High rates of ofloxacin resistance in Mycobacterium tuberculosis among both new and previously treated patients in Tamil Nadu, South India.

Science.gov (United States)

Selvakumar, N; Kumar, Vanaja; Balaji, S; Prabuseenivasan, S; Radhakrishnan, R; Sekar, Gomathi; Chandrasekaran, V; Kannan, T; Thomas, Aleyamma; Arunagiri, S; Dewan, Puneet; Swaminathan, Soumya

2015-01-01

Periodic drug resistance surveillance provides useful information on trends of drug resistance and effectiveness of tuberculosis (TB) control measures. The present study determines the prevalence of drug resistance among new sputum smear positive (NSP) and previously treated (PT) pulmonary TB patients, diagnosed at public sector designated microscopy centers (DMCs) in the state of Tamil Nadu, India. In this single-stage cluster-sampling prevalence survey, 70 of 700 DMCs were randomly selected using a probability-proportional to size method. A cluster size of 24 for NSP and a varying size of 0 to 99 for PT cases were fixed for each selected DMC. Culture and drug susceptibility testing was done on Lowenstein-Jensen medium using the economic variant of proportion sensitivity test for isoniazid (INH), rifampicin (RMP), ofloxacin (OFX) and kanamycin (KAN). Human Immunodeficiency Virus (HIV) status was collected from patient records. From June 2011 to August 2012, 1524 NSP and 901 PT patients were enrolled. Any RMP resistance and any INH resistance were observed in 2.6% and 15.1%, and in 10.4% and 30% respectively in NSP and PT cases. Among PT patients, multi drug resistant TB (MDR-TB) was highest in the treatment failure (35%) group, followed by relapse (13%) and treatment after default (10%) groups. Extensively drug resistant TB (XDRTB) was seen in 4.3% of MDR-TB cases. Any OFX resistance was seen in 10.4% of NSP, 13.9% of PT and 29% of PT MDR-TB patients. The HIV status of the patient had no impact on drug resistance levels. RMP resistance was present in 2.6% of new and 15.1% of previously treated patients in Tamil Nadu. Rates of OFX resistance were high among NSP and PT patients, especially among those with MDR-TB, a matter of concern for development of new treatment regimens for TB.

Radiation induced esophageal adenocarcinoma in a woman previously treated for breast cancer and renal cell carcinoma

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Raissouni Soundouss

2012-08-01

Full Text Available Abstract Background Secondary radiation-induced cancers are rare but well-documented as long-term side effects of radiation in large populations of breast cancer survivors. Multiple neoplasms are rare. We report a case of esophageal adenocarcinoma in a patient treated previously for breast cancer and clear cell carcinoma of the kidney. Case presentation A 56 year-old non smoking woman, with no alcohol intake and no familial history of cancer; followed in the National Institute of Oncology of Rabat Morocco since 1999 for breast carcinoma, presented on consultation on January 2011 with dysphagia. Breast cancer was treated with modified radical mastectomy, 6 courses of chemotherapy based on CMF regimen and radiotherapy to breast, inner mammary chain and to pelvis as castration. Less than a year later, a renal right mass was discovered incidentally. Enlarged nephrectomy realized and showed renal cell carcinoma. A local and metastatic breast cancer recurrence occurred in 2007. Patient had 2 lines of chemotherapy and 2 lines of hormonotherapy with Letrozole and Tamoxifen assuring a stable disease. On January 2011, the patient presented dysphagia. Oesogastric endoscopy showed middle esophagus stenosing mass. Biopsy revealed adenocarcinoma. No evidence of metastasis was noticed on computed tomography and breast disease was controlled. Palliative brachytherapy to esophagus was delivered. Patient presented dysphagia due to progressive disease 4 months later. Jejunostomy was proposed but the patient refused any treatment. She died on July 2011. Conclusion We present here a multiple neoplasm in a patient with no known family history of cancers. Esophageal carcinoma is most likely induced by radiation. However the presence of a third malignancy suggests the presence of genetic disorders.

Lack of Cetuximab induced skin toxicity in a previously irradiated field: case report and review of the literature

Science.gov (United States)

2010-01-01

Introduction Mutation, amplification or dysregulation of the EGFR family leads to uncontrolled division and predisposes to cancer. Inhibiting the EGFR represents a form of targeted cancer therapy. Case report We report the case of 79 year old gentlemen with a history of skin cancer involving the left ear who had radiation and surgical excision. He had presented with recurrent lymph node in the left upper neck. We treated him with radiation therapy concurrently with Cetuximab. He developed a skin rash over the face and neck area two weeks after starting Cetuximab, which however spared the previously irradiated area. Conclusion The etiology underlying the sparing of the previously irradiated skin maybe due to either decrease in the population of EGFR expressing cells or decrease in the EGFR expression. We raised the question that "Is it justifiable to use EGFR inhibitors for patients having recurrence in the previously irradiated field?" We may need further research to answer this question which may guide the physicians in choosing appropriate drug in this scenario. PMID:20478052

Thyroid abnormalities in patients previously treated with irradiation for acne vulgaris

International Nuclear Information System (INIS)

Thomson, D.B.; Grammes, C.F.; Starkey, R.H.; Monsaert, R.P.; Sunderlin, F.S.

1984-01-01

Of 1203 patients who received radiation treatment for acne vulgaris between 1940 and 1968, 302 were recalled and examined, 121 at Geisinger Medical Center and the remainder by their local physicians. Radiation records were reviewed on all patients. Lead-rubber and cones had been used as shielding. Mean age at the time of exposure was 21 years and mean total exposure was 692 R. Palpable nodular thyroid disease was found in eight patients (2.6%). Of these, thyroid carcinoma was detected in two patients (0.66%). Although the number of patients examined was small, the incidence of carcinomas was unexpectedly high. The authors conclude that follow-up examination is worthwhile for patients previously treated by irradiation for acne vulgaris

Hepatocellular Carcinoma Metastasis to the Orbit in a Coinfected HIV+ HBV+ Patient Previously Treated with Orthotopic Liver Transplantation: A Case Report

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S. Guerriero

2011-01-01

Full Text Available Hepatocellular carcinoma rarely metastasizes to the orbit. We report a 45-year-old male, HBV+, HIV+, with a past history of a liver transplant for ELSD (end-stage liver disease with hepatocellular carcinoma and recurrent HCC, who presented with proptosis and diplopia of the left eye. CT scans of the head revealed a large, irregular mass in the left orbit causing superior and lateral destruction of the orbital bone. Biopsy specimens of the orbital tumor showed features of metastatic foci of hepatocellular carcinoma. Only 16 other cases of HCC metastasis to the orbit have been described in literature, and this is the first case in a previously transplanted HIV+, HBV+ patient.

Rapid mineralisation of the herbicide isoproturon in soil from a previously treated Danish agricultural field.

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Sørensen, Sebastian R; Aamand, Jens

2003-10-01

Mineralisation of the phenylurea herbicide isoproturon (3-(4-isopropylphenyl)-1,1-dimethylurea) and two of its known metabolites, 3-(4-isopropylphenyl)-1-methylurea (monodesmethyl-isoproturon) and 4-isopropylaniline, was studied in Danish agricultural soils with or without previous exposure to isoproturon. A potential for rapid mineralisation of isoproturon and the two metabolites was present in soils sampled from three plots within an agricultural field previously treated regularly with the herbicide, with 34-45%, 51-58% and 33-36% of the added [phenyl-U-14C]isoproturon, [phenyl-U-14C]monodesmethyl-isoproturon and [phenyl-U-14C]4-isopropylaniline metabolised to [14C]carbon dioxide within 30 days at 20 degrees C. In contrast, such extensive mineralisation of these three compounds was not observed within this period in soils sampled from two other agricultural fields without previous treatment with isoproturon. The mineralisation patterns indicated growth-linked metabolism of the three compounds in the previously exposed soils, and doubling times for [14C]carbon dioxide production ranged from 1.6 to 3.2, 1.0 to 2.1 and 1.3 to 1.7 days for isoproturon, monodesmethyl-isoproturon and 4-isopropylaniline, respectively. The ability to mineralise [phenyl-U-14C]isoproturon to [14C]carbon dioxide was successfully sub-cultured to a fresh mineral medium which provided isoproturon as sole source of carbon and nitrogen. One of the soils sampled from an agricultural field not previously treated with isoproturon showed accelerated mineralisation of [phenyl-U-14C]4-isopropylaniline toward the end of the experiment, with a doubling time for [14C]carbon dioxide production of 7.4days. This study indicates that the occurrence of rapid mineralisation of the phenyl ring of isoproturon to carbon dioxide is related to previous exposure to the herbicide, which suggests that microbial adaptation upon repeated isoproturon use may occur within agricultural fields.

Thyroid abnormalities in patients previously treated with irradiation for acne vulgaris

International Nuclear Information System (INIS)

Thomson, D.B.; Grammes, C.F.; Starkey, R.H.; Monsaert, R.P.; Sunderlin, F.S.

1984-01-01

Of 1,203 patients who received radiation treatment for acne vulgaris between 1940 and 1968, 302 patients were recalled and examined, 121 at Geisinger Medical Center and the remainder by their local physicians. Radiation records were reviewed on all patients. Lead-rubber and cones had been used as shielding. Mean age at the time of exposure was 21 years and mean total exposure was 692 R. Palpable nodular thyroid disease was found in eight patients (2.6%). Of these, thyroid carcinoma was detected in two patients (0.66%). Although the number of patients examined was small, the incidence of carcinomas was unexpectedly high. We conclude that follow-up examination is worthwhile for patients previously treated by irradiation for acne vulgaris

Chronic idiopathic intestinal pseudo-obstruction treated with jejunostomy: case report and literature review

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Carlos Renato dos Reis Lemos

Full Text Available CONTEXT: Chronic idiopathic intestinal pseudo-obstruction is a very rare condition. CASE REPORT: This study describes a male patient who had presented obstructive symptoms for 24 years. He had been treated clinically and had undergone two previous operations in different services, with no clinical improvement or correct diagnosis. He was diagnosed with intestinal obstruction without mechanical factors in our service and underwent jejunostomy, which had a significant decompressive effect. The patient was able to gain weight and presented improvements in laboratory tests. Jejunostomy is a relatively simple surgical procedure that is considered palliative but, in this case, it was resolutive.

A Case of Trapezium Avascular Necrosis Treated Conservatively

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Evangelos Petsatodis

2017-01-01

Full Text Available Introduction. Avascular necrosis (AVN of the bones of the wrist most commonly involves the lunate followed by the proximal pole of the scaphoid and the capitate. Trapezium avascular necrosis is extremely rare with only two cases reported in the literature, both of which were treated surgically. In this article, we report a unique case of trapezium avascular necrosis treated conservatively. Case Presentation. A 38-year-old man complaining of a 4-month history of mild pain on the base of his right thumb. MRI scan was performed. The clinical presentation and the imaging findings indicated avascular osteonecrosis of the trapezium. The patient was treated with immobilization of the wrist joint for a period of six weeks. Three months later, the patient was free of symptoms and the MRI scan revealed a normal trapezium. Conclusion. AVN of trapezium is extremely rare. Our case shows that immobilization of an early stage avascular necrosis of the trapezium might be a treatment option.

Korean Herbal Medicine for Treating Henoch-Schonlein Purpura with Yin Deficiency: Five Case Reports

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Sung-Kyung Kim

2014-12-01

Full Text Available Objectives: The purpose of this study is to report the clinical effect of Korean medicine (KM treatment for Henoch-Schonlein purpura (HSP. Methods: Five HSP patients who demonstrated a Yin deficiency and who had a history of a previous upper respiratory tract infection were included in this study. Four patients had arthritis and three had severe stomachache. One of them appeared to have proteinuria and hematuria before starting KM treatment. Results: All patients were improved with only herbal medicine, Jarotang (JRT. Purpura in the lower extremities and abdominal pain, which were not treated by using a corticosteroid, disappeared and had not recurred after 6 months. Conclusion: These cases indicate that JRT may be effective in treating HSP in patients who demonstrate Yin deficiency, even though the number of cases was limited to five.

Endovascular approach to treat ascending aortic pseudoaneurysm in a patient with previous CABG and very high surgical risk.

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Zago, Alexandre C; Saadi, Eduardo K; Zago, Alcides J

2011-10-01

Pseudoaneurysm of the ascending aorta is an uncommon pathology and a challenge in high-risk patients who undergo conventional surgery because of high operative morbidity and mortality. Endovascular exclusion of an aortic pseudoaneurysm using an endoprosthesis is a less invasive approach, but few such cases have been reported. Moreover, the use of this approach poses unique therapeutic challenges because there is no specific endoprosthesis for ascending aortic repair, particularly to treat patients with previous coronary artery bypass graft (CABG). We describe the case of a 74-year-old patient who had undergone CABG and later presented with an iatrogenic ascending aortic pseudoaneurysm that occurred during an angiography. This patient was at very high risk for surgical treatment and, therefore, an endovascular approach was adopted: percutaneous coronary intervention for the left main coronary artery, left anterior descending and left circumflex native coronary arteries followed by endovascular endoprosthesis deployment in the ascending aorta to exclude the pseudoaneurysm. Both procedures were successfully performed, and the patient was discharged without complications 4 days later. At 5 months' clinical follow-up, his clinical condition was good and he had no complications. Copyright © 2011 Wiley-Liss, Inc.

A Case of Trapezium Avascular Necrosis Treated Conservatively.

Science.gov (United States)

Petsatodis, Evangelos; Ditsios, Konstantinos; Konstantinou, Panagiotis; Pinto, Iosafat; Kostretzis, Lazaros; Theodoroudis, Ioannis; Pilavaki, Mayia

2017-01-01

Avascular necrosis (AVN) of the bones of the wrist most commonly involves the lunate followed by the proximal pole of the scaphoid and the capitate. Trapezium avascular necrosis is extremely rare with only two cases reported in the literature, both of which were treated surgically. In this article, we report a unique case of trapezium avascular necrosis treated conservatively. A 38-year-old man complaining of a 4-month history of mild pain on the base of his right thumb. MRI scan was performed. The clinical presentation and the imaging findings indicated avascular osteonecrosis of the trapezium. The patient was treated with immobilization of the wrist joint for a period of six weeks. Three months later, the patient was free of symptoms and the MRI scan revealed a normal trapezium. AVN of trapezium is extremely rare. Our case shows that immobilization of an early stage avascular necrosis of the trapezium might be a treatment option.

Typhi–Induced Septic Shock and Acute Respiratory Distress Syndrome in a Previously Healthy Teenage Patient Treated With High-Dose Dexamethasone

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Melissa Brosset Ugas MD

2016-05-01

Full Text Available Typhoid fever is commonly characterized by fever and abdominal pain. Rare complications include intestinal hemorrhage, bowel perforation, delirium, obtundation, and septic shock. Herein we describe the case of a previously healthy 16-year-old male without history of travel, diagnosed with typhoid fever complicated by septic shock and acute respiratory distress syndrome treated with high-dose dexamethasone. This case details severe complications of typhoid fever that are uncommonly seen in developed countries, and the successful response to high-dose dexamethasone as adjunct therapy. High-dose dexamethasone treatment has reportedly decreased Salmonella Typhi mortality, but controlled studies specifically performed in children are lacking, and most reports of its use are over 30 years old and all have originated in developing countries. Providers should include Salmonella Typhi in the differential diagnosis of the pediatric patient with fever, severe abdominal pain, and enteritis, and be aware of its potentially severe complications and the limited data on safety and efficacy of adjunctive therapies that can be considered in addition to antibiotics.

Artemisia annua dried leaf tablets treated malaria resistant to ACT and i.v. artesunate: Case reports.

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Daddy, Nsengiyumva Bati; Kalisya, Luc Malemo; Bagire, Pascal Gisenya; Watt, Robert L; Towler, Melissa J; Weathers, Pamela J

2017-08-15

Dried leaf Artemisia annua (DLA) has shown efficacy against Plasmodium sp. in rodent studies and in small clinical trials. Rodent malaria also showed resiliency against the evolution of artemisinin drug resistance. This is a case report of a last resort treatment of patients with severe malaria who were responding neither to artemisinin combination therapy (ACT) nor i.v. artesunate. Of many patients treated with ACTs and i.v. artesunate during the 6 mon study period, 18 did not respond and were subsequently treated with DLA Artemisia annua. Patients were given a dose of 0.5g DLA per os, twice daily for 5d. Total adult delivered dose of artemisinin was 55mg. Dose was reduced for body weight under 30kg. Clinical symptoms, e.g. fever, coma etc., and parasite levels in thick blood smears were tracked. Patients were declared cured and released from hospital when parasites were microscopically undetectable and clinical symptoms fully subsided. All patients were previously treated with Coartem® provided through Santé Rurale (SANRU) and following the regimen prescribed by WHO. Of 18 ACT-resistant severe malaria cases compassionately treated with DLA, all fully recovered. Of the 18, this report details two pediatric cases. Successful treatment of all 18 ACT-resistant cases suggests that DLA should be rapidly incorporated into the antimalarial regimen for Africa and possibly wherever else ACT resistance has emerged. Copyright © 2017. Published by Elsevier GmbH.

Radiation induced esophageal adenocarcinoma in a woman previously treated for breast cancer and renal cell carcinoma.

Science.gov (United States)

Raissouni, Soundouss; Raissouni, Ferdaous; Rais, Ghizlane; Aitelhaj, Meryem; Lkhoyaali, Siham; Latib, Rachida; Mohtaram, Amina; Rais, Fadoua; Mrabti, Hind; Kabbaj, Nawal; Amrani, Naima; Errihani, Hassan

2012-08-09

Secondary radiation-induced cancers are rare but well-documented as long-term side effects of radiation in large populations of breast cancer survivors. Multiple neoplasms are rare. We report a case of esophageal adenocarcinoma in a patient treated previously for breast cancer and clear cell carcinoma of the kidney. A 56 year-old non smoking woman, with no alcohol intake and no familial history of cancer; followed in the National Institute of Oncology of Rabat Morocco since 1999 for breast carcinoma, presented on consultation on January 2011 with dysphagia. Breast cancer was treated with modified radical mastectomy, 6 courses of chemotherapy based on CMF regimen and radiotherapy to breast, inner mammary chain and to pelvis as castration. Less than a year later, a renal right mass was discovered incidentally. Enlarged nephrectomy realized and showed renal cell carcinoma. A local and metastatic breast cancer recurrence occurred in 2007. Patient had 2 lines of chemotherapy and 2 lines of hormonotherapy with Letrozole and Tamoxifen assuring a stable disease. On January 2011, the patient presented dysphagia. Oesogastric endoscopy showed middle esophagus stenosing mass. Biopsy revealed adenocarcinoma. No evidence of metastasis was noticed on computed tomography and breast disease was controlled. Palliative brachytherapy to esophagus was delivered. Patient presented dysphagia due to progressive disease 4 months later. Jejunostomy was proposed but the patient refused any treatment. She died on July 2011. We present here a multiple neoplasm in a patient with no known family history of cancers. Esophageal carcinoma is most likely induced by radiation. However the presence of a third malignancy suggests the presence of genetic disorders.

Clinical activity of fulvestrant in metastatic breast cancer previously treated with endocrine therapy and/or chemotherapy.

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Heo, Mi Hwa; Kim, Hee Kyung; Lee, Hansang; Kim, Ji-Yeon; Ahn, Jin-Seok; Im, Young-Hyuck; Park, Yeon Hee

2018-03-16

We conducted a retrospective analysis of the clinical activity of fulvestrant in postmenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (MBC) previously treated with endocrine therapy and/or chemotherapy. We reviewed the medical records of all patients with MBC treated at Samsung Medical Center between January 2009 and August 2016. Patients received fulvestrant 250 mg intramuscularly every 28 days (from January 2009 to November 2010) or 500 mg intramuscularly every 28 days (from December 2010 to August 2016). Tumor responses were assessed every 8 weeks and at the end of treatment, as well as when disease progression was suspected. A total of 84 patients were included in this study. A median of two previous endocrine treatments had been performed; 79% of the patients had received two or more endocrine treatments. Forty-five patients (54%) had been treated with chemotherapy for MBC before the fulvestrant treatment course. Visceral metastasis was found in 49 patients (58%). The estimated median progression-free survival and overall survival were 4.4 months (95% confidence interval [CI], 3.4 to 5.5) and 32.5 months (95% CI, 17.6 to 47.4), respectively. The disease control rate was 40.5% (95% CI, 30.5 to 51.5); partial response was observed in 16% of the patients and stable disease was observed in 25% of the patients. The most frequently reported adverse reactions were mild-to-moderate grade myalgia (10.5% of the patients), injection site pain (7%), and fatigue (7%). Fulvestrant was generally well tolerated. Fulvestrant showed encouraging clinical activity and favorable feasibility in postmenopausal women with MBC who had been treated with multiple endocrine therapies and/or cytotoxic chemotherapies.

Treating a case of Savant syndrome

OpenAIRE

Busuttil, Joseph

1994-01-01

Memory and artistic prodigies among the population at large are uncommon; among the mentally retarded, they are rarer still. This article describes the treatment of such a case, technically known as the Savant Syndrome, seen by occupational therapists at Mount Carmel Psychiatric Hospital and treated over a period of 18 years.

Outcome after arthroscopic labral surgery in patients previously treated with periacetabular osteotomy

DEFF Research Database (Denmark)

Hartig-Andreasen, Charlotte; Nielsen, Torsten G; Lund, Bent

2017-01-01

To identify factors predicting failure after hip arthroscopy in patients with previous periacetabular osteotomy (PAO) defined as a conversion to total hip replacement (THR) and to evaluate the patient reported outcome scores. Of 55 hips treated with hip arthroscopy after PAO from Aug 2008 to 2012....... Nine hips were converted to a THR. Kaplan-Meier survival rate was 52.8% (95% CI, 10%-83.8%) at 6.5 years follow-up. Statistically significant predictors of failure: joint space width after PAO ...% of the hips. In 42% of the hips cartilage lesions of Becks grade >3 were found. Mean mHHS and HOS were 65.7 and 68.8 respectively at follow-up. A NRS pain score of >3 in rest and during activity were present in respectively, 43% and 62% of the patients. Hip arthroscopy after PAO demonstrated limited clinical...

QualiCOP: real-world effectiveness, tolerability, and quality of life in patients with relapsing-remitting multiple sclerosis treated with glatiramer acetate, treatment-naïve patients, and previously treated patients.

Science.gov (United States)

Ziemssen, Tjalf; Calabrese, Pasquale; Penner, Iris-Katharina; Apfel, Rainer

2016-04-01

Treatment of symptoms and signs beyond the expanded disability status scale remains a major target in multiple sclerosis. QualiCOP was an observational, non-interventional, open-label study conducted at 170 sites in Germany. Of the 754 enrolled patients, 96 % had relapsing-remitting multiple sclerosis (MS) and were either disease-modifying therapy naïve (de novo, n = 481) or previously treated (n = 237) with once-daily, subcutaneous 20-mg/mL glatiramer acetate (GA). Assessments of relapse rate, disease progression, overall functioning, quality of life (QoL), cognition, fatigue, and depression were performed over 24 months. GA treatment over 24 months was associated with reduced annual relapse rate for previously treated (from 0.98 to 0.54 relapses) and de novo (from 0.81 to 0.48 relapses) patients. Multiple Sclerosis Functional Composite scores showed slight improvement in both cohorts (all p Multiple Sclerosis Inventory Cognition scale scores showed robust improvement in cognition among previously treated and de novo cohorts (all p treatment in important QoL parameters beyond standard measures of relapse and disease severity.

Total brain, cortical and white matter volumes in children previously treated with glucocorticoids

DEFF Research Database (Denmark)

Holm, Sara K; Madsen, Kathrine S; Vestergaard, Martin

2018-01-01

BACKGROUND: Perinatal exposure to glucocorticoids and elevated endogenous glucocorticoid-levels during childhood can have detrimental effects on the developing brain. Here, we examined the impact of glucocorticoid-treatment during childhood on brain volumes. METHODS: Thirty children and adolescents...... with rheumatic or nephrotic disease previously treated with glucocorticoids and 30 controls matched on age, sex, and parent education underwent magnetic resonance imaging (MRI) of the brain. Total cortical grey and white matter, brain, and intracranial volume, and total cortical thickness and surface area were...... were mainly driven by the children with rheumatic disease. Total cortical thickness and cortical surface area did not significantly differ between groups. We found no significant associations between glucocorticoid-treatment variables and volumetric measures. CONCLUSION: Observed smaller total brain...

[Parathyroid cancer in a patient with previous history of hypernephroma: a clinical case].

Science.gov (United States)

Martín Navarro, J; Mendoza, E; Mateos, P; Cereceda, A; Coca, S

2007-01-01

We report the clinical case of a 55 year-old male patient, with a previous history of nephrectomy by hypernephroma sixteen years ago, first presenting hypercalcemia and rising of intact parathyroid hormone (iPTH) levels. A localization study revealed an intrathyroid nodule with cystic appearance. After undergoing a hemi-thyroidectomy, the patient is diagnosed with parathyroid carcinoma. This article analyzes previously published cases presenting parathyroidal pathologies associated with hypernephroma. A broader differential diagnosis--including the screening of parathyroidal pathologies should be considered in patients with hypercalcemia and hypernephroma.

Bypass surgery to treat symptomatic fusiform dilation of the internal carotid artery following craniopharyngioma resection: report of 2 cases.

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Wang, Long; Shi, Xiang'en; Liu, Fangjun; Qian, Hai

2016-12-01

Fusiform dilation of the internal carotid artery (FDICA) is an infrequent vascular complication following resection of suprasellar lesions in the pediatric population, and its course appears to be benign without apparent clinical symptoms. However, data correlating symptomatic FDICA with bypass surgery are scarce. The authors here report 2 symptomatic cases that were treated using internal maxillary artery bypass more than 5 years after total removal of a craniopharyngioma at an outside institution. Both cases of FDICA were resected to relieve the mass effect and to expose the craniopharyngioma. The postoperative course was uneventful, and radiological imaging revealed graft conduit patency. To the authors' knowledge, this is the first reported use of extracranial to intracranial bypass to treat FDICA following removal of a suprasellar lesion. Their findings suggest that bypass surgery is a useful therapeutic approach for symptomatic cases of FDICA and total removal of recurrent craniopharyngioma. Moreover, the indications for surgical intervention and treatment modalities are discussed in the context of previous relevant cases.

Granulomatous lobular mastitis: report of a case with previously undescribed histopathological abnormalities.

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Axelsen, R A; Reasbeck, P

1988-10-01

A 41-yr-old multiparous woman presented with a discrete breast lump which proved histologically to be an example of granulomatous lobular mastitis. The clinical and histological features were similar to those noted in previous reports. Additional histological features in the present case were an intense mononuclear cell infiltration of lobular and ductal epithelium, associated with nuclear fragments morphologically suggestive of apoptosis. These appearances, which have not previously been described, are illustrated, together with the more classical features of the condition well demonstrated by the present case. The novel histological features noted here suggest that the development of granulomatous lobular mastitis may be at least in part immunologically mediated, and that the cellular infiltrates seen may be a manifestation of cell-mediated destruction of mammary epithelium.

A case study of IMRT planning (Plan B) subsequent to a previously treated IMRT plan (Plan A)

International Nuclear Information System (INIS)

2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" data-affiliation=" (Department of Medical Physics and 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" >Cao, F; 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" data-affiliation=" (Department of Medical Physics and 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" >Leong, C; 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" data-affiliation=" (Department of Medical Physics and 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" >Schroeder, J; 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" data-affiliation=" (Department of Medical Physics and 2Department of Radiation Oncology, Fraser Valley Centre, BC Cancer Agency, Surrey, British Columbia (Canada))" >Lee, B

2014-01-01

Background and purpose: Treatment of the contralateral neck after previous ipsilateral intensity modulated radiation therapy (IMRT) for head and neck cancer is a challenging problem. We have developed a technique that limits the cumulative dose to the spinal cord and brainstem while maximizing coverage of a planning target volume (PTV) in the contralateral neck. Our case involves a patient with right tonsil carcinoma who was given ipsilateral IMRT with 70Gy in 35 fractions (Plan A). A left neck recurrence was detected 14 months later. The patient underwent a neck dissection followed by postoperative left neck radiation to a dose of 66 Gy in 33 fractions (Plan B). Materials and Methods: The spinal cord-brainstem margin (SCBM) was defined as the spinal cord and brainstem with a 1.0 cm margin. Plan A was recalculated on the postoperative CT scan but the fluence outside of SCBM was deleted. A further modification of Plan A resulted in a base plan that was summed with Plan B to evaluate the cumulative dose received by the spinal cord and brainstem. Plan B alone was used to evaluate for coverage of the contralateral neck PTV. Results: The maximum cumulative doses to the spinal cord with 0.5cm margin and brainstem with 0.5cm margin were 51.96 Gy and 45.60 Gy respectively. For Plan B, 100% of the prescribed dose covered 95% of PTVb1. Conclusion: The use of a modified ipsilateral IMRT plan as a base plan is an effective way to limit the cumulative dose to the spinal cord and brainstem while enabling coverage of a PTV in the contralateral neck.

Doxorubicin and ifosfamide combination chemotherapy in previously treated acute leukemia in adults: a Southwest Oncology Group pilot study.

Science.gov (United States)

Ryan, D H; Bickers, J N; Vial, R H; Hussein, K; Bottomley, R; Hewlett, J S; Wilson, H E; Stuckey, W J

1980-01-01

The Southwest Oncology Group did a limited institutional pilot study of the combination of doxorubicin and ifosfamide in the treatment of previously treated adult patients with acute leukemia. Thirty-four patients received one or two courses of the combination. All patients had received prior chemotherapy and 32 had received prior anthracycline chemotherapy. Three patients died before their responses could be fully evaluated. Fourteen patients achieved complete remission (41%) and one patient achieved partial remission. The complete remission rate was 27% for patients with acute myeloblastic leukemia (myelomonoblastic leukemia, monoblastic leukemia, and erythroleukemia) and 89% for patients with acute lymphocytic and undifferentiated leukemia (ALL). Toxic effects included severe hematologic reactions in 33 of 34 patients, hematuria in six patients, altered sensorium in one patient, and congestive heart failure in one patient. The safety of the combination was established and toxic side effects of this therapy were tolerable. The 89% complete remission rate for previously treated patients with ALL suggests that the combination of doxorubicin and ifosfamide may be particularly effective in ALL.

Outcome of secondary high-grade glioma in children previously treated for a malignant condition: A study of the Canadian Pediatric Brain Tumour Consortium

International Nuclear Information System (INIS)

Carret, Anne-Sophie; Tabori, Uri; Crooks, Bruce; Hukin, Juliette; Odame, Isaac; Johnston, Donna L.; Keene, Daniel L.; Freeman, Carolyn; Bouffet, Eric

2006-01-01

Background and purpose: Reports of secondary high-grade glioma (HGG) in survivors of childhood cancer are scarce. The aim of this study was to review the pattern of diagnosis, the treatment, and outcome of secondary pediatric HGG. Patients and methods: We performed a multi-center retrospective study among the 17 paediatric institutions participating in the Canadian Pediatric Brain Tumour Consortium (CPBTC). Results: We report on 18 patients (14 males, 4 females) treated in childhood for a primary cancer, who subsequently developed a HGG as a second malignancy. All patients had previously received radiation therapy +/- chemotherapy for either acute lymphoblastic leukaemia (n = 9) or solid tumour (n = 9). All HGG occurred within the previous radiation fields. At the last follow-up, 17 patients have died and the median survival time is 9.75 months. Conclusion: Although aggressive treatment seems to provide sustained remissions in some patients, the optimal management is still to be defined. Further documentation of such cases is necessary in order to better understand the pathogenesis, the natural history and the prevention of these tumours

Congenital craniopharyngioma treated by radical surgery: case report and review of the literature.

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Kageji, Teruyoshi; Miyamoto, Takeshi; Kotani, Yumiko; Kaji, Tsuyoshi; Bando, Yoshimi; Mizobuchi, Yoshifumi; Nakajima, Kohei; Nagahiro, Shinji

2017-02-01

Craniopharyngiomas are 5-10 % of all pediatric tumors, but are seldomly encountered in the perinatal period. Only seven instances of a truly antenatal diagnosis of a congenital craniopharyngioma that subsequently underwent radical surgery have been reported. We present the case of a patient who received the diagnosis of a suprasellar tumor during the prenatal period and received radical surgery. We report a case of a neonatal craniopharyngioma treated surgically. The pregnancy progressed uneventfully until a routine ultrasound at 37 weeks of gestation showed a 15 × 15 mm high echoic mass in the center of the fetal head. Neonatal Gd-enhanced T1-weighted MRI at 5 days of life showed a homogenously enhanced mass (16×22×15 mm) in the sellar and suprasellar lesion. As the tumor showed rapid growth at the 3rd month of life, the patient underwent a surgical treatment and the mass was totally removed. Three years later, the physical and mental development of the patient was normal, and Gd-MRI studies showed no tumor recurrence. The present case is the eighth case of a truly antenatal diagnosis of a craniopharyngioma that underwent successful radical surgery. Craniopharyngioma is a benign tumor and thought to be a slow growing tumor in childhood. The results of radical surgery were very poor, and the mortality and morbidity rates were high in the previous reports due to the huge size of tumor at operation. The present case demonstrated the rapid growth in short interval of Gd-MRI. This is the first report of tumor kinetics of congenital craniopharyngioma with previous reports. The calculated tumor doubling time in our case was 37 days.

The use of etoricoxib to treat an idiopathic stabbing headache: a case report

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O'Connor Mortimer B

2007-09-01

Full Text Available Abstract According to the International Headache Society, idiopathic stabbing headache (ISH, an indomethacin-responsive headache syndrome, is a paroxysmal disorder of short duration manifested as head pain occurring as a single stab or a series of stabs involving the area supplied in the distribution of the first division of the trigeminal nerve. Stabs last for approximately a few seconds, occurring and recurring from once to multiple times per day in an irregular frequency, with no underlying attributable disorder. Previously indomethacin was the principle treatment option for ISH, despite therapeutic failure in up to 35% of cases, until reports showed gabapentin, melatonin and selective cyclo-oxygenase-2 (COX-2 inhibitors were also possibly effective. In this report we present the full case report of an 88 year old lady with a history of untreated ISH where etoricoxib, a selective COX-2 inhibitor, was used to effectively treat her ISH.

Salvage brachytherapy for local recurrences of prostate cancer treated previously with radiotherapy.

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Gawkowska-Suwinska, Marzena; Fijałkowski, Marek; Białas, Brygida; Szlag, Marta; Kellas-Ślęczka, Sylwia; Nowicka, Elżbieta; Behrendt, Katarzyna; Plewicki, Grzegorz; Smolska-Ciszewska, Beata; Giglok, Monika; Zajusz, Aleksander; Owczarek, Grzegorz

2009-12-01

The aim of the study was to analyze early effects and toxicity of salvage high dose rate brachytherapy for local recurrences of adenocarcinoma of the prostate after external beam radiotherapy (EBRT). In MCS Memorial Institute of Oncology in Gliwice a research programme on salvage HDR brachytherapy for local recurrences of prostate cancer treated previously with EBRT has been ongoing since February 2008. The treatment consisted of 3 fractions of 10 Gy each given every 14 days. Maximal urethral doses were constrained to be ≤ 120% of the prescribed dose. Maximal bladder and rectum doses were constrained to be ≤ 70% of the prescribed dose. Fifteen eligible patients were treated and analyzed from February 2008. All patients completed the treatment without major complications. The most common early complications were: macroscopic haematuria, pain in lower part of the abdomen, and transient dysuria. During the first week after the procedure a transient increase in IPSS score was noticed. The Foley catheter was removed on day 2 to 5. No complications after spinal anaesthesia were observed. Acute toxicity according to EORTC/RTOG was low. For bladder EORTC/RTOG score ranged from 0 to 2. Only in two patients grade 1 toxicity for rectum was observed. The follow-up ranged from 3 to 9 months. In one patient grade 2 rectal toxicity was observed, and one had urethral stricture. Other patients did not have any other significant late toxicity of the treatment. Two patients developed bone metastases. Salvage brachytherapy for localized prostate cancer (3 × 10 Gy every 14 days) seems to be a safe and well tolerated procedure. A significant decline in prostate-specific antigen (PSA) level is seen in patients with hormone-responsive cancer. Long-term efficiency and toxicity of the procedure are yet to be established.

Predicting Radiation Pneumonitis After Stereotactic Ablative Radiation Therapy in Patients Previously Treated With Conventional Thoracic Radiation Therapy

International Nuclear Information System (INIS)

Liu Hui; Zhang Xu; Vinogradskiy, Yevgeniy Y.; Swisher, Stephen G.; Komaki, Ritsuko; Chang, Joe Y.

2012-01-01

Purpose: To determine the incidence of and risk factors for radiation pneumonitis (RP) after stereotactic ablative radiation therapy (SABR) to the lung in patients who had previously undergone conventional thoracic radiation therapy. Methods and Materials: Seventy-two patients who had previously received conventionally fractionated radiation therapy to the thorax were treated with SABR (50 Gy in 4 fractions) for recurrent disease or secondary parenchymal lung cancer (T 10 and mean lung dose (MLD) of the previous plan and the V 10 -V 40 and MLD of the composite plan were also related to RP. Multivariate analysis revealed that ECOG PS scores of 2-3 before SABR (P=.009), FEV1 ≤65% before SABR (P=.012), V 20 ≥30% of the composite plan (P=.021), and an initial PTV in the bilateral mediastinum (P=.025) were all associated with RP. Conclusions: We found that severe RP was relatively common, occurring in 20.8% of patients, and could be predicted by an ECOG PS score of 2-3, an FEV1 ≤65%, a previous PTV spanning the bilateral mediastinum, and V 20 ≥30% on composite (previous RT+SABR) plans. Prospective studies are needed to validate these predictors and the scoring system on which they are based.

Refractory acute promyelocytic leukemia successfully treated with combination therapy of arsenic trioxide and tamibarotene: A case report

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Minoru Kojima

2016-01-01

Full Text Available A 40-year-old male developed refractory acute promyelocytic leukemia (APL after various treatments including all-trans retinoic acid, tamibarotene, arsenic trioxide (As2O3, conventional chemotherapy, and autologous peripheral blood stem cell transplantation. We attempted to use both tamibarotene and As2O3 as a combination therapy, and he achieved molecular complete remission. Grade 2 prolongation of the QTc interval on the electrocardiogram was observed during the therapy. The combination therapy of As2O3 and tamibarotene may be effective and tolerable for treating refractory APL cases who have no treatment options, even when they have previously been treated with tamibarotene and As2O3 as a single agent.

Dexamethasone intravitreal implant in previously treated patients with diabetic macular edema : Subgroup analysis of the MEAD study

OpenAIRE

Augustin, A.J.; Kuppermann, B.D.; Lanzetta, P.; Loewenstein, A.; Li, X.; Cui, H.; Hashad, Y.; Whitcup, S.M.; Abujamra, S.; Acton, J.; Ali, F.; Antoszyk, A.; Awh, C.C.; Barak, A.; Bartz-Schmidt, K.U.

2015-01-01

Background Dexamethasone intravitreal implant 0.7?mg (DEX 0.7) was approved for treatment of diabetic macular edema (DME) after demonstration of its efficacy and safety in the MEAD registration trials. We performed subgroup analysis of MEAD study results to evaluate the efficacy and safety of DEX 0.7 treatment in patients with previously treated DME. Methods Three-year, randomized, sham-controlled phase 3 study in patients with DME, best-corrected visual acuity (BCVA) of 34?68 Early Treatment...

Forty Cases of Insomnia Treated by Suspended Moxibustion at Baihui (GV 20)

Institute of Scientific and Technical Information of China (English)

JU Yan-li; CHI Xu; LIU Jian-xin

2009-01-01

Objective:To observe the therapeutic effect of suspended moxibustion at Baihui (GV 20) for insomnia.Methods: 75 cases were divided randomly into two groups, with 40 cases in the treatment group treated by suspended moxibustion over Baihui (GV 20) and 35 cases in the control group treated by oral administration of Estazolam. Results: The difference in therapeutic effect between the two groups was not statistically significant (P>0.1). Conclusion: It was concluded that suspended moxibustion at Baihui (GV 20) is as effective as Estazolam for insomnia.

A Case of Acrokeratosis Verruciformis Treated with Acitretin

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Ebru Güler

2009-03-01

Full Text Available Acrokeratosis Verruciformis is a rare autosomal dominant genodermatosis. Typically, the lesions are small, verrucous, flat papules on the dorsal aspects of the hands and feet, elbows and knees. Herein, we report a sporodic case of acrokeratosis verruciformis, succesfully treated with acitretin, and review of the literatures.

A cross-sectional study of tuberculosis drug resistance among previously treated patients in a tertiary hospital in Accra, Ghana: public health implications of standardized regimens.

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Forson, Audrey; Kwara, Awewura; Kudzawu, Samuel; Omari, Michael; Otu, Jacob; Gehre, Florian; de Jong, Bouke; Antonio, Martin

2018-04-02

Mycobacterium tuberculosis drug resistance is a major challenge to the use of standardized regimens for tuberculosis (TB) therapy, especially among previously treated patients. We aimed to investigate the frequency and pattern of drug resistance among previously treated patients with smear-positive pulmonary tuberculosis at the Korle-Bu Teaching Hospital Chest Clinic, Accra. This was a cross-sectional survey of mycobacterial isolates from previously treated patients referred to the Chest Clinic Laboratory between October 2010 and October 2013. The Bactec MGIT 960 system for mycobactrerial culture and drug sensitivity testing (DST) was used for sputum culture of AFB smear-positive patients with relapse, treatment failure, failure of smear conversion, or default. Descriptive statistics were used to summarize patient characteristics, and frequency and patterns of drug resistance. A total of 112 isolates were studied out of 155 from previously treated patients. Twenty contaminated (12.9%) and 23 non-viable isolates (14.8%) were excluded. Of the 112 studied isolates, 53 (47.3%) were pan-sensitive to all first-line drugs tested Any resistance (mono and poly resistance) to isoniazid was found in 44 isolates (39.3%) and any resistance to streptomycin in 43 (38.4%). Thirty-one (27.7%) were MDR-TB. Eleven (35.5%) out of 31 MDR-TB isolates were pre-XDR. MDR-TB isolates were more likely than non-MDR isolates to have streptomycin and ethambutol resistance. The main findings of this study were the high prevalence of MDR-TB and streptomycin resistance among previously treated TB patients, as well as a high prevalence of pre-XDR-TB among the MDR-TB patients, which suggest that first-line and second-line DST is essential to aid the design of effective regimens for these groups of patients in Ghana.

Endovascular graft exclusion in treating thoracic aortic dissection: a report of 25 cases

International Nuclear Information System (INIS)

Chen Wei; Yang Jianyong; Zhuang Wenquan; Guo Wenbo; Li Heping; Zhong Lizhen; Huang Qiuping

2003-01-01

Objective: To evaluate the usefulness and efficacy of endovascular graft exclusion (EVGE) in treating thoracic aortic dissection (TAD). Methods: Twenty-five cases of TAD, including 24 cases of Standford B and 1 case of A, were treated by EVGE. The clinical outcome and morphological changes of the lesions were analyzed during a 2-20 months' follow-up. Results: Procedures were technically successful in all 25 cases, while a total of 28 stent-grafts were deployed (3 cases with 2 stent-grafts in each). Complete disappearance of the false lumen or remarkable decrease of the endoleak was noted on the angiograms after stent placement. No severe procedure-related complication was observed, and thrombosis of the false lumen was noted during the follow-up. Conclusion: EVGE is effective and reliable in treating TAD, especially for patients with sub-acute or chronic courses

Automatic treatment planning implementation using a database of previously treated patients

International Nuclear Information System (INIS)

Moore, J A; Evans, K; Yang, W; Herman, J; McNutt, T

2014-01-01

Purpose: Using a database of prior treated patients, it is possible to predict the dose to critical structures for future patients. Automatic treatment planning speeds the planning process by generating a good initial plan from predicted dose values. Methods: A SQL relational database of previously approved treatment plans is populated via an automated export from Pinnacle 3 . This script outputs dose and machine information and selected Regions of Interests as well as its associated Dose-Volume Histogram (DVH) and Overlap Volume Histograms (OVHs) with respect to the target structures. Toxicity information is exported from Mosaiq and added to the database for each patient. The SQL query is designed to ask the system for the lowest achievable dose for a specified region of interest (ROI) for each patient with a given volume of that ROI being as close or closer to the target than the current patient. Results: The additional time needed to calculate OVHs is approximately 1.5 minutes for a typical patient. Database lookup of planning objectives takes approximately 4 seconds. The combined additional time is less than that of a typical single plan optimization (2.5 mins). Conclusions: An automatic treatment planning interface has been successfully used by dosimetrists to quickly produce a number of SBRT pancreas treatment plans. The database can be used to compare dose to individual structures with the toxicity experienced and predict toxicities before planning for future patients.

Fifty Cases of Parkinson's Disease Treated by Acupuncture Combined with Madopar

Institute of Scientific and Technical Information of China (English)

REN Xiao-ming

2008-01-01

objective;To search for an effective therapy for trealing motor disorder due to Parkinson's disease(PD).Methods;Fifty cases in a treatrnent group were treated by acupuncture combined with madopar,and 30 cases in a control group treated by madopar only.Results;A total effective rate of 92%was achieved with obvious alleviation of motor disorder in the treatment group,which was significantly higher than that in the control group(P＜0.05).Conclusion;Acupuncture can enhance therapeutic effects of western medicine and lessen the dose of the medicine needed.

Clinical observation of 5686 cases of infant hemangioma treated by 32P

International Nuclear Information System (INIS)

Liu Qinyuan; Lin Shixiu; Liu Jingtao

2002-01-01

Objective: To explore the therapeutic method of treating infant hemangioma by radioisotopes 32 P. Methods: Simple hemangiomata were treated by 32 P dermal application method. The authors prepared 32 P at the activity of 165.98 kBq/cm 2 /h, diluted it with 2 ml water, and then dropped it on filter paper. The authors applied the paper to the impaired site according to the shape and the size of hemangioma. The impaired site received 32 P radiation at the dosage of 9.41 Gy/cm 2 each time. The treatment was repeated once every month. Cavernous hemangiomata were treated by local injections of colloid 32 P at the dosage of 370 kBq/cm 3 once every 2-3 months. Mixed hemangiomata received combined treatment mentioned above. Results: 3383 cases (99.0%) of simple hemangioma were cured by 32 P dermal application method. 1241 case (98.7%) of cavernous hemangioma were cured. 397 cases (83.0%) of mixed hemangioma were cured. 534 cases (98.1%) of naevus flammeus were improved by 32 P application method. The total effective rate was 99.8%. The cure rate was 88.3%. Conclusion: Treating hemangioma with 32 P is satisfactory for its high efficiency and low toxicity. It may be advisable for infant skin disease

Primary intraosseous squamous cell carcinoma arising in an odontogenic keratocyst previously treated with marsupialization: case report and immunohistochemical study.

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Martínez-Martínez, Marisol; Mosqueda-Taylor, Adalberto; Delgado-Azañero, Wilson; Rumayor-Piña, Alicia; de Almeida, Oslei Paes

2016-04-01

A rare case of primary intraosseous squamous cell carcinoma arising in an odontogenic keratocyst (OKC) is presented here, with the clinical and histologic features of the first biopsy showing characteristics of OKC and the second biopsy disclosing a squamous cell carcinoma. Immunoprofile of this case was compared with five cases of classical OKC by using cytokeratins CK5, CK14, and CK19, CD138, p63, Ki-67, p53, and bcl-2. Classic OKCs showed expected positivity, mainly in the basal and/or suprabasal layers with most antibodies, except for p53, which was negative, whereas the present case showed irregular positivity in all layers, indicating that this can be useful for differential diagnosis and suggesting a possible role in malignant transformation into primary intraosseous squamous cell carcinoma. In conclusion, immunohistochemical differences between the first biopsy of the present case and classic OKC suggest that immunohistochemistry can be helpful in cases with areas of subtle initial malignant transformation. Copyright © 2016 Elsevier Inc. All rights reserved.

Retreatment of failed regenerative endodontic of orthodontically treated immature permanent maxillary central incisor: a case report

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Musaed Fahad Al-Tammami

2017-02-01

Full Text Available A revascularization procedure was shown to be the best alternative therapy for immature teeth with necrotic pulp and apical infection. A 12 year old female with a history of trauma to her upper central incisor and a sinus tract was referred for endodontic treatment. She was an active orthodontic patient and had undergone regenerative endodontic treatment for the past 2 years. Clinical examination revealed no response to sensibility, percussion, and palpation tests. The preoperative radiograph showed an open apex and apical rarefaction. The case was diagnosed as previously treated tooth with asymptomatic apical periodontitis. Regenerative endodontic retreatment was performed, and the case was followed for 3 years. Clinical, radiographic, and cone-beam computed tomography follow-up examination revealed an asymptomatic tooth, with evidence of periapical healing and root maturation.

Case Report: A Non-small Cell Lung Cancer Patient Treated with GcMAF, Sonodynamic Therapy and Tumor Treating Fields.

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Inui, Toshio; Amitani, Haruka; Kubo, Kentaro; Kuchiike, Daisuke; Uto, Yoshihiro; Nishikata, Takahito; Mette, Martin

2016-07-01

Macrophage activating factor (MAF)-based immunotherapy has a wide application for use in treating many diseases via macrophage activation. Sonodynamic therapy (SDT) using low-intensity ultrasound and tumor treating field (TTF) therapy are novel therapeutic modalities. SDT is usually combined with ozone therapy to improve local hypoxia within the tumor environment. We treated a 77-year-old male diagnosed with non-small cell lung cancer ((NSCLC) stage 3B) using second-generation serum GcMAF and oral colostrum MAF-based immunotherapy combined with SDT, TTF and ozone therapies. This case report demonstrates that GcMAF, oral colostrum MAF, SDT, TTF and ozone therapy can be used for NSCLC without adverse effects. This case report suggests a new concept of cancer treatment using local destruction of cancer tissue, in this case conducted with SDT and TTF therapy, to be used in combination with serum GcMAF and colostrum MAF immunotherapy as a systemic treatment. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

A case report of percutaneous endoscopic gastrostomy left-side gastropexy to resolve a recurrent gastric dilatation in a dog previously treated with right-side gastropexy for gastric dilatation volvulus.

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Spinella, Giuseppe; Cinti, Filippo; Pietra, Marco; Capitani, Ombretta; Valentini, Simona

2014-12-01

A 6-year-old, large-breed, female dog was evaluated for gastric dilatation (GD). The dog was affected by GD volvulus, which had been surgically treated with gastric derotation and right incisional gastropexy. Recurrence of GD appeared 36 hours after surgery. The dilatation was immediately treated with an orogastric probe but still recurred 4 times. Therefore, a left-side gastropexy by percutaneous endoscopic gastrostomy (PEG) was performed to prevent intermittent GD. After PEG tube placement, the patient recovered rapidly without side effects. Several techniques of gastropexy have been described as a prophylactic method for gastric dilatation volvulus, but to the authors' knowledge, this is the first report of left-sided PEG gastropexy performed in a case of canine GD recurrence after an incisional right gastropexy. Copyright © 2015 Elsevier Inc. All rights reserved.

Clinical Observation on Intractable Insomnia Treated by Point Pressure in 42 Cases

Institute of Scientific and Technical Information of China (English)

张庆萍

2002-01-01

@@ The author have in recent years treated 42 cases of intractable insomnia (with a history of over 2 years) by point pressure, yielding quite satisfactory results when compared with those treated with clonazepam. This is reported as follows.

Treatment of Previously Treated Facial Capillary Malformations: Results of Single-Center Retrospective Objective 3-Dimensional Analysis of the Efficacy of Large Spot 532 nm Lasers.

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Kwiek, Bartłomiej; Ambroziak, Marcin; Osipowicz, Katarzyna; Kowalewski, Cezary; Rożalski, Michał

2018-06-01

Current treatment of facial capillary malformations (CM) has limited efficacy. To assess the efficacy of large spot 532 nm lasers for the treatment of previously treated facial CM with the use of 3-dimensional (3D) image analysis. Forty-three white patients aged 6 to 59 were included in this study. Patients had 3D photography performed before and after treatment with a 532 nm Nd:YAG laser with large spot and contact cooling. Objective analysis of percentage improvement based on 3D digital assessment of combined color and area improvement (global clearance effect [GCE]) were performed. The median maximal improvement achieved during the treatment (GCE) was 59.1%. The mean number of laser procedures required to achieve this improvement was 6.2 (range 1-16). Improvement of minimum 25% (GCE25) was achieved by 88.4% of patients, a minimum of 50% (GCE50) by 61.1%, a minimum of 75% (GCE75) by 25.6%, and a minimum of 90% (GCE90) by 4.6%. Patients previously treated with pulsed dye lasers had a significantly less response than those treated with other modalities (GCE 37.3% vs 61.8%, respectively). A large spot 532 nm laser is effective in previously treated patients with facial CM.

Surgically treated cases of lumbar spondylolysis and isthmic spondylolisthesis: a multicenter study.

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Hirano, Kenichi; Imagama, Shiro; Matsuyama, Yukihiro; Kawakami, Noriaki; Yukawa, Yasutsugu; Kato, Fumihiko; Hachiya, Yudo; Kanemura, Tokumi; Kamiya, Mitsuhiro; Deguchi, Masao; Ito, Zenya; Wakao, Norimitsu; Ando, Kei; Tauchi, Ryoji; Muramoto, Akio; Ishiguro, Naoki

2015-06-01

Prospective database study. To grasp the characteristics of surgically treated cases with lumbar spondylolysis or isthmic spondylolisthesis. A detailed analysis of surgically treated cases with spondylolysis or isthmic spondylolisthesis has never been reported. An epidemiological study in Japan conducted on 2000 subjects found the incidence of lumbar spondylolysis in the Japanese general population (population-based study) to be 5.9% (males: 7.9%, females: 3.9%). Among 124 vertebrae with spondylolysis, there were 0.8% L2 lesions, 3.2% L3 lesions, 5.6% L4 lesions, and 90.3% L5 lesions, including 5 cases (4.3%) with multiple-level lesions. We have been registering surgically treated spine cases in our database since 2000. From this database, we prospectively collected cases with lumbar spondylolysis or isthmic spondylolisthesis that were treated surgically between January 2000 and December 2009. We determined the age at surgery, sex, and vertebral level of spondylolysis. Of the 564 spondylolysis patients treated surgically, 66.8% were male and 33.2% were female. The mean age at surgery was 52.5 years (range, 13-84 y). There were 585 vertebrae with spondylolysis including 21 cases (3.7%) with multiple-level lesions. L5 spondylolysis affected 432 vertebrae and was the most common location (73.8%), followed by 125 L4 lesions (21.4%), 24 L3 lesions (4.1%), and 2 L2 lesions (0.7%). The percentage of L4 lesions in our study was significantly higher and of L5 lesions was significantly lower than those lesions' percentages in the population-based study. L4 spondylolysis may be more unstable or cause clinical symptoms more frequently leading to more surgical intervention. The percentage of multiple-level spondylolysis was similar between the 2 studies, suggesting these patients respond relatively well to conservative treatment. The male/female ratio was 2:1 in both studies, indicating that males and females require surgery at a similar frequency.

Mammographic breast cancer screening for women previously treated with high breast doses for diseases such as Hodgkin's

International Nuclear Information System (INIS)

Faulkner, K.; Law, J.

2005-01-01

In screening of a general population for breast cancer, benefit/risk ratios are of the order of 100/1. For the very small subgroup of women treated by radiotherapy for Hodgkin's disease below age 35, calculations of this type require different considerations, an overview of which is given in this text. It is concluded that although such previous exposures will increase their radiation risk, their increased risk of carrying an undetected breast cancer means that the potential benefit for them of screening is increased even more. In the United Kingdom, the Dept. of Health has recommended annual screening for these women. (authors)

Severe Hypertriglyceridemia Induced by Sirolimus Treated With Medical Management Without Plasmapheresis: A Case Report.

Science.gov (United States)

Kido, Kazuhiko; Evans, Rickey A; Gopinath, Anil; Flynn, Jeremy D

2018-02-01

Hypertriglyceridemia and hyperlipidemia are the most remarkable metabolic complications seen with long-term sirolimus therapy. We report the case of a 36-year-old woman status post bilateral lung transplantation on a maintenance immunosuppression regimen of sirolimus, tacrolimus, and prednisone who presented with status migrainosus, chest pain, abdominal discomfort, and triglyceride levels greater than 4425 mg/dL. In previously reported cases of severe hypertriglyceridemia that developed on maintenance sirolimus therapy, plasmapheresis has been utilized as an early strategy to rapidly lower triglycerides in order to minimize the risk of acute complications such as pancreatitis, but our case was managed medically without plasmapheresis. The most recent triglyceride was down to 520 mg/dL 2 months after discontinuation of sirolimus. We estimate the probability of this reaction to sirolimus as probable based on a score of 5 points on the Naranjo scale. This is the first case report to our knowledge that highlights the sole use of oral lipid-lowering drug agents to treat severe hypertriglyceridemia secondary to sirolimus without the use of plasmapheresis. Sirolimus-induced severe hypertriglyceridemia can be managed with oral lipid-lowering agents without plasmapheresis. Clinician needs to be aware of the importance of baseline and regular triglyceride monitoring in patients on sirolimus.

A case report: mixed thrombus formation in a previously sutured right atrium.

Science.gov (United States)

Yunfei, Ling; Dongxu, Li; Shuhua, Luo; Yabo, Wang; San, Deep; Changping, Gan; Ke, Lin; Qi, An

2014-08-01

We describe the case of a 19-year-old Chinese woman who nine months prior underwent repair of an atrial septal defect and came to our hospital with a right atrial mass attached to the anterior wall of the right atrium on transthoracic echocardiography. Pathologic examination revealed the mass was a mixed-type thrombosis with some unusual organization, which previously was not described in literature.

Detection of previously undiagnosed cases of COPD in a high-risk population identified in general practice

DEFF Research Database (Denmark)

Løkke, Anders; Ulrik, Charlotte Suppli; Dahl, Ronald

2012-01-01

Background and Aim: Under-diagnosis of COPD is a widespread problem. This study aimed to identify previously undiagnosed cases of COPD in a high-risk population identified through general practice. Methods: Participating GPs (n = 241) recruited subjects with no previous diagnosis of lung disease,...

Efficacy of a preservative-free formulation of fixed-combination bimatoprost and timolol (Ganfort PF in treatment-naïve patients vs previously treated patients

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Cordeiro MF

2015-08-01

Full Text Available M Francesca Cordeiro,1 Ivan Goldberg,2 Rhett Schiffman,3 Paula Bernstein,3 Marina Bejanian31Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK; 2Discipline of Ophthalmology, University of Sydney, Sydney, NSW, Australia; 3Allergan, Inc., Irvine, CA, USAPurpose: To evaluate, using subgroup analysis, the effect of treatment status on the intraocular pressure (IOP-lowering efficacy of a preservative-free formulation of fixed-combination bimatoprost 0.03%/timolol 0.5% (FCBT PF.Methods: A primary, multicenter, randomized, double-masked, 12-week study compared the efficacy and safety of FCBT PF with preserved FCBT (Ganfort® in 561 patients diagnosed with glaucoma or ocular hypertension. For this analysis, eligible patients were treatment-naïve or had inadequate IOP lowering and underwent a washout of previous treatment. IOP (8 am, 10 am, and 4 pm was measured at baseline and weeks 2, 6, and 12. Subgroup analysis of the FCBT PF arm assessed changes in average eye IOP from baseline in treatment-naïve vs previously treated patients. To evaluate the effect of treatment status at baseline (treatment-naïve vs previously treated on IOP reduction in the FCBT PF treatment group, an analysis of covariance model was used with treatment status and investigator as fixed effects, and baseline average eye IOP, age, glaucoma diagnosis, and baseline average eye corneal thickness as covariates. P-values and the 95% confidence intervals were determined using the model.Results: In the FCBT PF arm, IOP mean changes from baseline ranged from -8.7 mmHg to -9.8 mmHg in treatment-naïve patients (N=50, compared with -7.3 mmHg to -8.5 mmHg in previously treated patients (N=228. Baseline IOP, age, glaucoma diagnosis, and corneal thickness significantly affected IOP reduction in the FCBT PF group. Adjusting for these covariates, FCBT PF had a greater IOP-lowering effect (0.8–1.7 mmHg in treatment-naïve patients than previously treated patients

Capnocytophaga canimorsus: a rare case of conservatively treated prosthetic valve endocarditis.

Science.gov (United States)

Jalava-Karvinen, Päivi; Grönroos, Juha O; Tuunanen, Helena; Kemppainen, Jukka; Oksi, Jarmo; Hohenthal, Ulla

2018-05-01

We describe a rare case of prosthetic valve endocarditis caused by the canine bacterium Capnocytophaga canimorsus in a male aged 73 years. The diagnosis of infective endocarditis was unequivocal, as it blood cultures were positive for C. canimorsus and vegetations were detected on transesophageal echocardiography; the modified Duke criteria were fulfilled. PET-CT showed intense 18 F-FDG uptake of the prosthetic valve area. The patient was treated with antibiotics alone (no surgery), and is now on life-long suppressive antibiotic therapy. To our knowledge, this is the third reported case of prosthetic valve endocarditis caused by C. canimorsus and the first one to have been treated conservatively. © 2018 APMIS. Published by John Wiley & Sons Ltd.

Inherited multicentric osteolysis: case report of three siblings treated with bisphosphonate

Directory of Open Access Journals (Sweden)

Whitewood Colin

2010-04-01

Full Text Available Abstract Inherited Multicentric Osteolysis (IMO is an uncommon familial condition of idiopathic pathophysiology causing bone osteolysis and dysplasia. These patients present with common rheumatologic complaints of pain, dysfunction and disability, and are often initially misdiagnosed as a chronic rheumatic disease of childhood such as juvenile idiopathic arthritis. We report a case of three siblings diagnosed with IMO. Diagnosis was made during childhood, with each sibling having different manifestations and course of disease. One had a previous history of bilateral hip dysplasia. Two had osteolysis of the foot, distal tibia and femur (lower limb bones, whilst one had osteolysis of the rib and unusual clavicular fractures. Unusually, all siblings appear to experience decreased pain sensation compared to norms. All siblings were treated with bisphosphonates and experienced a rapid improvement in pain symptoms, decreased analgesic requirements. Two had bone mineral density testing performed and both had increases post-bisphosphonate. In all three, there was subjective evidence of stabilisation of bone disease. Testing for matrix metalloproteinase-2 (MMP2 gene was negative.

Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy

Science.gov (United States)

Jung, Ye-Ryung; Taek Jeong, Joon; Kyu Lee, Myoung; Kim, Sang-Ha; Joong Yong, Suk; Jeong Lee, Seok; Lee, Won-Yeon

2016-01-01

Post-intubation tracheal stenosis accounts for the greatest proportion of whole-cause tracheal stenosis. Treatment of post-intubation tracheal stenosis requires a multidisciplinary approach. Surgery or an endoscopic procedure can be used, depending on the type of stenosis. However, the efficacy of cryotherapy in post-intubation tracheal stenosis has not been validated. Here, we report a case of recurring post-intubation tracheal stenosis successfully treated with bronchoscopic cryotherapy that had previously been treated with surgery. In this case, cryotherapy was effective in treating web-like fibrous stenosis, without requiring more surgery. Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis. PMID:27853078

Erlotinib-induced rash spares previously irradiated skin

International Nuclear Information System (INIS)

Lips, Irene M.; Vonk, Ernest J.A.; Koster, Mariska E.Y.; Houwing, Ronald H.

2011-01-01

Erlotinib is an epidermal growth factor receptor inhibitor prescribed to patients with locally advanced or metastasized non-small cell lung carcinoma after failure of at least one earlier chemotherapy treatment. Approximately 75% of the patients treated with erlotinib develop acneiform skin rashes. A patient treated with erlotinib 3 months after finishing concomitant treatment with chemotherapy and radiotherapy for non-small cell lung cancer is presented. Unexpectedly, the part of the skin that had been included in his previously radiotherapy field was completely spared from the erlotinib-induced acneiform skin rash. The exact mechanism of erlotinib-induced rash sparing in previously irradiated skin is unclear. The underlying mechanism of this phenomenon needs to be explored further, because the number of patients being treated with a combination of both therapeutic modalities is increasing. The therapeutic effect of erlotinib in the area of the previously irradiated lesion should be assessed. (orig.)

Initial results of CyberKnife treatment for recurrent previously irradiated head and neck cancer

International Nuclear Information System (INIS)

Himei, Kengo; Katsui, Kuniaki; Yoshida, Atsushi

2003-01-01

The purpose of this study was to evaluate the efficacy of CyberKnife for recurrent previously irradiated head and neck cancer. Thirty-one patients with recurrent previously irradiated head and neck cancer were treated with a CyberKnife from July 1999 to March 2002 at Okayama Kyokuto Hospital were retrospectively studied. The accumulated dose was 28-80 Gy (median 60 Gy). The interval between CyberKnife treatment and previous radiotherapy was 0.4-429.5 months (median 16.3 months). Primary lesions were nasopharynx: 7, maxillary sinus: 6, tongue: 5, ethmoid sinus: 3, and others: 1. The pathology was squamous cell carcinoma: 25, adenoid cystic carcinoma: 4, and others: 2. Symptoms were pain: 8, and nasal bleeding: 2. The prescribed dose was 15.0-40.3 Gy (median 32.3 Gy) as for the marginal dose. The response rate (complete response (CR)+partial response (PR)) and local control rate (CR+PR+no change (NC)) was 74% and 94% respectively. Pain disappeared for 4 cases, relief was obtained for 4 cases and no change for 2 cases and nasal bleeding disappeared for 2 cases for an improvement of symptoms. An adverse effects were observed as mucositis in 5 cases and neck swelling in one case. Prognosis of recurrent previously irradiated head and neck cancer was estimated as poor. Our early experience shows that CyberKnife is expected to be feasible treatment for recurrent previously irradiated head and neck cancer, and for the reduction adverse effects and maintenance of useful quality of life (QOL) for patients. (author)

4-Aminopyridine (fampridine) effectively treats amlodipine poisoning: A case report

NARCIS (Netherlands)

Wilffert, B.; Boskma, R.J.; Van Der Voort, P.H.J.; Uges, D.R.A.; Van Roon, E.N.; Brouwers, J.R.B.J.

2007-01-01

A case of a serious poisoning with the calcium entry blocker amlodipine is described, which was treated effectively with 4-aminopyridine. Calcium is suggested as general treatment of poisoning with calcium entry blockers in many guidelines. The use of intravenous 4-aminopyridine is theoretically

4-Aminopyridine (fampridine) effectively treats amlodipine poisoning : a case report

NARCIS (Netherlands)

Wilffert, B.; Boskma, R. J.; van der Voort, P. H. J.; Uges, D. R. A.; van Roon, E. N.; Brouwers, J. R. B. J.

2007-01-01

A case of a serious poisoning with the calcium entry blocker amlodipine is described, which was treated effectively with 4-aminopyridine. Calcium is suggested as general treatment of poisoning with calcium entry blockers in many guidelines. The use of intravenous 4-aminopyridine is theoretically

Pulmonary lymphangioleiomyomatosis presenting as spontaneous pneumothorax treated with sirolimus - A case report

Science.gov (United States)

Verma, Ajay Kumar; Joshi, Ambarish; Mishra, Amritesh Ranjan; Kant, Surya; Singh, Arpita

2018-01-01

Spontaneous pneumothorax is a very common medical emergency. Patients are often treated without treating the underlying cause. Lymphangioleiomyomatosis (LAM) is a rare cystic lung disease. Until recently, diagnosis of LAM was a challenge with nearly 100% mortality in 10 years, but better understanding of the disease through research and better radiological techniques and newer drugs such as sirolimus has improved the survival in such patients. We are presenting a rare case of LAM presenting as a secondary spontaneous pneumothorax treated with sirolimus. PMID:29487252

(hydronsan) in previously untreated cases of pulmo

African Journals Online (AJOL)

B., M.D., King George V. Hospital, Durban. SUMMARY. The results of a randomized, single-blind, between-paTienI trial of various combinations of rifampicin, .... clearing after 16 weeks of trial is higher in the rifampicin- treated groups than in the ethambutol-plus-Hydronsan group. Table III shows the radiological clearing.

Neonatal Intracranial Aneurysm Rupture Treated by Endovascular Management: A Case Report

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Yi-Pei Tai

2010-08-01

Full Text Available Pediatric intracranial aneurysm rupture is rare, and is traditionally managed by surgical clipping. To the best of our knowledge, endovascular embolization of aneurysms in neonates has not previously been reported in Taiwan. We report a 9-day-old boy with intracranial aneurysms who underwent endovascular embolization, representing the youngest reported case in Taiwan. The 9-day-old boy presented with non-specific symptoms of irritable crying, seizure and respiratory distress. Computed tomography disclosed intraventricular hemorrhage, subarachnoid hemorrhage and focal intracranial hemorrhage around the right cerebellum. Subsequent computed tomographic angiography showed two sequential fusiform aneurysms, measuring 3 mm, located in the right side posterior inferior cerebellar artery (PICA. The patient underwent endovascular embolization because of the high risk of aneurysm re-rupture and the impossibility of surgical clipping due to the fusiform nature of the aneurysms. A postembolization angiogram revealed complete obliteration of the right distal PICA and proximal aneurysm. The distal PICA aneurysm was revascularized from the collateral circulation, but demonstrated a slow and delayed filling pattern. The patient's condition remained stable over the following week, and he was discharged without anticonvulsant therapy. No significant developmental delay was noted at follow-up at when he was 3 months old. This case emphasizes the need for clinical practitioners to consider a diagnosis of intracranial hemorrhage in neonates with seizure and increased intracranial pressure. Neonatal intracranial aneurysms can be treated safely by endovascular treatment.

FORTY CASES OF INSOMNIA TREATED WITH ACUPUNCTURE, MASSAGE AND MUSIC THERAPY

Institute of Scientific and Technical Information of China (English)

WANG Lin-yu

2005-01-01

@@ Insomnia is a commonly encountered sleep disorder in clinical practice. The author of the present paper treated 40 cases of insomnia with acupuncture and massage combined with music therapy and achieved satisfied outcomes. Following is the report.

Infantile acne treated with oral isotretinoin

DEFF Research Database (Denmark)

Miller, Iben Marie; Echeverría, Begoña; Torrelo, Antonio

2013-01-01

In contrast to adolescent acne, infantile acne (IA) is a rare condition with only a limited body of available literature. In this descriptive, retrospective study, we reviewed six cases from 2002 to 2010 treated with oral isotretinoin. The average age of onset was 6.16 months (range 0-21 mos......). Consistent with the previous, limited literature, we found predominantly boys are affected, a predilection for the cheeks, and a polymorphic inflammatory morphology. Two patients had a family history of acne. All cases were successfully and safely treated with oral isotretinoin. The suggested treatment...... of childhood acne is similar to that of adolescents (graded according to the severity of the skin disease and risk of scarring). Oral isotretinoin appears to be an effective and safe treatment for severe IA....

A Flexible-Dose Study of Paliperidone ER in Patients With Nonacute Schizophrenia Previously Treated Unsuccessfully With Oral Olanzapine.

Science.gov (United States)

Kotler, Moshe; Dilbaz, Nesrin; Rosa, Fernanda; Paterakis, Periklis; Milanova, Vihra; Smulevich, Anatoly B; Lahaye, Marjolein; Schreiner, Andreas

2016-01-01

The goal of this study was to explore the tolerability, safety, and treatment response of switching from oral olanzapine to paliperidone extended release (ER). Adult patients with nonacute schizophrenia who had been treated unsuccessfully with oral olanzapine were switched to flexible doses of paliperidone ER (3 to 12 mg/d). The primary efficacy outcome was a ≥ 20% improvement in Positive and Negative Syndrome Scale (PANSS) total scores from baseline to endpoint for patients who switched medications because of lack of efficacy with olanzapine and noninferiority versus previous olanzapine treatment (mean endpoint change in PANSS total scores vs. baseline of ≤ 5 points) for patients who switched for reasons other than lack of efficacy. Safety and tolerability were assessed by monitoring adverse events, extrapyramidal symptoms, and weight change. Of 396 patients, 65.2% were men, mean age was 40.0 ± 12.0 years, and 75.5% had paranoid schizophrenia. Among the patients whose main reason for switching was lack of efficacy, an improvement in the PANSS total score of ≥ 20% occurred in 57.4% of patients. Noninferiority was confirmed for each subgroup of patients whose main reason for switching was something other than lack of efficacy. Paliperidone ER was generally well tolerated. Extrapyramidal symptoms as measured by total Extrapyramidal Symptom Rating Scale scores showed statistically significant and clinically relevant improvements at endpoint, the average weight decreased by 0.8 ± 5.2 kg at endpoint, and a clinically relevant weight gain of ≥ 7% occurred in 8.0% of patients. Paliperidone ER flexibly-dosed over 6 months was well tolerated and associated with a meaningful clinical response in patients with nonacute schizophrenia who had previously been unsuccessfully treated with oral olanzapine.

Chondroblastoma of the Patella Treated With Curettage And Bone Graft:A Case Report

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Khodamorad Jamshidi

2011-07-01

Full Text Available Patella is a relative uncommon site for chondroblastoma. Most of cases of chondroblastoma in patella reported in literature are treated with patellectomy. We treated a large chondroblastic lesion in patella of an 18- year-old male with curettage, burring & bone graft and the result was satisfactory after 3 years post operation.

A Case Study Using Child-Centered Play Therapy Approach to Treat Enuresis and Encopresis.

Science.gov (United States)

Cuddy-Casey, Maria

1997-01-01

Demonstrates an alternative method (nondirective child-centered therapy) in treating enuresis and encopresis resulting from emotional disturbances. Examines various etiologies and approaches to treating these conditions. Provides a case study example. Claims that professionals must differentiate between primary and secondary occurrences of these…

Case-control study for colorectal cancer genetic susceptibility in EPICOLON: previously identified variants and mucins

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Moreno Victor

2011-08-01

Full Text Available Abstract Background Colorectal cancer (CRC is the second leading cause of cancer death in developed countries. Familial aggregation in CRC is also important outside syndromic forms and, in this case, a polygenic model with several common low-penetrance alleles contributing to CRC genetic predisposition could be hypothesized. Mucins and GALNTs (N-acetylgalactosaminyltransferase are interesting candidates for CRC genetic susceptibility and have not been previously evaluated. We present results for ten genetic variants linked to CRC risk in previous studies (previously identified category and 18 selected variants from the mucin gene family in a case-control association study from the Spanish EPICOLON consortium. Methods CRC cases and matched controls were from EPICOLON, a prospective, multicenter, nationwide Spanish initiative, comprised of two independent stages. Stage 1 corresponded to 515 CRC cases and 515 controls, whereas stage 2 consisted of 901 CRC cases and 909 controls. Also, an independent cohort of 549 CRC cases and 599 controls outside EPICOLON was available for additional replication. Genotyping was performed for ten previously identified SNPs in ADH1C, APC, CCDN1, IL6, IL8, IRS1, MTHFR, PPARG, VDR and ARL11, and 18 selected variants in the mucin gene family. Results None of the 28 SNPs analyzed in our study was found to be associated with CRC risk. Although four SNPs were significant with a P-value ADH1C (OR = 1.63, 95% CI = 1.06-2.50, P-value = 0.02, recessive, rs1800795 in IL6 (OR = 1.62, 95% CI = 1.10-2.37, P-value = 0.01, recessive, rs3803185 in ARL11 (OR = 1.58, 95% CI = 1.17-2.15, P-value = 0.007, codominant, and rs2102302 in GALNTL2 (OR = 1.20, 95% CI = 1.00-1.44, P-value = 0.04, log-additive 0, 1, 2 alleles], only rs3803185 achieved statistical significance in EPICOLON stage 2 (OR = 1.34, 95% CI = 1.06-1.69, P-value = 0.01, recessive. In the joint analysis for both stages, results were only significant for rs3803185 (OR = 1

Case-control study for colorectal cancer genetic susceptibility in EPICOLON: previously identified variants and mucins

International Nuclear Information System (INIS)

Abulí, Anna; Morillas, Juan D; Rigau, Joaquim; Latorre, Mercedes; Fernández-Bañares, Fernando; Peña, Elena; Riestra, Sabino; Payá, Artemio; Jover, Rodrigo; Xicola, Rosa M; Llor, Xavier; Fernández-Rozadilla, Ceres; Carvajal-Carmona, Luis; Villanueva, Cristina M; Moreno, Victor; Piqué, Josep M; Carracedo, Angel; Castells, Antoni; Andreu, Montserrat; Ruiz-Ponte, Clara; Castellví-Bel, Sergi; Alonso-Espinaco, Virginia; Muñoz, Jenifer; Gonzalo, Victoria; Bessa, Xavier; González, Dolors; Clofent, Joan; Cubiella, Joaquin

2011-01-01

Colorectal cancer (CRC) is the second leading cause of cancer death in developed countries. Familial aggregation in CRC is also important outside syndromic forms and, in this case, a polygenic model with several common low-penetrance alleles contributing to CRC genetic predisposition could be hypothesized. Mucins and GALNTs (N-acetylgalactosaminyltransferase) are interesting candidates for CRC genetic susceptibility and have not been previously evaluated. We present results for ten genetic variants linked to CRC risk in previous studies (previously identified category) and 18 selected variants from the mucin gene family in a case-control association study from the Spanish EPICOLON consortium. CRC cases and matched controls were from EPICOLON, a prospective, multicenter, nationwide Spanish initiative, comprised of two independent stages. Stage 1 corresponded to 515 CRC cases and 515 controls, whereas stage 2 consisted of 901 CRC cases and 909 controls. Also, an independent cohort of 549 CRC cases and 599 controls outside EPICOLON was available for additional replication. Genotyping was performed for ten previously identified SNPs in ADH1C, APC, CCDN1, IL6, IL8, IRS1, MTHFR, PPARG, VDR and ARL11, and 18 selected variants in the mucin gene family. None of the 28 SNPs analyzed in our study was found to be associated with CRC risk. Although four SNPs were significant with a P-value < 0.05 in EPICOLON stage 1 [rs698 in ADH1C (OR = 1.63, 95% CI = 1.06-2.50, P-value = 0.02, recessive), rs1800795 in IL6 (OR = 1.62, 95% CI = 1.10-2.37, P-value = 0.01, recessive), rs3803185 in ARL11 (OR = 1.58, 95% CI = 1.17-2.15, P-value = 0.007, codominant), and rs2102302 in GALNTL2 (OR = 1.20, 95% CI = 1.00-1.44, P-value = 0.04, log-additive 0, 1, 2 alleles], only rs3803185 achieved statistical significance in EPICOLON stage 2 (OR = 1.34, 95% CI = 1.06-1.69, P-value = 0.01, recessive). In the joint analysis for both stages, results were only significant for rs3803185 (OR = 1.12, 95% CI = 1

Survival, Durable Response, and Long-Term Safety in Patients With Previously Treated Advanced Renal Cell Carcinoma Receiving Nivolumab.

Science.gov (United States)

McDermott, David F; Drake, Charles G; Sznol, Mario; Choueiri, Toni K; Powderly, John D; Smith, David C; Brahmer, Julie R; Carvajal, Richard D; Hammers, Hans J; Puzanov, Igor; Hodi, F Stephen; Kluger, Harriet M; Topalian, Suzanne L; Pardoll, Drew M; Wigginton, Jon M; Kollia, Georgia D; Gupta, Ashok; McDonald, Dan; Sankar, Vindira; Sosman, Jeffrey A; Atkins, Michael B

2015-06-20

Blockade of the programmed death-1 inhibitory cell-surface molecule on immune cells using the fully human immunoglobulin G4 antibody nivolumab mediates tumor regression in a portion of patients with advanced treatment-refractory solid tumors. We report clinical activity, survival, and long-term safety in patients with advanced renal cell carcinoma (RCC) treated with nivolumab in a phase I study with expansion cohorts. A total of 34 patients with previously treated advanced RCC, enrolled between 2008 and 2012, received intravenous nivolumab (1 or 10 mg/kg) in an outpatient setting once every two weeks for up to 96 weeks and were observed for survival and duration of response after treatment discontinuation. Ten patients (29%) achieved objective responses (according to RECIST [version 1.0]), with median response duration of 12.9 months; nine additional patients (27%) demonstrated stable disease lasting > 24 weeks. Three of five patients who stopped treatment while in response continued to respond for ≥ 45 weeks. Median overall survival in all patients (71% with two to five prior systemic therapies) was 22.4 months; 1-, 2-, and 3-year survival rates were 71%, 48%, and 44%, respectively. Grade 3 to 4 treatment-related adverse events occurred in 18% of patients; all were reversible. Patients with advanced treatment-refractory RCC treated with nivolumab demonstrated durable responses that in some responders persisted after drug discontinuation. Overall survival is encouraging, and toxicities were generally manageable. Ongoing randomized clinical trials will further assess the impact of nivolumab on overall survival in patients with advanced RCC. © 2015 by American Society of Clinical Oncology.

Efficacy of spinal cord stimulators in treating peripheral neuropathy: a case series.

Science.gov (United States)

Abd-Elsayed, Alaa; Schiavoni, Nick; Sachdeva, Harsh

2016-02-01

Peripheral neuropathy is a common cause of pain, and it is increasing in prevalence. Peripheral neuropathic pain is very hard to treat and can be resistant to multiple pain management modalities. Our series aimed at testing the efficacy of spinal cord stimulators (SCSs) in treating resistant painful peripheral neuropathy. Case 1: A 79-year-old man presented to our clinic with long-standing history of painful peripheral diabetic neuropathy resistant to conservative management. After failure of all possible modalities, we offered the patient an SCS trial that was very successful, and we proceeded with the permanent implant that continued to help with his pain and allowed the patient to wean down his medications. Case 2: A 60-year-old man presented with chronic peripheral neuropathy secondary to HIV, patient failed all conservative and procedural management. Patient then had an SCS trial that relieved his pain significantly. Unfortunately, we did not proceed with the implant due to deterioration of the patient general health. Case 3: A 39-year-old woman presented with painful peripheral neuropathy secondary to chemotherapy for breast cancer. After failure of medication management and procedures, patient had a SCS trial that improved her pain and we then proceeded with performing the permanent implant that controlled her pain. We presented 3 cases with chronic painful peripheral neuropathy secondary to HIV, diabetes mellitus, and chemotherapy that was resistant to conservative pain management and procedures that was successfully treated with neurostimulation. Copyright © 2016 Elsevier Inc. All rights reserved.

Anaesthetic management for caesarean section in a case of previously operated with residual pituitary tumour

Directory of Open Access Journals (Sweden)

Prerana N Shah

2011-01-01

Full Text Available Successful anaesthetic management for caesarean section in a case with previous pituitary tumour resection, with residual tumour, is reported. The pituitary gland undergoes global hyperplasia during pregnancy. Functional pituitary tumours may exhibit symptomatic enlargement during pregnancy. Growth hormone secreting tumour is associated with acromegaly which has associated anaesthetic implications of difficult airway, systemic hypertension, and diabetes and electrolyte imbalance. Intracranial space occupying lesions can increase intra cranial pressure and compromise cerebral perfusion or cause herniation. We report management of this case.

Fibrolipoma of the lip treated by diode laser surgery: A case report

Directory of Open Access Journals (Sweden)

Capodiferro Saverio

2008-09-01

Full Text Available Abstract Introduction Several neoplasms of the adipose tissue can involve the soft tissues of the head and neck region. These neoplasms are mainly treated surgically and an accurate histological examination is mandatory for a precise diagnosis. Case presentation We report a case of fibrolipoma involving the lower lip of a 43-year-old man, which was successfully treated by diode laser surgery. This approach allowed adequate resection of the neoplasm with minimal damage to the adjacent tissues, thus reducing post-surgical scarring. Conclusion Diode laser surgery for the treatment of benign lesions of the oral mucosa appears to be a convenient alternative to conventional blade surgery and has proved to be effective for the excision of fibrolipoma of the lip. The possibility of avoiding direct suture after excision is surely helpful when aesthetic areas, such as the lip, are surgically treated. For these reasons, and also considering the lower histological alteration of the specimen obtained with diode laser surgery if adequately used, the diode laser is undoubtedly a good alternative to conventional surgery.

Secondary Knee Osteoarthritis due to Neurofibromatosis Type 1 Treated with above the Knee Amputation: A Case Report

Directory of Open Access Journals (Sweden)

Jay Patel

2013-01-01

Full Text Available Background. Neurofibromatosis Type 1 (NF-1 has a variety of associated orthopaedic manifestations that have been previously reported. We report a case of severe, grade 4 knee osteoarthritis (OA with recurrent subluxation and joint laxity due to multiple extra-articular neurofibromas ultimately treated with Above the Knee Amputation (AKA. Case Description. A 39-year-old man presented with multiple neurofibromas and lymphedema leading to degenerative changes of the knee. Conservative treatment failed due to the severity of the knee degeneration and patient discomfort. Likewise, arthroplasty was not possible due to poor bone quality and joint instability. Therefore, AKA was selected to relieve symptoms and provide functional improvement. six months after the procedure the patient has increased functional capacity for ambulation and activities of daily living, as well as significant decrease in pain and discomfort. Clinical Relevance. Extra-articular neurofibromas causing severe secondary OA in relatively young patients can be functionally improved with AKA and prosthetic device use.

[Two cases of phytobezoars treated by adminsitration of Coca-Cola by oral route].

Science.gov (United States)

Lee, Hyun Jai; Kang, Hyoun Goo; Park, Se Young; Yi, Chea Yong; Na, Gyoung Jun; Lee, Tae Yeong; Kim, Sang Hyun; Song, Chul Soo

2006-12-01

Bezoars are concretions of foreign bodies found in the gastrointestinal tract. In the past, most common method for the treatment of bezoar was surgical management. However, the current treatment methods include chemical dissolution and endoscopic mechanical lithotripsy. There were few reports on the treatment of phytobezoars by nasogastric Cola lavage. However, there was no report succeeded by oral route alone. In our two cases, phytobezoars were treated by oral administration of Coca-Cola. Our patients drank 700-800 mL of Coca-Cola daily, and after two months, complete dissolutions of bezoars were achieved. We report two cases of phytobezoars completely treated by drinking Coca-Cola.

Popliteal lymphadenectomy for treating metastatic melanoma: case report

Directory of Open Access Journals (Sweden)

Sergio Renato Pais Costa

Full Text Available CONTEXT: Regional lymph node involvement in patients with malignant melanomas has been associated with poor prognosis. In-transit metastases also lead to poor long-term survival. Whereas for nodal disease only regional lymphadenectomy offers adequate locoregional control, for in-transit metastasis both local excision and isolated limb perfusion with chemotherapy plus tumor necrosis factor-alpha can be used for disease control. In cases of tumors located in the distal region of the legs, the lymphatic dissemination most commonly observed is to the inguinal chain. Consequently, therapeutic inguinal lymphadenectomy or even selective lymphadenectomy (sentinel lymph node biopsy have been recommended. On the other hand, involvement of the popliteal chain is very rare. When this occurs, popliteal lymphadenectomy should be indicated. Local excision may be the logical approach for a few small in-transit metastases because of the low morbidity in this procedure, when compared with isolated limb perfusion. CASE REPORT: A case of melanoma of the heel with popliteal chain involvement and in-transit metastases is presented. This was treated by means of regional lymphadenectomy plus in-transit metastases excision, with a good postoperative course.

Recombinant EphB4-HSA Fusion Protein and Azacitidine or Decitabine for Relapsed or Refractory Myelodysplastic Syndrome, Chronic Myelomonocytic Leukemia, or Acute Myeloid Leukemia Patients Previously Treated With a Hypomethylating Agent

Science.gov (United States)

2017-08-18

Acute Myeloid Leukemia Arising From Previous Myelodysplastic Syndrome; Chronic Myelomonocytic Leukemia; Previously Treated Myelodysplastic Syndrome; Recurrent Acute Myeloid Leukemia With Myelodysplasia-Related Changes; Recurrent Adult Acute Myeloid Leukemia

Phase I/II study of gefitinib (Iressa(®)) and vorinostat (IVORI) in previously treated patients with advanced non-small cell lung cancer.

Science.gov (United States)

Han, Ji-Youn; Lee, Soo Hyun; Lee, Geon Kook; Yun, Tak; Lee, Young Joo; Hwang, Kum Hui; Kim, Jin Young; Kim, Heung Tae

2015-03-01

Vorinostat has been shown to overcome resistance to gefitinib. We performed a phase I/II study combining gefitinib with vorinostat in previously treated non-small cell lung cancer (NSCLC). A 3 + 3 dose-escalation design was used to determine maximum tolerated dose (MTD) and recommended phase II dose (RP2D). Three dose levels were tested: 250 mg/day gefitinib on days 1-28 and 200, 300 or 400 mg/day vorinostat on days 1-7, and 15-21 out of every 28 days. The primary endpoint was median progression-free survival (PFS). Fifty-two patients were enrolled and treated (43 in phase II). The median age was 59 years, 28 patients were male, 44 had adenocarcinoma, 29 had never smoked, and 36 had undergone one prior treatment. Twenty-two patients exhibited sensitive EGFR mutations. Planned dose escalation was completed without reaching the MTD. The RP2D was 250 mg gefitinib and 400 mg vorinostat. In 43 assessable patients in phase II, the median PFS was 3.2 months; the overall survival (OS) was 19.0 months. There were 16 partial responses and six cases of stable disease. In EGFR-mutant NSCLC, response rate was 77 %, median PFS was 9.1 months, and median OS was 24.1 months. The most common adverse events were anorexia and diarrhea. Treatment with 250 mg gefitinib daily with biweekly 400 mg/day vorinostat was feasible and well tolerated. In an unselected patient population, this combination dose did not improve PFS. However, this combination showed a potential for improving efficacy of gefitinib in EGFR-mutant NSCLC (NCT01027676).

Clinical study of Atopic Dermatitis patient treated with Poison Extraction Method

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Park Chi-young

2007-06-01

Full Text Available Objectives : This study is desinged in order to evaluate the Poison extraction method for the Atopic dermatitis. Methods : The authors observed the two cases of Atopic dermatitis patients who previously used steroid-based ointment. for treating the Poison Extraction Method. Conclusions : 1. In case 1, the patient with mild case of Atopic dermatitis in face is treated with the Poison extraction method. Rash symptoms intensed for first few days. As sweating appeared in the local area from the seventh day, all the symptoms was disappeared rapidly. No recurrence was found. 2. In case 2, the patient with severe case of Atopic dermatitis in whole body is treated with the Poison extraction method. The symptoms intensed after two months and all the symptoms of itchiness, rash, scaly letter dissapeared in the third and fourth months. No recurrence was found. 3. In both cases of mild and severe cases of Atopic dermatitis. all the symptoms were disappeared and no recurrence was found with the Poison Extraction Method.

Hyponatraemia and hypothyroidism in a previously irradiated case of carcinoma of the tongue

International Nuclear Information System (INIS)

Nasser, N.A.; Lever, E.G.

1987-01-01

A case of squamous cell carcinoma of the tongue was complicated by post operative hyponatraemia. The criteria for the syndrome of inappropriate secretion of anti diuretic hormone, (ADH) (SIADH) were met but the patient remained hyponatraemic despite adequate treatment. The patient had previously received radical external radiotherapy to the neck and was found to be profoundly hypothyroid. Correction of the hypothyroid state led to clinical and biochemical recovery. The frequency of post-irradiation hypothyroidism and the possible mechanisms of hypothyroid-induced hyponatraemia are discussed. (author)

'Vague Oviedo': autonomy, culture and the case of previously competent patients.

Science.gov (United States)

Pascalev, Assya; Vidalis, Takis

2010-03-01

The paper examines the ethical and legal challenges of making decisions for previously competent patients and the role of advance directives and legal representatives in light of the Oviedo Convention. The paper identifies gaps in the Convention that result in conflicting instructions in cases of a disagreement between the expressed prior wishes of a patient, and the legal representative. The authors also examine the legal and moral status of informally expressed prior wishes of patients unable to consent. The authors argue that positivist legal reasoning is insufficient for a consistent interpretation of the relevant provisions of the Convention and argue that ethical argumentation is needed to provide guidance in such cases. Based on the ethical arguments, the authors propose a way of reconciling the apparent inconsistencies in the Oviedo Convention. They advance a culturally sensitive approach to the application of the Convention at the national level. This approach understands autonomy as a broader, relational consent and emphasizes the social and cultural embeddedness of the individual. Based on their approach, the authors argue that there exists a moral obligation to respect the prior wishes of the patient even in countries without advance directives. Yet it should be left to the national legislations to determine the extent of this obligation and its concrete forms.

A case of severe thallium poisoning successfully treated with hemoperfusion and continuous veno-venous hemofiltration.

Science.gov (United States)

Huang, C; Zhang, X; Li, G; Jiang, Y; Wang, Q; Tian, R

2014-05-01

Thallium poisoning is a rare condition that is often misdiagnosed, delaying appropriate treatment. Left untreated, thallium toxicity can permanently damage the nervous and digestive systems or, in severe cases, lead to paralysis and death. It is most often treated by an oral administration of Prussian blue. Thallium has a long physiological half-life, and Prussian blue cannot sequester thallium outside the digestive tract. Therefore, the first priority in treating severe thallium poisoning is to lower blood levels as soon as possible. We report the case of a patient with supralethal blood levels of thallium treated successfully using combined hemoperfusion (HP) and continuous veno-venous hemofiltration (CVVH). Three rounds of HP alone decreased blood thallium levels by 20.2%, 34.8%, and 32.2%, while each of the five subsequent rounds of CVVH reduced thallium blood levels by 63.5%, 64.2%, 42.1%, 18.6%, and 22.6%. The reversal of symptoms and prevention of lasting neurological damage indicates that HP, CVVH, 2,3-dimercaptopropane-1-sulfonate, neuroprotective agents along with supportive therapy were used successfully to treat a case of severe thallium poisoning.

The Clinical Report on the 3 Cases of Sciatica treated on Direct Moxibustion

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Jun-Hyuk Kang

2007-06-01

Full Text Available Objectives : The purpose of this report is to examine the effects of direct moxibustion on the Low back pain and Lowerlimb radiating pain. Methods : The patients were hospitalized in Daejeon Univ. Oriental Hospital and treated with acupuncture treatment, physical treatment and direct moxibustion. After treatments, we measured the Results & Conclusions : VAS(Visual Analogue Scale and PRS(Pain Rating Scale. VAS(Visual Analogue Scale and PRS(Pain Rating Scale scores were improved in 3 cases of Low back pain and Lowerlimb radiating pain treated with direct moxibustion. So it is suggested that direct moxibution have the possibility to treat on sciatica

Osseous union in cases of nonunion in long bones treated by ...

African Journals Online (AJOL)

To determine the incidence of osseous union in cases of nonunion of long bones managed by open reduction and compression plating. : Between November, 2003 and June, 2005, 53 patients with nonunion of long bones were treated by open reduction and internal fixation and followed up. The follow up period for each ...

Phase III Study of Cabozantinib in Previously Treated Metastatic Castration-Resistant Prostate Cancer: COMET-1.

Science.gov (United States)

Smith, Matthew; De Bono, Johann; Sternberg, Cora; Le Moulec, Sylvestre; Oudard, Stéphane; De Giorgi, Ugo; Krainer, Michael; Bergman, Andries; Hoelzer, Wolfgang; De Wit, Ronald; Bögemann, Martin; Saad, Fred; Cruciani, Giorgio; Thiery-Vuillemin, Antoine; Feyerabend, Susan; Miller, Kurt; Houédé, Nadine; Hussain, Syed; Lam, Elaine; Polikoff, Jonathan; Stenzl, Arnulf; Mainwaring, Paul; Ramies, David; Hessel, Colin; Weitzman, Aaron; Fizazi, Karim

2016-09-01

Cabozantinib is an inhibitor of kinases, including MET and vascular endothelial growth factor receptors, and has shown activity in men with previously treated metastatic castration-resistant prostate cancer (mCRPC). This blinded phase III trial compared cabozantinib with prednisone in patients with mCRPC. Men with progressive mCRPC after docetaxel and abiraterone and/or enzalutamide were randomly assigned at a two-to-one ratio to cabozantinib 60 mg once per day or prednisone 5 mg twice per day. The primary end point was overall survival (OS). Bone scan response (BSR) at week 12 as assessed by independent review committee was the secondary end point; radiographic progression-free survival (rPFS) and effects on circulating tumor cells (CTCs), bone biomarkers, serum prostate-specific antigen (PSA), and symptomatic skeletal events (SSEs) were exploratory assessments. A total of 1,028 patients were randomly assigned to cabozantinib (n = 682) or prednisone (n = 346). Median OS was 11.0 months with cabozantinib and 9.8 months with prednisone (hazard ratio, 0.90; 95% CI, 0.76 to 1.06; stratified log-rank P = .213). BSR at week 12 favored cabozantinib (42% v 3%; stratified Cochran-Mantel-Haenszel P < .001). rPFS was improved in the cabozantinib group (median, 5.6 v 2.8 months; hazard ratio, 0.48; 95% CI, 0.40 to 0.57; stratified log-rank P < .001). Cabozantinib was associated with improvements in CTC conversion, bone biomarkers, and post-random assignment incidence of SSEs but not PSA outcomes. Grade 3 to 4 adverse events and discontinuations because of adverse events were higher with cabozantinib than with prednisone (71% v 56% and 33% v 12%, respectively). Cabozantinib did not significantly improve OS compared with prednisone in heavily treated patients with mCRPC and progressive disease after docetaxel and abiraterone and/or enzalutamide. Cabozantinib had some activity in improving BSR, rPFS, SSEs, CTC conversions, and bone biomarkers but not PSA outcomes. © 2016 by

Correlation between epithelial thickness in normal corneas, untreated ectatic corneas, and ectatic corneas previously treated with CXL; is overall epithelial thickness a very early ectasia prognostic factor?

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Kanellopoulos, Anastasios John; Aslanides, Ioannis M; Asimellis, George

2012-01-01

To determine and correlate epithelial corneal thickness (pachymetric) measurements taken with a digital arc scanning very high frequency ultrasound biomicroscopy (HF UBM) imaging system (Artemis-II), and compare mean and central epithelial thickness among normal eyes, untreated keratoconic eyes, and keratoconic eyes previously treated with collagen crosslinking (CXL). Epithelial pachymetry measurements (topographic mapping) were conducted on 100 subjects via HF UBM. Three groups of patients were included: patients with normal eyes (controls), patients with untreated keratoconic eyes, and patients with keratoconic eyes treated with CXL. Central, mean, and peripheral corneal epithelial thickness was examined for each group, and a statistical study was conducted. Mean, central, and peripheral corneal epithelial thickness was compared between the three groups of patients. Epithelium thickness varied substantially in the keratoconic group, and in some cases there was a difference of up to 20 μm between various points of the same eye, and often a thinner epithelium coincided with a thinner cornea. However, on average, data from the keratoconic group suggested an overall thickening of the epithelium, particularly over the pupil center of the order of +3 μm, while the mean epithelium thickness was on average +1.1 μm, compared to the control population (P = 0.005). This overall thickening was more pronounced in younger patients in the keratoconic group. Keratoconic eyes previously treated with CXL showed, on average, virtually the same average epithelium thickness (mean -0.7 μm, -0.2 μm over the pupil center, -0.9 μm over the peripheral zone) as the control group. This finding further reinforces our novel theory of the "reactive" component of epithelial thickening in corneas that are biomechanically unstable, becoming stable when biomechanical rigidity is accomplished despite persistence of cornea topographic irregularity. A highly irregular epithelium may be

A Single Case of Tourette’s Syndrome Treated with Traditional Chinese Medicine

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Min-Hwa Lee

2017-02-01

Full Text Available The objective of this case study was to investigate the effectiveness of Chinese medicine in treating Tourette's syndrome. Tourette's syndrome is a childhood- onset disorder that is characterized by sudden, involuntary movements or tics. The participant in this study was a 33-year-old male who had been diagnosed with Tourette's syndrome at the age of 9 years. His major complaints included facial tics, shoulder shrugging, and clearing the throat. Using a combination of acupuncture, herbs, Gua-Sha, and lifestyle changes once a week for 35 treatments, all the symptoms were reduced by 70%, as reported by the patient. In this case, the results indicated that Chinese medicine was able to minimize the symptoms of Tourette's syndrome. Further investigation is needed to support this argument. Tourette's syndrome, which was first described in 1885 by a French physician named Gilles de la Tourette, is characterized by facial tics, involuntary body movements from the head to the extremities, or vocal tics, and it usually has its onset in childhood. It is a neuropsychiatric disorder. The treatment for Tourette's syndrome is based on pharmacological treatment, behavior treatment, and deep brain stimulation. Unfortunately, none of these could completely control the symptoms; furthermore, antipsychiatric drugs might cause additional side effects, such as Parkinson symptoms, tardive dyskinesia, and metabolic disturbances. Finding acupuncture and oriental medicine literature on treatment of Tourette's syndrome was difficult, especially that written in English. Some research papers that have been translated into English indicated that Chinese herbs and acupuncture could reduce the tics significantly. For example, a study by Dr Pao-Hua Lin reported the significant effects of using acupuncture and oriental medicine in treating 1000 Tourette's syndrome cases. This case was treated to further investigate the principles of Dr Lin's study.

A case series investigating acceptance and commitment therapy as a treatment for previously treated, unremitted patients with anorexia nervosa.

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Berman, M I; Boutelle, K N; Crow, S J

2009-11-01

The aim of the present study was to evaluate the effectiveness of Acceptance and Commitment Therapy (ACT) for treatment of anorexia nervosa (AN) using a case series methodology among participants with a history of prior treatment for AN. Three participants enrolled; all completed the study. All participants had a history of 1-20 years of intensive eating disorder treatment prior to enrollment. Participants were seen for 17-19 twice-weekly sessions of manualized ACT. Symptoms were assessed at baseline, post-treatment and 1-year follow-up. All participants experienced clinically significant improvement on at least some measures; no participants worsened or lost weight even at 1-year follow-up. Simulation modelling analysis (SMA) revealed for some participants an increase in weight gain and a decrease in eating disorder symptoms during the treatment phase as compared to a baseline assessment phase. These data, although preliminary, suggest that ACT could be a promising treatment for subthreshold or clinical cases of AN, even with chronic participants or those with medical complications.

{sup 177}Lu-octreotate, alone or with radiosensitising chemotherapy, is safe in neuroendocrine tumour patients previously treated with high-activity {sup 111}In-octreotide

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Hubble, Daniel; Kong, Grace; Michael, Michael; Johnson, Val; Ramdave, Shakher; Hicks, Rodney John [Peter MacCallum Cancer Centre, Centre for Molecular Imaging, East Melbourne, VIC (Australia)

2010-10-15

The aim of this retrospective study was to determine whether patients with previous peptide receptor radionuclide therapy using high-activity {sup 111}In-pentetreotide can be safely treated with {sup 177}Lu-octreotate and whether addition of radiosensitising chemotherapy increases the toxicity of this agent. Records of 27 patients (aged 17-75) who received 69 (median 3 per patient) {sup 177}Lu-octreotate administrations, including 29 in conjunction with radiosensitising infusional 5-fluorouracil (5-FU) (n = 27), or capecitabine (n = 2), between October 2005 and July 2007 subsequent to 1-8 prior cycles of {sup 111}In-pentetreotide therapy were analysed. Toxicity was assessed during and at 8-12 weeks post-treatment, with further long-term assessments including survival status reviewed till death or study close-out date of 1 November 2009. Reduction in blood counts was most marked following the first dose of {sup 177}Lu-octreotate but at early follow-up the only major haematological toxicity was a single case of grade 4 lymphopaenia. Both the presence of bone metastases and the administration of chemotherapy tended to result in greater reduction in blood counts, but these differences did not reach statistical significance. On long-term follow-up, 16 patients (59%) are alive with median overall survival of 36 months (32-44 months from first {sup 177}Lu-octreotate therapy). None of the recorded deaths was directly related to treatment toxicity. One patient had late grade 4 anaemia and thrombocytopaenia secondary to bone marrow failure from progressive infiltration by tumour. No other significant long-term haematological toxicities were recorded and no leukaemia was observed. No renal toxicity was observed on serial serum creatinine or radionuclide glomerular filtration rate (GFR) determination on initial or long-term follow-up. {sup 177}Lu-octreotate is a safe and well-tolerated therapy for patients who have previously been treated with {sup 111}In-pentetreotide and can

Placenta Percreta Invading Broad Ligament and Parametrium in a Woman with Two Previous Cesarean Sections: A Case Report

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Mansoureh Vahdat

2012-01-01

Full Text Available Introduction. The incidence of placenta accreta has dramatically increased due to increasing caesarean section rate all over the world. Placenta percreta is the most severe form of placenta accretes. It frequently results in maternal morbidity and mortality mainly caused by massive obstetric hemorrhage or emergency hysterectomy. Percreta invading into the broad ligament has rarely been previously reported. Case presenting. We presented a case of placenta percreta invading left broad ligament and parametrium in a woman with two previous cesarean sections, which led to massive intraoperative hemorrhage during hysterectomy and transient ischemic encephalopathy. Conclusion. In cases of parametrial involvement, it would be more difficult to decide whether to remove placenta or leave it in site. In surgical removal neither local excision of placental bed and uterine repair nor traditional hysterectomy is adequate if parametrium invaded by placenta. We suggest delayed elective hysterectomy in such cases. So, pregnancy-induced pelvic congestion would be decreased, we can gather an expert team of gynecologists, urologists, and vascular surgeons, we could get plenty of blood products, and we may have the chance to administer methotrexate.

Results of 52 cases with struma maligna treated with radio-iodine

International Nuclear Information System (INIS)

Grebe, S.F.; Huth, K.D.

1982-01-01

Results of 52 cases with struma maligna treated with radio-iodine. Between 1966 and 1977, 52 thyroid carcinoma patients received radio-iodine therapy. Their age ranged from 18 to 82 years. Out of 52 patients, 46 underwent surgery with 26 thyrodectomized subtotally and 20 totally so. No surgery was performed in 6 cases since this was refused in 2 cases and inoperable for clinical reasons in 4 cases. Radio-iodine treatment was performed 6 to 10 weeks after operation or 2 to 4 weeks after diagnosis. In 9 cases, additional irradiation therapy was performed on metastases (predominantly in skeleton) at total doses ranging between 2500-7500 R focal dose for palliative reasons. In terms of summary, the authors draw the conclusion that surgical ablation of thyroid tissue as total as possible combined with subsequent radio-iodine treatments till complete destruction of the iodine-storing tissue imposes as the optimum treatment of follicular and papillary thyroid carcinoma. (orig./MG) [de

Everolimus for Previously Treated Advanced Gastric Cancer: Results of the Randomized, Double-Blind, Phase III GRANITE-1 Study

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Ohtsu, Atsushi; Ajani, Jaffer A.; Bai, Yu-Xian; Bang, Yung-Jue; Chung, Hyun-Cheol; Pan, Hong-Ming; Sahmoud, Tarek; Shen, Lin; Yeh, Kun-Huei; Chin, Keisho; Muro, Kei; Kim, Yeul Hong; Ferry, David; Tebbutt, Niall C.; Al-Batran, Salah-Eddin; Smith, Heind; Costantini, Chiara; Rizvi, Syed; Lebwohl, David; Van Cutsem, Eric

2013-01-01

Purpose The oral mammalian target of rapamycin inhibitor everolimus demonstrated promising efficacy in a phase II study of pretreated advanced gastric cancer. This international, double-blind, phase III study compared everolimus efficacy and safety with that of best supportive care (BSC) in previously treated advanced gastric cancer. Patients and Methods Patients with advanced gastric cancer that progressed after one or two lines of systemic chemotherapy were randomly assigned to everolimus 10 mg/d (assignment schedule: 2:1) or matching placebo, both given with BSC. Randomization was stratified by previous chemotherapy lines (one v two) and region (Asia v rest of the world [ROW]). Treatment continued until disease progression or intolerable toxicity. Primary end point was overall survival (OS). Secondary end points included progression-free survival (PFS), overall response rate, and safety. Results Six hundred fifty-six patients (median age, 62.0 years; 73.6% male) were enrolled. Median OS was 5.4 months with everolimus and 4.3 months with placebo (hazard ratio, 0.90; 95% CI, 0.75 to 1.08; P = .124). Median PFS was 1.7 months and 1.4 months in the everolimus and placebo arms, respectively (hazard ratio, 0.66; 95% CI, 0.56 to 0.78). Common grade 3/4 adverse events included anemia, decreased appetite, and fatigue. The safety profile was similar in patients enrolled in Asia versus ROW. Conclusion Compared with BSC, everolimus did not significantly improve overall survival for advanced gastric cancer that progressed after one or two lines of previous systemic chemotherapy. The safety profile observed for everolimus was consistent with that observed for everolimus in other cancers. PMID:24043745

A meta-analysis of drug resistant tuberculosis in Sub-Saharan Africa: how strongly associated with previous treatment and HIV co-infection?

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Berhan, Asres; Berhan, Yifru; Yizengaw, Desalegn

2013-11-01

In Sub-Saharan Africa, the fight against tuberculosis (TB) has encountered a great challenge because of the emergence of drug resistant TB strains and the high prevalence of HIV infection. The aim of this meta-analysis was to determine the association of drug-resistant TB with anti-TB drug treatment history and HIV co-infection. After electronic based literature search in the databases of Medline, HINARI, EMBASE and the Cochrane library, article selection and data extraction were carried out. HIV co-infection and previous history of TB treatment were used as predictors for the occurrence of any anti-TB drug resistant or multiple drug resistant TB (MDR-TB). The risk ratios for each included study and for the pooled sample were computed using the random-effects model. Heterogeneity test, sensitivity analyses and funnel plots were also done. The pooled analysis showed that the risk of developing drug-resistant TB to at least one anti-TB drug was about 3 times higher in individuals who had a previous history of anti-TB treatment than new TB cases. The risk of having MDR-TB in previously anti-TB treated TB cases was more than 5-fold higher than that of new TB cases. Resistance to Ethambutol and Rifampicin was more than fivefold higher among the previously treated with anti-TB drugs. However, HIV infection was not associated with drug-resistant TB. There was a strong association of previous anti-TB treatment with MDR-TB. Primary treatment warrants special emphasis, and screening for anti-TB drugs sensitivity has to be strengthened.

A case of ocular toxocariasis successfully treated with albendazole and triamcinolon.

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Seong, San; Moon, Daruchi; Lee, Dong Kyu; Kim, Hyung Eun; Oh, Hyun Sup; Kim, Soon Hyun; Kwon, Oh Woong; You, Yong Sung

2014-10-01

We present a case of ocular toxocariasis treated successfully with oral albendazole in combination with steroids. A 26-year-old male visited the authors' clinic with the chief complaint of flying flies in his right eye. The fundus photograph showed a whitish epiretinal scar, and the fluorescein angiography revealed a hypofluorescein lesion of the scar and late leakage at the margin. An elevated retinal surface and posterior acoustic shadowing of the scar were observed in the optical coherence tomography, and Toxocara IgG was positive. The patient was diagnosed with toxocariasis, and the condition was treated with albendazole (400 mg twice a day) for a month and oral triamcinolone (16 mg for 2 weeks, once a day, and then 8 mg for 1 week, once a day) from day 13 of the albendazole treatment. The lesions decreased after the treatment. Based on this study, oral albendazole combined with steroids can be a simple and effective regimen for treating ocular toxocariasis.

The efficacy of negative pressure wound therapy in treating sacroiliac joint tuberculosis with a chronic sinus tract: a case series.

Science.gov (United States)

Luo, Xiaobo; Tang, Xiangyu; Ma, Yuanzheng; Zhang, Yonggang; Fang, Shuzhi

2015-08-06

Tuberculous sacroiliitis with abscess accounts for approximately 50 % of all sacroiliac joint tuberculosis cases. Tuberculous abscesses spread into the sacroiliac joint capsule, subcutaneous tissue, and the skin, and finally becomes a skin sinus. As there are no previous reports about sacroiliac joint tuberculosis with a chronic sinus, we evaluated its clinical characteristics and management by negative pressure wound therapy. A retrospective analysis of 12 patients with sacroiliac joint tuberculosis with chronic sinuses treated between January 2005 and January 2010 was conducted. Patients were treated with negative pressure wound therapy (NPWT). Treatment was divided into three phases: control phase, standard dressing changes daily for 4 weeks; interphase washout period, dressing changes every 3 days for 1 week; and intervention phase, no dressing changes until minimal sinus tract drainage (sacroiliac joint tuberculosis with a chronic sinus can be difficult. NPWT provides better healing of sacroiliac joint tuberculosis with a chronic sinus than standard dressing changes.

Is drug-resistant Mycobacterium leprae a real cause for concern?: First approach to molecular monitoring of multibacillary Colombian patients with and without previous leprosy treatment.

Science.gov (United States)

Guerrero, Martha Inírida; Colorado, Claudia Lucía; Torres, José Fernando; León, Clara Inés

2014-04-01

There is no information in Colombia on Mycobacterium leprae primary and secondary drug resistance in regards to the WHO-multidrug therapy regime. On the other hand, public health authorities around the world have issued various recommendations, one of which prompts for the immediate organization of resistance surveillance through simple molecular methods. To determine the prevalence of Mycobacterium leprae drug resistance to rifampicin, ofloxacin and dapsone in untreated and previously treated patients at the Centro Dermatológico Federico Lleras Acosta during the 1985-2004 period. We conducted a retrospective study which included multibacillary patient biopsies through elective sampling: 381 of them from new patients and 560 from previously treated patients. Using a microtome, we obtained six slides from each skin biopsy preserved in paraffin, and we extracted M. leprae DNA. We amplified three molecular targets through PCR and obtained the patterns of drug resistance to dapsone, rifampicin and ofloxacin by reverse hybridization. Finally, we collected epidemiological, clinical and demographical data for analyses. From 941 samples under study, 4.14% of them were resistant to one or more drugs, and 5.77 and 3.04% had resistant genotypes in new and previously treated patients, respectively. Total resistance for each drug was 0.43% for dapsone, 3.19% for rifampicin and 1.17% for ofloxacin. We found statistically significant differences for rifampicin and for the total population when comparing the results from untreated versus previously treated patients. Two thirds of the resistant samples were resistant to rifampicin alone or combined. The standard multidrug therapy schemes continue being effective for leprosy cases; however, it is necessary to guarantee adherence and regularity. Surveillance to drug resistance in new and previously treated leprosy cases should be established.

Living donor liver transplantation from a donor previously treated with interferon for hepatitis C virus: a case report

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Nakao Kazuhiko

2011-07-01

Full Text Available Abstract Introduction Selecting a marginal donor in liver transplantation (LT remains controversial but is necessary because of the small number of available donors. Case presentation A 46-year-old Japanese woman was a candidate to donate her liver to her brother, who had decompensated liver cirrhosis of unknown origin. Eight years before the donation, she had a mild liver dysfunction that was diagnosed as a hepatitis C virus (HCV infection (serotype 2. She had received anti-viral therapy with interferon α-2b three times weekly for 24 weeks and had a sustained viral response (SVR. A biopsy of her liver before the donation showed normal findings without any active hepatitis, and her serum was negative for HCV-RNA. Only 67 patients have undergone LT from a cadaveric donor in Japan. The family in this case decided to have living donor LT. A careful selection for the liver graft donation was made; however, since she was the only candidate, we approved her as a living donor. She was discharged nine days after the liver donation. Her liver function recovered immediately. A computed tomography scan showed sufficient liver regeneration one year later. Her brother also had good liver function after LT and had no HCV infection 48 months after surgery and no de novo malignancy. Neither of the siblings has developed an HCV infection. Conclusions A patient with SVR status after interferon therapy might be considered a candidate for living donor LT but only if there are no other possibilities of LT for the recipient. A careful follow-up of the donor after donation is needed. The recipient also must have a very close follow-up because it is difficult to predict what might happen to the graft with post-transplant immunosuppression.

Laser in situ keratomileusis enhancements with the Ziemer FEMTO LDV femtosecond laser following previous LASIK treatments.

Science.gov (United States)

Pietilä, Juhani; Huhtala, Anne; Mäkinen, Petri; Uusitalo, Hannu

2013-02-01

The aim of this paper is to present the accuracy, predictability, and safety outcomes of LASIK enhancements performed with the FEMTO LDV femtosecond laser (Ziemer Ophthalmic Systems, Port, Switzerland) and the Allegretto Wave Concerto 500 Hz excimer laser (Wavelight AG, Erlangen, Germany), following previous LASIK treatments. FEMTO LDV was used for flap creation in 85 previously LASIK-treated eyes of 62 patients. The intended flap thickness was 90 μm in 81 eyes and 140 μm in 4 eyes. The size of the suction ring was 9.0 mm in 72 eyes and 9.5 mm in 13 eyes. Flap dimensions were measured and correlated to preoperative characteristics. With the intended flap thickness of 90 μm in previously LASIK-treated eyes, the actual flap thickness was 90.2 ± 6.6 μm (range 80-122), and the flap diameter was 9.2 ± 0.2 mm (range 8.7-9.9). The mean hinge length was 4.0 ± 0.2 mm (range 3.0-4.8). Flap thickness correlated positively with patient age and hinge length. Complications were reported in 12 eyes (14.1 %). Most of the complications were very mild, and none of them prevented further refractive laser treatment. One eye lost two Snellen lines of best spectacle-corrected visual acuity. Femtosecond LASIK enhancement is warranted only in rare cases. Surgical experience is needed and special caution must be practiced. For cases of a primary free cap, femtosecond LASIK is not recommended.

Retreatment with sofosbuvir/velpatasvir in cirrhotic patients with genotype-4 who failed a previous interferon-free regimen: a case series.

Science.gov (United States)

Boglione, Lucio; Pinna, Simone Mornese; Lupia, Tommaso; Cariti, Giuseppe; Di Perri, Giovanni

2018-02-14

The novel available interferon (IFN)-free regimens significantly improved the sustained virological response (SVR) in patients with chronic hepatitis C (CHC), without important side effects and with shorter duration of treatment. In a subset of patients, however, the treatment failure (TF) was due to the presence of resistance-associated substitutions (RAS) that lead to virological breakthrough (BT) or relapse. We analysed in this case series the role of RAS on the TF in cirrhotic patients with genotype (GT)4, treated with a previous IFN-free regimen, and retreated with the combination of sofosbuvir (SOF)/velpatasvir (VEL) for 12 or 24 weeks, without ribavirin (RBV). We included in this analysis all patients with GT4 who failed a previous IFN-free treatment, with the presence of RAS at BT or relapse. All patients were retreated with a fixed combination of SOF/VEL for 12/24 weeks, without RBV. We evaluated the SVR and the MELD score change after the treatment. Seven patients were described. All were cirrhotic, Child-Pugh A (n=5), B (n=2); baseline RAS were detected in 4/7 subjects; at post-treatment detection, NS5 RAS were: F28S (n=1), Q30K (n=2), S30G (n=1), NS3 were: S122R (n=1), S122G (n=2), D168V (n=3). All retreated patients gained SVR. MELD score improved in all subjects with a median change of 3 points. No significant side effects or adverse events were reported. The combination SOF/VEL could be considered for the retreatment of cirrhotic GT4 patients who failed a previous IFN-free treatment with the presence of RAS in NS3 or NS5 regions.

Retreatment with sofosbuvir/velpatasvir in cirrhotic patients with genotype 4 who failed a previous interferon-free regimen: a case series.

Science.gov (United States)

Boglione, Lucio; Pinna, Simone Mornese; Lupia, Tommaso; Cariti, Giuseppe; Di Perri, Giovanni

2018-02-14

The novel available interferon (IFN)-free regimens significantly improved the sustained virological response (SVR) in patients with chronic hepatitis C (CHC), without important side-effects and with shorter duration of treatment. In a subset of patients, however, the treatment failure (TF) was due to the presence of resistance-associated substitutions (RAS) that lead to virological breakthrough (BT) or relapse. We analyzed in this case-series the role of RAS on the TF in cirrhotic patients with GT4, treated with a previous IFN-free regimen, and retreated with the combination of sofosbuvir (SOF)/velpatasvir (VEL) for 12 or 24 weeks, without ribavirin (RBV). We included in this analysis all patients with GT4 who failed a previous IFN-free treatment, with the presence of RAS at BT or relapse. All patients were retreated with a fixed combination of SOF/VEL for 12/24 weeks, without RBV. We evaluated the SVR and the MELD score change after the treatment. Seven patients were described. All were cirrhotic, Child-Pug A (n=5), B (n=2); baseline RAS were detected in 4/7 subjects; at post-treatment detection, NS5 RAS were: F28S (n=1), Q30K (n=2), S30G (n=1), NS3 were: S122R (n=1), S122G (n=2), D168V (n=3). All retreated patients gained the SVR. MELD score improved in all subjects with a median change of 3 points. No significant side-effects or adverse events were reported. The combination SOF/VEL could be considered for the retreatment of cirrhotic GT4 patients who failed a previous IFN-free treatment with the presence of RAS in NS3 or NS5 regions.

Congenital scoliosis - presentation of three severe cases treated conservatively.

Science.gov (United States)

Weiss, H-R

2008-01-01

In view of the very limited data about conservative treatment of patients with congenital scoliosis (CS) available, early surgery is suggested already in mild cases with formation failures in the first three years of life. It is common sense that patients with failures of segmentation will not benefit from conservative treatment at all and the same applies to failures of formation with curves of >50 degrees in infancy. Two patients with rib synostosis denied surgery before entering the pubertal growth spurt. These patients have been treated conservatively with braces and Scoliosis In-Patient Rehabilitation (SIR) and now are beyond the pubertal growth spurt. One patient with a formation failure and a curve of >50 degrees lumbar has been treated with the help of braces and physiotherapy from 1.6 years on and is still under treatment now at the age of 15 years. Severe decompensation was prevented in the two patients with failure of segmentation, however a severe thoracic deformity is evident with underdeveloped lung function and severe restrictive ventilation disorder. The patient with failure of formation is well developed, now without cosmetic or physical complaints although his curve progressed at the end of the growth spurt due to final mal-compliance. Failures of segmentation should be advised to have surgery before entering the pubertal growth spurt. In case they deny, conservative treatment can at least in part be beneficial. For patients with failures of formation conservative treatment should be suggested in the first place because long-term outcomes of early surgery beyond pubertal growth spurt are not yet revealed.

Mesonephroid adenocarcinoma in urethral diverticulum treated with diverticulectomy. Case report and review of the literature

DEFF Research Database (Denmark)

Jacobsen, F; Sørensen, Flemming Brandt; Nielsen, J B

1989-01-01

A case of mesonephroid adenocarcinoma in an urethral diverticulum treated with diverticulectomy in a 53 year old female is reported. To our knowledge 26 cases of similar tumours have been reported in the literature. A review of symptoms, management and possible relationship to nephroid metaplasia...

Impact of ibrutinib dose adherence on therapeutic efficacy in patients with previously treated CLL/SLL.

Science.gov (United States)

Barr, Paul M; Brown, Jennifer R; Hillmen, Peter; O'Brien, Susan; Barrientos, Jacqueline C; Reddy, Nishitha M; Coutre, Steven; Mulligan, Stephen P; Jaeger, Ulrich; Furman, Richard R; Cymbalista, Florence; Montillo, Marco; Dearden, Claire; Robak, Tadeusz; Moreno, Carol; Pagel, John M; Burger, Jan A; Suzuki, Samuel; Sukbuntherng, Juthamas; Cole, George; James, Danelle F; Byrd, John C

2017-05-11

Ibrutinib, an oral inhibitor of Bruton's tyrosine kinase (BTK), at a once-daily dose of 420 mg achieved BTK active-site occupancy in patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) that was maintained at 24 hours. It is unknown if intermittent interruption of ibrutinib therapy contributes to altered clinical outcomes. We therefore evaluated the effect of ibrutinib dose adherence on patient outcomes in the phase 3 RESONATE trial. The overall mean dose intensity (DI) was 95% with median treatment duration of ∼9 months. Pharmacokinetic assessment of ibrutinib exposure at 420-mg dose suggested similar exposure regardless of patient weight or age. As assessed by independent review committee, patients with higher DI experienced longer median progression-free survival (PFS) compared with those with lower DI regardless of del17p and/or TP53 status. Of 79 patients requiring a drug hold, treatment was restarted at the original dose in 73 (92%) patients. Mean duration of a missed-dose event was 18.7 days (range, 8-56). Patients missing ≥8 consecutive days of ibrutinib had a shorter median PFS vs those missing ibrutinib dosing at 420 mg as clinically feasible to achieve optimal outcomes in patients with previously treated CLL. The trial was registered at www.clinicaltrials.gov as #NCT01578707. © 2017 by The American Society of Hematology.

Echinocandin Failure Case Due to a Previously Unreported FKS1 Mutation in Candida krusei

DEFF Research Database (Denmark)

Jensen, Rasmus Hare; Justesen, Ulrik Stenz; Rewes, Annika

2014-01-01

Echinocandins are the preferred therapy for invasive infections due to Candida krusei. We present here a case of clinical failure involving C. krusei with a characteristic FKS1 hot spot mutation not previously reported in C. krusei that was isolated after 14 days of treatment. Anidulafungin MICs...... were elevated by ≥5 dilution steps above the clinical breakpoint but by only 1 step for a Candida albicans isolate harboring the corresponding mutation, suggesting a notable species-specific difference in the MIC increase conferred by this mutation....

Three cases of zolpidem dependence treated with fluoxetine: the serotonin hypothesis.

Science.gov (United States)

Liappas, Ioannis A; Malitas, Petros N; Dimopoulos, Nikolaos P; Gitsa, Olympia E; Liappas, Alexandros I; Nikolaou, Chrisoula K; Christodoulou, Georgios N

2003-04-01

Zolpidem is an imidazopyridine hypnotic that is believed to act selectively at alpha(1) subunit-containing gamma-aminobutyric acid type A (GABA(A)) receptors and thus to have minimal abuse and dependence potential. We present three cases of zolpidem abuse and dependence in which the drug was used not for sedation but for stimulation and anxiolysis. All of the patients were treated with fluoxetine (a selective serotonin reuptake inhibitor) and managed to discontinue the abuse and remain abstinent from the drug. The efficacy of this kind of medication on the abuse of a GABAergic agonist, in this case dependence on zolpidem, leads to a serotonergic and GABAergic system interaction hypothesis.

The Efficacy and Safety of Icotinib in Patients with Advanced Non-Small Cell Lung Cancer Previously Treated with Chemotherapy: A Single-Arm, Multi-Center, Prospective Study.

Directory of Open Access Journals (Sweden)

Xingsheng Hu

Full Text Available Icotinib is a small molecule targeting epidermal growth factor receptor tyrosine kinase, which shows non-inferior efficacy and better safety comparing to gefitinib in previous phase III trial. The present study was designed to further evaluate the efficacy and safety of icotinib in patients with advanced non-small-cell lung cancer (NSCLC previously treated with platinum-based chemotherapy.Patients with NSCLC progressing after one or two lines of chemotherapy were enrolled to receive oral icotinib (125 mg tablet, three times per day. The primary endpoint was progression-free survival. The secondary endpoints included overall survival, objective response rate, time to progression, quality of life and safety.From March 16, 2010 to October 9, 2011, 128 patients from 15 centers nationwide were enrolled, in which 124 patients were available for efficacy evaluation and 127 patients were evaluable for safety. The median progression-free survival and time to progression were 5.0 months (95%CI 2.9-6.6 m and 5.4 months (95%CI 3.1-7.9 m, respectively. The objective response rate and disease control rate were 25.8% and 67.7% respectively. Median overall survival exceeded 17.6 months (95%CI 14.2 m-NA according to censored data. Further follow-up of overall survival is ongoing. The most frequent treatment-related adverse events were rash (26%, 33/127, diarrhea (12.6%, 16/127 and elevation of transaminase (15.7%, 20/127.In general, this study showed similar efficacy and numerically better safety when compared with that in ICOGEN trial, further confirming the efficacy and safety of icotinib in treating patients with advanced NSCLC previously treated with chemotherapy.ClinicalTrials.gov NCT02486354.

The Efficacy and Safety of Icotinib in Patients with Advanced Non-Small Cell Lung Cancer Previously Treated with Chemotherapy: A Single-Arm, Multi-Center, Prospective Study.

Science.gov (United States)

Hu, Xingsheng; Zhang, Li; Shi, Yuankai; Zhou, Caicun; Liu, Xiaoqing; Wang, Dong; Song, Yong; Li, Qiang; Feng, Jifeng; Qin, Shukui; Xv, Nong; Zhou, Jianying; Zhang, Li; Hu, Chunhong; Zhang, Shucai; Luo, Rongcheng; Wang, Jie; Tan, Fenlai; Wang, Yinxiang; Ding, Lieming; Sun, Yan

2015-01-01

Icotinib is a small molecule targeting epidermal growth factor receptor tyrosine kinase, which shows non-inferior efficacy and better safety comparing to gefitinib in previous phase III trial. The present study was designed to further evaluate the efficacy and safety of icotinib in patients with advanced non-small-cell lung cancer (NSCLC) previously treated with platinum-based chemotherapy. Patients with NSCLC progressing after one or two lines of chemotherapy were enrolled to receive oral icotinib (125 mg tablet, three times per day). The primary endpoint was progression-free survival. The secondary endpoints included overall survival, objective response rate, time to progression, quality of life and safety. From March 16, 2010 to October 9, 2011, 128 patients from 15 centers nationwide were enrolled, in which 124 patients were available for efficacy evaluation and 127 patients were evaluable for safety. The median progression-free survival and time to progression were 5.0 months (95%CI 2.9-6.6 m) and 5.4 months (95%CI 3.1-7.9 m), respectively. The objective response rate and disease control rate were 25.8% and 67.7% respectively. Median overall survival exceeded 17.6 months (95%CI 14.2 m-NA) according to censored data. Further follow-up of overall survival is ongoing. The most frequent treatment-related adverse events were rash (26%, 33/127), diarrhea (12.6%, 16/127) and elevation of transaminase (15.7%, 20/127). In general, this study showed similar efficacy and numerically better safety when compared with that in ICOGEN trial, further confirming the efficacy and safety of icotinib in treating patients with advanced NSCLC previously treated with chemotherapy. ClinicalTrials.gov NCT02486354.

Development of an Internet-Administered Cognitive Behavior Therapy Program (ENGAGE) for Parents of Children Previously Treated for Cancer: Participatory Action Research Approach.

Science.gov (United States)

Wikman, Anna; Kukkola, Laura; Börjesson, Helene; Cernvall, Martin; Woodford, Joanne; Grönqvist, Helena; von Essen, Louise

2018-04-18

Parenting a child through cancer is a distressing experience, and a subgroup of parents report negative long-term psychological consequences years after treatment completion. However, there is a lack of evidence-based psychological interventions for parents who experience distress in relation to a child's cancer disease after end of treatment. One aim of this study was to develop an internet-administered, cognitive behavior therapy-based, psychological, guided, self-help intervention (ENGAGE) for parents of children previously treated for cancer. Another aim was to identify acceptable procedures for future feasibility and efficacy studies testing and evaluating the intervention. Participatory action research methodology was used. The study included face-to-face workshops and related Web-based exercises. A total of 6 parents (4 mothers, 2 fathers) of children previously treated for cancer were involved as parent research partners. Moreover, 2 clinical psychologists were involved as expert research partners. Research partners and research group members worked collaboratively throughout the study. Data were analyzed iteratively using written summaries of the workshops and Web-based exercises parallel to data collection. A 10-week, internet-administered, cognitive behavior therapy-based, psychological, guided, self-help intervention (ENGAGE) was developed in collaboration with parent research partners and expert research partners. The content of the intervention, mode and frequency of e-therapist support, and the individualized approach for feedback were modified based on the research partner input. Shared solutions were reached regarding the type and timing of support from an e-therapist (eg, initial video or telephone call, multiple methods of e-therapist contact), duration and timing of intervention (eg, 10 weeks, 30-min assessments), and the removal of unnecessary support functions (eg, removal of chat and forum functions). Preferences for study procedures in

Peripheral neuropathy in a diabetic child treated with linezolid for multidrug-resistant tuberculosis: a case report and review of the literature.

Science.gov (United States)

Swaminathan, Aravind; du Cros, Philipp; Seddon, James A; Mirgayosieva, Shamsiya; Asladdin, Rajabov; Dusmatova, Zulfiya

2017-06-12

Extensively drug-resistant (XDR) tuberculosis (TB) and multidrug resistant (MDR)-TB with additional resistance to injectable agents or fluoroquinolones are challenging to treat due to lack of available, effective drugs. Linezolid is one of the few drugs that has shown promise in treating these conditions. Long-term linezolid use is associated with toxicities such as peripheral and optic neuropathies. Diabetes mellitus (DM), especially when uncontrolled, can also result in peripheral neuropathy. The global burden of DM is increasing, and DM has been associated with a three-fold increased risk of developing TB disease. TB and DM can be a challenging combination to treat. DM can inhibit the host immune response to tuberculosis infection; and TB and some anti-TB drugs can worsen glycaemic control. A child experiencing neuropathy that is a possible complication of both DM and linezolid used to treat TB has not been reported previously. We report peripheral neuropathy in a 15-year-old boy with type 1 DM, diagnosed with MDR-TB and additional resistance to injectable TB medications. The boy was treated with a linezolid-based regimen, but after 8 months developed peripheral neuropathy. It was unclear whether the neuropathy was caused by the DM or the linezolid therapy. He had clinical improvement following cessation of linezolid and was declared cured following 21 months of treatment. Following completion of treatment, nerve conduction studies demonstrated significant improvement in neuropathy. To the best of our knowledge, this is the first case of peripheral neuropathy reported in a diabetic child on long-term linezolid therapy for tuberculosis. This case study underlines the importance of stringent follow-up for side effects of linezolid, especially when associated with co-morbidity such as DM that increases the chances of adverse effects. The presence of both DM and TB should alert a physician to strive for optimal glycaemic control to minimize the risk of

A Case of Pyoderma Gangrenosum with Ulcerative Colitis Treated with Mesalazine

OpenAIRE

Lee, Jae In; Park, Hyun Jeong; Lee, Jun Young; Cho, Baik Kee

2010-01-01

Pyoderma gangrenosum (PG) manifests as recurrent deep ulceration of the skin and PG is associated with a variety of disorders. Approximately 30% of the cases of PG develop in patients with inflammatory bowel disease. A 34-year-old woman presented with a one-week history of recurrent ulcers on the right cheek and back. She was diagnosed with ulcerative colitis (UC) 4 years previously and with PG 1 year previously. The clinical course of the skin lesions followed the status of her UC. The patie...

A case of pyoderma gangrenosum with ulcerative colitis treated with mesalazine.

Science.gov (United States)

Lee, Jae In; Park, Hyun Jeong; Lee, Jun Young; Cho, Baik Kee

2010-11-01

Pyoderma gangrenosum (PG) manifests as recurrent deep ulceration of the skin and PG is associated with a variety of disorders. Approximately 30% of the cases of PG develop in patients with inflammatory bowel disease. A 34-year-old woman presented with a one-week history of recurrent ulcers on the right cheek and back. She was diagnosed with ulcerative colitis (UC) 4 years previously and with PG 1 year previously. The clinical course of the skin lesions followed the status of her UC. The patient's skin lesions and bowel symptoms were not improved with prednisolone. After she was started on mesalazine, we observed rapid resolution of skin lesions and bowel symptoms. Herein, we report a case of recurrent PG with UC, and we discuss the possible association between these two conditions, and the efficacy of mesalazine therapy for the treatment of PG combined with UC.

Correlation between epithelial thickness in normal corneas, untreated ectatic corneas, and ectatic corneas previously treated with CXL; is overall epithelial thickness a very early ectasia prognostic factor?

Directory of Open Access Journals (Sweden)

Kanellopoulos AJ

2012-05-01

Full Text Available Anastasios John Kanellopoulos,1,2 Ioannis M Aslanides,3 George Asimellis11Laservision Eye Institute, Athens, 2Emmetropia Mediterranean Eye Clinic, Crete, Greece, 3New York University School of Medicine, NY, USAPurpose: To determine and correlate epithelial corneal thickness (pachymetric measurements taken with a digital arc scanning very high frequency ultrasound biomicroscopy (HF UBM imaging system (Artemis-II, and compare mean and central epithelial thickness among normal eyes, untreated keratoconic eyes, and keratoconic eyes previously treated with collagen crosslinking (CXL.Methods: Epithelial pachymetry measurements (topographic mapping were conducted on 100 subjects via HF UBM. Three groups of patients were included: patients with normal eyes (controls, patients with untreated keratoconic eyes, and patients with keratoconic eyes treated with CXL. Central, mean, and peripheral corneal epithelial thickness was examined for each group, and a statistical study was conducted.Results: Mean, central, and peripheral corneal epithelial thickness was compared between the three groups of patients. Epithelium thickness varied substantially in the keratoconic group, and in some cases there was a difference of up to 20 µm between various points of the same eye, and often a thinner epithelium coincided with a thinner cornea. However, on average, data from the keratoconic group suggested an overall thickening of the epithelium, particularly over the pupil center of the order of +3 µm, while the mean epithelium thickness was on average +1.1 µm, compared to the control population (P = 0.005. This overall thickening was more pronounced in younger patients in the keratoconic group. Keratoconic eyes previously treated with CXL showed, on average, virtually the same average epithelium thickness (mean –0.7 µm, –0.2 µm over the pupil center, –0.9 µm over the peripheral zone as the control group. This finding further reinforces our novel theory of the

Dipeptidyl Peptidase-4 Inhibitor Sitagliptin Prevented Weight Regain in Obese Women with Polycystic Ovary Syndrome Previously Treated with Liraglutide: A Pilot Randomized Study.

Science.gov (United States)

Ferjan, Simona; Janez, Andrej; Jensterle, Mojca

2017-12-01

Weight loss is often nonsustainable after liraglutide cessation. The present study is the first insight into the potential prevention of weight regain in obese subjects who have been withdrawn from liraglutide. We evaluated whether dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin in adjunct to metformin prevents body weight regain more effectively than metformin alone in obese polycystic ovary syndrome (PCOS) previously treated with liraglutide. A 12-week prospective randomized open-label study was conducted with 24 obese women with PCOS who had been pretreated with liraglutide 3.0 mg due to antiobesity management (aged 34.3 ± 6.8 years, body mass index [BMI] 36.3 ± 5.2 kg/m 2 , mean ± standard deviation). They were randomized to combined treatment (COMBO) with sitagliptin 100 mg per day (QD) and metformin (MET) 1000 mg twice daily (BID) (n = 12) or MET 1000 mg BID (n = 12). Lifestyle intervention was promoted in both groups. The primary outcome was change in anthropometric measures of obesity. Women treated with MET regain 4.7 ± 2.7 kg (P = 0.002) compared with a 0.9 ± 2.5 kg in COMBO (P = 0.147). BMI increased for 1.7 ± 0.9 kg/m 2 in MET (P = 0.002) compared with 0.3 ± 0.8 kg/m 2 increase in COMBO (P = 0.136). MET group regain 4.5% ± 2.5% of body weight as opposed to 0.8% ± 2.6% in COMBO. The between-treatment differences were significant for weight change (P weight change (P weight regain in obese women with PCOS previously treated with liraglutide.

Gefitinib Plus Interleukin-2 in Advanced Non-Small Cell Lung Cancer Patients Previously Treated with Chemotherapy

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Bersanelli, Melissa, E-mail: melissa.bersanelli@alice.it; Buti, Sebastiano; Camisa, Roberta [Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma (Italy); Brighenti, Matteo; Lazzarelli, Silvia [Oncology Unit, Azienda Istituti Ospitalieri di Cremona, Largo Priori, 1, 26100 Cremona (Italy); Mazza, Giancarlo [Radiology Division, Spedali Civili di Brescia, P.le Spedali Civili,1, 25123 Brescia (Italy); Passalacqua, Rodolfo, E-mail: melissa.bersanelli@alice.it [1Oncology Unit, University Hospital of Parma, Via Gramsci, 14, 43126 Parma (Italy)

2014-09-30

The activation of lymphocytes by gefitinib treatment has been described. In this phase II pilot trial, we explored the possible synergism between IL-2 and gefitinib for non-small cell lung cancer (NSCLC) treatment. From September, 2003, to November, 2006, 70 consecutive patients with advanced, progressive NSCLC, previously treated with chemotherapy, received oral gefitinib 250 mg daily. The first 39 patients received gefitinib alone (G group). The other 31 also received subcutaneous IL-2 (GIL-2 group): 1 MIU/m{sup 2} (Million International Unit/m{sup 2})twice a day on Days 1 and 2, once a day on Days 3, 4, 5 every week for four consecutive weeks with a four-week rest period. Median follow-up was 25.2 months. Grade 3–4 toxicity of gefitinib was represented by skin rash (7%), asthenia/anorexia (6%) and diarrhea (7%); patients treated with IL-2 showed grade 2–3 fever (46%), fatigue (21%) and arthralgia (13%). In the GIL-2 group and G-group, we respectively observed: an overall response rate of 16.1% (6.4% complete response) and 5.1% (only partial response); a disease control rate of 41.9% and 41%; a median time to progression of 3.5 (CI 95% = 3.2–3.8) and 4.1 (CI 95% = 2.6–5.7) months; a median overall survival of 20.1 (CI 95% = 5.1–35.1) and 6.9 (CI 95% = 4.9–8.9) months (p = 0.002); and an actuarial one-year survival rate of 54% and 30%. Skin toxicity (p < 0.001; HR = 0.29; CI 95% = 0.16–0.54) and use of IL-2 (p < 0.001; HR = 0.33; CI 95% = 0.18–0.60) were independently associated with improvement of survival. In this consecutive, non-randomized, series of advanced NSCLC patients, the use of IL-2 increased the efficacy of gefitinib.

Gefitinib Plus Interleukin-2 in Advanced Non-Small Cell Lung Cancer Patients Previously Treated with Chemotherapy

Directory of Open Access Journals (Sweden)

Melissa Bersanelli

2014-09-01

Full Text Available The activation of lymphocytes by gefitinib treatment has been described. In this phase II pilot trial, we explored the possible synergism between IL-2 and gefitinib for non-small cell lung cancer (NSCLC treatment. From September, 2003, to November, 2006, 70 consecutive patients with advanced, progressive NSCLC, previously treated with chemotherapy, received oral gefitinib 250 mg daily. The first 39 patients received gefitinib alone (G group. The other 31 also received subcutaneous IL-2 (GIL-2 group: 1 MIU/m2 (Million International Unit/m2twice a day on Days 1 and 2, once a day on Days 3, 4, 5 every week for four consecutive weeks with a four-week rest period. Median follow-up was 25.2 months. Grade 3–4 toxicity of gefitinib was represented by skin rash (7%, asthenia/anorexia (6% and diarrhea (7%; patients treated with IL-2 showed grade 2–3 fever (46%, fatigue (21% and arthralgia (13%. In the GIL-2 group and G-group, we respectively observed: an overall response rate of 16.1% (6.4% complete response and 5.1% (only partial response; a disease control rate of 41.9% and 41%; a median time to progression of 3.5 (CI 95% = 3.2–3.8 and 4.1 (CI 95% = 2.6–5.7 months; a median overall survival of 20.1 (CI 95% = 5.1–35.1 and 6.9 (CI 95% = 4.9–8.9 months (p = 0.002; and an actuarial one-year survival rate of 54% and 30%. Skin toxicity (p < 0.001; HR = 0.29; CI 95% = 0.16–0.54 and use of IL-2 (p < 0.001; HR = 0.33; CI 95% = 0.18–0.60 were independently associated with improvement of survival. In this consecutive, non-randomized, series of advanced NSCLC patients, the use of IL-2 increased the efficacy of gefitinib.

Radioimmunotherapy with Y-90-epratuzumab in patients with previously treated B-cell lymphoma. A fractionated dose-escalation study

International Nuclear Information System (INIS)

Linden, O.; Cavallin-Stahl, E.; Tennvall, J.; Hindorf, C.; Olsson, T.; Strand, S.E.; Stenberg, L.; Wingardh, K.

2002-01-01

Aim: Fractionated RIT may improve outcome by decreasing heterogeneity in absorbed dose and by increasing therapeutic window. The humanised anti-CD22 antibody, Epratuzumab, (Immunomedics, Inc., Morris Plains, NJ) can be given repeatedly with minimal risk of neutralising Ab (HAHA), making fractionated treatment with 90 Y-labelled epratuzumab possible. Materials and Methods: Patients with previously treated B-cell lymphoma received increasing number (2-4) of weekly infusions of 90 Y-epratuzumab. Patients received either 185 MBq/m 2 per infusion (group A), or, if they had a history of high-dose chemotherapy with stem-cell rescue, 92.5 MBq/m 2 per infusion (group B). The first infusion included 150 MBq of 111 Indium for scintigraphic verification of tumour targeting and dosimetry. 1.5 mg/kg epratuzumab was administered with each infusion. The treatment could be repeated once after 3 m. Results: Of 23 patients, 16 in group A and 6 in group B were evaluable for response. The RR in group A was 62% objective response (OR) and 25% CR/CRu. One patient in group B showed OR. OR was seen in aggressive and indolent lymphoma. Response was also long-lasting and event-free survival of patients showing CR/CRu was 14 to 25+ months. In group A all seven patient, receiving three infusions, showed less than grade 3 platelet and neutrophil toxicity, except for two patients suffering grade 3 neutropenia. Of five patients with 4 weekly infusions there were two patients with dose-limiting haematological toxicity (DLT), both recently treated with high dose cytosar before RIT. With criteria used the maximal tolerated dose was three infusions 185 MBq/m 2 . In group B no patient suffered DLT and one patient exhibited OR. Seven patients were retreated after 3 months with minor toxicity, but improvement in OR in two cases. No patient has developed HAHA. CD22 expression on tumour cells, as assessed by flow cytometry, is available in 18 of 22 patients. In group A, seven of eight patients with

Previous treatment, sputum-smear nonconversion, and suburban living: The risk factors of multidrugresistant tuberculosis among Malaysians

Directory of Open Access Journals (Sweden)

Noorsuzana Mohd Shariff

2016-01-01

Full Text Available The number of multidrug-resistant tuberculosis patients is increasing each year in many countries all around the globe. Malaysia has no exception in facing this burdensome health problem. We aimed to investigate the factors that contribute to the occurrence of multidrug-resistant tuberculosis among Malaysian tuberculosis patients. An unmatched case-control study was conducted among tuberculosis patients who received antituberculosis treatments from April 2013 until April 2014. Cases are those diagnosed as pulmonary tuberculosis patients clinically, radiologically, and/or bacteriologically, and who were confirmed to be resistant to both isoniazid and rifampicin through drug-sensitivity testing. On the other hand, pulmonary tuberculosis patients who were sensitive to all first-line antituberculosis drugs and were treated during the same time period served as controls. A total of 150 tuberculosis patients were studied, of which the susceptible cases were 120. Factors found to be significantly associated with the occurrence of multidrug-resistant tuberculosis are being Indian or Chinese (odds ratio 3.17, 95% confidence interval 1.04–9.68; and odds ratio 6.23, 95% confidence interval 2.24–17.35, respectively, unmarried (odds ratio 2.58, 95% confidence interval 1.09–6.09, living in suburban areas (odds ratio 2.58, 95% confidence interval 1.08–6.19, are noncompliant (odds ratio 4.50, 95% confidence interval 1.71–11.82, were treated previously (odds ratio 8.91, 95% confidence interval 3.66–21.67, and showed positive sputum smears at the 2nd (odds ratio 7.00, 95% confidence interval 2.46–19.89 and 6th months of treatment (odds ratio 17.96, 95% confidence interval 3.51–91.99. Living in suburban areas, positive sputum smears in the 2nd month of treatment, and was treated previously are factors that independently contribute to the occurrence of multidrug-resistant tuberculosis. Those with positive smears in the second month of treatment

PHACES syndrome: a review of eight previously unreported cases with late arterial occlusions

International Nuclear Information System (INIS)

Bhattacharya, J.J.; Luo, C.B.; Alvarez, H.; Rodesch, G.; Lasjaunias, P.L.; Pongpech, S.

2004-01-01

PHACE and PHACES are acronyms for a syndrome of variable expression comprising posterior cranial fossa malformations, facial haemangiomas, arterial anomalies, aortic coarctation and other cardiac disorders, ocular abnormalities and stenotic arterial disease. We review five girls and three boys aged 1 month-14 years with disorders from this spectrum. Six had large facial haemangiomas but recent reports suggest that small haemangiomas may occur; hence our inclusion of two possible cases. We also focus on the recently recognised feature of progressive intracranial arterial occlusions, present in four of our patients, later than previously recognised, from 4 to 14 years of age. We suggest that many elements of this disorder could reflect an abnormality of cell proliferation and apoptosis. (orig.)

A case of pulmonary carcinoid tumour in a pregnant woman successfully treated with bronchoscopic (electrocautery) therapy

Science.gov (United States)

Binesh, Fariba; Samet, Mohammad; Bovanlu, Taghi Roshan

2013-01-01

We present an uncommon case of a carcinoid tumour of the bronchus that was diagnosed during pregnancy in a 28-year-old woman. The patient was admitted at the emergency department with massive haemoptysis. Owing to the patient's critical condition, she underwent urgent flexible bronchoscopy. Bleeding was controlled by local injection of 500 mg tranexamic acid and electrocautery. After the bleeding has stopped, multiple specimens were taken. Histological examination confirmed typical carcinoid tumour. Owing to repeated haemoptysis, she was treated with bronchoscopic (electrocautery) therapy, and, after delivery, she underwent pulmonary lobectomy. Only a few similar cases were found in the literature reporting bronchopulmonary carcinoid tumour during pregnancy and we could not find any similar case which was treated by electrocautery. PMID:23608865

Use of cone-beam computed tomography in diagnosing and treating endodontic treatment failure: A case study

Directory of Open Access Journals (Sweden)

Gloria Lee

2017-01-01

Full Text Available The use of cone-beam computed tomography (CBCT as a complementary imaging modality applies to various clinical situations that with conventional two-dimensional radiographs alone may pose diagnostic challenges. These challenges include but are not limited to locating missed canals in endodontic retreatment and diagnosing the presence of lesions such as resorption, periapical bone defects, root fractures, and perforations. In this study, we present a case of an asymptomatic apical periodontitis that was incidentally found on a panoramic radiograph. Analyses based on panoramic and periapical radiographs and clinical examinations were insufficient for definitive diagnosis, which necessitated the use of CBCT. The CBCT scan allowed identification of the cause of the apical disease, an unfilled mesiolingual canal in previously root canal treated left mandibular second molar, as well as the extent of the lesion. We also explore the diagnostic challenges in using traditional two-dimensional radiographs only, the challenges in locating root canals in mandibular second molars, and risks and benefits in using CBCT.

Phobic postural vertigo treated with autogenic training: a case report.

Science.gov (United States)

Goto, Fumiyuki; Nakai, Kimiko; Kunihiro, Takanobu; Ogawa, Kaoru

2008-09-30

Patients suffering from dizziness due to vertigo are commonly encountered in the department of otolaryngology. If various clinical examinations do not reveal any objective findings, then the patients are referred to the department of internal medicine or psychiatry. In many cases, the diagnosis is psychological dizziness. Phobic postural vertigo, which was first reported by Brandt T et al in 1994, is supposed to be a type of psychological dizziness. The diagnosis is based on 6 characteristics proposed by Brandt et al. Patients are usually treated with conventional medical therapy, but some cases may be refractory to such a therapy. Psychotherapy is recommended in some cases; however, psychotherapy including autogenic training, which can be used for general relaxation, is not widely accepted. This paper describes the successful administration of autogenic training in a patient suffering from phobic postural vertigo. We present a case of a patient who suffered from phobic postural vertigo. A 37-year-old female complained of dizziness. She had started experiencing dizziness almost 3 years She was intractable to many sort of conventional therapy. In the end, her symptom disappeared after introduction of autogenic training. Autogenic training can be a viable and acceptable treatment option for phobic postural vertigo patients who fail to respond to other therapies. This case emphasizes the importance of autogenic training as a method to control symptom of phobic postural vertigo.

Cephalometric evaluation of maxillary retrognathism cases treated with FR-3 appliance.

Science.gov (United States)

Biren, S; Erverdi, N

1993-09-01

The purpose of this investigation was to evaluate the efficiency of the FR-3 appliance on functional Cl III malocclusion cases. A total of 45 functional Cl III cases were chosen from a general clinic intake of which 25 were treated with the FR-3 appliance and 20 were untreated and were taken as a control group. Patients that were treated with FR-3 had the following characteristics: Cl III with maxillary deficiency; functional anterior cross-bite; absence of anterior open-bite; patients in mixed dentition. The mean age in the treatment group was 8.4 years 8.8 years in the control group. The observation period was one year for both groups. The results were as follows: Sagittal forward growth stimulation was not observed in the maxilla. Mandibular growth was redirected in the vertical direction. The SNB angle decreased in that the mandible rotated downward and backward. The ANB angle increased. There was an increase in total and lower anterior facial height and reduction in the overbite. Another skeletal change observed was the increase in the cranial flexure angle. Improved dental results were a significant amount of overjet increase and a decrease in the IMPA. There was also a beneficial effect on the soft tissue profile.

Variation in case-mix between hospitals treating colorectal cancer patients in the Netherlands

NARCIS (Netherlands)

Kolfschoten, N. E.; Marang van de Mheen, P. J.; Gooiker, G. A.; Eddes, E. H.; Kievit, J.; Tollenaar, R. A. E. M.; Wouters, M. W. J. M.; Bemelman, W. A.; Busch, O. R. C.; van Dam, R. M.; van der Harst, E.; Jansen-Landheer, M. L. E. A.; Karsten, Th M.; van Krieken, J. H. J. M.; Kuijpers, W. G. T.; Lemmens, V. E.; Manusama, E. R.; Meijerink, W. J. H. J.; Rutten, H. J. T.; Wiggers, T.; van de Velde, C. J. H.

2011-01-01

The purpose of this study was to determine how expected mortality based on case-mix varies between colorectal cancer patients treated in non-teaching, teaching and university hospitals, or high, intermediate and low-volume hospitals in the Netherlands. We used the database of the Dutch Surgical

Catatonia after deep brain stimulation successfully treated with lorazepam and right unilateral electroconvulsive therapy: a case report.

Science.gov (United States)

Quinn, Davin K; Rees, Caleb; Brodsky, Aaron; Deligtisch, Amanda; Evans, Daniel; Khafaja, Mohamad; Abbott, Christopher C

2014-09-01

The presence of a deep brain stimulator (DBS) in a patient who develops neuropsychiatric symptoms poses unique diagnostic challenges and questions for the treating psychiatrist. Catatonia has been described only once, during DBS implantation, but has not been reported in a successfully implanted DBS patient. We present a case of a patient with bipolar disorder and renal transplant who developed catatonia after DBS for essential tremor. The patient was successfully treated for catatonia with lorazepam and electroconvulsive therapy after careful diagnostic workup. Electroconvulsive therapy has been successfully used with DBS in a handful of cases, and certain precautions may help reduce potential risk. Catatonia is a rare occurrence after DBS but when present may be safely treated with standard therapies such as lorazepam and electroconvulsive therapy.

A Unique Case of Hepatocellular Carcinoma Treated with Radiofrequency Ablation with More than 12 Years Overall Survival: A Case Report

Directory of Open Access Journals (Sweden)

Loukas Thanos

2010-01-01

Full Text Available The case of a 72-year-old male patient with HCC is presented in whom percutaneous RFA was used as the sole first-line anticancer treatment, since he denied having partial hepatectomy. The patient underwent RFA two more times, at 1.5 years for treating a local tumor progression at the initial ablation site and at 11 years after the first session for treating a new remote intrahepatic recurrence. He revealed a long-term survival of more than 12 years so far and still remains in excellent clinical status.

Characterization of sporotrichosis cases treated in a dermatologic teaching unit in the state of São Paulo - Brazil, 2003 - 2013.

Science.gov (United States)

Marques, Gabriela Franco; Martins, Ana Luiza Grizzo Peres; Sousa, Juliana Martins Prazeres; Brandão, Letícia Stella Gardini; Wachholz, Patrick Alexander; Masuda, Paula Yoshiko

2015-01-01

We conducted a transversal retrospective study with secondary data collection from 25 cases of sporotrichosis, treated at a teaching unit in inner São Paulo (Brazil), between the years 2003-2013. We found that the prevalence was higher in men (72%), rural workers (44%) and those living in rural areas (60%), with an average age of 42.48 years. The median between the onset of lesions and diagnosis was six weeks. Lesions predominated in the upper limbs (92%), and were classified as lymphocutaneous (80%) and fixed cutaneous (20%) forms. Clinical cure was observed in 62.5% of the cases treated with potassium iodide and 100% of cases treated with itraconazole.

Previous treatment, sputum-smear nonconversion, and suburban living: The risk factors of multidrug-resistant tuberculosis among Malaysians.

Science.gov (United States)

Mohd Shariff, Noorsuzana; Shah, Shamsul Azhar; Kamaludin, Fadzilah

2016-03-01

The number of multidrug-resistant tuberculosis patients is increasing each year in many countries all around the globe. Malaysia has no exception in facing this burdensome health problem. We aimed to investigate the factors that contribute to the occurrence of multidrug-resistant tuberculosis among Malaysian tuberculosis patients. An unmatched case-control study was conducted among tuberculosis patients who received antituberculosis treatments from April 2013 until April 2014. Cases are those diagnosed as pulmonary tuberculosis patients clinically, radiologically, and/or bacteriologically, and who were confirmed to be resistant to both isoniazid and rifampicin through drug-sensitivity testing. On the other hand, pulmonary tuberculosis patients who were sensitive to all first-line antituberculosis drugs and were treated during the same time period served as controls. A total of 150 tuberculosis patients were studied, of which the susceptible cases were 120. Factors found to be significantly associated with the occurrence of multidrug-resistant tuberculosis are being Indian or Chinese (odds ratio 3.17, 95% confidence interval 1.04-9.68; and odds ratio 6.23, 95% confidence interval 2.24-17.35, respectively), unmarried (odds ratio 2.58, 95% confidence interval 1.09-6.09), living in suburban areas (odds ratio 2.58, 95% confidence interval 1.08-6.19), are noncompliant (odds ratio 4.50, 95% confidence interval 1.71-11.82), were treated previously (odds ratio 8.91, 95% confidence interval 3.66-21.67), and showed positive sputum smears at the 2nd (odds ratio 7.00, 95% confidence interval 2.46-19.89) and 6th months of treatment (odds ratio 17.96, 95% confidence interval 3.51-91.99). Living in suburban areas, positive sputum smears in the 2nd month of treatment, and was treated previously are factors that independently contribute to the occurrence of multidrug-resistant tuberculosis. Those with positive smears in the second month of treatment, have a history of previous

Has introduction of rapid drug susceptibility testing at diagnosis impacted treatment outcomes among previously treated tuberculosis patients in Gujarat, India?

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Paresh Dave

Full Text Available Revised National TB Control Programme (RNTCP in India recommends that all previously-treated TB (PT patients are offered drug susceptibility testing (DST at diagnosis, using rapid diagnostics and screened out for rifampicin resistance before being treated with standardized, eight-month, retreatment regimen. This is intended to improve the early diagnosis of rifampicin resistance and its appropriate management and improve the treatment outcomes among the rest of the patients. In this state-wide study from Gujarat, India, we assess proportion of PT patients underwent rapid DST at diagnosis and the impact of this intervention on their treatment outcomes.This is a retrospective cohort study involving review of electronic patient-records maintained routinely under RNTCP. All PT patients registered for treatment in Gujarat during January-June 2013 were included. Information on DST and treatment outcomes were extracted from 'presumptive DR-TB patient register' and TB treatment register respectively. We performed a multivariate analysis to assess if getting tested is independently associated with unfavourable outcomes (death, loss-to-follow-up, failure, transfer out.Of 5,829 PT patients, 5306(91% were tested for drug susceptibility with rapid diagnostics. Overall, 71% (4,113 TB patients were successfully treated - 72% among tested versus 60% among non-tested. Patients who did not get tested at diagnosis had a 34% higher risk of unsuccessful outcomes as compared to those who got tested (aRR - 1.34; 95% CI 1.20-1.50 after adjusting for age, sex, HIV status and type of TB. Unfavourable outcomes (particularly failure and switched to category IV were higher among INH-resistant patients (39% as compared to INH-sensitive (29%.Offering DST at diagnosis improved the treatment outcomes among PT patients. However, even among tested, treatment outcomes remained suboptimal and were related to INH resistance and high loss-to-follow-up. These need to be addressed

High prevalence of metabolic syndrome features in patients previously treated for nonfunctioning pituitary macroadenoma

NARCIS (Netherlands)

Joustra, Sjoerd D.; Claessen, Kim M. J. A.; Dekkers, Olaf M.; van Beek, Andre P.; Wolffenbuttel, Bruce H. R.; Pereira, Alberto M.; Biermasz, Nienke R.

2014-01-01

Objective: Patients treated for nonfunctioning pituitary macroadenoma (NFMA) with suprasellar extension show disturbed sleep characteristics, possibly related to hypothalamic dysfunction. In addition to hypopituitarism, both structural hypothalamic damage and sleep restriction per se are associated

Stevens-Johnson Syndrome Induced by Carbamazepine Treatment in a Patient Who Previously Had Carbamazepine Induced Pruritus - A Case Report -

OpenAIRE

Bae, Hyun Min; Park, Yoo Jung; Kim, Young Hoon; Moon, Dong Eon

2013-01-01

Stevens-Johnson syndrome (SJS) is a rare but life-threatening skin reaction disease and carbamazepine is one of its most common causes. We report a case of SJS secondary to carbamazepine in a patient with previous pruritus due to carbamazepine which was given for treatment of trigeminal neuralgia. We would like to caution all providers that carbamazepine readministration should be avoided in the patient with a previous history of SJS or adverse skin reaction. In addition, we strongly recommen...

A prospective evaluation of treatment with Selective Internal Radiation Therapy (SIR-spheres) in patients with unresectable liver metastases from colorectal cancer previously treated with 5-FU based chemotherapy

International Nuclear Information System (INIS)

Lim, L; Gibbs, P; Yip, D; Shapiro, JD; Dowling, R; Smith, D; Little, A; Bailey, W; Liechtenstein, M

2005-01-01

To prospectively evaluate the efficacy and safety of selective internal radiation (SIR) spheres in patients with inoperable liver metastases from colorectal cancer who have failed 5FU based chemotherapy. Patients were prospectively enrolled at three Australian centres. All patients had previously received 5-FU based chemotherapy for metastatic colorectal cancer. Patients were ECOG 0–2 and had liver dominant or liver only disease. Concurrent 5-FU was given at investigator discretion. Thirty patients were treated between January 2002 and March 2004. As of July 2004 the median follow-up is 18.3 months. Median patient age was 61.7 years (range 36 – 77). Twenty-nine patients are evaluable for toxicity and response. There were 10 partial responses (33%), with the median duration of response being 8.3 months (range 2–18) and median time to progression of 5.3 mths. Response rates were lower (21%) and progression free survival shorter (3.9 mths) in patients that had received all standard chemotherapy options (n = 14). No responses were seen in patients with a poor performance status (n = 3) or extrahepatic disease (n = 6). Overall treatment related toxicity was acceptable, however significant late toxicity included 4 cases of gastric ulceration. In patients with metastatic colorectal cancer that have previously received treatment with 5-FU based chemotherapy, treatment with SIR-spheres has demonstrated encouraging activity. Further studies are required to better define the subsets of patients most likely to respond

Metastatic extraskeletal Ewing's sarcoma treated with trabectedin: A case report.

Science.gov (United States)

Hernando-Cubero, Jorge; Sanz-Moncasi, Pilar; Hernández-García, Alba; Pajares-Bernard, Isabel; Martínez-Trufero, Javier

2016-10-01

The Ewing's sarcoma family of tumors (ESFT) comprises a number of rare malignant tumors. Standard first-line treatment for patients with these tumors includes chemotherapy with a five-drug regimen of vincristine, doxorubicin (Adriamycin ® ) and cyclophosphamide, alternating with ifosfamide and etoposide (VAC/IE). In cases of inadequate response, there are a number of second-line regimens available. However, further treatment options are required for those patients with disease unresponsive to standard treatment. Trabectedin is a novel treatment option for patients with ESFT. The present study reports the case of a Caucasian 69-year-old female patient who presented with a soft tissue mass on the chest wall that had developed 7 months earlier. A computed tomography scan revealed a 9×8×7-cm mass on the anterior chest wall above the pectoral muscle. Histopathological evaluations and molecular analysis indicated that it was consistent with a metastatic extraskeletal Ewing's sarcoma. The patient was treated with an alternating VAC/IE regimen; however, an inadequate response was observed. The patient received second-line treatment with a gemcitabine and dacarbazine combination regimen, but the disease progressed. Subsequently, treatment with trabectedin (1.5 mg/m 2 as a 24-h continuous infusion every 3 weeks) was initiated. Trabectedin treatment resulted in long-lasting (18 months) progression-free survival. It is vital that novel drugs continue to being developed for patients with ESFT following progression subsequent to standard chemotherapy. The current report presents a case of a patient with metastatic, pre-treated Ewing's sarcoma achieving disease stabilization with trabectedin. Based on these results and the observed tolerability profile, trabectedin represents an alternative treatment for patients with ESFT. Further studies are required in order to determine the efficacy of trabectedin as monotherapy or in combination with other drugs. It is also important to

A study on lung cancer cases treated with radiation therapy

International Nuclear Information System (INIS)

Kim, W.T.

1983-01-01

This study was carried out on 468 cases among total 4347 cancer cases which was confirmly diagnosed as malignant neoplasms at Yonsei Center Hospital, appended to Yonsei University, during 10 years from January 1, 1971 to December 31, 1980. The results of this study are as follows: 1. Total malignant neoplasm cases treated with radiation were 4347, 1685 of whom were males, and 2662 females (male to female ratio was 1:1.58). 2. Lung cancer were 10.8% of total malignant neoplasm cases(468 cases), 391 cases for the male and 77 cases for the female. So, average the male to female ratio was 8:1 and cases of the male were much more. 3. The age distribution of lung cancer cases was from 27 to 82 years old. The highest age distribution was 50-59 for males (37.9%) and 60-69 for females (41.6%); 77.1% of total lung cancer cases were over 50 years old. 4. In regard to stages, the distribution of the third stage was highest (49.3%). That of the first stage was much higher during the last period (11.8%) than the first period (2.7%), and that of the fourth stage was much lower during the last period (7.8%) than the first period (21.1%). 5. In regard to pathological type, the distribution was 51.3% for squamous cell carcinoma, 29.3% for undifferentiated cell carcinoma, 12.2% for adenocarcinoma, and 7.2% for bronchoalveolar cell carcinoma in order of frequency. In regard to adenocarcinoma, the male ratio was 1:3.7 and cases of the female were much more. 6. In regard to tumor location,the distribution of tumor location in the right-left lobe was 59.1% in the right lobe, 33.6% in the left lobe, and 7.3% in the both lobes in order of frequency. And that of tumor location in the upper and lower lobes was all higher in the upper in the upper lobe; especially, that of the right upper lobe was highest (31.2% of total cases). 7. For the main symptom, coughing was highest (64%), 50% for hemoptysis, and 41% for dyspnea. (Author)

Heterotopic pancreas causing duodenal obstruction in a patient previously treated for choledochal cyst

Directory of Open Access Journals (Sweden)

Vidyanand P Deshpande

2012-01-01

Full Text Available A 9-year-old boy presented with duodenal pancreatic rest causing obstruction and required surgical intervention. He had been treated at the age of 4 months for a choledochal cyst. Both choledochal cyst and heterotopic pancreas are entities that are commonly encountered in children, but the incidental presence of both the entities in the same child, albeit presenting metachronously, is extremely rare.

About the case of a bronchi carcinoma tumor treated by Cyberknife

International Nuclear Information System (INIS)

Delourme, J.; Prevost, B.; Lacornerie, T.; Dansin, E.; Lartigau, E.

2009-01-01

The carcinoid tumors represent less than 2% of bronchi cancers. The best treatment of resectable tumors is surgery. The chemotherapy is inefficient. the part of radiotherapy is currently controverted, these tumors being generally considered as little radiosensitive with classical techniques. We report the case of a sixty three years patients treated by stereotactic irradiation for a recurrence of a carcinoid bronchi tumor. As conclusion: the typical or atypical character of the tumor is important to consider. The atypical carcinoid tumors have a reserved prognosis because of the frequent existence of ganglions metastases and a recurrence rate higher than the typical carcinoid tumors. The stereotactic and hypo fractionated radiotherapy can constitute an interesting therapy option in case of unresectable tumor or incomplete surgical resection, because of an increased equivalent biological dose. (N.C.)

Characterization of sporotrichosis cases treated in a dermatologic teaching unit in the state of São Paulo - Brazil, 2003 - 2013*

Science.gov (United States)

Marques, Gabriela Franco; Martins, Ana Luiza Grizzo Peres; Sousa, Juliana Martins Prazeres; Brandão, Letícia Stella Gardini; Wachholz, Patrick Alexander; Masuda, Paula Yoshiko

2015-01-01

We conducted a transversal retrospective study with secondary data collection from 25 cases of sporotrichosis, treated at a teaching unit in inner São Paulo (Brazil), between the years 2003-2013. We found that the prevalence was higher in men (72%), rural workers (44%) and those living in rural areas (60%), with an average age of 42.48 years. The median between the onset of lesions and diagnosis was six weeks. Lesions predominated in the upper limbs (92%), and were classified as lymphocutaneous (80%) and fixed cutaneous (20%) forms. Clinical cure was observed in 62.5% of the cases treated with potassium iodide and 100% of cases treated with itraconazole. PMID:25831006

Two cases of Chest Heating Sensation treated by Hwangryunhaedok-tang Herbal-Acupuncture

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Gwon-Il Cho

2003-06-01

Full Text Available The purpose of this study is to evaluate the clinical effect of Hwangryunhaedok-tang Herbal-Acupuncture. Hwangryunhaedok-tang is used in all heating diseases. Chest Heating Sensation is a unique concept in Oriental Medicine. So we applied Hwangryunhaedok-tang Herbal-Acupuncture to treat the Chest Heating Sensation. We used DITI(Digital Infrared Thermographic Imaging to estimate the temperatures of chest surface for the outcome assessment. We came to know that the chest surface temperatures were all reduced in both cases after Herbal-Acupuncture treatment. The reduced average temperature was 1.5℃ in case 1 and 0.9℃ in case 2. The above result indicates that Hwangryunhaedok-tang Herbal-Acupuncture treatment has an effect on Chest Heating Sensation, thus continuous Hwangryunhaedok-tang Herbal-Acupuncture study will be needed for more clinical applications.

Central diabetes insipidus: a previously unreported side effect of temozolomide.

Science.gov (United States)

Faje, Alexander T; Nachtigall, Lisa; Wexler, Deborah; Miller, Karen K; Klibanski, Anne; Makimura, Hideo

2013-10-01

Temozolomide (TMZ) is an alkylating agent primarily used to treat tumors of the central nervous system. We describe 2 patients with apparent TMZ-induced central diabetes insipidus. Using our institution's Research Patient Database Registry, we identified 3 additional potential cases of TMZ-induced diabetes insipidus among a group of 1545 patients treated with TMZ. A 53-year-old male with an oligoastrocytoma and a 38-year-old male with an oligodendroglioma each developed symptoms of polydipsia and polyuria approximately 2 months after the initiation of TMZ. Laboratory analyses demonstrated hypernatremia and urinary concentrating defects, consistent with the presence of diabetes insipidus, and the patients were successfully treated with desmopressin acetate. Desmopressin acetate was withdrawn after the discontinuation of TMZ, and diabetes insipidus did not recur. Magnetic resonance imaging of the pituitary and hypothalamus was unremarkable apart from the absence of a posterior pituitary bright spot in both of the cases. Anterior pituitary function tests were normal in both cases. Using the Research Patient Database Registry database, we identified the 2 index cases and 3 additional potential cases of diabetes insipidus for an estimated prevalence of 0.3% (5 cases of diabetes insipidus per 1545 patients prescribed TMZ). Central diabetes insipidus is a rare but reversible side effect of treatment with TMZ.

Post-transfusion purpura treated with plasma exchange by haemonetics cell separator. A case report

DEFF Research Database (Denmark)

Laursen, B; Morling, N; Rosenkvist, J

1978-01-01

A case of post-transfusion purpura in a 61-year-old, multiparous female with a platelet alloantibody (anti-Zwa) in her serum is reported. The patient was successfully treated with plasma exchange by means of a Haemonetics 30 cell separator and corticosteroids. Compared with other therapeutic...

Correlation between bone scan findings and serum PSA level in prostate cancer patients in Bangladesh: both newly diagnosed and hormonally treated cases

International Nuclear Information System (INIS)

Yasmeen, S.; Nasreen, F.; Kabir, M.F.

2007-01-01

Full text: The objective of the current study was to determine whether pre- treatment serum prostate specific antigen (PSA) levels can identify a group with low probability of osseous metastases and safely eliminate the need for bone scan as a routine part of the staging evaluation in Bangladeshi patients with newly diagnosed prostate carcinoma. Also, to find out a cut off value for serum PSA level for predicting positive bone scan in newly diagnosed Bangladeshi prostate cancer patients and to assess the role of PSA level in hormonally treated cases. Prostate cancer most commonly metastasizes to the bone. Bone scintigraphy is one of the best methods in detecting bone metastases, assessing the progression of the disease and response to therapy. For more than 30 yrs it has been known that bone scintigraphy is more sensitive than radiographic, clinical evaluation or chemical markers such as alkaline phosphatase or acid phosphatase in detection of early osseous metastatic prostate cancer. The introduction of PSA has dramatically changed the management of prostate cancer. Serum PSA level has proven to be a useful serum marker for detection of metastatic prostate cancer and it provides the best overall correlation. It also has considerable impact on bone scanning. Of special significance is the fact that patients who have a low PSA level in previously untreated carcinoma of prostate are extremely unlikely to have positive findings on a bone scan for metastases. The picture is different in patients who has received and responded to hormonal therapy. Bone scintigraphy appears to be extremely useful in patients whose PSA level begins to rise after surgical procedure. Patients, who were on anti- androgen therapy, even though they had visible metastatic disease on bone scans, had normal level of PSA Patients and methods: A total of 390 cases were studied. Some (n=242) were newly diagnosed without having any specific treatment other than surgery. Others (n=148) were old cases

Supporting clinical management of the difficult-to-treat TB cases: the ERS-WHO TB Consilium

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Lia D’Ambrosio

2015-03-01

The primary objective of the ERS/WHO TB Consilium is to provide clinical consultation for drug-resistant TB and other difficult-to-treat TB cases, including co-infection with HIV and paediatric cases. Through technical guidance to clinicians managing complex TB cases, the main contribution and outcome of the initiative will be a public health response aimed at achieving correct treatment of affected patients and preventing further development of drug resistance. The Consilum's secondary objective is to ensure monitoring and evaluation of clinical practices on the ground (diagnosis, treatment and prevention.

Thirty-six Cases of Pseudobulbar Palsy Treated by Needling with Prompt and Deep Insertion

Institute of Scientific and Technical Information of China (English)

Chen Hong

2006-01-01

@@ Pseudobulbar palsy refers to bulbar paralysis due to the upper motor neuron injury, which is one of the severe complications of cerebrovascular diseases.The author has treated 36 cases of the disease with acupuncture by a prompt and deep insertion technique, and achieved satisfactory therapeutic results. A report follows.

Forty Cases of Insomnia Treated by Multi-output Electric Pulsation and Auricular Plaster Therapy

Institute of Scientific and Technical Information of China (English)

Liu Weizhe

2007-01-01

@@ The writer has treated 40 cases of insomnia by the method of multi-output electric pulsation in combination with auricular plaster therapy (with a seed of Vaccariae segetalis 王不留行 taped tightly to a particular ear point and pressed) and received satisfactory therapeutic effects. A report follows.

A Case of Refractory Pulmonary Coccidioidomycosis Successfully Treated with Posaconazole Therapy

Science.gov (United States)

Patel, RH; Pandya, S; Nanjappa, S; Greene, JN

2018-01-01

Coccidioidomycosis is an endemic fungal infection caused by the inhalation of the spores of Coccidioides species. Patients with underlying immunosuppressive illness can contract chronic or disseminated disease which requires prolonged systemic therapy. Pulmonary coccidioidomycosis remains as an illusory and abstruse disease, with increased prevalence that poses as a challenge for clinicians in developing an effective strategy for treatment. Here, we report successful treatment of a refractory case of chronic relapsing pulmonary coccidioidomycosis in a 50-year old woman with a thin-walled cavitary lung lesion who was ultimately treated with posaconazole.

A previously unreported variant of the synostotic sagittal suture: Case report and review of salient literature

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Madison Budinich

2016-12-01

Full Text Available Introduction: Sagittal synostosis is a rare congenital disease caused by the premature fusion of the sagittal suture. Craniosynostosis occurs for a variety of reasons, different for every case, and often the etiology is unclear but the anomaly can frequently be seen as part of Crouzon's or Apert's syndromes. Herein, we discuss a rare case of craniosynostosis where the patient presented with a, to our knowledge, a previously undescribed variant of sagittal synostosis. Case report: A 3-month-old female infant presented to a craniofacial clinic for a consultation regarding an abnormal head shape. Images of the skull were performed, demonstrating that the patient had craniosynostosis. The patient displayed no other significant symptoms besides abnormalities in head shape. The sagittal suture was found to extend into the occipital bone where it was synostotic. Conclusion: To our knowledge, a synostotic sagittal suture has not been reported that extended posteriorly it involve the occipital bone. Those who interpret imaging or operate on this part of the skull should consider such a variation. Keywords: Anatomy, Craniosynostosis, Skull, Malformation, Pediatrics

Is Cup Positioning Challenged in Hips Previously Treated With Periacetabular Osteotomy?

DEFF Research Database (Denmark)

Hartig-Andreasen, Charlotte; Stilling, Maiken; Søballe, Kjeld

2014-01-01

After periacetabular osteotomy (PAO), some patients develop osteoarthritis with need of a total hip arthroplasty (THA). We evaluated the outcome of THA following PAO and explored factors associated with inferior cup position and increased polyethylene wear. Follow-up were performed 4 to 10years...... after THA in 34 patients (38 hips) with previous PAO. Computer analysis evaluated cup position and wear rates. No patient had dislocations or revision surgery. Median scores were: Harris hip 96, Oxford hip 38 and WOMAC 78. Mean cup anteversion and abduction angles were 22(o) (range 7°-43°) and 45......° (range 28°-65°). Outliers of cup abduction were associated with persisting dysplasia (CE...

Efficacy and Safety of IncobotulinumtoxinA in Subjects Previously Treated with Botulinum Toxin versus Toxin-Naïve Subjects with Cervical Dystonia

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Hubert Fernandez

2013-05-01

Full Text Available Background: To determine whether botulinum toxin treatment history affected the outcomes of a study comparing the safety and efficacy of incobotulinumtoxinA with placebo in subjects with cervical dystonia (CD.Methods: This was a prospective, double‐blind, randomized, placebo‐controlled, multicenter trial in botulinum toxin‐treated or toxin‐naïve CD subjects. Subjects received a fixed dose of either 120 U or 240 U of incobotulinumtoxinA or placebo. The primary outcome measure was change from baseline to Week 4 in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS total score. Treatment‐emergent adverse events (TEAEs were also evaluated. This report represents a subgroup analysis of botulinum toxin‐treated or toxin‐naïve subjects.Results: Participants (N = 233; 38.6% toxin‐naïve had a mean age of 52.8 years. IncobotulinumtoxinA significantly improved TWSTRS total scores from baseline to Week 4 in both dose groups versus placebo, and the improvement persisted through the end of the study (≤20 weeks. Both the previously toxin‐treated and toxin‐naïve subjects demonstrated significant improvements in TWSTRS total scores at Week 4 compared to baseline. The most frequent TEAEs in the incobotulinumtoxinA groups were dysphagia, neck pain, and muscular weakness, which were generally mild. TEAEs were more common in the 240 U group and toxin‐naïve subjects. Discussion: Overall, incobotulinumtoxinA was safe and effective in CD, regardless of toxin therapy history. A lower starting dose may be better tolerated among toxin‐naïve subjects without sacrificing efficacy.

Pustular Palmoplantar Psoriasis Successfully Treated with Nb-UVB Monochromatic Excimer Light: A Case-Report

Directory of Open Access Journals (Sweden)

Serena Gianfaldoni

2017-07-01

Full Text Available Barber’s palmoplantar pustulosis (PPP is a form of localised pustular psoriasis, affecting the palmar and plantar surfaces. It is a chronic disease, with a deep impact on the patients’ quality of life. The Authors discuss a case of Baber Psoriasis successfully treated with monochromatic excimer light.

Development of infantile hypertrophic pyloric stenosis in patients treated for oesophageal atresia. A case report

DEFF Research Database (Denmark)

Qvist, N; Rasmussen, L; Hansen, L P

1986-01-01

Two cases of infantile hypertrophic pyloric stenosis (IHPS) developed in 74 patients treated for oesophageal atresia. Treatment of oesophageal atresia is frequently followed by vomiting and failure to thrive due to gastrooesophageal reflux or anastomotic stricture. The diagnose of IHPS must...

A Case of High Mortality, Treated with Multidisciplinary Approach in Intensive Care: Meningococcal Meningitis

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Mehtap Pehlivanlar Küçük

2018-04-01

Full Text Available Meningococcemia is a highly mortal disease that can cause septic shock and multiple organ failure, which can be accompanied by sudden onset, rapid course, purpura fulminans and diffuse intravenous coagulation tables. Mortality increases when meningococcal causes to meningitis. The fact that it is the cause of neurological sequelae and extremity losses even in the recovering cases makes the support provided by the intensive care unit quite important in the management of cases. A case with meningococcal meningitis with high mortality, who was successfully treated through the use of supportive methods, such as monitorization, mechanical ventilation practices with new modalities, plasmapheresis and sympathetic ganglion blockage, has been presented in company with the literature.

Bioremediation case studies: Abstracts. Final report

International Nuclear Information System (INIS)

Devine, K.

1992-03-01

The report contains abstracts of 132 case studies of bioremediation technology applied to hazardous waste clean-up. It was prepared to compile bioremediation studies in a variety of locations and treating diverse contaminants, most of which were previously undocumented. All data are based on vendor-supplied information and there was no opportunity to independently confirm its accuracy. These 132 case studies, from 10 different biotechnology companies, provide users with reference information about on-going and/or completed field applications and studies. About two-thirds of the cases were at full-scale clean-up level with the remainder at pilot or laboratory scale. In 74 percent of the cases, soil was at least one of the media treated. Soil alone accounts for 46 percent of the cases. Petroleum-related wastes account for the largest contaminant with 82 cases. Thirty-one states are represented in the case studies

[Comparison of the Efficacy and Safety of Icotinib with Standard Second-line 
Chemotherapy in Previously Treated Advanced Non-small Cell Lung Cancer].

Science.gov (United States)

Yao, Shuyang; Qian, Kun; Wang, Ruotian; Li, Yuanbo; Zhang, Yi

2015-06-01

This study compared the efficacy and safety of icotinib with standard second-line chemotherapy (single-agent docetaxel or pemetrexed) in previously treated advanced non-small cell lung cancer (NSCLC). Thirty-two consecutive patients treated with icotinib and 33 consecutive patients treated with standard second-line chemotherapy in Xuanwu Hospital from January 2012 to July 2013 were enrolled in our retrospective research. The Response Evaluation Criteria in Solid Tumors were used to evaluate the tumor responses, and the progression-free survival (PFS) was evaluated by Kaplan-Meier method. Icotinib was comparable with standard second-line chemotherapy for advanced NSCLC in terms of overall response rate (ORR) (28.1% vs 18.2%, P=0.341), disease control rate (DFS)(43.8% vs 45.5%, P=0.890), and PFS (4.3 months vs 3.8 months, P=0.506). In the icotinib group, the ORR of epidermal growth factor receptor (EGFR) mutant was significantly higher than that of EGFR unknown or wild type (P=0.017). In multivariate analysis, age, gender, histology, and the optimum first-line treatment response were dependent prognostic factors based on the PFS of the icotinib group. The incidence of adverse events was significantly fewer in the icotinib group than in the chemotherapy group (P=0.001). Compared with the standard second-line chemotherapy, icotinib is active in the treatment of advanced NSCLC patients, especially with EGFR unknown in the second line, with an acceptable adverse event profile.

Feline leprosy due to Candidatus 'Mycobacterium lepraefelis': Further clinical and molecular characterisation of eight previously reported cases and an additional 30 cases.

Science.gov (United States)

O'Brien, Carolyn R; Malik, Richard; Globan, Maria; Reppas, George; McCowan, Christina; Fyfe, Janet A

2017-09-01

This paper, the last in a series of three on 'feline leprosy', provides a detailed description of disease referable to the previously unnamed species, Candidatus 'Mycobacterium lepraefelis', a close relative of the human pathogens Mycobacterium leprae and Mycobacterium lepromatosis. Cases were sourced retrospectively and prospectively for this observational study, describing clinical, geographical and molecular microbiological data for cats definitively diagnosed with Candidatus 'M lepraefelis' infection. A total of 145 cases of feline leprosy were scrutinised; 114 'new' cases were sourced from the Victorian Infectious Diseases Reference Laboratory (VIDRL) records, veterinary pathology laboratories or veterinarians, and 31 cases were derived from six published studies. Thirty-eight cats were definitively diagnosed with Candidatus 'M lepraefelis' infection. Typically, cats tended to be middle-aged or older when first infected, with a male predilection. Affected cats typically had widespread cutaneous lesions, in some cases after initially localised disease. Advanced cases were often systemically unwell. All cats had outdoor access. The histological picture was lepromatous in the majority of patients, although two cases had tuberculoid disease. In one case that underwent necropsy, lesions were evident in the liver, spleen and lungs. Treatment was varied, although most cats received a combination of oral clarithromycin and rifampicin. Prognosis for recovery was variable, but typically poor. Candidatus 'M lepraefelis' typically causes high bacterial index (lepromatous) feline leprosy that in some cases progresses to systemic mycobacteriosis. The disease has a variable clinical course and prognosis. Many cases either died or were euthanased due to the infection. Multilocus sequence analysis reveals a heterogeneous picture and further analysis of draft genome sequencing may give clues to the taxonomy and epidemiology of this organism. Prospective treatment trials and

Toddler's Paralysis: An Acute Case of Leg Stiffening in a Previously Healthy 2-Year-Old.

Science.gov (United States)

Kahne, Kimberly Renee; Tay, Ee Tein

2018-05-14

Vegetarian and vegan diets are gaining popularity in the United States. Although appropriately planned vegetarian diets, including vegan diets, are healthful and nutritionally adequate and may provide health benefits in the prevention and treatment of certain diseases, not all families are aware of the nutritional supplements that may be required for their children. We describe a case of a 2-year-old previously healthy child consuming a vegan diet who presented to the pediatric emergency department with an acute inability to move her legs. Ionized calcium was found to be 0.89 mmol/L, and symptoms completely resolved within 2 hours of calcium gluconate infusion.

Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus

DEFF Research Database (Denmark)

Damm, P.; Kühl, C.; Bertelsen, Aksel

1992-01-01

OBJECTIVES: The purpose of this study was to determine the incidence of diabetes in women with previous dietary-treated gestational diabetes mellitus and to identify predictive factors for development of diabetes. STUDY DESIGN: Two to 11 years post partum, glucose tolerance was investigated in 241...... women with previous dietary-treated gestational diabetes mellitus and 57 women without previous gestational diabetes mellitus (control group). RESULTS: Diabetes developed in 42 (17.4%) women with previous gestational diabetes mellitus (3.7% insulin-dependent diabetes mellitus and 13.7% non...... of previous patients with gestational diabetes mellitus in whom plasma insulin was measured during an oral glucose tolerance test in late pregnancy a low insulin response at diagnosis was found to be an independent predictive factor for diabetes development. CONCLUSIONS: Women with previous dietary...

[Renal oncocytoma in the single kidney after previous surgery of renal carcinoma. Apropos of 2 cases].

Science.gov (United States)

Veneroni, L; Canclini, L; Berti, G L; Giola, V; Leidi, G L; Maccaroni, A; Raimoldi, A; Sironi, M; Assi, A; Bacchioni, A M

1997-12-01

Renal oncocytoma is a neoplasm which rarely occurs in patients with solitary kidney, the other being absent because of a previous nephrectomy performed for renal cancer. We present two case reports and a literature review. We have studied some important problems such as the histogenesis, the potential for malignancy, the diagnosis, the treatment and the follow up. The high incidence of coexistence of renal oncocytoma and renal cell carcinoma has important clinical implications. We would like to emphasize the importance of preoperatory FNAB, nephron sparing surgery and very careful follow up.

New technique for treating pseudocyst of the auricle.

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Zhu, L X; Wang, X Y

1990-01-01

Although pseudocyst of the auricle is a common disease in China, its cause and mechanism are still not clear. Several methods of treatment have been advocated: repeated aspirations combined with physiotherapy, and incision and drainage with contour pressure dressing, magnetotherapy etc. In recent years, a new technique with a drainage tube inserted into the pseudocyst using a guide needle has been used in our hospital in the treatment of this condition. We report 45 cases treated by this method, none of whom had the condition previously.

Rhabdomyosarcoma of the trachea: first reported case treated with proton beam therapy.

Science.gov (United States)

Exley, R; Bernstein, J M; Brennan, B; Rothera, M P

2012-09-01

We report a case of rhabdomyosarcoma of the trachea in a 14-month-old child, and we present the first reported use of proton beam therapy for this tumour. A 14-month-old girl presented acutely with a seven-day history of biphasic stridor. Emergency endoscopic debulking of a posterior tracheal mass was undertaken. Histological examination revealed an embryonal rhabdomyosarcoma with anaplasia. Multimodality therapy with surgery and chemotherapy was administered in the UK, and proton beam therapy in the USA. Only three cases of rhabdomyosarcoma of the trachea have previously been reported in the world literature. This is the first reported case of treatment of this tumour with proton beam therapy. Compared with conventional radiotherapy, proton beam therapy may confer improved long-term outcome in children, with benefits including reduced irradiation of the spinal cord.

Subtrochanteric femoral fractures treated with the Long Gamma3® nail: A historical control case study versus Long trochanteric Gamma nail®.

Science.gov (United States)

Georgiannos, D; Lampridis, V; Bisbinas, I

2015-10-01

Gamma nail was developed for the treatment of subtrochanteric hip fractures. Despite its advantages over extramedullary devices, gamma nail has been historically related to significant complications (implant breakage, femoral fractures at the tip of the nail). There is limited data to determine if the rate of these complications was minimized by using a new design of the gamma nail. Therefore we performed a case control study between the long gamma3 nail (LG3N) and the long trochanteric gamma nail (LTGN) to assess if: (1) the complication rate in the treatment of subtrochanteric fractures using the LG3N was lower than the one using the LTGN; (2) the reoperation rate was lower after using the LG3N. The complication rate after fixation of subtrochanteric fracture of the femur is lower with LG3N than with the LTGN. This study prospectively recorded the intra- and postoperative complications of 75 patients with subtrochanteric fractures treated with the LG3N and compared them with those of a historical cohort of 83 patients treated with the LTGN. The two groups were matched regarding age, gender and fracture type. Patients with open, pathological, or impending fractures were excluded. Intraoperative complications in the LG3N group were lower (4 cases, 5.3%) compared with those in the LTGN group (9 cases, 10.8%; P=0.04). The major intraoperative complication encountered with the use of LTGN was fracture of the femur in 3 cases. We encountered in total 9 postoperative complications in LG3N (12%) and 20 in group LTGN (24%). The most frequent complication in both groups was the cut out of the lag screw (3 cases in LG3N and 7 cases in LTGN group). The overall reoperation rate was higher in LTGN group (20.4% vs 10.6%; P=0.03). As a result of the improvement of its mechanical characteristics, LG3N has proved a safe and efficient implant for the treatment of subtochanteric fractures. The new design seems superior to previous generation, giving promising outcomes, reduced

A case of sleep bruxism treated through behavioural change using hypnosis

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Shakir Quaid Johar

2012-01-01

Full Text Available The mouth has been a natural site for release of stress. Right from the time of birth, a new born child cries and attracts attention of parents during stress. As the child grows, they spit and bite to release stress and frustration. As an adult, the same child uses abusive language, alcohol, smokes, and uses drugs (all orally to release stress. Clenching, grinding, and bruxism are also a form of stress release using the oral route. Dentist is the first to detect such habit, and treat such cases with habit breaking appliances, which usually fail. This article highlights the need to refer cases for psychiatric treatment and hypnotherapy may be a choice of treatment. A female aged 26 year, reported with pain in all her teeth due to bruxism. All conventional dental treatments failed. This outlined a strong psychological component, hence hypnosis was tried. A 5-year follow-up showed no relapse.

Three cases of severely disseminated Staphylococcus aureus infection in patients treated with tocilizumab

DEFF Research Database (Denmark)

Nguyen, Mai; Pødenphant, Jan; Ravn, Pernille

2013-01-01

-intensive diagnostic work-up and early treatment should be performed. Systematic postmarketing studies are needed to clarify if there is a true increased risk of disseminated S aureus infections. We suggest caution when prescribing tocilizumab to patients with prosthetic joints and/or prior invasive S aureus......We report three cases of severe disseminated Staphylococcus aureus infection in patients with rheumatoid arthritis (RA) treated with tocilizumab. Tocilizumab is a new drug, unknown to most internists, and injections given weeks before admission may not be considered by the patient as part...... of their 'current medical treatment', and the physician may not be aware that the patient is severely immunosuppressed. Severe infections in RA patients treated with tocilizumab may present with mild symptoms despite severe and disseminated infection and, as these patients are severely immunodeficient...

Local control and image diagnosis of cases of esophageal carcinoma treated by external and intracavitary irradiation

International Nuclear Information System (INIS)

Hishikawa, Yoshio; Miura, Takashi

1984-01-01

Discussions are made on local control of 31 cases of esophageal carcinoma which were treated by external and intracavitary irradiation between May 1980 and March 1983. X-ray and endoscopic findings have been used for the image diagnosis. Before the begining of radiotherapy, types of esophageal carcinoma were determined from X-ray findings according to Borrmann's classification. There were 10 cases of types 1 and 2, and 21 cases of types 3 and 4. After completion of external and intracvitary irradiation, all 10 cases of types 1 and 2 were locally controlled. Of the 21 cases of types 3 and 4, 8 cases which developed stenosis or deep ulcer after external irradiation all failed in local control. The remaining 13 cases of types 3 and 4 were locally controlled except 2 by radiotherapy. (author)

[Self-amputation of the penis treated immediately: Case report and review of the literature].

Science.gov (United States)

Odzébé, A W S; Bouya, P A; Otiobanda, G F; Banga Mouss, R; Nzaka Moukala, C; Ondongo Atipo, A M; Ondziel Opara, A S

2015-12-01

Self-amputation of the penis treated immediately: case report and review of the literature. Self-amputation of the penis is rare in urological practice. It occurs more often in a context psychotic disease. It can also be secondary to alcohol or drugs abuse. Treatment and care vary according on the severity of the injury, the delay of consultation and the patient's mental state. The authors report a case of self-amputation of the penis in an alcoholic context. The authors analyze the etiological and urological aspects of this trauma. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Successful Magnetic Resonance Imaging-Guided Focused Ultrasound Surgery for Recurrent Uterine Fibroid Previously Treated with Uterine Artery Embolization

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Sang-Wook Yoon

2010-01-01

Full Text Available A 45-year-old premenopausal woman was referred to our clinic due to recurring symptoms of uterine fibroids, nine years after a uterine artery embolization (UAE. At the time of screening, the patient presented with bilateral impairment and narrowing of the uterine arteries, which increased the risk of arterial perforation during repeated UAE procedures. The patient was subsequently referred for magnetic resonance imaging-guided focused ultrasound surgery (MRgFUS treatment. Following the treatment, the patient experienced a significant improvement in symptoms (symptom severity score was reduced from 47 to 12 by 1 year post-treatment. MR images at 3 months showed a 49% decrease in fibroid volume. There were no adverse events during the treatment or the follow-up period. This case suggests that MRgFUS can be an effective treatment option for patients with recurrent fibroids following previous UAE treatment.

Dermatitis herpetiformis misdiagnosed and treated as tinea cutis glabrae

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Marta Stawczyk-Macieja

2016-02-01

Full Text Available Introduction . Dermatitis herpetiformis is a rare bullous disorder. Autoimmunological disturbances associated with hypersensitivity to gluten play the main role in the etiopathogenesis of the disease. Clinical manifestations include polymorphic skin lesions which may cause diagnostic difficulties. Objective. To present a case of dermatitis herpetiformis diagnosed and treated without any clinical improvement as tinea cutis glabrae. Case report . A 20-year-old male patient was admitted for the evaluation of polymorphic skin lesions of 7-month duration distributed symmetrically on the skin of elbows, knees, face and the gluteal and sacral region. The patient was previously treated with systemic and topical antimycotic drugs. Due to a typical distribution of skin lesions as well as symptoms reported by the patient, we started to suspect Duhring’s disease. The diagnosis was confirmed by direct immunofluorescence of skin biopsy and serological tests. Systemic treatment with dapsone and a gluten-free diet led to clinical improvement. Conclusions . The morphology and localization of skin lesions in Duhring’s disease may be similar to the clinical presentation of fungal infection of the skin, which in equivocal cases should be excluded by a mycological test.

An analysis of an immunological effect in the cases of osteogenic sarcoma treated with massive radiotherapy

International Nuclear Information System (INIS)

Fukushima, Hiroshi; Itami, Yasuto; Akamatsu, Noriya; Matsuura, Koichi; Aoki, Haruhito

1978-01-01

Changes in immunological competence of 16 patients with osteogenic sarcoma treated with long-term radiotherapy with massive doses were investigated. The irradiation dose ranged from 7600 to 24200 rad with a mean dose of 13000 rad, and the irradiation term ranged from 7 to 24 weeks. The treatment with linac was performed except one case treated with tele-cobalt. The number of lymphocytes in peripheral blood decreased during the irradiation, but a tendency to recover appeared within about 6 months after discontinuance of the irradiation. The number of T cells showed the same change as that of lymphocytes during and after the irradiation. In cases fairly progressed, decreases of lymphocytes and T cells during the irradiation were small as compared to those in cases poorly progressed. A tendency to recover was marked, in the former cases. The effect of the irradiation on B cells was small in comparison with that on T cells. The difference by prognosis was not recognized. The numbers of lymphocytes and T cells and juvenile rate of lymphocytes by PHA in cases which progressed satisfactory over 3 years showed high values after the finish of the irradiation as compared to those in cases in which the time after the irradiation was short. The prognosis in the PPD negative cases and the cases whose PPD changed to negative was clearly unfavorable in comparison with that in the cases in which PPD was positive before to after the irradiation. The above-mentioned results suggested a relationship between an appearance of metastasis to the lung and changes in immunological competence, and these were interesting findings showing a treatment principle for patients with osteogenic sarcoma and an expectation of prognosis. (Tsunoda, M.)

Comparison of the Efficacy and Safety of Icotinib with Standard Second-line 
Chemotherapy in Previously Treated Advanced Non-small Cell Lung Cancer

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Shuyang YAO

2015-06-01

Full Text Available Background and objective This study compared the efficacy and safety of icotinib with standard second-line chemotherapy (single-agent docetaxel or pemetrexed in previously treated advanced non-small cell lung cancer (NSCLC. Methods Thirty-two consecutive patients treated with icotinib and 33 consecutive patients treated with standard second-line chemotherapy in Xuanwu Hospital from January 2012 to July 2013 were enrolled in our retrospective research. The Response Evaluation Criteria in Solid Tumors were used to evaluate the tumor responses, and the progression-free survival (PFS was evaluated by Kaplan-Meier method. Results Icotinib was comparable with standard second-line chemotherapy for advanced NSCLC in terms of overall response rate (ORR (28.1% vs 18.2%, P=0.341, disease control rate (DFS(43.8% vs 45.5%, P=0.890, and PFS (4.3 months vs 3.8 months, P=0.506. In the icotinib group, the ORR of epidermal growth factor receptor (EGFR mutant was significantly higher than that of EGFR unknown or wild type (P=0.017. In multivariate analysis, age, gender, histology, and the optimum first-line treatment response were dependent prognostic factors based on the PFS of the icotinib group. The incidence of adverse events was significantly fewer in the icotinib group than in the chemotherapy group (P=0.001. Conclusion Compared with the standard second-line chemotherapy, icotinib is active in the treatment of advanced NSCLC patients, especially with EGFR unknown in the second line, with an acceptable adverse event profile.

Case report of electronic cigarettes possibly associated with eosinophilic pneumonitis in a previously healthy active-duty sailor.

Science.gov (United States)

Thota, Darshan; Latham, Emi

2014-07-01

Electronic cigarettes (e-cigarettes) are a technology that has been touted as a safe and effective alternative to traditional cigarettes. There is, however, a paucity of literature showing the adverse outcomes of e-cigarettes and a correlation with acute eosinophilic pneumonia (AEP). To present a possible association between e-cigarettes and AEP. A 20-year-old previously healthy man was found to develop AEP after smoking an e-cigarette. He was treated with antibiotics and steroids and his symptoms improved. Though an alternative to traditional cigarettes, e-cigarettes can have unpredictable and potentially serious adverse effects. More research needs to be conducted to determine their safety. If seeing a patient in the ED with pulmonary symptoms after use of e-cigarettes, AEP should be considered in the differential. Published by Elsevier Inc.

Previous bacterial infection affects textural quality parameters of heat-treated fillets from rainbow trout (Oncorhynchus mykiss)

DEFF Research Database (Denmark)

Ingerslev, Hans-Christian; Hyldig, Grethe; Przybylska, Dominika Alicja

2012-01-01

Sensory quality of fish meat is influenced by many parameters prior to slaughter. In the present study, it was examined if previous infections or damages in the muscle tissue influence product quality parameters in fish. Fillets from rainbow trout (Oncorhynchus mykiss) reared in seawater....... This article was the first to describe a correlation between previous infections in fish and changes in sensory-quality parameters. PRACTICAL APPLICATIONS. This work contributes with knowledge about sensory-quality parameters of fish meat after recovery from infections and physical-tissue damage. Because...... the results demonstrate an influence on the texture from previous disease, the practical potentials of the results are valuable for the aquaculture industry. In order to minimize the effects of previous diseases on the sensory quality regarding the texture, these fishes should be processed as cold...

[Meningitis and white matter lesions due to Streptococcus mitis in a previously healthy child].

Science.gov (United States)

Yiş, Reyhan; Yüksel, Ciğdem Nükhet; Derundere, Umit; Yiş, Uluç

2011-10-01

Streptococcus mitis, an important member of viridans streptococci, is found in the normal flora of the oropharynx, gastrointestinal tract, female genital tract and skin. Although it is of low pathogenicity and virulence, it may cause serious infections in immunocompromised patients. Meningitis caused by S.mitis has been described in patients with previous spinal anesthesia, neurosurgical procedure, malignancy, bacterial endocarditis with neurological complications and alcoholics, but it is rare in patients who are previously healthy. In this report, a rare case of meningoencephalitis caused by S.mitis developed in a previously healthy child has been presented. A previously healthy eight-year-old girl who presented with fever, altered state of consciousness, and headache was hospitalized in intensive care unit with the diagnosis of meningitis. Past history revealed that she was treated with amoxicillin-clavulanate for acute sinusitis ten days before her admission. Whole blood count revealed the followings: hemoglobin 13 g/dl, white blood cell count 18.6 x 109/L (90% neutrophils), platelet count 200 x 109/L and 150 leucocytes were detected on cerebrospinal fluid (CSF) examination. Protein and glucose levels of CSF were 80 mg/dl and 40 mg/dl (concomitant blood glucose 100 mg/dl), respectively. Brain magnetic resonance imaging (MRI) revealed widespread white matter lesions, and alpha-hemolytic streptococci were grown in CSF culture. The isolate was identified as S.mitis with conventional methods, and also confirmed by VITEK2 (bioMerieux, France) and API 20 STREP (bioMerieux, France) systems. Isolate was found susceptible to penicillin, erythromycin, clindamycin, tetracycline, cefotaxime, vancomycin and chloramphenicol. Regarding the etiology, echocardiography revealed no vegetation nor valve pathology, and peripheral blood smear showed no abnormality. Immunoglobulin and complement levels were within normal limits. Ongoing inflammation in maxillary sinuses detected in

[A case-series analysis of tuberculosis in pediatric patients treated in a tertiary level hospital].

Science.gov (United States)

Vázquez Rosales, José Guillermo; Acosta Gallegos, Cynthia; Miranda Novales, María Guadalupe; Fuentes Pacheco, Yazmín Del Carmen; Labra Zamora, María Guadalupe; Pacheco Rosas, Daniel Octavio; Solórzano Santos, Fortino

Tuberculosis (TB) remains a challenge because severe forms occur most frequently in children under 5 years of age and the diagnosis is complex. The objective of this paper was to describe the clinical presentation, frequency, diagnostic methods used and response to treatment in children with TB treated at a tertiary level hospital. The study was retrospective and descriptive of a cohort of consecutive cases treated from January 2010 to December 2013. Ninety-three medical records of children diagnosed with TB according to the definition of the NOM-006-SSA2-2013 were reviewed. Descriptive statistics were used for the analysis. From 93 children, 58% were male (mean age of 7 years), 97% with a history of BCG vaccination, and 6% had contact with a TB case. The most frequent clinical forms were pulmonary (30.1%), lymph node (24.7%), miliary/disseminated (16.1%), meningeal (13%), and osteal TB (7.5%). The most common symptoms were fever and weight loss (50% and 40%, respectively). BAAR and culture were positive in 26% and 7% of all cases, respectively. The histopathological study was conclusive in 90% of the cases. The treatment was successful in 94.6%, with not associated mortality. The association of clinical symptoms with alterations in chest radiography and positive PPD are useful in establishing the presumptive diagnosis and an early and appropriate treatment. Copyright © 2017 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.

Characteristics of foot fractures in HIV-infected patients previously treated with tenofovir versus non-tenofovir-containing highly active antiretroviral therapy

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Horizon AA

2011-06-01

Full Text Available Arash A Horizon1, Robert J Joseph2, Qiming Liao3, Steven T Ross3, Gary E Pakes31Center for Rheumatology, 2Surgical Podiatry, Los Angeles, CA, USA; 3GlaxoSmithKline, Research Triangle Park, NC, USASummary: In a retrospective case series study, medical records were evaluated for all male patients infected with human immunodeficiency virus (HIV diagnosed over a one-year period with foot fractures (n = 30 confirmed by magnetic resonance imaging at a Los Angeles outpatient private practice rheumatology clinic. Proportionally more patients had received tenofovir prefracture (17 [57%] than those who had not (13 [43%]. At fracture diagnosis, these two groups were similar in median age (49 versus 48 years, HIV-1 RNA (both 1.7 log10 copies/mL, CD4 count (300 versus 364/mm3, time between HIV diagnosis and foot fracture (both 17 years, family history of degenerative bone disease (24% versus 23%, prevalence of malabsorption syndrome, renal failure, calcium deficiency, or vitamin D deficiency, and concurrent use of bisphosphonates, calcitonin, and diuretics. However, more tenofovir-treated patients had osteoporosis (35% versus 8%, stress-type fractures (53% versus 31%, concurrent fractures (12% versus 0%, wasting syndrome (29% versus 15%, truncal obesity (18% versus 8%, smoked cigarettes (more than one pack/day for more than one year; 35% versus 8%, dual energy X-ray absorptiometry (DEXA T scores <–2.4 (denoting osteoporosis at the femur (24% versus 9% and spine (47% versus 36%, and had received protease inhibitors (71% versus 46%, non-nucleoside reverse transcriptase inhibitors (24% versus 0%, prednisone (24% versus 0%, testosterone (47% versus 23%, and teriparatide (29% versus 8%. Median time from tenofovir initiation until fracture was 2.57 (range 1.17–5.69 years. In conclusion, more foot fractures were observed in tenofovir-treated patients than in non-tenofovir-treated patients with HIV infection. Comorbidities and/or coadministered drugs may have

Phase II trial of veliparib in patients with previously treated BRCA-mutated pancreas ductal adenocarcinoma.

Science.gov (United States)

Lowery, Maeve A; Kelsen, David P; Capanu, Marinela; Smith, Sloane C; Lee, Jonathan W; Stadler, Zsofia K; Moore, Malcolm J; Kindler, Hedy L; Golan, Talia; Segal, Amiel; Maynard, Hannah; Hollywood, Ellen; Moynahan, MaryEllen; Salo-Mullen, Erin E; Do, Richard Kinh Gian; Chen, Alice P; Yu, Kenneth H; Tang, Laura H; O'Reilly, Eileen M

2018-01-01

BRCA-associated cancers have increased sensitivity to poly(ADP-ribose) polymerase inhibitors (PARPis). This single arm, non-randomised, multicentre phase II trial evaluated the response rate of veliparib in patients with previously treated BRCA1/2- or PALB2-mutant pancreatic adenocarcinoma (PDAC). Patients with stage III/IV PDAC and known germline BRCA1/2 or PALB2 mutation, 1-2 lines of treatment, Eastern Cooperative Oncology Group 0-2, were enrolled. Veliparib was dosed at a volume of 300 mg twice-daily (N = 3), then 400 mg twice-daily (N = 15) days 1-28. The primary end-point was to determine the response rate of veliparib; secondary end-points included progression-free survival (PFS), duration of response, overall survival (OS) and safety. Sixteen patients were enrolled; male N = 8 (50%). Median age was 52 years (range 43-77). Five (31%) had a BRCA1 and 11 (69%) had a BRCA2 mutation. Fourteen (88%) patients had received prior platinum-based therapy. No confirmed partial responses (PRs) were seen: one (6%) unconfirmed PR was observed at 4 months with disease progression (PD) at 6 months; four (25%) had stable disease (SD), whereas 11 (69%) had PD as best response including one with clinical PD. Median PFS was 1.7 months (95% confidence interval [CI] 1.57-1.83) and median OS was 3.1 months (95% CI 1.9-4.1). Six (38%) patients had grade III toxicity, including fatigue (N = 3), haematology (N = 2) and nausea (N = 1). Veliparib was well tolerated, but no confirmed response was observed although four (25%) patients remained on study with SD for ≥ 4 months. Additional strategies in this population are needed, and ongoing trials are evaluating PARPis combined with chemotherapy (NCT01585805) and as a maintenance strategy (NCT02184195). Copyright © 2017 Elsevier Ltd. All rights reserved.

Aortic thrombus in a patient with myeloproliferative thrombocytosis, successfully treated by pharmaceutical therapy: a case report

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Imai Norikazu

2010-07-01

Full Text Available Abstract Introduction Thrombosis in myeloproliferative thrombocytosis occurs usually in the microvessels and medium-sized arteries and veins and only rarely in the aorta. Aortic thrombosis is usually treated with thrombectomy. Reported here is a rare case that was treated pharmacologically. Case presentation A 60-year-old Japanese woman presented with numbness of both lower extremities. Her platelet count was 1787 × 103/μl. Through bone marrow examination, we diagnosed her condition as myelodysplastic and/or myeloproliferative disorder-unclassifiable. Abdominal ultrasonography and computed tomographic scan revealed aortic thrombosis. Her platelet count was controlled with hydroxyurea and ranimustine. Aspirin and ticlopidine improved the numbness in both lower limbs on the second day. Aortic thrombosis was not observed in a computed tomographic scan on the seventh day. Conclusion For aortic thrombosis, surgical management is usually adopted, but pharmacological management is also an option because of its immediate curative effects.

An unusual case of lung abscess caused by Acremonium species treated with itraconazole.

Science.gov (United States)

Qazi, M S; Bowalekar, S S; Wanjare, V S; Shankar, A

2015-01-01

We present a report of a 37-year-old female with lung abscess due to Acremonium species that responded to oral itraconazole. There was a marked clinical as well as radiological improvement in patient. To the best of our knowledge, this is the first case of lung abscess due to Acremonium species which was treated by oral itraconazole. This cost-effective treatment modality proved to be significant in improving symptoms as well as morbidity in this patient.

Technique for sparing previously irradiated critical normal structures in salvage proton craniospinal irradiation

International Nuclear Information System (INIS)

McDonald, Mark W; Wolanski, Mark R; Simmons, Joseph W; Buchsbaum, Jeffrey C

2013-01-01

Cranial reirradiation is clinically appropriate in some cases but cumulative radiation dose to critical normal structures remains a practical concern. The authors developed a simple technique in 3D conformal proton craniospinal irradiation (CSI) to block organs at risk (OAR) while minimizing underdosing of adjacent target brain tissue. Two clinical cases illustrate the use of proton therapy to provide salvage CSI when a previously irradiated OAR required sparing from additional radiation dose. The prior radiation plan was coregistered to the treatment planning CT to create a planning organ at risk volume (PRV) around the OAR. Right and left lateral cranial whole brain proton apertures were created with a small block over the PRV. Then right and left lateral “inverse apertures” were generated, creating an aperture opening in the shape of the area previously blocked and blocking the area previously open. The inverse aperture opening was made one millimeter smaller than the original block to minimize the risk of dose overlap. The inverse apertures were used to irradiate the target volume lateral to the PRV, selecting a proton beam range to abut the 50% isodose line against either lateral edge of the PRV. Together, the 4 cranial proton fields created a region of complete dose avoidance around the OAR. Comparative photon treatment plans were generated with opposed lateral X-ray fields with custom blocks and coplanar intensity modulated radiation therapy optimized to avoid the PRV. Cumulative dose volume histograms were evaluated. Treatment plans were developed and successfully implemented to provide sparing of previously irradiated critical normal structures while treating target brain lateral to these structures. The absence of dose overlapping during irradiation through the inverse apertures was confirmed by film. Compared to the lateral X-ray and IMRT treatment plans, the proton CSI technique improved coverage of target brain tissue while providing the least

Pemetrexed single agent chemotherapy in previously treated patients with locally advanced or metastatic non-small cell lung cancer

International Nuclear Information System (INIS)

Russo, Francesca; Bearz, Alessandra; Pampaloni, Gianni; The investigators of the Italian Pemetrexed monotherapy of NSCLC group

2008-01-01

The main objective of this study was to evaluate the safety of second-line pemetrexed in Stage IIIB or IV NSCLC. Overall, 95 patients received pemetrexed 500 mg/m 2 i.v. over Day 1 of a 21-day cycle. Patients also received oral dexamethasone, oral folic acid and i.m. vitamin B12 supplementation to reduce toxicity. NCI CTC 2.0 was used to rate toxicity. All the adverse events were graded in terms of severity and relation to study treatment. Dose was reduced in case of toxicity and treatment was delayed for up to 42 days from Day 1 of any cycle to allow recovering from study drug-related toxicities. Tumor response was measured using the RECIST criteria. Patients received a median number of 4 cycles and 97.8% of the planned dose. Overall, 75 patients (78.9% of treated) reported at least one adverse event: 34 (35.8%) had grade 3 as worst grade and only 5 (5.2%) had grade 4. Drug-related events occurred in 57.9% of patients. Neutropenia (8.4%) and leukopenia (6.3 %) were the most common grade 3/4 hematological toxicities. Grade 3 anemia and thrombocytopenia were reported in 3.2% and 2.1% of patients, respectively. Diarrhea (6.3%), fatigue (3.2%) and dyspnea (3.2%) were the most common grade 3/4 non-hematological toxicities. The most common drug-related toxicities (any grade) were pyrexia (11.6%), vomiting, nausea, diarrhea and asthenia (9.5%) and fatigue (8.4%). Tumor Response Rate (CR/PR) in treated patients was 9.2%. The survival at 4.5 months (median follow-up) was 79% and the median PFS was 3.1 months. Twenty patients (21.1%) died mainly because of disease progression. Patients with locally advanced or metastatic NSCLC could benefit from second-line pemetrexed, with a low incidence of hematological and non-hematological toxicities

Should previous mammograms be digitised in the transition to digital mammography?

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Taylor-Phillips, S.; Gale, A.G.; Wallis, M.G.

2009-01-01

Breast screening specificity is improved if previous mammograms are available, which presents a challenge when converting to digital mammography. Two display options were investigated: mounting previous film mammograms on a multiviewer adjacent to the workstation, or digitising them for soft copy display. Eight qualified screen readers were videotaped undertaking routine screen reading for two 45-min sessions in each scenario. Analysis of gross eye and head movements showed that when digitised, previous mammograms were examined a greater number of times per case (p=0.03), due to a combination of being used in 19% more cases (p=0.04) and where used, looked at a greater number of times (28% increase, p=0.04). Digitising previous mammograms reduced both the average time taken per case by 18% (p=0.04) and the participants' perceptions of workload (p < 0.05). Digitising previous analogue mammograms may be advantageous, in particular in increasing their level of use. (orig.)

GITELMAN SYNDROME AND PREGNANCY- A RARE CASE REPORT

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Venkatachalam Sibiya

2017-09-01

Full Text Available PRESENTATION OF CASE A 22 years old G2 P1 D1 came with complaints of shivering of both upper limb and lower limb. She was diagnosed with Gitelman syndrome in previous pregnancy. Previous was a preterm delivery due to polyhydramnios and the baby died at 12 days of life due to some congenital malformation of heart. In previous pregnancy, patient presented with paralysis at 6 months of gestation and was treated conservatively by correcting the electrolytes level. In the present pregnancy, patient had persistent hypokalaemia and hypomagnesaemia, which was treated. Anomaly scan was done. No gross anomaly was detected. Patient is symptomatically better and she is continuing her pregnancy, hope better outcome since GS has no adverse effect on pregnancy.

An unusual case of lung abscess caused by Acremonium species treated with itraconazole

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M S Qazi

2015-01-01

Full Text Available We present a report of a 37-year-old female with lung abscess due to Acremonium species that responded to oral itraconazole. There was a marked clinical as well as radiological improvement in patient. To the best of our knowledge, this is the first case of lung abscess due to Acremonium species which was treated by oral itraconazole. This cost-effective treatment modality proved to be significant in improving symptoms as well as morbidity in this patient.

Effectiveness of Ritonavir-Boosted Protease Inhibitor Monotherapy in Clinical Practice Even with Previous Virological Failures to Protease Inhibitor-Based Regimens.

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Luis F López-Cortés

Full Text Available Significant controversy still exists about ritonavir-boosted protease inhibitor monotherapy (mtPI/rtv as a simplification strategy that is used up to now to treat patients that have not experienced previous virological failure (VF while on protease inhibitor (PI -based regimens. We have evaluated the effectiveness of two mtPI/rtv regimens in an actual clinical practice setting, including patients that had experienced previous VF with PI-based regimens.This retrospective study analyzed 1060 HIV-infected patients with undetectable viremia that were switched to lopinavir/ritonavir or darunavir/ritonavir monotherapy. In cases in which the patient had previously experienced VF while on a PI-based regimen, the lack of major HIV protease resistance mutations to lopinavir or darunavir, respectively, was mandatory. The primary endpoint of this study was the percentage of participants with virological suppression after 96 weeks according to intention-to-treat analysis (non-complete/missing = failure.A total of 1060 patients were analyzed, including 205 with previous VF while on PI-based regimens, 90 of whom were on complex therapies due to extensive resistance. The rates of treatment effectiveness (intention-to-treat analysis and virological efficacy (on-treatment analysis at week 96 were 79.3% (CI95, 76.8-81.8 and 91.5% (CI95, 89.6-93.4, respectively. No relationships were found between VF and earlier VF while on PI-based regimens, the presence of major or minor protease resistance mutations, the previous time on viral suppression, CD4+ T-cell nadir, and HCV-coinfection. Genotypic resistance tests were available in 49 out of the 74 patients with VFs and only four patients presented new major protease resistance mutations.Switching to mtPI/rtv achieves sustained virological control in most patients, even in those with previous VF on PI-based regimens as long as no major resistance mutations are present for the administered drug.

Clinical signs and outcome of dogs treated medically for degenerative lumbosacral stenosis: 98 cases (2004-2012).

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De Decker, Steven; Wawrzenski, Lauren A; Volk, Holger A

2014-08-15

To compare clinical signs of dogs treated medically or surgically for degenerative lumbosacral stenosis (DLSS) and assess outcome after medical treatment. Retrospective case series. Client-owned dogs treated medically (n = 49) or surgically (49) for DLSS. Medical records from 2004 to 2012 were reviewed. Dogs were included if they had clinical signs, clinical examination findings, and MRI abnormalities consistent with DLSS. Several variables were compared between surgically and medically treated dogs: age, sex, duration of clinical signs, presence or absence of neurologic deficits, urinary and fecal incontinence, concurrent medical conditions, and medical treatment before referral. Medical treatment after obtaining a final diagnosis of DLSS consisted of restricted exercise in combination with anti-inflammatory and analgesic drugs. Surgical treatment consisted of dorsal lumbosacral laminectomy. Outcome for medically treated dogs was obtained via a standardized questionnaire. Neurologic deficits were observed significantly more often in surgically treated dogs. Surgically treated dogs had unsuccessful medical treatment before referral significantly more often than did medically treated dogs. Thirty-one of 49 (63.3%) medically treated dogs were available for follow-up evaluation. Of these 31 dogs, 17 (55%) were managed successfully, 10 (32.3%) were managed unsuccessfully and underwent surgical treatment, 3 (9.7%) were euthanized because of progression of clinical signs, and 1 (3.2%) was alive but had an increase in severity of clinical signs after medical management. Clinical signs differed in dogs treated medically or surgically for DLSS. Medical treatment for dogs with DLSS was associated with a fair prognosis.

A Rare case of Guillain-Barré syndrome in pregnancy treated with plasma exchange

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Rahul Vasudev

2014-01-01

Full Text Available Guillain-Barre syndromé (GBS is an autoimmune disorder. It is rare in pregnancy as there is a decrease in cell-mediated immunity. A case of 28-year-old pregnant woman who presented with acute flaccid quadriplegia suffering from GBS is discussed in this study. She was treated with plasma exchange in her immediate post-partum period. The management of GBS in pregnancy has been discussed.

Treating Mucocele in Pediatric Patients Using a Diode Laser: Three Case Reports

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Sara M. Bagher

2018-05-01

Full Text Available A mucocele is the most common minor salivary gland disease and among the most common biopsied oral lesions in pediatric patients. Clinically, a mucocele appears as a round well-circumscribed painless swelling ranging from deep blue to mucosa alike in color. Mucoceles rarely resolve on their own and surgical removal under local anesthesia is required in most cases. Different treatment options are described in the literature, including cryosurgery, intra-lesion injection of corticosteroid, micro-marsupialization and conventional surgical removal using a scalpel, and laser ablation. Therefore, the goal of this paper was to report three cases of mucocele removal in pediatric patients using a diode laser with a one-month follow-up. Mucoceles were removed by a pediatric dentist using a diode laser with a wavelength of 930 nm in continuous mode and a power setting of 1.8 Watts. In all cases, no bleeding occurred during or after the procedure and there was no need for suturing. On clinical examination during the one-month follow-up, in all three cases there was minimal or no scarring, minimal post-operative discomfort or pain, and no recurrence. Diode lasers provide an effective, rapid, simple, bloodless and well accepted procedure for treating mucocele in pediatric patients. Minimal post-operative discomfort and scarring was reported by all the three patients.

Treating Mucocele in Pediatric Patients Using a Diode Laser: Three Case Reports.

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Bagher, Sara M; Sulimany, Ayman M; Kaplan, Martin; Loo, Cheen Y

2018-05-09

A mucocele is the most common minor salivary gland disease and among the most common biopsied oral lesions in pediatric patients. Clinically, a mucocele appears as a round well-circumscribed painless swelling ranging from deep blue to mucosa alike in color. Mucoceles rarely resolve on their own and surgical removal under local anesthesia is required in most cases. Different treatment options are described in the literature, including cryosurgery, intra-lesion injection of corticosteroid, micro-marsupialization and conventional surgical removal using a scalpel, and laser ablation. Therefore, the goal of this paper was to report three cases of mucocele removal in pediatric patients using a diode laser with a one-month follow-up. Mucoceles were removed by a pediatric dentist using a diode laser with a wavelength of 930 nm in continuous mode and a power setting of 1.8 Watts. In all cases, no bleeding occurred during or after the procedure and there was no need for suturing. On clinical examination during the one-month follow-up, in all three cases there was minimal or no scarring, minimal post-operative discomfort or pain, and no recurrence. Diode lasers provide an effective, rapid, simple, bloodless and well accepted procedure for treating mucocele in pediatric patients. Minimal post-operative discomfort and scarring was reported by all the three patients.

A case of surgically treated peristomal pyoderma gangrenosum in a patient with rheumatoid arthritis

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Khajehnoori, Masoomeh; O'Brien, Tim

2016-01-01

Peristomal pyoderma gangrenosum (PPG) is a rare subtype of pyoderma gangrenosum that is difficult to diagnose and treat. It is characterized by the rapid progression of painful necrotic ulcer surrounding an area of abdominal stoma. It is almost exclusively associated with inflammatory bowel disease even after bowel surgery and is associated with significant morbidity. Diagnosis of pyoderma gangrenosum is based on exclusion of other disorders replicating some of its clinical features and histopathological evidence. This is a case report of a 56-year-old lady with rheumatoid arthritis who presented with rapidly progressing abdominal ulcer 8 months after a Hartmanns procedure for perforated diverticulitis. The ulcer had formed a large cavity causing faecal filling in the dependent defect. The other causes of ulcer were excluded with negative histopathology, negative polymerase chain reaction for Mycobacterium ulcerans and negative acid fast bacillus (AFB) test. She was diagnosed with PPG which is routinely treated medically due to risk of setting off a second focus of pyoderma if surgically intervened. However due to increased risk of faecal peritonitis, it was decided to proceed with surgical debridement. This article will discuss the case in more detail and briefly discuss diagnosis and treatment options for PPG. PMID:27302499

Upper gastrointestinal ectopic variceal bleeding treated with various endoscopic modalities: Case reports and literature review.

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Park, Sang Woo; Cho, Eunae; Jun, Chung Hwan; Choi, Sung Kyu; Kim, Hyun Soo; Park, Chang Hwan; Rew, Jong Sun; Cho, Sung Bum; Kim, Hee Joon; Han, Mingui; Cho, Kyu Man

2017-01-01

Ectopic variceal bleeding is a rare (2-5%) but fatal gastrointestinal bleed in patients with portal hypertension. Patients with ectopic variceal bleeding manifest melena, hematochezia, or hematemesis, which require urgent managements. Definitive therapeutic modalities of ectopic varices are not yet standardized because of low incidence. Various therapeutic modalities have been applied on the basis of the experiences of experts or availability of facilities, with varying results. We have encountered eight cases of gastrointestinal ectopic variceal bleeding in five patients in the last five years. All patients were diagnosed with liver cirrhosis presenting melena or hematemesis. All patients were treated with various endoscopic modalities (endoscopic variceal obturation [EVO] with cyanoacrylate in five cases, endoscopic variceal band ligation (EVL) in two cases, hemoclipping in one case). Satisfactory hemostasis was achieved without radiologic interventions in all cases. EVO and EVL each caused one case of portal biliopathy, and EVL induced ulcer bleeding in one case. EVO generally accomplished better results of variceal obturations than EVL or hemoclipping, without serious adverse events. EVO may be an effective modality for control of ectopic variceal bleeding without radiologic intervention or surgery.

Effect of donepezil in patients with Alzheimer's disease previously untreated or treated with memantine or nootropic agents in Germany: an observational study.

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Klinger, Tatjana; Ibach, Bernd; Schoenknecht, Peter; Kamleiter, Martin; Silver, Gabrielle; Schroeder, Johannes; Mielke, Ruediger

2005-05-01

This open-label, prospective, observational, Post-Marketing Surveillance (PMS) study assessed the efficacy and safety of donepezil in patients who had been switched from therapies currently used in Germany to treat Alzheimer's disease (AD), such as memantine and nootropics, due to insufficient efficacy or poor tolerability. A treatment-naive population was included as a comparator. Patients with AD were treated with donepezil and observed for a period of approximately 3 months. A cognitive assessment was made using the Mini-Mental State Examination (MMSE). Quality of life (QoL) was assessed by the investigators who answered the question 'How did therapy with donepezil influence the QoL of the patient and/or his family over the observation period?' and was graded using three ratings: improved/unchanged/worsened. Adverse events (AEs) were also monitored. A total of 913 patients entered the study (mean +/- SD MMSE score 18.03 +/- 5.34). Efficacy assessments were analyzed for three groups: an overall group of patients who had received any form of prior AD drug therapy (N+ group; n = 709); a subgroup of patients from the N+ group who had received prior memantine therapy only (M+ group; n = 111) and patients who were drug treatment naive (N- group; n = 204). In the evaluable population donepezil improved MMSE scores by 2.21 +/- 3.47 points on average, with similar improvements observed in all three groups. QoL was judged to be improved in at least 70% of patients, again with similar results obtained for all three groups. Donepezil was well tolerated, with 85 of 913 (9.3%) patients reporting AEs. The most common AEs were those typically seen with cholinergic therapies (i.e., diarrhoea, vomiting and nausea). In this observational PMS study, donepezil was shown to be efficacious and well tolerated in patients who were being insufficiently treated with memantine or nootropic therapy. The magnitude of response was similar to that observed in patients who were previously

Chemotherapy-associated paronychia treated with 2% povidone–iodine: a series of cases

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Capriotti K

2017-06-01

Full Text Available Kara Capriotti,1,2 Joseph Capriotti,1,3 Jesse Pelletier,1,3 Kevin Stewart1,3 1Veloce BioPharma LLC, Fort Lauderdale, FL, 2Bryn Mawr Skin and Cancer Institute, Rosemont, PA, 3Plessen Ophthalmology Consultants, Christiansted, VI, USA Background: Nail changes are known to occur during the use of chemotherapy for a variety of malignancies, particularly those treated with taxanes and EGFR inhibitors. There are currently no actively recruiting prospective clinical trials investigating potential treatments. There are also no US Food and Drug Administration-approved medical treatments for chemotherapy-associated paronychia and no consensus on the best way to treat these common chemotherapy-induced events. Methods: A retrospective review of all cases presenting to a single dermatology private practice from June 2016 to January 2017 identified nine patients with chemotherapy-associated paronychia seeking treatment. Each patient was prescribed a topical solution comprised of 2% povidone–iodine in a dimethylsulfoxide vehicle that was prepared by a licensed compounding pharmacy. Patients were seen at 3 week and 6 week follow-up visits. Results: All 9/9 patients demonstrated complete or partial resolution. The number of nails involved for each patient ranged from 4–12. There were a total of 58 nails affected in the case series, and 44/58 (76% resolved overall. The treatment was well tolerated. Conclusion: The topical povidone–iodine/dimethylsufoxide solution described is very effective in alleviating the signs and symptoms of paronychia associated with chemotherapy. This novel combination warrants further investigation in randomized, controlled trials to further elucidate its clinical utility. Keywords: paronychia, chemotherapy, taxanes, epidermal growth factor receptor inhibitor, povidone–iodine, dimethylsulfoxide

Persistent sciatica induced by quadratus femoris muscle tear and treated by surgical decompression: a case report

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Tzanakakis George

2010-08-01

Full Text Available Abstract Introduction Quadratus femoris tear is an uncommon injury, which is only rarely reported in the literature. In the majority of cases the correct diagnosis is delayed due to non-specific symptoms and signs. A magnetic resonance imaging scan is crucial in the differential diagnosis since injuries to contiguous soft tissues may present with similar symptoms. Presentation with sciatica is not reported in the few cases existing in the English literature and the reported treatment has always been conservative. Case presentation We report here on a case of quadratus femoris tear in a 22-year-old Greek woman who presented with persistent sciatica. She was unresponsive to conservative measures and so was treated with surgical decompression. Conclusion The correct diagnosis of quadratus muscle tear is a challenge for physicians. The treatment is usually conservative, but in cases of persistent sciatica surgical decompression is an alternative option.

Treating bulimia with hypnosis and low-level light therapy: a case report

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Laser, Eleanor; Sassack, Michael

2012-03-01

This case report describes an effort to control bulimia nervosa by combining low-level laser therapy (LLLT)-the application of red and near-infrared light to specific body points-and hypnosis. A 29-year old female with a 14-year history of bulimia received one session of LLLT combined with hypnosis. Two weeks later, following a measurable decrease in bulimic episodes (purging), a session of psychotherapy and hypnosis was administered. Six months post-treatment, the patient has experienced a complete cessation of purging activities without recurrence. LLLT, when used in conjunction with hypnosis and psychotherapy, was effective in managing bulimia and may prove useful in treating other eating disorders.

Unreduced elbow dislocation treated by Ilizarov method: A case report

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Jovanović Vesna

2010-01-01

Full Text Available Introduction. Unreduced elbow dislocation is every elbow dislocation older than one week. It may be treated non-operatively (with prereduction traction or surgically. The treatment goals are: to reduce pain, to establish joint stability and movements. There are a lot of techniques described in literature, series are relatively small, mostly case reports. Multicentric studies have not been done. That is why there are no precisely defined therapeutic protocols. Every contribution in the field is valuable. Case Outline. A 43-year-old patient was admitted for the treatment of a three-month old unreduced elbow dislocation. Treatment has been done by Ilizarov method, using the reduction mechanism. The reduction process lasted two weeks. The Ilizarov device was removed two months after the operation, then physical therapy was started. Normal anatomical and functional findings were established five months following the operation. Conclusion. The presented method of treatment has been found as very useful, having in mind that it may solve two problems: difficult reduction and redislocation. Reduction may be done without the joint opening, step by step; retention of the reduced joint may be easily done. Physical therapy may be started without Ilizarov device removal, movements of flexion and extension may be improved without any lateral instability. There is no iatrogenic intraarticular damage, so there are no secondary joint degeneration, pains and invalidity.

[Complicated jejunoileal diverticular disease: a 12 cases' serie and literature review].

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López Marcano, Aylhin Joana; Ramia, José Manuel; De la Plaza Llamas, Roberto; Alonso, Soledad; Gonzales Aguilar, Johnny David; Kühnhardt Barrantes, Andree Wolfgang

2017-01-01

To perform a retrospective analysis of a series of complicated JID (jejunoileal diverticulitis) cases surgically treated in our service during the period from 2002 to 2015. We treated 12 cases of jejunoileal complicated diverticulosis. 7 women and 5 men. The mean age was 76 years. The clinical presentation in all cases was acute abdominal pain, one with gastrointestinal bleeding. All cases had leukocytosis, neutrophilia and increased acute phase reactants. All patients underwent emergency abdominal CT. In 11 cases, there was consistency between imaging studies and surgical findings. Diverticula were located: jejunum (9) and ileum (3). Urgent exploratory laparotomy was always done and findings were: diverticular perforation with peritonitis (7 cases), diverticular perforation with abscess (4 cases) and in one case an ischemic area with diverticular perforation after embolization. Intestinal resection and anastomosis was performed in all cases. There were no patients, in which the diagnosis of diverticulosis jejunoileal was previously known. Complications were: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1). Jejunoileal diverticulitis is a rare entity, usually the first sign of onset of diverticular disease not previously known. Abdominal CT is of great diagnostic value. Resection of the affected segment is the treatment of choice.

A diagnostic dilemma: Left-sided appendicitis in a 10 year old boy with previously undiagnosed intestinal malrotation. A case report

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Ashvini Shekhar

2015-01-01

Conclusion: Left sided acute appendicitis is a diagnostic dilemma, thus often leading to management delays. It is pertinent to remember that malrotation of the gut is more common than previously thought, and not just a disease of infancy. It is advisable to consider imaging studies while balancing the risk-benefit-ratio of radiation exposure, especially in paediatric cases to cinch the diagnosis.

FDA Approval: Ibrutinib for Patients with Previously Treated Mantle Cell Lymphoma and Previously Treated Chronic Lymphocytic Leukemia.

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de Claro, R Angelo; McGinn, Karen M; Verdun, Nicole; Lee, Shwu-Luan; Chiu, Haw-Jyh; Saber, Haleh; Brower, Margaret E; Chang, C J George; Pfuma, Elimika; Habtemariam, Bahru; Bullock, Julie; Wang, Yun; Nie, Lei; Chen, Xiao-Hong; Lu, Donghao Robert; Al-Hakim, Ali; Kane, Robert C; Kaminskas, Edvardas; Justice, Robert; Farrell, Ann T; Pazdur, Richard

2015-08-15

On November 13, 2013, the FDA granted accelerated approval to ibrutinib (IMBRUVICA capsules; Pharmacyclics, Inc.) for the treatment of patients with mantle cell lymphoma (MCL) who have received at least one prior therapy. On February 12, 2014, the FDA granted accelerated approval for the treatment of patients with chronic lymphocytic leukemia (CLL) who have received at least one prior therapy. Ibrutinib is a first-in-class Bruton's tyrosine kinase (BTK) inhibitor that received all four expedited programs of the FDA: Fast-Track designation, Breakthrough Therapy designation, Priority Review, and Accelerated Approval. Both approvals were based on overall response rate (ORR) and duration of response (DOR) in single-arm clinical trials in patients with prior treatment. In MCL (N = 111), the complete and partial response rates were 17.1% and 48.6%, respectively, for an ORR of 65.8% [95% confidence interval (CI), 56.2%-74.5%]. The median DOR was 17.5 months (95% CI, 15.8-not reached). In CLL (N = 48), the ORR was 58.3% (95% CI, 43.2%-72.4%), and the DOR ranged from 5.6 to 24.2 months. The most common adverse reactions (≥ 30% in either trial) were thrombocytopenia, diarrhea, neutropenia, bruising, upper respiratory tract infection, anemia, fatigue, musculoskeletal pain, peripheral edema, and nausea. ©2015 American Association for Cancer Research.

Quantifying the influence of previously burned areas on suppression effectiveness and avoided exposure: A case study of the Las Conchas Fire

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Matthew P. Thompson; Patrick Freeborn; Jon D. Rieck; Dave Calkin; Julie W. Gilbertson-Day; Mark A. Cochrane; Michael S. Hand

2016-01-01

We present a case study of the Las Conchas Fire (2011) to explore the role of previously burned areas (wildfires and prescribed fires) on suppression effectiveness and avoided exposure. Methodological innovations include characterisation of the joint dynamics of fire growth and suppression activities, development of a fire line effectiveness framework, and...

A Case Report of Metastatic Breast Cancer Treated with Korean Medicine Therapy as a Substitute for Chemotherapy

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Dong-hyun Lee

2017-01-01

Full Text Available The purpose of this case report is to show the potential benefit of Korean medicine therapy for treating multiple metastatic breast cancer. A 45-year-old Korean woman was diagnosed with right breast invasive ductal carcinoma in August 2012 but did not receive any treatment until October 2015 when she was diagnosed with stage 4 right breast cancer with multiple liver, bone, mesentery, retroperitoneum, and axillary lymph node metastases. After chemo-port insertion, she was treated with palliative chemotherapy and the first line of trastuzumab and paclitaxel, and the port was removed due to port infection. To treat sepsis, vancomycin and tazoperan were administered, before the third line of trastuzumab and paclitaxel was carried out. However, the patient gave up chemotherapy due to vancomycin-resistant enterococci and general weakness. Later, she received Korean medicine therapy with wild ginseng pharmacopuncture, distilled Soramdan S, Hae, and Jeobgoldan for 8 months, which led to a significant decrease of the multiple metastases. The patient was able to start walking again with the help of a walking stick. However, a new metastatic lesion was found on the right adrenal gland. This case suggests that the combination of chemotherapy and Korean medicine therapy may be valuable. Further research is indicated.

Curative Intent Treatment of Hepatocellular Carcinoma - 844 Cases Treated in a General Surgery and Liver Transplantation Center.

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Grigorie, Răzvan; Alexandrescu, Sorin; Smira, Gabriela; Ionescu, Mihnea; Hrehoreţ, Doina; Braşoveanu, Vladislav; Dima, Simona; Ciurea, Silviu; Boeţi, Patricia; Dudus, Ionut; Picu, Nausica; Zamfir, Radu; David, Leonard; Botea, Florin; Gheorghe, Liana; Tomescu, Dana; Lupescu, Ioana; Boroş, Mirela; Grasu, Mugur; Dumitru, Radu; Toma, Mihai; Croitoru, Adina; Herlea, Vlad; Pechianu, Cătălin; Năstase, Anca; Popescu, Irinel

2017-01-01

Background: The objective of this study is to assess the outcome of the patients treated for hepatocellular carcinoma (HCC) in a General Surgery and Liver Transplantation Center. Methods: This retrospective study includes 844 patients diagnosed with HCC and surgically treated with curative intent methods. Curative intent treatment is mainly based on surgery, consisting of liver resection (LR), liver transplantation (LT). Tumor ablation could become the choice of treatment in HCC cases not manageable for surgery (LT or LR). 518 patients underwent LR, 162 patients benefited from LT and in 164 patients radiofrequency ablation (RFA) was performed. 615 patients (73%) presented liver cirrhosis. Results: Mordidity rates of patient treated for HCC was 30% and mortality was 4,3% for the entire study population. Five year overall survival rate was 39 % with statistically significant differences between transplanted, resected, or ablated patients (p 0.05) with better results in case of LT followed by LR and RFA. Conclusions: In HCC patients without liver cirrhosis, liver resection is the treatment of choice. For early HCC occurred on cirrhosis, LT offers the best outcome in terms of overall and disease free survival. RFA colud be a curative method for HCC patients not amenable for LT of LR. Celsius.

EBUS-TBNA in PET-positive lymphadenopathies in treated cancer patients

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Juliana Guarize

2017-10-01

Full Text Available Mediastinal lymph node enlargement is common in the follow-up of patients with previously treated malignancies. The aim of this study is to assess the role of endobronchial ultrasound (EBUS transbronchial needle aspiration (TBNA for cyto-histological evaluation of positron emission tomography with 18fluorodeoxyglucose (PET positive mediastinal and hilar lymph nodes developed in patients with previous malignancies. All EBUS-TBNA cases performed from January 2012 to May 2016 were retrospective reviewed. Results of EBUS-TBNA in patients with mediastinal and/or hilar lymphadenopathies were analysed. Non-malignant cytopathologies were confirmed with surgical procedures or clinical and radiological follow-up. Among 1780 patients, 176 were included in the analysis. 103 of these (58.5% had a diagnosis of tumour recurrence whereas 73 (41.5% had a different diagnosis: 63 (35.8% had a non-neoplastic diagnosis and 8 patients (4.6% had a different cell type malignancy. Samples were false-negative in 5 (2.8% out of 176 patients. The overall sensitivity, specificity, negative predicted value and diagnostic accuracy were 95.7% (95% CI 90.2–98.6%, 100% (95% CI 94.0–100%, 92.3% (95% CI 83.2–96.7% and 97.2% (95% CI 93.5–98.8%, respectively. EBUS-TBNA demonstrated a pathological diagnosis different from the previous tumour in a large percentage of patients, confirming its strategic role in the management of patients with previously treated malignancies.

Enterprise Deployment Through PulseRider To Treat Anterior Communicating Artery Aneurysm Recurrence.

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Valente, Iacopo; Limbucci, Nicola; Nappini, Sergio; Rosi, Andrea; Laiso, Antonio; Mangiafico, Salvatore

2018-02-01

PulseRider (Pulsar Vascular, Los Gatos, California, USA) is a new endovascular device designed to treat wide-neck bifurcation intracranial aneurysms. Deployment of a stent through a PulseRider to treat an aneurysm's recurrence has never been described before. We report the case of a 55-year-old man who underwent coiling of an 8-mm anterior communicating artery aneurysm with assistance of a PulseRider neck reconstruction device. The 6-month digital subtraction angiography control showed aneurysm recurrence, so we deployed an Enterprise 2 closed-cell stent (Codman, Miami Lakes, Florida, USA) in the A1-A2 segment passing across the previously implanted PulseRider. Enterprise correctly expanded and allowed for adequate coiling of the aneurysm. An Enterprise stent can be safely opened through a PulseRider in order to treat aneurysm recurrence. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparing hospital outcomes between open and closed tibia fractures treated with intramedullary fixation.

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Smith, Evan J; Kuang, Xiangyu; Pandarinath, Rajeev

2017-07-01

Tibial shaft fractures comprise a large portion of operatively treated long bone fractures, and present with the highest rate of open injuries. Intramedullary fixation has become the standard of care for both open and closed injuries. The rates of short term complications and hospital length of stay for open and closed fractures treated with intramedullary fixation is not fully known. Previous series on tibia fractures were performed at high volume centers, and data were not generalizable, further they did not report on length of stay and the impact of preoperative variables on infections, complications and reoperation. We used a large surgical database to compare these outcomes while adjusting for preoperative risk factors. Data were extracted from the ACS-NSQIP database from 2005 to 2014. Cases were identified based on CPT codes for intramedullary fixation and categorized as closed vs open based on ICD9 code. In addition to demographic and case data, primary analysis examined correlation between open and closed fracture status with infection, complications, reoperation and hospital length of stay. Secondary analysis examined preoperative variables including gender, race, age, BMI, and diabetes effect on outcomes. There were 272 cases identified. There were no significant demographic differences between open and closed tibia fracture cases. Open fracture status did not increase the rate of infection, 30day complications, reoperation, or length of stay. The only preoperative factor that correlated with length of stay was age. There was no correlation between BMI, presence of insulin dependent and nondependent diabetes, and any outcome measure. When considering the complication rates for open and closed tibial shaft fractures treated with intramedullary fixation, there is no difference between 30-day complication rate, length of stay, or return to the operating room. Our reported postoperative infection rates were comparable to previous series, adding validity to

Unexpected finding of T-cell lymphoma in a previously healthy 16-year-old patient after a thorax trauma: a case report

DEFF Research Database (Denmark)

Bach Okholm-Hansen, Anna; Brorson, Stig

2014-01-01

INTRODUCTION: We describe the clinical course and emphasize the difficulties in diagnosing T-cell lymphoblastic lymphoma. The differential diagnostic difficulties have previously been described in regard to pneumonia, but to the best of the authors' knowledge this is the first case report to desc...... relevant to pediatricians, surgeons, anesthesiologists, and general practitioners....

Inadvertent yellow fever vaccination of a patient with Crohn's disease treated with infliximab and methotrexate

DEFF Research Database (Denmark)

Ekenberg, C.; Friis-Møller, N.; Ulstrup, Thomas

2016-01-01

We present a case of a 56-year-old woman with Crohn's disease, treated with methotrexate and infliximab, who inadvertently received yellow fever vaccination (YFV) prior to a journey to Tanzania. She was not previously vaccinated against YF. YFV contains live-attenuated virus, and is contraindicated...... in patients treated with immunosuppressive drugs. Following vaccination, the patient fell ill with influenza-like illness. Elevated transaminase levels and YF viremia were detected. Despite being immunocompromised, the patient did not develop more severe adverse effects. Neutralising antibodies to YF virus...... were detected on day 14 following vaccination and remained protective at least 10 months after vaccination. Limited data is available on outcomes of YFV in patients receiving immunosuppressive therapy, including biologics, and we report this case as a reminder of vigilance of vaccine recommendations...

Iodine-131 induced hepatotoxicity in previously healthy patients with Grave's disease.

Science.gov (United States)

Jhummon, Navina Priya; Tohooloo, Bhavna; Qu, Shen

2013-01-01

To describe the association of the rare and serious complication of liver toxicity in previously healthy Grave's disease (GD) patients after the treatment with radioactive iodine (131)I (RAI). We report the clinical, laboratory and pathologic findings of 2 cases of severe liver toxicity associated with the treatment with RAI in previously healthy patients with GD. Clinical examination and laboratory investigations excluded viral hepatitis, autoimmune hepatitis, granulomatous disease, primary biliary disease, extrahepatic biliary obstruction, and heart failure. Case 1: A previously healthy 52-years old man reportedly having a typical GD but following RAI treatment, concomitantly developed severe liver toxicity that required 1 week of treatment in hospital. Case 2: A previously healthy 34-years old woman is reported as having a typical GD but developed jaundice following RAI treatment that required several weeks of in hospital treatment in the hepato-biliary department. In both cases, the liver dysfunction resolved after intensive treatment with hepato-protective agents. In this report the therapeutic considerations as well as the pathogenetic possibilities are reviewed. To the best of our knowledge, this is the first description of the association observed, which is rare but may be severe and should be considered in any case of thyrotoxicosis where a liver dysfunction develops after the treatment with radioactive iodine (131)I.

Four cases of facial melanoma treated by BNCT with 10B-p-boronophenylalanine

International Nuclear Information System (INIS)

Fukuda, H.; Mishima, Y.; Hiratsuka, J.; Kobayashi, T.; Karashima, H.; Yoshino, K.; Tsuru, K.; Araki, K.; Ichihashi, M.

2000-01-01

We treated four cases of facial melanoma by BNCT with 10 B-paraboronophenylalanine · fructose complex (BPA). The patients received 180 to 200 mg BPA/kg-BW intravenously for 3 to 5 hours. One to two hours after the end of BPA administration, they were irradiated with a thermal neutron beam at the Kyoto University Reactor (KUR). The local control of the tumors was good and complete regression was achieved in all cases. The acute and subacute skin reactions ranged from dry desquamation to erosion and were within tolerable limits. After 2 to 3 months, the skin recovered from damage with slight pigmentation or depigmentation and without serious functional or cosmetic problems. Our results indicate BNCT of facial melanoma is promising not only for tumor cure but also for good QOL of the patients, although surgery is the standard and first choice for the treatment of malignant melanoma. (author)

Previous Employment and Job Satisfaction Conditions: The Case of Regional Administration

Science.gov (United States)

Amalia, Myronaki; Nikolaos, Antonakas

2009-08-01

In the present work we study the different dimensions of satisfaction and the way of constitution of satisfaction of an important sample of the employees in the Regional administration of Crete and in their connection with the variable of the previous employment. We found statistically important differences for the components of satisfaction from the life, collaboration in and outside from the department, in the social satisfaction and the variable of the years in the service (labour group with satisfaction than the other previous employment groups. In the other hand the group with many years in the service presents bigger satisfaction than the other groups. Finally, is important to note that the sample present some interesting characteristics.

Paclitaxel with Cisplatin as Salvage Treatment for Patients with Previously Treated Advanced Transitional Cell Carcinoma of the Urothelial Tract

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Ji Eun Uhm

2007-01-01

Full Text Available BACKGROUND: This study was performed to evaluate the safety and efficacy of paclitaxel with cisplatin as salvage therapy in patients previously treated with gemcitabine and cisplatin (G/C for advanced transitional cell carcinoma (TCC of the urothelial tract. METHODS: Twenty-eight patients with metastatic or locally advanced TCC who had received prior G/C chemotherapy were enrolled. All patients received paclitaxel (175 mg/m2 and cisplatin (60 mg/m2 every 3 weeks for eight cycles or until disease progression. RESULTS: The median age was 61 years (range, 43–83 years, and the median Eastern Cooperative Oncology Group performance status was 1 (range, 0–2. The overall response rate was 36% [95% confidence interval (95% CI = 18–54], with three complete responses and seven partial responses. The median time to progression was 6.2 months (95% CI = 3.9–8.5, and the median overall survival was 10.3 months (95% CI = 6.1–14.1. The most common Grade 3/4 nonhematologic and hematologic toxicities were emesis (10 of 28 patients; 36% and neutropenia (5 of 110 cycles; 5%. CONCLUSIONS: Salvage chemotherapy with paclitaxel and cisplatin displayed promising results with tolerable toxicity profiles in patients with metastatic or locally advanced TCC who had been pretreated with G/C.

A Case of Refractory Type III Hyperlypoproteinemia Successfully Treated with Plasmapheresis

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Alpaslan Tuzcu

2004-01-01

Full Text Available A 42-year-old male was hospitalized in Department of Endocrinologyfor evaluation of persistent hypertriglyceridemia and hypercholestrolemia.He was normal on physical examination except having multiple xanthomasin elbow, knee and ankle. ApoE genotyping was performed by PCR andapoE phenotype was found to be E2/E2. Firstly, he was treated withatorvastatin (40mg/day and niacin (1500mg/day but it was found that thepatient did not respond the after three months of the treatment. Then he wastreated with plasmapheresis twice a week. After three weeks ofplasmapheresis treatment triglyceride and cholesterol levels was markedlydecreased.Plasmapheresis can be highly effective in removing the lipoproteinremnantparticles, leading to generalized improvement in the lipoproteinprofile in severe type III hyperlipidemia, which do not respond conventionalthreapies as in our case.

Primary meningeal pheochromocytoma: a case report

Energy Technology Data Exchange (ETDEWEB)

Yoon, Il Ju; Suh, Hyoung Sim [Myung-Ji St. Mary' s Hospital, Seoul (Korea, Republic of); Kim, Sung Nam [Green Cross Reference Lab, Seoul (Korea, Republic of)

2007-04-15

Pheochromocytoma is a rare endocrine tumor arising from the chromaffin tissue, and it is able to produce and secrete catecholamines. Lymph nodes, liver, lung and bone are the most frequent sites of metastasis. We report here on a case of pheochromocytoma arising from the dura in a patient who was surgically treated for bilateral pheochromocytoma five years previously.

Enhanced Morbidity of Pectoralis Major Myocutaneous Flap Used for Salvage after Previously Failed Oncological Treatment and Unsuccessful Reconstructive Head and Neck Surgery

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Christiana Maria Ribeiro Salles Vanni

2012-01-01

Full Text Available Introduction. The reconstruction of complex cervicofacial defects arising from surgical treatment for cancer is a real challenge for head and neck surgeons, especially in salvage reconstruction surgery and/or failed previous reconstruction. The pectoralis major myocutaneous flap (PMMF has been widely used in these specific situations due to its reliability and low rate of failure or complications. Objectives. Identify factors that determine complications and influence the final outcome of the reconstructions with PMMF in salvage cancer surgery or in salvage reconstruction. Methods. A cross-sectional study design was used to evaluate a sample including 17 surgical patients treated over a period of ten years that met the inclusion criteria. Results. Reconstruction was successful in 13 cases (76.5%, with two cases of partial flap loss and no case of total loss. Complications occurred in 13 cases (76.5% and were specifically related to the flap in nine instances (52.9%. An association was identified between the development of major complications and reconstruction of the hypopharynx (=0.013 as well as in patients submitted to surgery in association with radiation therapy as a previous cancer treatment (=0.002. The former condition is also associated with major reconstruction failure (=0.018. An even lower incidence of major complications was noted in patients under the age of 53 (=0.044. Conclusion. Older patients, with hypopharyngeal defects and submitted to previous surgery plus radiation therapy, presented a higher risk of complications and reconstruction failure with PMMF.

Second malignancies in high-dose areas of previous tumor radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Welte, Birgitta; Suhr, Peter; Bottke, Dirk; Bartkowiak, Detlef; Wiegel, Thomas [Dept. of Radiotherapy and Radiation Oncology, Univ. of Ulm (Germany); Doerr, Wolfgang [Dept. of Radiotherapy and Radiation Oncology, Radiobiology Lab., Univ. of Technology Dresden (Germany); Trott, Klaus Ruediger [UCL Cancer Centre, Univ. Coll. London (United Kingdom)

2010-03-15

Purpose: To characterize second tumors that developed in or near the high-dose areas of a previous radiotherapy, regarding their frequency, entities, latency, and dose dependence. Patients and Methods: 9,995/15,449 tumor patients of the Radiation Oncology Department in Ulm, Germany, treated between 1981 and 2003, survived at least 1 year after radiotherapy. By long-term follow-up and review of treatment documentation, 100 of them were identified who developed an independent second cancer in or near the irradiated first tumor site. Results: Major primary malignancies were breast cancer (27%), lymphoma (24%), and pelvic gynecologic tumors (17%). Main second tumors were carcinomas of the upper (18%) and lower (12%) gastrointestinal tract, head and neck tumors (10%), lymphoma (10%), breast cancer (9%), sarcoma (9%), and lung cancer (8%). Overall median second tumor latency was 7.4 years (1-42 years). For colorectal cancer it was 3.5 and for leukemia 4.3 years, but for sarcoma 11.7 and for breast cancer 17.1 years. The relatively frequent second tumors of the upper gastrointestinal tract were associated with median radiation doses of 24 Gy. By contrast, second colorectal cancer and sarcoma developed after median doses of 50 Gy. Conclusion: The 5- and 15-year probability to develop a histopathologically independent second tumor in or near the irradiated first tumor site, i.e., after intermediate or high radiation doses, was 0.5% and 2.2%, respectively. To identify potentially radiogenic second malignancies, a follow-up far beyond 5 years is mandatory. The incidence and potential dose-response relationship intermediate will be analyzed by a case-case and a case-control study of the Ulm data. (orig.)

Necrotising fasciitis of the shoulder in association with rheumatoid arthritis treated with etanercept: a case report

LENUS (Irish Health Repository)

Smyth, Andrew

2010-11-17

Abstract Introduction Necrotising fasciitis is a severe infection characterised by the fulminant destruction of tissue with associated systemic signs of sepsis and toxicity. Etanercept is a fully human fusion protein that inhibits tumor necrosis factor and the inflammatory cascade. It is effective in the treatment of many disorders but concerns regarding severe life threatening infections have been raised in multiple reports. Case presentation We present the case of a 39-year-old Caucasian man, who presented with sudden onset of severe and progressive neck and left shoulder pain, with a two-year history of seronegative rheumatoid arthritis treated with azathoprine and etanercept. On examination the left side of his neck and his left shoulder were oedematous, tender with an erythematous rash and his active range of movement was limited. Magnetic resonance imaging of his shoulder showed extensive oedema of the subcutaneous and intramuscular fat of the left lower neck consistent with fasciitis. He was treated medically and made a good recovery. Conclusion Our patient, while having a pre-existing increased mortality risk, had a serious infection which responded well to optimum medical treatment without the need for surgery. As anti tumor necrosis factor agents are frequently associated with infection, including tuberculous infection, this case highlights the need for a high index of suspicion for other severe bacterial infections in patients on immunosuppressants.

Necrotising fasciitis of the shoulder in association with rheumatoid arthritis treated with etanercept: a case report

Directory of Open Access Journals (Sweden)

Tuite Helen

2010-11-01

Full Text Available Abstract Introduction Necrotising fasciitis is a severe infection characterised by the fulminant destruction of tissue with associated systemic signs of sepsis and toxicity. Etanercept is a fully human fusion protein that inhibits tumor necrosis factor and the inflammatory cascade. It is effective in the treatment of many disorders but concerns regarding severe life threatening infections have been raised in multiple reports. Case presentation We present the case of a 39-year-old Caucasian man, who presented with sudden onset of severe and progressive neck and left shoulder pain, with a two-year history of seronegative rheumatoid arthritis treated with azathoprine and etanercept. On examination the left side of his neck and his left shoulder were oedematous, tender with an erythematous rash and his active range of movement was limited. Magnetic resonance imaging of his shoulder showed extensive oedema of the subcutaneous and intramuscular fat of the left lower neck consistent with fasciitis. He was treated medically and made a good recovery. Conclusion Our patient, while having a pre-existing increased mortality risk, had a serious infection which responded well to optimum medical treatment without the need for surgery. As anti tumor necrosis factor agents are frequently associated with infection, including tuberculous infection, this case highlights the need for a high index of suspicion for other severe bacterial infections in patients on immunosuppressants.

Case report: AREB in a patient with rheumatoid arthritis treated with methotrexate and infliximab

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Giuseppe Rossi

2011-09-01

Full Text Available Anti TNF-a drugs seem to be the new frontier of Rheumatoid Arthritis (RA therapy. The association infliximab methotrexate has been approved for the treatment of RA not responding to the classic therapy, but the short clinical experience in using antiTNF-a molecules brings to segnalation of new risks or adverse events. We describe a case of a patient, treated for many years with classic RA therapy, which developed a refractory anemia after treatment with association infliximab-methotrexate.

Vitiligo in a patient with lung adenocarcinoma treated with nivolumab: A case report.

Science.gov (United States)

Uenami, Takeshi; Hosono, Yuki; Ishijima, Mikako; Kanazu, Masaki; Akazawa, Yuki; Yano, Yukihiro; Mori, Masahide; Yamaguchi, Toshihiko; Yokota, Soichiro

2017-07-01

Nivolumab, an anti-programmed cell death-1 protein monoclonal antibody, is effective for treating patients with late-stage non-small-cell lung cancer. Immune checkpoint inhibitors such as nivolumab induce various kinds of immune-related adverse events, including vitiligo. Vitiligo has been reported in patients with melanoma but not lung cancer. We describe a 75-year-old man with lung adenocarcinoma, stage 4 with pleural and pericardial effusion, that progressed after first-line chemotherapy. Subsequently, he was treated with nivolumab as second-line therapy. After 6days of administering nivolumab, he developed vitiligo suddenly on the trunk of his body. Except for vitiligo, his physical examination was normal, and treatment with nivolumab was well tolerated. Therefore, this treatment was continued without further development or expansion of vitiligo. A computed tomography scan showed a reduction in the size of the lung nodule and stabilization of the pleural and pericardial effusion. This is the first case of vitiligo associated with the use of nivolumab in a patient with lung adenocarcinoma. Copyright © 2017. Published by Elsevier B.V.

Iodine-131 induced hepatotoxicity in previously healthy patients with Grave’s disease

Science.gov (United States)

2013-01-01

Objective To describe the association of the rare and serious complication of liver toxicity in previously healthy Grave’s disease (GD) patients after the treatment with radioactive iodine 131I (RAI). Case presentation We report the clinical, laboratory and pathologic findings of 2 cases of severe liver toxicity associated with the treatment with RAI in previously healthy patients with GD. Clinical examination and laboratory investigations excluded viral hepatitis, autoimmune hepatitis, granulomatous disease, primary biliary disease, extrahepatic biliary obstruction, and heart failure. Case 1: A previously healthy 52-years old man reportedly having a typical GD but following RAI treatment, concomitantly developed severe liver toxicity that required 1 week of treatment in hospital. Case 2: A previously healthy 34-years old woman is reported as having a typical GD but developed jaundice following RAI treatment that required several weeks of in hospital treatment in the hepato-biliary department. In both cases, the liver dysfunction resolved after intensive treatment with hepato-protective agents. In this report the therapeutic considerations as well as the pathogenetic possibilities are reviewed. Conclusion To the best of our knowledge, this is the first description of the association observed, which is rare but may be severe and should be considered in any case of thyrotoxicosis where a liver dysfunction develops after the treatment with radioactive iodine 131I. PMID:23497434

Comparative adequacy of surgery and radiation therapy in 175 T2 glottic carcinomas: 116 cases treated with surgery and 59 with radiation therapy

International Nuclear Information System (INIS)

Cellai, E.; Olmi, P.; Chiavacci, A.; Fallai, C.; Aulisi, L.; Bottai, G.A.; De Meester, W.

1991-01-01

The results were analyzed of 175 patients with glottic squamous cell carcinomas who were treated with curative purposes (1970-1986). Overall 10-year local control rates were 74% for the surgical series and 69% for the cases treated by radiation therapy. After salvage therapy 10-year survival rates were 83% and 76% respectively. The analysis of the results showed no statistically significant difference. In the group treated by radical surgery 80% local control was observed, versus 66% in the cases treated with conservative surgery. 10-year survival rate was higher in the latter group (89% versus 81%) because of better results of salvage therapy: 7 of 10 recurrences were salvaged with the second treatment. Several prognostic factors were evaluated-i.e., T extent, anterior commissure involvement, subglottic invasion, vocal cord mobility impairment, and ventricular involvement. Anterior commissure involvement was the main factor affecting out-come in the surgical series: in the presence of this factor, 64% 10-year local control was observed versus 85% in the patients without commissure involvement. This factor proved more important in the patients treated with conservative surgery (10-year control: 42 versus 88%) than in those undergoing radical surgery (78% versus 85%). Anterior commissure involvement and the number of involved subsites were found to worsen prognosis in the serial treated by radiation therapy: cases with anterior commissure involvement had 59% 10-year local control versus 83%. The cases with a deeper spread had 60% local control versus 75%. Vocal cord mobility impairment was a less important prognosis factor in both series. Our results suggest radiation therapy as a valuable method in a treatment of the small T2 laryngeal cancers which are not suitable for conservative surgery

Injection related anxiety in insulin-treated diabetes.

Science.gov (United States)

Zambanini, A; Newson, R B; Maisey, M; Feher, M D

1999-12-01

The presence of injection related anxiety and phobia may influence compliance, glycaemic control and quality of life in patients with insulin-treated diabetes. Unselected consecutive, insulin-treated patients attending a diabetes clinic for follow-up, completed a standardised questionnaire providing an injection anxiety score (IAS) and general anxiety score (GAS). A total of 115 insulin-treated (80 Type 1 and 35 Type 2) diabetic patients completed the questionnaire. Injections had been avoided secondary to anxiety in 14% of cases and 42% expressed concern at having to inject more frequently. An IAS > or = 3 was seen in 28% of patients and of these, 66% injected insulin one to two times/day, 45% had avoided injections, and 70% would be bothered by more frequent injections. A significant correlation between IAS and GAS was seen (Kendall's tau-a 0.30, 95% CI 0.19-0.41, P < 0.001). GAS was significantly associated with both previous injection avoidance and expressed concern at increased injection frequency. No significant correlation was seen with HbA1c and injection or general anxiety scores. Symptoms relating to insulin injection anxiety and phobia have a high prevalence in an unselected group of diabetic patients requiring insulin injections and are associated with higher levels of general anxiety.

Severe florid cemento-osseous dysplasia: a case report treated conservatively and literature review.

Science.gov (United States)

Sarmento, Dmitry José de Santana; Monteiro, Bárbara Vanessa de Brito; de Medeiros, Ana Miryam Costa; da Silveira, Ericka Janine Dantas

2013-03-01

Florid cemento-osseous dysplasia (FCOD) has been described as a condition that characteristically affects the jaws of middle-aged black women. Radiographically, FCOD appears as dense, lobulated masses, often symmetrically located in various regions of the jaws. FCOD is usually asymptomatic. In severe cases, focal expansion may occur due to infection. Management of the symptomatic patient is more difficult due to the avascular nature of the lesion which contributes to susceptibility severe infection, bone sequestration, and osteomyelitis when surgery is performed. This paper presents a rare case of severe FCOD; the black woman patient was diagnosed based on clinical and radiographic findings and treated conservatively. The examination of panoramic radiographs revealed a multiple sclerotic masses with radiolucent borders, found in the mandible and maxilla which were symmetrical at presentation. The patient continuous with the follow-up. This report confirms that a diagnosis can be made with accurate clinical and radiographic assessment. The correct selection of treatment for FCOD depends on this information.

Four cases of intracranial AVM successfully treated by radiation therapy

International Nuclear Information System (INIS)

Chen, Mau-Nan; Imaya, Hisatoshi; Nakazawa, Shozo.

1990-01-01

We have treated three patients with conventional radiotherapy and one with stereotactic radiosurgery and report the follow-up results. A 63-year-old woman had a dural arteriovenous malformation (AVM) in the right cavernous sinus. She was irradiated using 10 MV X-ray with a total of 30 Gy. Post irradiation angiography showed a complete absence of dural AVM. A 62-year-old woman had a dural AVM fed by the left external carotid artery in the right cavernous sinus. Embolization by gelfoam was performed before irradiation. The irradiation was given with a total dose of 30 Gy. Post irradiation angiography showed disappearance of the dural AVM. A 26-year-old woman had a small AVM (about 20 x 15 x 15 mm) in the posterior corpus callosum. An operation was performed but the AVM was not excised completely. We irradiated to the residual AVM with a total of 30 Gy. The follow-up angiography one year after treatment, showed disappearance of the AVM. She had no neurological deficit two years after the treatment. A 14-year-old boy had a small AVM (about 20 x 15 x 10 mm) in the left anterior wall of the fourth ventricle. The AVM was located deeply, so an operation was not performed. Radiosurgery was undertaken four months after onset in Buenos Aires. The total dose was 36 Gy. The follow-up angiography one year after treatment, showed disappearance of the AVM. He also had no neurological deficit two years after the treatment. These four cases of AVM (two dural AVMs) were successfully treated by radiation therapy. No side effect was observed. (author)

Sleep bruxism possibly triggered by multiple sclerosis attacks and treated successfully with botulinum toxin: Report of three cases.

Science.gov (United States)

Sevim, Serhan; Kaleağası, Hakan; Fidancı, Halit

2015-09-01

Sleep bruxism refers to a nocturnal parafunctional activity including the clenching, grinding or gnashing of teeth. While most of the nocturnal bruxism cases seen in the general population are apparently idiopathic, it has been reported to be associated with a range of neurological diseases such as Huntington's disease, cranio-cervical dystonia and post-anoxic brain damage, but not multiple sclerosis (MS). We describe three cases of MS patients who have had moderate to severe complaints of bruxism in the two weeks following their relevant MS attacks. None of the three patients had a diagnosis of bruxism prior to her attack. The diagnosis was confirmed in one out of three by a polysomnography. One patient did not have any complaints related to bruxism previous to her attack, whereas two had mild and infrequent complaints. The symptoms of the relevant attacks were left hemihypesthesia in all and hemiparesis in two. None of the patients had spasticity that could result in severe teeth clenching. All three patients presented with morning headaches and jaw pain or tightness and were treated successfully with botulinum toxin (Btx) injections applied to their masseter and temporalis muscles. The cause of bruxism is controversial but lesions of the cortico-basalganglia-thalamo-cotrical loops are thought to be most likely. However, acute or chronic lesions in those pathways were not demonstrated in the 3 patients. It is feasible that they had normal appearing white matter interruptions in their cortico-basalganglia-thalamocortical loops along with their relevant attack. Copyright © 2015 Elsevier B.V. All rights reserved.

Infantile myofibroma of the zygomatoco-maxillo-orbital complex: Case report with spontaneous regression

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K. Arab

2016-12-01

Conclusion: Radiologically aggressive infantile myofibroma has been previously treated by surgical intervention. In this case report there was a significant spontaneous regression. Conservative treatment and follow-up may be an appropriate alternative.

Case Report of Pes Anserine Bursitis patient treated with Bee Venom Acua-Acupuncture Therapy by Using DITI

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Moon Ja-Young

2004-02-01

Full Text Available Objective : The purpose of this study is to report the effect of Bee Venom Acua-Acupuncture Therapy to the patient of Pes Anserine Bursitis by using DITI. Patient & Methods : The patient was 60-year-old woman who complained severe knee pain. She was treated by bee venom acuaacupuncture therapy. To estimate the efficacy of tratment, we used DITI, visual analog scale, knee joint check(ROM. Results : In this case, we treated patient of Pes Anserine Bursitis for 28 days. bee venom acua-acupuncture therapy efficiently relieved patient's pain and improved ROM. DITI and Visual analog scale also showed significantly valuable changes.

Treatment resistant adolescent depression with upper airway resistance syndrome treated with rapid palatal expansion: a case report

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Miller Paul

2012-12-01

Full Text Available Abstract Introduction To the best of our knowledge, this is the first report of a case of treatment-resistant depression in which the patient was evaluated for sleep disordered breathing as the cause and in which rapid palatal expansion to permanently treat the sleep disordered breathing produced a prolonged symptom-free period off medication. Case presentation An 18-year-old Caucasian man presented to our sleep disorders center with chronic severe depression that was no longer responsive to medication but that had recently responded to electroconvulsive therapy. Ancillary, persistent symptoms included mild insomnia, moderate to severe fatigue, mild sleepiness and severe anxiety treated with medication. Our patient had no history of snoring or witnessed apnea, but polysomnography was consistent with upper airway resistance syndrome. Although our patient did not have an orthodontic indication for rapid palatal expansion, rapid palatal expansion was performed as a treatment of his upper airway resistance syndrome. Following rapid palatal expansion, our patient experienced a marked improvement of his sleep quality, anxiety, fatigue and sleepiness. His improvement has been maintained off all psychotropic medication and his depression has remained in remission for approximately two years following his electroconvulsive therapy. Conclusions This case report introduces the possibility that unrecognized sleep disordered breathing may play a role in adolescent treatment-resistant depression. The symptoms of upper airway resistance syndrome are non-specific enough that every adolescent with depression, even those responding to medication, may have underlying sleep disordered breathing. In such patients, rapid palatal expansion, by widening the upper airway and improving airflow during sleep, may produce a prolonged improvement of symptoms and a tapering of medication. Psychiatrists treating adolescents may benefit from having another treatment option for

Styloid-carotid artery syndrome treated surgically with Piezosurgery: a case report and literature review.

Science.gov (United States)

Hoffmann, Eike; Räder, Christian; Fuhrmann, Hendrik; Maurer, Peter

2013-03-01

Styloid-carotid artery syndrome was first described by Eagle and is associated with cervical and facial pain caused by head movement resulting from mechanical compression of the carotid nerve plexus due to an elongated styloid process. The case of a 49-year-old man with persistent cervical pain, neurological symptoms and an elongated styloid process of 7.5 cm is reported here; this patient was successfully treated using Piezosurgery. In addition, a literature review is included. Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Spontaneous pseudoaneurysm of the uterine artery during pregnancy treated by direct thrombin injection: A case report

Energy Technology Data Exchange (ETDEWEB)

Hong, Jung Hee; Kim, See Hyung; Kim, Young Hwan [Dept. Radiology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu (Korea, Republic of)

2016-04-15

Pseudoaneurysm of uterine artery during pregnancy is a very rare disease. It is mostly associated with uterine artery injury, usually occurring after proceeding conditions such as history of gynecologic operation and infection. However, the best treatment modality has not been established yet. Herein, we reported a case of spontaneous formation of uterine artery pseudoaneurysm during pregnancy treated by direct thrombin injection without any complication or recurrence.

Spontaneous pseudoaneurysm of the uterine artery during pregnancy treated by direct thrombin injection: A case report

International Nuclear Information System (INIS)

Hong, Jung Hee; Kim, See Hyung; Kim, Young Hwan

2016-01-01

Pseudoaneurysm of uterine artery during pregnancy is a very rare disease. It is mostly associated with uterine artery injury, usually occurring after proceeding conditions such as history of gynecologic operation and infection. However, the best treatment modality has not been established yet. Herein, we reported a case of spontaneous formation of uterine artery pseudoaneurysm during pregnancy treated by direct thrombin injection without any complication or recurrence

Congenital peripheral primitive neuroectodermal tumor: A case treated successfully with multimodality treatment

International Nuclear Information System (INIS)

Goyal, Sh.; Biswas, A.; Mohanti, B.K.; Gupta, R.

2014-01-01

Neonatal tumors comprise less than two percent of childhood malignancies. Most are solid tumors, most common histologies being teratoma and neuroblastoma. We encountered a child who was detected to have a right arm mass on antenatal sonogram, which was diagnosed to be a primitive neuroectodermal tumor involving the triceps on fine needle aspiration cytology performed in the post-natal period. The child was successfully treated with multimodality treatment consisting of surgery, chemotherapy and radiotherapy. We also discuss briefly the problems associated with therapy in neonatal period. A review of all cases reported to have congenital Ewing’s sarcoma family of tumors is presented. Novel therapies are needed to improve efficacy and decrease the devastating side effects of treatment in this age group.

Integrating Hypnosis with Other Therapies for Treating Specific Phobias: A Case Series.

Science.gov (United States)

Hirsch, Joseph A

2018-04-01

There is a high prevalence of anxiety disorders including specific phobias and panic disorder in the United States and Europe. A variety of therapeutic modalities including pharmacotherapy, cognitive behavioral therapy, systematic desensitization, hypnosis, in vivo exposure, and virtual reality exposure therapy have been applied. No one modality has been entirely successful. There has been only a limited attempt to combine psychological therapies in the treatment of specific phobias and panic disorder and what has been done has been primarily with systematic desensitization or cognitive behavioral therapy along with hypnotherapy. I present two cases of multiple specific phobias that were successfully treated with hypnotherapy combined with virtual reality exposure therapy or in vivo exposure therapy. The rationale for this integrative therapy and the neurobiological constructs are considered.

Lyme neuroborreliosis in HIV-1 positive men successfully treated with oral doxycycline: a case series and literature review

OpenAIRE

Gisslén Magnus; Säll Christer; Bremell Daniel; Hagberg Lars

2011-01-01

Abstract Introduction Lyme neuroborreliosis is the most common bacterial central nervous system infection in the temperate parts of the northern hemisphere. Even though human immunodeficiency virus (HIV) -1 infection is common in Lyme borreliosis endemic areas, only five cases of co-infection have previously been published. Four of these cases presented with typical Lyme neuroborreliosis symptoms such as meningoradiculitis and facial palsy, while a fifth case had more severe symptoms of encep...

[Assessment, delivery and peripartum care in the case of a uterine rupture during labor of a woman with a previous C-section].

Science.gov (United States)

Parrilla-Fernández, Alberto; Manrique-Tejedor, Javier; Figuerol-Calderó, M Inmaculada; García-Romero, Verónica

Uterine rupture is a rare but severe complication in obstetrics. A previous C-section is the most important risk factor. Its incidence during labor in women with a previous C-section is of approximately 0.3-0.47%, being potentially severe. We present the case of a pregnant women with a previous C-section who suffered uterine rupture during labor. The rapid assessment and action of the midwife and obstetric team was essential to obtain a successful obstetric outcome, avoiding maternal and fetal mortality; and nursing care given to the mother and the newborn after birth contributed to achieving a normal postpartum. It is necessary to have specific knowledge about this condition that, despite rare, can present insidiously with a potential risk for the mother and the fetus. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Gemtuzumab ozogamicin-induced sinusoidal obstructive syndrome treated with defibrotide: a case report.

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Lannoy, D; Decaudin, B; Grozieux de Laguérenne, A; Barrier, F; Pignon, J M; Wetterwald, M; Odou, P

2006-08-01

New treatments for relapse of acute myeloid leukaemia (AML), include gemtuzumab ozogamicin (GO), an anti-CD33 monoclonal antibody. We describe a second case of GO-induced sinusoidal obstructive syndrome (SOS) effectively treated with defibrotide (DF). No stem-cell transplantation was involved. On day 23 after the first GO dose, a patient presented with ascites, weight gain, liver enlargement and pain in the right upper quadrant. Sudden hepatic cytolysis (transaminases at six times the normal range: grade 3) and cholestasis [alkaline phosphatase ALP and gamma-glutamyltransferase (GGT) respectively at four and eight times the normal range: grade 2] were observed but there was no evidence of increase serum bilirubin. Treatment with DF (Prociclide), Crinos; 10 mg/kg/day, or 200 mg, q.i.d.) improved the hepatic abnormality within a few days (serum transaminases decreased from 312 to 103 IU/L for aspartate aminotransferase (AST) and from 141 to 80 IU/L for alanine aminotransferase (ALT) within 3 days ALP increased from 253 to 383 IU/L and gamma-GT from 238 to 417 IU/L 4 days after administration of DF. The clinical and biological features of our case suggest a direct involvement of GO in causing SOS, even when used as monotherapy, without allogenic stem-cell transplantation. Low dose DF (10 mg/kg/day) given early during the development of SOS associated with GO was effective. Unfortunately, in our case the patient eventually died of multi-organ failure probably because of failure of GO.

Factors predicting recurrence in successfully treated cases of anisometropic amblyopia

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Rohit Saxena

2013-01-01

Full Text Available Context: Recurrence after successful treatment of amblyopia is known and understanding the risk factors could help effective management. Aim: To measure incidence of recurrence in successfully treated cases of anisometropic amblyopia and evaluate factors predicting it. Settings and Design: Cohort Study at a tertiary level institution. Materials and Methods: Successfully treated anisometropic amblyopes aged 4−12 years were followed up for 1 year after stopping therapy. Best corrected visual acuity (BCVA, refractive error, stereoacuity and contrast sensitivity were evaluated at baseline and follow-up. Statistical Analysis: Intergroup analysis with appropriate tests: Chi-square test, Fisher′s exact test, Wilcoxon rank sum test and paired t-test. Results: One hundred and two patients with mean age at diagnosis 7.06 μ 1.81 years were followed-up for a mean duration of 1.0 μ 0.2 years. The mean pre-treatment BCVA (LogMAR score at diagnosis was 0.73 μ 0.36 units which improved to 0.20 μ 0.00 with treatment and after 1 year of stopping treatment was 0.22 μ 0.07. Thirteen (12.74% patients showed amblyopia recurrence during follow-up. Risk of recurrence was higher with older age of onset of treatment (6.64 μ 1.77 years without recurrence v/s 8.53 μ 1.39 years with recurrence, P = 0.0014. Greater extent of improvement of VA (P = 0.048 and final VA at stopping occlusion (P = 0.03 were associated with higher recurrence. Binocularity status or stereoacuity changes were not associated with risk of recurrence. Conclusions: Significant numbers of children suffer recurrence of amblyopia after stopping therapy. Older age, better BCVA after stopping therapy and greater magnitude of improvement in BCVA are important risk factors for recurrence. Careful follow-up is essential for early detection and management of recurrence.

Factors predicting recurrence in successfully treated cases of anisometropic amblyopia

Science.gov (United States)

Saxena, Rohit; Puranik, Shraddha; Singh, Digvijay; Menon, Vimla; Sharma, Pradeep; Phuljhele, Swati

2013-01-01

Context: Recurrence after successful treatment of amblyopia is known and understanding the risk factors could help effective management. Aim: To measure incidence of recurrence in successfully treated cases of anisometropic amblyopia and evaluate factors predicting it. Settings and Design: Cohort Study at a tertiary level institution. Materials and Methods: Successfully treated anisometropic amblyopes aged 4−12 years were followed up for 1 year after stopping therapy. Best corrected visual acuity (BCVA), refractive error, stereoacuity and contrast sensitivity were evaluated at baseline and follow-up. Statistical Analysis: Intergroup analysis with appropriate tests: Chi-square test, Fisher's exact test, Wilcoxon rank sum test and paired t-test. Results: One hundred and two patients with mean age at diagnosis 7.06 ± 1.81 years were followed-up for a mean duration of 1.0 ± 0.2 years. The mean pre-treatment BCVA (LogMAR score) at diagnosis was 0.73 ± 0.36 units which improved to 0.20 ± 0.00 with treatment and after 1 year of stopping treatment was 0.22 ± 0.07. Thirteen (12.74%) patients showed amblyopia recurrence during follow-up. Risk of recurrence was higher with older age of onset of treatment (6.64 ± 1.77 years without recurrence v/s 8.53 ± 1.39 years with recurrence, P = 0.0014). Greater extent of improvement of VA (P = 0.048) and final VA at stopping occlusion (P = 0.03) were associated with higher recurrence. Binocularity status or stereoacuity changes were not associated with risk of recurrence. Conclusions: Significant numbers of children suffer recurrence of amblyopia after stopping therapy. Older age, better BCVA after stopping therapy and greater magnitude of improvement in BCVA are important risk factors for recurrence. Careful follow-up is essential for early detection and management of recurrence. PMID:24343594

Factors predicting recurrence in successfully treated cases of anisometropic amblyopia.

Science.gov (United States)

Saxena, Rohit; Puranik, Shraddha; Singh, Digvijay; Menon, Vimla; Sharma, Pradeep; Phuljhele, Swati

2013-11-01

Recurrence after successful treatment of amblyopia is known and understanding the risk factors could help effective management. To measure incidence of recurrence in successfully treated cases of anisometropic amblyopia and evaluate factors predicting it. Cohort Study at a tertiary level institution. Successfully treated anisometropic amblyopes aged 4-12 years were followed up for 1 year after stopping therapy. Best corrected visual acuity (BCVA), refractive error, stereoacuity and contrast sensitivity were evaluated at baseline and follow-up. Intergroup analysis with appropriate tests: Chi-square test, Fisher's exact test, Wilcoxon rank sum test and paired t-test. One hundred and two patients with mean age at diagnosis 7.06 μ 1.81 years were followed-up for a mean duration of 1.0 μ 0.2 years. The mean pre-treatment BCVA (LogMAR score) at diagnosis was 0.73 μ 0.36 units which improved to 0.20 μ 0.00 with treatment and after 1 year of stopping treatment was 0.22 μ 0.07. Thirteen (12.74%) patients showed amblyopia recurrence during follow-up. Risk of recurrence was higher with older age of onset of treatment (6.64 μ 1.77 years without recurrence v/s 8.53 μ 1.39 years with recurrence, P = 0.0014). Greater extent of improvement of VA (P = 0.048) and final VA at stopping occlusion (P = 0.03) were associated with higher recurrence. Binocularity status or stereoacuity changes were not associated with risk of recurrence. Significant numbers of children suffer recurrence of amblyopia after stopping therapy. Older age, better BCVA after stopping therapy and greater magnitude of improvement in BCVA are important risk factors for recurrence. Careful follow-up is essential for early detection and management of recurrence.

Diagnosis of sinusoidal obstruction syndrome by positron emission tomography/computed tomography: report of two cases treated by defibrotide.

Science.gov (United States)

Gauthé, Mathieu; Bozec, Laurence; Bedossa, Pierre

2014-11-01

Sinusoidal obstruction syndrome (SOS) is a potentially fatal liver injury that mainly occurs after myeloablative chemotherapy. We report two cases of SOS investigated by 18F-fluorodeoxyglucose positron emission tomography/computed tomography and treated with defibrotide. © 2014 by the American Association for the Study of Liver Diseases.

Acute calcific tendinopathy of the popliteus tendon: a rare case diagnosed using a multimodality imaging approach and treated conservatively

Energy Technology Data Exchange (ETDEWEB)

Doucet, Cedric; Gotra, Akshat; Reddy, Santhosh Mauvva Venkatesh; Boily, Mathieu [McGill University, Royal Victoria Hospital, Department of Radiology, Montreal, QC (Canada)

2017-07-15

Acute calcific tendinopathy of the popliteus tendon is a rare medical entity associated with significant patient discomfort. We present the case of a previously healthy 48-year-old female who presented to the emergency department with acute onset of left knee pain. Initial radiographs revealed calcifications within the posterolateral compartment of the knee. Ultrasound imaging demonstrated a swollen and hypoechoic popliteus tendon with an increased color Doppler signal at the periphery of the tendon as well as calcification in the tendon and adjacent soft tissues. Subsequently performed MRI revealed a thickened and heterogeneous popliteus tendon near its femoral attachment with marked edematous changes surrounding the tendon. Local ultrasound-guided glucocorticoid injection had successful clinical results with no recurrence at 8-month follow-up. In this case report we review the literature for similar previously reported cases. This case report of popliteus tendon calcific tendinopathy provides comprehensive multimodality imaging findings and a description of its non-surgical management. (orig.)

Application of a CCA-treated wood waste decontamination process to other copper-based preservative-treated wood after disposal

Energy Technology Data Exchange (ETDEWEB)

Janin, Amelie, E-mail: amelie.janin@ete.inrs.ca [University of Toronto, Faculty of Forestry, 33, Willcocks St., Toronto, ON, M5S 3B3 (Canada); Coudert, Lucie, E-mail: lucie.coudert@ete.inrs.ca [Institut national de la recherche scientifique (Centre Eau, Terre et Environnement), Universite du Quebec, 490 rue de la Couronne, Quebec, QC, G1K 9A9 (Canada); Riche, Pauline, E-mail: pauline.riche@ete.inrs.ca [Institut national de la recherche scientifique (Centre Eau, Terre et Environnement), Universite du Quebec, 490 rue de la Couronne, Quebec, QC, G1K 9A9 (Canada); Mercier, Guy, E-mail: guy_mercier@ete.inrs.ca [Institut national de la recherche scientifique (Centre Eau, Terre et Environnement), Universite du Quebec, 490 rue de la Couronne, Quebec, QC, G1K 9A9 (Canada); Cooper, Paul, E-mail: p.cooper@utoronto.ca [University of Toronto, Faculty of Forestry, 33, Willcocks St., Toronto, ON, M5S 3B3 (Canada); Blais, Jean-Francois, E-mail: blaisjf@ete.inrs.ca [Institut national de la recherche scientifique (Centre Eau, Terre et Environnement), Universite du Quebec, 490 rue de la Couronne, Quebec, QC, G1K 9A9 (Canada)

2011-02-28

Research highlights: {yields} This paper describes a process for the metal removal from treated (CA-, ACQ- or MCQ-) wood wastes. {yields} This sulfuric acid leaching process is simple and economic. {yields} The remediated wood could be recycled in the industry. - Abstract: Chromated copper arsenate (CCA)-treated wood was widely used until 2004 for residential and industrial applications. Since 2004, CCA was replaced by alternative copper preservatives such as alkaline copper quaternary (ACQ), copper azole (CA) and micronized copper quaternary (MCQ), for residential applications due to health concerns. Treated wood waste disposal is becoming an issue. Previous studies identified a chemical process for decontaminating CCA-treated wood waste based on sulfuric acid leaching. The potential application of this process to wood treated with the copper-based preservatives (alkaline copper quaternary (ACQ), copper azole (CA) and micronized copper quaternary (MCQ)) is investigated here. Three consecutive leaching steps with 0.1 M sulfuric acid at 75 deg, C for 2 h were successful for all the types of treated wood and achieved more than 98% copper solubilisation. The different acidic leachates produced were successively treated by coagulation using ferric chloride and precipitation (pH = 7) using sodium hydroxide. Between 94 and 99% of copper in leachates could be recovered by electrodeposition after 90 min using 2 A electrical current. Thus, the process previously developed for CCA-treated wood waste decontamination could be efficiently applied for CA-, ACQ- or MCQ-treated wood.

Autopsy findings in 40 cases of esophageal cancer treated with radiation therapy

International Nuclear Information System (INIS)

Yamakawa, Michitaka; Shiojima, Kazumi; Hasegawa, Masatoshi

1995-01-01

We analyzed local control, lymph node metastases and distant metastases for autopsy cases of esophageal cancer treated with radiation therapy alone. Thirty-eight patients had squamous cell carcinoma, one had adenosquamous carcinoma and one had undifferentiated carcinoma. Sixteen patients received a total dose less than 60 Gy and 24 received 60 Gy or more. The 1-year, 3-year, 5-year overall survival rates by Kaplan-Meier method were 45.8%, 16.7%, 8.3%, respectively. Four patients (10%) were free of tumors, and another six (15%) had no primary tumor but metastases. Thirty patients had persistent or recurrent primary tumors. Local tumor control rates were 25% for all patients and 34% for patients who survived more than 3 months and 33% for patients irradiated with 60 Gy or more. Tumor type, tumor length and survival times were significantly related with tumor control rates. Perforations into neighboring organs were observed in eighteen patients (45%); 12 were perforated into respiratory systems, 4 into vascular systems, 1 into the mediastinum and 1 into the pleural cavity. Thirty-two patients (80%) had lymph node metastases. Twenty-seven patients (68%) had distant metastases; 20 in the lung, 19 in the liver, 10 in the stomach, 8 in the pancreas and the adrenal gland, 7 in the pleura, 6 in the bone and the heart and the diaphragm. Concurrent double cancer was observed at autopsy in six patients; 2 early gastric cancers, 2 latent hepatomas, 1 lung cancer, 1 latent thyroid cancer. Three patients had a history of resection of other cancer before radiation therapy to esophageal cancer; 2 had gastric cancer and 1 had submandibular cancer. One patient who had another esophageal cancer apart from the first esophageal cancer received radiation therapy 12 years ago. In conclusion, the local control rate was 33% for autopsy cases of esophageal cancer treated with radiation therapy of 60 Gy or more. (J.P.N.)

Garenoxacin in difficult to treat lung abscess – A case study report

Directory of Open Access Journals (Sweden)

Ghosh CK, Hajare A, Krishnaprasad K, Bhargava A

2014-07-01

Full Text Available Lung abscess results from microbial infection causing necrosis of the lung parenchyma leading to one or more cavities. Lung abscesses usually occur in individuals who have a predisposition to aspiration, immunocompromised individuals, patients with long standing illnesses like malignancies, diabetes, chronic lung diseases. Both gram positive and gram negative pathogens are involved in the pathogenesis. Rising incidence of resistant pathogens has added to the burden of treating physicians. Garenoxacin a newer desfluoroquinolone with its broad spectrum of coverage appears to be a suitable fluoroquinolone for the treatment of respiratory tract infections. The case study mentioned below is of pulmonary emphysema with the existing lung cyst going in for secondary infection. The study looks to explain the utility of fluoroquinolones in the treatment of such infections.

An Eustachian Tube Neuroendocrine Carcinoma: A Previously Undescribed Entity and Review of the Literature

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Gavin J. le Nobel

2016-01-01

Full Text Available Primary sinonasal and middle ear neuroendocrine carcinomas are rare malignancies of the head and neck. Owing to the rarity of these tumors, the clinical behavior and optimal management of these tumors are not well defined. We present a case of an incidentally discovered sinonasal neuroendocrine carcinoma that was found to originate from the Eustachian tube, which has not previously been described in the literature. This patient was treated with primary surgical resection using a combination of transnasal and transaural approaches and achieved an incomplete resection. Follow-up imaging demonstrated continued tumor growth in the Eustachian tube as well as a new growth in the ipsilateral cerebellopontine angle and findings suspicious of perineural invasion. However, the tumor exhibited a benign growth pattern and despite continued growth the patient did not receive additional treatment and he remains asymptomatic 35 months following his original surgery.

Hepatitis B Virus Reactivation after Partial Hepatic Irradiation Alone: A Case Report

Energy Technology Data Exchange (ETDEWEB)

Kim, Bo Kyung [Dankook University College of Medicine, Cheonan (Korea, Republic of)

2010-11-15

Reactivation of the hepatitis B virus (HBV) is a well-recognized complication in patients with chronic HBV infection who receive cytotoxic or other immunosuppressive therapy. In cases of patients treated by radiotherapy however, only a few of such reports exist and most of these include the patients previously treated by chemotherapy or transarterial chemoembolization. The results of this study point to a case of a patient with reactivation of HBV after radiotherapy alone. This study shows the possibility of HBV reactivation by partial hepatic irradiation alone hence, special attention should be paid to patients with HBV disease.

Hepatitis B Virus Reactivation after Partial Hepatic Irradiation Alone: A Case Report

International Nuclear Information System (INIS)

Kim, Bo Kyung

2010-01-01

Reactivation of the hepatitis B virus (HBV) is a well-recognized complication in patients with chronic HBV infection who receive cytotoxic or other immunosuppressive therapy. In cases of patients treated by radiotherapy however, only a few of such reports exist and most of these include the patients previously treated by chemotherapy or transarterial chemoembolization. The results of this study point to a case of a patient with reactivation of HBV after radiotherapy alone. This study shows the possibility of HBV reactivation by partial hepatic irradiation alone hence, special attention should be paid to patients with HBV disease.

Systemic mast cell disease (SMCD) and bone pain. A case treated with radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Hesselmann, S.; Micke, O.; Schaefer, U.; Willich, N. [University Hospital Muenster (Germany). Dept. of Radiotherapy and Radiooncology

2002-05-01

Background: Systemic mast cell disease (SMCD) is a rare disease characterized by a multitopic proliferation of cytologically and/or functionally abnormal tissue mast cells. SMCD preferentially involves the skin, spleen, liver, lymph nodes and the bone marrow. The cause of SMCD is unknown. Bony pain, caused by mast cell infiltration of the marrow cavity, is present in up to 28% of cases and is frequently chronic and difficult to palliate with medical therapy. Case Report: We report one case of refractory bone pain in a 54-year-old female Caucasian patient with advanced SMCD and associated bony involvement, which was treated with radiotherapy for pain palliation. Between 1995 and 1998, the patient was irradiated at four different locations: 1) right shoulder and proximal right humerus, 2) both hands, 3) both knees, 4) left humerus with a total dose of 40 Gy in 2.0 or 2.5 Gy daily fractions. Results: Different results of pain palliation were achieved. In one location the pain was reduced for 55 months until her death due to disease progression, whereas in two other locations a pain control was maintained for 3 and 6 months after radiotherapy. In one location, no pain reduction was achieved. Severe side effects were not observed. Conclusion: Palliative radiotherapy has a role in the control of severe intractable bone pain in patients with advanced SMCD, though in some cases the effect may be short or incomplete. The observed palliation of pain can even differ in the same patient. (orig.)

Systemic mast cell disease (SMCD) and bone pain. A case treated with radiotherapy

International Nuclear Information System (INIS)

Hesselmann, S.; Micke, O.; Schaefer, U.; Willich, N.

2002-01-01

Background: Systemic mast cell disease (SMCD) is a rare disease characterized by a multitopic proliferation of cytologically and/or functionally abnormal tissue mast cells. SMCD preferentially involves the skin, spleen, liver, lymph nodes and the bone marrow. The cause of SMCD is unknown. Bony pain, caused by mast cell infiltration of the marrow cavity, is present in up to 28% of cases and is frequently chronic and difficult to palliate with medical therapy. Case Report: We report one case of refractory bone pain in a 54-year-old female Caucasian patient with advanced SMCD and associated bony involvement, which was treated with radiotherapy for pain palliation. Between 1995 and 1998, the patient was irradiated at four different locations: 1) right shoulder and proximal right humerus, 2) both hands, 3) both knees, 4) left humerus with a total dose of 40 Gy in 2.0 or 2.5 Gy daily fractions. Results: Different results of pain palliation were achieved. In one location the pain was reduced for 55 months until her death due to disease progression, whereas in two other locations a pain control was maintained for 3 and 6 months after radiotherapy. In one location, no pain reduction was achieved. Severe side effects were not observed. Conclusion: Palliative radiotherapy has a role in the control of severe intractable bone pain in patients with advanced SMCD, though in some cases the effect may be short or incomplete. The observed palliation of pain can even differ in the same patient. (orig.)

Histoplasmosis treated with a sulphonamide. A case report.

Science.gov (United States)

Mackenjee, M K; Coovadia, H M

1976-11-20

Disseminated histoplasmosis involving the reticuloendothelial system in a Black boy, successfully treated with a sulphonamide, is reported. The importance of this rare disease in South Africa is discussed.

Extranodal Rosai-Dorfman disease with bilateral orbital involvement: Report of a case treated with systemic steroid alone

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Safiye Yilmaz

2008-06-01

Full Text Available Safiye Yilmaz1, Melih Ture1, Ahmet Maden1, Mine Tunakan21Department of Ophthalmology, 2Department of Pathology, Izmir Atatürk Training and Research Hospital, Izmir, TurkeyAbstract: We report the case of a 41-year-old female with bilateral orbital Rosai-Dorfman disease (RDD and the result of corticosteroid therapy. The patient developed a swollen mass of bilateral upper and lower eye-lid over a six-month period. Diagnosis was based on the characteristic histopathologic features. She was treated with oral corticosteroids 60 mg/per day for ten days and the dose of corticostreoid was tapered every week. She is currently being treated with 10 mg/per day for 4 months. In general, the prognosis is good, with experiencing remission following a course of oral corticosteroids. There is no evidence that corticosteroids are beneficial in the treatment of RDD in the literature, but data regarding such treatment are sparse. A more formalized surveillance of these cases would help to define more clearly the natural history of the disease and the effects of various treatment modalities.Keywords: Rosai-Dorfman Disease, orbital involvement, treatment, corticosteroid

Clinical observation on 96 cases of primary osteoporosis treated with kidney-tonifying and bone-strengthening mixture.

Science.gov (United States)

Mingyue, Wang; Ling, Gong; Bei, Xia; Junqing, Cao; Peiqing, Zhou; Jie, Hu

2005-06-01

To objectively evaluate the therapeutic effect and safety of Mixture for Nourishing Kidney and Strengthening Bone. Among 160 cases of osteoporosis under clinical observation, 96 patients in the treatment group were treated with Mixture for Nourishing Kidney and Strengthening Bone, 32 patients in the control group were given Shen Gu Capsule and 32 patients in the blank group were given no drug in half a year. Observation and determination were conducted on bone mineral density (BMD), clinical symptoms, bone gla protein (BGP), pyridinoline (PYD), estradiol (E2), testosterone (T), blood urea nitrogen (BUN), transaminase and routine test on blood and urine. The comprehensive effect in the treatment group was remarkably superior to that in the control group. The safe and reliable Chinese drug can enhance BMD, promote osteogenesis and inhibit bone absorption, hence treating osteoporosis with marked effect.

Relapsing polychondritis associated with psoriasis vulgaris successfully treated with adalimumab: A case report with published work review.

Science.gov (United States)

Matsuo, Haruka; Asahina, Akihiko; Fukuda, Takeshi; Umezawa, Yoshinori; Nakagawa, Hidemi

2017-07-01

Relapsing polychondritis (RP) is a rare autoimmune-mediated disease characterized by inflammation involving cartilaginous tissues. We report here a case of RP in a 38-year-old Japanese man with 13-year duration of psoriasis vulgaris treated with topical steroids and vitamin D 3 . The patient presented with tender swelling and erythema of both auricles, and the antibody to type II collagen was detected. The biopsy specimen revealed a dense mixed cell infiltration over the auricular cartilage. We reviewed eight cases with the association of RP and psoriasis, and in all cases the clinical course of psoriasis did not correlate with that of RP. The severity of RP was mild in the majority of cases, and our case was unique in that the patient had no joint symptoms. Adalimumab treatment was effective for both RP and psoriasis. Fat-suppressed contrast-enhanced magnetic resonance imaging was beneficial, not only to demonstrate subclinical inflammation in the nasal septum, but also to subjectively assess the improvement of RP. © 2017 Japanese Dermatological Association.

External bioresorbable airway rigidification to treat refractory localized tracheomalacia.

Science.gov (United States)

Gorostidi, François; Reinhard, Antoine; Monnier, Philippe; Sandu, Kishore

2016-11-01

Our study evaluates the efficacy of extraluminal bioresorbable plates to treat refractory localized airway malacia in patients undergoing corrective surgery for complex multilevel laryngotracheal stenosis. Retrospective case series. Secondary malacic airway segments were characterized (severity, site, type) by a dynamic transnasal flexible laryngotracheobronchoscopy before surgery. Extraluminal bioresorbable plates were used to stabilize the malacic segment through a transcervical approach under intraoperative flexible endoscopic guidance. Results were evaluated subjectively and by a postoperative dynamic endoscopy. We report our experience in seven patients (6 children, 1 adult). External tracheal stiffening allowed complete or partial resolution of refractory proximal airway malacia in six of seven complex cases described (result in one case is awaited). It allowed quick decannulation in four of seven patients who experienced multiple previous failures. Decannulation failures were due to recurrence of stenosis. With up to 2 years of follow-up, we report no direct complications related to the presence of extraluminal bioresorbable plates around the airway. Extraluminal biodegradable tracheal stiffening represents a valid therapeutic option in select cases of upper airway malacia. It can be highly useful in cases of complex multilevel airway obstructions. External stiffening needs to be planned on a case-to-case basis according to the type of malacia and must be performed under endoscopic guidance. 4. Laryngoscope, 126:2605-2610, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Clinical impact of laboratory error on therapeutic drug monitoring of once-daily tobramycin in cystic fibrosis: Case series

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William A Prescott

2014-01-01

Full Text Available Once-daily dosing intravenous tobramycin is commonly used to treat cystic fibrosis pulmonary exacerbations. Clinicians often utilize historical therapeutic drug monitoring data to individualize the dose among patients who have been treated with tobramycin previously. This case series involves three patients with cystic fibrosis who had supra-therapeutic tobramycin levels despite use of a once-daily dosing that produced therapeutic drug levels during a previous hospital admission, raising questions about the validity of these levels. Investigation into several potential sources of error led to the discovery of an analyzer error in the laboratory. Once the laboratory’s tobramycin analyzer was recalibrated, the reported levels were comparable to historical levels. This case series emphasizes the clinical importance of critically analyzing reported levels, and specifically, the importance of utilizing past therapeutic drug monitoring data, if available, for all patients treated with intravenous tobramycin. If a patient was therapeutic on a similar dose of tobramycin during a previous admission, a dose adjustment may not be necessary, and clinicians should consider repeating levels while pursuing alternative explanations for the discrepant serum levels.

Phase II activity of belinostat (PXD-101), carboplatin, and paclitaxel in women with previously treated ovarian cancer

DEFF Research Database (Denmark)

Dizon, Don S; Damstrup, Lars; Finkler, Neil J

2012-01-01

specifically for women with recurrent epithelial ovarian cancer (EOC). METHODS: Thirty-five women were treated on the phase 2 expansion cohort. BelCap was given as follows: belinostat, 1000 mg/m² daily for 5 days with carboplatin, AUC 5; and paclitaxel, 175 mg/m² given on day 3 of a 21-day cycle. The primary...

Mycobacterium tuberculosis drug-resistance in previously treated ...

African Journals Online (AJOL)

Corresponding to: Professor Lassana Sangaré, Department of Bacteriology and Virology, University Hospital Centre. Yalgado Ouedraogo, 03 BP 7022 Ouagadougou 03, Burkina Faso. E-mail: sangarel@hotmail.com. Abstract. Background: Tuberculosis drug-resistance becomes common in sub-Saharan Africa; however, ...

Telaprevir for previously treated chronic HCV infection

NARCIS (Netherlands)

McHutchison, John G.; Manns, Michael P.; Muir, Andrew J.; Terrault, Norah A.; Jacobson, Ira M.; Afdhal, Nezam H.; Heathcote, E. Jenny; Zeuzem, Stefan; Reesink, Hendrik W.; Garg, Jyotsna; Bsharat, Mohammad; George, Shelley; Kauffman, Robert S.; Adda, Nathalie; Di Bisceglie, Adrian M.; Heathcote, E. J.; Kaita, K.; Ma, M.; Myers, R.; Sherman, M.; Yoshida, E.; Berg, T.; Manns, M. P.; Zeuzem, S.; de Knegt, R.; van Hoek, B.; Afdhal, N. H.; Arora, S.; Bernstein, D.; Cochran, J.; Di Bisceglie, A. M.; Dickson, R.; Dieterich, D. T.; Etzkorn, K.; Everson, G. T.; Faruqui, S.; Ghalib, R.; Gitlin, N.; Godofsky, E.; Gordon, S.; Hassanein, T.; Jacobson, I. M.; Kilby, A.; Kugelmas, M.; Kwo, P. Y.; Lawitz, E. S.; Lindsay, K.; Maillard, M.; Nelson, D. R.; Nyberg, L.

2010-01-01

Patients with genotype 1 hepatitis C virus (HCV) who do not have a sustained response to therapy with peginterferon alfa and ribavirin have a low likelihood of success with retreatment. We randomly assigned patients with HCV genotype 1 who had not had a sustained virologic response after

The etiology and symptoms of endodontic cases treated in a university clinic in Saudi Arabia

International Nuclear Information System (INIS)

AlYahya, A. S.; Selirn, H. A.; Guile, E. E.

1989-01-01

Endodontic patients treated at a University Dental Clinic over a two year period were studied. A total of 281 patients seen in a beginning endodontic course were analyzed to determine (1) the etiology of the pulpal disease presenting and (2) the signs and symptoms of pulpal disease. Results indicated that caries was the most prevalent reason for endodontic treatment. Most cases (40.6%) were asymptomatic. Lower molars were the most commonly affected and there was no significant difference in endodontic treatment distribution between males and females in the patient population studied. (author)

Subcutaneous metastasis from endometrial cancer; case report and literature review

OpenAIRE

Nicolae Bacalbasa; Irina Balescu; Alexandru Filipescu

2018-01-01

Subcutaneous metastases from endometrial cancer are rare situations, only few cases being described so far. The main incriminated mechanisms leading to the apparition of such lesions include hematogenous and lymphatic spread. We present the case of a 66-year-old patient known with previous history of stage IIIA endometroid endometrial carcinoma initially treated by surgery and adjuvant chemotherapy who developed at 18 months follow-up a distant subcutaneous oligometastasis. At this time the p...

[Domestic and family violence against women: a case-control study with victims treated in emergency rooms].

Science.gov (United States)

Garcia, Leila Posenato; Duarte, Elisabeth Carmen; Freitas, Lúcia Rolim Santana de; Silva, Gabriela Drummond Marques da

2016-01-01

This study aimed to identify factors associated with treatment of victims of domestic and family violence in emergency rooms in Brazil. This is a case-control study based on the Surveillance System for Violence and Accidents (VIVA), 2011. Women ≥ 18 years who were victims of family and domestic violence were selected as cases and compared to accident victims (controls). Adjusted odds ratios were estimated by unconditional logistic regression. 623 cases and 10,120 controls were included. Risk factors according to the adjusted analysis were younger age (18-29 years), low schooling, lack of paid work, alcohol consumption, having sought treatment in a different health service, and violence on weekends or at night or in the early morning hours. The study concludes that domestic and family violence shows alcohol consumption as a strongly associated factor. Days and hours with the highest ocurrence reveal the need to adjust emergency services to treat victims.

Patterns of presentation of chronic ischemic heart disease with and without previous myocardial infarction

International Nuclear Information System (INIS)

Ahmad, R.; Rabbani, A.; Awan, Z.A.

2009-01-01

The prevalence of Ischemic Heart Disease (IHD) is on the rise, from increasing lifespan of population and availability of better medical facilities. We studied chronic IHD cases with and without previous myocardial infarction, in Hazara, NWFP, Pakistan to evaluate left ventricular (LV) dysfunction, wall motion abnormalities and complications of IHD. All patients presenting with history of chest pain in Medical 'C' Unit, Ayub Teaching Hospital, Abbottabad from June 2004 to May 2005 were included in the study. Patients with non-cardiac chest pain were excluded from the study. Cases with congenital and rheumatic heart disease, cardiomyopathies, unstable angina and acute MI were excluded. Patients with IHD with or without myocardial infarction (MI) were studied for left ventricular dysfunction (ejection fraction, left atrial size, E/A ratio), wall motion abnormalities and complications of IHD (Mitral regurgitation, Ventricular Septal Defect (VSD), LV aneurysm, LV clot). Clinical and echocardiographic evaluation was done in each case. Out of 183 cases of chronic IHD, 123 patients were without previous MI and 60 had had previous MI. Ejection fraction (EF) was 45%+-15 in the group without MI and 35+-11% in cases with MI. Left Atrium (LA) size was 35+-6 mm and 39+-4 mm in the two groups respectively. LV diastolic dysfunction was seen in 17% in the first and 24% in the second group respectively. Global hypokinesia was seen in 8% and 17% in the 2 groups respectively. Regional Wall Motion Abnormality (RWMA) was observed in 12% in patients without MI and in 58% cases with MI. Mitral regurgitation was seen in 10 and 20% in the 2 groups respectively LV clots, VSD, LV and aneurysm were seen in 8.4, 5, and 6.5% respectively, only in cases with previous MI. LV dysfunction, wall motion abnormalities and mitral regurgitation were more common in IHD cases with previous heart attack. (author)

Laser iridotomy to treat uveitis-glaucoma-hyphema syndrome secondary to reverse pupillary block in sulcus-placed intraocular lenses: Case series.

Science.gov (United States)

Singh, Harmanjit; Modabber, Milad; Safran, Steven G; Ahmed, Iqbal Ike K

2015-10-01

To present cases of uveitis-glaucoma-hyphema (UGH) syndrome due to reverse pupillary block in sulcus-placed posterior chamber intraocular lenses (PC IOLs) that were managed with laser peripheral iridotomy (LPI). Community-based subspecialty clinics. Retrospective interventional case series. A chart review of patients with a sulcus-placed PC IOLs presenting with UGH syndrome and reverse pupillary block with posterior iris bowing as diagnosed by gonioscopy and anterior segment optical coherence tomography was carried out. Laser peripheral iridotomy was performed in the eyes included in the study. The main outcome measure was clinical resolution of UGH syndrome. The study included 6 eyes of 6 patients with a mean age of 59.8 years (range 43.0 to 66.0 years) who presented with unilateral UGH syndrome a mean of 28.7 months (range 0.3 to 84.0 months) after PC IOL implantation. All patients were previously myopic, with 5 (83.3%) having a history of vitrectomy. The mean axial length was 27.0 mm ± 1.4 (SD). An LPI was used to treat the reverse pupillary block with resultant improvement in iris profile and resolution of UGH syndrome in all eyes. The mean intraocular pressure decreased from 30.5 ± 10.0 mm Hg on 0.5 ± 0.8 glaucoma medications to 15.5 ± 3.2 mm Hg postoperatively on 0.7 ± 1.2 medications. The UGH syndrome due to reverse pupillary block occurred after sulcus-placed PC IOLs in susceptible patients, those with axial myopia, and post-vitrectomized eyes. The cases were managed with LPIs. Dr. Ahmed is a consultant to Alcon Laboratories, Inc. and Abbott Medical Optics, Inc. 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.

[Epidemiological study of acute poisoning cases treated at a Galician hospital between 2005 and 2008].

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de Miguel-Bouzas, José Carlos; Castro-Tubío, Eva; Bermejo-Barrera, Ana María; Fernández-Gómez, Purificación; Estévez-Núñez, Juan Carlos; Tabernero-Duque, María Jesús

2012-01-01

A descriptive retrospective study of acute intoxication cases registered at the Complexo Hospitalario de Pontevedra (CHOP) between January 2005 and December 2008 was performed to find out the number and types of poisoning cases treated, their distribution according to patient's sex and age, chronology, type of toxic agents involved, intentionality, history, symptoms, clinical development, treatment and toxicological analysis used for diagnosis. Data were recorded using Clinica and IANUS software and consulting all paper records of patients with symptoms of poisoning. Data from a total of 1893 patients with a mean age of 35.6 ± 17.6 years (66% men) were included. Highest rates of poisoning were recorded on Saturdays and Sundays during the summer months (June, July and August). Drugs of abuse were the most common toxic agents (70.4%), ethyl alcohol accounting for 61% of these cases, which often involved males and with people with high degrees of dependency. In second place was poisoning resulting from the abuse of medical drugs, more commonly associated with females, and involving benzodiazepines in 73.2% of cases. The majority of these intoxications were intentional, and suicide attempts accounted for 18.8%. The problems most commonly resulting from the poisoning were neurological, and mortality rate was just 0.2%.

Comparison of in vitro behavior of as-sprayed, alkaline-treated and collagen-treated bioceramic coatings obtained by high velocity oxy-fuel spray

Energy Technology Data Exchange (ETDEWEB)

Melero, H., E-mail: hortensia.melero.correas@gmail.com [Thermal Spray Centre, Universitat de Barcelona, Martí i Franqués, 1, 08028 Barcelona (Spain); Garcia-Giralt, N. [URFOA, IMIM (Institut Hospital del Mar d’Investigacions Mèdiques), RETICEF, Doctor Aiguader, 80, 08003 Barcelona (Spain); Fernández, J. [Thermal Spray Centre, Universitat de Barcelona, Martí i Franqués, 1, 08028 Barcelona (Spain); Díez-Pérez, A. [URFOA, IMIM (Institut Hospital del Mar d’Investigacions Mèdiques), RETICEF, Doctor Aiguader, 80, 08003 Barcelona (Spain); Servei de Medicina Interna, Hospital del Mar, Barcelona (Spain); Guilemany, J.M. [Thermal Spray Centre, Universitat de Barcelona, Martí i Franqués, 1, 08028 Barcelona (Spain)

2014-07-01

Hydroxyapatite (HAp)–TiO{sub 2} samples obtained using high velocity oxy-fuel spray (HVOF), that had previously shown excellent mechanical behaviour, were innovatively surface treated in order to improve their biological performance. The chosen treatments were an alkaline treatment to increase –OH radicals density on the surface (especially on TiO{sub 2} zones), and a collagen treatment to bond collagen fibrils to the –OH radicals present in hydroxyapatite. These coatings were analysed using scanning electron microscopy, energy-dispersive X-ray spectroscopy and infrared spectroscopy, and tested for human osteoblast biocompatibility and functionality. In the case of the alkaline treatment, although the –OH radicals density did not increase compared to the as-sprayed coatings, a nanostructured layer of sodium hydroxycarbonate precipitated on the surface, thus improving biological behaviour due to the nanoroughness effect. For the collagen-treated samples, collagen fibrils appeared well-adhered to the surface, and in vitro cell culture tests showed that these surfaces were much more conducive to cell adhesion and differentiation than the as-sprayed and alkaline-treated samples. These results pointed to collagen treatment as a very promising method to improve bioactivity of HAp–TiO{sub 2} thermal-sprayed coatings.

Metastatic papillary carcinoma of the thyroid in a patient previously ...

African Journals Online (AJOL)

Incidental papillary carcinoma of the thyroid in patients treated surgically for benign thyroid diseases including Graves' disease is a known phenomenon. However, the management of these patients remains an issue of concern and controversy for those who care for them. We report a case of metastatic paillary carcinoma of ...

A Case of Medication-Resistant Acanthamoeba Keratitis Treated by Corneal Crosslinking in Turkey

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Goktug Demirci

2013-01-01

Full Text Available Purpose. To report a case of medication-resistant acanthamoeba keratitis (AK treated successfully by corneal crosslinking (CXL. Methods. A 26-year-old male with medication-resistant AK underwent a standard CXL procedure with local anesthesia, followed by central corneal epithelial debridement, application of riboflavin 0.1%, and UV-A irradiation. Results. The patient experienced a dramatic symptomatic improvement within 24 hours. At two months, keratitis was healed with a semitransparent paracentral scar that did not affect visual acuity. Conclusions. Our experience, considered in the context of recent studies, suggests that CXL may be an option for selected patients with medication-resistant AK and corneal melting. CXL allows patients to avoid emergency keratoplasty and experience rapid symptomatic relief.

[A retrospective study of 180 cases of apical microsurgery].

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Wang, Hanguo; Li, Dan; Tian, Yu; Yu, Qing

2014-07-01

To evaluate the outcome and the potential prognostic factors of apical microsurgery. The teeth with persistent periapical diseases were treated by microsurgery using micro instruments, ultrasonic retrotips and mineral trioxide aggregate (MTA) under dental operate microscope. The procedure includes incision and flap retraction, osteotomy, apicoectomy, retro- preparation and retro- filling of root canal. Patients were recalled at 1, 3, 6, and 12- month intervals. The outcome was evaluated by clinical and radiographic examinations, and the potential prognostic factors were analyzed. One hundred and eighty cases (240 teeth), including 132 upper anterior teeth, 22 lower anterior teeth, 31 upper premolars, 18 lower premolars, 19 upper molars and 18 lower molars, were treated by microsurgery between July 2010 and December 2012. A total of 152 cases (207 teeth) were recalled. The application of the apical microsurgery included failure of previous endodontic treatment, periapical lesion with post, periapical cyst, calcified canals, separated instruments, overfilling, open apex, root facture, failure of previous apical surgery, apical fenestration, and special root canal system. The success rate was 90.8% (188/207). Age, sex, tooth position, type of periapical radiolucency, fistula and clinical application type appeared to have a negative effect on the outcome. Endo-perio lesion was a significant factor. Eighteen cases (19 teeth) failed mainly because of periodontally involved lesion and vertical root fracture. Apical microsurgery, which combines the magnification and illumination provided by the microscope with the proper use of micro instruments, can treat the teeth with persistent periapical diseases precisely and less traumatically with high success rate. Case selection and standardized operations play a key role for success.

Biomarker-driven trial in metastatic pancreas cancer: feasibility in a multicenter study of saracatinib, an oral Src inhibitor, in previously treated pancreatic cancer

International Nuclear Information System (INIS)

Arcaroli, John; Quackenbush, Kevin; Dasari, Arvind; Powell, Rebecca; McManus, Martine; Tan, Aik-Choon; Foster, Nathan R; Picus, Joel; Wright, John; Nallapareddy, Sujatha; Erlichman, Charles; Hidalgo, Manuel; Messersmith, Wells A

2012-01-01

Src tyrosine kinases are overexpressed in pancreatic cancers, and the oral Src inhibitor saracatinib has shown antitumor activity in preclinical models of pancreas cancer. We performed a CTEP-sponsored Phase II clinical trial of saracatinib in previously treated pancreas cancer patients, with a primary endpoint of 6-month survival. A Simon MinMax two-stage phase II design was used. Saracatinib (175 mg/day) was administered orally continuously in 28-day cycles. In the unselected portion of the study, 18 patients were evaluable. Only two (11%) patients survived for at least 6 months, and three 6-month survivors were required to move to second stage of study as originally designed. The study was amended as a biomarker-driven trial (leucine rich repeat containing protein 19 [LRRC19] > insulin-like growth factor-binding protein 2 [IGFBP2] “top scoring pairs” polymerase chain reaction [PCR] assay, and PIK3CA mutant) based on preclinical data in a human pancreas tumor explant model. In the biomarker study, archival tumor tissue or fresh tumor biopsies were tested. Biomarker-positive patients were eligible for the study. Only one patient was PIK3CA mutant in a 3′ untranslated region (UTR) portion of the gene. This patient was enrolled in the study and failed to meet the 6-month survival endpoint. As the frequency of biomarker-positive patients was very low (<3%), the study was closed. Although we were unable to conclude whether enriching for a subset of second/third line pancreatic cancer patients treated with a Src inhibitor based on a biomarker would improve 6-month survival, we demonstrate that testing pancreatic tumor samples for a biomarker-driven, multicenter study in metastatic pancreas cancer is feasible

Drug-Induced QT Prolongation as a Result of an Escitalopram Overdose in a Patient with Previously Undiagnosed Congenital Long QT Syndrome

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Paul Singh

2014-01-01

Full Text Available We present a case of drug-induced QT prolongation caused by an escitalopram overdose in a patient with previously undiagnosed congenital LQTS. A 15-year-old Caucasian female presented following a suicide attempt via an escitalopram overdose. The patient was found to have a prolonged QT interval with episodes of torsades de pointes. The patient was admitted to the telemetry unit and treated. Despite the resolution of the torsades de pointes, she continued to demonstrate a persistently prolonged QT interval. She was seen by the cardiology service and diagnosed with congenital long QT syndrome. This case illustrates the potential for an escitalopram overdose to cause an acute QT prolongation in a patient with congenital LQTS and suggests the importance of a screening electrocardiogram prior to the initiation of SSRIs, especially in patients at high risk for QT prolongation.

Pushing the boundaries in liver graft utilisation in transplantation: Case report of a donor with previous bile duct injury repair.

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Sultana, Asma; Powell, James J; Oniscu, Gabriel C

2017-01-01

Liver transplantation is a recognised treatment for extensive bile duct injuries with secondary biliary cirrhosis or recurring sepsis. However, there have been no reports of successful liver transplantation from a donor who sustained a previous bile duct injury. Here we discuss the case of a liver transplant from a 51-year-old brain dead donor who had suffered a Strasberg E1 bile duct injury and had undergone a Roux-en-Y hepaticojejunostomy 24 years prior to donation. The liver was successfully recovered and transplanted into a 56-year-old male recipient with end stage liver disease consequent to alpha 1 antitrypsin deficiency. The graft continues to function well 36 months post-transplant, with normal liver function tests and imaging revealing a patent hepaticojejunostomy. The potential associated vascular injuries should be identified during bench preparation whilst the management of biliary reconstruction at the time of transplant should follow the principles of biliary reconstruction in cases with biliary injuries, extending the hilar opening into the left duct. This case highlights the successful utilisation of a post bile duct injury repair liver, employing an experienced procurement team and careful bench assessment and reconstruction. Copyright © 2017. Published by Elsevier Ltd.

Exposure to radiologic contrast media and an increased risk of treated end-stage renal disease.

Science.gov (United States)

Muntner, Paul; Coresh, Josef; Klag, Michael J; Whelton, Paul K; Perneger, Thomas V

2003-12-01

Radiologic contrast media can cause acute renal failure, but whether their repeated use is associated with end-stage renal disease (ESRD) is unknown. We compared 716 incident case subjects of treated ESRD with 361 control subjects, frequency matched on age, drawn from the general population (age, 20-65 years). Participants were interviewed by telephone regarding their previous exposure (before initiation of dialysis for case subjects and the study interview for control subject) to various imaging procedures. As expected, the case subjects reported having more imaging procedures of the kidneys than did control subjects. Excluding persons who had been subjected to examinations of their kidney from the analysis and adjusting for ultrasound examinations and several possible confounders, persons who had a history of one [odds ratio (OR), 2.0; 95% confidence interval (CI), 1.0, 4.0], 2 or 3 (OR, 2.6; 95% CI, 1.2,5.9), or 4 or more (OR, 3.6; 95% CI, 1.0, 12.5) radiocontrast examinations were at higher risk of treated ESRD than persons who reported not having had such procedures. Ultrasound examinations and a history of barium enema were not associated with an increased risk of treated ESRD. In the current study, a graded association was present between increasing exposure to radiologic contrast media and higher risk of treated ESRD. Whether exposure to contrast media accelerates progression to ESRD or is merely a noncausal accompaniment to multiple disease processes occurring concurrently cannot be determined from our observational data. However, if these results are confirmed in future prospective studies, they will have important clinical implications.

Dying after cure: A case of suicide in an adolescent treated for cancer

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Laura Veneroni

2015-01-01

Full Text Available Although suicide among childhood cancer survivors is rare, there is still a significantly higher risk in this population than in healthy adolescents. A 17-year-old girl cured of Burkitt lymphoma committed suicide after completing her treatment. She had never previously shown signs of psychological suffering and was in good general health. This case made the operators wonder how this tragic possibility might be prevented. It is essential for the ongoing monitoring of the psychological and social suffering of young people during follow-up programs to be assured by a multidisciplinary team involved in the patient′s global care.

[Results of a regional survey on the treatment of rhizomelic pseudopolyarthritis and temporal arteritis. Apropos of 242 cases treated by various modalities with synthetic antimalarials, corticoids and non-steroidal anti-inflammatory agents].

Science.gov (United States)

David-Chaussé, J; Dehais, J; Leman, A

1983-01-01

The authors report the results of a retrospective therapeutic survey concerning 176 cases of rhizomelic pseudopolyarthritis (RPP) and 66 cases of temporal arteritis (TA). Of 128 cases of RPP treated initially by synthetic anti-malarials (SAM) and non-steroidal anti-inflammatory agents (NSAI), 66 were followed up until cure which was obtained after a mean of 23 months and 3 subsequently received brief steroid therapy. 45 cases of RPP were treated initially with corticosteroids. They were generally associated with SAM which enabled early weaning of the steroids, towards the 8 th month, or at least reducing the dose. Cure was obtained within 24 months. Three patients were treated by NSAI and gold therapy. After cure, 5 cases of recurrence and 1 case of TA were observed. 40 cases of TA were initially treated with SAM and NSAI. Twenty cures were obtained within a mean of 28 months. 4 patients later received brief corticosteroid therapy because of an extension of the signs, including two cases of ocular manifestations with a resolving course. Of 25 cases of TA initially treated with steroids, 20 received SAM in combination, or in relay which enabled either steroids, weaning towards the 14th month or a reduction in the dose of steroids. Cure was obtained in an average of 35 months. One case of impaired visual acuity occurred during corticosteroid treatment. Immunosuppressants were used in one patient. No cases of recurrence were observed. Iatrogenic complications with SAM were rare, generally benign and reversible, in contrast to those associated with corticosteroid therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Triceps Ruptures After Fluoroquinolone Antibiotics: A Report of 2 Cases.

Science.gov (United States)

Shybut, Theodore B; Puckett, Ernest R

Rupture of the triceps brachii tendon is exceedingly rare, and surgical repair is generally indicated. Fluoroquinolone antibiotics have been implicated in tendon pathology, including tendon ruptures. Triceps rupture has not been previously reported in the setting of fluoroquinolone antibiotic therapy. We present 2 cases of triceps tendon rupture after treatment with fluoroquinolones. In both cases, triceps repair was performed with good outcomes. These cases highlight a risk of fluoroquinolone-induced tendinopathy to athletes. The sports medicine team should be aware of this risk and consider it when choosing antibiotics to treat athletes.

Diode laser to treat small oral vascular malformations: A prospective case series study.

Science.gov (United States)

Bacci, Christian; Sacchetto, Luca; Zanette, Gastone; Sivolella, Stefano

2018-02-01

The current work examined a consecutive series of patients presenting vascular malformations (VMs) and venous lakes (VLs) of the lip and oral mucosa who were treated with transmucosal diode laser applications and assessed over a 1 year period. Fifty-nine patients (31 males and 28 females) presenting low-flow VMs or VLs of the oral cavity were treated transmucosally using a diode laser (with an 830 nm operating wavelength and 1.6 W output power) with a 320 µm diameter flexible fiber. All the lesions were assessed 7 days, 30 days, and 1 year after the laser treatment, and the lesion reduction percentage was scored on a one to five scale. The patients were also asked to assess their pain perception daily during the 7 days following the treatment using a visual analog scale (VAS). There were no procedure-related intra- or post-operative complications; only modest pain intensity was reported. Thirty days after the treatment, lesion reduction was described as excellent or good in 52 cases; it was fair or poor in 7. Six patients (F:M ratio 2:4) required a second diode laser application. At the 1 year follow-up, volume reduction was complete in 48 out of 59 patients; there were five recurrences (F:M ratio 3:2). No relevant gender-related differences were noted. The use of diode laser application to treat small oral VMs and VLs was associated to shorter operating times and fewer postoperative complications with respect to the scapel surgery approach. More than one session may nevertheless be required if the anomaly is larger than 10 mm. Lasers Surg. Med. 50:111-116, 2018. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Two cases of chronic myelogenous leukemia (CML) treated with Iminitab (Glivec) in different phases

International Nuclear Information System (INIS)

Davoli, R.; Ciarlo, S.; Acosta, I.; Perez, S.; Lagorio, S.; Pratti, A.A.

2003-01-01

Full text: IMINITAB, inhibitor of cytoplasmic transduction signs, and hindering neoplastic cells growth, is a new therapeutic agent for chronic myelogenous leukemia (CML). It is a tyrosine kinase bcrabl inhibitor, inhibiting also the c-kit receptor protein in gastrointestinal neoplasia and small cells lung cancer. The aim of the present work was to evaluate the effect of this agent in CML patients in two different time-periods, namely the chronic phase and the acute one. We hereby present two patients: 1) a 48 years old patient with radioactive contamination history, and 2) a 19 years old patient. In both cases diagnosis was confirmed by BM and BM biopsy, neutrophile alkaline phosphatase, and Ph chromosome t(9;22) (q34;q11). There were non-compatible BM donors available. Both patients were treated with hydroxyurea, hydroxyurea plus interferon, and one of them adding ARAC. Since there was no favorable response an Iminitab course was started. Patient (2) with blastic crisis remitted for 12 month until subsequent relapse and death. Patient (1) treated during chronic phase is still in remission. Neither of them attained negative Ph chromosome. Up to now, current reports show a high percentage of relapse in patients treated during the acute phase, while the chronic ones present a smaller number of relapses. It is to be noted the importance of the follow up during the chronic phase, due to the short time drug utilization in our country (May 2001). Good tolerance and sustained remission in CML patients allows being optimistic regarding this therapeutic agent. (author)

Radiation recall dermatitis with soft tissue necrosis following pemetrexed therapy: a case report

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Spirig Christian

2009-11-01

Full Text Available Abstract Introduction Radiation recall dermatitis is a well known but still poorly understood inflammatory reaction. It can develop in previously irradiated areas and has been shown to be triggered by a variety of different drugs, including cytostatic agents. Pemetrexed may cause radiation recall dermatitis in pre-irradiated patients. Case presentation We present the case of a 49-year-old Caucasian woman with non-small cell lung cancer who was initially treated with carboplatin and paclitaxel concomitant with radiotherapy after suffering a painful plexus brachialis infiltration. Due to disease progression, a second-line treatment with pemetrexed was started. A severe soft tissue necrosis developed despite steroid treatment and plastic surgery. Conclusion To the best of our knowledge, we present the first case of a patient with severe soft tissue necrosis in a pre-irradiated area after pemetrexed therapy. We believe that physicians treating patients with pemetrexed should be aware of the severe, possibly life-threatening effects that may be induced by pemetrexed after previous radiation therapy.

Cases of human fascioliasis in India: tip of the iceberg.

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Ramachandran, J; Ajjampur, S S R; Chandramohan, A; Varghese, G M

2012-01-01

This report presents two cases of human fascioliasis from different states in India. Although only few cases of human fascioliasis have been reported from India previously, both these cases were encountered within a span of three months at this tertiary care centre. Case 1 had significant symptoms with episodes of fever, abdominal pain and eosiniphilia and underwent multiple diagnostic procedures before the correct diagnosis was reached. Case 2, who had few symptoms, had fascioliasis diagnosed with minimal evaluation. These different presentations seen at two ends of the clinical spectrum of disease along with findings of peripheral eosinophilia, and radiological findings led to a presumptive diagnosis that was then confirmed by microscopic examination of bile. Morphometric analysis of ova from these cases was suggestive of infestation with F. gigantica or a F. gigantica-like hybrid. Both patients were treated with triclabendazole which was imported from Geneva. The need to be aware of the possibility of occurrence of this disease and the inclusion of drugs used for treating the disease, in the Indian drug list, should be emphasized.

Synovial chondrosarcoma: Report of two cases and literature review

Energy Technology Data Exchange (ETDEWEB)

Zamora, E.E. [Department of Orthopaedic Surgery, Hospital Dr. R.A Calderon Guardia, Universidad De Costa Rica, P.O. Box 628-3000, Heredia (Costa Rica); Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna (Italy); Mansor, A. [Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna (Italy); Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur 59100 (Malaysia); Vanel, D. [Musculoskeletal Oncology Research Center, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna (Italy)], E-mail: dvanel@ior.it; Errani, C.; Mercuri, M. [Musculoskeletal Oncology Department, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna (Italy); Picci, P. [Musculoskeletal Oncology Research Center, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna (Italy); Alberghini, M. [Musculoskeletal Anatomical Pathology Department, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna (Italy)

2009-10-15

Synovial chondrosarcoma is a rare soft tissue tumor that can arise from a previous synovial chondromatosis or as de novo tumor. The clinical and radiological findings of this malignancy are very similar to those of aggressive synovial chondromatosis. Confusion with other joint pathologies makes the diagnosis of synovial chondrosarcoma difficult in most of the cases. We present one recently diagnosed and treated case of synovial chondrosarcoma. The review of our hospital database revealed one more similar case. In both cases the malignancy arose from a pre-existing synovial chondromatosis. We also present a literature review emphasizing the clinical and histological findings of this rare entity.

The SNP rs6500843 in 16p13.3 is associated with survival specifically among chemotherapy-treated breast cancer patients.

Science.gov (United States)

Fagerholm, Rainer; Schmidt, Marjanka K; Khan, Sofia; Rafiq, Sajjad; Tapper, William; Aittomäki, Kristiina; Greco, Dario; Heikkinen, Tuomas; Muranen, Taru A; Fasching, Peter A; Janni, Wolfgang; Weinshilboum, Richard; Loehberg, Christian R; Hopper, John L; Southey, Melissa C; Keeman, Renske; Lindblom, Annika; Margolin, Sara; Mannermaa, Arto; Kataja, Vesa; Chenevix-Trench, Georgia; Lambrechts, Diether; Wildiers, Hans; Chang-Claude, Jenny; Seibold, Petra; Couch, Fergus J; Olson, Janet E; Andrulis, Irene L; Knight, Julia A; García-Closas, Montserrat; Figueroa, Jonine; Hooning, Maartje J; Jager, Agnes; Shah, Mitul; Perkins, Barbara J; Luben, Robert; Hamann, Ute; Kabisch, Maria; Czene, Kamila; Hall, Per; Easton, Douglas F; Pharoah, Paul D P; Liu, Jianjun; Eccles, Diana; Blomqvist, Carl; Nevanlinna, Heli

2015-04-10

We have utilized a two-stage study design to search for SNPs associated with the survival of breast cancer patients treated with adjuvant chemotherapy. Our initial GWS data set consisted of 805 Finnish breast cancer cases (360 treated with adjuvant chemotherapy). The top 39 SNPs from this stage were analyzed in three independent data sets: iCOGS (n=6720 chemotherapy-treated cases), SUCCESS-A (n=3596), and POSH (n=518). Two SNPs were successfully validated: rs6500843 (any chemotherapy; per-allele HR 1.16, 95% C.I. 1.08-1.26, p=0.0001, p(adjusted)=0.0091), and rs11155012 (anthracycline therapy; per-allele HR 1.21, 95% C.I. 1.08-1.35, p=0.0010, p(adjusted)=0.0270). The SNP rs6500843 was found to specifically interact with adjuvant chemotherapy, independently of standard prognostic markers (p(interaction)=0.0009), with the rs6500843-GG genotype corresponding to the highest hazard among chemotherapy-treated cases (HR 1.47, 95% C.I. 1.20-1.80). Upon trans-eQTL analysis of public microarray data, the rs6500843 locus was found to associate with the expression of a group of genes involved in cell cycle control, notably AURKA, the expression of which also exhibited differential prognostic value between chemotherapy-treated and untreated cases in our analysis of microarray data. Based on previously published information, we propose that the eQTL genes may be connected to the rs6500843 locus via a RBFOX1-FOXM1 -mediated regulatory pathway.

Case report and review of esophageal lichen planus treated with fluticasone

Science.gov (United States)

Ynson, Marie Lourdes; Forouhar, Faripour; Vaziri, Haleh

2013-01-01

Lichen planus is a fairly common chronic idiopathic disorder of the skin, nails and mucosal surfaces. Esophageal involvement of this disease on the other hand is rare and only about 50 cases have been reported in literature. Given its rarity, it can be difficult to diagnose and may be easily misdiagnosed as reflux esophagitis. Currently, there are no clear recommendations on the optimal management of this disease and little is known about the best treatment approach. Systemic steroids are usually the first line treatment and offer a favorable response. In this report, we would like to present a novel approach in the management of esophageal lichen planus in a middle-aged woman treated successfully with swallowed fluticasone propionate 220 mcg twice a day for 6 wk, as evidenced by objective clinical findings. Based on our review of related literature and experience in this patient, we feel that a trial of swallowed fluticasone may be a prudent approach in the management of these patients since it has a more favorable side effect profile than systemic treatment. PMID:23539434

[A case of recurrent transverse colon cancer invading the pancreas and duodenum successfully treated with biliary and duodenal stenting].

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Tonooka, Toru; Yoshioka, Shigeru; Shiobara, Masayuki; Wakatsuki, Kazuo; Kataoka, Masaaki; Arai, Shuka; Miyazawa, Kotaro; Nakada, Shinichiro; Kita, Kazuhiko; Saito, Hirofumi; Nomoto, Hiromasa; Usui, Masatoshi; Yabiki, Masashi; Ota, Yuki; Oeda, Yoshio

2013-11-01

We report a case of recurrent transverse colon cancer invading the pancreas and duodenum that was successfully treated with biliary and duodenal stenting. A 46-year-old man underwent ascending colostomy for the treatment of obstructive transverse colon cancer with hepatic metastasis. Chemotherapy achieved a partial response, but the levels of tumor markers later began to rise again. He then underwent right hemicolectomy and partial hepatectomy. Post-operative chemotherapy was administered, but the recurrent tumor caused obstructive jaundice and duodenal obstruction. These were successfully treated with biliary and duodenal stenting, and the patient was able to remain at home and maintain his quality of life.

Metabolic activity by {sup 18}F-FDG-PET/CT is predictive of early response after nivolumab in previously treated NSCLC

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Kaira, Kyoichi; Altan, Bolag [Gunma University Graduate School of Medicine, Department of Oncology Clinical Development, Maebashi, Gunma (Japan); Higuchi, Tetsuya; Arisaka, Yukiko; Tokue, Azusa [Gunma University Graduate School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Maebashi, Gunma (Japan); Naruse, Ichiro [Hidaka Hospital, Department of Respiratory Medicine, Hidaka (Japan); Suda, Satoshi [Hidaka Hospital, Department of Radiology, Hidaka (Japan); Mogi, Akira; Shimizu, Kimihiro [Gunma University Graduate School of Medicine, Department of General Surgical Science, Maebashi, Gunma (Japan); Sunaga, Noriaki [Gunma University Hospital, Oncology Center, Maebashi, Gunma (Japan); Hisada, Takeshi [Gunma University Hospital, Department of Respiratory Medicine, Maebashi, Gunma (Japan); Kitano, Shigehisa [National Cancer Center Hospital, Department of Experimental Therapeutics, Tokyo (Japan); Obinata, Hideru; Asao, Takayuki [Gunma University Initiative for Advanced Research, Big Data Center for Integrative Analysis, Maebashi, Gunma (Japan); Yokobori, Takehiko [Gunma University Initiative for Advanced Research, Division of Integrated Oncology Research, Research Program for Omics-based Medical Science, Maebashi, Gunma (Japan); Mori, Keita [Clinical Research Support Center, Shizuoka Cancer Center, Suntou-gun (Japan); Nishiyama, Masahiko [Gunma University Graduate School of Medicine, Department of Molecular Pharmacology and Oncology, Maebashi, Gunma (Japan); Tsushima, Yoshihito [Gunma University Graduate School of Medicine, Department of Diagnostic Radiology and Nuclear Medicine, Maebashi, Gunma (Japan); Gunma University Initiative for Advanced Research (GIAR), Research Program for Diagnostic and Molecular Imaging, Division of Integrated Oncology Research, Maebashi, Gunma (Japan)

2018-01-15

Nivolumab, an anti-programmed death-1 (PD-1) antibody, is administered in patients with previously treated non-small cell lung cancer. However, little is known about the established biomarker predicting the efficacy of nivolumab. Here, we conducted a preliminary study to investigate whether {sup 18}F-FDG-PET/CT could predict the therapeutic response of nivolumab at the early phase. Twenty-four patients were enrolled in this study. {sup 18}F-FDG-PET/CT was carried out before and 1 month after nivolumab therapy. SUV{sub max}, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were calculated. Immunohistochemical analysis of PD-L1 expression and tumour-infiltrating lymphocytes was conducted. Among all patients, a partial metabolic response to nivolumab was observed in 29% on SUV{sub max}, 25% on MTV, and 33% on TLG, whereas seven (29%) patients achieved a partial response (PR) based on RECIST v1.1. The predictive probability of PR (100% vs. 29%, p = 0.021) and progressive disease (100% vs. 22.2%, p = 0.002) at 1 month after nivolumab initiation was significantly higher in {sup 18}F-FDG on PET/CT than in CT scans. Multivariate analysis confirmed that {sup 18}F-FDG uptake after administration of nivolumab was an independent prognostic factor. PD-L1 expression and nivolumab plasma concentration could not precisely predict the early therapeutic efficacy of nivolumab. Metabolic response by {sup 18}F-FDG was effective in predicting efficacy and survival at 1 month after nivolumab treatment. (orig.)

Leiomyosarcoma of the Prostate: Case Report and Review of 54 Previously Published Cases

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Gerasimos P. Vandoros

2008-01-01

Full Text Available Prostate leiomyosarcoma is an extremely rare and highly aggressive neoplasm that accounts for less than 0.1% of primary prostate malignancies. We present a patient with primary leiomyosarcoma of the prostate and review 54 cases reported in the literature to discuss the clinical, diagnostic and therapeutic aspects of this uncommon tumor. Median survival was estimated at 17 months (95% C.I. 20.7–43.7 months and the 1-, 3-, and 5-year actuarial survival rates were 68%, 34%, and 26%, respectively. The only factors predictive of long-term survival were negative surgical margins and absence of metastatic disease at presentation. A multidisciplinary approach is necessary for appropriate management of this dire entity.

Two Cases of Type Va Extrahepatic Bile Duct Duplication With Distal Klatskin Tumor Surgically Treated with Whipple Procedure and Hepaticojejunostomy.

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Hammad, Tariq A; Alastal, Yaseen; Khan, Muhammad Ali; Hammad, Mohammad; Alaradi, Osama; Nigam, Ankesh; Sodeman, Thomas C; Nawras, Ali

2015-10-01

We describe the diagnostic and therapeutic challenges of a type Va extrahepatic bile duct duplication coexistent with distally located hilar cholangiocarcinoma (Klatskin tumor). We present 2 cases that were diagnosed preoperatively and treated with a modified surgical technique of a combined pylorus-preserving Whipple procedure and hepaticojejunostomy.

Squamous cell carcinoma arising in previously burned or irradiated skin

International Nuclear Information System (INIS)

Edwards, M.J.; Hirsch, R.M.; Broadwater, J.R.; Netscher, D.T.; Ames, F.C.

1989-01-01

Squamous cell carcinoma (SCC) arising in previously burned or irradiated skin was reviewed in 66 patients treated between 1944 and 1986. Healing of the initial injury was complicated in 70% of patients. Mean interval from initial injury to diagnosis of SCC was 37 years. The overwhelming majority of patients presented with a chronic intractable ulcer in previously injured skin. The regional relapse rate after surgical excision was very high, 58% of all patients. Predominant patterns of recurrence were in local skin and regional lymph nodes (93% of recurrences). Survival rates at 5, 10, and 20 years were 52%, 34%, and 23%, respectively. Five-year survival rates in previously burned and irradiated patients were not significantly different (53% and 50%, respectively). This review, one of the largest reported series, better defines SCC arising in previously burned or irradiated skin as a locally aggressive disease that is distinct from SCC arising in sunlight-damaged skin. An increased awareness of the significance of chronic ulceration in scar tissue may allow earlier diagnosis. Regional disease control and survival depend on surgical resection of all known disease and may require radical lymph node dissection or amputation

Implant breast reconstruction after salvage mastectomy in previously irradiated patients.

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Persichetti, Paolo; Cagli, Barbara; Simone, Pierfranco; Cogliandro, Annalisa; Fortunato, Lucio; Altomare, Vittorio; Trodella, Lucio

2009-04-01

The most common surgical approach in case of local tumor recurrence after quadrantectomy and radiotherapy is salvage mastectomy. Breast reconstruction is the subsequent phase of the treatment and the plastic surgeon has to operate on previously irradiated and manipulated tissues. The medical literature highlights that breast reconstruction with tissue expanders is not a pursuable option, considering previous radiotherapy a contraindication. The purpose of this retrospective study is to evaluate the influence of previous radiotherapy on 2-stage breast reconstruction (tissue expander/implant). Only patients with analogous timing of radiation therapy and the same demolitive and reconstructive procedures were recruited. The results of this study prove that, after salvage mastectomy in previously irradiated patients, implant reconstruction is still possible. Further comparative studies are, of course, advisable to draw any conclusion on the possibility to perform implant reconstruction in previously irradiated patients.

Case report and systematic literature review of a novel etiology of sinistral portal hypertension presenting with UGI bleeding: Left gastric artery pseudoaneurysm compressing the splenic vein treated by embolization of the pseudoaneurysm.

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Hakim, Seifeldin; Bortman, Jared; Orosey, Molly; Cappell, Mitchell S

2017-03-01

A novel case is reported of upper gastrointestinal (UGI) bleeding from sinistral portal hypertension, caused by a left gastric artery (LGA) pseudoaneurysm (PA) compressing the splenic vein (SV) that was successfully treated with PA embolization. A 41-year-old man with previous medical history of recurrent, alcoholic pancreatitis presented with several episodes of hematemesis and abdominal pain for 48 hours. Physical examination revealed a soft abdomen, with no abdominal bruit, no pulsatile abdominal mass, and no stigmata of chronic liver disease. The hemoglobin declined acutely from 12.3 to 9.3 g/dL. Biochemical parameters of liver function and routine coagulation profile were entirely within normal limits. Abdominal CT revealed a 5-cm-wide peripancreatic mass compressing the stomach and constricting the SV. Esophagogastroduodenoscopy showed blood oozing from portal hypertensive gastropathy, small nonbleeding gastric cardial and fundal varices, gastric compression from the extrinsic mass, and no esophageal varices. MRCP and angiography showed that the mass was vascular, arose from the LGA, compressed the mid SV without SV thrombosis, and caused sinistral portal hypertension. At angiography, the PA was angioembolized and occluded. The patient has been asymptomatic with no further bleeding and a stable hemoglobin level during 8 weeks of follow-up. Literature review of the 14 reported cases of LGA PA revealed that this report of acute UGI bleeding from sinistral portal hypertension from a LGA PA constricting the SV is novel; one previously reported patient had severe anemia without acute UGI bleeding associated with sinistral portal hypertension from a LGA PA. A patient presented with UGI bleeding from sinistral portal hypertension from a LGA PA compressing the SV that was treated by angiographic obliteration of the PA which relieved the SV compression and arrested the UGI bleeding. Primary therapy for this syndrome should be addressed to obliterate the PA and not

Giant Retinal Tear With Retinal Detachment in Regressed Aggressive Posterior Retinopathy of Prematurity Treated by Laser.

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Chandra, Parijat; Tewari, Ruchir; Salunkhe, Nitesh; Kumawat, Devesh; Kumar, Vinod

2017-06-29

Rhegmatogenous retinal detachment after successfully regressed retinopathy of prematurity is a rare occurrence. Late onset rhegmatogenous retinal detachment has been reported infrequently. The authors report a case of aggressive posterior retinopathy of prematurity that underwent uneventful regression after laser photocoagulation and later developed an inoperable closed funnel retinal detachment due to a giant retinal tear. This case represents the earliest development of such complications in regressed aggressive posterior retinopathy of prematurity treated by laser. Development of a giant retinal tear has also not been previously reported after laser treatment. This case highlights that successful regression of severe retinopathy of prematurity does not safeguard against future complications and requires frequent long-term follow-up. [J Pediatr Ophthalmol Strabismus. 2017;54:e34-e36.]. Copyright 2017, SLACK Incorporated.

Do attitudes of families concerned influence features of children who claim to remember previous lives?

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Pasricha, Satwant K

2011-01-01

Reported cases of nearly 2600 children (subjects) who claim to remember previous lives have been investigated in cultures with and without belief in reincarnation. The authenticity in most cases has been established. To study the influence of attitudes of parents of the subjects, families of the deceased person with whom they are identified and attention paid by others on the features of the cases. The study is based on field investigations. Data is derived from analysis of a larger series of an ongoing project. Information on initial and subsequent attitudes of subjects' mothers was available for 292 and 136 cases, respectively; attitudes of 227 families of deceased person (previous personality) with whom he is identified, and the extent of attention received from outsiders for 252 cases. Observations and interviews with multiple firsthand informants on both sides of the case as well as some neutral informants supplemented by examination of objective data were the chief methods of investigation. The initial attitude of mothers varied from encouragement (21%) to neutral or tolerance (51%) to discouragement (28%). However, it changed significantly from neutrality to taking measures to induce amnesia in their children for previous life memories due to various psychosocial pressures and prevalent beliefs. Families of the previous personalities, once convinced, showed complete acceptance in a majority of cases. Outside attention was received in 58% cases. The positive attitude of parents might facilitate expression of memories but subsequently attitudes of persons concerned do not seem to alter features of the cases.

Acupuncture-induced Popliteal Arteriovenous Fistula Successfully Treated With Percutaneous Endovascular Intervention

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Hsuan-Fu Kuo

2010-03-01

Full Text Available A 39-year-old female visited our cardiovascular outpatient department with paresthesia and soreness around the right popliteal fossa, where thrill was palpable. There was no history of trauma, apart from her having undergone acupuncture several years previously. An arteriovenous fistula (AVF was diagnosed by vascular ultrasonography and magnetic resonance imaging. Angiography confirmed the presence of an AVF fed by the medial geniculate artery. Transarterial embolization was performed to close the AVF using coils and tissue adhesive. To the best of our knowledge, acupuncture-induced AVF has not been previously reported. We present a case demonstrating the merits of percutaneous endovascular intervention for treating this rare complication. The additional administration of a tissue adhesive can achieve complete closure of the AVF in the event of an unsatisfactory result following coil embolization. Doctors should be aware of the potential vascular complications of acupuncture, and of the management options.

Mesotherapy-induced panniculitis treated with dapsone: case report and review of reported adverse effects of mesotherapy.

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Tan, Jennifer; Rao, Babar

2006-01-01

Mesotherapy is a procedure involving the injection of substances into the dermis and subcutaneous tissue. Used in Europe for decades in the treatment of various medical conditions and cosmetic fat dissolution, the technique only recently became widely available in the United States. Mesotherapy has been surrounded by controversy pertaining to efficacy and has been associated with localized complications, including allergic reactions, necrosis, and infections. Panniculitis is a rare adverse reaction to mesotherapy that may result from injection pressure, local trauma, or the type of injected substances. Treatment options for complications are limited. We report a case of mesotherapy-induced panniculitis successfully treated with dapsone. This case illustrates one of the potential adverse effects of mesotherapy and suggests that dapsone may be effective in the treatment of panniculitis resulting from such injections. Reported adverse effects associated with mesotherapy are also reviewed.

Surgery for acoustic neurinoma treated by gamma-knife radiosurgery. A case report

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Tokuda, Kentaro; Inamura, Takanori; Uesaka, Toshio; Matsushima, Toshio; Fukui, Masashi [Kyushu Univ., Fukuoka (Japan). Graduate School of Medical Science; Kenai, Hiroyuki; Karashima, Atushi

2001-08-01

A 52-year-old woman had a history of left hearing loss for 5 years. An acoustic neurinoma with 3.2 cm in diameter was diagnosed and treated with gamma-knife radiosurgery (19 Gy of marginal dose) 1 year and 4 months ago. She developed headache, nausea, and visual disturbance 1 month prior to admission. Slight left facial palsy appeared after radiosurgery. Magnetic resonance imaging demonstrated the tumor with central necrosis in the left cerebellopontine angle cistern, increasing in size to 3.5 cm in diameter, and hydrocephalus. Tumor removal was performed incompletely, because of the fibrous appearance of the tumor and severe adherence with the surrounding cerebellar tissue. Facial palsy did not worsen after surgery. Since the hydrocephalus was not resolved, a right ventriculo-peritoneal shunt was inserted. The clinical course in this case suggests that tumor removal followed by radiosurgery was an approximately effective treatment for large acoustic neurinoma. (author)

Fibre reinforcement in a structurally compromised endodontically treated molar: a case report

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Renita Soares

2016-05-01

Full Text Available The reconstruction of structurally compromised posterior teeth is a rather challenging procedure. The tendency of endodontically treated teeth (ETT to fracture is considerably higher than vital teeth. Although posts and core build-ups followed by conventional crowns have been generally employed for the purpose of reconstruction, this procedure entails sacrificing a considerable amount of residual sound enamel and dentin. This has drawn the attention of researchers to fibre reinforcement. Fibre-reinforced composite (FRC, designed to replace dentin, enables the biomimetic restoration of teeth. Besides improving the strength of the restoration, the incorporation of glass fibres into composite resins leads to favorable fracture patterns because the fibre layer acts as a stress breaker and stops crack propagation. The following case report presents a technique for reinforcing a badly broken-down ETT with biomimetic materials and FRC. The proper utilization of FRC in structurally compromised teeth can be considered to be an economical and practical measure that may obviate the use of extensive prosthetic treatment.

Reirradiation, surgery and IORT for recurrent rectal cancer in previously irradiated patients

International Nuclear Information System (INIS)

Vermaas, Maarten; Nuyttens, Joost J.M.E.; Ferenschild, Floris T.J.; Verhoef, Cornelis; Eggermont, Alexander M.M.; Wilt, Johannes H.W. de

2008-01-01

A total of 11 patients with recurrent rectal cancer who had been previously irradiated were treated with preoperative reirradiation (median dose 30 Gy), surgery and IORT. This treatment was related with high morbidity, a short pain-free survival (5 months) and poor local control (27% after 3 years), although some patients have long-term distant control and survival

Curative treatment for central nervous system medulloepithelioma despite residual disease after resection. Report of two cases treated according to the GPHO protocol HIT 2000 and review of the literature

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Mueller, Klaus [Leipzig Univ. (Germany). Dept. of Radiotherapy and Radiooncology; Zwiener, Isabella [University Medical Center Univ. Mainz (Germany). Inst. for Medical Biostatistics, Epidemiology and Informatics; Welker, Helmut [Katharinenhospital, Stuttgart (Germany). Dept. of Radiotherapy and Radiooncology; Maass, Eberhard [Klinikum Stuttgart - Olgahospital (DE). Pediatrics 5 (Oncology, Hematology, Immunology); Bongartz, Rudolf [Koeln Univ. (Germany). Dept. of Radiotherapy and Radiooncology; Berthold, Frank [Koeln Univ. (Germany). Dept. of Pediatric Oncology; Pietsch, Torsten [Bonn Univ. Medical Center (Germany). Dept. of Neuropathology; Warmuth-Metz, Monika [Wuerzburg Univ. (Germany). Dept. of Neuroradiology; Bueren, Andre von; Rutkowski, Stefan [University Medical Center Hamburg-Eppendorf, Hamburg (Germany). Dept. of Pediatric Hematology and Oncology

2011-11-15

Medulloepithelioma of the central nervous system (CNS) is an uncommon primitive neuroectodermal tumor (PNET) usually occurring in early childhood. It is characterized by highly malignant behavior with a propensity for progression, recurrence, and dissemination despite intensive therapy. Due to its rarity, the optimal management is still unknown. However, gross total resection (GTR) has been considered crucial to achieve cure. In this article, the authors report on 2 cases of CNS medulloepithelioma in which long-term survival (more than 6 years) could be achieved despite evidence of, or suspected postoperative residual disease with an otherwise dismal prognosis. The patients were treated according to different strata of the protocol for primitive neuroectodermal tumors (PNET) of the German-Austrian multicenter trial of the German Society for Pediatric Oncology and Hematology (GPOH) for childhood brain tumors (HIT 2000). Treatment included postoperative hyperfractionated radiotherapy of the craniospinal axis followed by a boost to the tumor site in combination with chemotherapy. A review of the 2 reported and 37 previously published cases confirmed GTR and older age as positive prognostic factors. (orig.)

Analysis of cervical cancer cells treated with radiotherapy or arterial infusion chemotherapy

International Nuclear Information System (INIS)

Izutu, Toshihiko; Nishiya, Iwao

1995-01-01

The present study was designed to analyze cervical cancer cells treated with radiotherapy or intraarterial infusion of CDDP using image analysis. Total nuclear extinction (TE), 5 N-exceeding rate (5 NER) and nuclear area (NA) gradually increased following irradiation, in cervical cancer cases. TE and 5 NER increased markedly following radiotherapy in good response cases. TE, 5 NER and NA were not-changed following irradiation in poor response cases. 5 NER, in good prognostic cases was higher than in poor prognostic cases, significantly among cervical cancer cases treated with radiotherapy. 5 NER and NA increased dramatically in good response cases treated with intraarterial infusion of CDDP. (author)

[Experience with Dohlman-Doane keratoprosthesis: case reports].

Science.gov (United States)

Stolz, Andressa Prestes; Kwitko, Sérgio; Dal Pizzol, Melissa Manfroi; Marinho, Diane; Rymer, Samuel

2008-01-01

To describe 9 eyes in 8 patients who received Dohlman-Doane type 1 keratoprosthesis (KPro) with a mean follow-up of 11.2 months (2 to 25 months). A retrospective, non-comparative interventional case series. Previous corneal disease was alcaline burn in 4 eyes, multiple graft failure in 3 eyes, Stevens-Johnson syndrome in 1 eye and thermal injury in 1 eye. Best corrected visual acuity (BCVA) was hand motions or worse in all patients. Glaucoma was present preoperatively in 3 eyes and received Ahmed valve implantation. 88,9% eyes achieved BCVA of better than or equal to 20/100, and 44,4% better than or equal to 20/40. In the postoperative period, 3 eyes developed posterior capsule opacity treated with YAG laser capsulotomy; 3 retroprosthetic membrane treated with tPA injection or steroids; 2 glaucoma in clinical treatment; 1 corneal melting, treated with donor cornea bottom exchange; and 1 fungic endophthalmitis, treated with corneal transplant, anterior vitrectomy, KPro and intraocular lens explantation, and specific intravitreal and endovenous treatment. Dohlman-Doane K-Pro seems to be a good option for cases of corneal blindness with poor prognosis for traditional penetrating keratoplasty. Its main advantage is not requesting systemic immunossuppression. Best results were achieved in non-immune diseases.

Effects of previous unsuccessful extracorporeal shockwave lithotripsy treatment on the performance and outcome of percutaneous nephrolithotomy.

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Türk, Hakan; Yoldaş, Mehmet; Süelözgen, Tufan; İşoğlu, Cemal Selcuk; Karabıçak, Mustafa; Ergani, Batuhan; Ün, Sıtkı

2017-06-01

To evaluate the effects of previous unsuccessful extracorporeal shockwave lithotripsy (ESWL) treatment on the performance and outcome of percutaneous nephrolithotomy (PCNL). Of 1625 PCNL procedures performed in our clinic, 393 renal units with similar stone burden and number of accesses was included in the present study. We categorised the study patients into two groups according to whether they underwent ESWL within 1 year prior to PCNL or not. Accordingly, Group 1 comprised 143 (36.3%) ESWL-treated patients and Group 2 comprised 250 (63.7%) non-ESWL-treated patients. Residual stones were detected in 36 (25.1%) of the ESWL-treated patients (Group 1) and in 60 (24%) of non-ESWL-treated patients (Group 2). There were no statistically significant differences between the groups for length of hospital stay (LOS), nephrostomy tube removal time, and the presence of residual stones. When we evaluated the groups for both the preoperative and postoperative haemoglobin (Hb) drop and blood transfusion rate, manifest Hb declines and more transfusions were required in the ESWL-treated patients (both P  = 0.01). In our study, previous ESWL treatment had no influence on the PCNL stone-free rate, operation time, incidence of postoperative complications, and LOS, in patients with similar stone burdens. However, bleeding during PCNL was more prevalent in the ESWL-treated patients, so close attention should be paid to bleeding in patients who have been pretreated with ESWL.

Outcomes for Women with Gestational Diabetes Treated with Metformin: A Retrospective, Case-Control Study

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Rachel T. McGrath

2018-03-01

Full Text Available Metformin is increasingly being used a therapeutic option for the management of gestational diabetes mellitus (GDM. The aim of this study was to compare the maternal characteristics and perinatal outcomes of women with GDM treated with metformin (with or without supplemental insulin with those receiving other management approaches. A retrospective, case-control study was carried out and 83 women taking metformin were matched 1:1 with women receiving insulin or diet and lifestyle modification alone. Women managed with diet and lifestyle modification had a significantly lower fasting plasma glucose (p < 0.001 and HbA1c (p < 0.01 at diagnosis of GDM. Furthermore, women managed with metformin had a higher early pregnancy body mass index (BMI compared to those receiving insulin or diet and lifestyle modification (p < 0.001. There was no difference in mode of delivery, birth weight or incidence of large- or small-for-gestational-age neonates between groups. Women receiving glucose lowering therapies had a higher rate of neonatal hypoglycaemia (p < 0.05. The incidence of other adverse perinatal outcomes was similar between groups. Despite their greater BMI, women with metformin-treated GDM did not have an increased risk of adverse perinatal outcomes. Metformin is a useful alternative to insulin in the management of GDM.

Leptotrichia endocarditis: report of two cases from the International Collaboration on Endocarditis (ICE) database and review of previous cases

NARCIS (Netherlands)

Caram, L. B.; Linefsky, J. P.; Read, K. M.; Murdoch, D. R.; Lalani, T.; Woods, C. W.; Reller, L. B.; Kanj, S. S.; Premru, M. M.; Ryan, S.; Al-Hegelan, M.; Donnio, P. Y.; Orezzi, C.; Paiva, M. G.; Tribouilloy, C.; Watkin, R.; Harris, O.; Eisen, D. P.; Corey, G. R.; Cabell, C. H.; Petti, C. A.; Gordon, David; Devi, Uma; Spelman, Denis; van der Meer, Jan T. M.; Kauffman, Carol; Bradley, Suzanne; Armstrong, William; Giannitsioti, Efthymia; Giamarellou, Helen; Lerakis, Stamatios; del Rio, Ana; Moreno, Asuncion; Mestres, Carlos A.; Paré, Carlos; de la Maria, Cristina Garcia; de Lazzario, Elisa; Marco, Francesc; Gatell, Jose M.; Miró, José M.; Almela, Manel; Azqueta, Manuel; Jiménez-Expósito, Maria Jesús; de Benito, Natividad; Perez, Noel; Almirante, Benito; Fernandez-Hidalgo, Nuria; de Vera, Pablo Rodriguez; Tornos, Pilar; Falcó, Vicente

2008-01-01

Leptotrichia species typically colonize the oral cavity and genitourinary tract. We report the first two cases of endocarditis secondary to L. goodfellowii sp. nov. Both cases were identified using 16S rRNA gene sequencing. Review of the English literature revealed only two other cases of

A 9 year-old girl with herpes simplex virus type 2 acute retinal necrosis treated with intravitreal foscarnet.

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King, John; Chung, Mina; DiLoreto, David A

2007-01-01

A 9-year-old girl presented with a 2-week history of redness in the left eye. Examination revealed vitritis, retinal whitening, vasculitis, and optic nerve head edema. Polymerase chain reaction testing of the aqueous fluid revealed herpes simplex virus type 2. The retinitis was controlled with intravenous acyclovir and intravitreal foscarnet. The clinical course was complicated by retinal neovascularization and vitreous hemorrhage, which was treated by pars plana vitrectomy and endolaser. While there are few case reports of herpes simplex virus type 2 retinitis in children, this one is unique for the following reasons: it is the first reported case of herpes simplex virus type 2 retinitis in a child less than 10 years old without a previous history of neonatal infection or central nervous system involvement; no other children have been reported to have been treated with intravitreal foscarnet; and retinal neovascularization complicated the recovery.

Hypertensive thalamic hematoma treated by CT stereotactic evacuation (with two cases reports)

International Nuclear Information System (INIS)

Wang Hongsheng; Zhu Fengqing

2002-01-01

Objective: To investigate new surgical method to treat hypertensive thalamic hematoma. Methods: Two medial-degree coma patients with hypertensive thalamic hematoma were treated by CT stereotactic evacuation. Results: One week after operation the two patients regained consciousness. The function of paraplegic appendage restored partly, and one patient could take care of himself. Conclusion: CT stereotactic evacuation to treat hypertensive thalamic hematoma has the advantages of small trauma, little complication and good clinical results. The authors suggest that it be selected firstly in treating hypertensive thalamic hematoma

A seven-year disease-free survivor of malignant pleural mesothelioma treated with hyperthermia and chemotherapy: a case report

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Okonogi Noriyuki

2012-12-01

Full Text Available Abstract Introduction Malignant pleural mesothelioma was once a rare finding but its incidence is increasing worldwide, most likely because of widespread exposure to asbestos. Although complete surgical resection is considered the only curative treatment, the results of surgery have shown a median survival time of only one year. In inoperable cases, chemotherapy, radiotherapy, and a combination of both have been considered as palliative therapy. Therefore, outcomes for inoperable cases have been poor. Here, we report the case of a long-term survivor treated with hyperthermia and chemotherapy. Case presentation A 61-year-old Japanese man with a performance status of 1 due to chest pain was referred to our hospital. He had a history of asbestos exposure for approximately five years. A computed tomography scan showed diffuse extensive right pleural thickening with small nodular lesions, and video-assisted thoracoscopy revealed tumor invasion of the ipsilateral chest wall muscles. The histopathologic findings were consistent with a diagnosis of malignant pleural mesothelioma (sarcomatoid type. The tumor was diagnosed as being stage cT3N0M0. Our patient refused any invasive therapies including surgery and radiotherapy, and was therefore treated with hyperthermia and systemic chemotherapy with agents such as cisplatin and irinotecan. He underwent three hyperthermia sessions and a single course of chemotherapy without any severe complications. One month after treatment, a follow-up computed tomography scan showed no definitive abnormality in the thoracic space. Our patient has subsequently survived without any evident disease for more than seven years. Conclusions The combination of hyperthermia and chemotherapy may be a novel and safe therapeutic option for malignant pleural mesothelioma, and can be considered for patients ineligible for radical treatment. Further clinical studies of the combination of hyperthermia and chemotherapy are needed to

Giant cell arteritis complicated by acute pancreatitis: a case report

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Seneviratne Deepthi

2008-11-01

Full Text Available Abstract Introduction We describe a case of giant cell arteritis in a woman who was treated with high-dose systemic corticosteroids and subsequently developed acute pancreatitis. Case presentation A 78-year-old Caucasian woman presented with four weeks of progressive headache and scalp tenderness. One day before ophthalmology assessment, she had experienced visual obscurations in both eyes. Her visual acuity was 6/9 in both eyes, with a right afferent pupillary defect and right swollen optic nerve. She was diagnosed as having temporal arteritis and was urgently treated with high-dose pulsed intravenous and oral corticosteroids. Her previous diet-controlled diabetes needed insulin and oral hyperglycaemic therapy to control erratic blood sugars. On day 8 of treatment with steroids, she became unwell with epigastric pain and vomiting. She was diagnosed with acute pancreatitis and was treated conservatively. Conclusion Acute pancreatitis, a potentially life-threatening condition, is a rare but important side effect of systemic corticosteroids.

Treating disorganized attachment in the Group Attachment-Based Intervention (GABI©): A case study.

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Knafo, Hannah; Murphy, Anne; Steele, Howard; Steele, Miriam

2018-05-24

This paper describes the treatment of a mother and child who demonstrated disorganized attachment behaviors in their interactions with one another. The mother, who was diagnosed with Borderline Personality Disorder, felt incapable of managing her aggressive toddler and his emotional needs. The dyad was referred for therapy due to concerns about his developmental progress, evident delays having been mainly attributed to the problems observed within the parent-child relationship. The primary intervention applied to working with the dyad was the Group Attachment-Based Intervention (GABI©), developed by Anne Murphy in collaboration with Miriam Steele and Howard Steele. The mother also received individual psychotherapy as a supplement to the dyadic and group work of GABI©. The process and outcome of this comprehensive approach to treating a vulnerable dyad is explored in this case study. © 2018 Wiley Periodicals, Inc.

A case with relapsed transient neonatal diabetes mellitus treated with sulfonylurea, ending chronic insulin requirement

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Akihiko Ando

2018-04-01

Full Text Available We report a case of a woman with diabetes mellitus caused by a genetic defect in ABCC8-coding sulfonylurea receptor 1 (SUR1, a subunit of the ATP-sensitive potassium (KATP channel protein. She was diagnosed with diabetes at 7 days after birth. After intravenous insulin drip for 1 month, her hyperglycaemia remitted. At the age of 13 years, her diabetes relapsed, and after that she had been treated by intensive insulin therapy for 25 years with relatively poor glycaemic control. She was switched to oral sulfonylurea therapy and attained euglycaemia. In addition, her insulin secretory capacity was ameliorated gradually.

Chondromalacia patellae treated by warming needle and rehabilitation training.

Science.gov (United States)

Qiu, Ling; Zhang, Min; Zhang, Ji; Gao, Le-Nv; Chen, Da-wei; Liu, Jun; She, Jia-yi; Wang, Ling; Yu, Jin-yan; Huang, Le-ping; Bai, Yang

2009-06-01

To observe the effect of warming needle combined with rehabilitation training on chondromalacia patellae in a randomized controlled trial. The 92 cases were randomly divided into a treatment group treated by warming needle plus rehabilitation training (47 cases) and a control group treated by medication plus rehabilitation training (45 cases), and the therapeutic effect was compared after 20 sessions. The pain was relieved more obviously in the treatment group than in the control group (P chondromalacia patellae.

Use of endobronchial valve insertion to treat relapsing pneumothorax: a case report and literature review.

Science.gov (United States)

Qi, Fei; Tian, Qing; Chen, Liang'an; Li, Chunyan; Zhang, Shu; Liu, Xingchen; Xiao, Binbin

2017-07-01

Backgorund and Aims: Unidirectional endobronchial valves have recently been shown to be beneficial as treatment for persistent air leaks. This report presents a first case of endobronchial valve implantation to treat relapsing pneumothorax in a Chinese patient, and also presents a review of the literature on the use of one-way valve insertion for the treatment of persistent air leaks. The patient did undergo a recent but failed chest tube intervention. By bronchoscopy and using Chartis® system measurements, the upper left lobe (including the left apical bronchus) was closed using a catheter. After the expected decrease in airflow following bronchial occlusion, increased air pressure and decreased spilled air were noted; it was concluded that the pneumothorax was located in the left upper lobe. A Zephyr ® endobronchial valve was placed in the left upper apical bronchus. The health benefits of the procedure were noticed in the following days. Our review suggests that the use of endobronchial valves could be used as an effective, minimally invasive, low-risk intervention for patients with pneumothorax that cannot be treated surgically. © 2015 John Wiley & Sons Ltd.

The case of inorganic hypersomnia treated with light therapy in the course of schizoaffective disorder

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Masiak Jolanta

2016-03-01

Full Text Available According to ICD 10, nonorganic hypersomnia is defined as “a condition of either excessive daytime sleepiness and sleep attacks (not accounted for by an inadequate amount of sleep or prolonged transition to the fully aroused state upon awakening. When no definite evidence of organic etiology can be found, this condition is usually associated with mental disorders”. The severe hypersomnia in the course of schizoaffective disorder is rather a rare phenomenon. The paper presents the case of 41-year-old female patient with severe hypersomnia during the course of the schizoaffective disorder. The course of hypersomnia was severe. The patient slept constantly day and night and was awoken by her family for about three-hour period of time. The duration of hypersomnia was about one year until the onset of treatment. The patient was successfully treated with light therapy that caused gradual resolution of the symptoms of hypersomnia. The patient is also treated as prior to the onset of hypersomnia with antipsychotics and the mood stabilizers for schizoaffective disorder. Since that time there were six-year-period of follow up when the patient was free of any symptoms of hypersomnia.

FDG-PET and CT patterns of bone metastases and their relationship to previously administered anti-cancer therapy

International Nuclear Information System (INIS)

Israel, Ora; Bar-Shalom, Rachel; Keidar, Zohar; Goldberg, Anat; Nachtigal, Alicia; Militianu, Daniela; Fogelman, Ignac

2006-01-01

To assess 18 F-fluorodeoxyglucose (FDG) uptake in bone metastases in patients with and without previous treatment, and compare positive positron emission tomography (PET) with osteolytic or osteoblastic changes on computed tomography (CT). One hundred and thirty-one FDG-PET/CT studies were reviewed for bone metastases. A total of 294 lesions were found in 76 patients, 81 in untreated patients and 213 in previously treated patients. PET was assessed for abnormal FDG uptake localised by PET/CT to the skeleton. CT was evaluated for bone metastases and for blastic or lytic pattern. The relationship between the presence and pattern of bone metastases on PET and CT, and prior treatment was statistically analysed using the chi-square test. PET identified 174 (59%) metastases, while CT detected 280 (95%). FDG-avid metastases included 74/81 (91%) untreated and 100/213 (47%) treated lesions (p<0.001). On CT there were 76/81 (94%) untreated and 204/213 (96%) treated metastases (p NS). In untreated patients, 85% of lesions were seen on both PET and CT (26 blastic, 43 lytic). In treated patients, 53% of lesions were seen only on CT (95 blastic, 18 lytic). Of the osteoblastic metastases, 65/174 (37%) were PET positive and 98/120 (82%), PET negative (p<0.001). The results of the present study indicate that when imaging bone metastases, prior treatment can alter the relationship between PET and CT findings. Most untreated bone metastases are PET positive and lytic on CT, while in previously treated patients most lesions are PET negative and blastic on CT. PET and CT therefore appear to be complementary in the assessment of bone metastases. (orig.)

Are previous episodes of bacterial vaginosis a predictor for vaginal symptoms in breast cancer patients treated with aromatase inhibitors?

DEFF Research Database (Denmark)

Gade, Malene R; Goukasian, Irina; Panduro, Nathalie

2018-01-01

Objective To estimate the prevalence of vaginal symptoms in postmenopausal women with breast cancer exposed to aromatase inhibitors, and to investigate if the risk of vaginal symptoms is associated with previous episodes of bacterial vaginosis. Methods Patients from Rigshospitalet and Herlev...... University Hospital, Denmark, were identified through the register of Danish Breast Cancer Cooperation Group and 78 patients participated in the study. Semiquantitave questionnaires and telephone interview were used to assess the prevalence of vaginal symptoms and previous episode(s) of bacterial vaginosis....... Multivariable logistic regression models were used to assess the association between vaginal symptoms and previous episodes of bacterial vaginosis. Results Moderate to severe symptoms due to vaginal itching/irritation were experienced by 6.4% (95% CI: 2.8-14.1%), vaginal dryness by 28.4% (95% CI: 19...

Pertussis-associated persistent cough in previously vaccinated children.

Science.gov (United States)

Principi, Nicola; Litt, David; Terranova, Leonardo; Picca, Marina; Malvaso, Concetta; Vitale, Cettina; Fry, Norman K; Esposito, Susanna

2017-11-01

To evaluate the role of Bordetella pertussis infection, 96 otherwise healthy 7- to 17-year-old subjects who were suffering from a cough lasting from 2 to 8 weeks were prospectively recruited. At enrolment, a nasopharyngeal swab and an oral fluid sample were obtained to search for pertussis infection by the detection of B. pertussis DNA and/or an elevated titre of anti-pertussis toxin IgG. Evidence of pertussis infection was found in 18 (18.7 %; 95 % confidence interval, 11.5-28.0) cases. In 15 cases, the disease occurred despite booster administration. In two cases, pertussis was diagnosed less than 2 years after the booster injection, whereas in the other cases it was diagnosed between 2 and 9 years after the booster dose. This study used non-invasive testing to show that pertussis is one of the most important causes of long-lasting cough in school-age subjects. Moreover, the protection offered by acellular pertussis vaccines currently wanes more rapidly than previously thought.

Intelligence, previous convictions and interrogative suggestibility: a path analysis of alleged false-confession cases.

Science.gov (United States)

Sharrock, R; Gudjonsson, G H

1993-05-01

The main purpose of this study was to investigate the relationship between interrogative suggestibility and previous convictions among 108 defendants in criminal trials, using a path analysis technique. It was hypothesized that previous convictions, which may provide defendants with interrogative experiences, would correlate negatively with 'shift' as measured by the Gudjonsson Suggestibility Scale (Gudjonsson, 1984a), after intelligence and memory had been controlled for. The hypothesis was partially confirmed and the theoretical and practical implications of the findings are discussed.

OBSESSIVE COMPULSIVE NEUROSIS: TREATMENT OF 28 CASES BY BEHAVIOUR THERAPY

OpenAIRE

Pradhan, P.V.; Ayyar, K.S.; Munjal, P.D.; Gopalani, J.H.; Mundra, A.V.; Doshi, Jyoti; Bagadia, V.N.

1984-01-01

SUMMARY Twenty-eight cases of obsessive compulsive neurosis were treated with a behaviour therapy package and good results were obtained in 15 (53.6%). Relaxation, thought-stopping, implosion, modelling, response prevention, electrical aversion and positive reinforcement wei; the techniques employed. Chronicity, previous treatments, follow-up data, drop-outs and the use of behaviour therapy in our setting are discussed in this paper.

Examining Pediatric Cases From the Clinical Research Office of the Endourological Society Ureteroscopy Global Study.

Science.gov (United States)

Guven, Selcuk; Basiri, Abbas; Varshney, Anil Kumar; Aridogan, Ibrahim Atilla; Miura, Hiroyasu; White, Mark; Kilinc, Mehmet; de la Rosette, Jean

2017-03-01

To evaluate the characteristics and outcomes of ureteroscopy (URS) in children treated in several hospitals participating in the Clinical Research Office of the Endourological Society (CROES) Study, and to present the overall results of pediatric URS compared with adults. The CROES Study collected data on consecutive patients treated with URS for urolithiasis at each participating center over a 1-year period. The collected prospective global database includes data for 11,885 patients who received URS at 114 centers in 32 countries. Of these URS-treated patients, 192 were ≤18 years old. Of the 114 centers participating in the study, 42% had conducted pediatric URS. Among the pediatric cases, 7 were infants, 53 were small children, 59 were school-aged children, and 73 were adolescents. A considerable number (37%) of the pediatric cases had previously undergone URS treatment. No differences in the surgical outcomes of the adults and children were reported. The URS-treated children had a greater number of positive preoperative urine cultures when compared with adult cases treated. A semirigid scope was used in the vast majority of pediatric cases (85%). According to the present data, within the group of URS-treated children, the younger the child, the more readmissions occurred. URS is as efficient and safe in children as it is in adults. The data suggest that readmissions among URS-treated children are associated with age, with the likelihood of readmissions greater among younger age groups. Copyright © 2016 Elsevier Inc. All rights reserved.

A rare case of Kounis syndrome provoked by mad honey poisoning

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Yakup Alsancak

2016-06-01

Full Text Available Kounis syndrome, resulting in acute coronary syndromes, as a result of allergic or hypersensitivity reaction is triggered by several factors. Vasospasm which is mediated by mediators released after mast cell activation, is the responsible mechanism for comprising of type 2-myocardial infarction. Mad honey containing grayanotoxin is previously shown to be associated with gastrointestinal, neurological and cardiac disorders. In this case report, we presented a Kounis syndrome that has occurred after the mad honey intake and treated successfully, previously not mentioned in the literature.

Rapid fish stock depletion in previously unexploited seamounts: the ...

African Journals Online (AJOL)

Rapid fish stock depletion in previously unexploited seamounts: the case of Beryx splendens from the Sierra Leone Rise (Gulf of Guinea) ... A spectral analysis and red-noise spectra procedure (REDFIT) algorithm was used to identify the red-noise spectrum from the gaps in the observed time-series of catch per unit effort by ...

Botulinum toxin for treating unilateral apraxia of eyelid opening in a patient with congenital myotonia

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Estrella Fernández

Full Text Available ABSTRACT A 37-year-old female presented with severe apraxia of lid opening (ALO affecting the right upper lid associated with Becker congenital myotonia (MC. The patient had a history of right upper lid ptosis for 25 years that was exacerbated over the previous month with severe incapacity to open her right eye. No other associated neurological or ophthalmic symptoms were observed. The patient was treated with botulinum toxin (BoNT-A injection into the pretarsal and lateral canthus region of the orbicularis oculi of the affected eyelid. Treatment with BoNT-A is an effective method of managing ALO in Becker MC. This is the first case of unilateral ALO in the course of Becker MC that was successfully treated with injections of botulinum toxin.

Angiographic findings of collateral vessels in cervicofacial vascular lesions with previously ligated carotid artery

International Nuclear Information System (INIS)

Na, Dong Gyu; Han, Moon Hee; Chang, Kee Hyun; Han, Gi Seok; Yeon, Kung Mo

1995-01-01

The purpose of this study is to describe the angiographic findings of collateral vessels in cervicofacial vascular lesions with previously ligated carotid arteries and to evaluate the extent of angiographic assessment needed before embolization. We retrospectively reviewed 10 cervicofacial vascular lesions with previously ligated carotid artery, which were 6 cases of arteriovenous malformation, 2 cases of carotid cavernous fistula, 1 case of hemangioma and 1 case of arteriovenous malformation with carotid cavernous fistula. The previously ligated arteries are proximal external carotid artery (n = 5), branches of external carotid artery (n = 2) and common carotid artery (n = 3). Common carotid artery or internal carotid artery (n = 9), vertebral artery (n = 5), ipsilateral external carotid artery (n = 4), contralateral external carotid artery (n = 5), costocervical trunk (n = 2), thyrocervical trunk (n = 2) were assessed by conventional angiography. Angiography of both carotid and vertebral arteries was performed in 5 cases. The collateral vascular channels were inferolateral trunk of internal carotid artery (n = 8), vertebral artery (n = 5), contralateral external carotid artery (n = 5), ipsilateral external carotid artery (n = 4), deep cervical artery (n = 2) and ascending cervical artery (n = 1). Embolization were performed in 9 cases with operative cannulation (n = 4), embolization via collateral branches of ipsilateral external carotid artery (n = 1), embolization via collateral branches of contralateral external carotid artery (n = 3) and balloon occlusion via direct puncture (n = 1). The collateral channels in cervicofacial vascular lesions with previously ligated carotid artery were inferolateral trunk of internal carotid artery, contralateral or ipsilateral external carotid artery, vertebral artery, deep cervical artery and ascending cervical artery on angiography. Complete angiographic assessment of possible collateral channels is mandatory for the

Bayesian pharmacokinetics of lithium after an acute self-intoxication and subsequent haemodialysis: a case report

NARCIS (Netherlands)

Kerbusch, Thomas; Mathôt, Ron A. A.; Otten, Hans M. M. B.; Meesters, Eelco W.; van Kan, Hendrikus J. M.; Schellens, Jan H. M.; Beijnen, Jos H.

2002-01-01

We report a case of a 39-year-old male with bipolar affective disorder who was admitted to hospital with an intentional acute lithium intoxication resulting in renal insufficiency. The patient had previously been treated with lithium, risperidone, fluoxetine and lorazepam, and successfully titrated

Reversible transvestic fetishism in a man with Parkinson's disease treated with selegiline.

Science.gov (United States)

Riley, David E

2002-01-01

Dopaminergic therapy in patients with Parkinson's disease may change the quality as well as the quantity of sexual interest and behavior. This 72-year-old man had a 37-year history of Parkinson's disease treated with a right thalamotomy and was later treated with levodopa for more than 20 years. Selegiline (5 mg twice daily) was added for motor fluctuations. He developed a frequent impulse to wear women's clothing but did not act on this impulse until his wife died over a year later. He then began to dress in women's clothing an average of once per week. He stated he had never thought of cross-dressing previously. The selegiline was stopped, and his urge to wear women's clothing ceased. Paraphilias are a rare behavioral complication of Parkinson's disease treatment. Other paraphilias have been attributed to dopamine agonists, suggesting that the action of the monoamine oxidase inhibitor responsible for the patient's transvestism in this case was dopamine potentiation. Drug-induced paraphilias and hypersexuality may represent a reversal of the putative premorbid Parkinson's disease personality traits of introversion, cautious behavior, and lack of "novelty-seeking." A biologic basis for transvestism, and paraphilias in general, is not known. Rare clues emerge from cases similar to this one.

The biomechanics of running in athletes with previous hamstring injury: A case-control study.

Science.gov (United States)

Daly, C; Persson, U McCarthy; Twycross-Lewis, R; Woledge, R C; Morrissey, D

2016-04-01

Hamstring injury is prevalent with persistently high reinjury rates. We aim to inform hamstring rehabilitation by exploring the electromyographic and kinematic characteristics of running in athletes with previous hamstring injury. Nine elite male Gaelic games athletes who had returned to sport after hamstring injury and eight closely matched controls sprinted while lower limb kinematics and muscle activity of the previously injured biceps femoris, bilateral gluteus maximus, lumbar erector spinae, rectus femoris, and external oblique were recorded. Intergroup comparisons of muscle activation ratios and kinematics were performed. Previously injured athletes demonstrated significantly reduced biceps femoris muscle activation ratios with respect to ipsilateral gluteus maximus (maximum difference -12.5%, P = 0.03), ipsilateral erector spinae (maximum difference -12.5%, P = 0.01), ipsilateral external oblique (maximum difference -23%, P = 0.01), and contralateral rectus femoris (maximum difference -22%, P = 0.02) in the late swing phase. We also detected sagittal asymmetry in hip flexion (maximum 8°, P = 0.01), pelvic tilt (maximum 4°, P = 0.02), and medial rotation of the knee (maximum 6°, P = 0.03) effectively putting the hamstrings in a lengthened position just before heel strike. Previous hamstring injury is associated with altered biceps femoris associated muscle activity and potentially injurious kinematics. These deficits should be considered and addressed during rehabilitation. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Nonunited humerus shaft fractures treated by external fixator augmented by intramedullary rod

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Mahmoud A El-Rosasy

2012-01-01

Full Text Available Background: Nonunion of humeral shaft fractures after previously failed surgical treatment presents a challenging therapeutic problem especially in the presence of osteoporosis, bone defect, and joint stiffness. It would be beneficial to combine the use of external fixation technique and intramedullary rod in the treatment of such cases. The present study evaluates the results of using external fixator augmented by intramedullary rod and autogenous iliac crest bone grafting (ICBG for the treatment of humerus shaft nonunion following previously failed surgical treatment. Materials and Methods: Eighteen patients with atrophic nonunion of the humeral shaft following previous implant surgery with no active infection were included in the present study. The procedure included exploration of the nonunion, insertion of intramedullary rod (IM rod, autogenous ICBG and application of external fixator for compression. Ilizarov fixator was used in eight cases and monolateral fixator in ten cases. The monolateral fixator was preferred for females and obese patients to avoid abutment against the breast or chest wall following the use of Ilizarov fixator. The fixator was removed after clinical and radiological healing of the nonunion, but the IM rod was left indefinitely. The evaluation of results included both bone results (union rate, angular deformity and limb shortening and functional outcome using the University of California, Los Angeles (UCLA rating scale. Results: The mean follow-up was 35 months (range 24 to 52 months. Bone union was obtained in all cases. The functional outcome was satisfactory in 15 cases (83% and unsatisfactory in 3 cases (17% due to joint stiffness. The time to bone healing averaged 4.2 months (range 3 to 7 months. The external fixator time averaged 4.5 months (range 3.2 to 8 months. Superficial pin tract infection occurred in 39% (28/72 of the pins. No cases of nerve palsy, refracture, or deep infection were encountered

[A case of flomoxef-induced pneumonitis].

Science.gov (United States)

Wako, Y; Hamauzu, T; Tamura, M; Yokote, M; Yokote, M; Shoji, S; Takikawa, H; Miyake, K; Yamanaka, M; Goto, H

1992-04-01

We report a case of flomoxef-induced pneumonitis. A 22-year-old man was treated with flomoxef following liver biopsy. A few days later he developed a high fever and severe dyspnea, and his chest X-ray film revealed diffuse reticulo-nodular shadows in both lung fields. We suspected interstitial pneumonitis due to flomoxef, and pulse therapy with methylprednisolone was started. He showed rapid recovery of symptoms and marked regression of pulmonary infiltration in his chest X-ray. Lymphocyte stimulation test was positive to flomoxef, which was compatible with the diagnosis of drug-induced pneumonitis. To our knowledge, there has been no previous case of pulmonary hypersensitivity to flomoxef reported in Japan.

Severe hypertriglyceridemia in diabetic ketoacidosis accompanied by acute pancreatitis: case report.

Science.gov (United States)

Hahn, Suk Jae; Park, Jung-hyun; Lee, Jong Ho; Lee, Jun Kyu; Kim, Kyoung-Ah

2010-09-01

We report a case of diabetic ketoacidosis (DKA) and hypertriglyceridemia (severely elevated to 15,240 mg/dL) complicated by acute pancreatitis, which was treated successfully with insulin therapy and conservative management. A 20-yr-old woman with a history of type 1 diabetes came to the emergency department 7 months after discontinuing insulin therapy. DKA, severe hypertriglyceridemia and acute pancreatitis were diagnosed, with DKA suspected of contributing to the development of the other conditions. In Korea, two cases of DKA-induced hypertriglyceridemia and 13 cases of hypertriglyceridemia-induced acute pancreatitis have been previously reported separately.

Roentgenographic findings in hyaline membrane disease treated with exogenous surfactant: comparison with control group

International Nuclear Information System (INIS)

Lee, Sun Kyoung; Lim, Chae Ha; Lim, Woo Young; Kim, Young Sook; Byen, Ju Nam; Oh, Jae Hee; Kim, Young Chul

1997-01-01

To compare, with the use of chest radiographic findings, improvement and complications in newborns treated with exogenous surfactant for hyaline membrane disease (HMD), and an untreated control group. Thirty-six patients with HMD were randomly assigned to a control group (n=18) or surfactant treated group (n=18). As part of an initial evaluation of their pulmonary status, we then performed a retrospective statistical analysis of chest radiographic findings obtained in exogenous surfactant treated and untreated infants within the first 90 minutes of life. Subsequent examinations were performed at less than 24 hours of age. Chest radiograph before treatment showed no significant differences between the two groups, but significant improvement was noted in the surfactant treated group, in contrast to the control group. The most common chest radiographic finding after surfactant administration was uniform (n=15) or disproportionate (n=2) improvement of pulmonary aeration. Patent ductus arteriosus developed in three treated neonates and in four cases in the control group. Air leak occurred in three cases in the treated group and in five cases in the control group. In one treated patient pulmonary hemorrhage developed and intracranial hemorrhage occurred in three treated neonates and in four cases in the control group. Bronchopulmonary dysplasia was developed in 6 cases of treated group and 3 cases of control group. A chest radiograph is considered to be helpful in the evaluation of improvement and complications of HMD in infants treated with surfactant

Use of acetazolamide in lithium-induced nephrogenic diabetes insipidus: a case report

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Ricardo A Macau

2018-02-01

Full Text Available Lithium-induced nephrogenic diabetes insipidus (Li-NDI is a rare and difficult-to-treat condition. A study in mice and two recent papers describe the use of acetazolamide in Li-NDI in 7 patients (a case report and a 6 patient series. We describe the case of a 63-year-old woman with bipolar disorder treated with lithium and no previous history of diabetes insipidus. She was hospitalized due to a bowel obstruction and developed severe dehydration after surgery when she was water deprived. After desmopressin administration and unsuccessful thiazide and amiloride treatment, acetazolamide was administrated to control polyuria and hydroelectrolytic disorders without significant side effects. To our knowledge, this is the third publication on acetazolamide use in Li-NDI patients.

Cauda equina enhancing lesion in a HIV-positive patient. Case report and literature revision.

Directory of Open Access Journals (Sweden)

Pasquale De Bonis

2011-10-01

Full Text Available We describe the case a spinal cord localization of neurological toxoplasmosis in a HIV-positive patient with Burkitt lymphoma, previously treated with chemotherapy and immunotherapy. This complication occurred while patient was in complete remission of lymphoma, with CD4+ T cell count of 270 /ml, undetectable HIV viremia, and despite the trimethoprim/ sulfamethoxazole prophylaxis. Indeed, we hypothesize that in our patient neurologic toxoplasmosis has been fostered more by previous immuno-chemotherapy than by HIV- related immunodeficiency. On the whole, this case suggests that parameters usually employed to predict the risk for opportunistic infections in HIV-positive people might not apply to patients with HIV-related lymphomas.

Haemophilus influenzae type f meningitis in a previously healthy boy

DEFF Research Database (Denmark)

Ronit, Andreas; Berg, Ronan M G; Bruunsgaard, Helle

2013-01-01

Non-serotype b strains of Haemophilus influenzae are extremely rare causes of acute bacterial meningitis in immunocompetent individuals. We report a case of acute bacterial meningitis in a 14-year-old boy, who was previously healthy and had been immunised against H influenzae serotype b (Hib...

Reasoning with Previous Decisions: Beyond the Doctrine of Precedent

DEFF Research Database (Denmark)

Komárek, Jan

2013-01-01

in different jurisdictions use previous judicial decisions in their argument, we need to move beyond the concept of precedent to a wider notion, which would embrace practices and theories in legal systems outside the Common law tradition. This article presents the concept of ‘reasoning with previous decisions...... law method’, but they are no less rational and intellectually sophisticated. The reason for the rather conceited attitude of some comparatists is in the dominance of the common law paradigm of precedent and the accompanying ‘case law method’. If we want to understand how courts and lawyers......’ as such an alternative and develops its basic models. The article first points out several shortcomings inherent in limiting the inquiry into reasoning with previous decisions by the common law paradigm (1). On the basis of numerous examples provided in section (1), I will present two basic models of reasoning...

A Case Report: Subanesthetic Ketamine Infusion for Treatment of Cancer-Related Pain Produces Urinary Urge Incontinence.

Science.gov (United States)

Vickers, Barbara A; Lee, Wayne; Hunsberger, Joann

2017-05-01

Oncology patients undergoing treatment can experience substantial pain related to their disease or prescribed therapy. Ketamine infusions at subanesthetic doses have been used at our institution to supplement the pain management regimens of 262 patients. We present 2 cases in which young adult patients being treated with subanesthetic ketamine for cancer-related pain experienced urinary urgency and incontinence after initiation or increase of the ketamine infusion. This adverse effect has not been reported previously at this dosing range. These case reports suggest that subanesthetic ketamine infusions may cause side effects that previously have been reported only at anesthetic or abuse doses.

Localized malignant pleural mesothelioma: report of two cases.

Science.gov (United States)

Tanzi, Silvia; Tiseo, Marcello; Internullo, Eveline; Cacciani, Giancarlo; Capra, Roberto; Carbognani, Paolo; Rusca, Michele; Rindi, Guido; Ardizzoni, Andrea

2009-08-01

Localized malignant pleural mesothelioma is very rare tumor disease. There are sporadic reports in the literature showing that this entity has a different biologic behavior compared with diffuse pleural mesothelioma. We report two cases of radically resected localized pleural malignant mesothelioma, with a previous history of asbestos exposure. Both cases showed a microscopic and immunohistochemical findings of malignant mesothelioma, biphasic and sarcomatoid lympho-histiocitoid variant type, respectively, without evidence of diffuse pleural spread. The first is very peculiar case of bilateral localized malignant pleural mesothelioma with complete response to chemotherapy and localized late recurrence, radically resected and treated with adjuvant radiotherapy. The second case revealed as a solitary localized mass, underwent a complete en bloc resection and adjuvant radiotherapy. Both cases demonstrate that the localized malignant mesothelioma should be distinguished from diffuse form and that complete resection is associated with good prognosis.

SAFETY AND ACTIVITY OF TEMSIROLIMUS AND BEVACIZUMAB IN PATIENTS WITH ADVANCED RENAL CELL CARCINOMA PREVIOUSLY TREATED WITH TYROSINE KINASE INHIBITORS: A PHASE 2 CONSORTIUM STUDY

Science.gov (United States)

Merchan, Jaime R.; Qin, Rui; Pitot, Henry; Picus, Joel; Liu, Glenn; Fitch, Tom; Maples, William J.; Flynn, Patrick J.; Fruth, Briant F.; Erlichman, Charles

2015-01-01

Purpose Bevacizumab or Temsirolimus regimens have clinical activity in the first line treatment of advanced renal cell carcinoma (RCC). This phase I/II trial was conducted to determine the safety of combining both agents and its efficacy in RCC patients who progressed on at least one prior anti-VEGF receptor tyrosine kinase inhibitor (RTKI) agent. Methods In the phase I portion, eligible patients were treated with Temsirolimus (25 mg IV weekly) and escalating doses of IV Bevacizumab (level 1=5mg/kg; level 2=10 mg/kg) every other week. The primary endpoint for the phase II portion (RTKI resistant patients) was the 6-month progression free rate. Secondary endpoints were response rate, toxicity evaluation, PFS and OS. Results MTD was not reached at the maximum dose administered in 12 phase I patients. Forty evaluable patients were treated with the phase II recommended dose (Temsirolimus 25 mg IV weekly and Bevacizumab 10 mg/kg IV every two weeks). The 6-month progression free rate was 40% (16/40 pts). Median PFS was 5.9 (4-7.8) months, and median OS was 20.6 (11.5-23.7) months. Partial response/stable/progressive disease were seen in 23%/63%/14% of patients. Most common grade 3-4 AEs included fatigue (17.8%), hypertriglyceridemia (11.1%), stomatitis (8.9%), proteinuria (8.9%), abdominal pain (6.7%), and anemia (6.7%). Baseline levels of serum sFLT-1 and VEGF-A were inversely correlated with PFS and OS, respectively. Conclusions Temsirolimus and Bevacizumab is a feasible combination in patients with advanced RCC previously exposed to oral anti-VEGF agents. The safety and efficacy results warrant further confirmatory studies in this patient population. PMID:25556030

Radionecrosis of the brain presenting as a mass lesion: a case report

Energy Technology Data Exchange (ETDEWEB)

Littman, P [Pennsylvania Univ., Philadelphia (USA). Dept. of Radiology; James, H; Zimmerman, R; Slater, R

1977-08-01

A case of radionecrosis of the brain in a patient previously treated for squamous cell carcinoma of the scalp is presented. Cerebral angiography revealed a mass effect primarily in the right frontal area. Computed tomography showed extensive hemispheric edema. A frontal lobectomy was performed, and the recovery was excellent. The lower limit for brain tolerance for irradiation is about 5000 rads given in five weeks. This dose should not be exceeded when extracranial lesions are treated. Although computed tomography cannot diagnose brain necrosis, specifically, it should, along with the clinical history, be very helpful.

Children of parents treated by irradiation and chemotherapy for Hodgkin's disease

International Nuclear Information System (INIS)

Dienstbier, Z.; Hermanska, Z.; Skala, E.; Vackova, B.; Melinova, L.

1994-01-01

Data are presented on the course of pregnancy, delivery and subsequent development of 20 children born to parents treated for Hodgkin's disease. Thirteen women in clinical stage II and III were delivered of 16 infants (10 daughters and 6 sons), and three men (IIA and IIIA) had 4 daughters. The parents were in one case treated by irradiation only, twice by chemotherapy only and thirteen times by a combination of irradiation and chemotherapy (COPP/ABVD). The gestation period, parameters of the infants at delivery and their subsequent physical and mental development were normal. In one instance (a girl, now ten and a half years old) the child was born with malformations of the extremities; according to the geneticist this is not related to the previous treatment of the mother. The second child (a son) of this mother is normal. The authors apply their opinion in the therapeutic protocol not to irradiate nodes in the pelvic region in patients of fertile age. In treated patients they allow pregnancy only after three or preferably five years following the end of treatment. Survival of patients in the whole group (269 subjects) regardless of age and clinical stage is 75%. A data base of Hodgkin patients has been set up since 1968. (author) 2 tabs., 14 refs

Kocuria varians infection associated with brain abscess: A case report

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Tsai Tai-Hsin

2010-04-01

Full Text Available Abstract Background Kocuria, established by Stackebrandt et al., previously was classified into Micrococcus. Only two species, K. rosea and K. kristinae are reported to be associated as pathogenic and found with catheter-related bacteremia and acute cholecystitis. Case presentation We herein report the first case of brain abscess caused by Kocuria varians, a gram-positive microorganism, in a 52-year-old man. Hematogenous spread is the probable pathogenesis. Conclusions This report presents a case of Kocuria varians brain abscess successfully treated with surgical excision combined with antimicrobial therapy. In addition, Vitek 2 system has been used to identify and differentiate between coagulase-negative staphylococcus.

[ANTITHROMBOTIC MEDICATION IN PREGNANT WOMEN WITH PREVIOUS INTRAUTERINE GROWTH RESTRICTION].

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Neykova, K; Dimitrova, V; Dimitrov, R; Vakrilova, L

2016-01-01

To analyze pregnancy outcome in patients who were on antithrombotic medication (AM) because of previous pregnancy with fetal intrauterine growth restriction (IUGR). The studied group (SG) included 21 pregnancies in 15 women with history of previous IUGR. The patients were on low dose aspirin (LDA) and/or low molecular weight heparin (LMWH). Pregnancy outcome was compared to the one in two more groups: 1) primary group (PG) including the previous 15 pregnancies with IUGR of the same women; 2) control group (CG) including 45 pregnancies of women matched for parity with the ones in the SG, with no history of IUGR and without medication. The SG, PG and CG were compared for the following: mean gestational age (g.a.) at birth, mean birth weight (BW), proportion of cases with early preeclampsia (PE), IUGR (total, moderate, and severe), intrauterine fetal death (IUFD), neonatal death (NND), admission to NICU, cesarean section (CS) because of chronic or acute fetal distress (FD) related to IUGR, PE or placental abruption. Student's t-test was applied to assess differences between the groups. P values < 0.05 were considered statistically significant. The differences between the SG and the PG regarding mean g. a. at delivery (33.7 and 29.8 w.g. respectively) and the proportion of babies admitted to NICU (66.7% vs. 71.4%) were not statistically significant. The mean BW in the SG (2114,7 g.) was significantly higher than in the PG (1090.8 g.). In the SG compared with the PG there were significantly less cases of IUFD (14.3% and 53.3% respectively), early PE (9.5% vs. 46.7%) moderate and severe IUGR (10.5% and 36.8% vs. 41.7% and 58.3%). Neonatal mortality in the SG (5.6%) was significantly lower than in the PG (57.1%), The proportion of CS for FD was not significantly different--53.3% in the SG and 57.1% in the PG. On the other hand, comparison between the SG and the CG demonstrated significantly lower g.a. at delivery in the SG (33.7 vs. 38 w.g.) an lower BW (2114 vs. 3094 g

Surgical repair of an aberrant splenic artery aneurysm: report of a case.

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Illuminati, Giulio; LaMuraglia, Glenn; Nigri, Giuseppe; Vietri, Francesco

2007-03-01

Aneurysms of the splenic artery are the most common splanchnic aneurysms. Aneurysms of a splenic artery with an anomalous origin from the superior mesenteric artery are however rare, with eight previously reported cases. Their indications for treatment are superposable to those of aneurysms affecting an orthotopic artery. Methods of treatment of this condition include endovascular, minimally invasive techniques and surgical resection. We report one more case of aneurysm of an aberrant splenic artery, treated with surgical resection, and preservation of the spleen.

A case of allergic bronchopulmonary aspergillosis successfully treated with mepolizumab.

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Terashima, Takeshi; Shinozaki, Taro; Iwami, Eri; Nakajima, Takahiro; Matsuzaki, Tatsu

2018-03-27

, by 4 weeks after mepolizumab treatment. Peripheral eosinophil count decreased to 174/μL. Spirometry revealed improvement of lung function (FEV 1 : 1.28 L). A chest CT scan demonstrated the disappearance of pulmonary infiltration and mucoid impaction. To our knowledge, this is the first case of ABPA to be treated with mepolizumab. Dramatic improvements were observed in symptoms, lung function, peripheral eosinophil counts, and chest images. Mepolizumab could serve as an alternative treatment with the potential to provide a systemic corticosteroid-sparing effect.

Use of Intracervical Foley Catheter for Induction of Labour in Cases of Previous Caesarean Section; Experience of a single tertiary centre in Oman

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Hazel Gonsalves

2016-11-01

Full Text Available Objectives: This study aimed to evaluate rates of success and perinatal complications of labour induction using an intracervical Foley catheter among women with a previous Caesarean delivery at a tertiary centre in Oman. Methods: This retrospective cohort study included 68 pregnant women with a history of a previous Caesarean section who were admitted for induction via Foley catheter between January 2011 and December 2013 to the Sultan Qaboos University Hospital, Muscat, Oman. Patient data were collected from electronic and delivery ward records. Results: Most women were 25–35 years old (76.5% and 20 women had had one previous vaginal delivery (29.4%. The most common indication for induction of labour was intrauterine growth restriction with oligohydramnios (27.9%. Most women delivered after 40 gestational weeks (48.5% and there were no neonatal admissions or complications. The majority experienced no complications during the induction period (85.3%, although a few had vaginal bleeding (5.9%, intrapartum fever (4.4%, rupture of the membranes (2.9% and cord prolapse shortly after insertion of the Foley catheter (1.5%. However, no cases of uterine rupture or scar dehiscence were noted. Overall, the success rate of vaginal birth after a previous Caesarean delivery was 69.1%, with the remaining patients undergoing an emergency Caesarean section (30.9%. Conclusion: The use of a Foley catheter in the induction of labour in women with a previous Caesarean delivery appears a safe option with a good success rate and few maternal and fetal complications.

Recurrent Hypothenar Hammer Syndrome: A Case Report.

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Adams, Nicholas S; Ford, Ronald D

2016-10-01

Hypothenar hammer syndrome (HHS) is a rare cause of digital ischemia and pain caused from repetitive trauma to the palm. Often related to occupational practices, thrombosis and embolization can occur. Treatment is often surgical and involves excision with or without reconstruction. We describe a 55 year-old, male pipe fitter previously diagnosed and treated for HHS with excision and repair using a reversed interpositional vein graft in the mid-1980's. He continued to work in the profession, which he regularly used his palm as a hammer and returned approximately 30 years later with recurrent symptoms of cold intolerance and pain. Angiography confirmed occlusion of the ulnar artery with emboli present distally. The patient was again treated with excision and reconstruction. HHS is an uncommon cause of digital ischemia. Its recurrence is even more rare. To our knowledge, this is the first described case of diagnosed and treated recurrent HHS.

Incidence of Acneform Lesions in Previously Chemically Damaged Persons-2004

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N Dabiri

2008-04-01

Full Text Available ABSTRACT: Introduction & Objective: Chemical gas weapons especially nitrogen mustard which was used in Iraq-Iran war against Iranian troops have several harmful effects on skin. Some other chemical agents also can cause acne form lesions on skin. The purpose of this study was to compare the incidence of acneform in previously chemically damaged soldiers and non chemically damaged persons. Materials & Methods: In this descriptive and analytical study, 180 chemically damaged soldiers, who have been referred to dermatology clinic between 2000 – 2004, and forty non-chemically damaged people, were chosen randomly and examined for acneform lesions. SPSS software was used for statistic analysis of the data. Results: The mean age of the experimental group was 37.5 ± 5.2 and that of the control group was 38.7 ± 5.9 years. The mean percentage of chemical damage in cases was 31 percent and the time after the chemical damage was 15.2 ± 1.1 years. Ninety seven cases (53.9 percent of the subjects and 19 people (47.5 percent of the control group had some degree of acne. No significant correlation was found in incidence, degree of lesions, site of lesions and age of subjects between two groups. No significant correlation was noted between percentage of chemical damage and incidence and degree of lesions in case group. Conclusion: Incidence of acneform lesions among previously chemically injured peoples was not higher than the normal cases.

Photodynamic therapy for mycosis fungoides: a case series and review of the literature

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Robert E. Hunger

2015-01-01

Full Text Available Mycosis fungoides (MF is the most common form of cutaneous T cell lymphoma. In early stages of the disease, topical therapeutic approaches like steroids, chemotherapy, phototherapy or spot radiation therapy are most commonly used. Photodynamic therapy (PDT is widely executed in the treatment of actinic keratosis and superficial basal cell carcinoma. The effective use of PDT for early forms of MF has been previously demonstrated in a series of cases. In this instance, the treatment of MF (n = 6, 11 lesions with methyl alanine PDT (MAL-PDT in 73% of the treated lesions showed a complete response. Within the timeframe of 25-51 months, no recurrence of the successfully treated lesions was observed, on the contrary some of the patients developed new lesions on different sites. Hence, this case study shows that patients having a single or few MF lesions can be successfully treated by PDT.

A successful antimicrobial therapeutic strategy for the discitis caused by Aggregatibacter actinomycetemcomitans under unknown drug susceptibility: A case report.

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Uno, Shunsuke; Horiuchi, Yosuke; Uchida, Takae; Yonaha, Akiko; Miyata, Takanori; Nagano, Eiko; Kodama, Takao; Hasegawa, Naoki

2018-04-20

Aggregatibacter actinomycetemcomitans is well-known as the pathogen of gingivitis or periodontitis, and discitis or vertebral osteomyelitis cases caused by this organism have rarely been reported. Ampicillin or amoxicillin has been used in the previously reported discitis cases; however, no cases have been reported that is treated with levofloxacin. We report the first published case we chose levofloxacin to treat. We failed to perform the susceptibility testing because of the poor growth and fastidious nature of the organism, and the result of susceptibility of amoxicillin was unclear. Levofloxacin, which A. actinomycetemcomitans is usually susceptible to, can be an effective alternative oral antimicrobial agent in such cases. Copyright © 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Logic of Accounting: The Case of Reporting Previous Options in Norwegian Activation Encounters

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Solberg, Janne

2017-01-01

The article deals with the enactment of client resistance in Norwegian vocational rehabilitation encounters. More specific, a practice here called "reporting previous options" is analyzed by using the resources of ethnomethodological conversation analysis (CA) in five instances as doing some sort of accounting. In response to the…

High 15-F2t-Isoprostane Levels in Patients with a Previous History of Nonmelanoma Skin Cancer: The Effects of Supplementary Antioxidant Therapy

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Betânia de Jesus e Silva de Almendra Freitas

2015-01-01

Full Text Available Background. Phase I of this study was aimed at comparing the profiles of oxidative stress biomarkers in patients with history of nonmelanoma skin cancer (NMSC, previously treated with surgery, to the healthy subjects. Phase II aimed to evaluate the effects of supplementary antioxidant therapy on the levels of biomarkers in the case group. Materials and Methods. In Phase I, oxidative stress biomarkers were measured in blood samples obtained from 24 healthy subjects and 60 patients with history of NMSC previously treated with surgery. In Phase II, the 60 patients with history of NMSC were randomized into two subgroups, one receiving placebo (n=34 and the other (n=26 receiving vitamin C, vitamin E, and zinc supplementation for 8 weeks, followed by reevaluation of biomarkers. Results. In Phase I, patients with history of NMSC showed increased plasma concentrations of all biomarkers, but only 15-F2t-isoprostane was significantly higher than in the healthy subjects. Risk of NMSC increased by 4% for each additional 1 pg/mL increase in 15-F2t-isoprostane. In Phase II, supplementation did not significantly reduce levels of oxidative stress biomarkers. Conclusion. Patients with history of NMSC had significantly high 15-F2t-isoprostane plasma levels; supplementation did not result in significant reduction of oxidative stress biomarkers. This trial was registered with ClinicalTrials.gov (ID NCT02248584.

Everolimus Implicated in Case of Severe Gastrointestinal Hemorrhage

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Paul Gonzales

2017-01-01

Full Text Available Breast cancer remains the leading cause of cancer and the third leading cause of cancer related deaths among our population with an estimated number of 246,660 new cases and 40,450 deaths in 2016. With treatment advancements, including targeted agents such as Everolimus, a mammalian target of rapamycin (mTOR inhibitor, survivability and quality of life continue to improve. However, with the use of these agents come adverse effects, some of which are still being characterized. Our case demonstrates recurrent episodes of gastrointestinal bleeding in a 60-year-old woman being treated with Everolimus for progressive metastatic breast cancer. On endoscopy, bleeding was secondary to erosive gastritis. Previous case reports have described bleeding due to gastric antral vascular ectasia (GAVE, which was described in two prior reported cases. In our case, bleeding also occurred on a reduced dose of Everolimus compared to what is previously reported (5 mg versus 10 mg. As a result of her gastrointestinal bleeding, she required multiple endoscopic interventions including argon plasma coagulation and multipolar heater probe to achieve hemostasis. This is the first case reported of gastrointestinal bleeding not consistent with GAVE and occurring while being on a reduced dose of Everolimus. It is important to document our case so that the Gastroenterology and Hematology communities can be educated and made aware for their patient populations on Everolimus.

Micrococcus sedentarius bacteraemia presenting with haemophagocytic syndrome in previously healthy boy.

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Kuskonmaz, Baris; Kara, Ates; Ozen, Maide; Cengiz, A Bülent; Ozen, Metehan; Seçmeer, Gülten; Gürgey, Aytemiz

2006-01-01

Haemophagocytic syndromes are the clinical manifestation of an increased macrophagic activity with haemophagocytosis. Infection-associated HS was originally described by Risdall in 1979, in viral disease. Since the initial description HS has also been documented in patients with bacterial, parasitic or fungal infections. We describe a case of Micrococcus sedentarius bacteraemia in a previously healthy 10-y-old boy with haemophagocytic syndrome. Species of micrococci are generally considered as non-pathogenic commensals that colonize the skin, mucosae and oropharynx. We report the first case of Microccoccus sedentarius bacteraemia in an immunocompetent host and first case of HS associated with Micrococcus species.

Integrating health economics into the product development cycle: a case study of absorbable pins for treating hallux valgus.

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Vallejo-Torres, Laura; Steuten, Lotte; Parkinson, Bonny; Girling, Alan J; Buxton, Martin J

2011-01-01

The probability of reimbursement is a key factor in determining whether to proceed with or abandon a product during its development. The purpose of this article is to illustrate how the methods of iterative Bayesian economic evaluation proposed in the literature can be incorporated into the development process of new medical devices, adapting them to face the relative scarcity of data and time that characterizes the process. A 3-stage economic evaluation was applied: an early phase in which simple methods allow for a quick prioritization of competing products; a mid-stage in which developers synthesize the data into a decision model, identify the parameters for which more information is most valuable, and explore uncertainty; and a late stage, in which all relevant information is synthesized. A retrospective analysis was conducted of the case study of absorbable pins, compared with metallic fixation, in osteotomy to treat hallux valgus. The results from the early analysis suggest absorbable pins to be cost-effective under the beliefs and assumptions applied. The outputs from the models at the mid-stage analyses show the device to be cost-effective with a high probability. Late-stage analysis synthesizes evidence from a randomized controlled trial and informative priors, which are based on previous evidence. It also suggests that absorbable pins are the most cost-effective strategy, although the uncertainty in the model output increased considerably. This example illustrates how the method proposed allows decisions in the product development cycle to be based on the best knowledge that is available at each stage.

Secondary recurrent miscarriage is associated with previous male birth.

LENUS (Irish Health Repository)

Ooi, Poh Veh

2012-01-31

Secondary recurrent miscarriage (RM) is defined as three or more consecutive pregnancy losses after delivery of a viable infant. Previous reports suggest that a firstborn male child is associated with less favourable subsequent reproductive potential, possibly due to maternal immunisation against male-specific minor histocompatibility antigens. In a retrospective cohort study of 85 cases of secondary RM we aimed to determine if secondary RM was associated with (i) gender of previous child, maternal age, or duration of miscarriage history, and (ii) increased risk of pregnancy complications. Fifty-three women (62.0%; 53\\/85) gave birth to a male child prior to RM compared to 32 (38.0%; 32\\/85) who gave birth to a female child (p=0.002). The majority (91.7%; 78\\/85) had uncomplicated, term deliveries and normal birth weight neonates, with one quarter of the women previously delivered by Caesarean section. All had routine RM investigations and 19.0% (16\\/85) had an abnormal result. Fifty-seven women conceived again and 33.3% (19\\/57) miscarried, but there was no significant difference in failure rates between those with a previous male or female child (13\\/32 vs. 6\\/25, p=0.2). When patients with abnormal results were excluded, or when women with only one previous child were considered, there was still no difference in these rates. A previous male birth may be associated with an increased risk of secondary RM but numbers preclude concluding whether this increases recurrence risk. The suggested association with previous male birth provides a basis for further investigations at a molecular level.

Secondary recurrent miscarriage is associated with previous male birth.

LENUS (Irish Health Repository)

Ooi, Poh Veh

2011-01-01

Secondary recurrent miscarriage (RM) is defined as three or more consecutive pregnancy losses after delivery of a viable infant. Previous reports suggest that a firstborn male child is associated with less favourable subsequent reproductive potential, possibly due to maternal immunisation against male-specific minor histocompatibility antigens. In a retrospective cohort study of 85 cases of secondary RM we aimed to determine if secondary RM was associated with (i) gender of previous child, maternal age, or duration of miscarriage history, and (ii) increased risk of pregnancy complications. Fifty-three women (62.0%; 53\\/85) gave birth to a male child prior to RM compared to 32 (38.0%; 32\\/85) who gave birth to a female child (p=0.002). The majority (91.7%; 78\\/85) had uncomplicated, term deliveries and normal birth weight neonates, with one quarter of the women previously delivered by Caesarean section. All had routine RM investigations and 19.0% (16\\/85) had an abnormal result. Fifty-seven women conceived again and 33.3% (19\\/57) miscarried, but there was no significant difference in failure rates between those with a previous male or female child (13\\/32 vs. 6\\/25, p=0.2). When patients with abnormal results were excluded, or when women with only one previous child were considered, there was still no difference in these rates. A previous male birth may be associated with an increased risk of secondary RM but numbers preclude concluding whether this increases recurrence risk. The suggested association with previous male birth provides a basis for further investigations at a molecular level.

A case of radiation ulcer of the neck treated by a lower trapezius myocutaneous flap

International Nuclear Information System (INIS)

Shimbashi, Takeshi; Satomi, Takao; Okuyama, Toshio.

1981-01-01

A case of radiation ulcer of the neck is reported. The patient is a 50-year-old male. He had been treated for a malignant parotid tumor 12 years earlier. Extirpation of the tumor and radical neck disection had been performed and after the operation he received radiation therapy. On 1979, erosion appeared and developed into an ulcer. On October 14, massive hemorrhage and cardiac arrest suddenly occurred. Immediate emergency treatment was administered and he was resuscitated. He was admitted to our division for the reconstruction of his ulcer. The operation was successfully performed on his ulcer using a lower trapezius myocutaneous flap. He has been followed up for 9 months. The effect of the operation is esthetically and functionally satisfactory. (author)

Forty-seven Cases of Gonitis Treated by A Combined Therapy of Chinese Drugs and Acupuncture

Institute of Scientific and Technical Information of China (English)

杨文鹤

2001-01-01

@@Osteoarthritis, a nonspecific inflammatory lesion, is a commonly seen joint disease. Clinically, it is mainly characterized by arthralgia, swelling, and motor impairment. Since the knee joint is the load-bearing joint of the human body, and is susceptible to trauma, gonitis tends to have the highest morbidity in the four limbs, which manifests itself arthritis of patella and femur at the early stage; narrowness or disappearance of the medial joint space at the mid stage; and damage of the cartilage accompanied with flexion deformity at the late stage. In recent years, based on the experience of Prof. Cao Yiming, the author has treated 47 cases of gonitis by combined use of Chinese drugs and acupuncture, and obtained satisfactory therapeutic results as reported in the following.

Congenital costo-vertebral fibrous band and congenital kyphoscoliosis: a previously unreported combination.

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Eid, Tony; Ghostine, Bachir; Kreichaty, Gaby; Daher, Paul; Ghanem, Ismat

2013-05-01

Congenital kyphoscoliosis (CKS) results from abnormal vertebral chondrification. Congenital fibrous bands occur in several locations with variable impact on vertebral development. We report a previously unreported case of a female infant with CKS presenting with an L2 hypoplastic vertebra and a costo-vertebral fibrous band extending to the skin in the form of a dimple. We also describe the therapeutic approach, consisting of surgical excision of the fibrous band and postoperative fulltime bracing, with a 7-year follow-up. We recommend a high index of suspicion in any unusual presentation of CKS and insist on case by case management in such cases.

Nonsurgical periodontal therapy to treat a case of severe periodontitis: A 12-year follow-up.

Science.gov (United States)

Carnio, João; Moreira, Ana Karina; Jenny, Todd; Camargo, Paulo M; Pirih, Flavia Q

2015-08-01

This case report describes the successful treatment of a severe chronic periodontitis case by nonsurgical therapy and a strict maintenance program over a 12-year period. A 38-year-old man concerned about the protrusion of his maxillary incisors was referred for periodontal treatment. The teeth in the maxillary arch had generalized severe chronic periodontitis. Several treatment options were presented to the patient including the most aggressive, extraction of all maxillary teeth, and the most conservative, scaling and root planing. The patient opted to having the most conservative approach, even though the prognoses for the maxillary teeth were unfavorable. Therefore, he received nonsurgical therapy via scaling and root planing combined with systemic antibiotics before referral to an orthodontist to address the esthetic concerns. The maxillary dentition was treated with orthodontic therapy to retract and align the maxillary anterior segment. Periodontal maintenance (1-hour session), including subgingival instrumentation, was performed 4 times per year until the end of the 12-year follow-up period. The patient only missed 2 appointments in 12 years. Twelve years later, the results revealed that all but 1 maxillary tooth were maintained in a state of acceptable health, function, and esthetics. Although most would agree with the initial poor prognosis of this patient's case, nonsurgical periodontal therapy was utilized with a 3-month periodontal maintenance program and demonstrated long-term success. The outcome presented in this case report may only have been possible because of patient compliance, professional experience, skill, and supervision throughout the course of treatment. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

Spinal and para spinal tumors treated by Cyberknife: feasibility and efficacy

International Nuclear Information System (INIS)

Castelli, J.; Thariat, J.; Benezery, K.; Courdi, A.; Doyen, J.; Mammar, H.; Bondiau, P.Y.; Chanalet, S.; Paquis, P.; Frenay, M.

2010-01-01

Purpose Stereotactic radiotherapy using the Cyberknife has become a key treatment in the multidisciplinary management of secondary tumours, as well as primary benign or malignant tumours located within or adjacent to vertebral bodies and the spinal cord. The aim of this treatment is to improve local control and clinical response, including previously irradiated cases. Patients and methods In this study, we present the first patients treated with Cyberknife between December 2006 and December 2007 for spinal or para spinal tumours. The primary aim was to assess the feasibility and tolerance of stereotactic radiotherapy using the Cyberknife. Secondary aims were to establish the short-term local control, to calculate the local progression-free survival and overall survival. Clinical examination and imaging procedures were performed every three months. Response was assessed according to RECIST criteria. Results During that period, 16 patients were treated with Cyberknife. Thirteen patients had been pre-treated, three of whom had received spinal cord doses considered to be maximal. Three patients did not receive previous irradiation. The median age was 59 (36-74). The most frequent symptoms were pain (n = 8) and motor weakness (n = 4). The median dose was 30 Gy (16-50). The median number of fractions was 3 (1-5). No patient developed acute myelitis. Three patients developed acute reaction. Overall survival at 18 months was 72.4%, with a mean survival of 18.2 months (95% CI: 15.4-20.9). Local progression-free survival at 18 months was 58.4%, with a mean value of 16.9 months (95% CI: 13.6-20.2). Conclusion The use of stereotactic radiotherapy with Cyberknife represents a major progress in the management of para spinal tumours. The main advantages are better sparing of the spinal cord and the possibility of increasing the dose to the tumour target volume. (authors)

Rapidly growing non-tuberculous mycobacteria infection of prosthetic knee joints: A report of two cases.

Science.gov (United States)

Kim, Manyoung; Ha, Chul-Won; Jang, Jae Won; Park, Yong-Beom

2017-08-01

Non-tuberculous mycobacteria (NTM) cause prosthetic knee joint infections in rare cases. Infections with rapidly growing non-tuberculous mycobacteria (RGNTM) are difficult to treat due to their aggressive clinical behavior and resistance to antibiotics. Infections of a prosthetic knee joint by RGNTM have rarely been reported. A standard of treatment has not yet been established because of the rarity of the condition. In previous reports, diagnoses of RGNTM infections in prosthetic knee joints took a long time to reach because the condition was not suspected, due to its rarity. In addition, it is difficult to identify RGNTM in the lab because special identification tests are needed. In previous reports, after treatment for RGNTM prosthetic infections, knee prostheses could not be re-implanted in all cases but one, resulting in arthrodesis or resection arthroplasty; this was most likely due to the aggressiveness of these organisms. In the present report, two cases of prosthetic knee joint infection caused by RGNTM (Mycobacterium abscessus) are described that were successfully treated, and in which prosthetic joints were finally reimplanted in two-stage revision surgery. Copyright © 2017 Elsevier B.V. All rights reserved.

Late-Onset Massive Epistaxis due to a Ruptured Traumatic Internal Carotid Artery Aneurysm: A Case Report

OpenAIRE

Arai, Nobuhiko; Nakamura, Akiyoshi; Tabuse, Masanao; Miyazaki, Hiromichi

2016-01-01

A traumatic internal carotid artery (ICA) aneurysm is rare and difficult to treat. Trapping of ICA is commonly performed owing to the difficulty of directly approaching ICA aneurysms. Recently, coiling the aneurysm itself was recommended if possible. However, it is controversial which of methods are best to completely treat aneurysm. We present the case of a 74-year-old man, who had experienced a head injury 8 years previously, with recurrent severe epistaxis. An ICA aneurysm was detected on ...

A role for b-cell-depleting agents in treating psoriatic skin lesions induced by tumor necrosis factor-alpha antagonists: A case report and literature review

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Ancuta Codrina Mihaela

2014-01-01

Full Text Available Despite recent advances in understanding the pathological pathways, clinical pattern and management opportunities for new-onset psoriasis as a paradoxical adverse event in patients receiving TNF inhibitors for their immune-mediated disorder, there is a subset of patients who are either partial responders or non-responders, whatever the therapeutic scenario. We present the case of new-onset psoriasis and severe alopecia development in a case study of long-standing rheumatoid arthritis (RA treated with adalimumab (ADA and leflunomide. Since skin lesions and alopecia are resistant to the classic protocol (topical treatment, ADA discontinuation and RA becomes highly active, rituximab (RTX was started. Dramatic improvement in joint disease, total remission of alopecia and partial remission of pustular psoriasis were described after the first RTX cycle. Although B-cell-depleting agents result in controversial effects on psoriatic skin lesions, this is the first case of ADA-induced psoriasis and alopecia that improved under RTX, suggesting a possible role in treating such a patient population.

A Case Report of Mania and Psychosis Five Months after Traumatic Brain Injury Successfully Treated Using Olanzapine

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Giordano F. Cittolin-Santos

2017-01-01

Full Text Available Background. There are few published pharmacologic trials for the treatment of acute mania following traumatic brain injury (TBI. To our knowledge, we present the first case report of an individual being treated and stabilized with olanzapine monotherapy for this condition. Case Presentation. We describe the case of a 53-year-old African American male admitted to an inpatient psychiatric hospital with one month of behavioral changes including irritability, decreased need for sleep, hyperverbal speech, hypergraphia, and paranoia five months after TBI. Using Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5 criteria, he was diagnosed with bipolar disorder due to traumatic brain injury, with manic features. He was serially evaluated with clinical rating scales to measure symptom severity. The Young Mania Rating Scale (YMRS score upon admission was 31, and the Clinician-Rated Dimensions of Psychosis Symptom Severity (CRDPSS score was initially 9. After eight days of milieu treatment and gradual titration of olanzapine to 15 mg nightly, his symptoms completely abated, with YMRS and CRDPSS scores at zero on the day of discharge. Conclusion. Olanzapine was effective and well tolerated for the treatment of mania following TBI.

Synergistic Increase of Serum BDNF in Alzheimer Patients Treated with Cerebrolysin and Donepezil: Association with Cognitive Improvement in ApoE4 Cases

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Alvarez, Irene; Iglesias, Olalla; Crespo, Ignacio; Figueroa, Jesus; Aleixandre, Manuel; Linares, Carlos; Granizo, Elias; Garcia-Fantini, Manuel; Marey, Jose; Masliah, Eliezer; Winter, Stefan; Muresanu, Dafin; Moessler, Herbert

2016-01-01

Background: Low circulating brain derived neurotrophic factor may promote cognitive deterioration, but the effects of neurotrophic and combination drug therapies on serum brain derived neurotrophic factor were not previously investigated in Alzheimer’s disease. Methods: We evaluated the effects of Cerebrolysin, donepezil, and the combined therapy on brain derived neurotrophic factor serum levels at week 16 (end of Cerebrolysin treatment) and week 28 (endpoint) in mild-to-moderate Alzheimer’s disease patients. Results: Cerebrolysin, but not donepezil, increased serum brain derived neurotrophic factor at week 16, while the combination therapy enhanced it at both week 16 and study endpoint. Brain derived neurotrophic factor responses were significantly higher in the combination therapy group than in donepezil and Cerebrolysin groups at week 16 and week 28, respectively. Brain derived neurotrophic factor increases were greater in apolipoprotein E epsilon-4 allele carriers, and higher brain derived neurotrophic factor levels were associated with better cognitive improvements in apolipoprotein E epsilon-4 allele patients treated with Cerebrolysin and the combined therapy. Conclusion: Our results indicate a synergistic action of Cerebrolysin and donepezil to increase serum brain derived neurotrophic factor and delaying cognitive decline, particularly in Alzheimer’s disease cases with apolipoprotein E epsilon-4 allele. PMID:27207906

Craniospinal Germinomas in Patient with Down Syndrome Successfully Treated with Standard-Dose Chemotherapy and Craniospinal Irradiation: Case Report and Literature Review.

Science.gov (United States)

Miyake, Yohei; Adachi, Jun-Ichi; Suzuki, Tomonari; Mishima, Kazuhiko; Sasaki, Atsushi; Nishikawa, Ryo

2017-12-01

Patients with Down syndrome (DS) are more likely to develop chemotherapy-related complications. The standard treatment for these patients with cancer has not yet been established, and the risks of standard chemotherapy are unclear. In this paper, a rare case of multiple craniospinal germinomas in a patient with DS, which was successfully treated with standard-dose chemotherapy combined with craniospinal irradiation, is reported. The authors report a case of multiple craniospinal germinomas in a DS patient who presented with bilateral oculomotor and facial nerve palsy and hearing loss. The patient underwent 3 courses of combination chemotherapy using a standard dose of carboplatin and etoposide and 23.4 Gy of concurrent craniospinal irradiation. Posttreatment magnetic resonance imaging showed reduction of the tumors. Both fluorodeoxyglucose- and methionine-positron emission tomography demonstrated no uptake in the residual tumors. Follow-up magnetic resonance imaging and positron emission tomography did not reveal tumor recurrence for 18 months. As far as we know, this is the first case of multiple craniospinal germinomas in a patient with DS who achieved a successful treatment result without fatal adverse events. The literature review indicated that disseminated germinomas may need intensive treatment to reduce recurrence risk. However, intensive chemotherapy using a combination of 3 or more anticancer drugs can increase the rate of treatment-related death during the early stage. Our case indicated that multiple craniospinal germinoma of DS patients could be treated with a standard dose of carboplatin and etoposide regimen with concurrent craniospinal irradiation along with appropriate supportive therapy and careful observation. Copyright © 2017 Elsevier Inc. All rights reserved.

A cross-sectional study of 'yaws' in districts of Ghana which have previously undertaken azithromycin mass drug administration for trachoma control.

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Rosanna Ghinai

2015-01-01

Full Text Available Yaws, caused by Treponema pallidum ssp. pertenue, is reportedly endemic in Ghana. Mass distribution of azithromycin is now the cornerstone of the WHO yaws eradication campaign. Mass distribution of azithromycin at a lower target dose was previously undertaken in two regions of Ghana for the control of trachoma. Ongoing reporting of yaws raises the possibility that resistance may have emerged in T. pallidum pertenue, or that alternative infections may be responsible for some of the reported cases. We conducted a cross-sectional survey in thirty communities in two districts of Ghana where MDA for trachoma had previously been conducted. Children aged 5-17 years with ulcerative lesions compatible with yaws were enrolled. Samples for treponemal serology and lesion PCR were collected from all children. 90 children with 98 lesions were enrolled. Syphilis serology was negative in all of them. PCR for T. pallidum ssp pertenue was negative in all children, but Haemophilus ducreyi DNA was detected in 9 lesions. In these communities, previously treated for trachoma, we found no evidence of ongoing transmission of yaws. H. ducreyi was associated with a proportion of skin lesions, but the majority of lesions remain unexplained. Integration of diagnostic testing into both pre and post-MDA surveillance systems is required to better inform yaws control programmes.

Hypophosphatemic osteomalacia: a case simulating anklylosing spondylitis treated with anti-TNF therapy.

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Sivas, F; Yurdakul, F G; Durak, M; Hatipoğlu, G; Önal, E D; Bodur, H

2016-12-01

In this case, a young male patient diagnosed as hypophosphatemic osteomalacia and ankylosing spondylitis (AS) will be assessed by literature. A 32-year-old male patient who had been previously diagnosed as ankylosing spondylitis and hypophosphatemic osteomalacia was admitted to our clinic. In the beginning of the disease, he complained of pain on the first metatarsal bone and low back. Sacroiliac magnetic resonance (MR) images were interpreted as sacroiliitis. He was diagnosed as AS, and referred to many hospitals and received several therapies. He did not benefit from the treatment and his complaints worsened. The human leukocyte antigen (HLA) B-27 test was negative and alkaline phosphatase level was high. Old femur fractures were reported in the whole body bone scintigraphy. In addition, the patient was diagnosed with osteomalacia. While the patient was receiving vitamin D, oral phosphate, anti-tumor necrosis factor therapy was added. Patient's diagnosis was reevaluated. His final diagnosis was hypophosphatemic osteomalacia instead of ankylosing spondylitis.

Combined Allergic Bronchopulmonary Aspergillosis and Eosinophilic Granulomatosis with Polyangiitis: Three Cases and a Review of the Literature.

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Ishiguro, Takashi; Takayanagi, Noboru; Takaku, Yotaro; Kagiyama, Naho; Kurashima, Kazuyoshi; Sugita, Yutaka

2016-01-01

Previous reports of combined allergic bronchopulmonary mycosis (ABPM) and eosinophilic granulomatosis with polyangiitis (EGPA) are limited; however, among 41 cases of ABPM and 18 cases of EGPA treated at our hospital, we experienced three cases of combined ABPM and EGPA. In two of these cases, the diagnosis of EGPA preceded that of ABPM, however, one of the two cases had already shown findings suggestive of ABPM, such as mucous plugs and central bronchiectasis, at the time of the diagnosis of EGPA. In six previously reported cases of combined ABPM and EGPA, ABPM preceded EGPA in four cases. In the other two cases in which EGPA was diagnosed before or simultaneously with ABPM, findings suggestive of ABPM had been detected when EGPA was diagnosed, which suggests that sensitization to fungi resulting in ABPM may play an important role in the development of EGPA. Careful attention should therefore be paid to the possibility that these diseases may coexist during the course of either disease.

Relapsing tumefactive lesion in an adult with medulloblastoma previously treated with chemoradiotherapy and stem cell transplant.

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Mahta, Ali; Qu, Yan; Nastic, Denis; Sundstrom, Maria; Kim, Ryan Y; Saria, Marlon; Santagata, Sandro; Kesari, Santosh

2012-04-01

Herein, we present an adult case of medulloblastoma who received chemotherapy, radiation therapy and stem cell transplantation, and underwent multiple surgical resections for what were thought to be recurrences; however pathology confirmed a diagnosis of relapsing tumefactive lesions. This phenomenon seems to be a consequence of stem cell transplantation rather than a simple radiation treatment effect.

A young man with myelosuppression caused by clindamycin: a case report

OpenAIRE

Morales, Manuel Polanco; Carvallo, Anna Paola Thome; Espinosa, Karla Adriana Bautista; Murillo, Edgar Enrique Meza

2014-01-01

Introduction Clindamycin is used to treat various bacterial infections, but its administration can cause anaphylaxis, liver reactions, pseudomembranous colitis, and peripheral blood cytopenias (anemia, neutropenia, and thrombocytopenia), alone or in combination. We report the case of a patient with a recurrent infection of the tonsils who received clindamycin. Pancytopenia, a previously unreported hematological disorder related to clindamycin use, was observed in conjunction with the infectio...

A Case of Ruptured Blood Blister-like Aneurysm Treated with Pipeline Embolization Device: Clinical Significance of Fetal-type Posterior Communicating Artery.

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Park, Ki-Su; Kang, Dong-Hun; Son, Won-Soo; Park, Jaechan; Kim, Young-Sun; Kim, Byung Moon

2017-03-01

Blood-blister like aneurysms (BBAs) are challenging lesions because of their wide fragile neck. Flow-diverting stents (FDSs), such as the Pipeline Embolization Device (PED), have been applied to treat BBAs less amenable to more established techniques of treatment. However, the use of FDSs, including the PED, in acute subarachnoid hemorrhage (SAH) still remains controversial. We report a case of aneurysm regrowth following PED application for a ruptured BBA that overlapped the origin of the dominant posterior communicating artery (PCoA), which was successfully treated after coil trapping of the origin of the fetal-type PCoA. And, we discuss the clinical significance of the fetal-type PCoA communicating with a BBA in terms of PED failure.

A case of reccuring giant condyloma of vulva in infant without sexual abuse successfully treated with electrocoagulation in Benin.

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Akpadjan, Fabrice; Adégbidi, Hugues; Attinsounon, Cossi Angelo; Koudoukpo, Christiane; Dégboé, Bérénice; Agbessi, Nadège; Atadokpèdé, Félix

2017-01-01

We report here a case of giant vulval condyloma in a two-year-old infant infected by her "baby sitter" without sexual abuse. Treated by surgical excision coupled with electrocoagulation, it was noted a rapid recurrence two weeks after treatment requiring a second electrocoagulation session. More than a year later, no lesion was noted, thus demonstrating therapeutic success. The unavailability of imiquimod in our context requires a systematic use of invasive treatment regardless of the age of the patient.

Oral health in patients treated by positive airway pressure for obstructive sleep apnea: a population-based case-control study.

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Carra, M C; Thomas, F; Schmitt, A; Pannier, B; Danchin, N; Bouchard, Ph

2016-03-01

Recent epidemiological evidence suggests that patients with obstructive sleep apnea (OSA) have an increased risk of periodontal disease. Little is known about the oral health of OSA patients treated by continuous or bi-level positive airway pressure (CPAP/BiPAP). The aim of this population-based case-control study was to compare oral health variables (amount of plaque, calculus, gingival inflammation, and masticatory function) between CPAP/BiPAP users and control subjects. The study population was retrieved from a French cohort examined between 2012 and 2013 at the Centre d'Investigations Préventives et Cliniques of Paris. Cases were selected if they reported to be treated by CPAP/BiPAP; controls were age-, gender-, and BMI-matched based on a 1:2 ratio. Univariate and logistic regression analyses were performed for group comparisons. Over a total of 20,436 subjects, 287 CPAP/BiPAP users (mean age (SD) 57.6 years (11.5); 76.3 % males) who underwent medical and dental examinations were compared with 574 matched controls (no OSA, no CPAP/BiPAP). CPAP/BiPAP users reported significantly higher prevalence of diabetes (15.6 vs. 10.3 %; p = 0.012; odds ratio (OR) 1.68), history of hypertension (36.5 vs. 26.1 %; p = 0.003; OR 1.62), cardiovascular diseases (14.1 vs. 8.8 %; p = 0.029; OR 1.69), and sleep complaints (59 vs. 34.4 %; p = 0.0001; OR 2.75). CPAP/BiPAP users also showed higher levels of depression and stress compared to controls. However, no group difference was observed for the amount of dental plaque, calculus, gingival inflammation, and masticatory function. Oral health of OSA patients treated by CPAP/BiPAP is comparable to that of matched controls in terms of amount of plaque, gingival inflammation, and masticatory function.

Case report of right hamate hook fracture in a patient with previous fracture history of left hamate hook: is it hamate bipartite?

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Norton Sandra

2006-10-01

Full Text Available Abstract Background Hamate hook fracture is a common fracture in golfers and others who play sports that involve rackets or sticks such as tennis or hockey. This patient had a previous hamate fracture in the opposing wrist along with potential features of hamate bipartite. Case presentation A 19 year old male presented with a complaint of right wrist pain on the ulnar side of the wrist with no apparent mechanism of injury. The pain came on gradually one week before being seen in the office and he reported no prior care for the complaint. His history includes traumatic left hamate hook fracture with surgical excision. Conclusion The patient was found to have marked tenderness over the hamate and with a prior fracture to the other wrist, computed tomography of the wrist was ordered revealing a fracture to the hamate hook in the right wrist. He was referred for surgical evaluation and the hook of the hamate was excised. Post-surgically, the patient was able to return to normal activity within eight weeks. This case is indicative of fracture rather than hamate bipartite. This fracture should be considered in a case of ulnar sided wrist pain where marked tenderness is noted over the hamate, especially after participation in club or racket sports.

Severe Hallux Valgus With Coalition of the Hallux Sesamoids Treated With Modified Lapidus Procedure: A Case Report.

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Kurashige, Toshinori; Suzuki, Seiichi

2017-12-01

Coalition of the hallux sesamoids is an extremely rare condition. To our knowledge, only 1 case report has been published. We report a case of severe hallux valgus deformities with coalitions of the hallux sesamoids. The coalitions themselves were asymptomatic; however, this severe hallux valgus deformity needed to be surgically treated. The hallux sesamoids in both feet appeared to be fused and heart shaped on anteroposterior radiographs and dumbbell shaped on axial radiographs. It is known that postoperative incomplete reduction of the medial sesamoids can be a risk factor for the recurrence of hallux valgus. The computed tomography scan demonstrated a groove in the bottom of the center of the heart-shaped sesamoid. The flexor hallucis longus tendon was located in the groove. Therefore, a modified Lapidus procedure was performed considering the medial half of the heart-shaped sesamoid as the medial sesamoid. Although delayed union occurred, successful correction of the deformity was achieved. Level IV.

Stent-in-Stent Technique for the Treatment of Proximal Bronchial Restenosis after Insertion of Metallic Stents: A Report of Two Cases

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Benjamin Bondue

2016-01-01

Full Text Available Endoscopic treatment of a bronchial restenosis previously treated by insertion of a partially covered self-expandable metallic stent (SEMS can be difficult. Classically, after recanalization of the bronchus, the stent is removed and replaced by a more adapted one. We report on two cases of proximal bronchial restenosis treated by insertion of an additional stent inside the lumen of the previously inserted stent using the stent-in-stent (SIS technique. The indications for the initial stent were malignancy in Patient 1 and posttransplant bronchial stenosis in Patient 2. Restenosis occurred at the proximal end of the stent within months in both cases. Stent removal and insertion of a new stent were considered, but this option was discarded because of an excessive risk of bronchial perforation and preference towards an alternative approach. In both cases, a second customized SEMS was placed using the SIS technique after ablation of the proximal end stenosis of the stent by argon plasma coagulation and/or dilation with a balloon. Recanalization of the bronchus was achieved in both cases without complications. The SIS technique is a valuable alternative to removal of SEMS in case of proximal bronchial restenosis.

Treatment of a Left Internal Mammary Artery to Pulmonary Artery Fistula with Polytetrafluoroethylene Covered Stents: A Case Report and Review of the Literature

International Nuclear Information System (INIS)

Abbott, J. Dawn; Brennan, Joseph J.; Remetz, Michael S.

2004-01-01

Internal mammary artery (IMA) to pulmonary artery (PA) fistula is a rare complication of coronary artery bypass grafting (CABG) that may present as myocardial ischemia. We describe a case of left IMA-to-PA fistula treated with balloon expandable coronary polytetrafluoroethylene (PTFE) graft stents and review previously reported cases of this entity

Branding to treat jaundice in India.

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John, Selva Inita; Balekuduru, Ainash; Zachariah, Uday; Eapen, C E; Chandy, George

2009-01-01

Jaundice is regarded as a mysterious disease rather than a symptom of disease in several parts of India. We describe 8 cases that underwent branding to treat jaundice and subsequently presented to our centre. The causes for jaundice in these patients included a variety of benign and malignant disorders. Our report suggests that despite being literate, strong cultural beliefs lead people to seek potentially harmful procedures like branding to treat jaundice in parts of India.

Kocuria varians infection associated with brain abscess: a case report.

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Tsai, Cheng-Yu; Su, Shou-hsin; Cheng, Yu-Hsin; Chou, Yu-lin; Tsai, Tai-Hsin; Lieu, Ann-Shung

2010-04-27

Kocuria, established by Stackebrandt et al., previously was classified into Micrococcus. Only two species, K. rosea and K. kristinae are reported to be associated as pathogenic and found with catheter-related bacteremia and acute cholecystitis. We herein report the first case of brain abscess caused by Kocuria varians, a gram-positive microorganism, in a 52-year-old man. Hematogenous spread is the probable pathogenesis. This report presents a case of Kocuria varians brain abscess successfully treated with surgical excision combined with antimicrobial therapy. In addition, Vitek 2 system has been used to identify and differentiate between coagulase-negative staphylococcus.

Primary lung sarcoma treated with stereotactic ablative radiotherapy: a case report

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Yeo SG

2017-07-01

Full Text Available Seung-Gu Yeo Department of Radiation Oncology, Soonchunhyang University College of Medicine, Soonchunhyang University Hospital, Cheonan, Republic of Korea Abstract: Primary lung sarcoma (PLS is an extremely rare, very aggressive malignancy. Surgical removal is considered the treatment of choice, and patients who have been given conventional radiotherapy have had inferior outcomes. This study is the first describing a case of PLS treated with stereotactic ablative radiotherapy (SABR, which precisely targets a small tumor with a markedly higher biologically effective dose than conventional radiotherapy. The patient was an 82-year-old man who was diagnosed with primary lung leiomyosarcoma based on radiology, pathology, and immunohistochemical examinations. The PLS was located in the right lower lobe and measured 2.5 cm. No regional nodal or distant organ metastasis was observed. He was inoperable medically. The SABR was performed using volumetric modulated arc therapy and a dose of 56 Gy in four fractions. Follow-up computed tomography 2 months after SABR revealed a complete tumor response. The toxicity was limited to mild respiratory symptoms. The patient is alive and has had no evidence of disease for 2 years. This study suggests that SABR can be a safe and effective treatment option for PLS. Keywords: primary lung sarcoma, leiomyosarcoma, stereotactic ablative radiotherapy, stereotactic body radiotherapy, radiation therapy, sarcoma 

Recurrent severe invasive pneumococcal disease in an adult with previously unknown hyposplenia

DEFF Research Database (Denmark)

Ballegaard, Vibe C; Schejbel, Lone; Hoffmann, Steen

2015-01-01

was found. Despite immunization against S. pneumoniae and measurement of what was interpreted as protective levels of serotype-specific IgG antibodies after vaccination, the patient suffered from a third episode of IPD. CONCLUSIONS: Individuals with predisposing medical conditions or a history of severe......BACKGROUND: The risk of life-threatening and invasive infections with encapsulated bacteria is increased in patients with hyposplenia or asplenia. We report a case of recurrent invasive pneumococcal meningitis in a woman with previous unknown hyposplenia. She was vaccinated after the first episode...... of meningitis and developed sufficient levels of pneumococcal antibodies. The pneumococcal strains isolated were serotype 7 F and 17 F. To our knowledge, there has been no previously reported case of recurrent invasive pneumococcal disease in a pneumococcal vaccinated adult with hyposplenia and apparently...

Scissor bite in a young patient treated with an orthodontic-orthopedic device. A case report.

Science.gov (United States)

Favero, V; Sbricoli, L; Favero, L

2013-06-01

Scissor bite is a rare malocclusion that often leads to minor facial asymmetry. An orthodontic and orthopaedic correction is advisable in young patients to prevent subsequent temporomandibular diseases requesting maxillofacial intervention. In this case report a 8-year-old girl in mixed dentition with unilateral left scissor bite was treated with a modified Rapid Palatal Expander. To modify an overexpanded maxilla (width 39 mm measured between both upper first molars) the device was used to close rather than to expand, without need of patient compliance. Orthodontic correction was then completed with traditional bracketing. Results were tangible (width 36 mm) and remained stable even for at least 2 years after retention. This original device has proved to be useful in this kind of situations and can be easily applied to young patient to correct such malocclusions.

Paraplegia due to extramedullary hematopoiesis in thalassemia treated successfully with radiation therapy.

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Malik, Monica; Pillai, Lakshmi S; Gogia, Nidhi; Puri, Tarun; Mahapatra, M; Sharma, Daya Nand; Kumar, Rajat

2007-03-01

Spinal cord compression due to extramedullary hematopoiesis (EMH) is a rare complication of thalassemia and generally presents as paraparesis with sensory impairment. Complete paraplegia is extremely rare in EMH due to thalassemia although it is known to occur in polycythemia vera and sickle cell anemia. Treatment options mostly include surgery and/or radiotherapy. Whereas cases presenting with paraparesis have been treated with either surgery or radiotherapy with equal frequency and efficacy, almost all reported cases with paraplegia have been treated with surgery with or without radiation therapy. We hereby report a case of thalassemia intermedia with paraplegia treated successfully with radiotherapy.

Dramatic course of osteomyelitis in a patient treated with immediately placed dental implants suffering from uncontrolled diabetes: A case report.

Science.gov (United States)

Doll, Christian; Hartwig, Stefan; Nack, Claudia; Nahles, Susanne; Nelson, Katja; Raguse, Jan-Dirk

2015-01-01

To report a rare and dramatic complication following immediate dental implant placement in a heavy smoker, who had a delayed diagnosis of uncontrolled diabetes. In this case report we present the dramatic course of a 64-year old female patient treated with five immediate post-extractive dental implants in the mandible, who developed osteomyelitis, which manifested initially as local peri-implant inflammation and progressed into a spontaneous jaw fracture, despite repeated surgical interventions and antibiotic courses over a 3-year period, until diabetes was diagnosed. A symptom-free status could be achieved only after partial mandibulectomy, treatment of diabetes and reconstruction with a microvascular fibula free flap. In the presence of mandibular osteomyelitis refractory to therapy, yet undiagnosed underlying pathologies, such as diabetes, should be investigated and treated urgently.

A Phase 3, multicenter, open-label, switchover trial to assess the safety and efficacy of taliglucerase alfa, a plant cell-expressed recombinant human glucocerebrosidase, in adult and pediatric patients with Gaucher disease previously treated with imiglucerase.

Science.gov (United States)

Pastores, Gregory M; Petakov, Milan; Giraldo, Pilar; Rosenbaum, Hanna; Szer, Jeffrey; Deegan, Patrick B; Amato, Dominick J; Mengel, Eugen; Tan, Ee Shien; Chertkoff, Raul; Brill-Almon, Einat; Zimran, Ari

2014-12-01

Taliglucerase alfa is a β-glucosidase enzyme replacement therapy (ERT) approved in the US and other countries for the treatment of Gaucher disease (GD) in adults and is approved in pediatric and adult patients in Australia and Canada. It is the first approved plant cell-expressed recombinant human protein. A Phase 3, multicenter, open-label, 9-month study assessed safety and efficacy of switching to taliglucerase alfa in adult and pediatric patients with GD treated with imiglucerase for at least the previous 2years. Patients with stable disease were offered taliglucerase alfa treatment using the same dose (9-60U/kg body weight) and regimen of administration (every 2weeks) as imiglucerase. This report summarizes results from 26 adult and 5 pediatric patients who participated in the trial. Disease parameters (spleen and liver volumes, hemoglobin concentration, platelet count, and biomarker levels) remained stable through 9months of treatment in adults and children following the switch from imiglucerase. All treatment-related adverse events were mild or moderate in severity and transient in nature. Exploratory parameters of linear growth and development showed positive outcomes in pediatric patients. These findings provide evidence of the efficacy and safety profile of taliglucerase alfa as an ERT for GD in patients previously treated with imiglucerase. This trial was registered at www.clinicaltrials.gov as # NCT00712348. Copyright © 2014 Elsevier Inc. All rights reserved.

3D Fourier synthesis of a new X-ray picture identical in projection to a previous picture

International Nuclear Information System (INIS)

Carlsson, P.E.

1993-01-01

A central problem in diagnostic radiology is to compare a new X-ray picture with a previous picture and from this comparison be able to decide if anatomical changes have occurred in the patient or not. It is of primary interest that these pictures are identical in projection. If not it is difficult to decide with confidence if differences between the pictures are due to anatomical changes or differences in their projection geometry. In this thesis we present a non invasive method that makes it possible to find the relative changes in the projection geometry between the exposure of a previous picture and a new picture. The method presented is based on the projection slice theorem (central section theorem). Instead of an elaborate search for a single new picture a pre-planned set of pictures are exposed from a circular orbit above the patient. By using 3D Fourier transform techniques we are able to synthesize a new X-ray picture from this set of pictures that is identical in projection to the previous one. The method has certain limits. Those are as follows: *The X-ray focus position must always be at a fixed distance from the image plane. *The object may only be translated parallel to the image plane and rotated around axes perpendicular to this plane. Under those restrictions, we may treat divergent projection pictures as if they are generated by a parallel projection of a scaled object. The unknown rotation and translation of the object in the previous case are both retrieved in two different procedures and compensated for. Experiments on synthetic data has proved that the method is working even in the presence of severe noise

Training in time-limited dynamic psychotherapy: A systematic comparison of pre- and post-training cases treated by one therapist.

Science.gov (United States)

Anderson, Timothy; Strupp, Hans H

2015-01-01

This qualitative study systematically compared cases treated by the same therapist in order to understand the group comparison findings of a larger study on training of experienced therapists (the "Vanderbilt II" psychotherapy project). The therapist, Dr C., was selected based on the therapist's overall treatment successes. His two patients were selected based on their outcomes and the relative training cohort from which they were drawn: a case with successful outcome from the pre-training cohort and a case of negligible improvement from the post-training cohort. Dr C. demonstrated a variety of interpersonal skills throughout his pre-training case, though there was also poor interpersonal process throughout. However, in the second case he had considerable difficulty in adapting his typical therapeutic approach to the requirements of the time-limited dynamic psychotherapy (TLDP) manual, even while appearing to work hard to find ways to use the manual. Dr C.'s spontaneity, and his unique set of interpersonal skills may enhanced his initial rapport and alliance building with clients and yet may not have interfaced well with TLDP. His unique interpersonal skills also may have contributed to problems of interpersonal process. Future research may benefit from examining the interaction of between therapist interpersonal skills and the implementation of the treatment manual.

Case report: An unusual case of cisplatin induced paralytic ileus

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Rosdiana Abd Rahim

2017-12-01

Full Text Available Background: Ileus is a failure of normal intestinal motility in the absence of mechanical obstruction. Ileus is thought to result from an imbalance between sympathetic and parasympathetic motor activity, resulting in intestinal atony. Few anti-cancer therapies reported to be associated with paralytic ileus, such as vincristine, vinblastine and paclitaxel. It is thought as a consequences of autonomic neuropathy. Here we present a paralytic ileus experience during cisplatin therapy. Case presentation: We present a case of 57 years old gentleman with diagnosis of metastatic nasopharyngeal carcinoma to lung and multiple bones who develop paralytic ileus following chemotherapy cisplatin and fluorouracil. The patient complained of abdominal discomfort with bloating and not tolerating Ryle tube feeding started 3 days after completion of cycle 2 cisplatin & fluorouracil infusion chemotherapy. No vomiting and still passing out small amount of stool everyday. Physical examination revealed abdominal distension, lower abdominal tenderness, sluggish bowel sound and empty rectum. The blood investigations for electrolyte, renal and hepatic function, and amylase were normal. Abdominal computerized tomography showed diffuse dilatation of small and large bowels extending to the rectum, without any obstructive pathology which was consistent with paralytic ileus. He was hospitalized and treated with nasogastric decompression and partial parenteral nutrition started. The symptoms improved after few days of decompression. Conclusion: Peripheral neuropathy due to cisplatin has been well described, however paralytic ileus has not previously been reported in medical literature. From patient self-reported outcome study, however, this complication was not that uncommon, and was reported by 0.76% of patients receiving cisplatin, especially people who are male, 60 years old and more, have been taking the drug for more than 1 month, also take medication dexamethasone. The

Catastrophic antiphospholipid syndrome. Case report and literature review

Science.gov (United States)

del Carpio-Orantes, Luis; Martínez-Anaya, Chantall Citlally; Bonilla-Casas, Elías

2017-01-01

The present document is the report of a case of a very rare clinical entity, which presents with acute multiorganic failure after a thrombotic storm related to antiphospholipid antibodies, the so-called catastrophic antiphospholipid syndrome, which began as a recurrent picture of mesenteric thrombosis, with a previous history of venous insufficiency and distal ulcers probably associated with an unidentified antiphospholipid; deserving management in intensive care and the consultation by the world expert, Dr. Ricard Cervera who confirmed the diagnosis and recommend treating as such entity, the patient's evolution was satisfactory so far. Final recommendations for diagnosis and current treatment options such as rituximab or eculizumab are made. The present case was added to the international registry that currently houses around 500 cases worldwide (International CAPS Registry). Copyright: © 2017 SecretarÍa de Salud

Tracheal adenoid cystic carcinoma masquerading asthma: A case report

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Kurul Cuneyt

2004-10-01

Full Text Available Abstract Background Tracheal tumors are often misdiagnosed as asthma and are treated with inhaled steroids and bronchodilators without resolution. Case Presentation Here, a patient with tracheal adenoid cystic carcinoma who had been previously diagnosed with difficult asthma was reported. The possibility of the presence of localized airway obstruction was raised when the flow-volume curve suggesting fixed airway obstruction, was obtained. Conclusion The presenting case report emphasizes the fact that not all wheezes are asthma. It is critical to bear in mind that if a patient does not respond to appropriate anti-asthma therapy, localized obstructions should be ruled out before establishing the diagnosis of asthma.

Ununited fracture neck of femur treated with closed reduction and internal fixation with cancellous screw and fibular strut graft

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Singh Daria

2006-01-01

Full Text Available Background: Ununited fracture neck of femur in young adults has been tackled in various ways. Methods: Twenty five patients of ununited fracture neck of femur in age group 21-55 years were treated by closed reduction, cancellous screw fixation and fibular strut graft and followed up for 2-6 years. Time gap between injury and operation was 6 weeks to 58 weeks. Five cases were previously fixed with various fixation devices. Results: Osseous union was achieved in 24 cases with average time of 18.16 weeks. Main complication encountered in follow-up was avascular necrosis of femoral head, others were joint stiffness and shortening. Functional end results were good to excellent in 24 cases. Conclusion: Closed reduction with internal fixation by cancellous screw and fibular strut grafting is easy and useful procedure.

[Fatal amnioinfusion with previous choriocarcinoma in a parturient woman].

Science.gov (United States)

Hrgović, Z; Bukovic, D; Mrcela, M; Hrgović, I; Siebzehnrübl, E; Karelovic, D

2004-04-01

The case of 36-year-old tercipare is described who developed choriocharcinoma in a previous pregnancy. During the first term labour the patient developed cardiac arrest, so reanimation and sectio cesarea was performed. A male new-born was delivered in good condition, but even after intensive therapy and reanimation occurred death of parturient woman with picture of disseminate intravascular coagulopathia (DIK). On autopsy and on histology there was no sign of malignant disease, so it was not possible to connect previous choricarcinoma with amniotic fluid embolism. Maybe was place of choriocarcinoma "locus minoris resistentiae" which later resulted with failure in placentation what was hard to prove. On autopsy we found embolia of lung with a microthrombosis of terminal circulation with punctiformis bleeding in mucous, what stands for DIK.

Serratus muscle stimulation effectively treats notalgia paresthetica caused by long thoracic nerve dysfunction: a case series

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Barad Meredith

2009-09-01

Full Text Available Abstract Currently, notalgia paresthetica (NP is a poorly-understood condition diagnosed on the basis of pruritus, pain, or both, in the area medial to the scapula and lateral to the thoracic spine. It has been proposed that NP is caused by degenerative changes to the T2-T6 vertebrae, genetic disposition, or nerve entrapment of the posterior rami of spinal nerves arising at T2-T6. Despite considerable research, the etiology of NP remains unclear, and a multitude of different treatment modalities have correspondingly met with varying degrees of success. Here we demonstrate that NP can be caused by long thoracic nerve injury leading to serratus anterior dysfunction, and that electrical muscle stimulation (EMS of the serratus anterior can successfully and conservatively treat NP. In four cases of NP with known injury to the long thoracic nerve we performed transcutaneous EMS to the serratus anterior in an area far lateral to the site of pain and pruritus, resulting in significant and rapid pain relief. These findings are the first to identify long thoracic nerve injury as a cause for notalgia paresthetica and electrical muscle stimulation of the serratus anterior as a possible treatment, and we discuss the implications of these findings on better diagnosing and treating notalgia paresthetica.

Endoscopic Third Ventriculostomy in Previously Shunted Children

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Eva Brichtova

2013-01-01

Full Text Available Endoscopic third ventriculostomy (ETV is a routine and safe procedure for therapy of obstructive hydrocephalus. The aim of our study is to evaluate ETV success rate in therapy of obstructive hydrocephalus in pediatric patients formerly treated by ventriculoperitoneal (V-P shunt implantation. From 2001 till 2011, ETV was performed in 42 patients with former V-P drainage implantation. In all patients, the obstruction in aqueduct or outflow parts of the fourth ventricle was proved by MRI. During the surgery, V-P shunt was clipped and ETV was performed. In case of favourable clinical state and MRI functional stoma, the V-P shunt has been removed 3 months after ETV. These patients with V-P shunt possible removing were evaluated as successful. In our group of 42 patients we were successful in 29 patients (69%. There were two serious complications (4.7%—one patient died 2.5 years and one patient died 1 year after surgery in consequence of delayed ETV failure. ETV is the method of choice in obstructive hydrocephalus even in patients with former V-P shunt implantation. In case of acute or scheduled V-P shunt surgical revision, MRI is feasible, and if ventricular system obstruction is diagnosed, the hydrocephalus may be solved endoscopically.

Nivolumab Versus Docetaxel in Previously Treated Patients With Advanced Non-Small-Cell Lung Cancer: Two-Year Outcomes From Two Randomized, Open-Label, Phase III Trials (CheckMate 017 and CheckMate 057).

Science.gov (United States)

Horn, Leora; Spigel, David R; Vokes, Everett E; Holgado, Esther; Ready, Neal; Steins, Martin; Poddubskaya, Elena; Borghaei, Hossein; Felip, Enriqueta; Paz-Ares, Luis; Pluzanski, Adam; Reckamp, Karen L; Burgio, Marco A; Kohlhäeufl, Martin; Waterhouse, David; Barlesi, Fabrice; Antonia, Scott; Arrieta, Oscar; Fayette, Jérôme; Crinò, Lucio; Rizvi, Naiyer; Reck, Martin; Hellmann, Matthew D; Geese, William J; Li, Ang; Blackwood-Chirchir, Anne; Healey, Diane; Brahmer, Julie; Eberhardt, Wilfried E E

2017-12-10

Purpose Nivolumab, a programmed death-1 inhibitor, prolonged overall survival compared with docetaxel in two independent phase III studies in previously treated patients with advanced squamous (CheckMate 017; ClinicalTrials.gov identifier: NCT01642004) or nonsquamous (CheckMate 057; ClinicalTrials.gov identifier: NCT01673867) non-small-cell lung cancer (NSCLC). We report updated results, including a pooled analysis of the two studies. Methods Patients with stage IIIB/IV squamous (N = 272) or nonsquamous (N = 582) NSCLC and disease progression during or after prior platinum-based chemotherapy were randomly assigned 1:1 to nivolumab (3 mg/kg every 2 weeks) or docetaxel (75 mg/m 2 every 3 weeks). Minimum follow-up for survival was 24.2 months. Results Two-year overall survival rates with nivolumab versus docetaxel were 23% (95% CI, 16% to 30%) versus 8% (95% CI, 4% to 13%) in squamous NSCLC and 29% (95% CI, 24% to 34%) versus 16% (95% CI, 12% to 20%) in nonsquamous NSCLC; relative reductions in the risk of death with nivolumab versus docetaxel remained similar to those reported in the primary analyses. Durable responses were observed with nivolumab; 10 (37%) of 27 confirmed responders with squamous NSCLC and 19 (34%) of 56 with nonsquamous NSCLC had ongoing responses after 2 years' minimum follow-up. No patient in either docetaxel group had an ongoing response. In the pooled analysis, the relative reduction in the risk of death with nivolumab versus docetaxel was 28% (hazard ratio, 0.72; 95% CI, 0.62 to 0.84), and rates of treatment-related adverse events were lower with nivolumab than with docetaxel (any grade, 68% v 88%; grade 3 to 4, 10% v 55%). Conclusion Nivolumab provides long-term clinical benefit and a favorable tolerability profile compared with docetaxel in previously treated patients with advanced NSCLC.

Challenging non-traumatic posterior urethral strictures treated with urethroplasty: a preliminary report

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Nicolaas Lumen

2009-08-01

Full Text Available Introduction: Posterior urethral strictures after prostatic radiotherapy or surgery for benign prostatic hyperplasia (BPH refractory to minimal invasive procedures (dilation and/or endoscopic urethrotomy are challenging to treat. Published reports of alternative curative management are extremely rare. This is a preliminary report on the treatment of these difficult strictures by urethroplasty. Materials and Methods: Seven cases were treated: 4 cases occurred after open prostatectomy or transurethral resection of the prostate for BPH, one case after external beam irradiation and 2 after brachytherapy. The 4 cases after BPH-related surgery were in fact complete obstructions at the bladder neck and the membranous urethra with the prostatic urethra still partially patent. Anastomotic repair by perineal route was done in all cases with bladder neck incision in the BPH-cases and prostatic apex resection in the radiotherapy cases. Results: Mean follow-up was 31 months (range: 12-72 months. The operation was successful, with preserved continence, in 3 of the 4 BPH-cases and in 2 of the 3 radiotherapy cases. An endoscopic incision was able to treat a short re-stricture in the BPH-patient and a longer stricture at the bulbar urethra could be managed with a perineostomy in the radiotherapy-patient. Conclusion: Posterior non-traumatic strictures refractory to minimal invasive procedures (dilation/endoscopic urethrotomy can be treated by urethroplasty using an anastomotic repair with a bladder neck incision if necessary.

Previously unreported abnormalities in Wolfram Syndrome Type 2.

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Akturk, Halis Kaan; Yasa, Seda

2017-01-01

Wolfram syndrome (WFS) is a rare autosomal recessive disease with non-autoimmune childhood onset insulin dependent diabetes and optic atrophy. WFS type 2 (WFS2) differs from WFS type 1 (WFS1) with upper intestinal ulcers, bleeding tendency and the lack ofdiabetes insipidus. Li-fespan is short due to related comorbidities. Only a few familieshave been reported with this syndrome with the CISD2 mutation. Here we report two siblings with a clinical diagnosis of WFS2, previously misdiagnosed with type 1 diabetes mellitus and diabetic retinopathy-related blindness. We report possible additional clinical and laboratory findings that have not been pre-viously reported, such as asymptomatic hypoparathyroidism, osteomalacia, growth hormone (GH) deficiency and hepatomegaly. Even though not a requirement for the diagnosis of WFS2 currently, our case series confirm hypogonadotropic hypogonadism to be also a feature of this syndrome, as reported before. © Polish Society for Pediatric Endocrinology and Diabetology.

A Case of Constrictive Pericarditis Associated with Melioidosis in an Immunocompetent Patient Treated by Pericardiectomy

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Lu, Hou Tee; Ramsamy, Gunasekaran; Lee, Chuey Yan; Syed Hamid, Syed Rasul G.; Kan, Foong Kee; Nordin, Rusli Bin

2018-01-01

Patient: Male, 38 Final Diagnosis: Constrictive pericarditis Symptoms: Shortness of breath Medication: — Clinical Procedure: Pericardiocentesis • pericardiectomy Specialty: Cardiology Objective: Unusual clinical course Background: Melioidosis is a rare tropical bacterial infection caused by the Gram-negative soil saprophyte, Burkholderia pseudomallei. Melioidosis can mimic a variety of diseases due to its varied presentation, and unless it is treated rapidly, it can be fatal. A rare case of melioidosis, with pericarditis and pericardial effusion, is described, which demonstrates the value of early diagnosis with echocardiography and pericardiocentesis. Case Report: A 38-year-old native (Iban) East Malaysian man presented with shortness of breath and tachycardia. Transthoracic echocardiography (TTE) showed cardiac tamponade. Urgent pericardiocentesis drained a large amount of purulent pericardial fluid that grew Burkholderia pseudomallei. Despite appropriate dose and duration of intravenous treatment with ceftazidime followed by meropenem, the patient developed recurrent pericardial effusion and right heart failure due to constrictive pericarditis. The diagnosis of constrictive pericarditis was confirmed by computed tomography (CT) and surgical exploration. Following pericardiectomy, his symptoms resolved, but patient follow-up was recommended for possible sequelae of constrictive pericarditis. Conclusions: After the onset of melioidosis pericarditis, the authors recommend follow-up and surveillance for possible complication of constrictive pericarditis. PMID:29551765

Tracheostomy-dependent child with temporomandibular ankylosis and severe micrognathia treated by piezosurgery and distraction osteogenesis: case report.

Science.gov (United States)

de Castro e Silva, Lucas Martins; Pereira Filho, Valfrido Antonio; Vieira, Eduardo Hochuli; Gabrielli, Mário Francisco Real

2011-10-01

Ankylosis of the temporomandibular joint in children is one the most difficult and complex conditions managed by oral and maxillofacial surgeons, and often leads to some facial deformity. Distraction osteogenesis of the mandible provides an excellent treatment for mandibular airway obstruction in children who do not respond to conservative measures, and allows for early removal of the tracheostomy. We report the case of a 1-year-old boy with severe micrognathia and temporomandibular ankylosis who was dependent on a tracheostomy; he was treated with piezosurgery and mandibular advancement by distraction osteogenesis. Copyright © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

A Case of Bilateral Acute Calcific Tendinitis of the Gluteus Medius, Treated by Ultrasound-guided Needle Lavage and Corticosteroid Injection

OpenAIRE

Vereecke, Elke; Mermuys, Koen; Casselman, Jan

2015-01-01

Calcium hydroxyapatite deposition disease is a common pathology, most frequently located in the rotator cuff tendons of the shoulder, for which different therapeutic approaches are used. Ultrasound guided needle lavage and injection of anesthetic/corticosteroid is a well-known and extensively described treatment for calcific tendinits of the rotator cuff. We present a case of bilateral calcific tendinitis of the gluteus medius tendon, both sides successfully treated using ultrasound guided ne...

Intractable depression successfully treated with a combination of autogenic training and high-dose antidepressant in department of otorhinolaryngology: a case report.

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Goto, Fumiyuki; Nakai, Kimiko; Murakami, Masato; Ogawa, Kaoru

2009-08-14

Patients suffering from ear discomfort are commonly encountered in the department of otolaryngology. If various clinical examinations do not reveal any objective findings, then the patients are referred to the department of internal medicine or psychiatry. Psychotherapy is recommended in some cases. This paper describes the successful administration of autogenic training in a patient suffering from ear discomfort due to major depression. We present a case of intractable depression that was successfully treated with a combination of psychotherapy, administered by a clinical psychologist, and high-dose antidepressant. The patient was a 36-year-old female with hearing discomfort in her left ear. In 2003, she experienced insomnia and an appetite loss, and her condition was diagnosed as major depression along with an avoidant personality disorder. Her depression has not been improved with antidepressant treatment for 3 years in department of psychosomatic medicine. She was referred to our department because of ear discomfort in her left ear. There was no abnormality in her physical examinations. She wanted to be treated in department of otorhinolaryngology. We increased the dose of fluvoxamine maleate up to 200 mg/day, and introduced cognitive therapy and autogenic training by a clinical psychologist. Eventually, her depressive state as well as the hearing complaint was markedly alleviated. Autogenic training can be a viable and acceptable treatment option for patients who fail to respond to other therapies. This case emphasizes the importance of autogenic training as a method to control physical symptom of depression.

Acute Fibrinous and Organizing Pneumonia Associated With Allogenic Hematopoietic Stem Cell Transplant Successfully Treated With Corticosteroids

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Lam-Phuong Nguyen DO

2016-04-01

Full Text Available Acute fibrinous and organizing pneumonia (AFOP is an extremely rare, relatively new, and distinct histological pattern of acute lung injury characterized predominately by the presence of intra-alveolar fibrin and associated organizing pneumonia. AFOP may be idiopathic or associated with a wide spectrum of clinical conditions. It has a variable clinical presentation from mild respiratory symptoms to that similar to the acute respiratory distress syndrome. Currently there is no consensus on treatment, and corticosteroids previously were of unclear benefit. To date, there are less than 40 cases of AFOP reported in the literature and only one has been linked to hematopoietic stem cell transplantation. Here we report the first case series of 2 patients who developed AFOP following allogenic stem cell transplant that were successfully treated with high-dose corticosteroids.

Physicochemical changes in minimal ozone-treated fresh shrimp ...

African Journals Online (AJOL)

treated fresh shrimp were evaluated tandem with microbiological efficacy of treatment during iced storage of up to 10 days. Safely discharged from commercially available domestic-type ozone facility, a previously defined minimal ozone treatment ...

TREAT (TREe-based Association Test)

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TREAT is an R package for detecting complex joint effects in case-control studies. The test statistic is derived from a tree-structure model by recursive partitioning the data. Ultra-fast algorithm is designed to evaluate the significance of association between candidate gene and disease outcome

Broken Esophageal Stent Successfully Treated by Interventional Radiology Technique

International Nuclear Information System (INIS)

Zelenak, Kamil; Mistuna, Dusan; Lucan, Jaroslav; Polacek, Hubert

2010-01-01

Esophageal stent fractures occur quite rarely. A 61-year-old male patient was previously treated for rupture of benign stenosis, occurring after dilatation, by implanting an esophageal stent. However, a year after implantation, the patient suffered from dysphagia caused by the broken esophageal stent. He was treated with the interventional radiology technique, whereby a second implantation of the esophageal stent was carried out quite successfully.

Cotard's syndrome with schizophreniform disorder can be successfully treated with electroconvulsive therapy: case report

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Caliyurt, Okan; Vardar, Erdal; Tuglu, Cengiz

2004-01-01

We report a case of Cotard's syndrome associated with psychotic symptoms. A 27-year-old man was admitted to hospital with the diagnosis of schizophreniform disorder. His presenting symptoms, which had started 1 month before hospital admission, were somatic delusions of gastrointestinal and cardiovascular malfunction and the absence of a stomach, which resulted in a decrease in weight from 75 kg to 63 kg in 1 month. Cranial computed tomographic images showed dilatation of the lateral and third ventricles, whereas magnetic resonance imaging revealed central atrophy and lateral ventricle dilatation. Single- photon emission computed tomography demonstrated left temporal, left frontal and left parietal hypoperfusion. The patient did not respond to antipsychotic therapies, but he was successfully treated with electroconvulsive therapy. This report emphasizes that Cotard's syndrome may be accompanied by lesions of the left hemisphere and that electroconvulsive therapy could be the first-line therapy in such patients with psychotic disorder. PMID:15069468

Bilateral orbital infarction and retinal detachment in a previously undiagnosed sickle cell hemoglobinopathy African child

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Helen, Onakpoya Oluwatoyin; Ajite, K. O.; Oyelami, O. A.; Asaleye, C. M.; Adeoye, A. O.

2013-01-01

Bone infarction involving the orbit in sickle cell disease is not common. Bilateral orbital infarction in a previously undiagnosed sickle cell hemoglobinopathy has not been previously reported. In this report, we present a case of an 11-year-old previously undiagnosed sickle cell disease Nigerian girl with severe acute bilateral orbital infarction and retinal detachment to highlight that hemoglobinopathy induced orbital infarction should be considered in African children with acute onset proptosis with or without previous history of sickle cell hemoglobinopathy. PMID:23901183

Pregnancy and Evans´ syndrome: case report

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Santiago Artucio

2015-12-01

Full Text Available Evans´ syndrome is the coexistence of autoimmune thrombocytopenia with autoimmune hemolytic anemia. It is rarely found during the course of a pregnancy. This makes treatment options more difficult, since some therapeutic drugs are teratogenic. The effects of Evans´ syndrome in the fetus and newborn are unknown given the low number of reported cases. We report the case of a patient with preconceptional diagnosis of Evans´ syndrome, who develops a hemolytic crisis during the course of a pregnancy, and diagnosis of intrauterine growth restriction (IUGR, treated at Clínica Ginecotocológica “A” at the Pereira Rossell Hospital Center, in Montevideo, Uruguay. Treatment options and evolution are analyzed, as well as previous reports.

[Mining analysis and experience summary for chronic atrophic gastritis cases treated by Professor LIU Feng-bin].

Science.gov (United States)

Hou, Zheng-kun; Liu, Feng-bin; Li, Pei-wu; Zhuang, Kun-hai

2015-06-01

To summarize Professor LIU Feng-bin's clinical experience and theoretical thoughts on chronic atrophic gastritis (CAG), the study group designed a retrospective study on his case series and expert interview. First of all, the data of CAG patients treated in the First Affiliated Hospital of Guangzhou University of Chinese Medicine between 2009 and 2013, e. g. herbs, diseases, syndrome type, prescription amount and number of herbs, was collected and processed. The statistical description and binary logistic regression were used to determined the syndrome type, initial basic remedy and modification. During the statistics, a complete and sub-group analysis was performed simultaneously. After the expert interview, the syndrome type and medication were finalized. As a result, a total of 228 CAG patients aged at (50.30 ± 10.18) were collected, including 151 males (66.23%). Of them, the TCM diagnosis and syndrome type were extracted from the information of 157 patients, including 115 cases with gastric stuffiness, 23 cases with gastric pain, 19 missing cases, 2 cases with spleen-stomach weakness syndrome, 57 cases with spleen deficiency and dampness-heat syndrome, 18 cases with spleen-stomach disharmony syndrome, 23 cases with syndrome of liver depression syndrome, 21 cases with liver qi invading stomach syndrome and 26 qi and yin deficiency syndrome, respectively. All of the 228 patients used totally 104 herbs, while the subgroups with 157 patients used 94 herbs. The most frequently used 15 herbs used in each groups were analyzed to determine the initial basic remedy and modification. Subsequently, based on the information of the sub-groups with 157 patients, with the syndrome type as the dependent variable, the logistic regression analysis was made on the most frequently used 32 herbs, in order to determined the modification in herbs for different syndrome types. After experts reviewed and modified, they believed the main causes of CAG were dietary irregularities

Percutaneous Soft Tissue Release for Treating Chronic Recurrent Myofascial Pain Associated with Lateral Epicondylitis: 6 Case Studies

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Ming-Ta Lin

2012-01-01

Full Text Available Objective. The purpose of this pilot study is to investigate the effectiveness of the percutaneous soft tissue release for the treatment of recurrent myofascial pain in the forearm due to recurrent lateral epicondylitis. Methods. Six patients with chronic recurrent pain in the forearm with myofascial trigger points (MTrPs due to chronic lateral epicondylitis were treated with percutaneous soft tissue release of Lin’s technique. Pain intensity (measured with a numerical pain rating scale, pressure pain threshold (measured with a pressure algometer, and grasping strength (measured with a hand dynamometer were assessed before, immediately after, and 3 months and 12 months after the treatment. Results. For every individual case, the pain intensity was significantly reduced (P<0.01 and the pressure pain threshold and the grasping strength were significantly increased (P<0.01 immediately after the treatment. This significant effectiveness lasts for at least one year. Conclusions. It is suggested that percutaneous soft tissue release can be used for treating chronic recurrent lateral epicondylitis to avoid recurrence, if other treatment, such as oral anti-inflammatory medicine, physical therapy, or local steroid injection, cannot control the recurrent pain.

De novo adamantinomatous craniopharyngioma presenting anew in an elderly patient with previous normal CT and MRI studies: A case report and implications on pathogenesis

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Amy Walker, B.S.

2015-09-01

Full Text Available Adamantinomatous craniopharyngiomas are histologically benign epithelial tumors which arise from embryonic remnants of the craniopharyngeal duct and Rathke’s pouch. They are thought to have a congenital origin and are histologically unique from papillary craniopharyngioma. We describe the case of an elderly male who presented with symptoms related to a large craniopharyngioma with previously normal brain magnetic resonance and computed tomography imaging studies. These findings dispute the embryogenic theory that craniopharyngiomas observed in adults develop from the persistent slow growth of embryonic remnants.

Severe iron intoxication treated with exchange transfusion

DEFF Research Database (Denmark)

Carlsson, M; Cortes, D; Jepsen, S

2009-01-01

An 18-month-old previous healthy girl who had ingested 442 mg elemental iron/kg was admitted to a paediatric intensive care unit. The child was treated with gastric lavage, whole bowel irrigation and intravenous deferoxamine. After 2 h of standard therapy serum iron had risen threefold to 1362 µg....../dl (244 µmol/l). The child was treated with exchange transfusion (ET; 52 ml/kg) and serum iron fell to 134 µg/dl (24 µmol/l). The patient made an uncomplicated recovery. ET should be considered in severe iron poisoning when standard therapy is inadequate....

RECURRENT CORNUAL ECTOPIC PREGNANCY – A CASE REPORT

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Velayudam DA, Radha Bai Prabhu T, Dipenty Devi L, Meenalochani P, Isha Gutgutia

2015-10-01

Full Text Available Cornual ectopic gestation is one of the causes of “Maternal near miss” cases. In the modern era of IVF treatments and better imaging techniques, more number of cases of cornual ectopic pregnancies is being diagnosed and treated both by conservative and radical methods. Here, we report a case of a recurrent cornual ectopic pregnancy in the early second trimester, which was managed by hysterectomy due to uncontrolled haemorrhage. Thirty five year old Mrs. S, Gravida 4, para2, with one previous ectopic pregnancy presented to the obstetric casualty with acute abdominal pain at 15 weeks +2 days of gestation. On vaginal examination, there was right fornicial fullness and both the fornices were tender. Cervical motion tenderness was also present. On review of her previous records, dating scan done at 8 to 9 weeks showed normal intrauterine pregnancy. An emergency scan was carried out which revealed an empty uterine cavity with gestational sac measuring 3.6×4.4×4.6 cms seen outside the uterus just above the fundus with absent cardiac activity. There was evidence of haemoperitoneum, therefore she was diagnosed with recurrent ruptured ectopic pregnancy.

Endovascular stenting of a chronic ruptured type B thoracic aortic dissection, a second chance: a case report.

Science.gov (United States)

Arshad, Ali; Khan, Sumaira L; Whitaker, Simon C; Macsweeney, Shane T

2008-02-07

We aim to highlight the need for awareness of late complications of endovascular thoracic aortic stenting and the need for close follow-up of patients treated by this method. We report the first case in the English literature of an endovascular repair of a previously stented, ruptured chronic Stanford type B thoracic aortic dissection re-presenting with a type III endoleak of the original repair. Endovascular thoracic stenting is now a widely accepted technique for the treatment of thoracic aortic dissection and its complications. Long term follow up is necessary to ensure that late complications are identified and treated appropriately. In this case of type III endoleak, although technically challenging, endovascular repair was feasible and effective.

BOS MOrth cases prize 2011.

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Patel, Jigar Vipinchandra

2013-12-01

This paper describes the orthodontic treatment of two cases awarded the prize by the British Orthodontic Society for best treated cases submitted for the Membership in Orthodontics. The first case reports on the treatment of a class III malocclusion with increased vertical lower anterior facial proportions and dentoalveolar compensation that was treated with orthodontic camouflage. The second case reports on the treatment of a class II division II malocclusion with reduced vertical lower anterior facial proportions and an overbite complete to the palate, which was treated with orthodontic camouflage.

Myelofibrosis and acquired hemophilia A: a case report.

Science.gov (United States)

Wrobel, Marie; Comio, Emilie; Gay, Valerie; Baroudi, Noureddine; Meyer, Pascal; Chuniaud-Louche, Christine; Hacini, Maya; Pica, Gian Matteo

2016-05-07

Myelofibrosis and acquired hemophilia A is a rare association. To the best of our knowledge only one case of myelofibrosis and acquired hemophilia A has been previously described. A 66-year-old Caucasian man diagnosed with myelofibrosis evolving in acute myeloid leukemia was referred to us for postoperative bleeding. Hemostatic studies showed prolonged activated partial thromboplastin time, decreased factor VIII coagulation, and a high factor VIII inhibitor titer; these findings led to a diagnosis of acquired hemophilia A for which he was treated with methylprednisolone and recombinant activated factor VII on admission. Due to a lack of response he was subsequently treated with rituximab combined with activated prothrombin complex concentrates. Furthermore, he received azacytidine to treat the underlying hematological malignancies. Immunosuppressive rituximab therapy resolved acquired hemophilia A with marked efficacy. Rapid and accurate diagnosis, effective hemostatic therapy, and timely treatment for underlying disease are important in the management of acquired hemophilia A secondary to hematological malignancy.

Trepanation to Treat a Head Wound: A Case of Neurosurgery from 13th-Century Tuscany.

Science.gov (United States)

Riccomi, Giulia; Fornaciari, Gino; Vitiello, Angelica; Bini, Anna; Caramella, Davide; Giuffra, Valentina

2017-08-01

During the archaeological excavations conducted in the 13th century cemetery of the Church of Sant'Agostino in Poggibonsi (Tuscany, Italy), a skull with evidence of neurosurgical intervention was brought to light. The skull, belonging to an adult male, shows two traumatic lesions produced by bladed instruments. The first lesion, located on the anterior part of the parietal bones, involved only the outer cranial table; bone remodeling indicates that the individual survived the injury for a long time. The second lesion, located on the frontal bone, involved all the thickness of the bone; the absence of reparative processes allows a diagnosis of peri mortem lesion. To treat this wound, the patient underwent surgical intervention. In fact, in correspondence to the lesion, an oval bone loss, with clean and well-defined cutting edges, can be interpreted as the result of a trepanation, probably performed to clean the wound and to remove any bone splinters. Half of the bone "rondella" was found in situ; it can be hypothesized that the surgeon decided to replace the bony piece to protect the brain. However, the surgical intervention failed, and the patient died soon afterwards. Trepanation for the treatment of cranial traumas is described by several medical classical and medieval authors, whose texts were available in the 13th century. This case represents rare Middle Ages evidence of neurosurgery used to treat a bone injury. Copyright © 2017 Elsevier Inc. All rights reserved.

[Results of conservative surgery in T1 breast carcinoma. Our experience in 66 treated cases].

Science.gov (United States)

Barillari, P; Leuzzi, R; Nardi, M; Cerasi, A; Calcaterra, D; Cesareo, S; Brandimarte, A; Manetti, G; Bovino, A; Sammartino, P

1994-11-01

Between 1989 and 1991, 66 women affected by breast cancer smaller than 2 cm in diameter, were treated with conservative procedure plus radiotherapy. Conservative procedure consisted in quadrantectomy and axillary dissection of the 3 axillary nodes levels. Neoplasms were grouped according to TNM classification. Eleven were classified as Tis, 9 as T1aN0M0, 12 as T1bN0M0, one case T1bN1M0, 24 as T1cN0M0 and finally 9 as T1cN1M0. Actuarial 5-year survival rate was related to TNM. It has been reported to be 100% in Tis and T1aN0M0 neoplasms; 91.7% in pT1bN0M0 tumors, 95.8% in pT1cN0M0 neoplasms, 55.6% in patients affected with pT1cN1M0 tumors. According to the relationship between receptor status of the neoplasm and survival, this was 88.9% in ER+ and 77.8% in ER- tumors, and 97.1% against 71.4% (p < 0.05) in PR+ and PR- neoplasms respectively. Two patients presented (3%) local recurrence which were treated by means of a tumorectomy and radiotherapy. Both patients are still living and disease free after 6 and 9 months from re-operation.

Cutaneous streptococcal abscess treated by photodynamic therapy ...

African Journals Online (AJOL)

Its action can alter fundamental structures for the survival of microorganisms without any development of microbial resistance. Materials and Methods: Young sheep presenting with abscess in the left forelimb caused by Streptococcus spp. was previously treated with antibiotics. There was no clinical improvement with the ...

A very rare case of a small bowel leiomyosarcoma leading to ileocaecal intussusception treated with a laparoscopic resection: a case report and a literature review.

Science.gov (United States)

Guzel, Tomasz; Mech, Katarzyna; Mazurkiewicz, Michał; Dąbrowski, Bohdan; Lech, Gustaw; Chaber, Andrzej; Słodkowski, Maciej

2016-02-24

Small bowel tumours are rare and comprise less than 2% of all primary gastrointestinal neoplasms. Among these tumours, a leiomyosarcoma belonging to soft tissue sarcomas is extremely rare and accounts for about 1 % of malignant mesenchymal lesions in the gastrointestinal tract. Due to its aggressive nature and slow growth, it is often diagnosed at the late stage when curative treatment is impossible. Authors report a first case of leiomyosarcoma with chronic recurrent ileocaecal intussusception and literature review to analyse diagnosis and treatment features of the ileum mesenchymal tumours. We present a case of an 87-year-old Caucasian man suffering from cramp-like abdominal pain for months. Due to lack of clinical signs and unspecific complaints, a diagnosis was delayed. Despite a detailed in-hospital examination, a proper diagnosis was established as late as during an operation. The patient was treated by surgery with good results. An uncommon laparoscopic resection of the small bowel with a tumour was performed. A histopathological investigation confirmed a very rare mesenchymal lesion of the distal ileum. The patient is under control with no recurrence for 1 year of the follow-up period. Reported case indicates that a usually asymptomatic tumour can cause uncommon chronic recurrent ileus signs. CT and MRI scans are investigation of choice in such cases, but they are sometimes inconclusive. It might be worth highlighting the good results of laparoscopic leiomyosarcoma lesion resection with a very good outcome.

Adverse obstetric outcomes in women with previous cesarean for dystocia in second stage of labor.

Science.gov (United States)

Jastrow, Nicole; Demers, Suzanne; Gauthier, Robert J; Chaillet, Nils; Brassard, Normand; Bujold, Emmanuel

2013-03-01

To evaluate obstetric outcomes in women undergoing a trial of labor (TOL) after a previous cesarean for dystocia in second stage of labor. A retrospective cohort study of women with one previous low transverse cesarean undergoing a first TOL was performed. Women with previous cesarean for dystocia in first stage and those with previous dystocia in second stage were compared with those with previous cesarean for nonrecurrent reasons (controls). Multivariable regressions analyses were performed. Of 1655 women, those with previous dystocia in second stage of labor (n = 204) had greater risks than controls (n = 880) to have an operative delivery [odds ratio (OR): 1.5; 95% confidence intervals (CI) 1.1 to 2.2], shoulder dystocia (OR: 2.9; 95% CI 1.1 to 8.0), and uterine rupture in the second stage of labor (OR: 4.9; 95% CI 1.1 to 23), and especially in case of fetal macrosomia (OR: 29.6; 95% CI 4.4 to 202). The median second stage of labor duration before uterine rupture was 2.5 hours (interquartile range: 1.5 to 3.2 hours) in these women. Previous cesarean for dystocia in the second stage of labor is associated with second-stage uterine rupture at next delivery, especially in cases of suspected fetal macrosomia and prolonged second stage of labor. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pregnancy in a Previously Conjoined Thoracopagus Twin with a Crisscross Heart

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Bassam H. Rimawi

2015-01-01

Full Text Available Background. Crisscross heart (CCH is a complex, rare, congenital, rotational, cardiac abnormality that accounts for <0.1% of congenital heart defects (CHD. CCH is characterized by the crossing of the inflow streams of the two ventricles due to an abnormal twisting of the heart. A case of maternal CCH has not been previously reported. Case. We report a case of a primigravida with a CCH, who was separated at birth from her thoracopagus conjoined twin. Pregnancy was managed by congenital cardiology, maternal-fetal medicine, anesthesiology, and obstetrics. She underwent a 39-week vaginal delivery without maternal or neonatal complication. Conclusion. A successful term pregnancy outcome was achieved in a patient with CCH using a multidisciplinary approach to address her cardiac condition.

Avascular osteonecrosis in patients treated for Hodgkin's disease

International Nuclear Information System (INIS)

Enrici, R.M.; Donato, V.; Santoro, M.; Tombolini, V.; Anselmo, A.P.

1998-01-01

The aim of this study is to assess the risk of avascular osteonecrosis (AVN) of the femoral head in patients treated for Hodgkin's disease (HD), in relation to the type of treatment they have received. For this purpose, a cohort of 1391 patients treated for HD at University of Rome between 1972 and 1996 was divided into 2 groups according to their initial treatment. The first group contained 784 patients treated, at the onset of HD, either with chemotherapy (CT) containing steroids, combined in some cases with subdiaphragmatic radiotherapy (RT), or with subdiaphragmatic RT combined with CT without steroids. The second group was made up of 607 patients who had received, initially, supradiaphragmatic RT alone or supradiaphragmatic RT combined with CT without steroids. For the purpose of this study, only the 784 patients belonging to the first group were observed for the appearance of AVN, which occurred in 9 cases. The period of time which elapsed between the end of treatment and the radiological evidence of AVN ranged from 23 to 97 months, with an average of 35 months. Because the number of cases of AVN was so small, the pathogenesis of this complication could not be identified. (au)

Treating infidelity in same-sex couples.

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Martell, Christopher R; Prince, Stacey E

2005-11-01

Psychotherapy with same-sex couples does not differ markedly from standard couple therapies; this is also true for treating couples facing infidelity. However, same-sex couples often design their relationships differently, without tradition and formal marital contracts to prescribe behavior. Based on clinical experience and the empirical research, this article addresses the differing norms involved in affirmatively treating infidelity in gay and lesbian couples within the framework of integrative behavioral couple therapy (IBCT). Two cases illustrate the process and outcome of IBCT with same-sex couples.

A case report: Pavlovian conditioning as a risk factor of heroin 'overdose' death

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Bácskai Erika

2005-07-01

Full Text Available Abstract Background The authors present a case illustrating a mechanism leading directly to death which is not rare but has received little attention. Case presentation The case was evaluated by autopsy, investigation of morphine concentration in the blood, and clinical data. The heroin dose causing the 'overdose' death of a young man who had previously been treated a number of times for heroin addiction did not differ from his dose of the previous day taken in the accustomed circumstances. The accustomed dose taken in a strange environment caused fatal complications because the conditioned tolerance failed to operate. The concentration of morphine in the blood did not exceed the level measured during earlier treatment. Conclusion These results are in line with the data in the literature indicating that morphine concentrations measured in cases of drug-related death do not differ substantially from those measured in cases where the outcome is not fatal. A knowledge of the conditioning mechanism can contribute to prevention of fatal cases of a similar type. The harm reduction approach places great stress on preventive intervention based on data related to drug-related death.

Botox® after Botox® - a new approach to treat diplopia secondary to cosmetic botulinic toxin use: case reports

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Cassiano Rodrigues Isaac

2012-06-01

Full Text Available A new technique for the treatment of diplopia secondary to cosmetic botulinum toxin A use is described. In this interventional case reports, two consecutive patients who developed diplopia after periocular cosmetic use of botulinum toxin A were treated with intramuscular botulinum toxin A injection into the antagonist extraocular muscle. Diplopia resolved in both patients in less than 1 week with no side effects or complications. In conclusion, the injection of intramuscular botulinum toxin A is an encouraging option for treatment of diplopia secondary to botulinum toxin A use for facial lifting.

Monteggia fracture dislocation equivalents - analysis of eighteen cases treated by open reduction and internal fixation

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Singh Ajay Pal

2012-02-01

Full Text Available 【Abstract】 Objective: Monteggia fracture dislocation equivalent, though already described by Bado, is still an unclassified entity. We aimed to retrospectively analyze 18 cases of Monteggia variants and discuss the injury mechanisms, management, and outcome along with a review of the literature. Methods: A retrospective record of Monteggia fracture dislocation (2003-2008 was reviewed from medical record department of our institute. Classic Monteggia fracture dislocation, children below 12 years or adults over 50 years, as well as open grade II & III cases were excluded from this study. Monteggia variant inclusion criteria included fracture of the proximal ulna together with a fracture of the radial head or neck and skeletal maturity. Totally 26 patients were identified with Monteggia variants and 18 were available for follow-up, including 11 males and 7 females with the mean age of 35 years. The ulna fracture was treated by compression plating along with tension band wiring. Radial head/neck was reconstructed in 12 patients while excised in 6 patients. Results: Follow-up ranged from 1-4 years, mean 2.6 years. Patients were assessed clinicoradiologically. Mayo Elbow Performance Score was employed to assess the outcomes. At final follow-up, the results were excellent in 10 patients, good in 4, fair in 2 and poor in 2. Mean range of motion of the elbow was 20°, 116°, 50° and 55° for extension, flexion, pronation and supination, respectively. Two patients had complications in the form of heterotopic ossification and stiffness of the elbow. One nonunion ulna, primarily treated by tension band wiring, was managed by refixation with locking reconstruction plate and bone grafting. Bone grafting was only required in this patient for nonunion. Another patient had implants removed on his request. The results in our series closely correlated with extent of intraarticular damage, coronoid fracture and comminuted fractures. Conclusions: Monteggia

Ibrutinib combined with bendamustine and rituximab compared with placebo, bendamustine, and rituximab for previously treated chronic lymphocytic leukaemia or small lymphocytic lymphoma (HELIOS): a randomised, double-blind, phase 3 study.

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Chanan-Khan, Asher; Cramer, Paula; Demirkan, Fatih; Fraser, Graeme; Silva, Rodrigo Santucci; Grosicki, Sebastian; Pristupa, Aleksander; Janssens, Ann; Mayer, Jiri; Bartlett, Nancy L; Dilhuydy, Marie-Sarah; Pylypenko, Halyna; Loscertales, Javier; Avigdor, Abraham; Rule, Simon; Villa, Diego; Samoilova, Olga; Panagiotidis, Panagiots; Goy, Andre; Mato, Anthony; Pavlovsky, Miguel A; Karlsson, Claes; Mahler, Michelle; Salman, Mariya; Sun, Steven; Phelps, Charles; Balasubramanian, Sriram; Howes, Angela; Hallek, Michael

2016-02-01

Most patients with chronic lymphocytic leukaemia or small lymphocytic lymphoma relapse after initial therapy. Bendamustine plus rituximab is often used in the relapsed or refractory setting. We assessed the efficacy and safety of adding ibrutinib, an oral covalent inhibitor of Bruton's tyrosine kinase (BTK), to bendamustine plus rituximab in patients with previously treated chronic lymphocytic leukaemia or small lymphocytic lymphoma. The HELIOS trial was an international, double-blind, placebo-controlled, phase 3 study in adult patients (≥18 years of age) who had active chronic lymphocytic leukaemia or small lymphocytic lymphoma with measurable lymph node disease (>1·5 cm) by CT scan, and had relapsed or refractory disease following one or more previous lines of systemic therapy consisting of at least two cycles of a chemotherapy-containing regimen, an Eastern Cooperative Oncology Group (ECOG) performance status of 0-1, and adequate bone marrow, liver, and kidney function. Patients with del(17p) were excluded because of known poor response to bendamustine plus rituximab. Patients who had received previous treatment with ibrutinib or other BTK inhibitors, refractory disease or relapse within 24 months with a previous bendamustine-containing regimen, or haemopoietic stem-cell transplant were also excluded. Patients were randomly assigned (1:1) by a web-based system to receive bendamustine plus rituximab given in cycles of 4 weeks' duration (bendamustine: 70 mg/m(2) intravenously on days 2-3 in cycle 1, and days 1-2 in cycles 2-6; rituximab: 375 mg/m(2) on day 1 of cycle 1, and 500 mg/m(2) on day 1 of cycles 2-6 for a maximum of six cycles) with either ibrutinib (420 mg daily orally) or placebo until disease progression or unacceptable toxicity. Patients were stratified according to whether they were refractory to purine analogues and by number of previous lines of therapy. The primary endpoint was independent review committee (IRC)-assessed progression

Muscle mitochondrial metabolism and calcium signaling impairment in patients treated with statins

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Sirvent, P., E-mail: pascal.sirvent@univ-bpclermont.fr [U1046, INSERM, Université Montpellier 1 and Université Montpellier 2, 34295 Montpellier (France); CHRU Montpellier, 34295 Montpellier (France); Clermont Université, Université Blaise Pascal, EA 3533, Laboratoire des Adaptations Métaboliques à l' Exercice en conditions Physiologiques et Pathologiques (AME2P), BP 80026, F-63171 Aubière cedex (France); Fabre, O.; Bordenave, S. [U1046, INSERM, Université Montpellier 1 and Université Montpellier 2, 34295 Montpellier (France); CHRU Montpellier, 34295 Montpellier (France); Hillaire-Buys, D. [CHRU Montpellier, 34295 Montpellier (France); Raynaud De Mauverger, E.; Lacampagne, A.; Mercier, J. [U1046, INSERM, Université Montpellier 1 and Université Montpellier 2, 34295 Montpellier (France); CHRU Montpellier, 34295 Montpellier (France)

2012-03-01

The most common and problematic side effect of statins is myopathy. To date, the patho-physiological mechanisms of statin myotoxicity are still not clearly understood. In previous studies, we showed that acute application in vitro of simvastatin caused impairment of mitochondrial function and dysfunction of calcium homeostasis in human and rat healthy muscle samples. We thus evaluated in the present study, mitochondrial function and calcium signaling in muscles of patients treated with statins, who present or not muscle symptoms, by oxygraphy and recording of calcium sparks, respectively. Patients treated with statins showed impairment of mitochondrial respiration that involved mainly the complex I of the respiratory chain and altered frequency and amplitude of calcium sparks. The muscle problems observed in statin-treated patients appear thus to be related to impairment of mitochondrial function and muscle calcium homeostasis, confirming the results we previously reported in vitro. -- Highlights: ► The most common and problematic side effect of statins is myopathy. ► Patients treated with statins showed impairment of mitochondrial respiration. ► Statins-treated patients showed altered frequency and amplitude of calcium sparks.

Muscle mitochondrial metabolism and calcium signaling impairment in patients treated with statins

International Nuclear Information System (INIS)

Sirvent, P.; Fabre, O.; Bordenave, S.; Hillaire-Buys, D.; Raynaud De Mauverger, E.; Lacampagne, A.; Mercier, J.

2012-01-01

The most common and problematic side effect of statins is myopathy. To date, the patho-physiological mechanisms of statin myotoxicity are still not clearly understood. In previous studies, we showed that acute application in vitro of simvastatin caused impairment of mitochondrial function and dysfunction of calcium homeostasis in human and rat healthy muscle samples. We thus evaluated in the present study, mitochondrial function and calcium signaling in muscles of patients treated with statins, who present or not muscle symptoms, by oxygraphy and recording of calcium sparks, respectively. Patients treated with statins showed impairment of mitochondrial respiration that involved mainly the complex I of the respiratory chain and altered frequency and amplitude of calcium sparks. The muscle problems observed in statin-treated patients appear thus to be related to impairment of mitochondrial function and muscle calcium homeostasis, confirming the results we previously reported in vitro. -- Highlights: ► The most common and problematic side effect of statins is myopathy. ► Patients treated with statins showed impairment of mitochondrial respiration. ► Statins-treated patients showed altered frequency and amplitude of calcium sparks.

Gardening can induce pulmonary failure: Aspergillus ARDS in an immunocompetent patient, a case report.

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Jung, Nina; Mronga, Silke; Schroth, Susanne; Vassiliou, Timon; Sommer, Frank; Walthers, Eduard; Aepinus, Christian; Jerrentrup, Andreas; Vogelmeier, Claus; Holland, Angelique; Koczulla, Rembert

2014-11-26

Acute Aspergillus fumigatus infection in immunocompetent patients is rare. This is the first known case of a patient who survived Aspergillus sepsis after being treated early with veno-venous extracorporeal membrane (ECMO) and antifungal therapy. An immunocompetent 54-year-old woman was exposed to plant mulch during gardening and subsequently developed pulmonary failure that progressed to sepsis with multiorgan failure. Owing to her severe clinical condition, she was treated for acute respiratory distress syndrome (ARDS) with veno-venous ECMO. Empiric antifungal therapy comprising voriconazole was also initiated owing to her history and a previous case report of aspergillosis after plant mulch exposure, though there was no microbiological proof at the time. A. fumigatus was later cultured and detected on antibody testing. The patient recovered, and ECMO was discontinued 1 week later. After 7 days of antifungal treatment, Aspergillus antibodies were undetectable. In cases of sepsis that occur after gardening, clinicians should consider Aspergillus inhalation as an aetiology, and early antimycotic therapy is recommended.

Curability of esophageal carcinoma treated with irradiation

International Nuclear Information System (INIS)

Yamada, Shogo; Takai, Yoshihiro; Nemoto, Kenji; Kakuto, Yoshihisa; Ogawa, Yoshihiro; Hoshi, Akihiko; Sakamoto, Kiyohiko

1994-01-01

The curability of 168 squamous cell carcinomas of the esophagus treated with more than 60 Gy of irradiation between 1980 and 1987 were discussed. There were 49 autopsied cases. The curability rat was calculated after the conversion of 13 local free or 46 metastasis free patients who had not undergone autopsy into unknown cases in each analysis. Disease free, local free, and metastasis free rates were 11.2, 20.0, and 26.0%, respectively. The curability rate was higher in the superficial type cancer and stage I cases. The local control rate and the metastasis free rate were extremely poor in the infiltrative type cancer. The actuarial survival rate of overall patients was 31.5% at one year, 11.3% at three years, and 7.1% at five years. Reconstructed survival rates: disease free, local free, and metastasis free survival rates, indicated that the survival rates of overall patients might be improved by decreasing the number of intercurrent death in stage I and by elevating the ratio of the local control in stages II and III. The disease free survival rate of cases treated with low dose rate telecobalt therapy as a boost was better than that of the conventionally fractionated irradiation alone cases in stages II and III. (author)

High-Grade Leiomyosarcoma Arising in a Previously Replanted Limb

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Tiffany J. Pan

2015-01-01

Full Text Available Sarcoma development has been associated with genetics, irradiation, viral infections, and immunodeficiency. Reports of sarcomas arising in the setting of prior trauma, as in burn scars or fracture sites, are rare. We report a case of a leiomyosarcoma arising in an arm that had previously been replanted at the level of the elbow joint following traumatic amputation when the patient was eight years old. He presented twenty-four years later with a 10.8 cm mass in the replanted arm located on the volar forearm. The tumor was completely resected and pathology examination showed a high-grade, subfascial spindle cell sarcoma diagnosed as a grade 3 leiomyosarcoma with stage pT2bNxMx. The patient underwent treatment with brachytherapy, reconstruction with a free flap, and subsequently chemotherapy. To the best of our knowledge, this is the first case report of leiomyosarcoma developing in a replanted extremity. Development of leiomyosarcoma in this case could be related to revascularization, scar formation, or chronic injury after replantation. The patient remains healthy without signs of recurrence at three-year follow-up.

A case of recurrent impetigo herpetiformis treated with systemic corticosteroids and narrowband UVB.

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Bozdag, Kubra; Ozturk, Serap; Ermete, Murat

2012-03-01

Impetigo herpetiformis is a rare pustular eruption with usual onset during the third trimester of pregnancy. The disease tends to remit after delivery, but may recur in subsequent pregnancies. Here we present a recurrent case of impetigo herpetiformis with earlier onset and poor response to corticosteroids in the subsequent pregnancy. She had widespread, erythematosquamous patches with tiny superficial pustules in the third trimester of her first pregnancy. Histopathological and clinical findings were consistent with impetigo herpetiformis. She was treated with systemic prednisolone and had a healthy baby without any complication. Three years later, the patient presented with impetigo herpetiformis again in the second trimester of her second pregnancy. After six weeks of oral prednisolone treatment, the lesions improved, but there were still new pustule formations and narrowband ultraviolet B treatment was added. Skin eruption cleared and she had a healthy baby in the 38th week of her second pregnancy. The corticosteroid dose was tapered gradually and stopped after delivery. Early diagnosis and treatment is crucial in impetigo herpetiformis because of the risk of maternal and fetal complications. When prednisolone is not enough to control the eruption alone, narrowband UVB can safely be added to the treatment.

A previous hamstring injury affects kicking mechanics in soccer players.

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Navandar, Archit; Veiga, Santiago; Torres, Gonzalo; Chorro, David; Navarro, Enrique

2018-01-10

Although the kicking skill is influenced by limb dominance and sex, how a previous hamstring injury affects kicking has not been studied in detail. Thus, the objective of this study was to evaluate the effect of sex and limb dominance on kicking in limbs with and without a previous hamstring injury. 45 professional players (males: n=19, previously injured players=4, age=21.16 ± 2.00 years; females: n=19, previously injured players=10, age=22.15 ± 4.50 years) performed 5 kicks each with their preferred and non-preferred limb at a target 7m away, which were recorded with a three-dimensional motion capture system. Kinematic and kinetic variables were extracted for the backswing, leg cocking, leg acceleration and follow through phases. A shorter backswing (20.20 ± 3.49% vs 25.64 ± 4.57%), and differences in knee flexion angle (58 ± 10o vs 72 ± 14o) and hip flexion velocity (8 ± 0rad/s vs 10 ± 2rad/s) were observed in previously injured, non-preferred limb kicks for females. A lower peak hip linear velocity (3.50 ± 0.84m/s vs 4.10 ± 0.45m/s) was observed in previously injured, preferred limb kicks of females. These differences occurred in the backswing and leg-cocking phases where the hamstring muscles were the most active. A variation in the functioning of the hamstring muscles and that of the gluteus maximus and iliopsoas in the case of a previous injury could account for the differences observed in the kicking pattern. Therefore, the effects of a previous hamstring injury must be considered while designing rehabilitation programs to re-educate kicking movement.

Successful use of a defined antigen/GM-CSF adjuvant vaccine to treat mucosal leishmaniasis refractory to antimony: a case report

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Badaro Roberto

2001-01-01

Full Text Available Immunotherapy has been proposed as a method to treat mucosal leishmaniasis for many years, but the approach has been hampered by poor definition and variability of antigens used, and results have been inconclusive. We report here a case of antimonial-refractory mucosal leishmaniasis in a 45 year old male who was treated with three single injections (one per month with a cocktail of four Leishmania recombinant antigens selected after documented hypo-responsiveness of the patient to these antigens, plus 50mg of GM-CSF as vaccine adjuvant. Three months after treatment, all lesions had resolved completely and the patient remains without relapse after two years. Side effects of the treatment included only moderate erythema and induration at the injection site after the second and third injections. We conclude that carefully selected microbial antigens and cytokine adjuvant can be successful as immunotherapy for patients with antimonial-refractory mucosal leishmaniasis.

[A girl with self-harm treated with N-acetylcysteine (NAC)].

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Rus, C P

Deliberate and recurrent self-harm could be regarded as addictive behaviour that can be treated with medication. In addiction, the dopaminergic mesolimbic reward system is activated. Pain caused by cutting stimulates the reward system through the opioid system. Glutamatergic neurotransmission follows the same pathway and plays a role in addiction as well. In this case-study a 17-year-old girl was successfully treated with N-acetylcysteine (nac) in order to reduce the frequency of self-cutting. In addition, in this case nac reduced the symptoms of attention deficit/hyperactivity disorder and depression. nac modulates the glutamatergic neurotransmission. This article provides possible explanations for the effect of nac in this case.

A case of neurosarcoidosis secondary to treatment of etanercept and review of the literature.

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Berrios, Idanis; Jun-O'Connell, Adalia; Ghiran, Sorina; Ionete, Carolina

2015-07-06

There are only three cases in the literature that describe development of neurosarcoidosis in a patient who is on tumour necrosis factor α inhibitors. We describe a case of a 33-year-old woman with a history of juvenile rheumatoid arthritis and refractory uveitis (with previous treatment trials of adalimumab, infliximab, mycophenolate, methotrexate) who had been stable for 2 years on etanercept. She was diagnosed with biopsy-proven systemic sarcoidosis with meningeal and parenchymal neurosarcoidosis. She was switched to infliximab and methotrexate, with clinical and imaging improvements. This is a case that demonstrates the difficulty of choosing tumour necrosis factor α (TNF-α) inhibitors when treating patients with multiple clinical autoimmune entities. It is also a case where a change in the mechanism of TNF-α inhibition pathway can still be used to treat refractory sarcoidoisis and rheumatoid arthritis. It is still unclear what the exact difference between the TNF-α blockers and their neurological complications is, and who the patients at risk of developing neurological complications are. 2015 BMJ Publishing Group Ltd.

A case of squamous cell lung cancer after treating with radiation for small cell lung cancer

International Nuclear Information System (INIS)

Hayashi, Toshinari; Ide, Hiroshi; Siomi, Katsuhiko; Nakamura, Yukinobu; Tada, Shinya; Kageyama, Hiroshi; Kido, Masamitsu

1999-01-01

A 77-year-old man was admitted due to an abnormal shadow on a chest X-ray film in September 1993. Small cell lung cancer was diagnosed by transbronchial lung biopsy of left S 3 . Because of his pulmonary and renal dysfunction, he received only 40 Gy irradiation alone, and the tumor shadow disappeared. After 38 months' observation, a new nodular shadow was detected in the left upper lung field in March 1997. A tumor was found in left B 3 by bronchoscopy, and biopsy revealed squamous cell carcinoma. Because of his advanced age and hypoxia, he has had no active treatment. This was a rare case of small cell lung cancer with long term survival, treated only by radiation, in which a different histologic type of carcinoma appeared in the same radiation field. (author)

A case of remnant pancreatic cancer after pancreatoduodenectomy successfully treated using chemotherapy and carbon-ion radiotherapy

International Nuclear Information System (INIS)

Yamamoto, Tatsuhito; Tokunou, Kazuhisa; Yamamoto, Hisato; Kamei, Ryoji; Kitamura, Yoshinori; Ando, Seiichiro

2016-01-01

We report a case of remnant pancreatic cancer after pancreatoduodenectomy that was successfully treated using chemotherapy and carbon-ion radiotherapy. A 68-year-old woman received SSPPD for pancreatic head cancer. Gemcitabine (GEM) was administered for a year as postoperative chemotherapy. One year 8 months after surgery, abdominal CT showed a 20 mm solid mass in the stump of the remnant pancreas and dilation of the distal pancreatic duct. FDG-PET revealed a solitary tumor without any recurrence. We diagnosed the patient with a solitary recurrence of pancreatic cancer. Chemotherapy (GEM) and carbon-ion radiotherapy were performed. After treatment, the lesion was not detected on CT or FDG-PET. Chemotherapy (GEM) and carbon-ion radiotherapy for locally advanced pancreatic cancer seems to be effective and there might result in a survival benefit. (author)

Candida glabrata prosthetic joint infection, successfully treated with anidulafungin: A case report and review of the literature.

Science.gov (United States)

Koutserimpas, Christos; Samonis, George; Velivassakis, Emmanouil; Iliopoulou-Kosmadaki, Stylliani; Kontakis, Georgios; Kofteridis, Diamantis P

2018-04-01

Non-albicans Candida prosthetic joint infection (PJI) is extremely rare. A case of a Candida glabrata knee PJI is a 68-year-old splenectomised female smoker, suffering from chronic obstructive pulmonary disease (COPD) and alcoholism is reported. The patient presented with a peri-prosthetic fracture, 15 years after total knee replacement surgery. Cultures of the intraoperative peri-prosthetic tissue and materials yielded C. glabrata, as well as a methicillin-resistant S. epidermitis. The patient was treated with anidulafungin and vancomycin. The knee prosthetic joint was removed and cement-spacer with vancomycin and gentamycin was placed. Additionally, an external fixation was performed. A second stage revision surgery was planned, after completion of the antimicrobial and antifungal treatment. The patient is followed up for 4 months without signs, symptoms or findings of infection. PJI Candida infections require a high clinical suspicion index. It is of utmost importance to report these cases, since there is no consensus yet of the proper antifungal treatment. Furthermore, a literature review regarding treatment of those cases is provided. First-line treatment with an echinocandin seems most proper, due to their fungicidal properties, their effectiveness against biofilm, as well as their minimal toxicity, making them ideal for long-term use. Further experience is needed, for better understanding the disease's pathogenesis and optimal treatment. © 2017 Blackwell Verlag GmbH.

Transjejunal Extraction of Gallbladder After Mini-Laparoscopic Cholecystectomy in Patients with Previous Roux-en-Y Gastric Bypass: A Small Case Series.

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Kayaalp, Cuneyt; Tardu, Ali; Yagci, Mehmet Ali; Sumer, Fatih

2015-07-01

The length of incisions on the abdominal wall directly correlates with wound-related morbidities and patient comfort. Both mini-laparoscopy (only ≤5-mm trocars) and natural orifice specimen extraction avoid larger abdominal incisions. This study described a new natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) cholecystectomy technique by combination of these two advanced laparoscopic techniques for cholelithiasis in patients who had prior laparoscopic Roux-en-Y gastric bypass (LRYGB) for obesity. Three patients (two males, one female; 39, 62, and 34 years old, respectively) were admitted with symptomatic cholelithiasis (multiple millimeter-sized gallstones), and all had previously had LRYGB. They were treated by mini-laparoscopic cholecystectomy using three 5-mm trocars. The gallbladder was removed through the dilated efferent limb of the jejunum, 5 cm distal from the gastrojejunostomy. Transjejunal extraction was performed under endoscopic guidance. The gallbladder in the jejenum was passed through the anastomosis and extracted with an endoscopic snare by the transoral way. The enterotomy was closed intracorporeally. There was no conversion or additional trocar requirement. All the procedures were completed successfully without problems. Respective operating times were 95, 75, and 120 minutes. Only 1 patient required postoperative analgesic; the others did not. The patients started to get a liquid diet on the night of surgery and were discharged on Days 1, 1, and 2, respectively, with normal diet recommendations. There were no morbidities. Mini-laparoscopic cholecystectomy is technically feasible in patients with previous LRYGB. Prior LRYGB was not an obstacle for transoral specimen extraction. The dilated efferent jejunal limb is a good alternative route for natural orifice specimen extraction. This

Management of Gynecomastia in Patients With Different Body Types: Considerations on 312 Consecutive Treated Cases.

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Innocenti, Alessandro; Melita, Dario; Mori, Francesco; Ciancio, Francesco; Innocenti, Marco

2017-05-01

Gynecomastia is a common finding in male subjects which incidence varies widely in the world population. In adolescents, it is frequently temporary but, if it becomes persistent, it generates considerable embarrassment, inducing the patients to seek surgical consultation. Even in patients with good body contour, gynecomastia creates even greater distress considering the special attention given by these subjects to their physical appearance. The authors present their experience in the treatment of gynecomastia comparing different body types of patients with the aim to investigate dissimilar expectations, needs and surgical outcomes thus optimizing the management of the pathological condition, achieving high levels of agreement and reducing unsatisfied patients arising from cosmetic surgery. Between January 2007 and January 2015, 312 selected patients have been treated surgically for gynecomastia. Patients were grouped according to their physical aspect: 97 were classified as high muscle mass body type (group A), 106 as normal (group B) and 109 as overweight patients (group C). All of them were adults ranging in age between 18 and 52 years. Follow-up ranged from 12 to 60 months. In all cases, an excision of the gland in the form of a subcutaneous mastectomy was performed; the most common surgical access was in the inferior part of the areola. No breast cancers were found at the histological examinations. Also, no skin or areola necrosis have been referred, and no recurrence of gynecomastia disorder has been reported. Six cases of seroma (limited to the fatty gynecomastia) and 3 cases of hematomas (requiring immediate surgical revision) were found. Although the patients in group B resulted more distressed by the disorder, higher levels of postoperative satisfaction were recorded in this group. The study demonstrates the importance of the different management of the same disorder according to the different patients' expectations, related to the different body type. Our

Lipoprotein glomerulopathy treated with LDL-apheresis (Heparin-induced Extracorporeal Lipoprotein Precipitation system: a case report

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Rivasi Paolo

2009-12-01

Full Text Available Abstract Introduction Lipoprotein glomerulopathy is a glomerulonephritis which was described for the first time by Saito in 1989 and is currently acknowledged as a separate nosological entity. It is histologically characterized by a marked dilatation of the glomerular capillaries and the presence of lipoprotein thrombi in the glomerular lumens. The dyslipidemic profile is similar to that of type III dyslipoproteinemia with Apolipoprotein E values that are often high; proteinuria and renal dysfunction are present. Proteinuria often does not respond to steroid and cytostatic treatments. The phenotypic expression of lipoprotein glomerulopathy is most probably correlated to a genetic alteration of the lipoprotein metabolism (mutation of the Apolipoprotein E coding gene. In literature, lipoprotein glomerulopathies have mainly been reported in Japanese and Chinese subjects, except for three cases in the Caucasian race, reported in France and the USA. Case presentation We describe the case of a 60-year-old female, Caucasian patient suffering from lipoprotein glomerulopathy, carrier of a new mutation on the Apolipoprotein E gene (Apolipoprotein EMODENA, and treated successfully with low density lipoprotein-apheresis with the Heparin induced extracorporeal lipoprotein precipitation system. After a first phase of therapeutic protocol with statins, the patient was admitted for nephrotic syndrome, renal failure and hypertension. Since conventional treatment alone was not able to control dyslipidemia, aphaeretic treatment with heparin-induced Extracorporeal Lipoprotein Precipitation - apheresis (HELP-apheresis was started to maintain angiotensin converting enzyme inhibitor therapy for the treatment of hypertension. Treatment with HELP-apheresis led to a complete remission of the proteinuria in a very short time (four months, as well as control of hypercholesterolemia and renal function recovery. Conclusion According to this case of lipoprotein glomerulopathy

Severe iron intoxication treated with exchange transfusion

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Carlsson, Marcella; Cortes, Dina; Jepsen, Søren

2008-01-01

An 18-month-old previous healthy girl who had ingested 442 mg elemental iron/kg was admitted to a paediatric intensive care unit. The child was treated with gastric lavage, whole bowel irrigation and intravenous deferoxamine. After 2 h of standard therapy serum iron had risen threefold to 1362 mi...... microg/dl (244 micromol/l). The child was treated with exchange transfusion (ET; 52 ml/kg) and serum iron fell to 134 microg/dl (24 micromol/l). The patient made an uncomplicated recovery. ET should be considered in severe iron poisoning when standard therapy is inadequate....

Cerebral Metastasis from a Previously Undiagnosed Appendiceal Adenocarcinoma

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Antonio Biroli

2012-01-01

Full Text Available Brain metastases arise in 10%–40% of all cancer patients. Up to one third of the patients do not have previous cancer history. We report a case of a 67-years-old male patient who presented with confusion, tremor, and apraxia. A brain MRI revealed an isolated right temporal lobe lesion. A thorax-abdomen-pelvis CT scan showed no primary lesion. The patient underwent a craniotomy with gross-total resection. Histopathology revealed an intestinal-type adenocarcinoma. A colonoscopy found no primary lesion, but a PET-CT scan showed elevated FDG uptake in the appendiceal nodule. A right hemicolectomy was performed, and the specimen showed a moderately differentiated mucinous appendiceal adenocarcinoma. Whole brain radiotherapy was administrated. A subsequent thorax-abdomen CT scan revealed multiple lung and hepatic metastasis. Seven months later, the patient died of disease progression. In cases of undiagnosed primary lesions, patients present in better general condition, but overall survival does not change. Eventual identification of the primary tumor does not affect survival. PET/CT might be a helpful tool in detecting lesions of the appendiceal region. To the best of our knowledge, such a case was never reported in the literature, and an appendiceal malignancy should be suspected in patients with brain metastasis from an undiagnosed primary tumor.