.C.; Rao, B.N.; Lynch, M.H.; Parham, D.M.; Meyer, W.H.

1996-01-01

Limb-sparing procedures utilizing endoprostheses improve both the quality of life and functional level of patients treated for primary bone sarcomas. Herein, we present the imaging findings of an uncommon cause of prosthetic failure, i. e., foreign body reaction, manifested by progressive multifocal osteolysis along the prosthetic femoral shaft. (orig.). With 3 figs

Preventing falls in older multifocal glasses wearers by providing single-lens distance glasses: the protocol for the VISIBLE randomised controlled trial

Directory of Open Access Journals (Sweden)

Lee Bonsan B

2009-03-01

Full Text Available Abstract Background Recent research has shown that wearing multifocal glasses increases the risk of trips and falls in older people. The aim of this study is to determine whether the provision of single-lens distance glasses to older multifocal glasses wearers, with recommendations for wearing them for walking and outdoor activities, can prevent falls. We will also measure the effect of the intervention on health status, lifestyle activities and fear of falling, as well as the extent of adherence to the program. Methods/Design Approximately 580 older people who are regular wearers of multifocal glasses people will be recruited. Participants will be randomly allocated to either an intervention group (provision of single lens glasses, with counselling and advice about appropriate use or a control group (usual care. The primary outcome measure will be falls (measured with 13 monthly calendars. Secondary measures will be quality of life, falls efficacy, physical activity levels and adverse events. Discussions The study will determine the impact of providing single-lens glasses, with advice about appropriate use, on preventing falls in older regular wearers of multifocal glasses. This pragmatic intervention, if found to be effective, will guide practitioners with regard to recommending appropriate glasses for minimising the risk of falls in older people. Trial Registration The protocol for this study was registered with the Clinical Trials.gov Protocol Registration System on June 7th 2006 (#350855.

The Effects of Hashimoto Thyroiditis on Lymph Node Metastases in Unifocal and Multifocal Papillary Thyroid Carcinoma: A Retrospective Chinese Cohort Study.

Science.gov (United States)

Zhu, Feng; Shen, Yi Bin; Li, Fu Qiang; Fang, Yun; Hu, Liang; Wu, Yi Jun

2016-02-01

The purpose of this study was to investigate the risk factors for central and lateral neck lymph node metastases in papillary thyroid carcinoma (PTC) and multifocal papillary thyroid carcinoma (MPTC), particularly when associated with Hashimoto thyroiditis (HT).A retrospective analysis of 763 consecutive patients who underwent total thyroidectomy with bilateral central neck dissection in the First Affiliated Hospital, College of Medicine, Zhejiang University between October 2011 and October 2014 was conducted. All patients had formal histological diagnoses of HT. Multivariable logistic regression analysis was performed to identify risk factors of neck lymph node metastases.Our study identified 277 PTC patients with HT and showed comparatively low rates of central lymph node metastases (CLNM) compared with the PTC patients without HT (37.2% versus 54.7%, P thyroid peroxidase antibody >140 IU/mL was established as the most sensitive and specific level for the prediction of MPTC based on receiver operating characteristic curve analyses. Thyroid peroxidase antibody, age, tumor size, and multifocality exhibited the ability to predict CLNM in PTC with HT patients with an area under the curve of 81.1% based on a multivariate model.Hashimoto thyroiditis was associated with increased prevalences of multifocality and capsular invasion. In contrast, HT was associated with a reduced risk of CLNM in PTC and MPTC patients, which indicated a potential protective effect. We found that the prognostic prediction model was applicable for predicting multifocality and CLNM in PTC patients with HT.

Lesao óssea em leucemias agudas linfoblásticas tipo T e TIPO nao T / nao B

OpenAIRE

Martins, Fernando Lopes

2013-01-01

Resumo: O AUTOR APRESENTA OS RESULTADOS DO ESTUDO RADIOLÓGICO DE ESQUELETO DE 61 PACIENTES PORTADORES DE LEUCEMIA AGUDA LINFOBLÁSTICA, CORRELACIONANDO A PRESENÇA OU NÃO DE Lesões ÓSSEAS COM A CLASSIFICAÇÃO IMUNOLÓGICA DE LAL TIPO T E TIPO não T / não B

Valor Diagnóstico do Aumento dos Eosinóftlos e Linfocitos no Lavado Bronco-Alveolar em Doentes com Insuficiência Respiratória Aguda e Infiltrados Pulmonares Difusos

OpenAIRE

Kazui Soma; Nobukazu Takada; Masaru Kubota; Masato Katagiri; Nobuo Yanase; Tomoyuki Tomita; Takashj Ohwada

2000-01-01

RESUMO: Os autores analisaram de 1983 a 199 1, a utilidade da contagem diferencial de células no Lavado Bronco-Alveolar (LBA) em doentes com Insuficiência Respiratória Aguda (IRA) e Infiltrados Pulmonares Difusos (IPD), com particular interesse nos que apresentavam níveis elevados de eosinóflos ou de linfocitos no LBA. Foram estudados 118 doentes com insuficiência respiratória para aguda e com PaO2

Comparison of a new refractive multifocal intraocular lens with an inferior segmental near add and a diffractive multifocal intraocular lens.

Science.gov (United States)

Alio, Jorge L; Plaza-Puche, Ana B; Javaloy, Jaime; Ayala, María José; Moreno, Luis J; Piñero, David P

2012-03-01

To compare the visual acuity outcomes and ocular optical performance of eyes implanted with a multifocal refractive intraocular lens (IOL) with an inferior segmental near add or a diffractive multifocal IOL. Prospective, comparative, nonrandomized, consecutive case series. Eighty-three consecutive eyes of 45 patients (age range, 36-82 years) with cataract were divided into 2 groups: group A, 45 eyes implanted with Lentis Mplus LS-312 (Oculentis GmbH, Berlin, Germany); group B, 38 eyes implanted with diffractive IOL Acri.Lisa 366D (Zeiss, Oberkochen, Germany). All patients underwent phacoemulsification followed by IOL implantation in the capsular bag. Distance corrected, intermediate, and near with the distance correction visual acuity outcomes and contrast sensitivity, intraocular aberrations, and defocus curve were evaluated postoperatively during a 3-month follow-up. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), corrected distance near and intermediate visual acuity (CDNVA), contrast sensitivity, intraocular aberrations, and defocus curve. A significant improvement in UDVA, CDVA, and UNVA was observed in both groups after surgery (P ≤ 0.04). Significantly better values of UNVA (P<0.01) and CDNVA (P<0.04) were found in group B. In the defocus curve, significantly better visual acuities were present in eyes in group A for intermediate vision levels of defocus (P ≤ 0.04). Significantly higher amounts of postoperative intraocular primary coma and spherical aberrations were found in group A (P<0.01). In addition, significantly better values were observed in photopic contrast sensitivity for high spatial frequencies in group A (P ≤ 0.04). The Lentis Mplus LS-312 and Acri.Lisa 366D IOLs are able to successfully restore visual function after cataract surgery. The Lentis Mplus LS-312 provided better intermediate vision and contrast sensitivity outcomes than the Acri.Lisa 366D. However, the

Chimeric immune receptors (CIRs) specific to JC virus for immunotherapy in progressive multifocal leukoencephalopathy (PML)

NARCIS (Netherlands)

W. Yang; E.L. Beaudoin; L. Lu; R.A. Du Pasquier (Renaud); M.J. Kuroda; R.A. Willemsen (Ralph); I.J. Koralnik; R.P. Junghans

2007-01-01

textabstractProgressive multifocal leukoencephalopathy (PML) is a deadly brain disease caused by the polyomavirus JC (JCV). The aim of this study is to develop 'designer T cells' armed with anti-JCV TCR-based chimeric immune receptors (CIRs) by gene modification for PML immunotherapy. Two T cell

Individualized laparoscopic B-ultrasound-guided microwave ablation for multifocal primary liver cancer.

Science.gov (United States)

Xu, Zhifeng; Yang, Zhangwei; Pan, Jianghua; Hu, Yiren

2018-03-01

Liver cancer is one of the most common malignancies of the digestive system. Minimally invasive ablation procedures have become one of the major means for treating unresectable multifocal liver cancer and have been extensively applied in primary and metastatic liver cancer treatment. Laparoscopic B-ultrasound-guided microwave ablation is an example of the progress made in this field. To analyze and summarize the results of and experience with laparoscopic B-ultrasound-guided microwave ablation for multifocal primary liver cancer; moreover, the ablation effects were compared between tumors of different sizes. Laparoscope-guided needle ablation was conducted on 84 lesions from 32 patients with primary liver cancer based on tumor size, quantity, and location. Moreover, the perioperative data, ablation effects according to tumor size, and long-term follow-up results were analyzed. Among the 84 nodules treated via microwave ablation, tumors measuring ≤ 3 cm demonstrated complete ablation upon imaging analysis conducted 1 month after surgery. Moreover, 5 of the tumors measuring > 3 cm demonstrated incomplete ablation. In these cases, a second procedure was performed, until imaging studies confirmed that complete ablation was achieved. Laparoscopic microwave ablation allows for precise puncture positioning, an effective ablation range, and safe and feasible surgery, which is especially suitable for liver tumors located in sites difficult to access.

Comparison of T stage, N stage, multifocality, and bilaterality in papillary thyroid carcinoma patients according to the presence of coexisting lymphocytic thyroiditis.

Science.gov (United States)

Park, Jin Young; Kim, Dong Wook; Park, Ha Kyung; Ha, Tae Kwun; Jung, Soo Jin; Kim, Do Hun; Bae, Sang Kyun

2015-01-01

This study aimed to assess the relationship between coexisting lymphocytic thyroiditis and T-N stages of papillary thyroid carcinoma (PTC) by histopathological analysis. The study included 653 patients who underwent thyroid surgery for PTC at our hospital. Each case was classified as either Hashimoto's thyroiditis (HT), non-Hashimoto type of lymphocytic thyroiditis (NHLT), or normal according to the histopathology of thyroid parenchyma. Patient age, gender, surgical modality, location, T stage, N stage, multifocality and bilaterality were compared according to the histopathology. The prevalence of coexisting lymphocytic thyroiditis was 25.8% (169/653); HT (7.5%, 49/653) and NHLT (18.3%, 120/653). There were no significant differences in T stage, N stage, multifocality and bilaterality with regard to coexisting lymphocytic thyroiditis, regardless of whether HT and NHLT were considered collectively or discretely. Primary tumor size (p thyroiditis did not differ from those with normal parenchyma in terms of T stage, N stage, multifocality and bilaterality.

Modulação da pressão intracraniana em um modelo experimental de hipertensão abdominal e lesão pulmonar aguda

OpenAIRE

Zampieri,Fernando Godinho; Almeida,Juliana Roberta; Schettino,Guilherme Pinto de Paula; Park,Marcelo; Machado,Fabio Santana; Azevedo,Luciano Cesar Pontes

2011-01-01

OBJETIVO: Avaliar o efeito de alterações hemodinâmicas, respiratórias e metabólicas sobre a pressão intracraniana em um modelo de lesão pulmonar aguda e síndrome compartimental abdominal. MÉTODOS: Oito porcos Agroceres foram submetidos, após a instrumentação, a cinco cenários clínicos: 1) estado basal com baixa pressão intra-abdominal e pulmão sadio; 2) pneumoperitôneo, com pressão intra-abdominal de 20 mm Hg; 3) lesão pulmonar aguda induzida por lavagem pulmonar e desativação de surfactante;...

Locally aggressive and multifocal phosphaturic mesenchymal tumors: two unusual cases of tumor-induced osteomalacia.

Science.gov (United States)

Higley, Meghan; Beckett, Brooke; Schmahmann, Sandra; Dacey, Elizabeth; Foss, Erik

2015-12-01

Tumor-induced osteomalacia (TIO) has long been recognized as a clinical paraneoplastic syndrome. The identification of a unique histopathologic entity, the phosphaturic mesenchymal tumor (PMT), as a distinct etiology for TIO has been a more recent discovery. The majority of published cases describe a solitary, non-aggressive appearing soft tissue or osseous lesions in patients with osteomalacia; aggressive appearing or multifocal lesions appear to be exceedingly rare. These tumors characteristically secrete fibroblast growth factor 23 (FGF23). Elevated serum levels of FGF23 result in phosphate wasting and osteomalacia. In the majority of cases, laboratory abnormalities and clinical signs and symptoms of osteomalacia precede identification of the causative lesion by years. Following diagnosis, complete resection with wide margins to prevent local recurrence is most often curative. Imaging characteristics of PMT are diverse and remain incompletely defined, as the majority of previous publications are outside of the radiologic literature. We present multiple imaging modalities in two cases of patients with debilitating osteomalacia and unusual appearing PMTs: one with a locally aggressive lesion leading to pathologic fracture, the second presenting with exceedingly rare multifocal PMT.

Imaging of chronic recurrent multifocal osteomyelitis of childhood first presenting with isolated primary spinal involvement

International Nuclear Information System (INIS)

Anderson, S.E.; Heini, P.; Kalbermatten, D.; Sauvain, M.J.; Stauffer, E.; Geiger, L.; Johnston, J.O.; Roggo, A.; Steinbach, L.S.

2003-01-01

Initial presentation with primary spinal involvement in chronic recurrent multifocal osteomyelitis of childhood (CRMO) is rare. Our objective was to review the imaging appearances of three patients who had CRMO who initially presented with isolated primary spinal involvement.Design and patients The imaging, clinical, laboratory and histology findings of the three patients were retrospectively reviewed. Imaging included seven spinal MR imaging scans, one computed tomography scan, nine bone scans, two tomograms and 16 radiographs. These were reviewed by two musculoskeletal radiologists and a consensus view is reported. All three patients presented with atraumatic spinal pain and had extensive bone spinal pathology. The patients were aged 11, 13 and 12 years. There were two females and one male.Results and conclusions The initial patient had thoracic T6 and T8 vertebra plana. Bone scan showed additional vertebral body involvement. Follow-up was available over a 3 year period. The second patient had partial collapse of T9 and, 2 years later, of C6. Subsequently extensive multifocal disease ensued and follow-up was available over 8 years. The third patient initially had L3 inferior partial collapse and 1 year later T8 involvement with multifocal disease. Follow-up was available over 3 years. The imaging findings of the three patients include partial and complete vertebra plana with a subchondral line adjacent to endplates associated with bone marrow MR signal alterations. Awareness of the imaging appearances may help the radiologist to include this entity in the differential diagnosis in children who present with spinal pathology and no history of trauma. Histopathological examination excludes tumor and infection but with typical imaging findings may not always be necessary. (orig.)

MRI shows thickening and altered diffusion in the median and ulnar nerves in multifocal motor neuropathy

DEFF Research Database (Denmark)

Haakma, Wieke; Jongbloed, Bas A.; Froeling, Martijn

2017-01-01

Objectives To study disease mechanisms in multifocal motor neuropathy (MMN) with magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) of the median and ulnar nerves. Methods We enrolled ten MMN patients, ten patients with amyotrophic lateral sclerosis (ALS) and ten healthy controls...

Strategy in Regulatory Decision-Making for Management of Progressive Multifocal Leukoencephalopathy.

Science.gov (United States)

Segec, A; Keller-Stanislawski, B; Vermeer, N S; Macchiarulo, C; Straus, S M; Hidalgo-Simon, A; De Bruin, M L

2015-11-01

Progressive multifocal leukoencephalopathy (PML) has been observed after the use of several medicines, including monoclonal antibodies. As these drugs play important roles in the therapeutic armamentarium, it is important to address the challenges that this severe adverse reaction poses to the safe use of medicines. Considering the need for consistent outcomes of regulatory decisions, the European Medicines Agency Pharmacovigilance Risk Assessment Committee (PRAC) used PML as an example to develop a systematic approach to labeling and risk minimization. © 2015 American Society for Clinical Pharmacology and Therapeutics.

A role for susceptibility weighted imaging in progressive multifocal leukoencephalopathy

LENUS (Irish Health Repository)

Yap, SM

2017-04-01

We report a radiologic finding on magnetic resonance imaging (MRI) of the brain of two cases of progressive multifocal leukoencephalopathy (PML) of hypointense signal of subcortical U-fibres on susceptibility weighted (SW) sequence. The first case is a 50-year-old man recently treated with chemotherapy including rituximab for non-Hodgkin\\'s lymphoma. The second case is a 64-year-old woman with human immunodeficiency virus (HIV) infection. Iron deposition is a likely causative factor. We propose that SWI may be especially useful in the assessment of indeterminate cases to reduce the likelihood of a missed diagnosis of PML

Multifocal bilateral metatarsal tuberculosis: a rare presentation.

Science.gov (United States)

Vijay, Vipul; Sud, Alok; Mehtani, Anil

2015-01-01

Tuberculosis, or phthisis (consumption) as it was popularly known in the Greek era, has been endemic in Southeast Asia and Sub-Saharan Africa; however, the human immunodeficiency virus epidemic has seen the re-emergence of this disease in the areas in which it was not very commonly reported. With this, the need for understanding and treatment of rare presentations of tuberculosis has become of paramount importance to achieve the World Health Organization millennium goal of a "reversal of incidence by 2015." Foot involvement has been reported in 0.1% to 0.3% of extrapulmonary cases. Multifocal lesions have an incidence of histopathologic owing to the paucibacillary nature of the disease. Early identification and treatment with antitubercular drugs will normally result in a good cosmetic and functional result. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Caries dental aguda del primer molar permanente en niños de 12 años

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Daniel Enrique Reyes Romagosa

Full Text Available Introducción: el primer molar permanente es considerado la llave de la oclusión dentaria, la presencia de caries en éste es elevada, lo que dificulta el logro de las metas trazadas por organizaciones de salud a nivel mundial en este grupo de edad. Objetivo: determinar el comportamiento de la caries dental aguda en primer molar permanente en una población de 12 años de edad atendida en la Clínica Estomatológica Santa Cruz de la Parroquia Goaigoaza. Métodos: se realizó un estudio descriptivo transversal en la Clínica Estomatológica Santa Cruz. Parroquia Goaigoaza, municipio Puerto Cabello, estado Carabobo, en el período comprendido entre abril del 2009 a abril 2010. Se seleccionaron 97 pacientes de 12 años de edad los que constituyeron el universo y la muestra. Acudieron a la consulta por dolor debido a la presencia de caries dental aguda. Se registraron las variables: edad, sexo, grado clínico de la caries dental, estímulos externos que provocaron dolor, la cara dental y la arcada dentaria más afectadas. La información fue recogida mediante interrogatorio y examen clínico. Resultados: el sexo masculino representó el 63,9 %. La caries dental de 3er grado estuvo presente en un 68 %. Los estímulos externos que provocaron dolor fueron: el frío presente en 75,2 % y los alimentos dulces en 69,1 % en ambos sexos. El primer molar inferior derecho resultó más afectado (46,4 % que el izquierdo (36,1 %, así como la arcada dentaria inferior (25,8 % y la cara oclusal (64,9 %. Conclusiones: predominaron el sexo masculino y la caries dental aguda de 3er grado. El frío y los alimentos dulces fueron los estímulos externos más frecuentes. Los más afectados resultaron el primer molar inferior derecho, la cara oclusal y la arcada dentaria inferior.

Clinical outcomes of a new diffractive multifocal intraocular lens

Directory of Open Access Journals (Sweden)

Baha Toygar

2017-12-01

Full Text Available AIM: To evaluate clinical outcomes after implantation of a new diffractive aspheric multifocal intraocular lens (IOL with +3.00 addition power. METHODS: This is a retrospective, consecutive case series of cataract patients who underwent bilateral implantation of the Optiflex MO/HF D012 (Moss Vision Inc. Ltd, London, UK multifocal IOL. Patients followed for 6mo were included in the study. Data on distance, intermediate and near visual acuity, refractive error [manifest spherical equivalent (MSE], contrast sensitivity, adverse events, subjective symptoms, spectacle independence and patient satisfaction [visual function questionnaire (VFQ-25 questionnaire] were retrieved from electronic medical records and analyzed. RESULTS: Forty eyes of 20 patients with a mean age of 66.7±8.5y (range: 53-82 were included in the study. Mean uncorrected distance, near and intermediate visual acuity remained stable through postoperative visits and was 0.19±0.19 logMAR, Jaeger 4 and Jaeger 3 respectively at the 6mo visit. At the end of postoperative 6mo, MSE was -0.14±0.42 diopters (D and 98% of the eyes were within 1.00 D of target refraction. Postoperative low contrast (10% visual acuity remained stable (P=0.54 through follow up visits with a mean of 0.35±0.17 logMAR at the 6mo visit. There were no reported adverse events. None of the patients reported subjective symptoms of halo or glare. Spectacle independence rate was 90%. Mean VFQ-25 questionnaire score was 93.5±6.12. CONCLUSION: The Optiflex MO/HF-DO12 IOL was safely implanted and successfully restored distance, intermediate and near visual acuity without impairing contrast sensitivity. High levels of spectacle independence were achieved at all distances including intermediate distance.

Diabetes insipidus como manifestação inicial de leucemia mieloide aguda em paciente com monossomia do cromossomo 7

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Amanda Dias Lima Morais

2017-04-01

Full Text Available O diabetes insipidus (DI central é uma síndrome caracterizada pela incapacidade de concentração urinária devido à deficiência do hormônio antidiurético. O envolvimento do sistema nervoso central é frequente nas leucemias, mas a ocorrência de DI é rara e confere pior prognóstico. A patogênese do DI na leucemia não é totalmente conhecida, mas a infiltração do eixo hipotálamo-hipofisário por células leucêmicas parece ser um fator responsável. O presente relato descreve o caso de um paciente que apresentou DI como primeira manifestação de leucemia mieloide aguda e que evoluiu com dificuldades de ajustes do sódio sérico, da poliúria e da reposição volêmica, necessitando de permanência prolongada em unidade de cuidados intensivos. Palavras-chave: diabetes insipidus; leucemia mieloide aguda; monossomia; cromossomo 7.

PROGNOSTIC FACTORS OF POSITIVE RESULTS OF MULTIFOCAL TRUS-GUIDED VESICOURETHRAL ANASTOMOSIS BIOPSY IN PATIENTS WITH BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY

Directory of Open Access Journals (Sweden)

P. D. Demeshko

2014-07-01

Full Text Available Purpose. To evaluate influence of clinical, biochemical and histological factors to detection rate of local recurrence following radical prostatectomy (RPE using multifocal TRUS-guided vesicourethral anastomosis (VUA biopsy.Material and methods. 59 patients with newly diagnosed biochemical recurrence (BR after RPE were included into prospective study. All of them underwent multifocal TRUS-guided VUA biopsy. Сlinical variables (serum prostate-specifi c antigen [PSA] level and PSA kinetics, time RPE-BR, Gleason grade, stage after RPE and clinical findings were evaluated. Logistic regression and receiver operating characteristic (ROC curve analyses were performed.Results. The detection rate of local prostate recurrence with TRUS-guided VUA biopsy was 45,8 % (95 % CI 33,7–58,3. At multivariate analysis only PSA level at the moment of biopsy (≤ 1,5 ng/ml vs > 1,5 ng/ml and time RPE-BR (≤ 15 months vs > 15 months were significantly associated with positive results of multifocal TRUS-guided VUA biopsy (p < 0,05.Conclusion The detection rate of local prostate recurrence with TRUS-guided VUA biopsy depends on combination of independent predictors (PSA level at the moment of biopsy and time RPE—BR.

[Sentinel node biopsy in patients with multifocal and multicentric breast cancer: A 5-year follow-up].

Science.gov (United States)

Blanco Saiz, I; López Carballo, M T; Martínez Fernández, J; Carrión Maldonado, J; Cabrera Pereira, A; Moral Alvarez, S; Santamaría Girón, L; Cantero Cerquella, F; López Secades, A; Díaz González, D; Llaneza Folgueras, A; Aira Delgado, F J

2014-01-01

Sentinel lymph node biopsy (SLNB) as a staging procedure in multiple breast cancer is a controversial issue. We have aimed to evaluate the efficacy of sentinel node (SN) detection in patients with multifocal or multicentric breast cancer as well as the safety of its clinical application after a long follow-up. A prospective descriptive study was performed. Eighty-nine patients diagnosed of multiple breast cancer (73 multifocal; 16 multicentric) underwent SLNB. These patients were compared to those with unifocal neoplasia. Periareolar radiocolloid administration was performed in most of the patients. Evaluation was made at an average of 67.2 months of follow-up (32-126 months). Scintigraphic and surgical SN localization in patients with multiple breast cancer were 95.5% and 92.1%, respectively. A higher percentage of extra-axillary nodes was observed than in the unifocal group (11.7% vs 5.4%) as well as a significantly higher number of SN per patient (1.70 vs 1.38). The rate of SN localization in multicentric cancer was slightly lower than in multifocal cancer (87.5% vs 93.1%), and the finding of extra-axillary drainages was higher (20% vs 10%). Number of SN per patient was significantly higher in multicentric breast cancer (2.33 vs 1.57). No axillary relapses have been demonstrated in the follow-up in multiple breast cancer patients group. SLNB performed by periareolar injection is a reliable and accurate staging procedure of patients with multiple breast cancer, including those with multicentric processes. Copyright © 2013 Elsevier España, S.L. and SEMNIM. All rights reserved.

Efeitos de um programa de reabilitação acelerado após o tratamento cirúrgico da ruptura aguda do tendão de Aquiles

OpenAIRE

Ott, Rafael Duvelius

2010-01-01

Objetivo: Avaliar os efeitos de um protocolo acelerado de reabilitação (ACE) versus um protocolo tradicional de imobilização do tornozelo (TRA) sobre a função muscular e articular, após o tratamento cirúrgico da ruptura aguda do tendão de Aquiles. Método: 37 pacientes com diagnóstico de ruptura aguda do tendão de Aquiles foram submetidos ao tratamento cirúrgico aberto com reparo término-terminal pela técnica de Krackow. Após a cirurgia, foram divididos em dois grupos: no grupo ACE foi utiliza...

Avaliação do antígeno SAG2a recombinante de Toxoplasma gondii como um potencial marcador diagnóstico para Toxoplasmose humana aguda

OpenAIRE

Béla, Samantha Ribeiro

2007-01-01

Proteínas recombinantes têm sido utilizadas para o diagnóstico sorológico da infecção por Toxoplasma gondii para diferenciar entre as fases aguda e crônica da toxoplasmose. Neste estudo, foi avaliada a reatividade de anticorpos IgG e IgG1 através de imunoensaios em soros de pacientes com toxoplasmose aguda e crônica dirigidos contra dois antígenos recombinantes clonados e expressos em E. coli, SAG2A (molécula recombinante total) e SAG2A(DELTA) (molécula recombinante deletada do...

Evaluation of Optical Quality: Ocular Scattering and Aberrations in Eyes Implanted with Diffractive Multifocal or Monofocal Intraocular Lenses.

Science.gov (United States)

Liao, Xuan; Lin, Jia; Tian, Jing; Wen, BaiWei; Tan, QingQing; Lan, ChangJun

2018-06-01

To compare objective optical quality, ocular scattering and aberrations of eyes implanted with an aspheric monofocal intraocular lens (IOL) or an aspheric apodized diffractive multifocal IOL three months after surgery. Prospective consecutive nonrandomized comparative cohort study. A total of 80 eyes from 57 cataract patients were bilaterally or unilaterally implanted with monofocal (AcrySof IQ SN60WF) or multifocal (AcrySof IQ ReSTOR SN6AD1) IOLs. Respectively, 40 eyes of 27 patients were implanted with monofocal IOLs, and 40 eyes of 30 patients were implanted with multifocal IOLs. Ocular high-order aberration (HOA) values were obtained using Hartmann-Shack aberrometer; objective scatter index (OSI), modulation transfer function (MTF) cutoff, Strehl ratio (SR), and contrast visual acuity OV at 100%, 20%, and 9% were measured using Objective Quality Analysis System II (OQAS II). Ocular aberrations performed similar in both groups (p > 0.05). However, significantly higher values of OSI and lower values of MTF cutoff, SR and OV were found in the SN6AD1 group (p < 0.05). Both ocular scattering and wave-front aberrations play essential role in retinal image quality, which may be overestimated when only aberrations were taken into account. Combining the effect of ocular scattering with HOA will result in a more accurate assessment of the visual and optical quality.

Digitally switchable multi-focal lens using freeform optics.

Science.gov (United States)

Wang, Xuan; Qin, Yi; Hua, Hong; Lee, Yun-Han; Wu, Shin-Tson

2018-04-16

Optical technologies offering electrically tunable optical power have found a broad range of applications, from head-mounted displays for virtual and augmented reality applications to microscopy. In this paper, we present a novel design and prototype of a digitally switchable multi-focal lens (MFL) that offers the capability of rapidly switching the optical power of the system among multiple foci. It consists of a freeform singlet and a customized programmable optical shutter array (POSA). Time-multiplexed multiple foci can be obtained by electrically controlling the POSA to switch the light path through different segments of the freeform singlet rapidly. While this method can be applied to a broad range of imaging and display systems, we experimentally demonstrate a proof-of-concept prototype for a multi-foci imaging system.

Transposición del ligamento coracoacromial en el tratamiento quirúrgico de la luxación acromioclavicular aguda

Directory of Open Access Journals (Sweden)

Osvaldo Pereda Cardoso

2017-12-01

Full Text Available Introducción: la luxación de la articulación acromioclavicular es frecuente en la práctica ortopédica diaria, estimándose su incidencia en aproximadamente el 10 % de todas las luxaciones alrededor del hombro. Existen numerosas técnicas quirúrgicas descritas para su tratamiento con resultados variables. Objetivo: describir la evolución clínica del dolor, la movilidad del hombro y la reincorporación de los pacientes a sus actividades habituales, con el uso de la técnica de transposición del ligamento acromioclavicular. Métodos: se realizó un estudio de descriptivo de 22 pacientes con diagnóstico de luxación acromioclavicular aguda tratados quirúrgicamente mediante la técnica mencionada; se tuvo en cuenta la evolución clínica del dolor, la movilidad del hombro y la reincorporación de los pacientes a sus actividades después de la cirugía, y para ello se empleó el test funcional de Imatani. Resultados: la transposición del ligamento coracoacromial resultó ser una técnica útil y relativamente sencilla para el tratamiento quirúrgico de la luxación acromioclavicular aguda, con muy buenos resultados inmediatos, se logró considerable disminución o alivio total del dolor y recuperación completa o casi completa del rango de movilidad de la articulación del hombro, que le permite al paciente una vez rehabilitado, reincorporarse a sus actividades habituales. Conclusiones: la transposición del ligamento coracoacromial resultó útil en el tratamiento quirúrgico de la luxación acromioclavicular aguda, en cuanto al alivio del dolor, la movilidad y reincorporación a las actividades habituales.

Right ventricular lipomatous mass and biventricular multifocal fat in a young woman: A case report

International Nuclear Information System (INIS)

Lee, Bo Rahm; Park, Jae Hyeong; Ahn, Kye Taek; Kim, Song Soo; Jeong, Jin Ok; Choi, Si Wan; Jin, Seon Ah; Lee, Jae Hwan

2015-01-01

Cardiac lipoma is a rare neoplasm of encapsulated mature adult adipose tissue. It is usually asymptomatic, but it may be related to hemodynamic obstruction depending on its location. We report a typical case of right ventricular lipomatous mass and multifocal fat infiltration of both ventricles, which were detected incidentally in a young woman.

Surto de toxoplasmose aguda transmitida através da ingestão de carne crua de gado ovino

Directory of Open Access Journals (Sweden)

Bonametti Ana Maria

1997-01-01

Full Text Available Os autores apresentam 17 casos de toxoplasmose aguda sintomática adquirida pela ingestão de carne crua de carneiro, servida em uma festa à qual todos os pacientes compareceram. Em relação ao quadro clínico, o período de incubação da doença variou de 6 a 13 dias (10,9 ± 7,0 e 16 (94,5% pacientes apresentaram febre, cefaléia, mialgia, artralgia e adenomegalia (cervical ou cervical/axilar. Outros sinais clínicos encontrados foram: hepatomegalia em 6 pacientes, esplenomegalia em 4 e exantema em 2. Um paciente apresentou quadro clínico de corioretinite, confirmada através de exame oftalmológico. Todos os pacientes apresentavam títulos séricos de anticorpos específicos (IgG e IgM que evidenciavam fase aguda de toxoplasmose, pela Reação de Imunofluorescência Indireta. Todos os pacientes foram tratados especificamente e houve boa resposta clínica e laboratorial ao tratamento.

Insuficiência renal aguda em pacientes com sepse grave: fatores prognósticos = Acute renal injury in patients with severe sepsis: prognostic factors

Directory of Open Access Journals (Sweden)

Okamoto, Thábata Yaedu

2012-01-01

Conclusões: A insuficiência renal aguda foi ocorrência comum nos pacientes com sepse, fazendo parte de um quadro de disfunção de múltiplos órgãos e sistemas, particularmente nos pacientes com diagnóstico de choque séptico, estando associada a aumento da probabilidade de morte nesses pacientes graves. O uso de drogas vasoativas foi o único fator de risco para mortalidade em pacientes com sepse e insuficiência renal aguda que se manteve na análise multivariada. Estes resultados apontam para a importância do tratamento precoce dos quadros de sepse grave a tempo de prevenir a evolução para choque séptico e para insuficiência renal

Hepatite aguda colestática pelo propiltiouracil: relato de caso

Directory of Open Access Journals (Sweden)

PAROLIN Mônica Beatriz

2000-01-01

Full Text Available Propiltiouracil é uma droga amplamente utilizada no tratamento do hipertiroidismo. A hepatotoxicidade é um dos efeitos colaterais mais raros e também mais graves associados a ela. Relata-se um caso de hepatite aguda colestática que acomete um jovem de 15 anos em uso de propiltiouracil para tratamento de hipertiroidismo. Causas virais, metabólicas e autoimunes foram excluídas e a biopsia hepática revelou achados histopatológicos sugestivos de hepatite colestática induzida por droga. Com a suspensão da droga, houve remissão dos sintomas e normalização progressiva das provas de função hepática. Raramente, os pacientes em uso de propiltiouracil podem desenvolver injúria hepática grave.

Estrategia de atención de niños hospitalizados por infecciones respiratorias agudas bajas

Directory of Open Access Journals (Sweden)

Ana M Ferrari

2002-06-01

Full Text Available OBJETIVO: Mejorar la calidad de la atención hospitalaria de los niños con infecciones respiratorias agudas bajas, aumentar los conocimientos sobre esa patología y mejorar la eficiencia en el uso de los recursos asistenciales, por medio de una estrategia que se denominó Plan de Invierno.MÉTODOS: La estrategia se basó en la utilización de protocolos de diagnóstico y tratamiento, internación por cuidados progresivos y por enfermedad, adecuación de los recursos asistenciales y creación de un sistema de registro permanente, informatizado. Se incorporó la investigación sistemática de la etiología viral para racionalizar el uso de la medicación y reducir las infecciones intrahospitalarias. RESULTADOS: Durante la aplicación del Plan (19/V-19/IX/99 ingresaron 3.317 niños; 1.347 (40.61% presentaban infecciones respiratorias agudas bajas. Se captaron 1.096 (81%, de los cuales 71% eran menores de un año. Predominaron las infecciones respiratorias virales (68%. Los criterios de ingreso fueron saturación de oxígeno <95%, polipnea, tiraje o derrame pleural en el 92.4% de los niños. La magnitud de la demanda impidió que las pautas de aislamiento individual o en grupo se cumplieran en todos los casos. El uso de la medicación se ajustó a lo recomendado en un elevado porcentaje: no recibieron antibióticos 73% de las bronquiolitis ni 72% de las neumonías virales, y 96% de las neumonias bacterianas los recibieron según pauta; se redujo el uso de broncodilatadores y de corticoides. El gasto en medicamentos disminuyó fundamentalmente en el grupo de los corticoides y tuvo el mayor impacto en el costo por día/cama de antibióticos. CONCLUSIONES: Disminuir la morbimortalidad por infecciones respiratorias agudas bajas requiere continuar mejorando la calidad de la atención hospitalaria y fortalecer los programas de promoción de salud y de control de las enfermedades prevalentes, en el primer nivel de atención.

Estrategia de atención de niños hospitalizados por infecciones respiratorias agudas bajas

Directory of Open Access Journals (Sweden)

Ferrari Ana M

2002-01-01

Full Text Available OBJETIVO: Mejorar la calidad de la atención hospitalaria de los niños con infecciones respiratorias agudas bajas, aumentar los conocimientos sobre esa patología y mejorar la eficiencia en el uso de los recursos asistenciales, por medio de una estrategia que se denominó Plan de Invierno.MÉTODOS: La estrategia se basó en la utilización de protocolos de diagnóstico y tratamiento, internación por cuidados progresivos y por enfermedad, adecuación de los recursos asistenciales y creación de un sistema de registro permanente, informatizado. Se incorporó la investigación sistemática de la etiología viral para racionalizar el uso de la medicación y reducir las infecciones intrahospitalarias. RESULTADOS: Durante la aplicación del Plan (19/V-19/IX/99 ingresaron 3.317 niños; 1.347 (40.61% presentaban infecciones respiratorias agudas bajas. Se captaron 1.096 (81%, de los cuales 71% eran menores de un año. Predominaron las infecciones respiratorias virales (68%. Los criterios de ingreso fueron saturación de oxígeno <95%, polipnea, tiraje o derrame pleural en el 92.4% de los niños. La magnitud de la demanda impidió que las pautas de aislamiento individual o en grupo se cumplieran en todos los casos. El uso de la medicación se ajustó a lo recomendado en un elevado porcentaje: no recibieron antibióticos 73% de las bronquiolitis ni 72% de las neumonías virales, y 96% de las neumonias bacterianas los recibieron según pauta; se redujo el uso de broncodilatadores y de corticoides. El gasto en medicamentos disminuyó fundamentalmente en el grupo de los corticoides y tuvo el mayor impacto en el costo por día/cama de antibióticos. CONCLUSIONES: Disminuir la morbimortalidad por infecciones respiratorias agudas bajas requiere continuar mejorando la calidad de la atención hospitalaria y fortalecer los programas de promoción de salud y de control de las enfermedades prevalentes, en el primer nivel de atención.

In-the-bag decentration of a hydrophilic radially asymmetric multifocal intraocular lens secondary to capsule contraction.

NARCIS (Netherlands)

Linden, J.W.M. van der; Meulen, I.J. van der; Mourits, M.P.; Lapid-Gortzak, R.

2013-01-01

We report a case of in-the-bag decentration and tilt of a hydrophilic rotationally asymmetric multifocal intraocular lens (IOL) of the M Plus type secondary to capsule contraction. After uneventful surgery and follow-up for 3 months, progressive decentering and tilting of the IOL secondary to

Hemiplejía aguda infantil asociada a infección por enterovirus

OpenAIRE

Muñoz, Erika; Caramuta, Luciana; Frenkel, Susana; Cáceres, Lidia

2005-01-01

El ictus isquémico en la infancia es una entidad infrecuente, en el 50% de los casos no existe una causa identificable. Sin embargo, con el advenimiento de nuevas técnicas diagnósticas se han podido conocer más afecciones causales. Presentamos el caso de una paciente de 9 años con hemiplejía aguda izquierda, con estudios de neuroimágenes poco significativos y en la cual el análisis del líquido cefalorraquídeo por método de reacción en cadena de polimerasa (PCR) para ARN viral, fue positivo pa...

Changes in the management of patients with severe acute pancreatitis Mudanças no manejo de doentes com pancreatite aguda grave

Directory of Open Access Journals (Sweden)

Tercio De Campos

2008-09-01

Full Text Available BACKGROUND: Severe acute pancreatitis is present in up to 25% of patients with acute pancreatitis, with considerable mortality. Changes in the management of acute pancreatitis in the last 2 decades contributed to reduce the mortality. AIM: To show the evolution in the management of severe acute pancreatitis, comparing two different approaches. METHODS: All patients with severe acute pancreatitis from 1999 to 2005 were included. We compared the results of a retrospective review from 1999 to 2002 (group A with a prospective protocol, from 2003 to 2005 (group B. In group A severe pancreatitis was defined by the presence of systemic or local complications. In group B the Atlanta criteria were used to define severity. The variables analyzed were: age, gender, etiology, APACHE II, leukocytes, bicarbonate, fluid collections and necrosis on computed tomography, surgical treatment and mortality. RESULTS: Seventy-one patients were classified as severe, 24 in group A and 47 in group B. The mean APACHE II in groups A and B were 10.7 ± 3.5 and 9.3 ± 4.5, respectively. Necrosis was seen in 12 patients (50% in group A and in 21 patients (44.7% in group B. Half of the patients in group A and two (4.3% in group B underwent to pancreatic interventions. Mortality reached 45.8% in group A and 8.5% in group B. CONCLUSION: A specific approach and a prospective protocol can change the results in the treatment of patients with severe acute pancreatitis.RACIONAL: A pancreatite aguda grave está presente em até 25% dos doentes com pancreatite aguda, com mortalidade considerável. Mudanças no tratamento da pancreatite aguda nas últimas duas décadas contribuíram para a redução da mortalidade destes doentes. OBJETIVO: Mostrar a evolução do manejo da pancreatite aguda, comparando duas diferentes abordagens. MÉTODOS: Todos os doentes com pancreatite aguda grave de 1999 a 2005 do Serviço de Emergência da Santa Casa de São Paulo, SP, foram incluídos. Os

Multifocal Spinal Cord Nephroblastoma in a Dog.

Science.gov (United States)

Henker, L C; Bianchi, R M; Vargas, T P; de Oliveira, E C; Driemeier, D; Pavarini, S P

2018-01-01

A 1-year-old male American pit bull terrier was presented with a history of proprioceptive deficits and mild lameness of the right hindlimb, which progressed after 5 months to paraparesis, culminating in tetraparesis after 2 weeks. Necropsy findings were limited to the spinal cord and consisted of multiple, intradural, extramedullary, slightly red masses which produced segmental areas of medullary swelling located in the cervical intumescence, thoracolumbar column, sacral segment and cauda equina. Histological evaluation revealed a tumour, composed of epithelial, stromal and blastemal cells, with structures resembling tubules, acini and embryonic glomeruli. Immunohistochemical labelling for vimentin, cytokeratin and S100 was positive for the stromal, epithelial and blastemal cells, respectively. A final diagnosis of multifocal spinal cord nephroblastoma was established. This is the first report of such a tumour showing concomitant involvement of the cervicothoracic, thoracolumbar, sacral and cauda equina areas of the spinal cord. Copyright © 2017 Elsevier Ltd. All rights reserved.

Ciencia, tecnología y sociedad: reflexiones sobre el tratamiento antimicrobiano secuencial en la apendicitis aguda complicada

Directory of Open Access Journals (Sweden)

José Carlos Bueno Rodríguez

Full Text Available Actualmente los estudios de Ciencia, Tecnología y Sociedad (CTS constituyen un importante espacio de trabajo en la política pública, la educación y la investigación. La introducción de nuevos procedimientos y tecnologías en la atención médica debe analizarse desde la perspectiva de los estudios de CTS porque requiere de un sustento científico-tecnológico y tiene que cumplir, entre otros, con los requisitos éticos de aplicabilidad a los seres humanos. La utilización secuencial de los antimicrobianos en el tratamiento postoperatorio de la apendicitis aguda complicada en los niños, constituye una modificación de la terapéutica comúnmente empleada en Cuba y en muchas instituciones de salud del mundo. El presente trabajo muestra una reflexión sobre los pilares científicos, tecnológicos y sociales que sustentan la aplicación de un nuevo protocolo de tratamiento con el uso secuencial de los antimicrobianos en los niños con apendicitis aguda complicada.

Abordaje transumbilical en pacientes pediátricos con sospecha de apendicitis aguda. Un serie de 424 pacientes

Directory of Open Access Journals (Sweden)

Luis Augusto Zárate Suárez

2013-05-01

Full Text Available Antecedentes: El tratamiento de la apendicitis aguda implica su extirpación; es frecuente la solicitud de cicatrices postquirúrgicas del mejor tamaño posible. Una de las estrategias disponibles es el abordaje transumbilical. Objetivos: Descubrir las características clínicas y los desenlaces operatorios de los pacientes pediátricos en quienes se realiza apendicectomía vía transumbilical. Metodología: Estudio prospectivo de 424 pacientes sucesivos en cuanto a los desenlaces operatorios a corto plazo. Resultados: El tiempo promedio de intervención quirúrgica fue de 22 minutos; 95,8% de los pacientes presentó evolución satisfactoria del postquirúrgico; 1,4% de los pacientes se reintervino para drenar un absceso intracavitario residual y 0,2% presentó infencción de sitio operatorio sin mas complicaciones. Conclusión: El abordaje transumbilical de la apendicitis es una alternativa minimamente invasiva para todos los estados de apendicitis aguda e implica disminución del tiempo de realización, menor estancia del postquirúrgico, menor incidencia de complicaciones y mayor conformidad con los resultados estéticos.

Correction of High Astigmatism after Penetrating Keratoplasty with Toric Multifocal Intraocular Lens Implantation

Directory of Open Access Journals (Sweden)

Raffaele Nuzzi

2017-07-01

Full Text Available After penetrating keratoplasty (PK, high astigmatism is often induced, being frequently about 4–6 dpt. According to the entity and typology of astigmatism, different methods of correction can be used. Selective suture removal, relaxing incisions, wedge resections, compression sutures, photorefractive keratectomy, and laser-assisted in situ keratomileusis can reduce corneal astigmatism and ametropia, but meanwhile they can cause a reduction in the corneal integrity and cause an over- or undercorrection. In case of moderate-to-high regular astigmatisms, the authors propose a toric multifocal intraocular lens (IOL implantation to preserve the corneal integrity (especially in PK after herpetic corneal leukoma keratitis. We evaluated a 45-year-old patient who at the age of 30 was subjected to PK in his left eye due to corneal leukoma herpetic keratitis, which led to high astigmatism (7.50 dpt cyl. 5°. The patient was subjected to phacoemulsification and customized toric multifocal IOL implantation in his left eye. The correction of PK-induced residual astigmatism with a toric IOL implantation is an excellent choice but has to be evaluated in relation to patient age, corneal integrity, longevity graft, and surgical risk. It seems to be a well-tolerated therapeutic choice and with good results.

Variation of stemness markers expression in tumor nodules from synchronous multi-focal hepatocellular carcinoma - an immunohistochemical study.

Science.gov (United States)

Lo, Regina Cheuk-Lam; Leung, Carmen Oi-Ning; Chok, Kenneth Siu-Ho; Ng, Irene Oi-Lin

2017-08-01

Advancing knowledge in molecular pathogenesis of hepatocellular carcinoma (HCC) opens up new horizons in the diagnostic, prognostic and therapeutic perspectives. Assessing the expression of molecular targets prior to definitive treatment is gaining importance in clinical practice. In this study, we investigated the variation in expression pattern of stemness markers in synchronous multi-focal HCC. In the first cohort, 21 liver explants with multi-focal HCC were examined for expression of stemness markers EpCAM, Sox9 and CK19 by immunohistochemistry (IHC). Expression data of 50 tumor nodules were analyzed to determine the concordance of expression among nodules in the same livers. In the second cohort, 14 tumor nodules from 6 multi-focal HCC cases proven as intra-hepatic metastasis were examined for Soc9 immunoexpression. In the first cohort, thirty nodules from 16 cases expressed one or more markers, with Sox9 being most frequently expressed. Complete concordance of expression pattern for all 3 markers was observed in 6 cases. Discrepancy of staining degree was noted in 4 cases for EpCAM, 14 cases for Sox9, and 6 cases for CK19. A two-tier or three-tier difference in staining scores was noted in 5 cases for Sox9 and one case for CK19. With Sox9, identical tumor morphology in terms of Edmondson grading and growth pattern did not infer the same degree of immunoexpression; and the largest tumor nodule was not representative of highest IHC score. In the second cohort of intra-hepatic metastasis, complete concordance of Sox9 expression level was observed in 5 out of 6 cases; while the remaining case showed a 1-tier difference of positive staining. Our findings suggested that clonality of tumor nodules is apparently an important factor to infer immunoexpression pattern. When there is limited information to discern multiple primaries versus intra-hepatic metastasis in multi-focal HCC, discordant degree of stemness markers expression among tumor nodules was commonly

Aggressive and multifocal pulmonary inflammatory myofiberblastic tumor in young woman

International Nuclear Information System (INIS)

Choi, Yang Sean; Chung, Myung Hee; Kim, Hyun Jung; Park, Ki Hoon; Kim, Jeanna; Kwon, Soon Suck; Yoo, Won Jong

2016-01-01

We report a case of pulmonary inflammatory myofibroblastic tumor (IMT) showing aggressive and unusually rapid progression. A 27-year-old woman was admitted to the emergency room due to dry cough, fever and blood-tinged sputum that lasted one week. Initial chest radiograph and computed tomography scan revealed multifocal pulmonary nodules, which subsequently progressed into large necrotic masses within two months. She underwent a fine needle biopsy of the largest mass in the right middle lung zone which revealed inflammatory myofibroblastic cells consistent with IMT. The masses showed complete regression after six months of corticosteroid therapy. This unusual clinical manifestation could help explain the reactive inflammatory nature associated with IMTs

Aggressive and multifocal pulmonary inflammatory myofiberblastic tumor in young woman

Energy Technology Data Exchange (ETDEWEB)

Choi, Yang Sean; Chung, Myung Hee; Kim, Hyun Jung; Park, Ki Hoon; Kim, Jeanna; Kwon, Soon Suck; Yoo, Won Jong [Bucheon St. Mary' s Hospital, The Catholic University of Korea, Bucheon (Korea, Republic of)

2016-08-15

We report a case of pulmonary inflammatory myofibroblastic tumor (IMT) showing aggressive and unusually rapid progression. A 27-year-old woman was admitted to the emergency room due to dry cough, fever and blood-tinged sputum that lasted one week. Initial chest radiograph and computed tomography scan revealed multifocal pulmonary nodules, which subsequently progressed into large necrotic masses within two months. She underwent a fine needle biopsy of the largest mass in the right middle lung zone which revealed inflammatory myofibroblastic cells consistent with IMT. The masses showed complete regression after six months of corticosteroid therapy. This unusual clinical manifestation could help explain the reactive inflammatory nature associated with IMTs.

Diagnósticos de enfermagem em adultos com leucemia mielóide aguda

OpenAIRE

Souza, Luccas Melo de; Gorini, Maria Isabel Pinto Coelho

2006-01-01

Trata-se de um estudo de casos, que objetivou identificar os Diagnósticos de Enfermagem (DE) de pacientes adultos com Leucemia Mielóide Aguda, a fim de fornecer subsídios à Sistematização da Assistência de Enfermagem. Utilizaram-se as técnicas de entrevista e observação, além da aplicação do Processo de Enfermagem. Durantes os três meses da coleta de dados, outros DEs foram encontrados através de novas buscas nos prontuários dos 6 pacientes. Os 32 DEs encontrados foram agrupados conforme a Te...

PARTO PRETÉRMINO Y SUFRIMIENTO FETAL SECUNDARIOS A PERITONITIS POR APENDICITIS AGUDA PERFORADA

OpenAIRE

Hidalgo M,Juan José; Molina P,Marta; Varo GM,Begoña; Rivas R,Salvador; Bernabeu A,José Ramón; Perales M,Alfredo

2009-01-01

La apendicitis aguda es la urgencia quirúrgica no obstétrica más frecuente durante el embarazo. Se ha asociado a parto pretérmino y a morbimortalidad fetal y materna, especialmente cuando se complica con peritonitis. Los cambios anatómicos, fisiológicos y bioquímicos que se producen durante la gestación pueden alterar los síntomas y signos típicos asociados a la apendicitis. Esto puede retrasar el diagnóstico y dar lugar a un aumento de la morbimortalidad materna y fetal. Presentamos el caso ...

Multifocal electroretinogram for functional evaluation of retinal injury following ischemia-reperfusion in pigs

DEFF Research Database (Denmark)

Morén, Håkan; Gesslein, Bodil; Andreasson, Sten

2010-01-01

Multifocal electroretinogram (mfERG) has the power to discriminate between localized functional losses and overall retinal changes when evaluating retinal injury. So far, full-field ERG has been the gold standard for examining retinal ischemia and the effects of different neuroprotectants...... in experimental conditions. The aim of the present study was to establish mfERG, with simultaneous fundus monitoring, for analyzing the localized functional response in the retina after ischemia-reperfusion in the porcine eye....

Recurrent multifocal cutaneous Kaposiform hemangioendothelioma: A rare vascular tumor of infancy and childhood.

Science.gov (United States)

Atla, Bhagyalakshmi; Sudhakar, P V; Rao, Nagarjun; Prasad, Uma

2016-01-01

Kaposiform hemangioendothelioma (KHE) is a locally aggressive vascular tumor of childhood although cases occurring in adulthood are also described. The features overlap with juvenile capillary hemangioma and Kaposi sarcoma. We report a rare case of recurrent, multifocal (nose and chin) cutaneous KHE initially occurring in a 3-year-old female child, uncomplicated by Kasabach-Merritt syndrome. Recurrences occurred over the next 6 years and resulted in complete distortion of the nose, requiring plastic repair.

Intoxicación aguda por cocaína en un lactante no asociada a lactancia materna: A propósito de un caso clínico

OpenAIRE

Decia1, Mónica; Pan, Melina; Telechea, Héctor; Laborde, Amalia; Menchaca, Amanda

2015-01-01

La intoxicación aguda por cocaína es infrecuente en lactantes y niños. Las formas más frecuentes de presentación clínica son las convulsiones tónico-clónicas en apirexia, alteraciones motoras y la excitación psicomotriz. Se presenta el caso de un lactante de 1 mes que ingresó a la Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell por una intoxicación aguda por cocaína. El cuadro clínico consistió en manifestaciones secundarias a un estado hiperadrenérgico generali...

HMB-45 negative multifocal malignant perivascular epithelioid cell tumor of the soft tissue responding to sirolimus: First case report from India.

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Kapoor, Akhil; Beniwal, Surender; Singhal, Mukesh Kumar; Kumar, Narender; Kumar, Vanita; Kumar, Harvindra Singh

2015-01-01

Perivascular epithelioid cell tumor (PEComa) is a group of sarcomas that exhibit a myomelanocytic phenotype and possess a unique cell type in the perivascular epithelioid cell. Traditionally HMB-45 immunoreactivity is the first criteria required to consider a tumor to be PEComa. We report a case of multifocal PEComa with negative HMB-45 marker. The patient presented with three big ulceroproliferative lesions; two over right thigh and one over the scalp in the right frontal region. The patient was prescribed with oral sirolimus to which good response was seen. To the best of our knowledge, this is the first case of HMB-45 negative multifocal malignant PEComa from India.

Incidental caseating granuloma of thyroid gland presenting with concomitant Graves′ disease and multifocal papillary microcarcinoma

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Muneera A Al Shareef

2013-01-01

Full Text Available A 36-year-old Saudi woman presented with symptoms and signs of hyperthyroidism and was diagnosed to have Graves′ disease. She was initially treated with antithyroid medications with no response. Subsequently, she underwent a total thyroidectomy. The histopathology of the specimen revealed caseating granulomatous thyroid suggestive of tuberculosis and multifocal papillary thyroid microcarcinoma

Inmunofenotipaje celular en el diagnóstico de las leucemias agudas híbridas Cellular immunophenotyping in the diagnosis of acute hybrid leukemias

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Vianed Marsán Suárez

1999-12-01

Full Text Available Se estudiaron 118 leucemias agudas en un período de 4 años. El fenotipaje celular se realizó a través del ultramicrométodo inmunocitoquímico (UMICIQ, mediante la utilización de un panel de anticuerpos monoclonales con el que se evaluó la expresión de antígenos linfoides y mieloides. La expresión de antígenos mieloides en pacientes con leucemia linfoide aguda se encontró en el 28,4 % y de antígenos linfoides en pacientes con leucemia mieloide aguda en el 56,7 %. Las leucemias agudas híbridas representaron el 16,1 % del total de pacientes estudiados: 73,7 % al inicio de la enfermedad y el 26,3 % restante en el estudio posterior al tratamiento de inducción de la remisión, lo que sugiere en estos últimos la posibilidad de cambio de linaje por la selección de variantes resistentes a drogas procedentes del clon original, o la aparición de neoplasias secundarias por el uso de drogas genotóxicas118 acute leukemias were studied during 4 years. The cellular phenotyping was carried out through the immunocytochemical ultramicromethod by using a panel of monoclonal antibodies with which the expression of lymphoid and myeloid antigens was evaluated. The expression of myeloid antigens in patients with acute lymphoid leukemia was found in 28.4 %, whereas the expression of lymphoid antigens in patients suffering from acute myeloid leukemia was observed in 56.7 %. The acute hybrid leukemias accounted for 16.1 % of the total of patients studied: 73.7 % at the onset of the disease and the other 26.3 % in the study following the induction treatment of the referred patients, which suggests in the latter the possibility of changing lineage by selecting variantes resistant to drugs from the original clon, or the appearance of secondary neoplasias due to the use of genotoxic drugs

Multifocal epithelial hyperplasia: a forgotten condition in the elderly.

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Shamloo, Nafiseh; Mortazavi, Hamed; Taghavi, Nasim; Baharvand, Maryam

2016-01-01

Multifocal epithelial hyperplasia (MEH), also known as focal epithelial hyperplasia and Heck disease, is a relatively rare condition caused by the human papillomavirus. This case report describes a 92-year-old man who presented with multiple, asymptomatic, circumscribed, soft, flattened papules in different sizes on the retrocommissure of his lower lip. The lesions were of 2 months' duration and had the same coloration as the adjacent normal mucosa. Histopathologic examination showed orthokeratinized stratified squamous epithelium with acanthosis, some areas of club-shaped rete ridges, and a few superficial epithelial cells with koilocytic changes and a mitosoid-like appearance. A diagnosis of MEH was established. Although MEH tends to occur in the first 2 decades of life, it can be encountered in elderly patients as well.

Can ratio of the biggest tumor diameter to total tumor diameter be a new parameter in the differential diagnosis of agressive and favorable multifocal papillary thyroid microcarcinoma?

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Tam, Abbas Ali; Özdemir, Didem; Çuhacı, Neslihan; Başer, Hüsniye; Dirikoç, Ahmet; Aydın, Cevdet; Yazgan, Aylin Kılıç; Ersoy, Reyhan; Çakır, Bekir

2017-02-01

In this study, we aimed to evaluate the usefulness of a new parameter -ratio of the biggest tumor diameter to total tumor diameter- for the differentiation of agressive and favorable papillary thyroid microcarcinomas (PTMC). The diameter of the biggest tumor focus was taken as the primary tumor diameter. Total tumor diameter was calculated as the sum of the maximal diameter of each lesion. Ratio of primary tumor diameter to total tumor diameter was defined as tumor diameter ratio (TDR). Positive and negative predictive value, sensitivity and specificity of TDR to predict capsular invasion, extrathyroidal extension (ETE) and lymph node metastasis (LNM) were determined. Mean TDR was significantly lower in multifocal PTMC patients with capsular invasion, ETE, lymphovascular invasion and LNM compared to patients without these features. The sensitivities of TDR for the detection of LNM, ETE and capsular invasion were 100%, 100% and 94.2%, respectively. Specificity of TDR was 86.2% for LNM, 88% for ETE and 94.7% for capsular invasion. Best cut off values of TDR that can predict capsular invasion, ETE and LNM in multifocal PTMC were 0.62, 0.57 and 0.56, respectively. Multifocal papillary thyroid carcinoma patients with capsular invasion, ETE and LNM had significantly lower mean TDR when compared to ones without these features. Decreased TDR was associated with capsular invasion, ETE and LNM in patients with multifocal PTMC and PTC. This new parameter might be particularly helpful for the detection of aggressive behavior in multifocal PTMCs. Copyright © 2016 Elsevier Ltd. All rights reserved.

El problema Patogénico de las Pancreatitis Agudas. Lesiones producidas por la Etionina.

OpenAIRE

Pera Blanco-Morales, Cristóbal

2016-01-01

Cuando en el año 1952 realizamos una extensa revisión del problema de la necrosis aguda del páncreas, conveníamos en que eran tres las razones que justifican el gran interés que el estudio de esta afección conserva en la actualidad: a) Las dudas existentes acerca de su etiología y patogénesis. b) La extraordinaria gravedad del proceso que conduce a la muerte en una elevada proporción de casos. c) La incertidumbre sobre cua...

Incidencia de las leucemias agudas en niños de la ciudad de México, de 1982 a 1991

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Mejía-Aranguré Juan Manuel

2000-01-01

Full Text Available OBJETIVO: Medir la tasa de incidencia de las leucemias agudas (LA en las diferentes delegaciones políticas del Distrito Federal y evaluar si existe una tendencia significativa en dichos padecimientos en tales delegaciones. MATERIAL Y MÉTODOS: Estudio longitudinal descriptivo realizado en seis hospitales de la ciudad de México, los que atienden a cerca de 97.5% de todos los niños con cáncer de esta ciudad. Los datos se capturaron de 1995 a 1996, y se analizaron en 1999, en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI, del Instituto Mexicano del Seguro Social. Para cada delegación se calcularon la tasa de incidencia anual promedio, la tasa estandarizada y la razón estandarizada de morbilidad (REM con intervalos de confianza al 95% (IC 95%. La tendencia se evaluó con la tasa de cambio promedio. RESULTADOS: Se observó una tendencia al incremento en la incidencia de la leucemia aguda linfoblástica (LAL en cinco delegaciones: Alvaro Obregón, Cuauhtémoc, Gustavo A. Madero, Iztacalco y Venustiano Carranza. En la leucemia aguda mieloblástica (LAM no se notificaron cambios estadísticamente significativos en la incidencia en ninguna delegación política. Sólo con LAM se encontró una REM significativa y correspondió a la delegación Alvaro Obregón (REM= 2.91, IC 95% 1.63 - 4.80. Las REM más altas se encontraron en el sur y suroeste de la ciudad. CONCLUSIONES: Sólo se observó incremento en la incidencia de LAL en cinco delegaciones políticas. La incidencia más alta de LAM se encontró en la delegación Alvaro Obregón.

Recurrent multifocal cutaneous Kaposiform hemangioendothelioma: A rare vascular tumor of infancy and childhood

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Bhagyalakshmi Atla

2016-01-01

Full Text Available Kaposiform hemangioendothelioma (KHE is a locally aggressive vascular tumor of childhood although cases occurring in adulthood are also described. The features overlap with juvenile capillary hemangioma and Kaposi sarcoma. We report a rare case of recurrent, multifocal (nose and chin cutaneous KHE initially occurring in a 3-year-old female child, uncomplicated by Kasabach–Merritt syndrome. Recurrences occurred over the next 6 years and resulted in complete distortion of the nose, requiring plastic repair.

Barriers, motivators and enablers for dispensing multifocal contact lenses in Mumbai, India.

Science.gov (United States)

Thite, Nilesh; Shah, Ukti; Mehta, Jasmin; Jurkus, Janice

2015-01-01

To understand the potential barriers, motivators and enablers in dispensing multifocal contact lenses (MFCL). Two focus group discussions were conducted to design questionnaires regarding the prescribing habits for multifocal contact lenses (MFCL). Questions on potential barriers and motivators were included. The questionnaires were distributed among 133 eye care practitioners across Mumbai, India. Practitioners fitting one or less patient per month with MFCL completed the survey describing potential barriers, while those who prescribed more MFCL's per month completed the survey describing enablers and motivators. Responses from 102 practitioners were received. Most common potential barriers in prescribing MFCL were increased chair time (75%), lack of readily available trials (69%) and limitation in power range (63%). Lack of awareness among patients (90%) was the most common barrier from patients' outlook. Professional satisfaction (88%) and better business proposition (82%) were observed as main motivators while availability of the trials (84%) and correct patient selection (82%) were the major enablers. Graduate Optometrists felt dispensing MFCL did not offer a good business proposition (p=0.02). Experienced practitioners were observed to be least motivated (p=0.01) and believed that their patients found these lenses expensive (p=0.02). To enhance the MFCL practice, barriers like lack of awareness and limitations in power range must be addressed. Trial lens availability may motivate practitioners to prescribe MFCL. Further probing is required to understand lack of motivation among experienced practitioners. Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

Multifocal Abrikossoff's granular cell tumor of the oesophagus: Case report

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Ranđelović Tomislav D.

2008-01-01

Full Text Available INTRODUCTION Granular cell tumors, relatively uncommon soft tissue tumors, have been a matter of debate among pathologists regarding histogenesis for a long time. Less common locations are in the aerodigestive tract including the oesophagus. CASE OUTLINE We have recently treated a rare case, a 37-year old male, who was admitted due to dysphagia and a painful swallow with occasional pharyngo-nasal regurgitation followed with a mild loss of weight. Standard clinical examination including X-ray chest, ECG and laboratory tests did not show pathological findings. Barium contrast oesophagography demonstrated multiple ovoid defects in the wall of the oesophagus. CT scan of the chest confirmed luminal narrowing owing to the tumor of the upper oesophagus. Upper endoscopy showed unusual multifocal nodular lesions alongside the oesophageal axis covered by smooth mucosa. A primary biopsy specimen taken from the largest nodules confirmed an unusual pathological finding of the granular cell tumor. Subtotal, transpleural oesophagectomy was performed and reconstruction was derived by long colon segment interposition through the posterior mediastinum. The postoperative course was uneventful. The operative specimen consisted of four ovoid tumors alongside the oesophagus (the greatest diameter 0.5-1.8, average 1.25. All verified tumors histologicaly consisted of a spindle-shaped or polygonal cells containing small and large eosinophilic granules and central nuclei. Most tumor cells showed strongly positive immunohistochemical staining for S-100 protein. These tumor cells were partially positive for p-53 and Ki-67. No lymph node metastases were detected histologically. CONCLUSION Multifocal granular cell tumor of the oesophagus is an unusual finding with low incidence, and rarely caused symptoms. Pathological features and multiplicity of such tumors emphasized malignant predisposition requiring surgical resection of the oesophagus.

Lesão renal aguda séptica versus não séptica em pacientes graves: características e desfechos clínicos

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Marília Galvão Cruz

2014-12-01

Full Text Available Objetivo: Descrever e comparar as características e os desfechos clínicos de pacientes com lesão renal aguda séptica e não séptica. Métodos: Coorte aberta com 117 pacientes graves com lesão renal aguda consecutivamente admitidos em unidade de terapia intensiva, sendo excluídos aqueles que apresentavam doença renal crônica em estágio avançado, transplante renal, internação ou morte em um período inferior a 24 horas. Presença de sepse e óbito intra-hospitalar representaram, respectivamente, a exposição e o desfecho principal. Análise de confundimento foi realizada com a regressão logística. Resultados: Não houve diferenças na média de idade entre os grupos com lesão renal aguda séptica e não séptica [65,30±(21,27 anos versus 66,35±12,82 anos; p=0,75]. Nos dois grupos, similarmente, observou-se predomínio do sexo feminino (57,4% versus 52,4%; p=0,49 e de afrodescendentes (81,5% versus 76,2%; p=0,49. Os pacientes com sepse apresentaram maiores médias de escore Acute Physiology and Chronic Health Evaluation II [21,73±7,26 versus 15,75± (5,98; p18,5 (OR: 9,77; IC95%: 3,73-25,58 foram associados ao óbito. Conclusão: Sepse foi um preditor independente para óbito. Existem diferenças entre as características e desfechos clínicos dos pacientes com lesão renal aguda séptica versus não séptica.

Multi-focal lobular carcinoma in situ arising in benign phylodes tumor: A case report

International Nuclear Information System (INIS)

Lee, Taeg Ki; Choi, Chang Hwan; Kim, Youn Jeong; Kim, Mi Young; Lee, Kyung Hee; Cho, Soon Gu

2015-01-01

Coexistent breast malignancy arising in phyllodes tumor is extremely rare, and most of them are incidental reports after surgical excision. Coexistent malignancy in phyllodes tumor can vary from in-situ to invasive carcinoma. Lobular neoplasia is separated into atypical lobular hyperplasia and lobular carcinoma in situ (LCIS). LCIS is known to have a higher risk of developing invasive cancer. We reported imaging findings of multifocal LCIS arising in benign phyllodes tumor

Multi-focal lobular carcinoma in situ arising in benign phylodes tumor: A case report

Energy Technology Data Exchange (ETDEWEB)

Lee, Taeg Ki; Choi, Chang Hwan; Kim, Youn Jeong; Kim, Mi Young; Lee, Kyung Hee; Cho, Soon Gu [Inha University Hospital, Incheon (Korea, Republic of)

2015-08-15

Coexistent breast malignancy arising in phyllodes tumor is extremely rare, and most of them are incidental reports after surgical excision. Coexistent malignancy in phyllodes tumor can vary from in-situ to invasive carcinoma. Lobular neoplasia is separated into atypical lobular hyperplasia and lobular carcinoma in situ (LCIS). LCIS is known to have a higher risk of developing invasive cancer. We reported imaging findings of multifocal LCIS arising in benign phyllodes tumor.

O uso do Aloe sp (aloe vera em feridas agudas e crônicas: revisão integrativa

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Lucélia Terra Chini

2017-01-01

Full Text Available Objetivos: buscar evidencias disponibles en la literatura acerca del uso de Aloe sp (sábila en la cicatrización de heridas agudas y crónicas. Materiales y método: se trata de una revisión integradora realizada en las bases de datos LILACS, PubMed y Scopus, en el periodo de febrero a marzo del 2015. La búsqueda resultó en 178 publicaciones. Resultados: siete estudios constituyeron la revisión, los cuales involucraron personas con heridas de cesárea, heridas de episiotomía, quemaduras, área donadora de injerto, heridas posthemorroidectomía y heridas fisuarias anales crónicas. Se evidenció que la sábila promueve la cicatrización de heridas, además de disminuir el dolor en fisuras anales crónicas y quemaduras. Conclusiones: la sábila representa una nueva terapéutica en el tratamiento de heridas; sin embargo, las evidencias disponibles sobre su eficacia y seguridad son ineficientes para legitimar su uso en la cicatrización de heridas agudas y crónicas; por lo tanto, no se pueden generalizar.

Multifocal bone and bone marrow lesions in children - MRI findings

Energy Technology Data Exchange (ETDEWEB)

Raissaki, Maria; Demetriou, Stelios; Spanakis, Konstantinos; Skiadas, Christos; Karantanas, Apostolos H. [University of Crete, Faculty of Medicine, Department of Radiology, University Hospital of Heraklion, Heraklion, Crete (Greece); Katzilakis, Nikolaos; Stiakaki, Eftichia [University of Crete, Faculty of Medicine, Department of Pediatric Hematology-Oncology, University Hospital of Heraklion, Heraklion, Crete (Greece); Velivassakis, Emmanouil G. [University Hospital of Heraklion, Orthopedic Clinic, Heraklion, Crete (Greece)

2017-03-15

Polyostotic bone and bone marrow lesions in children may be due to various disorders. Radiographically, lytic lesions may become apparent after loss of more than 50% of the bone mineral content. Scintigraphy requires osteoblastic activity and is not specific. MRI may significantly contribute to the correct diagnosis and management. Accurate interpretation of MRI examinations requires understanding of the normal conversion pattern of bone marrow in childhood and of the appearances of red marrow rests and hyperplasia. Differential diagnosis is wide: Malignancies include metastases, multifocal primary sarcomas and hematological diseases. Benign entities include benign tumors and tumor-like lesions, histiocytosis, infectious and inflammatory diseases, multiple stress fractures/reactions and bone infarcts/ischemia. (orig.)

Progressive Multifocal Leukoencephalopathy [version 1; referees: 2 approved

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Laura Adang

2015-12-01

Full Text Available Progressive multifocal leukoencephalopathy (PML is a devastating demyelinating disease with significant morbidity and mortality and no effective, targeted therapies. It is most often observed in association with abnormalities of cell-mediated immunity, in particular human immunodeficiency virus (HIV infection, but also occurs in association with lymphoproliferative diseases, certain immunosuppressive and immunomodulatory regimens, and other conditions. The etiologic agent of PML is a small, ubiquitous polyomavirus, the JC virus (JCV, also known as JCPyV, for which at least 50% of the adult general population is seropositive. PML results when JCV replicates within cerebral oligodendrocytes and astrocytes, leading to oligodendrocyte death and demyelination. Unfortunately, no treatments have been convincingly demonstrated to be effective, though some have been employed in desperation; treatment otherwise includes attempts to restore any immune system defect, such as the withdrawal of the causative agent if possible, and general supportive care.

Fatores de risco para internação por doença respiratória aguda em crianças até um ano de idade

OpenAIRE

Macedo,Silvia Elaine Cardozo; Menezes,Ana Maria Baptista; Albernaz,Elaine; Post,Paulo; Knorst,Marli

2007-01-01

OBJETIVO: Avaliar fatores de risco para hospitalização por doença respiratória aguda em crianças até um ano de idade. MÉTODOS: Estudo de casos e controles na cidade de Pelotas, RS. Os casos foram crianças de até um ano de idade, que se hospitalizaram por doença respiratória aguda, de agosto de 1997 a julho de 1998. Os controles foram crianças da comunidade, da mesma idade, sem hospitalização prévia por essa doença. Um questionário investigando exposição a fatores de risco foi aplicado às mães...

The brain triuno and the ethical intelligence: fundamental counterfoil of the multifocal intelligence

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C. Seijo

2013-10-01

Full Text Available This study has for aim offer an analysis as for the brain triuno and the ethical intelligence: fundamental Counterfoil of the multifocal intelligence, taking in tells one of the theories that it sustains her like they are the different types of multiple intelligences established by Beauport and Cury (2004. The theoretical sustenance, it is based on the contents of Martin (2005, Belohlavek (2007, Galicians (2002, Beauport and Cury (2004, between others, being realized under a symbolic interpretive approach, across a qualitative methodology, type descriptive and not experimental design, by means of a documentary analysis. In this regard, it is found that the ethical intelligence is a mental mechanism that constructs the structural preconceptos and the rules of game with which an individual approaches the reality, that is to say, it is the capacity of the general formation, predicting the behavior for the achievement of aims organizacionales. As for the final considerations they focused in obtaining the most wide knowledge inside the organizations, allowing to reflect before the weaknesses that they present thinking about the brain triuno applying the multifocal intelligence, fundamental counterfoil of the ethical intelligence and of what way the rationing visualizes the strengths, nevertheless of the weaknesses that they present. 

Evaluation of Different Power of Near Addition in Two Different Multifocal Intraocular Lenses

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Ugur Unsal

2016-01-01

Full Text Available Purpose. To compare near, intermediate, and distance vision and quality of vision, when refractive rotational multifocal intraocular lenses with 3.0 diopters or diffractive multifocal intraocular lenses with 2.5 diopters near addition are implanted. Methods. 41 eyes of 41 patients in whom rotational +3.0 diopters near addition IOLs were implanted and 30 eyes of 30 patients in whom diffractive +2.5 diopters near addition IOLs were implanted after cataract surgery were reviewed. Uncorrected and corrected distance visual acuity, intermediate visual acuity, near visual acuity, and patient satisfaction were evaluated 6 months later. Results. The corrected and uncorrected distance visual acuity were the same between both groups (p=0.50 and p=0.509, resp.. The uncorrected intermediate and corrected intermediate and near vision acuities were better in the +2.5 near vision added intraocular lens implanted group (p=0.049, p=0.005, and p=0.001, resp. and the uncorrected near vision acuity was better in the +3.0 near vision added intraocular lens implanted group (p=0.001. The patient satisfactions of both groups were similar. Conclusion. The +2.5 diopters near addition could be a better choice in younger patients with more distance and intermediate visual requirements (driving, outdoor activities, whereas the + 3.0 diopters should be considered for patients with more near vision correction (reading.

Efeitos hemodinâmicos da sobrecarga ventricular direita aguda experimental

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Flávio Brito Filho

2011-04-01

Full Text Available FUNDAMENTO: A sobrecarga ventricular direita aguda está associada a situações clínicas de elevada morbimortalidade, tais como: ressecções pulmonares extensas, tromboembolismo pulmonar, transplante pulmonar e edema pulmonar das altitudes. Alguns pontos de sua fisiopatologia permanecem obscuros. OBJETIVO: Avaliar os efeitos hemodinâmicos da sobrecarga ventricular direita aguda experimental em suínos. MÉTODOS: A sobrecarga ventricular direita foi induzida pela oclusão das artérias pulmonares através de ligaduras. Vinte porcos foram utilizados no estudo, sendo alocados em 04 grupos: um controle, não submetido à oclusão vascular pulmonar, e três de sobrecarga ventricular direita submetidos à oclusão das seguintes artérias pulmonares: SVD1 (artéria pulmonar esquerda; SVD2 (artéria pulmonar esquerda e do lobo inferior direito e SVD3 (artéria pulmonar esquerda, do lobo inferior direito e do lobo mediastinal, obstruindo a vasculatura pulmonar em 42, 76 e 82,0% respectivamente. Variáveis de hemodinâmica foram medidas a cada 15 minutos durante a uma hora do estudo. Na análise estatística, foram utilizados ajustes de modelos lineares mistos com estrutura de variâncias e covariâncias. RESULTADOS: Nas comparações intergrupais, houve aumento significativo da frequência cardíaca (p = 0,004, pressão arterial pulmonar média (p = 0,001 e pressão capilar pulmonar (p < 0,0001. Houve redução significativa da pressão arterial média (p = 0,01 e do índice sistólico (p = 0,002. Não houve diferença significativa no índice cardíaco (p = 0,94. CONCLUSÃO: Apesar da intensa sobrecarga ventricular direita promovida pela obstrução de 82,0% da vasculatura pulmonar e pelo aumento significativo da pressão arterial pulmonar não houve disfunção cardiovascular severa e/ou choque circulatório no período estudado.

Efficacy and safety of multifocal intraocular lenses following cataract and refractive lens exchange: Metaanalysis of peer-reviewed publications.

Science.gov (United States)

Rosen, Emanuel; Alió, Jorge L; Dick, H Burkhard; Dell, Steven; Slade, Stephen

2016-02-01

We performed a metaanaysis of peer-reviewed studies involving implantation of a multifocal intraocular lens (IOL) in presbyopic patients with cataract or having refractive lens exchange (RLE). Previous reviews have considered the use of multifocal IOLs after cataract surgery but not after RLE, whereas greater insight might be gained from examining the full range of studies. Selected studies were examined to collate outcomes with monocular and binocular uncorrected distance, intermediate, and near visual acuity; spectacle independence; contrast sensitivity; visual symptoms; adverse events; and patient satisfaction. In 8797 eyes, the mean postoperative monocular uncorrected distance visual acuity (UDVA) was 0.05 logMAR ± 0.006 (SD) (Snellen equivalent 20/20(-3)). In 6334 patients, the mean binocular UDVA was 0.04 ± 0.00 logMAR (Snellen equivalent 20/20(-2)), with a mean spectacle independence of 80.1%. Monocular mean UDVA did not differ significantly between those who had a cataract procedure and those who had an RLE procedure. Neural adaptation to multifocality may vary among patients. Dr. Alió is a clinical research investigator for Hanita Lenses, Carl Zeiss Meditec AG, Topcon Medical Systems, Inc., Oculentis GmbH, and Akkolens International BV. Dr. Dell is a consultant to Bausch & Lomb and Abbott Medical Optics, Inc. Dr. Slade is a consultant to Alcon Surgical, Inc., Carl Zeiss Meditec AG, and Bausch & Lomb. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

CT and MRI in progressive multifocal leukoencephalopathy

International Nuclear Information System (INIS)

Lanfermann, H.; Heindel, W.; Schroeder, R.; Lackner, K.

1994-01-01

Radiological findings and course of progressive multifocal leukoencephalopathy in 14 patients (1 woman, 13 men; 13 HIV seropositive, 1 chronic lymphatic leukaemia) were analysed retrospectively and correlated with clinical symptoms. A total of 21 CT and 16 MRI studies were evaluated. CT scans and MR images of 9 patients, which had been obtained in less than two weeks, could be compared to each other. MRI was superior to CT: 6 lesions with a diameter of 1 cm and below were not detected on CT scans, in 5 patients the extent of lesions was underestimated. Cortical involvement, mass effect or signs of atrophy were missing. Only 1 of 65 lesions showed a tiny enhancement after Gd injection. Due to the pattern and spread of lesions, which showed a close correlation to the neurologic symptoms, three different types of PML are suggested: 1. Initial precentral demyelinisation with contralateral hemiparesis (n=8); 2. lesions in temporo-occipital locations with visual disturbances (n=2); 3. predominantly bilateral lesions of cerebellar white matter with ataxia (n=4). (orig.) [de

Tratamiento de la leucemia mieloide aguda del niño en Cuba Treatment of children acute myeloid leukemia in Cuba

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Andrea Menéndez Veitía

2013-06-01

Full Text Available Introducción: la leucemia mieloide aguda representa alrededor del 20 % de las leucemias agudas de la niñez con una respuesta al tratamiento y supervivencia menores que la leucemia linfoide aguda. Objetivo: describir los resultados obtenidos con el tratamiento de la leucemia mieloide aguda del niño en algunos centros de Cuba en el período 2000-2008. Métodos: se trataron 46 pacientes con leucemia mieloide aguda, se excluyeron los casos con leucemia promielocítica, diagnosticados a partir del año 2000 en las provincias occidentales, Sancti Spíritus y Villa Clara. Se aplicaron dos esquemas de tratamiento tipo BFM en dos períodos: en el primero (2000 -2003 se incluyeron 27 enfermos y en el segundo (2004-2008, 19. La diferencia fundamental entre los dos períodos consistió en la consolidación que en la segunda etapa fue de ciclos más intensos y cortos. Resultados: predominó el sexo masculino (n = 32 y la mediana de edad fue de 9 años. La remisión inicial fue del 71 % en la primera etapa y 89 % en la segunda. La supervivencia libre de eventos (SLE en todos los pacientes fue del 40 % a los 5 años y la supervivencia global (SV fue del 44 % en igual período. En la SLE en las dos etapas se encontraron diferencias significativas siendo mayor en la segunda. En los años comprendidos entre el 2000 y el 2003 la SV a los 5 años fue del 31 %, mientras que entre 2004 y 2008 fue del 63 %. No se empleó el trasplante de células progenitoras hematopoyéticas de forma sistemática. Conclusiones: estos resultados muestran un nivel comparable a los alcanzados a internacionalmente, lo que representa un importante logro del Sistema Nacional de Salud de Cuba.Introduction. acute myeloid leukemia represents about 20 % of all leukemias in childhood with results and survival smaller than in acute lymphoid leukemia. Objectives: to describe the results obtained with the treatment of acute myeloid leukemia in children in some Cuban centers in from 2000 to 2008

Acute pancreatitis associated with hypercalcemia: A report of two cases Pancreatitis aguda asociada a hipercalcemia: Presentación de dos casos

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J. Egea Valenzuela

2009-01-01

Full Text Available Hypercalcemia due to hyperparathyroidism is a rare etiology for acute pancreatitis, oscillating between 1.5 and 7% in the different series. Although the cause-effect relationship and the pathophysiology of the condition are not clear, it seems that the association among them is not incidental, and serum calcium could be a major risk factor, so that pancreatitis would come to occur during severe hypercalcemia attacks. Mutations in different genes have been proposed as well to justify why only some patients with primary hyperparathyroidism and hypercalcemia develop acute pancreatitis. References to cases like these ones are rare in the literature. We report two patients with acute pancreatitis associated with hyperparathyroidism and hypercalcemia, one of them with a fatal outcome.La hipercalcemia secundaria a hiperparatiroidismo es una causa rara de pancreatitis aguda, variando entre el 1,5-7% según las series consultadas. Aunque la relación causal y la fisiopatología del proceso no están totalmente aclaradas, parece claro que la asociación no es incidental y que los niveles de calcio sérico serían un factor de riesgo mayor, desencadenándose los cuadros de pancreatitis durante las crisis de hipercalcemia. También se han descrito alteraciones en diversos genes que podrían estar implicados, justificando por qué sólo unos pocos pacientes con hiperparatiroidismo primario e hipercalcemia sufren pancreatitis aguda. Existen muy pocas referencias en la literatura a casos como los que nos ocupan. Presentamos a continuación dos pacientes con cuadros de pancreatitis aguda asociados a hiperparatiroidismo e hipercalcemia, uno de ellos con desenlace fatal.

Avaliação da sensibilidade ao contraste e da estereopsia em pacientes com lente intra-ocular multifocal Contrast sensitivity and stereopsis in pseudophakic patients with multifocal intraocular lens

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Filipe de Oliveira

2005-08-01

Full Text Available OBJETIVO: Avaliar a sensibilidade ao contraste e a acuidade estereoscópica em pacientes pseudofácicos, que receberam implante bilateral de lente intra-ocular multifocal. MÉTODOS: Prospectivamente foram realizados testes de sensibilidade ao contraste com o uso da tabela Pelli-Robson e teste de acuidade estereoscópica com emprego do Titmus Stereo Test, em 20 pacientes com implante bilateral de lente intra-ocular multifocal Acrysof Restor®, no pós-operatório de 1 a 2 meses e sem uso de qualquer correção óptica. RESULTADOS:O teste de sensibilidade ao contraste binocular demonstrou que 6 pacientes (30% apresentaram 1,80 unid. log, 13 (65% 1,65 e 1 (5% 1,50. No teste monocular, ocorreram as seguintes respostas: 17 pacientes (85% 1,65 unid. log e 3 (15% 1,50 para o teste do olho direito. O teste do olho esquerdo mostrou que 16 pacientes (80% apresentaram 1,65 unid. log e 4 (20% 1,50. A média e o desvio-padrão da sensibilidade ao contraste testada binocularmente foi 1,69 (±0,08, ao passo que monocularmente foi 1,63 (±0,05 para OD e 1,62 (±0,06 para OE. O teste de acuidade estereoscópica revelou que 12 pacientes (60% obtiveram 40", 6 (30% 50" e 2 (10% 60", com média de 45" e desvio-padrão de ±6,88". CONCLUSÃO: A lente intra-ocular empregada no estudo, proporcionou resultados de sensibilidade ao contraste e acuidade estereoscópica compatíveis e de acordo com critérios de normalidade estabelecidos anteriormente por outros estudos em grupos de pacientes fácicos e pseudofácicos, e portanto, impacto positivo na funcionalidade visual.PURPOSE: To evaluate the contrast sensitivity and stereopsis tests in patients who underwent bilateral implantation of multifocal intraocular lens. METHODS: Tests of contrast sensitivity using the Pelli-Robson chart and stereopsis evaluation with the Titmus Stereo Test were performed in 20 patients 30-60 days after the bilateral implantation of Acrysof Restor® multifocal intraocular lens. RESULTS: The

Tratamento da necrose aguda de retina: revisão sistemática Treatment of acute retinal necrosis: systematic review

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Moysés Eduardo Zajdenweber

2005-08-01

Full Text Available OBJETIVO: O objetivo deste estudo foi pela realização de revisão sistemática, determinar o melhor tratamento para a necrose aguda de retina. MÉTODOS: Seguindo a orientação metodológica da Colaboração Cochrane e de seu subgrupo editorial "Eye and Vision Group", o autor, por meio de mecanismos de busca, selecionou trabalhos sobre o tratamento da necrose aguda de retina. RESULTADO: Foram selecionadas 146 referências bibliográficas, sendo considerados como relevantes 13 estudos. Destes estudos 2 foram considerados como preenchendo os critérios de inclusão. O primeiro estudo aponta a possibilidade de o tratamento para necrose aguda de retina, com aciclovir endovenoso associado a corticóide sistêmico, proteger o olho contralateral de acometimento. Foram estudados 54 pacientes, 31 tratados e 23 não tratados, sendo observada incidência de doença no olho contralateral de 12,9% no grupo tratado e de 69,5% no grupo não tratado. O segundo estudo incluído mostra 19 olhos acometidos com necrose aguda de retina, sendo que 12 destes olhos foram submetidos à fotocoagulação com laser de argônio, com o objetivo de prevenir o descolamento de retina. Dos 12 olhos, 2 desenvolveram descolamento de retina (16,6% ao passo que, no grupo não tratado, composto por 7 olhos, 4 desenvolveram descolamento de retina (57,1%. CONCLUSÃO: O autor conclui que os dois tipos de intervenção propostos se mostraram eficazes, porém, como os estudos são metodologicamente fracos, torna-se necessária a realização de estudos clínicos randomizados para que se possa estabelecer o melhor tratamento para a necrose aguda de retina.PURPOSE: The purpose of this study was to identify, according to an sistematic review, the best treatment for acute retinal necrosis. METHODS: Following the methodologic guidance of the Cochrane Collaboration and its editorial subgroup "Eye and Vision Group", using search strategy for study identification, articles about the treatment

Pancreatitis aguda por hipertrigliceridemia severa: reporte de caso y revisión de la literatura

OpenAIRE

Herrera Del Águila, Dwight Denis; Garavito Rentería, Jorge; Linarez Medina, Karen; Lizarzaburu Rodríguez, Víctor

2015-01-01

La pancreatitis aguda por hipertrigliceridemia se presenta en aproximadamente 1-4 % de los casos, es la tercera causa de pancreatitis luego de la etiología biliar y alcohólica. La hipertrigliceridemia puede ser producida por causas primarias asociadas a trastornos genéticos en el metabolismo de los lípidos, y por casusas secundarias. Se presenta el caso de un paciente varón de 32 años de edad, natural de Huancayo, con antecedentes de diabetes mellitus tipo 2, dislipidemia mixta severa con hip...

Tratamiento quirúrgico de la diverticulitis aguda en la Comunidad Valenciana. Estudio multicéntrico.

OpenAIRE

Salvador Martínez, Antonio

2015-01-01

Diverticulitis aguda. Estado actual y controversias Este término representa un espectro de los cambios inflamatorios que van desde una inflamación local subclínica hasta la peritonitis generalizada con perforación libre. Su mecanismo de aparición gira alrededor de una perforación de un divertículo. El antiguo concepto de obstrucción luminal probablemente represente un hecho raro. El aumento de la presión intraluminal o las partículas espesadas de alimentos pueden erosionar la pared d...

Progressive multifocal leucoencephalopathy in a patient with idiopathic CD4+ lymphocytopenia.

LENUS (Irish Health Repository)

Moloney, F

2012-03-01

Progressive multifocal leucoencephalopathy (PML) is an opportunistic, demyelinating neurological disease caused by reactivation of the JC polyomavirus. PML occurs almost exclusively in immunosuppressed individuals, with only isolated case reports of PML occurring in patients without apparent immunosuppression. Idiopathic CD4+ lymohocytopenia (ICL) is a syndrome defined by the Centre for Disease Control and Prevention as a CD4+ count <300 cells\\/uL or <20% of total T cell count on >1 occasion, with no evidence of human immunodeficiency virus (HIV) infection, and the absence of other known immunodeficiency or therapy associated with lymphocytopenia. We describe a case of PML occurring in a patient with idiopathic CD4+ lymphocytopenia.

Efeito da hipertermia na pancreatite aguda grave experimental

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Maurício Gustavo Ieri Yamanari

Full Text Available OBJETIVO: O objetivo deste estudo é avaliar os efeitos da hipertermia na pancreatite aguda (PA grave experimental induzida por ácido taurocólico. MÉTODO: A PA grave foi induzida pela injeção retrógrada de ácido taurocólico a 2,5% ou 5% no ducto pancreático principal. Após a indução, os animais foram colocados numa gaiola contendo duas lâmpadas de 100 W. A temperatura corporal foi aumentada para 39,5ºC e mantida neste nível por 45 minutos. Foram estudados taxa de mortalidade em 72 horas, permeabilidade vascular no pâncreas, porcentagem de água no tecido pancreático, amilase sérica, histologia (edema, necrose acinar e infiltrado inflamatório e níveis séricos de IL-6 e IL-10. RESULTADOS: Não houve alteração em nenhum dos parâmetros avaliados. CONCLUSÃO: Não há benefício da hipertermia na PA grave experimental induzida por ácido taurocólico.

Fixation stability and implication for multifocal electroretinography in patients with neovascular age-related macular degeneration after anti-VEGF treatment

DEFF Research Database (Denmark)

Pedersen, Karen Bjerg; Sjølie, Anne Katrin; Vestergaard, Anders Højslet

2016-01-01

Purpose: To quantify fixation stability in patients with neovascular age-related macular degeneration (nAMD) at baseline, 3 and 6 months after anti-vascular endothelial growth factor (anti-VEGF) treatment and furthermore asses the implications of an unsteady fixation for multifocal...

MONTE CARLO SIMULATION OF MULTIFOCAL STOCHASTIC SCANNING SYSTEM

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LIXIN LIU

2014-01-01

Full Text Available Multifocal multiphoton microscopy (MMM has greatly improved the utilization of excitation light and imaging speed due to parallel multiphoton excitation of the samples and simultaneous detection of the signals, which allows it to perform three-dimensional fast fluorescence imaging. Stochastic scanning can provide continuous, uniform and high-speed excitation of the sample, which makes it a suitable scanning scheme for MMM. In this paper, the graphical programming language — LabVIEW is used to achieve stochastic scanning of the two-dimensional galvo scanners by using white noise signals to control the x and y mirrors independently. Moreover, the stochastic scanning process is simulated by using Monte Carlo method. Our results show that MMM can avoid oversampling or subsampling in the scanning area and meet the requirements of uniform sampling by stochastically scanning the individual units of the N × N foci array. Therefore, continuous and uniform scanning in the whole field of view is implemented.

Carcinoma superficial multifocal do pênis: ênfase ao teste do azul de toluidina

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Hélio Begliomini

Full Text Available The author reports a case of penile multifocal superficial carcinoma in a white 66 years old male. The lesions on glans penis and prepuce were asymptomatic. Their appearence were plain reddish ulceration, irregular margins which became evident after circumcision. There was no palpable groin lymph node. The toluidine blue test was useful for guiding biopsies. A partial penectomy was undertaken with free surgical margins of tumor. In a follow-up of two years, penil erectile function is preserve with no tumor recurrence.

Mefloquine improved progressive multifocal leukoencephalopathy in a patient with systemic lupus erythematosus.

Science.gov (United States)

Beppu, Minako; Kawamoto, Michi; Nukuzuma, Souichi; Kohara, Nobuo

2012-01-01

We describe a case of a 67-year-old man with systemic lupus erythematosus who presented with progressive left hemiplegia. Although the cerebral spinal fluid (CSF) polymerase chain reaction (PCR) for the JC virus was negative, a brain biopsy confirmed the diagnosis of progressive multifocal leukoencephalopathy (PML). The tapering of prednisone and the use of cidofovir could not arrest the disease progression. Administration of mefloquine stopped the extension of the lesion, and resulted in obvious clinical improvement. The CSF nested PCR for the JC virus also became negative. This widely used drug should be tried for the treatment of non-HIV PML.

High Resolution Depth-Resolved Imaging From Multi-Focal Images for Medical Ultrasound

DEFF Research Database (Denmark)

Diamantis, Konstantinos; Dalgarno, Paul A.; Greenaway, Alan H.

2015-01-01

An ultrasound imaging technique providing subdiffraction limit axial resolution for point sources is proposed. It is based on simultaneously acquired multi-focal images of the same object, and on the image metric of sharpness. The sharpness is extracted by image data and presents higher values...... calibration curves combined with the use of a maximum-likelihood algorithm is then able to estimate, with high precision, the depth location of any emitter fron each single image. Estimated values are compared with the ground truth demonstrating that an accuracy of 28.6 µm (0.13λ) is achieved for a 4 mm depth...

Progressive multifocal leukoencephalopathy restricted to the posterior fossa in a patient with systemic lupus erythematosus

Energy Technology Data Exchange (ETDEWEB)

Goncalves, Fabricio Guimaraes; Lamb, Leslie; Del Carpio-O' Donovan, Raquel, E-mail: goncalves.neuroradio@gmail.com [McGill University Health Center Montreal General Hospital (Canada)

2011-11-15

Progressive multifocal leukoencephalopathy is a neurological infectious disease caused by the John Cunningham polyoma virus (JCV), an opportunistic agent with worldwide distribution. This disease is frequently seen in immunosuppressed patients and rarely associated with systemic lupus erythematosus. In the central nervous system PML demyelinating lesions occur in the supratentorial compartment. The authors describe a rare case of PML secondary to SLE treatment with atypical presentation restricted to the posterior fossa (author)

Progressive multifocal leukoencephalopathy restricted to the posterior fossa in a patient with systemic lupus erythematosus

International Nuclear Information System (INIS)

Goncalves, Fabricio Guimaraes; Lamb, Leslie; Del Carpio-O'Donovan, Raquel

2011-01-01

Progressive multifocal leukoencephalopathy is a neurological infectious disease caused by the John Cunningham polyoma virus (JCV), an opportunistic agent with worldwide distribution. This disease is frequently seen in immunosuppressed patients and rarely associated with systemic lupus erythematosus. In the central nervous system PML demyelinating lesions occur in the supratentorial compartment. The authors describe a rare case of PML secondary to SLE treatment with atypical presentation restricted to the posterior fossa (author)

Bases moleculares de la depleción de glutatión y de la necrosis celular en la pancreatitis aguda. Papel de las proteín quinasas activadas por mitógenos.

OpenAIRE

Pereda Cervera, Javier

2006-01-01

RESUMEN La pancreatitis aguda es el proceso inflamatorio agudo del páncreas con afectación variable de otros tejidos regionales y sistemas orgánicos alejados. Es una enfermedad con una incidencia relativamente elevada en España y en el resto del mundo y con una mortalidad entre el 10 y el 45% de los casos graves de la enfermedad. Los mecanismos moleculares por los que una pancreatitis aguda se desarrolla, así como aquellos que conducen a una pancreatitis grave, aún no están del todo esclar...

Diabetes Mellitus en el servicio de urgencias: manejo de las complicaciones agudas en adultos

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Eder A. Hernández-Ruiz

2008-01-01

Full Text Available La Diabetes Mellitus (DM es una enfermedad de alta prevalencia, reconocida como un problema de salud pública, debido a sus altas tasas de morbilidad y mortalidad asociadas. Diferentes estudios han documentado que la falta de adherencia al tratamiento, constituye uno de los principales factores desencadenantes para las descompensaciones agudas en el paciente diabético. Dentro del espectro de dichas alteraciones se encuentran las crisis hiperglicémicas agudas, las cuales se han dicotomizado en dos entidades clínicas: la Cetoacidosis Diabética (CAD y el Estado Hiperglicémico Hiperosmolar (EHH, que constituyen complicaciones metabólicas potencialmente fatales en el corto plazo y de las cuales pueden encontrarse cuadros superpuestos. Se han establecido criterios diagnósticos específicos buscando realizar un diagnóstico diferencial acertado, que permita un tratamiento idóneo; sin embargo, las tasas de morbilidad y mortalidad siguen siendo considerables. Por su parte, la Hipoglicemia también constituye una emergencia médica que, de no ser tratada oportunamente, puede ocasionar daño neurológico permanente e incluso la muerte. De lo anterior se deduce la importancia de que existan guías claras de manejo de estas alteraciones en todos los centros y servicios donde se preste atención médica de urgencias. Se siguen realizando investigaciones en busca de nuevas estrategias diagnósticas y terapéuticas que permitan un manejo más integral de la DM y sus complicaciones, en aras de mejorar la calidad de vida de los pacientes.

Factores de riesgo de infecciones respiratorias agudas en menores de 5 años

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María Eulalia Prieto Herrera

2000-01-01

Full Text Available Se realizó un estudio analítico, retrospectivo de casos y controles, pareado 1:1 para conocer algunos factores de riesgo de infecciones respiratorias agudas en menores de 5 años del reparto La Yaba, pertenecientes al policlínico Este de Camagüey, durante el año 1996. El universo fueron 90 niños que padecieron infecciones respiratorias agudas durante este período. La fuente de obtención de datos fue la historia clínica familiar e individual. El registro primario fue la encuesta con las variables: lactancia materna, desnutrición, enfermedades asociadas, fumador pasivo, hacinamiento. Se concluyó que la lactancia materna inadecuada (RR 12, 152, la desnutrición (RR 2, 278, la enfermedad parasitaria (RR 1, 643, el fumador pasivo (RR, 536 y el hacinamiento (RR 2, 719 se comportaron como factores de riesgo.An analytic retrospective case-control study was performed, matched 1:1, with the aim of getting to know the risk factors for acute respiratory diseases in children under 5 years of age from La Yaba neighborhood belonging to the health area of the eastern policlinics of Camaguey, during the year 1996. The study material was made up of 90 children that suffered from acute respiratory diseases during that period. The data source was the individual and family medical histories. The primary record was a survey including the following variables: breast feeding, malnutrition, associated diseases, passive smoking, overcrowding. It was concluded that inadequate breast feeding (RR 12, 152, malnutrition (RR 2, 278, parasitic disease (RR 1, 643, passive smoking (RR, 536 and overcrowding (RR 2, 719 behaved as risk factors.

Incidência comparativa da apendicite aguda em população miscigenada, de acordo com a cor da pele Comparative incidence of acute appendicitis in a mixed population, related to the skin color

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Andy Petroianu

2004-03-01

Full Text Available RACIONAL: Apendicite aguda é uma emergência cirúrgica muito comum, mas sua etiopatogenia ainda permanece incompreendida. OBJETIVO: Avaliar aspectos epidemiológicos da apendicite aguda relacionados à cor da pele, sexo e idade. MÉTODOS: Foram estudados 500 pacientes operados de apendicite aguda e outros 500 doentes aleatórios tratados por diferentes doenças no Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG. Avaliaram-se sexo, idade e cor da pele. Os resultados foram comparados por meio do teste qui-quadrado. RESULTADOS: Significativa prevalência de pacientes leucodérmicos (73,8% foi verificada nessas séries. Não houve predominância por sexo. O número de homens leucodérmicos com apendicite aguda foi significativamente maior do que homens leucodérmicos do grupo-controle. A incidência de melanodérmicos com apendicite foi significativamente menor do que a de pacientes negros do grupo-controle. A idade média da apendicite aguda foi de 23,2 anos para os pacientes leucodérmicos e de 32,3 anos para os melanodérmicos. CONCLUSÕES: Foi nítida a relação entre apendicite aguda com a cor branca da pele.BACKGROUND: Acute appendicitis is a very common surgical emergency, but its etiology and pathology remain incompletely understood. OBJECTIVE: To elucidate epidemiological aspects of acute appendicitis related to skin color, gender and age. METHODS: Five-hundred patients operated on for acute appendicitis, and other 500 patients treated for different diseases and considered as a control group were studied at "Hospital das Clínicas", Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. Gender, age and skin color were investigated. The results were compared by chi-square test. RESULTS: There was no prevalence related to gender. A significant prevalence of white patients (73.8% was verified in this series. The number of white men with appendicitis was significantly higher than white men in the

Daño pulmonar agudo relacionado con la transfusión (Trali y Bartonelosis aguda

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Douglas López de Guimaraes

2006-07-01

Full Text Available Se presenta el caso de un varón de 22 años procedente de la periferia de la ciudad de Huaraz, Perú, que acude al Hospital "Victor Ramos Guardia" de Huaraz con un tiempo de enfermedad de 14 días, febril, pálido e ictérico, en el frotis de sangre periférica se encuentran formas bacilares de Bartonella bacilliformis en 99% de la lámina; se inicia tratamiento antibiótico con ceftriaxona y ciprofloxacino. Al día siguiente se le indica transfusión de dos paquetes globulares (puesto que tenía 6,2 g/dL de Hb, dos horas después presenta dolor toráxico, tos seca exigente, vómitos, dificultad respiratoria y cianosis, en la auscultación se encuentran roncantes y crepitantes, la radiografía de tórax muestra infiltrado alveolar difuso a predominio derecho. Es trasladado a la UCI donde recibe oxígeno con máscara de reservorio, dopamina, corticoides y se inicia el monitoreo hemodinámico; responde en forma satisfactoria, sale de alta con frotis negativo a Bartonella bacilliformis. Es el primer caso de daño pulmonar agudo relacionado con la transfusión (TRALI asociado con Bartonelosis aguda con cuadro clínico - radiológico y evolución compatible, es importante distinguir entre la complicación pulmonar debido a la sepsis grave por Bartonelosis aguda, que puede producir un cuadro clínico similar y el TRALI.

Comparison of visual function and patient satisfaction with AcrySof ReSTORSN6AD1 multifocal intraocular compared to monofocal intraocular lenses 5

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Aisa S Alchinova

2016-12-01

Full Text Available Aim. To compare visual function and satisfaction in patients after implantation of AcrySof ReSTOR SN6AD1 multifocal intraocular lens (IOL, AcrySof SA60AТ spherical monofocal IOL, or Akreos АО aspheric monofocal IOL during cataract surgery. Materials. Overall, 34 patients received SN6AD1 multifocal (group 1, 48 eyes, 19 patients received Akreos АО monofocal aspheric (group 2, 30 eyes, and 13 patients received AcrySof SA60AТ monofocal spherical (group 3, 18 eyes IOL. Patients with multifocal IOL were closely matched for age, sex, and ocular findings with patients who had monofocal IOL implantation. Six months postoperatively, uncorrected/corrected distance visual acuity (UDVA/CDVA, uncorrected intermediate (60 cm and near (35 cm visual acuity (UNVA, defocus curve, contrast sensitivity, and a quality-of-life questionnaire were evaluated. Furthermore, independence from glasses and presence of optical phenomena were assessed. Results. Patients in group 2 had statistically significant increase in UDVA than that in group 1 (p = 0.037. There was no significant difference in the mean uncorrected intermediate and best corrected distance visual acuities between the groups. UNVA was better in group 1 than that in groups 2 and 3 (p < 0.0001. Photopic contrast sensitivity for high spatial frequencies was better in groups 2 and 3. Glare was reported in 5.9% of patients in group 1. Halos occurred in 32.4% of patients in group 1. No one reported undesirable visual symptoms in groups 2 and 3. Conclusion. Multifocal IOLs provided higher spectacle independence and satisfactory functional vision over a broad range of distances but were associated with increased subjective visual symptoms and reduced photopic contrast sensitivity for high spatial frequencies and distance visual quality compared with monofocal IOLs.

IDIOPATHIC MULTIFOCAL CHOROIDITIS PRESENTING WITH A TRANSIENT PERIPAPILLARY WHITE RING.

Science.gov (United States)

Gattoussi, Sarra; Ghadiali, Quraish; Dolz-Marco, Rosa; Freund, K Bailey

2017-11-22

We describe with multimodal imaging the presentation and follow-up for a patient with idiopathic multifocal choroiditis and a transient peripapillary white ring. Case report. A 39-year-old Asian woman was initially seen for an evaluation of lattice degeneration in 2015. Her medical history included Graves disease and psoriasis. Best-corrected visual acuity was 20/25 in her right eye and 20/25 in her left eye. Ultra-widefield fundus autofluorescence imaging showed a curvilinear hyperautofluorescent line in her right eye. One year later, the patient returned complaining of floaters in her right eye for 1 month. Her visual acuity was unchanged. Funduscopic examination showed new inflammatory yellowish lesions in the right eye corresponding to hyperreflective sub-retinal pigment epithelium lesions on structural spectral domain optical coherence tomography. Fluorescein angiography showed corresponding late staining of these active lesions. Late-phase indocyanine green angiography showed multiple nummular hypocyanescent dots. Ultra-widefield fundus autofluorescence showed large areas of hyperautofluorescence. The patient was started on a 60-mg oral prednisone taper and demonstrated subsequent regression of the inflammatory lesions. Ten months later, the patient returned emergently with complaints of floaters in both eyes for 2 days and a new temporal scotoma in her left eye. Funduscopic examination demonstrated a white ring around the optic nerve of the left eye corresponding to a hyperautofluorescent lesion. Ultra-widefield fundus autofluorescence showed new areas of hyperautofluorescence in both eyes. Structural spectral domain optical coherence tomography showed new sub-retinal pigment epithelium inflammatory lesions and a disruption of the ellipsoid zone in both eyes. The patient was again treated with a 60-mg oral prednisone taper and demonstrated subsequent restoration of the ellipsoid zone. To our knowledge, this is the first report of a transient annular white

Porfiria aguda intermitente: relato de caso e revisão da literatura Acute intermittent porphyria: case report and review of the literature

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Daniela von Ah Lopes

2008-12-01

Full Text Available Porfiria aguda intermitente é patologia incomum, com conseqüências potencialmente graves se não reconhecida precocemente. Dentre as possíveis causas de indução de crises de porfiria, a redução da ingestão calórica é descrita na literatura. Relatamos um caso de porfiria aguda intermitente no pós-operatório tardio de gastroplastia indicada para tratamento da obesidade, revisando aspectos do diagnóstico e tratamento da patologia na unidade de terapia intensiva. Paciente feminina, 31 anos, com história de gastroplastia há 3 semanas admitida na unidade de terapia intensiva com rebaixamento do nível de consciência e desconforto respiratório. Evoluiu com agitação psicomotora, confusão mental, dor abdominal e tetraparesia proximal. Na investigação diagnóstica foi encontrado hiponatremia grave (92 mEq/L, hipomagnesemia, hipofosfatemia e hipocalcemia, urina turva, sem hematúria. Aventou-se hipótese de porfiria aguda, realizado dosagem do ácido delta-aminolevulínico e porfobilinogênio na urina de 24h, com elevação de ambos. Iniciado tratamento com dieta rica em carboidratos, sem utilizar hematina ou arginato de heme, devido à dificuldades no fornecimento destas medicações. Evoluiu com melhora clínica gradativa e recuperação completa da força muscular após 8 meses. A porfiria aguda intermitente possui sinais e sintomas comuns a muitas patologias clínicas e neuropsiquiátricas dificultando o diagnóstico, em especial quando estes se manifestam isoladamente. Assim, deve-se incluir a porfiria aguda intermitente no diagnóstico diferencial de distúrbios neurológicos, psiquiátricos e gastroenterológicos em crises, no qual todos os demais exames estejam normais. Atenção deve ser dada a pacientes submetidos à cirurgias, em especial cirurgia bariátrica que, além do estresse cirúrgico, limita substancialmente a ingesta calórica podendo desencadear crises. Não há descrito na literatura, até o momento, nenhum

Ataxia cerebelar aguda na criança Acute cerebellar ataxia in children

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Valeriana Moura Ribeiro

1968-03-01

Full Text Available São relatados os casos de 6 crianças com ataxia cerebelar aguda. Admitem os autores a presença de um fator etiológico de caráter viral comum a todos êles, discutindo os mecanismos patogênicos com base nos casos da literatura. A evolução foi favorável em todos os pacientes, com regressão completa da sintomatologia, dentro do período de 6 a 60 dias.Clinical observations of 6 children with acute cerebellar ataxia and respective laboratorial data are reported. Considerations are made in order to support the hypothesis of involving virus. The evolution of the disorder was a nonfatal one and the patients regained normal cerebellar function within a period of 6 to 60 days.

Guía para la práctica clínica de las enfermedades diarreicas agudas

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Freijoso Santiesteban, Elsie; Cires Pujol, María Miriam; Silva Herrera, Lázaro; Delgado Martínez, Ibis; Riverón Corteguera, Raúl; Ramírez, Margarita

2003-01-01

Se presenta una guía para la práctica clínica de las enfermedades diarreicas agudas (EDA), cuyo objetivo principal es el de establecer recomendaciones para el manejo terapéutico de pacientes con EDA. En la misma se abordan las definiciones y causas de las EDA, los objetivos del tratamiento, la evaluación del paciente con diarreas y las características clínico epidemiológicas, así como las consideraciones terapéuticas y tratamientos para las diarreas causadas por diferentes microorganismos.A c...

Leucograma e proteínas de fase aguda de ruminantes domésticos sadios e enfermos

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Simplicio, Kalina Maria de Medeiros Gomes [UNESP

2011-01-01

Foi avaliada a importância de proteínas de fase aguda (PFA) como biomarcadores de enfermidades em ruminantes domésticos. Para tal se determinou o proteinograma sérico e leucograma de 15 bovinos sadios e 15 doentes, 15 ovinos sadios e 15 doentes, e 15 caprinos sadios e 15 doentes. Todos foram submetidos a colheitas diárias de sangue durante sete dias, enquanto permaneciam internados no Hospital Veterinário da FCAV-UNESP, Câmpus de Jaboticabal. Em bovinos a haptoglobina teve destaque como bioma...

Visual outcomes after implantation of a novel refractive toric multifocal intraocular lens

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Talita Shimoda

2014-04-01

Full Text Available Purpose: To assess the postoperative outcomes of a novel toric multifocal in traocular lens (IOL in patients with cataract and corneal astigmatism. Methods: This prospective nonrandomized study included patients with cataract, corneal astigmatism, and a motivation for spectacle independence. In all patients, a Rayner M-flex® T toric IOL was implanted in the capsular bag. Three months after surgery, the distance, intermediate, and near visual acuities; spherical equivalent; residual refractive astigmatism; defocus curve; and contrast sensitivity were evaluated. A patient satisfaction and visual phenomena questionnaire was administered to all patients. Results: Thirty-four eyes of 18 patients were included in this study. Three months after surgery, the mean corrected distance visual acuity (logMAR was 0.00 ± 0.08 at 6 m, 0.20 ± 0.09 at 70 cm, and 0.08 ± 0.11 at 40 cm. Uncorrected distance vision acuity was 20/40 or better in 100% eyes. The preoperative mean refractive cylinder (RC was -2.19 (SD: ± 0.53. After a 3-month follow-up, the average RC was -0.44 D (SD: ± 0.27; p<0.001. Contrast sensitivity levels were high. At the last follow-up, 87.5% patients were spectacle-independent for near, intermediate, and distance vision, and approximately 44% patients reported halos and glare. Conclusion: Toric multifocal IOL implantation in patients with cataract and corneal astigmatism using the Rayner M-flex® T toric IOL was a simple, safe, and accurate option. This technology provides surgeons with a feasible option for meeting patient expectations of an enhanced lifestyle resulting from decreased spectacle dependence.

Infección por Campylobacter y Shigella como causa de Diarrea Aguda Infecciosa en niños menores de dos años en el Distrito de la Victoria, Lima-Perú

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María Perales D; Máximo Camiña; Carmen Quiñones

2002-01-01

Objetivo: Determinar la frecuencia de Campylobacter y Shigella como agentes etiológicos en diarrea aguda acuosa en niños menores de dos años atendidos en 4 centros de salud del distrito de La Victoria (Lima, Perú) Materiales y métodos: en este estudio transversal analítico se realizaron coprocultivos bajo técnica microbiológica estándar a los niños menores de dos años con diarrea aguda acuosa atendidos en 4 centros de salud de La Victoria entre abril y octubre de 2001. Fueron excluidos aquell...

Otitis media aguda: nuevo enfoque terapéutico

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Ileana Alvarez Lam

2004-03-01

Full Text Available La otitis media aguda continúa siendo una de las enfermedades infecciosas más frecuentes en la infancia. Se hace una revisión del tema haciendo énfasis en la conducta terapéutica actual luego del surgimiento de complejos mecanismos de resistencia bacteriana creados por los microorganismos causantes de la enfermedad. Como toda enfermedad infecciosa las esperanzas están cifradas en el surgimiento de una vacuna que impacte de forma positiva en nuestra población infantil. En tal sentido se hace una reflexión sobre el uso de la vacuna antineumocócica de 7 valencias (Prevnar y su repercusión sobre esta enfermedad.Acute otitis media is still one of the most common infectious diseases among children. A review of the topic is made giving emphasis to the present therapeutic conduct after the appearance of complex mechanisms of bacterial resistance created by the microorganisms causing the disease. As in every infectious disease, we place our hopes on the emergence of a vaccine with a positive impact on our infantile population. In this sense, a reflection is made on the use of the heptavalent antipneumococcic vaccine (Prevnar and its repercussion on this disease.

Clinical Evaluation of Reading Performance Using the Salzburg Reading Desk With a Refractive Rotational Asymmetric Multifocal Intraocular Lens.

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Linz, Katharina; Attia, Mary S A; Khoramnia, Ramin; Tandogan, Tamer; Kretz, Florian T; Auffarth, Gerd Uwe

2016-08-01

To evaluate functional results and reading performance using the Salzburg Reading Desk after implantation of a sector-shaped near-embedded, rotational asymmetrical multifocal intraocular lens (IOL) and a multifocal toric IOL with a +3.00 diopter (D) near addition. In a prospective study, the LentisMplus and Mplus toric IOLs (Oculentis GmbH, Berlin, Germany) were implanted in 34 eyes of 18 patients at the University Eye Hospital of Heidelberg. Uncorrected and corrected distance visual acuity (UDVA, CDVA) and uncorrected and corrected near visual acuity (UNVA, CNVA) were evaluated using standardized visual acuity charts (ETDRS). The Salzburg Reading Desk was used to analyze unilateral and bilateral uncorrected and corrected reading acuity, reading distance, reading speed, and the smallest log-scaled print size that could be read effectively at a set (40 cm/80 cm) and subjective chosen near and intermediate distance. Postoperatively, the median UDVA was 0.08 logMAR (20/25 Snellen) and the median CDVA was 0.01 logMAR (20/20 Snellen). The median UNVA was 0.12 logMAR (20/25 Snellen) and the median CNVA was 0.03 logMAR (20/20 Snellen). The median uncorrected reading acuity measured with the Salzburg Reading Desk for near distance at 40 cm was 0.18 logMAR (20/32 Snellen). The subjectively preferred near distance was 39 cm and revealed similar visual acuity results. The best reading acuity for intermediate distance with a median of 0.22 logMAR (20/32 Snellen) was achieved at a median distance of 62 cm. Reading performance of the multifocal IOL corresponded for near standardized and individual distance, whereas reading function was better at the patient's preferred intermediate distance. [J Refract Surg. 2016;32(8):526-532.]. Copyright 2016, SLACK Incorporated.

Multifocal, recurrent malignant chondroid syringoma with visceral metastases: A case report and literature review

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Ann Meredith Garcia

2016-03-01

Full Text Available We present the unusual case of malignant chondroid syringoma (MCS in a 64-year-old male with recurrent nodular skin lesions and visceral metastases. The patient underwent repeated excisions, with eventual development of widespread nodules and multiple pulmonary and hepatic nodules. Systemic chemotherapy was planned. MCS is a very rare skin adnexal tumor of the sweat glands with only around 50 cases reported worldwide. To the authors’ knowledge, this is the first reported case of MCS with a multifocal presentation and mucosal involvement.

Compensating additional optical power in the central zone of a multifocal contact lens forminimization of the shrinkage error of the shell mold in the injection molding process.

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Vu, Lien T; Chen, Chao-Chang A; Lee, Chia-Cheng; Yu, Chia-Wei

2018-04-20

This study aims to develop a compensating method to minimize the shrinkage error of the shell mold (SM) in the injection molding (IM) process to obtain uniform optical power in the central optical zone of soft axial symmetric multifocal contact lenses (CL). The Z-shrinkage error along the Z axis or axial axis of the anterior SM corresponding to the anterior surface of a dry contact lens in the IM process can be minimized by optimizing IM process parameters and then by compensating for additional (Add) powers in the central zone of the original lens design. First, the shrinkage error is minimized by optimizing three levels of four IM parameters, including mold temperature, injection velocity, packing pressure, and cooling time in 18 IM simulations based on an orthogonal array L 18 (2 1 ×3 4 ). Then, based on the Z-shrinkage error from IM simulation, three new contact lens designs are obtained by increasing the Add power in the central zone of the original multifocal CL design to compensate for the optical power errors. Results obtained from IM process simulations and the optical simulations show that the new CL design with 0.1 D increasing in Add power has the closest shrinkage profile to the original anterior SM profile with percentage of reduction in absolute Z-shrinkage error of 55% and more uniform power in the central zone than in the other two cases. Moreover, actual experiments of IM of SM for casting soft multifocal CLs have been performed. The final product of wet CLs has been completed for the original design and the new design. Results of the optical performance have verified the improvement of the compensated design of CLs. The feasibility of this compensating method has been proven based on the measurement results of the produced soft multifocal CLs of the new design. Results of this study can be further applied to predict or compensate for the total optical power errors of the soft multifocal CLs.

Food and Drug Administration study update. One-year results from 671 patients with the 3M multifocal intraocular lens.

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Lindstrom, R L

1993-01-01

The clinical evaluation of the Food and Drug Administration study of the 3M diffractive multifocal intraocular lens (IOL) is presented here to demonstrate the results of 1-year postoperative data accumulated for 671 patients, the first of whom received the implant in 1987. Patients were selected for study if they had absence of preoperative pathology, were at least 60 years of age, and had a reasonable postoperative prognosis. Extensive evaluations took place at 4 to 6 months and 12 to 14 months after surgery, including five different visual acuity measurements and contrast sensitivity. All testing was completed on both eyes. Data from the fellow eye served as a control when implanted with a monofocal IOL. Overall uncorrected distance visual acuity at 1 year after surgery shows 57% patients with 20/40 or better acuity. In this same group, 78% achieved J3 or better near vision, which improved to 82% in the best case group. Uncorrected visual acuity of 20/40 or better and J3 or better was achieved by 50% of best case multifocal IOL patients, compared with 26% of the monofocal best case comparison group. Measurements of contrast sensitivity consistently document a small loss, which is considered clinically insignificant. Statistical analysis of satisfaction ratings shows that predictors of satisfaction include uncorrected distance acuity, final near acuity, and fellow eye spherical equivalent. This multifocal lens appears to work very well for most patients, with more than half having functional uncorrected distance and near vision. The study showed several considerations that are important for optimizing clinical performance and patient satisfaction: patient selection, realistic expectations, accurate biometry, and adequate control of surgical procedures.

Pancreatite aguda leve: avaliação pela ultra-sonografia. estudo prospectivo Mild acute pancreatitis: ultrasound evaluation: a prospective study

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Márcio Martins Machado

2002-07-01

Full Text Available Resumo Neste estudo foram avaliados, por meio da ultra-sonografia, 21 pacientes com pancreatite aguda leve. Foram analisadas a presença ou ausência de hipoecogenicidade do pâncreas e a presença ou ausência de líquido peripancreático. Em 19 pacientes (90,5% foi identificada hipoecogenicidade pancreática, e em três (15,8% destes pacientes foi identificada a presença de pequena quantidade de líquido na pequena cavidade dos epíploons. Em dois pacientes (9,5% não se identificou qualquer alteração pancreática. Com relação à possível etiologia da pancreatite aguda, em 15 pacientes (71,5% pôde-se demonstrar a presença de colecistopatia calculosa, em quatro pacientes (19,0% havia história de alcoolismo crônico e não foram identificados cálculos na vesícula biliar, e em dois pacientes (9,5% não foi identificada qualquer causa aparente. Os autores concluem que a ultra-sonografia pode identificar alteração na maioria dos pacientes com pancreatite aguda leve e permite, ainda, o acompanhamento daqueles com pequenas coleções líquidas peripancreáticas.We analyzed the ultrasonographic findings of 21 patients with mild acute pancreatitis. The presence or absence of pancreatic hypoechogenicity and peripancreatic fluid collection was assessed. Pancreatic hypoechogenicity was identified in 19 patients (90.5% whereas small sac fluid collection was identified in 3 (15.8% of these patients. No abnormality was seen in 2 patients (9.5%. Regarding the etiology of acute pancreatitis, cholelithiasis was identified in 15 patients (71.5%, alcohol abuse was identified in 4 patients (19.0%, and in 2 patients (9.5% no probable etiology could be found. The authors conclude that ultrasonography may identify abnormalities in the majority of patients with mild acute pancreatitis and can be used to assess patients with peripancreatic fluid collections.

Multifocal Adenomatous Oncocytic Hyperplasia of the Parotid Gland

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Kinoshita, Yuichi; Harada, Hiroshi; Kobayashi, Tadao K.; Yoshizawa, Katsuhiko; Yuri, Takashi; Takasu, Kosho; Tsubura, Airo; Shikata, Nobuaki

2014-01-01

Multifocal adenomatous oncocytic hyperplasia (MAOH) is a non-neoplastic lesion that is classified as oncocytosis. MAOH is a rare entity of the parotid gland and accounts for approximately 0.1% of salivary gland lesions. Here, we report a case of MAOH of the parotid gland. The patient was a 71-year-old woman who presented with discomfort at the left side of her neck. Fine-needle aspiration cytology of the parotid gland revealed a loose sheet-like cluster of round to polygonal cells with granular cytoplasm against a hemorrhagic background. The cells had round to oval, centrally located nuclei with granular chromatin and without distinct nucleoli. Histologically, the lesion was formed of many variable-sized nodules, comprising oncocyte-like cells with small round nuclei and eosinophilic granular cytoplasm that was positive for mitochondrial antibodies. The diagnosis of MAOH is difficult to make by cytology alone, because the findings overlap with those of other oncocytic lesions. In particular, the cytological findings of MAOH have not been sufficiently reported to date. A correlation of cytology and histology was expected. PMID:25580104

Multifocal Adenomatous Oncocytic Hyperplasia of the Parotid Gland

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Yuichi Kinoshita

2014-12-01

Full Text Available Multifocal adenomatous oncocytic hyperplasia (MAOH is a non-neoplastic lesion that is classified as oncocytosis. MAOH is a rare entity of the parotid gland and accounts for approximately 0.1% of salivary gland lesions. Here, we report a case of MAOH of the parotid gland. The patient was a 71-year-old woman who presented with discomfort at the left side of her neck. Fine-needle aspiration cytology of the parotid gland revealed a loose sheet-like cluster of round to polygonal cells with granular cytoplasm against a hemorrhagic background. The cells had round to oval, centrally located nuclei with granular chromatin and without distinct nucleoli. Histologically, the lesion was formed of many variable-sized nodules, comprising oncocyte-like cells with small round nuclei and eosinophilic granular cytoplasm that was positive for mitochondrial antibodies. The diagnosis of MAOH is difficult to make by cytology alone, because the findings overlap with those of other oncocytic lesions. In particular, the cytological findings of MAOH have not been sufficiently reported to date. A correlation of cytology and histology was expected.

Progressive multifocal leukoence-phalopathy presenting as homonymous hemianopia in a patient with acquired immunodeficiency syndrome

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Amit Pandey

2012-01-01

Full Text Available We present a case of a Human Immunodeficiency Virus (HIV positive patient who was referred for retinal evaluation to rule out ophthalmic manifestations of Acquired Immunodeficiency Syndrome (AIDS. She complained of some disturbance in vision in both eyes. Fundus examination showed no abnormality. Perimetry, done to rule out optic nerve pathology, showed a left homonymous hemianopia. Magnetic Resonance Imaging (MRI scan showed features of Progressive Multifocal Leukoencephalopathy (PML. She had no other neurological symptoms or signs.

Prismatic displacement effect of progressive multifocal glasses on reaction time and accuracy in elderly people

OpenAIRE

Ellison, Ashton C; Campbell, A John; Robertson, M Clare; Sanderson, Gordon F

2014-01-01

Ashton C Ellison, A John Campbell, M Clare Robertson, Gordon F SandersonDunedin School of Medicine, Department of Medicine, Dunedin, New ZealandBackground: Multifocal glasses (bifocals, trifocals, and progressives) increase the risk of falling in elderly people, but how they do so is unclear. To explain why glasses with progressive addition lenses increase the risk of falls and whether this can be attributed to false projection, this study aimed to 1) map the prismatic displacement of a progr...

Progressive multifocal leukoence--phalopathy presenting as homonymous hemianopia in a patient with acquired immunodeficiency syndrome.

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Pandey, Amit; Bandivdekar, Karishma; Ramchandani, Suresh; Ramchandani, Sushama

2012-01-01

We present a case of a Human Immunodeficiency Virus (HIV) positive patient who was referred for retinal evaluation to rule out ophthalmic manifestations of Acquired Immunodeficiency Syndrome (AIDS). She complained of some disturbance in vision in both eyes. Fundus examination showed no abnormality. Perimetry, done to rule out optic nerve pathology, showed a left homonymous hemianopia. Magnetic Resonance Imaging (MRI) scan showed features of Progressive Multifocal Leukoencephalopathy (PML). She had no other neurological symptoms or signs.

Síndrome aguda do tórax como primeira manifestação de anemia falciforme em adulto

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BOK YOO HUGO HYUNG

2002-01-01

Full Text Available A síndrome aguda do tórax (SAT acomete portadores de anemia falciforme e é responsável por cerca de 25% dos óbitos. Relata-se o caso de um homem pardo de 45 anos, alcoolista crônico, sem nenhum antecedente de falcização, com quadro de pneumonia-símile havia sete dias. A radiografia simples do tórax mostrou infiltrado heterogêneo bilateral, com áreas de consolidação e broncograma aéreo e derrame pleural à esquerda. Outros exames laboratoriais revelaram anemia, leucocitose com desvio à esquerda e hipoxemia. Tratado com cefoxitina e amicacina, o paciente evoluiu rapidamente para insuficiência respiratória aguda e morreu 14 horas após a internação. Na necropsia, no exame dos pulmões observaram-se intensa congestão, hemorragia intra-alveolar, dano alveolar difuso e hemácias com morfologia falciforme. O caráter rápido, progressivo e freqüentemente mimetizado por outras doenças torna a SAT um evento dramático e de diagnóstico precoce difícil, sendo, entretanto, obrigatória tê-la sempre em mente, especialmente em um país com grande população da raça negra como o Brasil.

TBC1D24 Mutations in a Sibship with Multifocal Polymyoclonus

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Adeline Ngoh

2017-04-01

Full Text Available Background: Advances in molecular genetic technologies have improved our understanding of genetic causes of rare neurological disorders with features of myoclonus.Case Report: A family with two affected siblings, presenting with multifocal polymyoclonus and neurodevelopmental delay, was recruited for whole-exome sequencing following unyielding diagnostic neurometabolic investigations. Compound heterozygous mutations in TBC1D24, a gene previously associated with various epilepsy phenotypes and hearing loss, were identified in both siblings. The mutations included a missense change c.457G>A (p.Glu157Lys, and a novel frameshift mutation c.545del (p.Thr182Serfs*6.Discussion: We propose that TBC1D24-related diseases should be in the differential diagnosis for children with polymyoclonus. 

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

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M. Corti

2003-04-01

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

Lesiones periapicales agudas en pacientes adultos

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María Elena Fernández Collazo

2012-06-01

Full Text Available Se realizó un estudio analítico de corte transversal en el área de salud del Policlínico "27 de Noviembre" del municipio Marianao, La Habana, en el periodo correspondiente de enero a diciembre de 2009. Se incluyeron todos los pacientes que acudieron al servicio de urgencia y que presentaron lesiones periapicales agudas. Se recogió información de las variables edad, sexo, grupo dentario, causa de la enfermedad, características clínicas e higiene bucal. Esta última se clasificó en las categorías eficiente y deficiente según el índice simplificado de higiene bucal. Se utilizó el X² para estimar la relación entre las variables, y la comparación de proporciones para contrastar la hipótesis de que existieran diferencias entre las lesiones periapicales para las categorías de las variables grupo dentario, causa de la enfermedad y características clínicas. Se encontró un predominio del absceso periapical agudo en un 84,7 % del grupo de edad de 35 a 59 años y del sexo masculino, aunque no se encontraron diferencias significativas para estas variables, ni en los grupos dentarios con respecto a la enfermedad. La higiene bucal resultó estar relacionada con las lesiones periapicales. Se encontraron diferencias significativas en las lesiones periapicales respecto a todas las causas estudiadas, con excepción de las enfermedades periodontales. Respecto a las características clínicas hubo significación en cuanto al aumento de volumen del fondo del surco vestibular y la movilidad dentaria.

Comportamento da síndrome coronariana aguda: resultados de um registro brasileiro Acute coronary syndrome behavior: results of a Brazilian registry

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Leopoldo Soares Piegas

2013-01-01

Full Text Available FUNDAMENTO: O Brasil carece de registros multicêntricos publicados de síndrome coronariana aguda. OBJETIVO: O Registro Brasileiro de Síndrome Coronariana Aguda é um estudo multicêntrico nacional com objetivo de apresentar dados representativos das características clínicas, e manejo e evolução hospitalares dessa síndrome. MÉTODOS: Participaram 23 hospitais de 14 cidades. Foram elegíveis pacientes que se apresentaram com suspeita de síndrome coronariana aguda nas primeiras 24 horas, com quadro clínico sugestivo, associado a alterações eletrocardiográficas compatíveis e/ou marcadores de necrose. O seguimento foi realizado até o óbito ou a alta hospitalar. RESULTADOS: Entre os anos de 2003 e 2008, foram incluídos 2.693 pacientes com diagnóstico de síndrome coronariana aguda, sendo 864 (32,1% mulheres. O diagnóstico final foi de angina instável para 1.141 (42,4% pacientes, com mortalidade de 3,06% deles; de infarto agudo do miocárdio sem supradesnível de ST para 529 (19,6% pacientes, com mortalidade de 6,8% deles; e de infarto agudo do miocárdio com supradesnível de ST para 950 (35,3% pacientes, com mortalidade de 8,1% deles; tiveram diagnóstico não confirmado 73 (2,7% pacientes, com mortalidade de 1,36% deles. A mortalidade global foi de 5,53%. O modelo de regressão logística múltipla identificou o gênero feminino (OR=1,45, o diabetes melito (OR=1,59, o índice de massa corporal (OR=1,27 e a intervenção coronariana percutânea (OR=0,70 como fatores de risco de óbito, para demografia e intervenções. Um modelo para óbito por complicações maiores identificou choque cardiogênico/Edema Agudo de Pulmão (OR=4,57, reinfarto (OR=3,48, acidente vascular cerebral (OR=21,56, sangramento grave (OR=3,33, parada cardiorrespiratória (OR=40,27 e classe funcional de Killip (OR=3,37. CONCLUSÃO: Os dados do Registro Brasileiro de Síndrome Coronariana Aguda não diferem de outros coletados fora do país. Seus achados poder

Use of tacrolimus in rescue therapy of acute and chronic rejection in liver transplantation Uso de tacrolimus na terapia de resgate de rejeições agudas e crônicas no transplante de fígado

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Fabricio Ferreira Coelho

2003-01-01

Full Text Available PURPOSE: To study the indications and results of tacrolimus as rescue therapy for acute cellular or chronic rejection in liver transplantation. PATIENTS AND METHODS: Eighteen liver transplant recipients who underwent rescue therapy with tacrolimus between March 1995 and August 1999 were retrospectively studied. The treatment indication, patients, and graft situation were recorded as of October 31st, 1999. The response to tacrolimus was defined as patient survival with a functional graft and histological reversal of acute cellular, or for chronic rejection, bilirubin serum levels decreasing to up to twice the upper normal limit. RESULTS: Fourteen cases (77.8% presented a good response. The response rate for the different indications was: (1 acute cellular + sepsis - 0/1 case; (2 recurrent acute cellular - 1/1 case; (3 OKT3-resistant acute cellular - 2/2 cases; (4 steroid-resistant acute cellular + active viral infection - 3/3 cases; (5 chronic rejection - 8/11 cases (72.7% response rate. The 4 patients who did not respond died. CONCLUSION: Tacrolimus rescue therapy was successful in most cases of acute cellular and chronic rejection in liver transplantation.OBJETIVO: Estudar os critérios de indicação e o resultado do uso de tacrolimus na terapia de resgate de rejeições agudas ou crônicas no transplante de fígado. CASUÍSTICA E MÉTODO: Foram estudados 18 pacientes transplantados de fígado, submetidos a terapia de resgate com tacrolimus entre março de 1995 e agosto de 1999. Foram registradas a indicação do tratamento e a situação de pacientes e enxertos em 31/10/1999. Considerou-se "respondendores" pacientes vivos, com enxerto funcionante e regressão histológica da terapia de resgate de rejeições agudas, ou com bilirrubina até 2 vezes o valor normal, no caso de terapia de resgate de rejeições crônicas. RESULTADO: Observou-se resposta em 14 casos (77,8%. A taxa de resposta nas diferentes indicações foi: (1 terapia de resgate

Bilateral Multifocal Hamartoma of the Chest Wall in an Infant

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Yilmaz, Erdem; Erol, Oguz Bulent; Pekcan, Melih; Gundogdu, Gokcen; Bilgic, Bilge; Gun, Feryal; Yekeler, Ensar

2015-01-01

Summary Background Hamartoma of the thoracic wall is a rare benign tumor that occurs in infancy and can be mistaken for a malignancy due to its clinical and imaging features. Hamartomas are extrapleural soft tissue lesions that cause rib expansion and destruction and appear on imaging as cystic areas with fluid levels and calcification. They can cause scoliosis, pressure on the neighboring lung parenchyma and mediastinal displacement. While conservative treatment is recommended in asymptomatic cases, growing lesions require surgical excision. Case Report In this report, we present the imaging findings in a 3-month-old infant that presented with a firm swelling in the chest wall and was histopathologically confirmed to have a bilateral multifocal hamartoma. Conclusions Radiological imaging methods are important for accurate diagnosis of this very rare condition that can be confused with a malignancy. PMID:26082822

Multifocal epilepsy: the role of palliative resection - intractable frontal and occipital lobe epilepsy secondary to radiotherapy for acute lymphoblastic leukaemia.

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Radhakrishnan, Ashalatha; Sithinamsuwan, Pasiri; Harvey, A Simon; Flanagan, Danny; Fitt, Gregory; Berlangieri, Sam; Jackson, Graeme D; Berkovic, Samuel F; Scheffer, Ingrid E

2008-12-01

Patients with multifocal epilepsy are often considered unsuitable for epilepsy surgery. We report an adolescent with intractable frontal and occipital lobe seizures, secondary to complications of treatment for acute lymphoblastic leukaemia as a young child. Chemotherapy and radiotherapy were complicated by bilateral, posterior leukoencephalopathy and later an acquired frontal cerebral cavernous malformation (CCM). Detailed electro-clinical and imaging studies showed multiple, frontal lobe seizures per day with less frequent and non-debilitating, simple, occipital lobe seizures. Focal resection of the frontal CCM abolished the socially-disabling seizures with resultant marked improvement in the patient's quality of life at 12 months. Careful analysis of the type and impact of focal seizures in the setting of multifocal epilepsy may demonstrate that one seizure type is more deleterious to quality of life and may be amenable to surgery. In this situation, the patient may benefit significantly from surgery to resect the more active epileptic focus.

Relação entre polimorfismos de IL-8 e a gravidade da bronquiolite viral aguda

OpenAIRE

Leitão, Lidiane Alves de Azeredo

2013-01-01

Introdução : Até os 2 anos de idade, praticamente, todos os lactentes apresentam infecção por vírus sincicial respiratório (VSR). Entretanto, a gravidade da bronquiolite viral aguda (BVA) pode variar significativamente. Essa grande variação pode ser causada por fatores genéticos e imunológicos. Estudos prévios indicam que vias aéreas infectadas por VSR contêm níveis elevados de interleucina-8 (IL-8). O conhecimento de polimorfismos genéticos associados à BVA grave pode ter grande relevância c...

Forma atípica de tireoidite supurativa aguda em paciente pediátrico: relato de caso

OpenAIRE

Torres, Maria Rosineide dos S.; Medeiros, Carla C. M.; Nóbrega Neto, Sebastião Horácio; Souza, Lincoln S.; Rodrigues, Mônica L. C.; Silva, Maria Nelice M.; Maior, Lyzandra de H. C. S.; Avelino, Márcia C.; Mourão, Germana T. F.

2008-01-01

A tireoidite aguda é uma doença rara. Na infância associa-se principalmente a anormalidades congênitas com acometimento do lobo esquerdo. Na ausência de tireoidopatia preexistente, a função tireoidiana geralmente está normal. Relatamos um caso de uma menina, 6 anos de idade, com tumoração associada a sinais flogísticos na região cervical anterior há 15 dias acompanhada de leucocitose com desvio à esquerda, VSH e TSH elevados. Não havia história prévia de tireoidopatia. A ultra-sonografia da r...

Nuevo enfoque de la interpretación del dolor en una pulpitis aguda

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Andrés O Pérez Ruiz

2000-04-01

Full Text Available El dolor es probablemente el principal motivo de consulta en las urgencias estomatológicas y es precisamente el dolor de la pulpitis aguda el que comentamos en este trabajo. El dolor pulpar en sí mismo es similar al dolor que resulta por inflamación de los órganos viscerales y, por lo tanto, podrían ser inadecuados los intentos de explicarlos por comparación con los nociceptores de estructuras somáticas. Se propone analizar el comportamiento del dolor como consecuencia de una pulpitis aguda, con un nuevo enfoque, asimilándolo como el dolor proveniente de estructuras viscerales con manifestaciones dolorosas alejadas del sitio o zona dañada y en el propio diente en que el tejido ha sido injuriado y evoluciona rápidamente hacia la necrosis. Establecemos una analogía entre el dolor visceral como el generado de la pulpa y el del tipo somático profundo como el correspondiente a la afectación periapical por rápida evolución de la inflamación hacia la necrosis.Pain is probably the chief complaint in dental emergencies and this paper deals precisely with the pain caused by acute pulpitis. The pulpar pain itself is similar to the one resulting from inflammation of the visceral organs and, therefore, the attempts to explain these pains by comparing them with the nociceptors of somatic structures may be inappropiate. It is our objective to analyze the behaviour of pain caused by acute pulpitis with a new approach, assimilating it as the pain from visceral structures with painful manifestations far from the damaged site or zone and it is the own tooth whose tissue has been affected and evolves rapidly to necrosis.We establish an analogy between the visceral pain as the one generated by the pulpa and that of deep somatic type as the corresponding to the periapical affection by the fast evolution of inflammation to necrosis.

Micronutrientes: una opción en el tratamiento de las enfermedades diarreicas agudas

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Carlos Coronel Carbajal

2000-12-01

Full Text Available Se realizó un estudio longitudinal y prospectivo a 126 pacientes que ingresaron al Servicio de Diarreas Agudas del Hospital General Docente "Armando Enrique Cardoso", en el período comprendido entre junio de 1998 y enero de 1999. A 71 pacientes se les ofrecieron microelementos (vitamina A, sulfato de zinc y fumarato ferroso con el objetivo de conocer los beneficios de los microelementos en la enfermedad diarreica aguda. Al concluir el estudio se pudo comprobar que el grupo de pacientes suplementados tuvo una estadía más corta y la duración del episodio fue menor. Además se halló que en estos pacientes el número de deposiciones es menor, así como la afectación nutricional. También se comprobó cómo la recuperación nutricional es mucho más rápida, así como la recuperación del apetito. Se pudo mostrar cómo la consistencia de las deposiciones al tercer día de tratamiento, en el grupo que recibió micronutrientes, mejoró.A longitudinal and prospective study was conducted among 126 patients that were admitted in the Service of Acute Diarrheas of "Armando Enrique Cardoso" General Teaching Hospital between June, 1998, and January, 1999. 71 patients were administered microelements (vitamin A, zinc sulfate and ferrous fumarate in order to know their benefits in the acute diarrheal disease. On concluding the study, it was proved that the length of stay and the episode were shorter in the group of supplemented patients. It was also observed that the number of defecations as well as the nutritional affectation were lower in these patients and that the nutritional recovery and the recuperation of appetite were faster. The consistency of the defecations improved on the third day of treatment in the group that received micronutrients.

Multifocal multiphoton microscopy with adaptive optical correction

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Coelho, Simao; Poland, Simon; Krstajic, Nikola; Li, David; Monypenny, James; Walker, Richard; Tyndall, David; Ng, Tony; Henderson, Robert; Ameer-Beg, Simon

2013-02-01

Fluorescence lifetime imaging microscopy (FLIM) is a well established approach for measuring dynamic signalling events inside living cells, including detection of protein-protein interactions. The improvement in optical penetration of infrared light compared with linear excitation due to Rayleigh scattering and low absorption have provided imaging depths of up to 1mm in brain tissue but significant image degradation occurs as samples distort (aberrate) the infrared excitation beam. Multiphoton time-correlated single photon counting (TCSPC) FLIM is a method for obtaining functional, high resolution images of biological structures. In order to achieve good statistical accuracy TCSPC typically requires long acquisition times. We report the development of a multifocal multiphoton microscope (MMM), titled MegaFLI. Beam parallelization performed via a 3D Gerchberg-Saxton (GS) algorithm using a Spatial Light Modulator (SLM), increases TCSPC count rate proportional to the number of beamlets produced. A weighted 3D GS algorithm is employed to improve homogeneity. An added benefit is the implementation of flexible and adaptive optical correction. Adaptive optics performed by means of Zernike polynomials are used to correct for system induced aberrations. Here we present results with significant improvement in throughput obtained using a novel complementary metal-oxide-semiconductor (CMOS) 1024 pixel single-photon avalanche diode (SPAD) array, opening the way to truly high-throughput FLIM.

Chronic recurrent multifocal osteomyelitis: how to suggest this diagnosis?; L`osteite chronique recurrente multifocale. Un diagnostic qu`il faut savoir evoquer

Energy Technology Data Exchange (ETDEWEB)

Saint-Martin, Ch. [UCL Cliniques Saint-Luc, Bruxelles (Belgium); Kurelovic, I.; Soler, C.; Geoffray, A. [Fondation Laval, 06 - Nice (France); Durckel, J. [Hopital Hautepierre, 67 - Strasbourg (France)

1997-09-01

Chronic recurrent multifocal osteomyelitis is a rare disorder that affects children and teenagers. Clinically, it is characterized by insidious onset of local swelling and pain in several metaphyses. A symmetric, recurrent and multifocal pattern is usual. Spinal involvement is possible. Inconstant association with a cutaneous affection (palmo-plantar pustulosis, acne fulminans, psoriasis), or less frequently with an inflammatory chronic gut disorder is described. Pathogenesis usually recognized is an enthesopathy. Enthesitis may progress to the osseous part of the enthese and produce an aseptic chronic osteomyelitis. Biopsy specimen with culture is certainly necessary to rule out bacterial osteomyelitis and bone tumor. It is particularly true when the bone lesion is isolated. Disease course is benign and self-limited. The clinical course is characterized by recurrences and remissions occurring for 6 to 10 years. Treatment based on non steroid anti-inflammatory drugs is usually effective. (authors). 17 refs.

Colesterol y triglicéridos como marcadores bioquímicos del estado de la enfermedad del paciente con leucemia linfocítica aguda

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Marco Guzmán

2004-12-01

Full Text Available Objetivo: Determinar la relación de los niveles séricos de colesterol y triglicéridos con el estado de respuesta al tratamiento quimioterápico de inducción de pacientes con leucemia linfocítica aguda. Material y Métodos: La muestra la conforman 25 pacientes de 2 a 18 años de edad, admitidos al Instituto de Enfermedades Neoplásicas con un diagnóstico reciente de leucemia linfocítica aguda; determinándose en ellos sus concentraciones séricas de colesterol total, colesterol-HDL, colesterol-LDL y triglicéridos, antes y después de la primera fase de la quimioterapia de inducción. Resultados: Solamente 23 pacientes respondieron al tratamiento y en ellos observamos un incremento de 19,24 ± 4,49 mg/dL a 46,84 ± 15,38 mg/dL para el colesterol-HDL; y un descenso de 153,66 ± 36,39 mg/dL a 79,79 ± 34,53 mg/dL para los triglicéridos (p<0,0001. Por el contrario, en los pacientes que no respondieron al tratamiento, se obtuvo un incremento de 14,64 ± 2,46 mg/dL a 23,13 ± 14,23 mg/dL para el colesterol-HDL y un incremento de 121,88 ± 0,56 mg/dL a 161,01 ± 75,25 mg/dL para los triglicéridos. Conclusión: Las concentraciones séricas de colesterol y triglicéridos se relacionan con el estado de la enfermedad del paciente con leucemia linfocítica aguda. Proponemos a estos metabolitos, como marcadores bioquímicos en el seguimiento clínico de esta enfermedad.

[Hyperopic Laser-in-situ-Keratomileusis after trifocal intraocular lens implantation : Aberration-free femto-Laser-in-situ-Keratomileusis treatment after implantation of a diffractive, multifocal, toric intraocular lens-case analysis].

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Hemkeppler, E; Böhm, M; Kohnen, T

2018-05-29

A 52-year-old highly myopic female patient was implanted with a multifocal, diffractive, toric intraocular lens because of the wish to be independent of eyeglasses. Despite high-quality, extensive preoperative examinations, a hyperopic refractive error remained postoperatively, which led to the patient's dissatisfaction. This error was treated with Laser-in-situ-Keratomileusis (LASIK). After corneal LASIK treatment and implantation of a diffractive toric multifocal intraocular lens the patient showed a good postoperative visual result without optical phenomena.

Toxicidade aguda do extrato aquoso de folhas de Erythrina velutina em animais experimentais

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Ariadne Conceição Santos Craveiro

Full Text Available Este trabalho teve como objetivo a avaliação da toxicidade aguda do extrato aquoso de folhas de Erythrina velutina, espécie vegetal muito usada na medicina popular principalmente como tranqüilizante. O protocolo experimental utilizado seguiu o Guia para a Realização de Estudos de Toxicidade Pré-clínica de Fitoterápicos da Agência Nacional de Vigilância Sanitária (Anvisa, 2004. Ratos Wistar adultos foram tratados por via oral com a dose limite de 5 g/kg do extrato e observados por 14 dias consecutivos. Nenhum animal veio a óbito e nenhum sinal de toxicidade foi detectado nas observações comportamentais ou nas autópsias, indicando uma razoável atoxicidade do extrato.

Doença hepática aguda e edema palpebral persistente associados à mononucleose infecciosa

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Mônica Ayres de A. Scattolin

2007-05-01

Full Text Available Este trabalho tem como objetivo relatar e discutir o caso clínico de um paciente portador de mononucleose infecciosa, tendo como manifestação inicial edema palpebral seguido de hepatopatia aguda e icterícia. Descrição - J.F.G.F., masculino, cinco anos, com histórico de sete dias de edema bipalpebral, conjuntivas hiperemiadas, cansaço, anorexia, febre moderada, vômitos e dor abdominal em hipocôndrio direito. Há um dia passou a apresentar icterícia, urina escura, exantema urticariforme, febre de 39,5ºC e diarréia, tendo sido internado para rehidratação e investigação diagnóstica. Ao exame físico de entrada, apresentava-se abatido, estado geral comprometido, FC: 96, FR: 30, febril, PA: 110x 60 mmHg, descorado +/4+, desidratado de 2º grau, eupnéico e ictérico ++, infartamento ganglionar assimétrico generalizado, mais acentuado em região cervical posterior. Sem alterações ao exame cardíaco e pulmonar. Abdômen distendido, doloroso à palpação, fígado a 4 cm e baço a 2,5 cm. A avaliação laboratorial revelou Hb: 10,1 g/dL, leucocitose moderada com acentuada linfocitose e atipia linfocitária evidente, ALT: 179 U/L, AST: 232 U/L, LDH: 2.103 U/L e bilirrubinas: total 6,7 mg/Dl (direta 4,9 mg/dL, urina tipo I com bilirrubinas ++ e ultra-som de abdômen com hepatoesplenomegalia inespecífica. As sorologias para toxoplasmose citomegalovírus, hepatite foram negativas e para o vírus Epstein-Barr (EBV reagente: IgG: 108 UA/mL, e IgM 28 UA/mL. Após hidratação parenteral e antitérmico, o paciente evoluiu com a melhora dos parâmetros clínicos e laboratoriais. Discussão - Estima-se, atualmente, que 50% das crianças menores de cinco anos já apresentaram infecção pelo EBV. Vários agentes causam lesão hepática aguda. Entre os vírus ressalta-se os das hepatites, entretanto, pode ocorrer hepatopatia aguda por outras causas virais, entre elas, mononucleose e citomegalia. Sabe-se que a hepatomegalia ocorre em 10% a 20

Test-retest reliability of the multifocal photopic negative response.

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Van Alstine, Anthony W; Viswanathan, Suresh

2017-02-01

To assess the test-retest reliability of the multifocal photopic negative response (mfPhNR) of normal human subjects. Multifocal electroretinograms were recorded from one eye of 61 healthy adult subjects on two separate days using a Visual Evoked Response Imaging System software version 4.3 (EDI, San Mateo, California). The visual stimulus delivered on a 75-Hz monitor consisted of seven equal-sized hexagons each subtending 12° of visual angle. The m-step exponent was 9, and the m-sequence was slowed to include at least 30 blank frames after each flash. Only the first slice of the first-order kernel was analyzed. The mfPhNR amplitude was measured at a fixed time in the trough from baseline (BT) as well as at the same fixed time in the trough from the preceding b-wave peak (PT). Additionally, we also analyzed BT normalized either to PT (BT/PT) or to the b-wave amplitude (BT/b-wave). The relative reliability of test-retest differences for each test location was estimated by the Wilcoxon matched-pair signed-rank test and intraclass correlation coefficients (ICC). Absolute test-retest reliability was estimated by Bland-Altman analysis. The test-retest amplitude differences for neither of the two measurement techniques were statistically significant as determined by Wilcoxon matched-pair signed-rank test. PT measurements showed greater ICC values than BT amplitude measurements for all test locations. For each measurement technique, the ICC value of the macular response was greater than that of the surrounding locations. The mean test-retest difference was close to zero for both techniques at each of the test locations, and while the coefficient of reliability (COR-1.96 times the standard deviation of the test-retest difference) was comparable for the two techniques at each test location when expressed in nanovolts, the %COR (COR normalized to the mean test and retest amplitudes) was superior for PT than BT measurements. The ICC and COR were comparable for the BT/PT and

Lesão renal aguda em crianças: incidência e fatores prognósticos em pacientes gravemente enfermos Acute kidney injury in children: incidence and prognostic factors in critical ill patients

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Kenia Machado Souza Freire

2010-06-01

Full Text Available OBJETIVOS: Lesão renal aguda caracteriza-se pela redução súbita e, em geral, reversível da função renal com perda da capacidade de manutenção da homeostase do organismo. Em pediatria, as principais causas de lesão renal aguda são sepse, uso de drogas nefrotóxicas e isquemia renal nos pacientes criticamente enfermos. Nesses pacientes, a incidência de lesão renal aguda varia de 20 a 30%, resultando em aumento da taxa de morbi-mortalidade de 40 a 90%. Este estudo tem como objetivo avaliar a incidência de lesão renal aguda nos pacientes internados em unidade de terapia intensiva, classificar a gravidade da lesão renal aguda de acordo com o Pediatric Risk, Injury, Failure, Loss, End-Stage (pRIFLE, analisar a relação entre lesão renal aguda e a gravidade através do Pediatric Index of Mortality (PIM e estudar os fatores prognósticos associados. MÉTODOS: Realizou-se um estudo prospectivo entre julho de 2008 a janeiro de 2009 dos pacientes internados na unidade de terapia intensiva pediátrica do Hospital Infantil Joana de Gusmão - Florianópolis (SC - Brasil. Todos os pacientes foram analisados diariamente através do débito urinário e creatinina sérica e classificados de acordo com pRIFLE. RESULTADOS: No período de acompanhamento foram internadas 235 crianças. A incidência de lesão renal aguda foi de 30,6%, sendo que o pRIFLE máximo durante a internação foi de 12,1% para R, 12,1% para I e 6,4% para F. A taxa de mortalidade foi de 12,3%. Os pacientes que evoluíram com lesão renal aguda apresentaram risco dez vezes maior de óbito em relação aos não expostos. CONCLUSÃO: Lesão renal aguda é uma entidade comum nos pacientes críticos. O diagnóstico precoce a e instituição imediata de medidas terapêuticas adequadas a cada situação clínica podem alterar o curso e a gravidade do envolvimento renal reduzindo a morbi-mortalidade do paciente.OBJECTIVES: Acute kidney injury is characterized by sudden and generally

The effect of dimethyl fumarate (Tecfidera™) on lymphocyte counts: A potential contributor to progressive multifocal leukoencephalopathy risk.

Science.gov (United States)

Khatri, Bhupendra O; Garland, Jeffery; Berger, Joseph; Kramer, John; Sershon, Lisa; Olapo, Tayo; Sesing, Jean; Dukic, Mary; Rehn, Eileen

2015-07-01

Dimethyl fumarate (Tecfidera™) is an effective therapy for relapsing forms of multiple sclerosis (MS). Our study suggests that this drug may have immunosuppressive properties evidenced by significant sustained reduction in CD8 lymphocyte counts and, to a lesser extent, CD4 lymphocyte counts. This observation is relevant in light of the recent case of progressive multifocal leukoencephalopathy in a patient receiving this drug. Copyright © 2015. Published by Elsevier B.V.

A Cerebellar Tremor in a Patient with Human Immunodeficiency Virus-1 Associated with Progressive Multifocal Leukoencephalopathy

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Hee-Jin Kim

2009-10-01

Full Text Available Progressive multifocal leukoencephalopathy (PML is a demyelinating disease of the central nervous system (CNS caused by JC virus infection in oligodendrocytes, especially in patients with acquired immunodeficiency syndrome (AIDS. Movement disorders associated with PML are very rare. Here, we report a case of PML in an AIDS patient who presented with a cerebellar tremor, caused by lesions in the cerebellar outflow tract. A cerebellar tremor can be a rare clinical manifestation in patients with PML.

A Cerebellar Tremor in a Patient with Human Immunodeficiency Virus-1 Associated with Progressive Multifocal Leukoencephalopathy

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Kim, Hee-Jin; Lee, Jae-Jung; Lee, Phil Hyu

2009-01-01

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system (CNS) caused by JC virus infection in oligodendrocytes, especially in patients with acquired immunodeficiency syndrome (AIDS). Movement disorders associated with PML are very rare. Here, we report a case of PML in an AIDS patient who presented with a cerebellar tremor, caused by lesions in the cerebellar outflow tract. A cerebellar tremor can be a rare clinical manifestation in patients with PML. PMID:24868366

Multifocal epithelial hyperplasia: A potentially precancerous disease? (Review)

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BASCONES-MARTÍNEZ, A.; COK, S.; BASCONES-ILUNDÁIN, C.; ARIAS-HERRERA, S.; GOMEZ-FONT, R.; BASCONES-ILUNDÁIN, J.

2012-01-01

Multifocal epithelial hyperplasia (MEH), also known as Heck’s disease, manifests as a papulonodular lesion in the oral mucosa and has been associated with the human papillomavirus, a virus related to various precancerous diseases in the oral cavity. It has a predisposition for the female gender and for children. Although the majority of reported cases have been among American Indians and Eskimos, it has been described in multiple ethnic groups in various geographical locations. The objective of this review was to report on the clinical characteristics and epidemiology of MEH and its possible correlation with oral cancer. It is based on a search of articles in international journals published prior to April 2011, using the PubMed database and selecting articles related to the epidemiology and clinical characteristics of MEH. The review revealed a higher number of cases in individuals of American Indian origin and a predilection of the disease for the female gender and for patients between the 1st and 2nd decades of life. The most frequent lesion site was the lower lip. The disease has been associated with socio-economic and genetic factors, among others. No cases of malignant transformation have been reported. PMID:22740890

Abordando las enfermedades respiratorias agudas en niños con un Enfoque Ecológico en la Comunidad

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Francisco Lamus-Lemus

2015-01-01

Full Text Available Objetivos: Disminuir los episodios de enfermedad respiratoria aguda (ERA en las familias, mediante un enfoque modificado del modelo ecológico de Morelatto para identificar y tra-bajar colectivamente determinantes que influyen en la salud respiratoria de niños y niñas.Materiales y Métodos: Durante el proceso se realizaron actividades encaminadas a pre-venir las principales causas de ERA basadas en el modelo transteórico del comportamiento con el fin de generar cambios conductuales en las familias. Para ello se creó una escala de valoración del riesgo de ERA como instrumento de medición de la efectividad de las activi-dades realizadas, otorgándole a cada familia un puntaje antes y después de la intervención para determinar si hubo disminución del mismo. Resultados: Las actividades realizadas conducen a cambios evidenciados en las prácticas cotidianos de las madres y sus familias, reflejadas en la escala de valoración de riesgos a partir de la disminución de conductas que favorecen la enfermedad respiratoria aguda y sus complicaciones en la primera infancia afiliada a la FA R -Génesis.Conclusiones: Una menor exposición a eventos y complicaciones de la ERA en miembros de grupos familiares de la FA R -Génesis puede contribuir a mejorar la resiliencia y dismi-nuir la vulnerabilidad socioeconómica de las familias afectadas regularmente por la ERAsus complicaciones.

Colecistitis aguda calculosa y síndrome de disfunción múltiple de órganos

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Jorge Reyes Cardero

1997-04-01

Full Text Available Se hizo un estudio de 12 fallecidos, cuya causa principal de muerte fue la peritonitits aguda, que evolucionó hacia el síndrome de disfunción múltiple de órganos. Entre ellos predominó el sexo femenino, la edad avanzada y la presencia de alguna enfermedad asociada o de base. Afectados por una colecistopatía litiásica de más de 1 año de evolución, se demoraron en asistir al Cuerpo de Guardia del Hospital Provincial Clinicoquirúrgico Docente "Saturnino Lora", de Santiago de Cuba, cuando sufrieron los síntomas de colecistitis aguda, de modo que fueron operados en las primeras 24 horas del diagnóstico o después de ese tiempo, pero ya las complicaciones habían condicionado una evolución desfavorable. En algunos casos se hizo necesario reintervenir en más de una ocasiónA study was carried out in 40 deceased patients who died because of an acute peritonitis resulting in a syndrome of multiple organ failure. Most patients were female aged subjects who presented with an associated or baseline disease. Patients were affected by a cholelithiasis with more than I year of evolution and came late to the Emergency Department of "Saturnino Lora" Provincial Teaching hospital when they began to suffer the symptoms of acute cholecystitis, so they were operated on within the first 24 hours of the diagnosis or afterwards, but at that moment complications had led to a nonfavourable evolution. In certain cases it was necessary to reoperate more than once

7-Hexagon Multifocal Electroretinography for an Objective Functional Assessment of the Macula in 14 Seconds.

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Schönbach, Etienne M; Chaikitmongkol, Voraporn; Annam, Rachel; McDonnell, Emma C; Wolfson, Yulia; Fletcher, Emily; Scholl, Hendrik P N

2017-01-01

We present the multifocal electroretinogram (mfERG) with a 7-hexagon array as an objective test of macular function that can be recorded in 14 s. We provide normal values and investigate its reproducibility and validity. Healthy participants underwent mfERG testing according to International Society for Clinical Electrophysiology of Vision (ISCEV) standards using the Espion Profile/D310 multifocal ERG system (Diagnosys, LLC, Lowell, MA, USA). One standard recording of a 61-hexagon array and 2 repeated recordings of a custom 7-hexagon array were obtained. A total of 13 subjects (mean age 46.9 years) were included. The median response densities were 12.5 nV/deg2 in the center and 5.2 nV/deg2 in the periphery. Intereye correlations were strong in both the center (ρCenter = 0.821; p < 0.0001) and the periphery (ρPeriphery = 0.862; p < 0.0001). Intraeye correlations were even stronger: ρCenter = 0.904 with p < 0.0001 and ρPeriphery = 0.955 with p < 0.0001. Bland-Altman plots demonstrated an acceptable retest mean difference in both the center and periphery, and narrow limits of agreement. We found strong correlations of the center (ρCenter = 0.826; p < 0.0001) and periphery (ρPeriphery = 0.848; p < 0.0001), with recordings obtained by the 61-hexagon method. The 7-hexagon mfERG provides reproducible results in agreement with results obtained according to the ISCEV standard. © 2017 S. Karger AG, Basel.

Noncontiguous multifocal brucellar spondylitis involving the cervical, thoracic, and lumbar spine: A case report

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Rong Wang

2017-06-01

Full Text Available Brucellosis is a zoonosis infectious disease, brucellar spondylitis primarily infects the lumbar, the cervical is uncommon. Multiple-level involvement is extremely rare. This report describes a 46-year-old man with noncontiguous multifocal brucellar spondylitis involving the cervical, thoracic, and lumbar spine. Brucellar spondylitis is difficult to diagnose. Routine laboratory findings for the disease have little diagnostic value. Manifestations and radiological features are usually nonspecific. Radiological features of brucellar spondylitis are similar to tuberculous spondylitis and pyogenic spondylitis. MRI findings have diagnostic value. Suspicious patients with unexplained fever, musculoskeletal complaints at risk of infection should be considered.

Pancreatitis aguda secundaria a hipertrigliceridemia: presentación de dos casos clínicos Acute pancreatitis secondary to hypertriglyceridemia: A report of two cases

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S. J. Jiménez Forero

2008-06-01

Full Text Available La pancreatitis aguda es un proceso inflamatorio reversible. La hipertrigliceridemia como etiología de la pancreatitis aguda varía entre un 1,3 y un 11%, de acuerdo a la literatura, cuando los niveles de triglicéridos alcanzan valores por encima de 1.000 mg/dl; sin embargo, la hipertrigliceridemia se observa en un 12 a un 39% de las pancreatitis agudas como factor asociado. El objetivo del tratamiento médico es aumentar la actividad de la lipoproteinlipasa y aumentar la degradación de los quilomicrones; disminuyendo así los valores plasmáticos de triglicéridos a niveles menores de 500 mg/dl, incluso a menos de 200 mg/dl si es posible con diferentes estrategias, entre ellas la insulina. En el presente artículo, presentamos dos casos clínicos de pancreatitis severas inducidas por hipertrigliceridemia, manejadas con terapia de infusión de insulina con adecuada respuesta clínica y paraclínica con disminución significativa de los niveles de triglicéridos, 48 horas postratamiento.Acute pancreatitis is a reversible inflammatory process. Hypertriglyceridemia as a cause of acute pancreatitis reaches frequencies of 1.3-11% according to the literature when triglyceride levels reach values over 1,000 mg/dl; nevertheless hypertriglyceridemia is observed in 12-39% of acute pancreatitis cases as an associated factor. The objective of medical treatment is to increase lipoprotein-lipase activity, and to increase chylomicron breakdown thus diminishing serum triglycerides to levels smaller than 500 or even 200 mg/dl (when possible using a variety of strategies including insulin administration. In the present article, we report two cases of severe pancreatitis induced by hypertriglyceridemia that were managed with insulin infusion; both responded adequately, as measured by a significant reduction of triglyceride levels at 48 hours post-treatment.

Biphasic papillary renal cell carcinoma is a rare morphological variant with frequent multifocality: a study of 28 cases.

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Trpkov, Kiril; Athanazio, Daniel; Magi-Galluzzi, Cristina; Yilmaz, Helene; Clouston, David; Agaimy, Abbas; Williamson, Sean R; Brimo, Fadi; Lopez, Jose I; Ulamec, Monika; Rioux-Leclercq, Nathalie; Kassem, Maysoun; Gupta, Nilesh; Hartmann, Arndt; Leroy, Xavier; Bashir, Samir Al; Yilmaz, Asli; Hes, Ondřej

2018-04-01

To further characterise biphasic squamoid renal cell carcinoma (RCC), a recently proposed variant of papillary RCC. We identified 28 tumours from multiple institutions. They typically showed two cell populations-larger cells with eosinophilic cytoplasm and higher-grade nuclei, surrounded by smaller, amphophilic cells with scanty cytoplasm. The dual morphology was variable (median 72.5% of tumour, range 5-100%); emperipolesis was found in all cases. The male/female ratio was 2:1, and the median age was 55 years (range 39-86 years). The median tumour size was 20 mm (range 9-65 mm). Pathological stage pT1a was found in 21 cases, pT1b in three, and pT3a and pT3b in one each (two not available). Multifocality was found in 32%: multifocal biphasic RCC in one case, biphasic + papillary RCC in two cases, biphasic + clear cell RCC in three cases, biphasic + low-grade urothelial carcinoma of the renal pelvis in one case, and biphasic + Birt-Hogg-Dubé syndrome in one case. Positive immunostains included: PAX8, cytokeratin (CK) 7, α-methylacyl-CoA racemase, epithelial membrane antigen, and vimentin. Cyclin D1 was expressed only in the larger cells. The Ki67 index was higher in the larger cells (median 5% versus ≤1%). Negative stains included: carbonic anhydrase 9, CD117, GATA-3, WT1, CK5/6, and CK20; CD10 and 34βE12 were variably expressed. Gains of chromosomes 7 and 17 were found in two evaluated cases. Follow-up was available for 23 patients (median 24 months, range 1-244 months): 19 were alive without disease, one was alive with recurrence, and one had died of disease (two had died of other causes). Biphasic papillary RCC is a rare variant of papillary RCC, and is often multifocal. © 2017 John Wiley & Sons Ltd.

OTITIS MEDIA AGUDA. DIAGNÓSTICO Y MANEJO PRÁCTICO

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Dr. Francisco J. Krause

2016-11-01

Full Text Available La otitis media aguda es una patología infecciosa del oído medio muy frecuente. El diagnóstico es clínico, por lo que es fundamental un acucioso examen físico y una neumootoscopía para evaluar la movilidad timpánica. Hay dos tendencias respecto al manejo, tratamiento antibiótico inmediato u observación estricta (dependiendo de las características del paciente y del cuadro clínico. Los gérmenes más frecuentes son los virus, Neumococo, Haemophilus influenza y Moraxella catarrhalis. La prevalencia de cada uno de ellos varía según región geográfica y según la presencia de vacunación. La resistencia a antibióticos ha ido en aumento en estos años, pero aún puede considerarse sensible a amoxicilina por lo que se recomienda su uso como primera línea. En el caso de fracaso a tratamiento pueden utilizarse asociaciones con B-lactámicos y/o cefalosporinas, dejando en forma excepcional clindamicina o quinolonas. Aquellos niños con OMA recurrente requerirán evaluación por especialidad para mayor estudio y tratamiento.

Insuficiência aórtica aguda por avulsão de comissura valvar aórtica

OpenAIRE

Cunha,Claudio Ribeiro da; Santos,Paulo César; Atik,Fernando Antibas; Conti,Daniel Oliveira de

2012-01-01

Paciente do sexo masculino, de 66 anos, previamente hipertenso, com história de ortopneia, palpitações e dor precordial de início súbito, que teve o diagnóstico de avulsão espontânea de uma comissura valvar aórtica e consequente insuficiência aórtica aguda, evoluindo com insuficiência cardíaca esquerda refratária ao tratamento clínico. O paciente foi submetido precocemente à substituição cirúrgica da valva aórtica por uma bioprótese, e apresentou evolução pós-operatória satisfatória. Atualmen...

Multifocal Gastric Ulcers Caused by Diffuse Large B Cell Lymphoma in a Patient With Significant Weight Loss

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Gromski, Mark A.; Peng, Jennifer L.; Zhou, Jiehao; Masuoka, Howard C.; Suvannasankha, Attaya; Liangpunsakul, Suthat

2016-01-01

Primary gastrointestinal (GI) lymphoma is a heterogeneous disease with varied clinical presentations. The stomach is the most common GI site and accounts for 70% to 75% of GI lymphomas. We present a patient with gastric diffuse large B cell lymphoma (DLBCL) who presented with significant weight loss, early satiety, and multifocal ulcerated gastric lesions. Esophagoduodenoscopy should be performed in patients presenting with warning symptoms as in our case. Diagnosis is usually made by endosco...

Consenso intersociedades para el manejo de infecciones respiratorias: bronquitis aguda y enfermedad pulmonar obstructiva crónica

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Gustavo Lopardo; Claudia Pensotti; Pablo Scapellato; Oscar Caberlotto; Aníbal Calmaggi; Liliana Clara; Manuel Klein; Gabriel Levy Hara; María J. López Furst; Analía Mykietiuk; Daniel Pryluka; Maria J. Rial; Claudia Vujacich; Diego Yahni

2013-01-01

La Sociedad Argentina de Infectología convocó a otras sociedades científicas para elaborar una guía práctica y actualizada para el manejo del tratamiento antibiótico de las bronquitis agudas (BA) y los episodios de reagudización de enfermedad pulmonar obstructiva crónica (EPOC), con el objetivo de promover el uso racional de los recursos diagnósticos y terapéuticos. La BA se caracteriza por la inflamación del árbol bronquial que afecta tanto a adultos como a niños sin enfermedades pulmonares ...

Efecto del ejercicio físico basado en el juego en la leucemia linfocítica aguda

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González García, Laura Ximena; Escobar Zabala, Paola Andrea

2012-01-01

Objetivo: Establecer el efecto de un programa de ejercicio físico (EF) basado en el juego sobre el Síndrome de Desacondicionamiento Físico (SDF) de niños con Leucemia Linfocítica Aguda (LLA) entre 5-12 años. Materiales y Métodos: Se realizó un estudio cuasi-experimental con la participación de siete niños tratados por LLA en el Instituto Nacional de Cancerología (INC). Se hizo una evaluación inicial de los determinantes de la condición física (capacidad aeróbica, fuerza muscular, flexibil...

Etnografía de la infección respiratoria aguda en una zona rural del altiplano mexicano

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MARTÍNEZ HOMERO

1997-01-01

Full Text Available Objetivo. Identificar los términos utilizados por las madres para referirse a enfermedades, signos y síntomas relacionados con infecciones respiratorias agudas, así como los signos de alarma que las motivan a buscar atención médica; asimismo, describir prácticas comunes de manejo de la enfermedad en el hogar. Material y métodos. Se trata de un estudio etnográfico en seis comunidades rurales del altiplano mexicano. Se entrevistó a 12 informantes clave, a seis madres de niños fallecidos por infección respiratoria aguda, y a 24 madres de niños menores de cinco años, con diversas técnicas etnográficas para complementar la información obtenida ("triangulación". Resultados. Las enfermedades comúnmente identificadas incluyeron gripa, anginas, tos, bronquitis, pulmonía, neumonía y "broncomonía". Los síntomas clave para el diagnóstico fueron escurrimiento de moco nasal, dolor de garganta, tos, dolor de cabeza o de cuerpo, calentura, "hervor" de pecho, y referencias a que el niño "está molesto o llorón", se pone morado o le hace falta el aire. La taquipnea fue referida como "respira fuerte", "respira mucho", "respira rápido" y "tiene sesido"; el tiraje, "se le hunde el pecho"; el estridor, como "quejido o ronquido de pecho"; la sibilancia, como "ronquido de pecho", y para la cianosis; "se pone morado". Entre los tratamientos ofrecidos en el hogar destacan el uso de tés, aplicación de limón, jitomate, tomate o papa en la garganta, y aplicación de sebo o pomada en pecho y espalda. No fue común la autoprescripción de antibióticos pero sí la de antipiréticos. La mayoría de las madres reconoció enfermedades leves y, en menor proporción, graves. Ante un caso grave de insuficiencia respiratoria aguda, la opción más frecuentemente elegida fue acudir a la clínica del proyecto; en segundo lugar al médico particular en la cabecera municipal, y al hospital de la Secretaría de Salud en la Jurisdicción. La cercanía y el

Inmunofenotipaje y supervivencia global de pacientes pediátricos con leucemias agudas Immunophenotyping and global survival of pediatric patients with acute leukemia

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Vianed Marsán Suárez

2002-04-01

Full Text Available El inmunofenotipaje celular (IFC permite identificar la línea específica de origen de las células leucémicas y su nivel de maduración. Se determinó la frecuencia de los distintos subtipos inmunológicos de leucemias agudas (LA y su posible relación con la supervivencia global de los pacientes. Se estudiaron 117 niños con LA entre 1983 y 1999. El IFC se realizó mediante el ultramicrométodo inmunocitoquímico y el de fosfatasa alcalina-antifosfatasa alcalina. Del total de LA, 77(65,8 % fueron linfoides agudas (LLA, 26 (22,2 % mieloides agudas, 9 (8 % LA indiferenciadas y 5 (4 % se clasificaron como LA híbridas. Del total de LLA, 59 (76,6 % fueron de fenotipo B y 18 (23,4 % de fenotipo T. Se observó una mayor sobrevida en los pacientes de linaje B en relación con los de linaje T y mieloide, con una diferencia muy significativa (p Cell immunophenotyping (CIP identifies the specific line of origin of leukemic cells and their maturing level. The frequency of the various immunological subtypes of acute leukemias (AL and their possible relationship with global survival rate of patients were determined. One hundred and seventeen children with AL were studied from 1983 to 1999. The CIP was conducted through the immunocytochemical ultramicromethod and the alkaline phosphatase - anti-alkaline phosphatase method. Seventy seven (65,8% of all AL were acute lymphoid leukemias (ALL, 26(22,2% acute myeloid (AML, 9 (8% undifferentiated AL, and 5 (4% were hybrid AL. Fifty-nine (76,6% ALL belonged to phenotype B and 18 (23,4% to phenotype T. A higher survival rate was observed in phenotype B ALL patients than in phenotype T ALL and myeloid anemia patients, with a very significant difference (p< 0,001. Survival was also analyzed among the various types of phenotype B acute leukemias; a lower survival rate was observed in patients with more immature phenotypes

The effects of fundus photography on the multifocal electroretinogram.

Science.gov (United States)

Suresh, Sandip; Tienor, Brian J; Smith, Scott D; Lee, Michael S

2016-02-01

To determine the effect of flash fundus photography (FFP) on the multifocal electroretinogram (mfERG). Ten subjects underwent mfERG testing on three separate dates. Subjects received either mfERG without FFP, mfERG at 5 and 15 min after FFP, or mfERG at 30 and 45 min after FFP on each date. The FFP groups received 10 fundus photographs followed by mfERG testing, first of the right eye then of the left eye 10 min later. Data were averaged and analyzed in six concentric rings at each time point. Average amplitude and implicit times of the N1, P1, and N2 peaks for each concentric ring at each time point after FFP were compared to baseline. Flash fundus photography did not lead to a significant change of amplitude or implicit times of N1, P1, or N2 at 5 min after light exposure. These findings suggest that it is acceptable to perform mfERG testing without delay after performance of FFP.

Chronic multifocal osteomyelitis: Is infectious causation a moot point?

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Nevio Cimolai

2011-09-01

Full Text Available Summary: Chronic multifocal osteomyelitis (CMO is an uncommon disease entity with descriptions possibly emanating from the medical literature over one century ago, and there are numerous disease entities which have been historically detailed and which are probably synonymous. The illness is one of chronicity with exacerbating and remitting focal bony lesions. The differential diagnosis for a bony lesion which ultimately proves to be CMO is initially quite broad. There is no absolute pathognomonic clinical finding, and the diagnosis is highly dependent on clinical course, histopathology, and an absence of microbial infection. Recent studies have focused on immune dysfunction or dysregulation, and there are now many other diseases which are inflammatory in nature and which have been diagnosed among patients with CMO. Despite the aforementioned, the potential for direct infectious causation or indirect causation by infectious stimulation of immunity cannot be entirely excluded. Infection as a mechanism for pathogenesis must continue to be entertained. Multi-centre studies are key to future research. Key words: Osteomyelitis, Infection, SAPHO, Immunity

Correlation of visual performance with quality of life and intraocular aberrometric profile in patients implanted with rotationally asymmetric multifocal IOLs.

Science.gov (United States)

Ramón, María L; Piñero, David P; Pérez-Cambrodí, Rafael J

2012-02-01

To examine the visual performance of a rotationally asymmetric multifocal intraocular lens (IOL) by correlating the defocus curve of the IOL-implanted eye with the intraocular aberrometric profile and impact on the quality of life. A prospective, consecutive, case series study including 26 eyes from 13 patients aged between 50 and 83 years (mean: 65.54±7.59 years) was conducted. All patients underwent bilateral cataract surgery with implantation of a rotationally asymmetric multifocal IOL (Lentis Mplus LS-312 MF30, Oculentis GmbH). Distance and near visual acuity outcomes, intraocular aberrations, defocus curve, and quality of life (assessed using the National Eye Institute Visual Functioning Questionnaire-25) were evaluated postoperatively (mean follow-up: 6.42±2.24 months). A significant improvement in distance visual acuity was found postoperatively (P<.01). Mean postoperative logMAR distance-corrected near visual acuity was 0.19±0.12 (∼20/30). Corrected distance visual acuity and near visual acuity of 20/20 or better were achieved by 30.8% and 7.7% of eyes, respectively. Of all eyes, 96.2% had a postoperative addition between 0 and 1.00 diopter (D). The defocus curve showed two peaks of maximum visual acuity (0 and 3.00 D of defocus), with an acceptable range of intermediate vision. LogMAR visual acuity corresponding to near defocus was directly correlated with some higher order intraocular aberrations (r⩾0.44, P⩽.04). Some difficulties evaluated with the quality of life test correlated directly with near and intermediate visual acuity (r⩾0.50, P⩽.01). The Lentis Mplus multifocal IOL provides good distance, intermediate, and near visual outcomes; however, the induced intraocular aberrometric profile may limit the potential visual benefit. Copyright 2012, SLACK Incorporated.

Sensitivity of imaging for multifocal-multicentric breast carcinoma

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Viale Giuseppe

2008-09-01

Full Text Available Abstract Background This retrospective study aims to determine: 1 the sensitivity of preoperative mammography (Mx and ultrasound (US, and re-reviewed Mx to detect multifocal multicentric breast carcinoma (MMBC, defined by pathology on surgical specimens, and 2 to analyze the characteristics of both detected and undetected foci on Mx and US. Methods Three experienced breast radiologists re-reviewed, independently, digital mammography of 97 women with MMBC pathologically diagnosed on surgical specimens. The radiologists were informed of all neoplastic foci, and blinded to the original mammograms and US reports. With regards to Mx, they considered the breast density, number of foci, the Mx characteristics of the lesions and their BI-RADS classification. For US, they considered size of the lesions, BI-RADS classification and US pattern and lesion characteristics. According to the histological size, the lesions were classified as: index cancer, 2nd lesion, 3rd lesion, and 4th lesion. Any pathologically identified malignant foci not previously described in the original imaging reports, were defined as undetected or missed lesions. Sensitivity was calculated for Mx, US and re-reviewed Mx for detecting the presence of the index cancer as well as additional satellite lesions. Results Pathological examination revealed 13 multifocal and 84 multicentric cancers with a total of 303 malignant foci (282 invasive and 21 non invasive. Original Mx and US reports had an overall sensitivity of 45.5% and 52.9%, respectively. Mx detected 83/97 index cancers with a sensitivity of 85.6%. The number of lesions undetected by original Mx was 165/303. The Mx pattern of breasts with undetected lesions were: fatty in 3 (1.8%; scattered fibroglandular density in 40 (24.3%, heterogeneously dense in 91 (55.1% and dense in 31 (18.8% cases. In breasts with an almost entirely fatty pattern, Mx sensitivity was 100%, while in fibroglandular or dense pattern it was reduced to 45

Pupil Influence on the Visual Outcomes of a New-Generation Multifocal Toric Intraocular Lens With a Surface-Embedded Near Segment.

Science.gov (United States)

Wang, Mengmeng; Corpuz, Christine Carole C; Huseynova, Tukezban; Tomita, Minoru

2016-02-01

To evaluate the influences of preoperative pupil parameters on the visual outcomes of a new-generation multifocal toric intraocular lens (IOL) model with a surface-embedded near segment. In this prospective study, patients with cataract had phacoemulsification and implantation of Lentis Mplus toric LU-313 30TY IOLs (Oculentis GmbH, Berlin, Germany). The visual and optical outcomes were measured and compared preoperatively and postoperatively. The correlations between preoperative pupil parameters (diameter and decentration) and 3-month postoperative visual outcomes were evaluated using the Spearman's rank-order correlation coefficient (Rs) for the nonparametric data. A total of 27 eyes (16 patients) were enrolled into the current study. Statistically significant improvements in visual and refractive performances were found after the implantation of Lentis Mplus toric LU-313 30TY IOLs (P 0; P .05). Lentis Mplus toric LU-313 30TY IOLs provided excellent visual and optical performances during the 3-month follow-up. The preoperative pupil size is an important parameter when this toric multifocal IOL model is contemplated for surgery. Copyright 2016, SLACK Incorporated.

Risk stratification for progressive multifocal leukoencephalopathy in patients treated with natalizumab

DEFF Research Database (Denmark)

Sørensen, Per Soelberg; Bertolotto, Antonio; Edan, Gilles

2012-01-01

using or considering natalizumab therapy. Recommendations for clinical management of patients with MS and use of natalizumab are provided based on the presence of these three risk factors. The identification of risk factors that increase the likelihood of PML in natalizumab-treated patients can......Natalizumab is a highly effective immunomodulator in the treatment of multiple sclerosis (MS). Treatment with natalizumab has been associated with progressive multifocal leukoencephalopathy (PML), an infection of the central nervous system (CNS) caused by a pathogenic form of the normally benign JC......-treated patients. With the development of a reliable and validated assay for detection of antibodies in patients with MS directed against JCV, it is now possible to identify persons who are carriers of JCV. The availability of this assay provides an additional option for risk stratification of PML in patients...

Chromatic Multifocal Pupillometer for Objective Perimetry and Diagnosis of Patients with Retinitis Pigmentosa.

Science.gov (United States)

Chibel, Ron; Sher, Ifat; Ben Ner, Daniel; Mhajna, Mohamad O; Achiron, Asaf; Hajyahia, Soad; Skaat, Alon; Berchenko, Yakir; Oberman, Bernice; Kalter-Leibovici, Ofra; Freedman, Laurence; Rotenstreich, Ygal

2016-09-01

To assess visual field (VF) defects and retinal function objectively in healthy participants and patients with retinitis pigmentosa (RP) using a chromatic multifocal pupillometer. Cross-sectional study. The right eyes of 16 healthy participants and 13 RP patients. Pupil responses to red and blue light (peak, 485 and 625 nm, respectively) presented by 76 light-emitting diodes, 1.8-mm spot size at different locations of a 16.2° VF were recorded. Subjective VFs of RP patients were determined using chromatic dark-adapted Goldmann VFs (CDA-GVFs). Six healthy participants underwent 2 pupillometer examinations to determine test-retest reliability. Three parameters of pupil contraction were determined automatically: percentage of change of pupil size (PPC), maximum contraction velocity (MCV; in pixels per second), and latency of MCV (LMCV; in seconds). The fraction of functional VF was determined by CDA-GVF. In healthy participants, higher PPC and MCV were measured in response to blue compared with red light. The LMCV in response to blue light was relatively constant throughout the VF. Healthy participants demonstrated higher PPC and MCV and shorter LMCV in central compared with peripheral test points in response to red light. Test-retest correlation coefficients were 0.7 for PPC and 0.5 for MCV. In RP patients, test point in which the PPC and MCV were lower than 4 standard errors from the mean of healthy participants correlated with areas that were indicated as nonseeing by CDA-GVF. The mean absolute deviation in LMCV parameter in response to the red light between different test point was significantly higher in RP patients (range, 0.16-0.47) than in healthy participants (range, 0.02-0.16; P chromatic multifocal pupillometer for objective diagnosis of RP and assessment of VF defects. Copyright © 2016 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Clinical, therapeutic, and pathogenic aspects of chronic oral multifocal candidiasis.

Science.gov (United States)

Holmstrup, P; Bessermann, M

1983-10-01

In 32 patients (11 females, 21 males) the diagnosis of chronic oral multifocal candidiasis was established on the basis of erythematous, plaquelike, or nodular lesions in two or more of the following locations: commissural area, palate, or dorsum of the tongue. Hyphae and/or pseudohyphae of Candida-like organisms were demonstrated in PAS-stained smears from all lesions. Ninety-seven separate lesions were registered. Thirty patients experienced pain, burning, or itching from affected areas. All of the patients were tobacco smokers, and 21 were denture wearers. The patients were treated with antimycotics; the median length of treatment was 46 days for denture wearers and 44 days for nondenture wearers. After antimycotic therapy the change in the lesions followed certain patterns which were determined by the original type of lesion. Palatal lesions in nondenture wearers and nodular lesions of the commissural areas showed the highest recurrence rate after 6 and 12 months. The pathogenic role of tobacco and other factors in the development of candidal infection are discussed.

Multifocal atherosclerosis in patient after acute first degree radiation sickness.

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Metlyaeva N.A.

2014-12-01

Full Text Available Purpose: assessment the heavy psychosomatic and all-somatic cardiovascular and cerebrovascular pathology of patient, transferred an acute I degree radiation sickness, from the general evenly gamma-beta radiation. Conclusions. The subdepressive and disturbing-depressive syndrome of patient, transferred an acute radiation sickness (ARS of I degree, from the general evenly gamma-beta radiation, was independent risk factor of development of multifocal atherosclerosis; Features of development of all-somatic and psychosomatic pathology of patient are based on a combination of genetic prerequisites, environment influences (the stress caused by accident on the ChNPP and social factors, influencing on him during a course of life, especially during early socialization. Thus at development of psychosomatic frustration the combination of feature of the mental reaction connected with the personal characteristic and special relationship between mental (stress and physiological (somatic by aspects of reaction which led to metabolism violation, to aging, decrease in adaptation opportunities of an organism and development age — dependent pathology took place.

Chronic Recurrent Multifocal Osteomyelitis in a 9-year-old Boy

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Abdolreza Malek

2017-05-01

Full Text Available Chronic recurrent multifocal osteomyelitis (CRMO is a rare aseptic, auto-inflammatory bone disorder. CRMO presents with bone pain with or without fever. The diagnosis of CRMO is a diagnosis of exclusion and should be included in the differential diagnosis of chronic inflammatory bone lesions in children. Cultures of the bone are typically sterile, antibiotic therapy does not result in clinical improvement whereas anti-inflammatory drugs improve the condition. Furthermore, biopsy should be considered in chronic and relapsing bone pain and swelling unresponsive to treatment. Herein, we present a nine-year-old boy complaining of recurrent pain in his upper and lower extremities. On examination he had mild fever and cervical lymphadenopathy. He also had experienced bone pain and weight loss in the recent month. Based on biopsy and bone scan he was finally diagnosed with CRMO. Naproxen and Pamidronate was prescribed and he was getting better and returned to normal life and activity without need to corticosteroids.

Uso de la antibioticoterapia perioperatoria en la apendicitis aguda: Use of perioperative antibiotic therapy Acute appendicitis:

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Gimel Sosa Martín

2009-09-01

Full Text Available INTRODUCCIÓN. La apendicitis aguda es la afección que más frecuentemente requiere intervención quirúrgica de urgencia. El uso de profilaxis antimicrobiana disminuye la incidencia de sepsis de la herida quirúrgica y mejora la relación riesgo-beneficio y costo-beneficio de la operación. El presente estudio buscó diseñar e implantar un protocolo terapéutico para el uso de antimicrobianos, según estadio de la apendicitis aguda, para uso en centros de atención secundaria. MÉTODOS. Se realizó un estudio prospectivo de indicación-prescripción con elementos de consecuencias prácticas y un grupo de intervención. Se seleccionaron de manera aleatoria 215 pacientes con diagnóstico de apendicitis aguda, atendidos entre diciembre del 2002 y diciembre del 2006. Se establecieron dos grupos, uno de control y uno experimental. Se instauró un protocolo de profilaxis aplicado al grupo experimental, basado en textos de referencia y adecuado al contexto socioeconómico cubano. RESULTADOS. Se aplicó el protocolo de profilaxis a 105 pacientes. La incidencia de sepsis fue del 8,5 %, significativamente menor a la del grupo control (24,5 %. El costo fue igualmente menor en el grupo experimental. CONCLUSIONES. El uso racional de la terapéutica antimicrobiana para la profilaxis de la infección de la herida quirúrgica mejora la relación riesgo-beneficio y costo-beneficio del procedimiento quirúrgico y la calidad de la atención médica.INTRODUCTION: Acute appendicitis if the affection that more frequent requires of an emergence surgical intervention. Use of antimicrobial prophylaxis decreases sepsis incidence of surgical wound, and to improve the risk-benefit and the cost-benefit relation of surgery. Present study tried to design and to creates a therapeutical protocol for use of antimicrobials, according to acute appendicitis stage to use in secondary care centers. METHODS: We made a prospective study of prescription-indication with the elements

Intoxicación aguda por hidrato de hidracina

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Santiago Nogué Xarau

2008-06-01

Full Text Available Se aporta un caso de exposición aguda, debido a un vertido accidental de unos 25 litros de hidrato de hidracina, que el trabajador estuvo recogiendo sin ningún tipo de equipo de protección individual. El trabajador presentó alteraciones bucales, cutáneas y dolores abdominales difusos. De las pruebas complementarias únicamente se detectó un aumento de la bilirrubina total con predominio de la indirecta. Se le separó de la exposición, se le administró un tratamiento sintomático y en un periodo de un mes se recuperó íntegramente. Se comenta los principales casos de intoxicación por hidracina descritos en la literatura médica y se enfatiza en las medidas preventivas que se deben tomar para evitar casos como éste.We report a case of poisoning by acute exposure to hydrazine hydrate in a worker clearing up an accidental spillage of about 25 litres of the product who had no type of individual protective equipment. The patient presented buccal and cutaneous involvement and diffuse abdominal pain. Complementary tests were unremarkable except for an increase in total bilirubin with a predominance of indirect bilirubin. The patient was removed from the occupational exposure, symptomatic treatment was administered and the patient recovered completely after one month. We review the main reported cases of hydrazine poisoning and emphasize the preventive measures that should be taken to avoid this type of poisoning.

Uso de antimicrobianos en la enfermedad diarreica aguda

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Enrique A. González Corona

1996-04-01

Full Text Available Se realizó un estudio sobre el estado actual del uso de antimicrobianos en el Servicio de Enfermedades Diarreicas Agudas del Hospital Infantil Docente Sur de Santiago de Cuba, durante el período comprendido entre marzo y agosto de 1992. El universo estuvo integrado por 427 pacientes ingresados, de los cuales sólo 13,1 % requirió el empleo de estos medicamentos: 9,4 % por infección enteral y 3,7 % por extraenteral bacteriana. Más de la tercera parte de los afectados curaron con alimentación continuada y rehidratación, en su mayoría oral, y fueron las diarreas persistentes y disentéricas las que más frecuentemente condicionaron su administración. El criterio clínico fue determinante en su indicación.A study was carried out on the current state of the use of microbicidals in the Acute Diarrhea Service of the Southern Educational Children's Hospital at Santiago de Cuba, during the period between March and August 1992. The universe was integrated by 427 inpatients, of which only the 13,1 % required the use of these drugs: 9,4 % due to enteral infection, and 3,7 % due to bacterial extraenteral infection. More than the third part of the patients healed with continuous feeding and rehydration, mostly oral, and the persistent and dysenteric diarrheas conditioned most frequently its administration. The clinical criterion was determining in its indication.

Rotationally asymmetric multifocal IOL implantation with and without capsular tension ring: refractive and visual outcomes and intraocular optical performance.

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Alió, Jorge L; Plaza-Puche, Ana B; Piñero, David P

2012-04-01

To ascertain whether the refractive, visual, and intraocular optical quality outcomes of a rotationally asymmetric multifocal intraocular lens (IOL) are enhanced by the use of a capsular tension ring. Ninety consecutive eyes from 53 patients (age range: 36 to 82 years) were divided into two groups: the no ring group comprised 43 eyes implanted with the multifocal rotationally asymmetric Lentis Mplus LS-312 (Oculentis GmbH) without a capsular tension ring; and the ring group comprised 47 eyes with the same IOL with a capsular tension ring. Distance and near visual acuity and refractive outcomes were evaluated pre- and postoperatively. Contrast sensitivity, intraocular aberrations, and defocus curve were evaluated postoperatively. Significant postoperative differences between groups were found in sphere, spherical equivalent refraction, and near addition (P<.02). Regarding defocus curve, significantly better visual acuity was present in eyes with the capsular tension ring for intermediate vision conditions (P<.05). Intraocular aberrometry did not differ significantly between groups (P<.09). Refractive predictability and intermediate visual outcomes with the Lentis Mplus LS-312 IOL improved significantly when implanted in combination with a capsular tension ring. Copyright 2012, SLACK Incorporated.

Caracterización clínico-epidemiológica de la otitis media aguda en pacientes pediátricos

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Ileana Álvarez Lam

2011-09-01

Full Text Available Introducción: la otitis media aguda es una de las enfermedades infecciosas más frecuentes en la infancia, y constituye una de las causas más importantes de consultas médicas y prescripción de antibióticos en los menores de 5 años. Objetivo: determinar el comportamiento clínico epidemiológico de la enfermedad. Métodos: se realizó un estudio descriptivo, longitudinal prospectivo con 60 pacientes entre 1 mes y 14 años de edad con diagnóstico de otitis media aguda purulenta en el Hospital Pediátrico Docente "William Soler", durante el período de 1 año (enero a diciembre de 2008. Los datos clínicos se obtuvieron mediante una encuesta a los padres o tutores de los pacientes. A todos se les realizó timpanocentesis con cultivo y exudado nasofaríngeo. Las cepas aisladas fueron enviadas al Laboratorio Nacional de Referencia de S. pneumoniae y H. influenzae del Instituto de Medicina Tropical "Pedro Kourí" para la caracterización microbiológica y determinación de susceptibilidad antimicrobiana. Resultados: la enfermedad predominó en el grupo ubicado entre 12 y 23 meses (55 %, con mayor afectación del sexo masculino (52 %. La fiebre y las manifestaciones locales referidas a oído medio (irritabilidad, otalgia, llanto nocturno fueron los elementos clínicos referidos con mayor frecuencia. El cuidado fuera del hogar, la exposición al humo de tabaco y el destete precoz fueron los factores de riesgo más frecuentes. S. pneumoniae, H. influenzae no tipificable y S. epidermidis fueron los gérmenes aislados con mayor frecuencia. El 25 % de las cepas de S. pneumoniae tuvieron resistencia intermedia a la penicilina, pero no se reportó resistencia a cefalosporinas de tercera generación. El 98,4 % de los pacientes evolucionaron satisfactoriamente. Las complicaciones de la enfermedad se presentaron en 1,6 % de los casos. Conclusiones: la otitis media aguda es frecuente en niños menores de 36 meses, y está muy relacionada con la presencia

Acute pancreatitis as a postburn complication: report of two cases in children Pancreatitis aguda como complicación de quemadura en dos niños

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Jairo Alberto Patarroyo Serrano

2007-04-01

Full Text Available Acute pancreatitis in burnt adults has been reported with some frequency; contrariwise, there has been only one report of this complication in a burnt child. We reviewed the medical records of two childrenwith acute pancreatitis as a postburn complication, who were treated at the Burns Unit of the San Vicente de Paúl Hospital, in Medellín, Colombia. As a result, we add two documented cases to the limited literature on this subject. La pancreatitis aguda ha sido reportada con alguna frecuencia en adultos quemados pero sólo se ha publicado un caso de esta complicación en un niño quemado. Se revisan las historias clínicas de dos niños con pancreatitis aguda como complicación de quemaduras, atendidos en la Unidad de Quemados del Hospital Universitario San Vicente de Paúl (Medellín. Como resultado de la revisión se añaden dos casos bien documentados a la escasa literatura al respecto.

Nutritional support in patients with severe acute pancreatitis Soporte nutricional en pacientes con pancreatitis aguda grave

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Mónica Marcela Peláez Hernández

2007-04-01

Full Text Available Severe acute pancreatitis is associated with a systemic inflammatory response leading to a hypermetabolic, hypercatabolic condition; for those reasons, patients suffering from this disease require an excellent artificial nutritional support in order to maintain the structural integrity and the function of vital organs with minimal pancreatic secretion. Total parenteral nutrition has been the standard practice in the treatment of patients with severe acute pancreatitis because of the favorable outcomes of early nutritional support while avoiding pancreatic stimulation; however, recent evidence suggests there are potentially greater benefits with enteral as compared with parenteral nutrition, including fewer septic and metabolic complications and lesser costs. That is why present guidelines for the management of acute pancreatitis recommend that enteral instead of parenteral nutrition be used in patients with severe acute pancreatitis. La pancreatitis aguda, especialmente en su forma grave, está asociada con una respuesta inflamatoria sistémica que lleva a un estado de hipermetabolismo e hipercatabolismo, en el que se requiere un excelente soporte nutricional que permita mantener la integridad estructural y la función de los órganos vitales con un estímulo mínimo de la secreción pancreática. La nutrición parenteral total era el soporte de elección, que permitía obtener todos los beneficios de la nutrición temprana sin estimular la secreción pancreática; pero la evidencia actual muestra mayores beneficios con la nutrición enteral, porque se asocia con menos complicaciones infecciosas y metabólicas y con disminución en los costos. Por ello las guías actuales de tratamiento de la pancreatitis aguda grave recomiendan como primera elección el soporte nutricional enteral.

A case of natalizumab-associated progressive multifocal leukoencephalopathy with repeated negative CSF JCV testing.

Science.gov (United States)

Mazda, Monica E; Brosch, Jared R; Wiens, Andrea L; Bonnin, José M; Kamer, Aaron P; Mattson, David H; Snook, Riley J

2013-05-01

The development of progressive multifocal leukoencephalopathy (PML) in patients treated with natalizumab is a well-known potential risk. Diagnosis of PML can be confounded in patients with multiple sclerosis (MS) if new demyelinating lesions develop, and the sensitivity of existing diagnostic tests is less than ideal. In the case presented here, four samples of cerebrospinal fluid tested negative for John Cunningham virus (JCV) DNA by polymerase chain reaction, yet brain biopsy eventually proved positive by immunohistochemistry. A review of the limitations of existing clinical diagnostic tests is addressed, and we review the most recent literature on the proper management of natalizumab-treated MS patients.

Renal hemodynamics and renin-angiotensin system activity in humans with multifocal renal artery fibromuscular dysplasia.

Science.gov (United States)

van Twist, Daan J L; Houben, Alphons J H M; de Haan, Michiel W; de Leeuw, Peter W; Kroon, Abraham A

2016-06-01

Fibromuscular dysplasia (FMD) is the second most common cause of renovascular hypertension. Nonetheless, knowledge on the renal microvasculature and renin-angiotensin system (RAS) activity in kidneys with FMD is scarce. Given the fairly good results of revascularization, we hypothesized that the renal microvasculature and RAS are relatively spared in kidneys with FMD. In 58 hypertensive patients with multifocal renal artery FMD (off medication) and 116 matched controls with essential hypertension, we measured renal blood flow (Xenon washout method) per kidney and drew blood samples from the aorta and both renal veins to determine renin secretion and glomerular filtration rate per kidney. We found that renal blood flow and glomerular filtration rate in FMD were comparable to those in controls. Although systemic renin levels were somewhat higher in FMD, renal renin secretion was not elevated. Moreover, in patients with unilateral FMD, no differences between the affected and unaffected kidney were observed with regard to renal blood flow, glomerular filtration rate, or renin secretion. In men, renin levels and renin secretion were higher as compared with women. The renal blood flow response to RAS modulation (by intrarenal infusion of angiotensin II, angiotensin-(1-7), an angiotensin II type 1 receptor blocker, or a nitric oxide synthase blocker) was also comparable between FMD and controls. Renal blood flow, glomerular filtration, and the response to vasoactive substances in kidneys with multifocal FMD are comparable to patients with essential hypertension, suggesting that microvascular function is relatively spared. Renin secretion was not increased and the response to RAS modulation was not affected in kidneys with FMD.

Hidratación oral continua o a dosis fraccionadas en niños deshidratados por diarrea aguda

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Mota-Hernández Felipe

2002-01-01

Full Text Available Objetivo. Evaluar la seguridad y efectividad de dos técnicas de hidratación oral. Material y métodos. Ensayo clínico aleatorio, hecho en el Servicio de Hidratación Oral del Hospital Infantil de México, Federico Gómez, entre septiembre de 1998 y junio de 1999. Cuarenta pacientes deshidratados por diarrea aguda, menores de cinco años, recibieron suero oral ad libitum (grupo AL y otros cuarenta lo recibieron en dosis fraccionada (grupo DF. Las características clínicas fueron similares en ambos grupos. Los resultados se presentan como promedio y desviación estándar o mediana, según la distribución de frecuencias simples y relativas. Resultados. El promedio de gasto fecal en el grupo AL fue 11.0±7.5 g/kg/h y en el grupo DF 7.1±7.4 (p=0.03. La ingesta de suero, el tiempo de hidratación y la diuresis promedio, fueron similares entre ambos grupos (p>0.05. Seis pacientes del grupo AL y cinco del DF tuvieron gasto fecal alto (>10 g/kg/hora, mejorando con la administración de atole de arroz. Un paciente del grupo AL y dos pacientes del DF tuvieron vómitos persistentes, mejorando con gastroclisis. Ningún paciente requirió rehidratación intravenosa. Conclusiones. Estos resultados sugieren que la administración de suero oral ad libitum, bajo supervisión, es tan segura y efectiva como la técnica de dosis fraccionada para el tratamiento de niños deshidratados por diarrea aguda.

Intoxicação experimental aguda por Senecio brasiliensis em ovinos e indução de resistência à intoxicação

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Fabiane B. Grecco

2012-09-01

Full Text Available Ovinos são mais resistentes à intoxicação por Senecio spp. que bovinos e equinos. Para determinar se essa resistência é induzida pela ingestão de pequenas e repetidas doses da planta e se essa resistência é duradoura, foram realizados três experimentos com folhas e talos verdes de Senecio brasilienses. Para determinar a dose mínima que causa intoxicação aguda (experimento 1, foram administradas doses únicas de 60, 80, 90, 100 e 100g/kg de peso corporal (pc a cinco ovinos, respectivamente. Os animais que receberam 60 e 80 g/kg de pc de S. brasiliensis não adoeceram, porém o ovino que recebeu 80g/kg de pc apresentava fibrose e megalocitose discretas nas biópsias realizadas aos 90, 120 e 150 dias do término da administração da planta. Os ovinos que receberam 90 e 100g/kg de pc apresentaram anorexia, prostração, movimentos de pedalagem, dor abdominal e morte 12-48 horas após o aparecimento dos sinais clínicos. Na necropsia havia ascite, petéquias disseminadas e acentuação do padrão lobular hepático. Histologicamente havia necrose hemorrágica centro-lobular. No Experimento 2 a dose capaz de causar a intoxicação aguda foi fracionada e administrada em duas, cinco e 10 doses diárias para 3 ovinos, respectivamente. A dose tóxica fracionada não provocou sinais clínicos de intoxicação em nenhum dos ovinos, porém havia fibrose periportal e megalocitose moderadas nas biopsias realizadas aos 60 dias do término da administração da planta, as quais não evoluíram. O ovino que recebeu a dose fracionada em 10 administrações não apresentou lesões histológicas nas biópsias. Para determinar se os ovinos tornam-se resistentes à forma aguda da intoxicação (experimento 3, foram administradas doses diárias de 15g/kg de pc por 30 dias e 30g/kg de pc por 10 dias a quatro ovinos. No dia seguinte à última administração dois ovinos receberam a dose única de 100g/kg de pc de S. brasiliensis, mas não adoeceram nem

Incidencia de las leucemias agudas en niños de la ciudad de México, de 1982 a 1991

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Mejía-Aranguré Juan Manuel; Fajardo-Gutiérrez Arturo; Bernáldez-Ríos Roberto; Paredes-Aguilera Rogelio; Flores-Aguilar Hilario; Martínez-García María del Carmen

2000-01-01

OBJETIVO: Medir la tasa de incidencia de las leucemias agudas (LA) en las diferentes delegaciones políticas del Distrito Federal y evaluar si existe una tendencia significativa en dichos padecimientos en tales delegaciones. MATERIAL Y MÉTODOS: Estudio longitudinal descriptivo realizado en seis hospitales de la ciudad de México, los que atienden a cerca de 97.5% de todos los niños con cáncer de esta ciudad. Los datos se capturaron de 1995 a 1996, y se analizaron en 1999, en el Hospital de Pedi...

Chronic Recurrent Multifocal Osteomyelitis Causing an Acute Scoliosis

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Alexander Armstrong

2013-01-01

Full Text Available Study Design. A Case Report. Objective. We present a 15-year-old girl with an acute atypical scoliosis secondary to chronic recurrent multifocal osteomyelitis (CRMO. Summary of Background Data. CRMO is a rare nonpyogenic inflammatory bone condition with unclear aetiology. CRMO mainly affects the metaphyses of long bones, the pelvis, shoulder girdle, and less commonly the spine. Methods. Our case presented with a 6-month history of worsening thoracic back pain, asymmetry of her shoulders and abnormal posture. Whole spine radiographs revealed a right atypical thoracic scoliosis. Magnetic Resonance Imaging showed abnormal signal on the short TI inversion recovery (STIR sequences in multiple vertebrae. A bone biopsy demonstrated evidence of fibrosis and chronic inflammatory changes. Interval MRI scans revealed new oedematous lesions and disappearance of old lesions. Symptoms improved. Results. It is important to consider CRMO as an acute cause of atypical scoliosis. Malignancy, pyogenic infections and atypical presentations of juvenile arthritis need excluding. Conclusion. This 24-month follow-up describes a rare cause of an atypical scoliosis and fortifies the small amount of the currently available literature. The case highlights the relapsing and remitting nature of CRMO with new lesions developing and older lesions burning out. We advise close radiological surveillance and symptomatic management.

Respuesta del sistema antioxidante en varones sanos, frente a hiperglicemia aguda inducida

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Raquel Oré

2009-09-01

Full Text Available Objetivo: determinar la respuesta del sistema antioxidante en varones sanos, frente a la hiperglicemia aguda inducida. Diseño: estudio prospectivo, descriptivo, longitudinal, experimental. Lugar: Instituto Nacional de Biología Andina, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú. Material biológico: Sangre y suero de sujetos aparentemente sanos. Intervenciones: A 13 sujetos adultos clínicamente sanos, entre 20 y 41años, después de 10 horas de ayuno, se administró glucosa vía endovenosa, mediante el método de clamp hiperglicémico, a 125 mg/dL por encima del valor basal, durante 120 minutos. Se realizó mediciones de la glicemia a 0, 5, 10, 15, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110 y 120 minutos. Se tomó la muestra sanguínea con anticoagulante EDTA y otra de sangre total, para obtención de suero, para las pruebas bioquímicas a los 0, 60 y 120 minutos. Principales medidas de resultados: Modificaciones de la glicemia y lipoperoxidación en suero, glutatión y actividad superóxido dismutasa en glóbulos rojos lisados e índices de estrés oxidativo. Resultados: El nivel de glucosa durante el clamp hiperglicémico, luego de alcanzar el ‘equilibrio’, fue 197±17,58 mg/dL. La lipoperoxidación aumentó de 2,54 + 0,51 a 2,90 + 0,58 umol/L, de 0 a 60 minutos, y a 2,66 + 0,55 umol/L a los 120 minutos. El glutatión se redujo en 8,10% a la hora, aumentando 7,08% a los 120 minutos. La actividad superóxido dismutasa se elevó 0,54% a los 60 minutos y 5,66% a los 120 minutos, sobre el basal. Los índices de valoración del estrés oxidativo tuvieron correlación r Pearson positiva, en nivel alto a muy alto. Conclusiones: la hiperglicemia aguda inducida hasta 2 horas elevó el estrés oxidativo, promoviendo generación de defensa antioxidante, con síntesis de glutatión reducido de novo y mayor actividad de la superóxido dismutasa.

Prevención de las infecciones respiratorias agudas: Presente y futuro

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Roberto Razón Behar

2003-12-01

Full Text Available Las infecciones respiratorias agudas (IRA, son las causas más frecuentes de morbilidad en el mundo y de elevada mortalidad particularmente en los países en desarrollo. Los virus son los agentes etiológicos más frecuentes. Los virus influenza a y b, y el virus sincitial respiratorio (VSR son los más importantes por la severidad de la enfermedad y por la alta transmisibilidad. Las bacterias, principalmente el Streptococcus pneumoniae (neumococo, y el Haemophilus influenzae tipo B (Hib, son las causas más frecuentes de neumonías adquiridas en la comunidad. Las estrategias generales en la prevención y en el tratamiento se basan en: evaluar sistemáticamente los conocimientos existentes acerca de las IRA, divulgarlos y aplicarlos, desarrollar una guía nacional para las indicaciones de los antibióticos, aplicar las vacunas existentes: DPT, triple viral (SRP, anti-Hi, incrementar la inmunización contra el neumococo y los virus influenza, particularmente en grupos de riesgo y desarrollar y evaluar nuevas vacunas contra el VSR, Haemophilus influenzae no serotipificables, Bordetella pertussis y otros agentes infecciosos que afectan el aparato respiratorio. Se realiza una revisión de nuevos agentes y drogas antivirales, así como del desarrollo presente y futuro de las inmunizaciones contra los principales virus y bacterias, que causan infecciones respiratorias agudas.Acute respiratory infections (ARI are the most frequent cause of morbidity and of the high mortality in the world, particularly in the developing countries. The viruses are the most common etiological agents.The influenza a and b viruses and the syncytial respiratory virus (SRV are the most important due to the severity of the disease and to their high transmissibility. The bacteria, mainly Streptococcus pneumoniae (Pneumococcus, and Haemophilus influenzae type B (Hib, are the most frequent cause of pneumonias acquired in the community. The general strategies in the prevention and

Papel de la ecoendoscopia en el estudio etiológico de la pancreatitis aguda idiopática The role of endoscopic ultrasonography in the etiological evaluation of idiopathic acute pancreatitis

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J. J. Vila

2008-02-01

Full Text Available Hasta el 30% de los pacientes con pancreatitis aguda son diagnosticados de una pancreatitis aguda idiopática tras un estudio inicial que debe incluir una anamnesis completa, exploración física, análisis con determinación de calcio y triglicéridos y al menos una ecografía abdominal. Esta situación representa un reto diagnóstico, aunque en la mayoría de los casos se encuentra una causa que justifique la pancreatitis tras realizar diferentes exploraciones diagnósticas. En los últimos años la ecoendoscopia está demostrando ser de gran utilidad en el estudio de estos pacientes, produciendo a cambio una baja morbilidad. En este artículo hacemos una revisión del papel de la ecoendoscopia en el estudio etiológico de la pancreatitis aguda idiopática.Up to 30% of patients with acute pancreatitis are diagnosed of idiopathic acute pancreatitis after an initial evaluation including a complete clinical history, physical examination, analysis with calcium and triglycerides determination, and at least one transabdominal ultrasonography. Unexplained pancreatitis represents a diagnostic challenge, although after different explorations a cause is found in the majority of these patients. During the last years endosonography has proved to be a low morbidity exploration very useful in the evaluation of patients with this entity. In this article we review the role of endosonography in the etiologic study of patients with idiopathic acute pancreatitis.

Estudio clínico-epidemiológico y molecular de Metapneumovirus Humano en pacientes con Infecciones Respiratorias Agudas (IRA) en Venezuela

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Tovar H, Cerraf E; Moncho S, Alessandra; Fernandez S, David; Aguilar M, Marwan S; Morón, Dulce

2014-01-01

El Metapneumovirus Humano (MPVh) ha sido asociado con Infecciones Respiratorias Agudas (IRA) en pacientes de todas las edades. Estudios epidemiológicos indican la prevalencia del MPVh alrededor del mundo, sin embargo, en Venezuela poco se conoce sobre su comportamiento en la población. Este estudio pretende describir el comportamiento epidemiológico de la infección por MPVh en pacientes venezolanos. Se evaluaron por RT-PCR multiplex 1812 hisopados nasales (HN) provenientes de pacientes con di...

Infección respiratoria aguda en menores de una año en San José, Costa Rica

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Chavarría Milanés, José Fernando; Salas Chaves, Pilar; Jiménez, Rosa; Mata, Leonardo

1994-01-01

Artículo científico -- Universidad de Costa Rica, Instituto de Investigaciones en Salud. 1994 Se estudiaron 178 niños menores de un año admitidos durante un año al Hospital Nacional de niños de San José, Costa Rica por infección respiratoria aguda. Se observe; un predominio de varones sobre las mujeres. La mayoría eran menores de seis meses. Más de la mitad egresaron con diagnostico de neumonía-bronconeumonía (N-Bn) y una cuarta parte con diagnostico de bronquiolitis. El resto de los pacie...

Resposta de fase aguda e níveis séricos de magnésio em pacientes hospitalizados

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Cunha,D. F. da; Bianco,M. de P.; Lenza,R. da M.; Cunha,S. F. de C. da

1999-01-01

OBJETIVO: A resposta de fase aguda (RFA), caracteriza-se por proteólise, com hipotrofia da massa celular corporal, hiperglicemia, retenção hídrica e disfunção renal, fenômenos que potencialmente afetam os níveis de magnésio (Mg++) sérico. O objetivo do estudo foi comparar os níveis séricos de Mg++ entre pacientes hospitalizados, com ou sem RFA. MÉTODOS: Obteve-se um banco de dados do mainframe do Hospital-Escola contendo informações sobre dosagens bioquímicas simultâneas de creatinina, glicos...

Efecto de la infección aguda con Trypanosoma cruzi sobre el sistema nervioso central de rata gestante

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Lugo de Yarbuh, Ana; Rondón, Johan; Alarcón, Maritza; Moreno, Elio; Araujo, Sonia

2009-01-01

Este estudio analizó el efecto de la infección aguda con Trypanosoma cruzi sobre la histología del sistema nervioso central de ratas durante la gestación. Las ratas Wistar fueron infectadas por inoculación intraperitoneal de 5x10(4) tripanosomas sanguícolas de la cepa M/HOM/Bra/53/Y. Para obtener la preñez durante el ascenso de la parasitemia, las ratas en estrus del ciclo menstrual fueron apareadas con los machos a los 12 días posinfección (pi). Ratas vírgenes/infectadas, vírgenes/sanas y sa...

Uso de terapias não convencionais no manejo da crise aguda de asma refratária

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OLIVEIRA RAQUEL HERMES ROSA; RIBEIRO ALEXANDRE DE OLIVEIRA; AMARANTE GUSTAVO ADOLPHO JUNQUEIRA; TEDDE MIGUEL LIA

2002-01-01

Uma paciente em crise aguda de asma, refratária ao uso de beta2-agonista inalatório e intravenoso, aminofilina intravenosa e corticóide, em ventilação mecânica, foi tratada com métodos terapêuticos não convencionais: broncoscopia, lavado broncoalveolar com N-acetilcisteína e ventilação com halotano. Houve melhora dos parâmetros ventilatórios após o lavado e a resolução do broncoespasmo ocorreu após a anestesia, propiciando a extubação e alta da UTI. É feita uma revisão da literatura sobre o u...

The Benefit of Mirtazapine in the Treatment of Progressive Multifocal Leukoencephalopathy in a Young HIV-positive Patient

Science.gov (United States)

Miranda, Jorge; Sandoval, Hugo; Ramos-Duran, Luis; Tonarelli, Silvina B.

2018-01-01

Highly active antiretroviral therapy is well-established in the treatment of human immunodeficiency virus (HIV)-positive patients. Nonadherence with therapy regimens often leads to the occurrence of opportunistic infections that further complicate treatment and challenge the treating physician. We report a young HIV-positive patient who suffered from progressive multifocal leukoencephalopathy caused by the human John Cunningham virus and showed objective clinical improvement after adding mirtazapine to the treatment regimen, an observation that is supported by the emerging literature. PMID:29497578

Near-point string: Simple method to demonstrate anticipated near point for multifocal and accommodating intraocular lenses.

Science.gov (United States)

George, Monica C; Lazer, Zane P; George, David S

2016-05-01

We present a technique that uses a near-point string to demonstrate the anticipated near point of multifocal and accommodating intraocular lenses (IOLs). Beads are placed on the string at distances corresponding to the near points for diffractive and accommodating IOLs. The string is held up to the patient's eye to demonstrate where each of the IOLs is likely to provide the best near vision. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Escala RIPASA para el diagnóstico de apendicitis aguda: comparación con la escala de Alvarado modificada

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C.Z. Díaz-Barrientos

2018-04-01

Full Text Available Resumen: Introducción y objetivos: La apendicitis aguda es la primera causa de las urgencias quirúrgicas. Permanece como un diagnóstico difícil de establecer, particularmente entre jóvenes, ancianos y mujeres en edad reproductiva, en los cuales una serie de condiciones inflamatorias pueden presentar síntomas y signos similares a los de la apendicitis aguda. Diversos sistemas de puntuación se han creado con el fin de incrementar la certeza diagnóstica; estos son baratos, no invasivos y fáciles de usar o reproducir. La escala de Alvarado modificada es probablemente la más difundida y de mayor aceptación en los servicios de urgencias del mundo. Por otro lado, la escala RIPASA fue elaborada en 2010 con mejor sensibilidad y especificidad. En México se encuentran pocos estudios que comparen los diversos sistemas de puntuación en apendicitis. El objetivo es comparar la escala de Alvarado modificada y la escala RIPASA para el diagnóstico de pacientes con dolor abdominal y sospecha de apendicitis aguda. Material y métodos: Se realizó un estudio observacional, analítico y prolectivo, de julio de 2012 a febrero 2014 en el Hospital Universitario de Puebla. Las encuestas en proceso de evaluación fueron aplicadas a los pacientes con sospecha clínica de apendicitis. Resultados: Escala de RIPASA: curva ROC/PC 8.5 (área 0.595, sensibilidad (93.3%, especificidad (8.3%, VPP (91.8%, VPN (10.1%. Escala de Alvarado modificada: Curva ROC/PC 6 (área 0.719, sensibilidad (75%, especificidad (41.6%, VPP (93.7%, VPN (12.5%. Conclusiones: La escala de RIPASA contrastada con la escala de Alvarado modificada no mostró ventajas al aplicarse a pacientes con sospecha de apendicitis aguda. Abstract: Introduction and objectives: Acute appendicitis is the first cause of surgical emergencies. It is still a difficult diagnosis to make, especially in young persons, the elderly, and in reproductive-age women, in whom a series of inflammatory conditions can have

The pathogenesis of progressive multifocal leukoencephalopathy.

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Berger, Joseph R; Khalili, Kamel

2011-12-01

Interest in pathogenesis of progressive multifocal leukoencephalopathy (PML) followed the observation of the high risk for the disease in HIV infection and the recent observation of an association with a variety of newer therapeutic modalities, e.g., natalizumab, an α4β1 integrin inhibitor, and efalizumab, an anti-CD11a monoclonal antibody. Any hypothesis of PML pathogenesis must account for a number of facts. Firstly, the causative agent JC virus is ubiquitously present, yet only a vanishingly small number of infected persons develop the disease. Secondly, disorders of cell-mediated immunity increase the risk of the disease, particularly HIV infection. Impaired innate immunity is not a risk for PML, and antibodies against JC virus are not protective. Thirdly, a latent period of several months appears necessary following the administration of natalizumab and efalizumab before PML develops. Fourthly, restoration of the immune system can arrest the PML. It is possible that infection with JC virus occurs with a form of the virus shed in the urine of as many as 40% of all adults and present in sewage worldwide. Once acquired, perhaps through an oropharyngeal route, it may replicate and disseminate. A neurotropic form of JC virus that replicates in glial tissues causes PML when immunosurveillance is impaired. There are many unanswered questions with respect to PML pathogenesis. How is virus acquired? What tissues are infected? What is the origin of the neurotropic form? When does virus enter brain? What is the role of central nervous system immunosurveillance? The lack of an animal model has made answering these questions challenging. © Discovery Medicine

Effects of vitamin D in the prevention of acute viral bronchiolitis: systematic review = Efeitos da vitamina D na prevenção da bronquiolite viral aguda: revisão sistemática

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Rueda, Angélica Maria Barba

2015-01-01

Full Text Available Objetivos: Evidências publicadas sugerem que a suplementação da vitamina D pode ter efeito protetor nas infecções do trato respiratório inferior. O objetivo desta revisão foi avaliar os efeitos da ingestão de vitamina D na prevenção da bronquiolite viral aguda em crianças. Métodos: Foram feitas buscas nas bases de dados Medline, EMBASE, Web of Science, LILACS e Cochrane Central Register of Controlled Trials, até dezembro de 2014, usando os descritores "Vitamin D" ou cholecalciferol ou ergocalciferol e "bronchiolitis, viral" ou "viral bronchiolitis" ou "bronchiolitides, viral" ou "viral bronchiolitides". Foram incluídos estudos que avaliaram o efeito da ingesta da vitamina D na prevenção da bronquiolite viral aguda em crianças. Estudos com intervenção menor que duas semanas e artigos de revisão foram excluídos. Resultados: A busca identificou 241 artigos, entre os quais 20 artigos foram selecionados para leitura na íntegra e dois artigos foram incluídos na revisão sistemática, incluindo 296 crianças. Nenhum estudo mediu os níveis séricos de vitamina D. Um dos estudos incluídos foi um ensaio clinico, no qual o número de episódios de bronquiolite foi significativamente menor nas crianças suplementadas com vitamina D (Grupo I: média 0, 6±0, 7 Grupo II: média 1, 4 ±0, 9; P =0, 001. No outro, um estudo de casos e controles, não se encontrou relação significativa entre casos de bronquiolite viral aguda e ingesta de vitamina D (odds ratio 1, 7 – intervalo de confiança 95% 0, 7 - 4, 0. Conclusões: As evidências científicas atuais são insuficientes para comprovar os benefícios clínicos da vitamina D na prevenção da bronquiolite viral aguda

Multifocal visual evoked responses to dichoptic stimulation using virtual reality goggles: Multifocal VER to dichoptic stimulation.

Science.gov (United States)

Arvind, Hemamalini; Klistorner, Alexander; Graham, Stuart L; Grigg, John R

2006-05-01

Multifocal visual evoked potentials (mfVEPs) have demonstrated good diagnostic capabilities in glaucoma and optic neuritis. This study aimed at evaluating the possibility of simultaneously recording mfVEP for both eyes with dichoptic stimulation using virtual reality goggles and also to determine the stimulus characteristics that yield maximum amplitude. ten healthy volunteers were recruited and temporally sparse pattern pulse stimuli were presented dichoptically using virtual reality goggles. Experiment 1 involved recording responses to dichoptically presented checkerboard stimuli and also confirming true topographic representation by switching off specific segments. Experiment 2 involved monocular stimulation and comparison of amplitude with Experiment 1. In Experiment 3, orthogonally oriented gratings were dichoptically presented. Experiment 4 involved dichoptic presentation of checkerboard stimuli at different levels of sparseness (5.0 times/s, 2.5 times/s, 1.66 times/s and 1.25 times/s), where stimulation of corresponding segments of two eyes were separated by 16.7, 66.7,116.7 & 166.7 ms respectively. Experiment 1 demonstrated good traces in all regions and confirmed topographic representation. However, there was suppression of amplitude of responses to dichoptic stimulation by 17.9+/-5.4% compared to monocular stimulation. Experiment 3 demonstrated similar suppression between orthogonal and checkerboard stimuli (p = 0.08). Experiment 4 demonstrated maximum amplitude and least suppression (4.8%) with stimulation at 1.25 times/s with 166.7 ms separation between eyes. It is possible to record mfVEP for both eyes during dichoptic stimulation using virtual reality goggles, which present binocular simultaneous patterns driven by independent sequences. Interocular suppression can be almost eliminated by using a temporally sparse stimulus of 1.25 times/s with a separation of 166.7 ms between stimulation of corresponding segments of the two eyes.

Uso de la citometría de flujo en la caracterización de las leucemias agudas de pacientes del Hospital San Vicente de Paúl y la Clínica León XIII

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Lía Upegui

2001-04-01

Full Text Available

Las leucemias agudas son neoplasias hematológicas frecuentes en niños y la clasificación adecuada de un caso es importante para dar  un buen tratamiento (1. La manera más eficaz de clasificar las leucemias agudas es la inmunofenotipificación por medio de citometría de flujo, que identifica las células leucémicas con base en sus antígenos de superficie (2. En el Hospital Universitario San Vicente de Paúl no se ha estandarizado la citometría con fines diagnósticos, aunque existe consenso general sobre su importancia y necesidad (3.

Multifocal Electroretinography after High Dose Chloroquine Therapy for Malaria

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Aline Correa de Carvalho

2013-01-01

Full Text Available Purpose: To investigate changes in multifocal electroretinography (mfERG parameters associated with high dose chloroquine therapy for treatment of malaria in the Amazonia region of Brazil. Methods: Forty-eight subjects who had received chloroquine treatment for single or multiple malaria infections with a cumulative dose ranging from 1,050 to 27,000mg were included. The control group consisted of 37 healthy aged-matched subjects. Data was collected on amplitude and implicit time of the N1, P1 and N2 waves in the central macular hexagon (R1 and in five concentric rings at different retinal eccentricities (R2-R6. Results: No significant difference was observed in any mfERG parameter between chloroquine treated patients and control subjects. A comparison with previous data obtained from patients with rheumatologic disorders in the same region of Brazil who had received larger cumulative doses of chloroquine and had displayed mfERG changes, indicated that retinal toxicity seems to be dependent on cumulative dose. Conclusion: Lack of mfERG changes in the current study suggests that intensive high dose chloroquine therapy for treatment of malaria is not associated with retinal toxicity.

Meningoencefalite na fase aguda do sarampo : relato de seis casos

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EL-FAR FABIANE

2000-01-01

Full Text Available Apresentamos 6 casos de meningoencefalite aguda por sarampo, diagnosticados durante epidemia na cidade de São Paulo, em 1997. Os prontuários dos 6 pacientes foram analisados retrospectivamente. O diagnóstico de meningoencefalite baseou-se nas alterações clínicas e liquóricas, e foi confirmado por sorologia específica. Dos 467 pacientes com sarampo atendidos no Instituto de Infectologia Emílio Ribas nesse período, estes 6 evoluíram com alterações neurológicas e liquóricas durante a fase exantemática, sendo a sonolência e rigidez de nuca os achados mais frequentes. Os pacientes tinham entre 2 meses e 28 anos de idade. O exame do líquor mostrou pleocitose em todos. Não houve correlação entre a severidade do quadro clínico e liquórico com a evolução. Em 4 casos foi necessária internação na unidade de terapia intensiva; destes, 2 foram intubados. Apenas 2 pacientes apresentaram alterações na tomografia computadorizada de crânio. Todos tiveram boa evolução, sem sequelas.

Alternativa quirúrgica en el tratamiento de la osteomielitis aguda posfractura abierta de la tibia: Presentación de un caso

OpenAIRE

García Moreiro, Reynol Delfín; Collazo Álvarez, Hilario; Estenoz Esquivel, Juan Carlos; Ayup García, Diana

2000-01-01

Se presenta un caso de fractura abierta del tercio inferior de la tibia y el peroné derechos. Como intervención de urgencia se realiza debridamiento y osteosíntesis. Se observa con posterioridad signos necróticos en partes blandas con osteomielitis aguda. Se mantienen todos los cuidados generales necesarios, se le coloca fijador externo RALCA e injerto libre de piel en tejido de granulación; este último proceder resulta infructuoso al persistir los signos anteriormente expuestos. A continuaci...

Injúria renal aguda: um alerta global

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Philip Kam Tao Li

2013-03-01

Full Text Available A Injúria Renal Aguda (IRA é cada vez mais prevalente nos países desenvolvidos e nos em desenvolvimento, e está associada com morbidade e mortalidade severas. A maioria das causas da IRA pode ser evitada por meio de intervenções em nível individual, comunitário, regional e intra-hospitalar. Medidas efetivas devem incluir, em toda a comunidade, os esforços para aumentar a consciência dos efeitos devastadores do IRA e fornecer orientações sobre as estratégias de prevenção, bem como o reconhecimento e tratamento precoces. Os esforços devem ser focados em minimizar as causas de IRA, aumentando a consciência da importância de medidas seriadas de creatinina sérica em pacientes de alto risco para IRA, e documentar o volume de urina em pessoas gravemente doentes para obtenção de diagnóstico precoce; até o momento, não há ainda um papel definitivo para outros biomarcadores. Há a necessidade de protocolos para sistematizar a conduta em condições de IRA pré-renal e em infecções específicas. Dados mais precisos sobre a verdadeira incidência e o impacto clínico da IRA ajudarão a melhor conhecer a importância desta doença, a aumentar o conhecimento de IRA por parte dos governantes, dos médicos em geral e de outros profissionais de saúde para ajudar na prevenção da doença. A prevenção é a chave para evitar a pesado ônus de mortalidade e morbidade associada com IRA.

Uncária tomentosa e a lesão renal aguda isquêmica em ratos

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Maria de Fátima Fernandes Vattimo

2011-03-01

Full Text Available O objetivo deste estudo foi avaliar o efeito renoprotetor do fitoterápico Uncaria tomentosa sobre a lesão renal aguda isquêmica induzida pelo clampeamento dos pedículos renais de ratos. A hipóxia e a hipoperfusão geradas com a isquemia intensificam a produção de espécies reativas já presentes no processo inflamatório. Os resultados mostraram que a função renal avaliada pelo clearance de creatinina, a excreção de peróxidos urinários (FOX e a excreção urinária de malondealdeído (TBARS desses animais apresentou renoproteção induzida pela UT, provavelmente relacionada às suas atividades antioxidantes.

Meaning of visualizing retinal cone mosaic on adaptive optics images.

Science.gov (United States)

Jacob, Julie; Paques, Michel; Krivosic, Valérie; Dupas, Bénédicte; Couturier, Aude; Kulcsar, Caroline; Tadayoni, Ramin; Massin, Pascale; Gaudric, Alain

2015-01-01

To explore the anatomic correlation of the retinal cone mosaic on adaptive optics images. Retrospective nonconsecutive observational case series. A retrospective review of the multimodal imaging charts of 6 patients with focal alteration of the cone mosaic on adaptive optics was performed. Retinal diseases included acute posterior multifocal placoid pigment epitheliopathy (n = 1), hydroxychloroquine retinopathy (n = 1), and macular telangiectasia type 2 (n = 4). High-resolution retinal images were obtained using a flood-illumination adaptive optics camera. Images were recorded using standard imaging modalities: color and red-free fundus camera photography; infrared reflectance scanning laser ophthalmoscopy, fluorescein angiography, indocyanine green angiography, and spectral-domain optical coherence tomography (OCT) images. On OCT, in the marginal zone of the lesions, a disappearance of the interdigitation zone was observed, while the ellipsoid zone was preserved. Image recording demonstrated that such attenuation of the interdigitation zone co-localized with the disappearance of the cone mosaic on adaptive optics images. In 1 case, the restoration of the interdigitation zone paralleled that of the cone mosaic after a 2-month follow-up. Our results suggest that the interdigitation zone could contribute substantially to the reflectance of the cone photoreceptor mosaic. The absence of cones on adaptive optics images does not necessarily mean photoreceptor cell death. Copyright © 2015 Elsevier Inc. All rights reserved.

Extended depth of focus contact lenses vs. two commercial multifocals: Part 1. Optical performance evaluation via computed through-focus retinal image quality metrics.

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Bakaraju, Ravi C; Ehrmann, Klaus; Ho, Arthur

To compare the computed optical performance of prototype lenses designed using deliberate manipulation of higher-order spherical aberrations to extend depth-of-focus (EDOF) with two commercial multifocals. Emmetropic, presbyopic, schematic eyes were coupled with prototype EDOF and commercial multifocal lenses (Acuvue Oasys for presbyopia, AOP, Johnson & Johnson & Air Optix Aqua multifocal, AOMF, Alcon). For each test configuration, the through-focus retinal image quality (TFRIQ) values were computed over 21 vergences, ranging from -0.50 to 2.00D, in 0.125D steps. Analysis was performed considering eyes with three different inherent aberration profiles: five different pupils and five different lens decentration levels. Except the LOW design, the AOP lenses offered 'bifocal' like TFRIQ performance. Lens performance was relatively independent to pupil and aberrations but not centration. Contrastingly, AOMF demonstrated distance centric performance, most dominant in LOW followed by MED and HIGH designs. AOMF lenses were the most sensitive to pupil, aberrations and centration. The prototypes demonstrated a 'lift-off' in the TFRIQ performance, particularly at intermediate and near, without trading performance at distance. When compared with AOP and AOMF, EDOF lenses demonstrated reduced sensitivity to pupil, aberrations and centration. With the through focus retinal image quality as the gauge of optical performance, we demonstrated that the prototype EDOF designs were less susceptible to variations in pupil, inherent ocular aberrations and decentration, compared to the commercial designs. To ascertain whether these incremental improvements translate to a clinically palpable outcome requires investigation through human trials. Copyright © 2017 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.

Nerve sonography in multifocal motor neuropathy and chronic inflammatory demyelinating polyneuropathy

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D. S. Druzhinin

2016-01-01

Full Text Available The quantitative ultrasound characteristics (USC of the median, ulnar nerve at different levels and the spinal nerves in patients with multifocal motor neuropathy (MMN; n=13; 40,4 ± 12,6 years old and chronic inflammatory demyelinating polyneuropathy (CIDP; n = 7; 47,3 ± 11,2 year old did not reveal statistical difference in cross sectional area (CSA between analyzed groups. Patients with MMN have more pronounced asymmetry of CSA in comparison with CIDP patients which have a symmetrical pattern of diffuse nerve involvement. Quantitative USC has shown to be not informative enough in differentiation of MMN and CIDP. The qualitative analysis (QA according to 3 described types of nerve changes has shown that CIDP is characterized by the prevalence of type 3 pattern (85.8 % while MMN – by type 2 (69.2 %. The sensitivity and specificity of proposed QA patterns in nerve USC need to be analyzed in additional investigations. 

Toxicidad aguda de las hojas de Xanthium spinosum en ratones BALB/C

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Arturo Silvero-Isidre

2016-01-01

Full Text Available Las hojas de la planta Xanthium spinosum se utilizan culturalmente en Paraguay por sus propiedades medicinales. Se evaluó la toxicidad aguda del extracto de hojas maduras; para el estudio se seleccionaron 35 ratones BALB/C machos que fueron distribuidos en 7 grupos, 6 de ensayo y 1 de control. El extracto fue preparado en concentraciones de 6 y 9% (g/dL; se administró la solución 6% a tres grupos y la solución 9% a los otros tres grupos, con dosis entre 200 y 1000 mg/kg. Al final de 14 días de observación, se extrajeron muestras de sangre para estudios laboratoriales de urea y transaminasas, además de órganos para estudios anatomopatológicos. Se determinaron aumentos en los niveles de GOT y urea en comparación al grupo control. Se concluye que el consumo del extracto de hojas maduras de Xanthium spinosum puede causar daño hepático.

Actuación de enfermería en la leucemia mieloide aguda.

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Melchor Pino, Pilar

2012-08-01

Full Text Available La leucemia mieloide aguda (LMA es una proliferación neoplásica de células inmaduras de estirpe mieloide que se produce por una alteración en el crecimiento y diferenciación de las células hematopoyéticas.En este trabajo se presenta un caso clínico sobre un paciente de 37 años diagnosticado de LMA. Se hace una valoración de las necesidades básicas siguiendo el modelo de Virginia Henderson al ingreso del paciente, mediante una entrevista dirigida y la obtención de datos mediante la observación.El objetivo general es elaborar un plan individualizado de cuidados a dicho paciente, mediante la aplicación del Proceso Enfermero y la utilización de la taxonomía NANDA-NOC-NIC que nos permitirá aplicar unos cuidados de calidad a este paciente.Cuando el paciente abandone el hospital, la enfermera le entregará un informe de alta, que asegurará la continuidad de sus cuidados.

Quantificação gênica pré-transplante renal : predição da rejeição aguda

OpenAIRE

Raphael Sahd

2012-01-01

Introdução. A rejeição aguda (RA) permanece entre as principais causas de perda de enxertos renais. A disponibilidade de biomarcadores prognósticos de RA no período pré-transplante poderia ser útil na individualização do tratamento destes pacientes. Neste estudo avaliamos o potencial da mensuração do RNA mensageiro de diferentes genes envolvidos na resposta alogênica como biomarcadores prognósticos pré-transplante. Material. Foram coletadas amostras pré-transplante de 51 pacientes que receber...

Associação entre o polimorfismo rs2275913 de IL-17 e a gravidade da bronquiolite aguda em lactentes

OpenAIRE

Mocellin, Magáli

2014-01-01

Introdução: a bronquiolite viral aguda (BVA) é uma infecção respiratória de elevada incidência em lactentes. Os mecanismos associados à severidade da doença são ainda pouco conhecidos. Sua gravidade pode estar associada a fatores genéticos e imunológicos. Alguns mediadores da reposta imune parecem influenciar a resposta aos vírus, especialmente as interleucinas (ILs). A IL-17 é uma citocina pró-inflamatória presente no aspirado traqueal de pacientes com BVA. Esta interleucina induz a expressã...

Calidad visual en pacientes con lente intraocular multifocal modelo OcuFlex operados de catarata The quality of vision in patients operated on from cataract and implanted with OcuFlex multifocal intraocular lenses

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Eneida Pérez Candelaria

2010-01-01

Full Text Available OBJETIVO: Describir la calidad visual en 8 pacientes operados de catarata bilateral con la técnica de Faco-chop e implante de lente intraocular multifocal modelo OcuFlex, en el ICO "Ramón Pando Ferrer", desde septiembre 2007 a febrero 2008. MÉTODOS: Se realizó un estudio observacional, descriptivo, longitudinal y prospectivo para lo cual se analizaron variables como equivalente esférico, sensibilidad al contraste en el preoperatorio y posoperatorio; fenómenos visuales, centrado y localización del lente intraocular, así como el estado de satisfacción subjetiva de los pacientes. Se utilizó la estadística descriptiva con ayuda del sistema Microsoft Excel y Word 2003, para Windows XP. RESULTADOS: El equivalente esférico medio posoperatorio fue -0,59 tanto para frecuencias bajas como medias, en visión binocular la sensibilidad al contraste media fue de 1,12 unid.log en el preoperatorio y de 1,74 unid.log. en el posoperatorio. Por biomicroscopia con lámpara de hendidura en el 100 % de los casos el lente intraocular estaba centrado y por biomicroscopia ultrasónica el 93,75 % se encontraba en el saco capsular. Ningún paciente refirió la presencia de glare y solamente uno (12,5 % reportó visión de halos nocturnos. La totalidad de los pacientes se manifestaron satisfechos. CONCLUSIONES: Los lentes multifocales disminuyen la dependencia de las gafas después de la cirugía de catarata, razón por la que constituye una buena opción en la recuperación de la función visual óptima.OBJECTIVE: To describe the quality of vision in 8 patients, who were operated on from bilateral cataract using Phaco-chop technique and implanted with Ocuflex multifocal intraocular lens in "Ramón Pando Ferrer" Cuban Institute of Ophthalmology from September 2007 to February 2008. METHODS: A prospective, longitudinal, observational and descriptive study was made in which the variables spheral equivalent, contrast sensitivity in the pre- and post

Increasing the diagnosis of multifocal primary breast cancer by the use of bilateral whole-breast ultrasound

International Nuclear Information System (INIS)

Wilkinson, L.S.; Given-Wilson, R.; Hall, T.; Potts, H.; Sharma, A.K.; Smith, E.

2005-01-01

AIM: The aim of this study was to evaluate the contribution of bilateral whole-breast ultrasound (BBUS) to the diagnosis and management of women with newly diagnosed breast cancer. METHODS: Over a period of 6 months, 102 women presenting with breast cancer underwent BBUS. Data were collected on clinical findings, radiology, histology and surgical outcome. These women were compared with a control group of 124 women presenting over a similar 6-month period 1 year previously, who had undergone targeted breast ultrasound. RESULTS: Multicentric/multifocal tumours were demonstrated in 35 (34%) of the 102 participants and in 18 (15%) of the 124 controls, a statistically significant difference (Fisher's exact test, p=0.001). Multiple tumours were diagnosed preoperatively in 18% of the study population compared with 8% of the controls, and BBUS identified invasive multifocal/multicentric tumours in significantly more women in the study population (11 versus 1 control) (Fisher's exact test, p=0.019). Contralateral cancer was diagnosed in 4 women in the study population and none in the control population (Fisher's exact test, p=0.040). Surgical review showed that the surgical management changed significantly in 8% (95% confidence interval 4 to 14%) of cases in the study population following BBUS. The increase in the number of women undergoing benign biopsies in the study population (10 versus 5 controls) was not statistically significant (Fisher's exact test, p=0.11). CONCLUSION: BBUS increased the preoperative diagnosis of multiple tumours in women presenting with primary breast cancer, resulting in a management change in 8% of cases

Can the accuracy of multifocal intraocular lens power calculation be improved to make patients spectacle free?

Science.gov (United States)

Ramji, Hasnain; Moore, Johnny; Moore, C B Tara; Shah, Sunil

2016-04-01

To optimise intraocular lens (IOL) power calculation techniques for a segmental multifocal IOL, LENTIS™ MPlus(®) (Oculentis GmbH, Berlin, Germany) and assess outcomes. A retrospective consecutive non-randomised case series of patients receiving the MPlus(®) IOL following cataract surgery or clear lens extraction was performed at a privately owned ophthalmic hospital, Midland Eye, Solihull, UK. Analysis was undertaken of 116 eyes, with uncomplicated lens replacement surgery using the LENTIS™ MPlus(®) lenses. Pre-operative biometry data were stratified into short (<22.00 mm) and long axial lengths (ALs) (≥22.00 mm). IOL power predictions were calculated with SRK/T, Holladay I, Hoffer Q, Holladay II and Haigis formulae and compared to the final manifest refraction. These were compared with the OKULIX ray tracing method and the stratification technique suggested by the Royal College of Ophthalmologists (RCOphth). Using SRK/T for long eyes and Hoffer Q for short eyes, 64% achieved postoperative subjective refractions of ≤±0.25 D, 83%≤±0.50 D and 93%≤±0.75 D, with a maximum predictive error of 1.25D. No specific calculation method performed best across all ALs; however for ALs under 22 mm Hoffer Q and Holliday I methods performed best. Excellent but equivalent overall refractive results were found between all biometry methods used in this multifocal IOL study. For eyes with ALs under 22 mm Hoffer Q and Holliday I performed best. Current techniques mean that patients are still likely to need top up glasses for certain situations. Copyright © 2015 Elsevier Ltd. All rights reserved.

Evaluation of the True Wavefront Aberrations in Eyes Implanted With a Rotationally Asymmetric Multifocal Intraocular Lens.

Science.gov (United States)

Akondi, Vyas; Pérez-Merino, Pablo; Martinez-Enriquez, Eduardo; Dorronsoro, Carlos; Alejandre, Nicolás; Jiménez-Alfaro, Ignacio; Marcos, Susana

2017-04-01

Standard evaluation of aberrations from wavefront slope measurements in patients implanted with a rotationally asymmetric multifocal intraocular lens (IOL), the Lentis Mplus (Oculentis GmbH, Berlin, Germany), results in large magnitude primary vertical coma, which is attributed to the intrinsic IOL design. The new proposed method analyzes aberrometry data, allowing disentangling the IOL power pupillary distribution from the true higher order aberrations of the eye. The new method of wavefront reconstruction uses retinal spots obtained at both the near and far foci. The method was tested using ray tracing optical simulations in a computer eye model virtually implanted with the Lentis Mplus IOL, with a generic cornea or with anterior segment geometry obtained from custom quantitative spectral-domain optical coherence tomography in a real patient. The method was applied to laser ray tracing aberrometry data at near and far fixation obtained in a patient implanted with the Lentis Mplus IOL. Higher order aberrations evaluated from simulated and real retinal spot diagrams following the new reconstruction approach matched the nominal aberrations (approximately 98%). Previously reported primary vertical coma in patients implanted with this IOL lost significance with the application of the proposed reconstruction. Custom analysis of ray tracing-based retinal spot diagrams allowed decoupling of the true higher order aberrations of the patient's eye from the power pupillary distribution of a rotationally asymmetric multifocal IOL, therefore providing the appropriate phase map to accurately evaluate through-focus optical quality. [J Refract Surg. 2017;33(4):257-265.]. Copyright 2017, SLACK Incorporated.

Test-retest variability of multifocal electroretinography in normal volunteers and short-term variability in hydroxychloroquine users

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Browning DJ

2014-08-01

Full Text Available David J Browning,1 Chong Lee2 1Charlotte Eye, Ear, Nose and Throat Associates, 2University of North Carolina – Charlotte, Charlotte, NC, USA Purpose: To determine measurement variability of N1P1 amplitudes and the R1/R2 ratio in normal subjects and hydroxychloroquine users without retinopathy. Design: Retrospective, observational study. Subjects: Normal subjects (n=21 and 44 patients taking hydroxychloroquine (n=44 without retinopathy. Methods: Multifocal electroretinography (mfERG was performed twice in one session in the 21 normal subjects and twice within 1 year in the hydroxychloroquine users, during which time no clinical change in macular status occurred. Main outcome measures: N1P1 amplitudes of rings R1–R5, the R1/R2 ratio, and coefficients of repeatability (COR for these measurements. Results: Values for N1P1 amplitudes in hydroxychloroquine users were reduced compared with normal subjects by the known effect of age, but R1/R2 was not affected by age. The COR for R1–R5 ranged from 43% to 52% for normal subjects and from 43% to 59% for hydroxychloroquine users; for R1/R2 the COR was 29% in normal subjects and 45% in hydroxychloroquine users. Conclusion: mfERG measurements show high test-retest variability, limiting the ability of a single mfERG test to influence a decision to stop hydroxychloroquine; corroborative evidence with a different ancillary test is recommended in a suspicious case. Keywords: multifocal electroretinography, hydroxychloroquine, test-retest variability 

Manifestações músculo-esqueléticas como apresentação inicial das leucemias agudas na infância Musculoskeletal manifestations as the onset of acute leukemias in childhood

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Cássia Maria Passarelli Lupoli Barbosa

2002-12-01

Full Text Available Objetivo: estudar a prevalência e as características clínicas e laboratoriais dos pacientes com manifestações músculo-esqueléticas na apresentação inicial das leucemias agudas. Métodos: estudo de casos prevalentes, retrospectivo, descritivo, no qual foram avaliados pacientes com diagnóstico de leucemia aguda, atendidos no Instituto de Oncologia Pediátrica da UNIFESP, de novembro de 1999 a fevereiro de 2000. As queixas músculo-esqueléticas foram investigadas através de um questionário. Os dados referentes ao exame físico e provas laboratoriais, no início da doença, foram obtidos através da revisão de prontuários. Resultados: sessenta e uma crianças foram incluídas neste estudo, sendo que 93% apresentavam leucemia linfóide aguda, e 7% leucemia mielóide aguda. Trinta e oito crianças (62% apresentaram dor músculo-esquelética no início da doença. Artrite foi observada em 8 casos (13%. A média de articulações acometidas foi 2,5 (variando de 1 a 6, sendo as mais acometidas os joelhos, os tornozelos e os cotovelos. Três pacientes (4,9% apresentavam hemograma normal, 54 (88% hemoglobina baixa (em 6 pacientes foi a única alteração, leucopenia em 14 (22%, leucocitose em 26 (42%, e plaquetopenia em 46 (75% pacientes. Oito pacientes (13% mostravam blastos em sangue periférico. Conclusão: as queixas músculo-esqueléticas são manifestações iniciais freqüentes das leucemias agudas, e devem ser consideradas no diagnóstico diferencial da dor em membros e das artrites agudas ou crônicas da infância. Os exames laboratoriais podem ser inicialmente normais, tornando ainda mais difícil esta diferenciação.Objective: to study the frequency, the clinical features and laboratory exams of patients with musculoskeletal symptoms at the onset of acute leukemia. Methods: retrospective, descriptive study including patients diagnosed with acute leukemia, and treated at the Institute of Pediatric Oncology of UNIFESP, carried out

Exacerbação aguda da fibrose pulmonar idiopática

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Natália Melo

2009-03-01

Full Text Available Resumo: Alguns doentes com fibrose pulmonar idiopática (FPI apresentam durante a sua evolução fases de agravamento clínico sem causa conhecida, designadas como “exacerbação aguda” ou “fase acelerada” da doença (EA. Caracterizam-se pelo agravamento marcado da dispneia, hipoxemia e pelo aparecimento de novas opacidades pulmonares ou pelo agravamento das já existentes no estudo imagiológico. Os achados histológicos típicos são o dano alveolar difuso (DAD sobreposto a alterações de pneumonia intersticial usual (UIP. Esta entidade clínica associa-se a uma mortalidade elevada, não havendo até ao momento nenhuma terapêutica de comprovada eficácia.Os autores descrevem os casos clínicos de cinco doentes que apresentaram alterações clínicas, funcionais e radiológicas sugestivas de EA-FPI, assim como o tratamento efectuado e a evolução observada, enquadrando-os na discussão das características normalmente apresentadas por esta entidade. Abstract: Some patients with Idiopathic Pulmonary Fibrosis (IPF have disease accelerated deterioration without identifiable cause referred as “acute exacerbation” or “accelerated stage”. It is characterized by severe worsening of dyspnea, hypoxemia and new or progressive opacities on imaging studies. The typical histological findings are diffuse alveolar damage in addition to the features of usual interstitial pneumonia pattern. Mortality in this clinical entity is very high and no efficacious therapeutic have been described.The authors describe the clinical, functional and radiological features, treatment and evolution of five patients with IPF acute exacerbation. A discussion will be carry out concerning the IPF acute exacerbation usual features comparing with the alterations noticed in those patients. Palavras-chave: Fibrose pulmonar idiopática, exacerbação aguda, Key words: Idiopathic

Pneumonia aguda fibrinosa e organizante

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C. Damas

2006-09-01

Full Text Available Resumo: A designação acute fibrinous and organizing pneumonia (AFOP foi proposta por Beasley et al para os casos em que as características histopatológicas das lesões não se enquadravam em outras situações clínicas (agu-das ou subagudas conhecidas. A presença de fibrina intra alveolar e de pneumonia organizativa, com distribuição difusa, é a principal alteração histológica associada a esta entidade.Os autores descrevem o caso de um doente do sexo masculino, com o diagnóstico de AFOP, por bióp-sia pulmonar cirúrgica. O doente teve uma apresentação subaguda, apresentando por queixas principais tosse, dor torácica e febre. TAC torácica mostrou infiltrados bilaterais, difusos. Após início de corticoterapia sistémica e ciclofosfamida, o doente apresentou melhoria clínica significativa. Ao elaborar este caso, os autores esperam acrescentar mais alguns dados sobre esta nova entidade.Rev Port Pneumol 2006; XII (5: 615-620 Abstract: The term Acute Fibrinous and Organizing Pneumonia (AFOP has been proposed by Beasley et al for cases that not fit into the histopathologic criteria of the recognized entities described as acute or subacute clinical presentations. The presence of intra-alveolar fibrin in the form of fibrin ‘balls’ and organizing pneumonia with patchy distribution are the main histological features of this entity. We describe the case of a male patient with the diagnostic of AFOP made by surgical lung biopsy. He had a subacute presentation of symptoms consisting of productive cough, chest pain and fever. Bilateral infiltrates with patchy and diffuse distribution were the predominant features in his chest HRCT scan. The patient had a good clinical course after a treatment with prednisone and cyclophosphamide. Our hope in reporting this case study is to add some more data to the discussion of this new entity.Rev Port Pneumol 2006; XII (5: 615-620 Palavras

Toxicidad aguda oral y subcrónica en ratas de un extracto acuoso liofilizado de Ocimum tenuiflorum L

OpenAIRE

A Lagarto; J Tillán; V Bueno; I Chávez; I Guerra; Y Vega; O Valdés; T Gabilondo

2005-01-01

El potencial tóxico de un extracto acuoso liofilizado fue evaluado mediante el ensayo de toxicidad aguda oral y subcrónica a 90 días en ratas Wistar de ambos sexos. Los métodos empleados fueron los descritos por las normas OECD. En el ensayo agudo se administró por vía oral la dosis de 2000 mg/kg y en el ensayo subcrónico 250, 500 y 1000 mg/kg/día durante 13 semanas. Se evaluaron los signos tóxicos y peso corporal en ambos ensayos. En el estudio subcrónico además se evalu...

Intoxicaciones agudas por cocaína: Caracterización, factores de riesgo, conocimientos y precauciones de los consumidores

OpenAIRE

Santos Sanz, Sara

2012-01-01

La cocaína es la tercera droga ilegal más consumida después del cannabis y las anfetaminas. España es uno de los países donde su consumo está más extendido, sobretodo en el grupo de adultos jóvenes de 15-34 años. Los problemas de salud asociados al consumo de cocaína son frecuentes (13%-30%) entre los consumidores, aunque la intoxicación aguda por cocaína así como sus factores de riesgo no se han estudiado tanto como en el caso de la sobredosis por heroina. Existen vacios en la literatura sob...

Malformación arteriovenosa pancreática como causa de pancreatitis aguda tratada por vía endovascular

OpenAIRE

Kohan, Gustavo; Provenzano, Matías; Rosado, Martín; Farfan, Grisel; Sánchez, Nicolás; Fastman, Denise

2017-01-01

La malformación arterio-venosa (MAV) en el páncreas es una anomalía anatómica poco frecuente que puede ser causa de pancreatitis aguda. Presentamos el caso de un paciente de 46 años cuyo diagnóstico se sospechó por los hallazgos de la tomografía computarizada con contraste endovenoso y por resonancia magnética y se confirmó mediante una arteriografía del tronco celíaco y de la arteria mesentérica superior. El tratamiento recibido fue por vía endovascular, aunque la otra opción válida para el ...

Infección por Campylobacter y Shigella como causa de Diarrea Aguda Infecciosa en niños menores de dos años en el Distrito de la Victoria, Lima-Perú

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María Perales D

2002-10-01

Full Text Available Objetivo: Determinar la frecuencia de Campylobacter y Shigella como agentes etiológicos en diarrea aguda acuosa en niños menores de dos años atendidos en 4 centros de salud del distrito de La Victoria (Lima, Perú Materiales y métodos: en este estudio transversal analítico se realizaron coprocultivos bajo técnica microbiológica estándar a los niños menores de dos años con diarrea aguda acuosa atendidos en 4 centros de salud de La Victoria entre abril y octubre de 2001. Fueron excluidos aquellos niños con disentería y aquellos que habían recibido tratamiento antibiótico previo a la atención. Resultados: se estudiaron un total de 248 casos, de los cuales 48 (19,4% coprocultivos fueron positivos: 33 (13.3% a Campylobacter, 12 (4,8% a Shigella y 3 (1,2% a Salmonella. No se identificaron otros patógenos. Las especies de Shigella identificadas fueron: Shigella flexneri en 9 (75,0% casos y Shigella sonnei en 3 (25,0% La única especie de Campylobacter identificada fue Campylobacter jejuni siendo el biotipo I el más frecuente (84,6% Conclusiones: Campylobacter y Shigella juegan un importante papel como agentes etiológicos causantes de diarrea aguda acuosa en niños menores de dos años.

Progressive multifocal leukoencephalopathy after fingolimod treatment.

Science.gov (United States)

Berger, Joseph R; Cree, Bruce A; Greenberg, Benjamin; Hemmer, Bernhard; Ward, Brian J; Dong, Victor M; Merschhemke, Martin

2018-04-18

We describe the characteristics of the 15 patients with fingolimod-associated progressive multifocal leukoencephalopathy (PML) identified from the Novartis data safety base and provide risk estimates for the disorder. The Novartis safety database was searched for PML cases with a data lock point of August 31, 2017. PML classification was based on previously published criteria. The risk and incidence were estimated using the 15 patients with confirmed PML and the overall population of patients treated with fingolimod. As of August 31, 2017, 15 fingolimod-treated patients had developed PML in the absence of natalizumab treatment in the preceding 6 months. Eleven (73%) were women and the mean age was 53 years (median: 53 years). Fourteen of the 15 patients were treated with fingolimod for >2 years. Two patients had confounding medical conditions. Two patients had natalizumab treatment. This included one patient whose last dose of natalizumab was 3 years and 9 months before the diagnosis of PML. The second patient was receiving fingolimod for 4 years and 6 months, which was discontinued to start natalizumab and was diagnosed with PML 3 months after starting natalizumab. Absolute lymphocyte counts were available for 14 of the 15 patients and none exhibited a sustained grade 4 lymphopenia (≤200 cells/μL). The risk of PML with fingolimod in the absence of prior natalizumab treatment is low. The estimated risk was 0.069 per 1,000 patients (95% confidence interval: 0.039-0.114), and the estimated incidence rate was 3.12 per 100,000 patient-years (95% confidence interval: 1.75-5.15). Neither clinical manifestations nor radiographic features suggested any unique features of fingolimod-associated PML. © 2018 American Academy of Neurology.

Magnetic resonance imaging may simulate progressive multifocal leucoencephalopathy in a patient with chronic lymphocytic leukemia after fludarabine therapy

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Kalita J

2008-01-01

Full Text Available A 60-year-old male with chronic lymphatic leukemia (CLL after 6 months of fludarabine therapy was admitted with status epilepticus and developed left hemiplegia. His magnetic resonance imaging revealed multiple T2 hyperintense lesions in the right frontal and left parieto-occipital lesion, simulating progressive multifocal leucoencephalopathy (PML. Cerebrospinal fluid Polymerase Chain Reaction (PCR for JC virus was negative. We suggest the possible role of fludarabine in producing PML-like lesions in patients with Chronic Lymphocytic Leukemia (CLL.

Squamous Cell Carcinoma of the Larynx Arising in Multifocal Pharyngolaryngeal Oncocytic Papillary Cystadenoma

Science.gov (United States)

Stenner, Markus; Müller, Klaus-Michael; Koopmann, Mario; Rudack, Claudia

2014-01-01

Abstract We report on a rare case of a laryngeal carcinoma arising in a multifocal pharyngolaryngeal oncocytic papillary cystadenoma (OPC). The disease of a 63-year-old man is well documented by computed and positron emission tomography, histology, and electron microscopy. We could show that an OPC can even develop in the pharynx. The coexistence of both tumors makes this a challenging diagnosis for pathologists. Treated by surgery and radiotherapy, both lesions dissolved. Based on the literature available, we discuss the theory that the laryngeal carcinoma might be the result of a true metaplasia facilitated by chronic irritation and recommend a regular follow-up for OPC too. As in benign oncocytic lesions, we could show that the detection of numerous mitochondria is a diagnostic indicator for malignant variants as well. PMID:25211046

Intoxicação aguda por cobre em ovinos

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Marcele Bettim Bandinelli

2013-10-01

Full Text Available Descrevem-se casos de intoxicação aguda por cobre em ovinos da raça Santa Inês, numa propriedade rural, no Rio Grande do Sul. Três ovelhas recém-paridas, que consumiam ração formulada para bovinos, ingeriram, avidamente, sal mineral comercial para bovinos e apresentaram doença clínica e morte, uma semana após a introdução do sal. Os animais desenvolveram anorexia, permaneceram em decúbito lateral, o qual evoluiu para esternal e apresentaram fasciculação e rigidez muscular generalizada, antes de morrerem. À necropsia de um desses animais, as principais alterações foram hepatomegalia moderada e acentuação do padrão lobular hepático, além de erosões e ulcerações multifocais aleatórias na mucosa abomasal. Na avaliação histológica do fígado, havia necrose hepatocelular centrolobular acentuada e difusa, tumefação de hepatócitos, predominantemente, na região periportal, além de pequena quantidade de células de Kupffer com pigmento granular citoplasmático. O diagnóstico baseou-se na história clínica, nos achados de necropsia e histopatológicos e confirmou-se pelas altas concentrações de cobre detectadas no tecido hepático e nas amostras de ração e sal mineral.

Sarcoma granulocítico multicêntrico como recidiva de leucemia mieloide aguda Multicentric granulocytic sarcoma as relapse of acute myelogenous leukemia

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Taciana G. S. Aguiar

2009-01-01

Full Text Available Sarcoma granulocítico (SG é um tumor sólido extramedular, constituído por células precursoras de granulócitos. É geralmente associado a leucemia mieloide aguda ou raramente a outras desordens mieloproliferativas. O tumor geralmente ocorre precedendo uma leucemia mieloide aguda, durante o seu curso ou após a remissão ter sido alcançada. O prognóstico é pobre e tem como principais modalidades terapêuticas a quimioterapia e a radioterapia. Relata- se um caso de SG multicêntrico, de evolução rápida, com acometimento difuso de pele, mamas, gânglios linfáticos, tecido celular subcutâneo e líquor, em mulher de 45 anos, fora de tratamento para leucemia mieloide aguda e em remissão hematológica há 18 meses. A paciente apresentava dor intensa em membro inferior direito há uma semana e estava em anticoagulação oral há seis meses por trombose venosa profunda neste membro. Diagnosticado o SG, a paciente foi tratada com radioterapia e quimioterapia com boa resposta. Após três meses de seguimento, em vigência do tratamento quimioterápico, evoluiu com recidiva do SG neste membro, associado ao acometimento das mamas e posteriormente do sistema nervoso central, evoluindo para óbito em aplasia e sepses.Granulocytic sarcoma is an extramedullary solid tumor consisting of immature granulocytic cells. It is often associated with acute myelogenous leukemia and more rarely with other myeloproliferative disorders. The tumor generally occurs before acute myeloid leukemia, during its course or after disease remission. It has a poor prognosis with the main therapeutic options being chemotherapy and radiotherapy. A multicentric accelerated case of granulocytic sarcoma of a 45- year- old woman with diffuse skin, breast, lymphatic ganglia and subcutaneous tissue presentations no longer undergoing treatment for acute myeloid leukemia and in hematologic remission for 18 months is reported. The patient presented with severe pain of right lower

Malondialdehyde in early phase of acute pancreatitis Malondialdehído en la fase inicial de la pancreatitis aguda

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Vicent Hernández

2011-11-01

Full Text Available Aims: to assess oxidative stress in acute pancreatitis, its evolution over time and its relationship with the severity of the disease. Methods: during a two-year period, patients with acute pancreatitis with less than 24 hours of pain were evaluated. Serum was obtained the first, second and fourth day from admittance, if complications were detected, and after recovery. Malondialdehyde was determined by high performance liquid chromatography. Twenty healthy volunteers constituted the control group. Malondialdehyde between groups was compared with Mann-Whitney and Kruskal-Wallis tests; malondialdehyde evolution was studied with Wilcoxon test. Results: one hundred and sixty-nine patients were included (91 women, median age 67 years, range 20-95; 33 suffered a severe episode. Malondialdehyde decreased from first to fourth day (0.600 vs. 0.451 vs. 0.343 μM, respectively, p 0.05. In severe attacks malondialdehyde was higher than in control group at day 2 (severe: 0.514; mild: 0.440; control: 0.347 μM, p Objetivos: valorar el estrés oxidativo en la pancreatitis aguda, su evolución a lo largo del tiempo y su relación con la gravedad de la enfermedad. Métodos: durante un periodo de dos años, se estudiaron los pacientes ingresados por pancreatitis aguda con dolor abdominal de menos de 24 horas de evolución. Se obtuvo suero de los pacientes el primer, segundo y cuarto día de ingreso, en el momento en que se detectaban complicaciones y tras la recuperación. La concentración de malondialdehído fue determinada utilizando cromatografía líquida de alta resolución. Veinte voluntarios sanos conformaron el grupo control. La concentración de malondialdehído entre los diferentes grupos se comparó utilizando el test de Mann-Whitney y el test de Kruskal-Wallis; la evolución de malondialdehído se valoró mediante el test de Wilcoxon. Resultados: se incluyeron 169 pacientes (91 mujeres, edad mediana 67 años, rango 20-95; 33 sufrieron un episodio

Chronic recurrent multifocal osteomyelitis with an atypical presentation in an adult man

International Nuclear Information System (INIS)

Hong, Cheng William; Hsiao, Edward C.; Horvai, Andrew E.; Link, Thomas M.

2015-01-01

We present the case of a 33-year-old man with no significant medical history who developed right scapular pain, left-sided sacroiliac joint pain, and lower back pain, and was eventually diagnosed with chronic recurrent multifocal osteomyelitis (CRMO). Imaging demonstrated multiple scattered T2-hyperintense lesions on MRI at the spine and the left SI joint, some of which progressed and one regressed in size on follow-up. Histopathology demonstrated only non-specific chronic inflammation compatible with CRMO. No evidence of infectious organisms or neoplastic processes was found. The pain was relapsing and remitting in nature. Laboratory investigations were notable for no evidence of hematologic malignancy or infection, but only a mild increase in alkaline phosphatase. This case highlights that CRMO, despite being thought of as a childhood-onset disease, can present in adults as well, and also provides illustrative examples of imaging and histological findings. (orig.)

Chronic recurrent multifocal osteomyelitis with an atypical presentation in an adult man

Energy Technology Data Exchange (ETDEWEB)

Hong, Cheng William [University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Cleveland Clinic, Lerner College of Medicine, Cleveland, OH (United States); Hsiao, Edward C. [University of California San Francisco, Division of Endocrinology and Metabolism, and the Institute for Human Genetics, Department of Medicine, San Francisco, CA (United States); Horvai, Andrew E. [University of California San Francisco, Department of Pathology, San Francisco, CA (United States); Link, Thomas M. [University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States)

2015-09-15

We present the case of a 33-year-old man with no significant medical history who developed right scapular pain, left-sided sacroiliac joint pain, and lower back pain, and was eventually diagnosed with chronic recurrent multifocal osteomyelitis (CRMO). Imaging demonstrated multiple scattered T2-hyperintense lesions on MRI at the spine and the left SI joint, some of which progressed and one regressed in size on follow-up. Histopathology demonstrated only non-specific chronic inflammation compatible with CRMO. No evidence of infectious organisms or neoplastic processes was found. The pain was relapsing and remitting in nature. Laboratory investigations were notable for no evidence of hematologic malignancy or infection, but only a mild increase in alkaline phosphatase. This case highlights that CRMO, despite being thought of as a childhood-onset disease, can present in adults as well, and also provides illustrative examples of imaging and histological findings. (orig.)

Multifocal Choroiditis with Retinal Vasculitis, Optic Neuropathy, and Keratoconus in a Young Saudi Male.

Science.gov (United States)

Dhafiri, Yousef; Al Rubaie, Khalid; Kirat, Omar; May, William N; Nguyen, Quan D; Kozak, Igor

2017-01-01

The purpose of this study is to describe an association of unilateral multifocal choroiditis (MFC), retinal vasculitis, optic neuropathy, and bilateral keratoconus in a young Saudi male. A 27-year-old male patient with stable bilateral keratoconus presented with a painless vision loss in his left eye. Ophthalmic examinations revealed multiple foci of idiopathic chorioretinitis, retinal vasculitis, and mild optic disc leakage on fluorescein angiography, all of which resolved on systemic therapy with mycophenolate mofetil and prednisone after 3 months. Systemic medication was stopped after 8 months. One year after presentation, patient's visual acuity has improved and remained stable. Systemic immunomodulatory therapy can be effective in managing and leading to resolution of MFC, retinal vasculitis, and optic disc leak in young patients.

Posterior reversible encephalopathy syndrome masquerading as progressive multifocal leukoencephalopathy in rituximab treated neuromyelitis optica.

Science.gov (United States)

Berger, Joseph R; Neltner, Janna; Smith, Charles; Cambi, Franca

2014-11-01

Both progressive multifocal leukoencephalopathy (PML) and posterior reversible encephalopathy syndrome (PRES) have been reported as complications of rituximab therapy. These disorders may appear indistinguishable on magnetic resonance imaging (MRI). We report on a 42 year old woman with neuromyelitis optica (NMO) of 10 years duration who developed extensive white matter disease affecting chiefly both parietal lobes 6 months after her first and only dose of rituximab. The MRI findings suggested the diagnosis of PML, but her history was more consistent with PRES. Ultimately, a brain biopsy was performed which was consistent with the diagnosis of PRES. PRES and PML may have overlapping symptomatology and be indistinguishable on MRI. An approach to distinguishing between these two disorders is addressed. Copyright © 2014. Published by Elsevier B.V.

Progressive multifocal leukoencephalopathy. Epidemiology, clinical pictures, diagnosis and therapy

International Nuclear Information System (INIS)

Kishida, Shuji

2007-01-01

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by the reactivation of a ubiquitous polyomavirus JC (JCV). PML was for many years a rare disease occurring only in patients with underlying severe impaired immunity. Over the past three decades, the incidence of PML has significantly increased related to the AIDS (acquired immunodeficiency syndrome) pandemic and, more recently, to the growing use of immunosuppressive drugs. The clinical presentation of PML is variable with neurological symptoms corresponding to affected cerebral areas. Usually, the clinical outcome of patients with PML is poor with an inexorable progression to death within 6 months of symptom onset. Although PML usually requires a brain biopsy or autopsy for confirmation, radiological imaging and a demonstration of JCV-DNA in the CSF (cerebrospinal fluid) provide supportive evidence for the diagnosis. Although there is no proven effective therapy for PML, patients with HIV (human immunodeficeincy virus)-related PML may benefit significantly from HAART (highly active antiretroviral therapy). In this article the author reviews the epidemiology, especially in Japan, current challenges in the diagnosis and the treatment guidelines of patients with PML based on recent advances in the understanding of the JC virus biology. (author)

Estudio experimiental de la infiltración leucocitaria de amígdalas palatinas durante la crisis aguda de la amigdalitis pultácea en niños: Implicaciones terapéuticas sobre la modulación de la inflamación

OpenAIRE

Alonso Rosa, D.; López González, M.A.; Mata Maderuelo, F.; Delgado Moreno, F.

2002-01-01

La infección de garganta es uno de los problemas más comunes durante la infancia. El Streptococcus pyogenes está presente en la mayoría de los casos de amigdalitis pultácea. El propósito de este estudio ha sido profundizar en el conocimiento de la respuesta inmune durante la crisis aguda y el período intercrisis de la amigdalitis pultácea. Veinte niños se diagnosticaron de amigdalitis aguda recurrente (más de 4 brotes por año durante más de 1 año) con indicación de amigdalectomía con o sin...

Piggyback intraocular lens implantation to correct pseudophakic refractive error after segmental multifocal intraocular lens implantation.

Science.gov (United States)

Venter, Jan A; Oberholster, Andre; Schallhorn, Steven C; Pelouskova, Martina

2014-04-01

To evaluate refractive and visual outcomes of secondary piggyback intraocular lens implantation in patients diagnosed as having residual ametropia following segmental multifocal lens implantation. Data of 80 pseudophakic eyes with ametropia that underwent Sulcoflex aspheric 653L intraocular lens implantation (Rayner Intraocular Lenses Ltd., East Sussex, United Kingdom) to correct residual refractive error were analyzed. All eyes previously had in-the-bag zonal refractive multifocal intraocular lens implantation (Lentis Mplus MF30, models LS-312 and LS-313; Oculentis GmbH, Berlin, Germany) and required residual refractive error correction. Outcome measurements included uncorrected distance visual acuity, corrected distance visual acuity, uncorrected near visual acuity, distance-corrected near visual acuity, manifest refraction, and complications. One-year data are presented in this study. The mean spherical equivalent ranged from -1.75 to +3.25 diopters (D) preoperatively (mean: +0.58 ± 1.15 D) and reduced to -1.25 to +0.50 D (mean: -0.14 ± 0.28 D; P < .01). Postoperatively, 93.8% of eyes were within ±0.50 D and 98.8% were within ±1.00 D of emmetropia. The mean uncorrected distance visual acuity improved significantly from 0.28 ± 0.16 to 0.01 ± 0.10 logMAR and 78.8% of eyes achieved 6/6 (Snellen 20/20) or better postoperatively. The mean uncorrected near visual acuity changed from 0.43 ± 0.28 to 0.19 ± 0.15 logMAR. There was no significant change in corrected distance visual acuity or distance-corrected near visual acuity. No serious intraoperative or postoperative complications requiring secondary intraocular lens removal occurred. Sulcoflex lenses proved to be a predictable and safe option for correcting residual refractive error in patients diagnosed as having pseudophakia. Copyright 2014, SLACK Incorporated.

Associação dos níveis de citocinas no pós-transplante de células-tronco hematopoiéticas com a Doença do Enxerto Contra o Hospedeiro aguda Association of cytokine levels with acute graft versus host disease following full match allogeneic stem cell transplantation

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Jeane E. L. Visentainer

2005-09-01

Full Text Available Este estudo foi realizado para investigar se os níveis séricos de sIL-2R, TNF-alfa, IFN-gama, IL-6, IL-10 e TGF-beta1 estavam associados com o desenvolvimento de DECH (Doença do Enxerto Contra o Hospedeiro aguda. Os níveis de citocinas foram seqüencialmente mensurados por Elisa em 13 pacientes que haviam sido submetidos ao transplante alogênico de células progenitoras hematopoiéticas. Os níveis de sIL-2R e IL-10 da 1ª a 15ª semanas pós-transplante foram significativamente maiores no grupo que desenvolveu DECH aguda que naquele sem a doença. Os níveis de sIL-2R aumentaram em direta correlação com a pega do enxerto e ao tempo do DECH aguda, enquanto os níveis de IL-10 aumentaram transitoriamente pós-transplante. A média da concentração de TNF-alfa nas primeiras semanas após o transplante foi maior no grupo que desenvolveu DECH aguda. Além disso, uma queda dos níveis de TGF-beta1 após a pega esteve significativamente associada à DECH aguda. Nenhuma correlação foi encontrada entre DECH aguda e as outras citocinas investigadas. Estes resultados suportam a idéia de que um balanço entre as citocinas derivadas de linfócitos T auxiliadores do tipo 1 e 2 pode ser importante no desenvolvimento e controle da DECH aguda. Embora os níveis de sIL-2R, TNF-alfa, IL-10 e TGF-beta1 tenham sido correlacionados com a DECH aguda, os níveis de sIL-2R ao tempo da pega podem prover um melhor parâmetro para a detecção precoce de DECH aguda após o transplante alogênico.This study was performed to investigate whether the serum levels of sIL-2R, TNF-alpha, IFN-gamma, IL-6, IL-10, and TGF-beta1 are associated with the development of acute GVHD. Serum cytokine levels were sequentially measured by sandwich Enzyme Linked-Immuno-Sorbent Assay (Elisa in 13 patients who had received full match allogeneic stem cell transplantation. Serum sIL-2R and IL-10 levels from the 1st to the 15th week post transplantation were significantly higher in the

Linfonodo pulmonar na paracoccidioidomicose aguda infantil (relato de um caso

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Evanil Pires de Campos

1992-09-01

Full Text Available Observou-se a evolução de um linfonodo pulmonar na paracoccidioidomicose (PCM aguda infantil. Doente, masculino, 6 anos, branco, natural de Curitiba (PR, procedente de Guaratinguetá (SP, que há 3 meses desenvolveu quadro gripal, febre diária, bimodal, prolongada, precedida de calafrio, acompanhada de sudorese inodora, cefaléia frontal e anorexia. Diagnosticado e tratado como pneumonia por cinco dias, sem melhora do quadro. Há 2 meses, apresentou dor óssea nos braços e articulações do pé, com edema inflamatório e emagrecimento de 6 kg em 3 meses. Exame físico revelou: peso 20 kg; estatura 120 cm; P. A. 90/60 mmHg; facies atípica, hipoativo, palidez cutâneo-mucosa (+ +, hipotrofia muscular, adenopatiageneralizada, sopro sistólico suave em foco aórtico acessório e hepatesplenomegalia. Imunodifusão com exoantígeno glicoprotéico 43 kdpositiva (1/32. A biópsia de gânglio revelou Paracoccidioides brasiliensis. A radiologia demonstrou na primeira consulta, discreto infiltrado intersticial bilateral com linfoadenomegaliapara-hilar que desaparecu em 30 dias. Observou- se, ainda, massa tumoral mediastínica superior, hiperplasia do sistema fagocítico mononuclear e lesões osteolíticas nos 60 dias iniciais da evolução.

Contaminación atmosférica, asma bronquial e infecciones respiratorias agudas en menores de edad, de La Habana Air pollution, bronchial asthma, and acute respirator and infections in children less years of age, Habana City

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Manuel Romero-Placeres

2004-06-01

Full Text Available OBJETIVO: Identificar la relación que guardan las consultas de urgencias por enfermedades respiratorias agudas, crisis agudas de asma bronquial e infecciones respiratorias agudas, con los cambios diarios en los niveles de contaminación atmosférica, en menores de 14 años de edad que fueron atendidos en dos centros hospitalarios de la ciudad de La Habana. MATERIAL Y MÉTODOS: Se realizó un estudio ecológico de series de tiempo durante el periodo comprendido entre el 1 de octubre de 1996 y el 11 marzo de 1998. Se estudió la asociación entre la presencia de crisis agudas de asma bronquial, infecciones respiratorias agudas y enfermedades respiratorias agudas por un lado, y la exposición a niveles de partículas menores de 10 µg/m³ (PM10, humo y dióxido de azufre (SO2, por otro; asimismo, se construyeron modelos con la técnica de regresión binomial negativa, para estudiar periodos de latencia de 1 a 5 días y el efecto acumulado de siete días, previos a las consultas de urgencia. RESULTADOS: Los niveles de contaminación atmosférica, por lo general, resultaron bajos, ya que el promedio de 24 horas para PM10, humo y SO2 fue de 59.2 µg/m³ (DE=29.2, 27.7 µg/m³ (DE=21.2 y 21.1 µg/m³ (DE=20.1, respectivamente. Un incremento de 20 µg/m³ en el promedio diario de humo se relacionó con un incremento de 2.2% (IC 95% 0.9-3.6 en el número de consultas de urgencias por crisis agudas de asma bronquial. Un incremento de 20 µg/m³ en el promedio diario de humo y de SO2 se relacionó con un incremento en las infecciones respiratorias agudas de 2.4% (95% CI 1.2-3.6 y 5% (95% CI 1.3-5.3, respectivamente, con un retraso de cinco días. Además, se presentó un efecto acumulado en todos los contaminantes estudiados. CONCLUSIONES: Los resultados sugieren que los niveles de contaminantes atmosféricos en la ciudad de La Habana afectan la salud respiratoria de los niños, por lo que se requiere de la aplicación de medidas de control, en particular

Cirurgia conservadora da endocardite bacteriana aguda da valva tricúspide Conservative operation for bacterial endocardites of the tricuspide valve

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Iseu Affonso da Costa

1988-08-01

Full Text Available É relatado o caso de 1 paciente que apresentou endocardite aguda da valva tricúspide pós-aborto, cujo agente causal era o S. aureus. Como não houvesse resposta favorável ao tratamento antibiótico (gentamicina, vancomicina e oxacilina, optou-se pela intervenção, vinte dias após a internação. Foi praticada excisão de uma vegetação única e do tecido valvar adjacente, na comissura ântero-posterior e plicatura anular. O resultado foi favorável, com cura clínica. O exame ecocardiográfico confirmou a presença da vegetação no pré-operatório e o funcionamento conservado da valva, após a plastia. O tratamento cirúrgico, com retirada do tecido infectado e preservação da valva constitui uma alternativa aplicável a certos casos de endocardite aguda das valvas atrioventriculares.One case of acute bacterial endocarditis of the tricuspid valve caused by S. aureus and following a septic abortion is presented. Surgical treatment was indicated after failure of antibiotics. Operation consisted of excision of a large vegetation adherent to the anterior and posterior cusps at the commisure and of the affected valvar tissue. Annular plicature at the segment corresponding to the posterior cuspid was employed to maintain competence. Clinical result was very satisfactory with resolution of sepsis. Dopplerecocardiography revealed the presence of the vegetation before the operation and showed a small regurgitation after valvoplasty. Conservative operation upon the atrioventricular valves must be kept in mind as an alternative in the treatment of acute bacterial endocarditis.

Estado nutricional como fator prognóstico em crianças portadoras de Leucemia Linfocítica Aguda

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Borim Leila N. B.

2000-01-01

Full Text Available Com o objetivo de conhecer a frequência de desnutrição proteico-calórica ao diagnóstico e avaliar a sua importância na evolução clínica de crianças portadoras de Leucemia Linfocítica Aguda, com idades inferiores a quinze anos, estudamos trinta e oito crianças com Leucemia Linfocítica Aguda e sem tratamento prévio, atendidas no Hospital de Base de São José do Rio Preto-SP, no período de Setembro/89 a Dezembro/97. Entre as crianças, 63,2% eram do sexo masculino e 36,8% do sexo feminino (1,7:1,0, a faixa etária predominante foi de cinco a nove anos (44,8%, seguida daquela entre um e quatro anos (36,8%, superscript three 10 anos (10,5% e menores de um ano (7,9%. Ao diagnóstico, 52,7% eram eutróficos e 47,3% desnutridos (escore Z. Os índices nutricionais avaliados foram peso/estatura, estatura/idade e peso/idade e 21%, 34,2% e 31,5% deles, respectivamente, estavam abaixo da normalidade. Foi observada uma alta frequência de desnutrição ao diagnóstico. Porém, na avaliação do estado nutricional, entre os pacientes vivos e não-vivos, a presença de desnutrição não foi estatisticamente significativa. Este estudo reforçou a evidência da necessidade de estabelecer uma rotina de avaliação nutricional ao diagnóstico, bem como, a presença de um profissional especializado em nutrição, numa unidade de oncologia pediátrica.

Apendicite aguda: achados na tomografia computadorizada - ensaio iconográfico Acute appendicitis: computed tomography findings - an iconographic essay

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Marcelo Eustáquio Montandon Júnior

2007-06-01

Full Text Available A apendicite aguda é a causa mais comum de dor abdominal aguda que requer intervenção cirúrgica no mundo ocidental. O diagnóstico precoce é essencial para minimizar a morbidade da doença. O uso dos métodos de imagem significou grande avanço no diagnóstico desta entidade, até então avaliada apenas com base na história clínica, exame físico e dados laboratoriais, haja vista que 20% a 33% dos pacientes apresentam sintomas atípicos. O diagnóstico é mais difícil nas crianças, nos idosos e nas mulheres em idade fértil. Os principais métodos de imagem para sua avaliação são a ultra-sonografia e a tomografia computadorizada. Os objetivos deste trabalho são: descrever a fisiopatologia da doença, comentar os principais aspectos técnicos da tomografia computadorizada, demonstrar e ilustrar os achados tomográficos e citar os principais diagnósticos diferenciais.Acute appendicitis is the most important cause of abdominal pain requiring surgical intervention in the Western world. The early diagnosis of this disease is of paramount relevance for minimizing its morbidity. Imaging methods have represented a huge progress in the diagnosis of this entity, which used to be based essentially on clinical history, physical examination and laboratory tests results, considering that 20% to 33% of patients present with atypical symptoms. Diagnostic difficulty is higher in children, the elderly, and women in childbearing age. The main imaging methods for evaluation of acute appendicitis are ultrasound and computed tomography. The present study is aimed at describing the disease physiopathology, commenting main computed tomography technical aspects, demonstrating and illustrating tomographic findings, and describing main differential diagnoses.

Idiopathic multifocal choroiditis/punctate inner choroidopathy with acute photoreceptor loss or dysfunction out of proportion to clinically visible lesions

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Munk, Marion R.; Jung, Jesse J.; Biggee, Kristin; Tucker, William R.; Sen, H. Nida; Schmidt-Erfurth, Ursula; Fawzi, Amani A.; Jampol, Lee M.

2014-01-01

Purpose To report acute/subacute vision loss and paracentral scotomata in patients with idiopathic multifocal choroiditis/punctate inner choroidopathy (MFC/PIC) due to large zones of acute photoreceptor attenuation surrounding the chorioretinal lesions. Methods Multimodal-imaging case-series Results Six females and 2 males were included (mean age 31.5±5.8 years). Vision ranged from 20/20-1 to hand motion (mean 20/364). SD-OCT demonstrated extensive attenuation of the external limiting membrane (ELM), ellipsoid and interdigitation zones, adjacent to the visible MFC/PIC lesions. The corresponding areas were hyperautofluorescent on fundus-autofluorescence (FAF), and were associated with corresponding visual field defects. Full-field ERG (available in 3 cases) showed markedly decreased cone/rod response and multifocal ERG revealed reduced amplitudes and increased implicit times in 2 cases. Three patients received no treatment, the remaining were treated with oral corticosteroids (n=4), oral acyclovir/valacyclovir (n=2), intravitreal/posterior subtenon triamcinolone-acetate (n=3) and anti-VEGF (n=2). Visual recovery occurred in only 3 cases, of whom 2 were treated. Varying morphological recovery was found in 6 cases, associated with decrease in hyperautofluorescence on FAF. Conclusions MFC/PIC can present with transient or permanent central photoreceptor attenuation/loss. This presentation is likely a variant of MFC/PIC with chorioretinal atrophy. Associated changes are best evaluated using multimodal imaging. PMID:25322466

La Proteína C reactiva como predictor de la evolución de la neumopatía aguda comunitaria

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De Los Santos, Ernesto; Quijano, Ana Laura; Castrillón, Carolina; Grille, Sofía; Frugon, Fiorella; Mariño, Nicolás

2013-01-01

La Proteína C reactiva es un biomarcador sensible, específico y buen predictor del fracaso terapéutico de las neumonías. A nivel mundial hay posturas controversiales sobre su utilidad. En nuestro medio no hay estudios reportados al respecto. El propósito de nuestro trabajo fue intentar predecir la evolución de la neumonía aguda comunitaria (NAC). A todos los pacientes con diagnostico de NAC ingresados al Hospital Español durante junio y julio de 2012 se les dosificó los niveles de PcR a las 2...

Insuficiência Hepática Aguda da Gravidez Experiência Clínica com Sete Casos Acute Liver Failure of Pregnancy ¾ Clinical Experience with Seven Cases

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Marcelo Perosa

2001-04-01

Full Text Available Objetivos: avaliar a dificuldade diagnóstica, o tratamento e seu resultado em casos de insuficiência hepática aguda da gravidez. Métodos: sete pacientes com insuficiência hepática aguda da gravidez admitidas em nosso Serviço nos últimos quatro anos foram estudadas com ênfase nos sintomas presentes, achados laboratoriais, curso clínico, complicações maternas e sobrevida fetal. Resultados: a média de idade foi de 25,8 anos (sendo duas primigestas com idade gestacional média de 30,1. Destas, quatro receberam diagnóstico final de esteatose hepática aguda da gravidez e três de colestase intra-hepática da gravidez. Os principais sinais e sintomas encontrados foram: anorexia, náusea, dor abdominal, icterícia e encefalopatia. Ocorreu morte materna em dois casos: uma paciente por falência hepática enquanto aguardava órgão para transplante e outra por falência hepática, coagulopatia grave e choque hemorrágico após biópsia hepática. Uma paciente com esteatose hepática aguda evoluiu para cronicidade e encontra-se viva um ano após transplante hepático. Nos quatro casos restantes houve completa remissão do quadro com as medidas de suporte, associadas à interrupção da gravidez. As mortalidades materna e fetal foram, respectivamente, 28,6% e 57,1%. Conclusões: concluiu-se, nesta experiência inicial, que a insuficiência hepática aguda da gravidez constitui evento clínico grave, de elevada mortalidade materno-fetal, e que seu pronto reconhecimento e encaminhamento para centros terciários especializados em fígado, além da imediata interrupção da gestação, são fatores decisivos para o sucesso do tratamento.Purpose: to evaluate the diagnostic difficulties, treatment and outcome in cases of acute liver failure of pregnancy. Methods: seven patients with acute liver failure of pregnancy, managed during the past 4 years, were studied with emphasis on presenting symptoms, laboratory findings, clinical course, maternal

Leucemias agudas en ancianos de la provincia de Santiago de Cuba

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Lidia Clara Suárez Beyríes

2015-04-01

Full Text Available Se realizó un estudio descriptivo y retrospectivo de 64 pacientes mayores de 60 años con leucemia aguda, atendidos en el Servicio de Hematología del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, durante el quinquenio 2006-2011, para determinar las principales características clínicas y hematológicas en el momento del diagnóstico, así como la supervivencia global de los afectados, aunque los tratamientos administrados no tenían criterio curativo. La edad promedio de los ancianos fue de 70 años, en un rango etario de 60 a 90; en tanto, la variedad no linfoblástica representó 98,4 %, y todos los pacientes presentaron anemia y trombocitopenia como alteraciones hematológicas, con incremento en los requerimientos transfusionales. De igual forma, la presencia de blastos en la sangre periférica se demostró en 50 % y la hiperleucocitosis en 59,4 %, mientras las principales causas de muerte estuvieron relacionadas con la hemorragia cerebral y la progresión de la enfermedad con la infiltración multiorgánica, lo cual condujo a una supervivencia muy corta de los integrantes de la serie

Small-Gauge Pars Plana Vitrectomy for the Management of Symptomatic Posterior Vitreous Detachment after Phacoemulsification and Multifocal Intraocular Lens Implantation: A Pilot Study from the Pan-American Collaborative Retina Study Group

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Navarro, Rodrigo M.; Machado, Leonardo M.; Maia, Ossires; Wu, Lihteh; Farah, Michel E.; Magalhaes, Octaviano; Arevalo, J. Fernando; Maia, Mauricio

2015-01-01

Purpose. To determine the efficacy of 23-gauge pars plana vitrectomy (PPV) for symptomatic posterior vitreous detachment (PVD) on visual acuity (VA) and quality after multifocal intraocular lenses (IOLs). Methods. In this prospective case series, patients who developed symptomatic PVD and were not satisfied with visual quality due to floaters and halos after multifocal IOL implantation underwent PPV. Examinations included LogMAR uncorrected visual acuity (UCVA), intraocular pressure, biomicroscopy, and indirect ophthalmoscopy at baseline and 1, 7, 30, and 180 days postoperatively. Ultrasonography and aberrometry were performed. The Visual Functioning Questionnaire 25 (VFQ-25) was administered preoperatively and at 30 days postoperatively. Both the postoperative UCVA and questionnaire results were compared to preoperative findings using the Wilcoxon test. Results. Sixteen eyes of 8 patients were included. VA significantly improved from 0.17 to 0.09 postoperatively (P = 0.017). All patients reported improvement of halos, glare, and floaters. VFQ-25 scores significantly improved in general vision (P = 0.023), near activities (P = 0.043), distance activities (P = 0.041), mental health (P = 0.011), role difficulties (P = 0.042), and driving (P = 0.016). Conclusion. PPV may increase UCVA and quality of vision in patients with bilateral multifocal IOLs and symptomatic PVD. Larger studies are advised. PMID:26504590

Lesão pulmonar aguda associada à transfusão Transfusion-related acute lung injury

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Antonio Fabron Junior

2007-04-01

Full Text Available Lesão pulmonar aguda associada à transfusão (transfusion-related acute lung injury, TRALI é uma complicação clínica grave relacionada à transfusão de hemocomponentes que contêm plasma. Recentemente, TRALI foi considerada a principal causa de morte associada à transfusão nos Estados Unidos e Reino Unido. É manifestada tipicamente por dispnéia, hipoxemia, hipotensão, febre e edema pulmonar não cardiogênico, que ocorre durante ou dentro de 6 h, após completada a transfusão. Embora o exato mecanismo não tenha sido totalmente elucidado, postula-se que TRALI esteja associada à infusão de anticorpos contra antígenos leucocitários (classes I ou II ou aloantígenos específicos de neutrófilos e a mediadores biologicamente ativos presentes em componentes celulares estocados. A maioria dos doadores implicados em casos da TRALI são mulheres multíparas. TRALI, além de ser pouco diagnosticada, pode ainda ser confundida com outras situações de insuficiência respiratória aguda. Um melhor conhecimento sobre TRALI pode ser crucial na prevenção e tratamento desta severa complicação transfusional.Transfusion-related acute lung injury (TRALI is a serious clinical syndrome associated with the transfusion of plasma-containing blood components. Recently, TRALI has come to be recognized as the leading cause of transfusion-related death in the United States and United Kingdom. This complication typically presents as shortness of breath, hypoxemia, hypotension, fever and noncardiogeneic pulmonary edema, all occurring during or within 6 h after transfusion. Although the mechanism of TRALI has not been fully elucidated, it has been associated with human leukocyte antigen antibodies (class I, class II or neutrophil alloantigens and with biologically active mediators in stored cellular blood components. Most of the donors implicated in cases of TRALI are multiparous women. Rarely diagnosed, TRALI can be confused with other causes of acute

Virus isolation and molecular characterization of canine distemper virus by RT-PCR from a mature dog with multifocal encephalomyelit Isolamento e caracterização molecular do vírus da cinomose canina por RT-PCR a partir de um cão adulto com encefalomielite multifocal

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Alexandre Mendes Amude

2007-06-01

Full Text Available A case of multifocal distemper encephalomyelitis in a mature dog is described. In the presented case the ante mortem clinical diagnosis of canine distemper virus (CDV infection could not be ideally performed due to the absence of typical signs of distemper, such as myoclonus and systemic signs accompanying the nervous signs. The definitive diagnosis of distemper encephalomyelitis was only carried out at post mortem through virus isolation in cell culture from fresh central nervous system (CNS fragments and CDV nucleoprotein gene detection in the CNS by RT-PCR.Descreve-se um caso de encefalomielite multifocal pela cinomose em um cão adulto. No caso apresentado o diagnóstico clínico da infecção pelo vírus da cinomose canina (CDV não pode ser adequadamente realizado devido à ausência de sinais típicos da enfermidade, tais como mioclonia e sinais sistêmicos. O diagnóstico definitivo somente foi possível post mortem pelo isolamento do CDV em cultivo celular a partir dos fragmentos frescos do sistema nervoso central (SNC e pela detecção do gene da nucleoproteína do CDV em fragmentos do SNC por meio da RT-PCR.

Consumo alimentar e estresse em pacientes com síndrome coronariana aguda

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Evelise Helena Fadini Reis Brunori

2015-10-01

Full Text Available RESUMOObjetivo:Avaliar se o consumo alimentar de pacientes com síndrome coronariana aguda (SCA segue as recomendações nacionais e internacionais e se existe relação com níveis de estresseMétodo:Estudo transversal com 150 pacientes com SCA que foram entrevistados utilizando-se os Questionários de Frequência Alimentar e Escala de Estresse Percebido-10.Resultados:Consumo diário acima das recomendações: colesterol (92%, fi bras (42,7% e proteínas (68%; consumo abaixo das recomendações: potássio (88% e carboidratos (68,7%; consumo conforme recomendações: sódio (53,3% e lípides (53,3%. A maioria (54% com consumo alimentar inadequado era estressada ou altamente estressada. Houve associação estatisticamente signifi cante entre menor nível de estresse e maior consumo de fibras.Conclusão:Em pacientes com SCA, o consumo alimentar esteve fora do recomendado pelas diretrizes e o menor consumo de fibras ocorre concomitantemente com maior estresse. Esforços educativos podem instrumentalizar os pacientes na adequação do consumo alimentar e no controle do estresse.

Multifocal pancreatic serous cystadenoma with atypical cells and focal perineural invasion.

Science.gov (United States)

Kamei, K; Funabiki, T; Ochiai, M; Amano, H; Kasahara, M; Sakamoto, T

1991-10-01

A case of multifocal pancreatic serous cystadenoma with atypical cells is reported. The patient was a 72-yr-old female who complained of jaundice. The distal common bile duct was obstructed, and the proximal bile duct was remarkably dilated on cholangiography. The main portal vein was obstructed and collateral vessels had developed on portal angiography. Total pancreatectomy was performed. The resected specimen contained one tumor in the head of the pancreas, five in the body, and one in the tail. The tumors of the head and body were morphologically the same. Microscopically, both contained spongelike multilocular cysts on their cut surfaces. These cysts were covered with low cuboid epithelium containing clear cytoplasm and abundant glycogen. Neural invasion was also found. The tumor cells exhibited an increased N/C ratio, variable nuclear size, irregular nuclear margins, and coarse nuclear chromatin. These tumors had aneuploid nuclear DNA with a DNA index of 1.9 and a proliferation index of 0.28. We feel that it is necessary to reconsider the biological concept of serous cystadenoma.

ANALYSIS OF THE RESULTS OF PRESBYOPIA CORRECTION WITH APPLICATION OF A BI-ASPHERIC MULTIFOCAL PROFILE ON THE CORNEA BY THE PRK FOR PATIENTS WITH MYOPIA AND HYPEROPIA

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E. N. Eskina

2017-01-01

Full Text Available Purpose. To compare the efficacy, safety and predictability of presbyopia correction by the PRK with application of a bi-aspheric multifocal profile on the cornea with PresbyMax software for patients with hyperopia and myopia.Patients and methods: There were 2 patients group of 25 people each (50 eyes. They were operated with PRK method with application of a multifocal biaspheric profile for simultaneous correction of ametropia and presbyopia. Group I — patients with myopia and presbyopia. Group II — patients with hypermetropia and presbyopia.Results. In the group 1 year post operation binocular DUCVA was 0,93±0,19, NUCVA — 0,86±0,14, IUCVA — 0,67±0,11. Only two eyes (4 % lost DBCVA on the 1–2 lines. Target refraction of a dominant eye — emmetropia was 72 % of patients, 28 % observed myopia of –0,75 D. Target refraction of a nondominant eye was –0,75, 68 % had this result, 28 % had deviation –0,50 D of the target refraction, and 4 % — 1,00 D. In group 2 a year post operation binocular DUCVA was 0,96±0,16, NUCVA — 0,77±0,19, IUCVA — 0,64±0,15. Only two eyes (4 % lost DBCVA on the 1–2 lines. Target refraction of a dominant eye — emmetropia was 72 % of patients, 28 % observed myopia of –0,75 D. Target refraction of a nondominant eye was –0,75, 68 % had this result, 32 % had deviation to –0,75 D of the target refraction.Conclusions. PRK with application of a bi-aspheric multifocal profile on the cornea using PresbyMAX software and µ-monovision is effective for correction myopia and hypermetropia. Simultaneous correction of ametropia and presbyopia by the PRK method with the application of the multifocal biospheric profile to the cornea with the formation of a slight anisometropia (the concept of µ-monovision with the PresbyMax software is an effective, safe and predictable method of surgical intervention, both in myopia and hypermetropia.

Estudo epidemiológico e avaliação de fatores de risco da infecção por Toxoplasma gondii e achados clinico-patológicos da infecção aguda em cães admitidos em um Hospital Escola Veterinário

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Angelita D. Strital

Full Text Available RESUMO: Esse trabalho teve como objetivo estudar a prevalência e respectivos fatores de risco para infecção do Toxoplasma gondii em cães provenientes de uma população hospitalar. Além disso, avaliou-se as taxas de ocorrência e as repercussões clínico-patológicas da infecção aguda pelo T. gondii nesses animais. Anticorpos foram detectados em 7% (26/386 da população estudada, composta de 386 cães de ambos os sexos e diferentes raças e idades. Somente as variáveis, ingestão de vísceras, origem rural e contato com bovinos apresentaram valores significativos com p<0.05. Adicionalmente os cães de origem rural apresentaram maiores risco (OD=7.00 de infecção do que aqueles de origem urbana. Em 6,5% (25/386 foram detectados títulos de contato (entre 16 e 256; esses títulos não significam necessariamente infecção aguda e sim apenas exposição prévia. É de fundamental importância o reconhecimento da infecção prévia por T. gondii nesses pacientes hospitalares. Dependendo da causa da admissão, mesmo não sendo a toxoplasmose a responsável, o paciente deve receber o tratamento anti-protozoário profilaticamente ou ser monitorado para posterior tratamento em caso de reagudização da enfermidade por recrudescência dos bradizoítos encistados. Apenas um animal (3.44%, 1/386 foi admitido com titulação elevada, o qual pode ser sugestivo de infecção aguda (titulo de 4096. Embora o animal com infecção aguda tenha sido apresentado com sinais neurológicos, cautela é necessária para não extrapolar uma falsa interpretação que a toxoplasmose é a grande responsável por quadros neurológico, uma vez que inúmeros outros casos incluídos nesse estudo tinham manifestações neurológicas e não tinham títulos de infecção aguda, nem mesmo título de contato prévio. A toxoplasmose aguda não foi uma afecção clínica expressiva nessa ambiência hospitalar, no entanto diagnóstico diferencial deve ser feito nos pacientes

Dacriocistitis aguda neonatal (1996-2005 Acute neonatal dacryocystitis

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Zoila del S López Díaz

2006-12-01

Full Text Available Se realizó un estudio longitudinal y retrospectivo en diez años (1996-2005, de todos los neonatos cuyo motivo de ingreso en nuestra Unidad de Cuidados Intensivos Neonatales fue ser portadores de dacriocistitis aguda. Se obtuvo los siguientes resultados: incidencia 0,04 c/ 100 ingresos. Predominio: edades entre 7-27días (sepsis tardía, sexo femenino 66,6 %, nacidos de embarazos a término y con buen peso al nacer 100 %. Etiología no precisada 83,3 %. Tratamiento utilizado: antibioticoterapia (penicilina + gentacina, 4 pacientes, 66,6 %, (unasyn, 1 paciente, 16,6 %, (amoxicilina + unasyn + gentamicina, 1 paciente, 16,6 %; uso de inmunoglobulina humana en 2 pacientes. Complicaciones: celulitis facial y periorbitaria 66,6 %; absceso periorbitario 33,3 %; fiebre (33,3 % y obstrucción nasal 16,6 %. Evolución satisfactoria con seguimiento por Oftalmología después del egreso hospitalario, en 100 % de los casosA retrospective longitudinal study of all neonates admitted to our Intensive Care Unit because they suffered from acute dacryocystitis was performed for 10 years (1996-2005. The results were as follows: incidence rate of 0,04 per 100 admissions; prevalence: 7-27d age groups (late sepsis, females with 66,6%; neonates born to term pregnancies and with good birthweight in 100%. Inaccurate etiology in 83,3 %. Treatment: antibiotic therapy (penicilline + gentamycin in 4 paients, 66,6%, (unasyn, one patient, 16,6 %, (amoxycillin + unasyn +gentamycin, 1 patient, 16.6 %. Use of human immunoglobulin in 2 patients. Complications: facial and periorbital cellulitis, 66,6%; periorbital abscess 33,3 %; fever (33,3 % and nasal obstruction (16,6 %. Satisfactory recovery with ophtalmological follow-up after discharge from hospital in 100 % of cases

Influência da criação de um serviço de tratamento da dor aguda nos custos e no consumo de drogas analgésicas na sala de recuperação pós-anestésica

OpenAIRE

Gomes,Marcos Emanuel Wortmann; Evangelista,Paulo Ernani; Mendes,Florentino Fernandes

2003-01-01

JUSTIFICATIVA E OBJETIVOS: Sabe-se que a dor aguda pós-operatória apresenta grande influência na evolução dos pacientes cirúrgicos. Mobilização precoce, menor tempo de hospitalização, diminuição de custos e maior satisfação são resultados do adequado manuseio da dor. Observa-se uma tendência mundial ao surgimento de serviços especializados no tratamento da dor pós-operatória. O presente estudo visa descrever a influência da criação de um serviço de tratamento da dor aguda pós-operatória nos c...

Fatores de risco para internação por doença respiratória aguda em crianças até um ano de idade Risk factors for acute respiratory disease hospitalization in children under one year of age

OpenAIRE

Silvia Elaine Cardozo Macedo; Ana Maria Baptista Menezes; Elaine Albernaz; Paulo Post; Marli Knorst

2007-01-01

OBJETIVO: Avaliar fatores de risco para hospitalização por doença respiratória aguda em crianças até um ano de idade. MÉTODOS: Estudo de casos e controles na cidade de Pelotas, RS. Os casos foram crianças de até um ano de idade, que se hospitalizaram por doença respiratória aguda, de agosto de 1997 a julho de 1998. Os controles foram crianças da comunidade, da mesma idade, sem hospitalização prévia por essa doença. Um questionário investigando exposição a fatores de risco foi aplicado às mães...

Fibrilação atrial, infarto agudo do miocárdio e oclusão arterial aguda em paciente jovem com hipertireoidismo

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Fabrício Thebit Bortolon

2009-09-01

Full Text Available Relato de caso de paciente jovem com hipertireoidismo não diagnosticado, apresentando quadro de fibrilação atrial, infarto agudo do miocárdio e oclusão arterial aguda de perna direita. Submetido à trombólise, embolectomia e iniciado tratamento para hipertireoidismo com tapazol. A evolução foi satisfatória, com reversão da alteração eletrocardiográfica isquêmica, melhora dos sintomas de oclusão arterial, controle do ritmo cardíaco e da função tireoidiana.

Transplante de células-tronco hematopoéticas em crianças e adolescentes com leucemia aguda: experiência de duas instituições Brasileiras Hematopoietic stem cell transplantation in children and adolescents with acute leukemia: experience of two Brazilian institutions

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Juliane Morando

2010-01-01

Full Text Available O transplante de células-tronco hematopoéticas (TCTH é o tratamento de escolha para leucemias agudas de alto risco. Apesar da melhora na sobrevida destes pacientes, a recidiva continua sendo a maior causa de óbito pós-transplante de células-tronco hematopoéticas. O objetivo deste trabalho foi analisar os resultados dos transplantes realizados em crianças com leucemia aguda em duas instituições brasileiras. Realizou-se estudo retrospectivo de 208 pacientes transplantados entre 1990-2007. Mediana de idade: 9 anos; 119 pacientes com leucemia linfoide aguda (LLA e 89 com leucemia mieloide aguda (LMA. Doença precoce: CR1 e CR2. Doença avançada: >CR3, doença refratária ou recidivada. Noventa pacientes vivos entre 258-6.068 dias (M:1.438, com sobrevida global (SG de 45% (3 anos e a sobrevida livre de recaída (SLR 39% (três anos. 14/195 pacientes tiveram falha primária de pega (8%. Não houve diferença na sobrevida global e sobrevida livre de recaída entre pacientes com leucemia linfoide aguda e leucemia mieloide aguda, entre transplantes aparentados e não aparentados, tampouco entre as fontes de células utilizadas. O desenvolvimento da doença do enxerto contra hospedeiro (DECH aguda ou crônica também não influenciou a sobrevida global e sobrevida livre de recaída. Pacientes com leucemia linfoide aguda condicionados com irradiação corporal total (TBI apresentaram melhor sobrevida global e sobrevida livre de recaída (pHematopoietic Stem Cell transplantation (HSCT is the treatment of choice for patients with high-risk leukemia. In spite of this, relapse remains a major cause of death of these patients. Our objective was to analyze the outcomes of patients with acute leukemia submitted to hematopoietic stem cell transplantation in two Brazilian institutions. A retrospective study of 208 patients transplanted between 1990 and 2007 with a median age of 9 years (range: 1-18 years was made. One hundred and nineteen patients had

Leucemia mielóide aguda (LMA secundária à trombocitemia essencial (TE: um relato de caso

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Marcelo Gil Cliquet

2015-10-01

Full Text Available Introdução: A trombocitemia essencial é classificada como pertencente ao grupo de distúrbios mieloproliferativos clássicos BCR/ABL negativos. A progressão para leucemia aguda é rara (<2% e é considerada, na maioria das vezes, no contexto da terapia leucemogênica. A transformação em leucemia pode demorar de 1,7 a 16 anos. Relato de caso: Paciente de 56 anos, do sexo feminino. Apresentou plaquetose de 655.000/mm3. Foram afastadas causas reacionais de plaquetose e solicitados exames como mutação da JAK2 (V617F presente, biópsia de medula óssea e cariótipo (Ph1 negativo, que mostraram-se compatíveis com diagnóstico de Trombocitemia Essencial. Em 2008 foi iniciado tratamento com Hidroxiureia mas a pedido da paciente houve mudança para Anagrelide. Como o controle com esse medicamento foi inadequado (plaquetose chegando a 1.000.000/mm3, foi reiniciando tratamento com Hidroxiureia, obtendo-se boa resposta, apesar do uso irregular.Em Maio de 2015 retornou ao serviço com hemograma de Março apresentando anemia (11,5g/dl, neutrófilos no limite inferior (1617/mm3 e plaquetas de 285.000/mm3. Apesar da suspensão da hydroxiureia por 1 semana, evoluiu com piora do hemograma, passando a apresentar pancitopenia. Foi solicitada avaliação de medula, resultando em diagnóstico de Leucemia Mielóide Aguda do tipo M6 com características de Síndrome Mieloproliferativa Crônica e de Síndrome Mielodisplasica e 20% de blastos Paciente veio a óbito por sangramentos e sepse após o primeiro ciclo. Conclusão: Apesar de pouco frequente, a transformação da Trombocitemia Essencial pode ocorrer e a observação constante desses pacientes deve sempre procurar alterações que possam sugerir esta complicação.

Avaliação da toxicidade aguda e potencial neurotóxico do óleo-resina de copaíba (Copaifera reticulata Ducke, Fabaceae

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Camile Giaretta Sachetti

Full Text Available O óleo-resina de copaíba obtido do gênero Copaifera L., Fabaceae, é largamente utilizado na medicina popular como antiinflamatório, antimicrobiano e antitumoral. Porém, informações sobre seu potencial tóxico são escassos na literatura. O objetivo deste estudo foi estabelecer a toxicidade oral aguda e os possíveis efeitos neurotóxicos relacionados à ingestão do óleo-resina de Copaifera reticulata Ducke, Fabaceae, em ratas Wistar. O estudo foi conduzido com quinze ratas nulíparas distribuídas nos grupos de doses 300 e 2000 mg/kg pc de óleo-resina administrado por gavagem. Os resultados obtidos mostraram que nestas doses não houve sinais clínicos de toxicidade ou neurotoxicidade, alteração no consumo de ração ou alteração no peso corpóreo. A dose letal aguda foi estimada como maior que 2000 mg/kg pc e classificada como categoria 5, segundo o Guia OECD 423. Estes resultados indicam que existe uma relativa margem de segurança para o uso do óleo-resina de copaíba como agente terapêutico, embora estudos toxicológicos adicionais sejam ainda necessários, principalmente com a administração repetida de baixas doses.

Improvement of the classification accuracy in discriminating diabetic retinopathy by multifocal electroretinogram analysis

Institute of Scientific and Technical Information of China (English)

无

2007-01-01

The multifocal electroretinogram (mfERG) is a newly developed electrophysiological technique. In this paper, a classification method is proposed for early diagnosis of the diabetic retinopathy using mfERG data. MfERG records were obtained from eyes of healthy individuals and patients with diabetes at different stages. For each mfERG record, 103 local responses were extracted. Amplitude value of each point on all the mfERG local responses was looked as one potential feature to classify the experimental subjects. Feature subsets were selected from the feature space by comparing the inter-intra distance. Based on the selected feature subset, Fisher's linear classifiers were trained. And the final classification decision of the record was made by voting all the classifiers' outputs. Applying the method to classify all experimental subjects, very low error rates were achieved. Some crucial properties of the diabetic retinopathy classification method are also discussed.

Colangiopancreatografía magnética: valor diagnóstico para detectar coledocolitiasis en pacientes con pancreatitis aguda leve

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Geanny Mogollón Reyes

Full Text Available Introducción: la pancreatitis aguda (PA es una enfermedad clínica común que puede ser desde leve hasta fatal. En el 40 % de los casos es de origen biliar, y es causada por una obstrucción de la ampolla de Váter por barro biliar o por cálculos. En el diagnóstico de la pancreatitis aguda de origen biliar (PAB se emplean métodos invasivos como la colangiopancreatografía endoscópica retrógrada (CPRE, la cual se asocia a morbilidad y mortalidad, y métodos no invasivos como la colangiopancreatografía magnética (CRM, que emerge como modalidad diagnóstica en los centros de tercer y cuarto nivel de complejidad. Métodos: se evaluaron las características diagnósticas de la CRM a través de los registros históricos de pacientes que ingresaron a un hospital universitario de nivel IV a los que se les realizó CRM y CPRE. Esta última fue considerada el método de referencia para la evaluación. Resultados: Para la CRM se determinó una sensibilidad del 97 % y una especificidad del 44 % para la detección de coledocolitiasis, con un valor predictivo positivo de 0,35 y un valor predictivo negativo de 0,99. Algunos de estos resultados son inferiores a los documentados en la bibliografía mundial. Conclusiones: la CRM permite obtener imágenes precisas de la vía biliar, en un ambiente seguro y sin riesgos para el paciente. Esta técnica tiene una capacidad de detección de coledocolitiasis que oscila entre el 78 y el 97 %, resultado que concuerda con lo descrito en otros estudios.

Riedel's thyroiditis and multifocal fibrosclerosis are part of the IgG4-related systemic disease spectrum.

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Dahlgren, Mollie; Khosroshahi, Arezou; Nielsen, G Petur; Deshpande, Vikram; Stone, John H

2010-09-01

Riedel's thyroiditis is a chronic fibrosing disorder of unknown etiology often associated with "multifocal fibrosclerosis." IgG4-related systemic disease is characterized by IgG4+ plasma cell infiltration and fibrosis throughout many organs. We hypothesized that Riedel's thyroiditis is part of the IgG4-related systemic disease spectrum. We searched our institution's pathology database using the terms "Riedel's," "struma," "thyroid," and "fibrosis," and identified 3 cases of Riedel's thyroiditis. Riedel's thyroiditis was diagnosed if there was a fibroinflammatory process involving all or a portion of the thyroid gland, with evidence of extension of the process into surrounding tissues. Immunohistochemical stains for IgG4 and IgG were performed. The histopathologic and immunohistochemical features of each involved organ were evaluated. The clinical features of one patient with multiple organ system disease were described. All 3 thyroidectomy samples stained positively for IgG4-bearing plasma cells. One patient had extensive extrathyroidal involvement diagnostic of IgG4-related systemic disease, including cholangitis, pseudotumors of both the lung and lacrimal gland, and a lymph node contiguous to the thyroid that stained intensely for IgG4+ plasma cells. The histologic features of all organs involved were consistent with IgG4-related systemic disease. Patient 3 had 10 IgG4+ plasma cells per high-power field initially, but rebiopsy 2 years later demonstrated no IgG4+ plasma cells. That patient's second biopsy, characterized by fibrosis and minimal residual inflammation, further solidifies the link between IgG4-bearing plasma cells in tissue and the histologic evolution to Riedel's thyroiditis. Riedel's thyroiditis is part of the IgG4-related systemic disease spectrum. In many cases, multifocal fibrosclerosis and IgG4-related systemic disease are probably the same entity.

Doença de chagas aguda em mulher de 80 anos no México. Relato anatomopatológico

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Felipe Lozano Kasten

1993-12-01

Full Text Available Mulher de 80 anos de idade, com doença de Chagas aguda diagnosticada à necrópsia, adquirida, provavelmente, através de triatomíneos no município de Zacoelo de Torres, no Estado de Jalisco, México. Assinala-se a raridade do encontro de casos de doença de Chagas agudo, na faixa etária da paciente. O exame anatomopatológico mostrou comprometimento do coração, esôfago e intestino grosso. Encontrou-se lesões no sistema nervoso autônomo intramural do esôfago e do intestino grosso, sendo estes achados de interesse, por ocorrer em área geográfica onde os megas tem sido pouco relatados.