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Sample records for recurrent acute myoglobinuria

  1. Mutations in LPIN1 cause recurrent acute myoglobinuria in childhood

    NARCIS (Netherlands)

    Zeharia, Avraham; Shaag, Avraham; Houtkooper, Riekelt H.; Hindi, Tareq; de Lonlay, Pascale; Erez, Gilli; Hubert, Laurence; Saada, Ann; de Keyzer, Yves; Eshel, Gideon; Vaz, Frédéric M.; Pines, Ophry; Elpeleg, Orly

    2008-01-01

    Recurrent episodes of life-threatening myoglobinuria in childhood are caused by inborn errors of glycogenolysis, mitochondrial fatty acid beta-oxidation, and oxidative phosphorylation. Nonetheless, approximately half of the patients do not suffer from a defect in any of these pathways. Using

  2. Myoglobinuria with acute renal failure and hot kidneys seen on bone imaging

    International Nuclear Information System (INIS)

    Sheth, K.J.; Sty, J.R.; Johnson, F.; Tisdale, P.

    1984-01-01

    We report a case of myoglobinuria secondary to prolonged seizures. The child showed ''hot kidneys'' with bone scintigraphy. The disease entity and etiologies of nontraumatic rhabdomyolysis are discussed

  3. Recurrent myoglobinuria and deranged acylcarnitines due to a mutation in the mtDNA MT-CO2 gene

    DEFF Research Database (Denmark)

    Vissing, Christoffer Rasmus; Duno, Morten; Olesen, Jess Have

    2013-01-01

    Mitochondrial myopathies commonly present with exercise intolerance typified by breathlessness and fatigue on exercise. In contrast, exercise-induced rhabdomyolysis and myoglobinuria occur rarely. We present a 43-year-old man with a lifelong history of exercise intolerance associated with myalgia...

  4. Severe falciparum malaria with dengue coinfection complicated by rhabdomyolysis and acute kidney injury: an unusual case with myoglobinemia, myoglobinuria but normal serum creatine kinase

    Directory of Open Access Journals (Sweden)

    Yong Kok Pin

    2012-12-01

    Full Text Available Abstract Background Acute kidney injury (AKI is a complication of severe malaria, and rhabdomyolysis with myoglobinuria is an uncommon cause. We report an unusual case of severe falciparum malaria with dengue coinfection complicated by AKI due to myoglobinemia and myoglobinuria while maintaining a normal creatine kinase (CK. Case presentation A 49-year old Indonesian man presented with fever, chills, and rigors with generalized myalgia and was diagnosed with falciparum malaria based on a positive blood smear. This was complicated by rhabdomyolysis with raised serum and urine myoglobin but normal CK. Despite rapid clearance of the parasitemia with intravenous artesunate and aggressive hydration maintaining good urine output, his myoglobinuria and acidosis worsened, progressing to uremia requiring renal replacement therapy. High-flux hemodiafiltration effectively cleared his serum and urine myoglobin with recovery of renal function. Further evaluation revealed evidence of dengue coinfection and past infection with murine typhus. Conclusion In patients with severe falciparum malaria, the absence of raised CK alone does not exclude a diagnosis of rhabdomyolysis. Raised serum and urine myoglobin levels could lead to AKI and should be monitored. In the event of myoglobin-induced AKI requiring dialysis, clinicians may consider using high-flux hemodiafiltration instead of conventional hemodialysis for more effective myoglobin removal. In Southeast Asia, potential endemic coinfections that can also cause or worsen rhabdomyolysis, such as dengue, rickettsiosis and leptospirosis, should be considered.

  5. Myoglobinuria following the use of succinylcholine.

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    Bhave C

    1993-07-01

    Full Text Available Eight hours following tympanoplasty performed under general anaesthesia (sodium pentothal and trichloroethylene, a 30 year old male complained of muscular weakness and dark coloured urine. Urinalysis revealed myoglobin pigment. A rise in BUN (47mg%, serum creatinine (5.7mg%, creatinine phosphokinase (15,500 U/L and CPK-MB fraction (4690 U/L was noticed 36 hrs later. The patient developed acute renal failure, and recovered after haemodialysis. From a history of use of succinylcholine as a muscle relaxant during operation, myoglobinuria appears to be secondary to muscle damage caused by succinylcholine.

  6. Exercise Intolerance and Myoglobinuria Associated with a Novel Maternally Inherited MT-ND1 Mutation

    DEFF Research Database (Denmark)

    Rafiq, Jabin; Duno, Morten; Østergaard, Elsebet

    2016-01-01

    The most common clinical phenotype caused by a mtDNA mutation in complex I of the mitochondrial respiratory chain is Leber hereditary optic neuropathy. We report a family with a novel maternally inherited homoplasmic mtDNA m.4087A>G mutation in the ND1 gene (MT-ND1) associated with isolated...... myopathy, recurrent episodes of myoglobinuria, and rhabdomyolysis. DNA from blood in seven family members and muscle from four family members were PCR amplified and sequenced directly and assessed for the m.4087A>G variation in MT-ND1. Mitochondrial enzyme activity in all muscle biopsies was measured. PCR...... myoglobinuria is a rare phenotype of mitochondrial myopathies. We report this phenotype in a family affected by a novel homoplasmic mutation in MT-ND1. It is the first time such a phenotype has been associated with complex I gene mutations and a homoplasmic mutation of mtDNA....

  7. Clinical significance of myoglobinuria and serum myoglobin in heroin-addicted patients

    International Nuclear Information System (INIS)

    Chen Xuehong; Zhong Ganping; Zhang Lan; Liu Jiangyan

    2001-01-01

    The authors study the relationship between myoglobinuria and acute rhabdomyolysis in heroin-addicted patients. The levels of myoglobin in serum and urine were determined by RIA in 106 heroin-addicted patients and 30 healthy volunteers who were selected as the controls. The levels of myoglobin in serum and urine increased significantly in heroin-addicted patients in 3 days after giving up heroin, and gradually decreased in 2 weeks but still higher than the levels of the controls (P 0.05). Urine myoglobin detection is a simple and effective method to find out acute rhabdomyolysis derived from heroin addiction early

  8. Recurrent Acute Tonsillitis, The 'Core' Issue

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    Saikat Samaddar

    2016-04-01

    Full Text Available Introduction: Today bacteriological and patho-anatomical considerations too are taken into account while treating a case of tonsillitis. Past decade has seen the rise of resistance amongst the common pathogens, as well as rise in the number of unusual offenders. Determination of the true offending organism and prescribing an antibiotic as per the sensitivity pattern is of utmost importance.  Materials and Method: A prospective longitudinal study was conducted in a tertiary care hospital in Kolkata. The study population consisted of patients presenting with recurrent attacks of acute tonsillitis. Determination of throat swab micro flora, ASO titre and core tissue microflora was done and correlated statistically. Result: There was poor correlation between throat swab and core tissue microflora. Positive predictive value of throat swab was 10%. Pseudomonas is the predominant flora harbouring tonsillar core in our study population. Amoxicillin the most commonly prescribed antibiotic stands out to be the most resistant one. No statistical significance could be reached comparing streptococcal tonsillitis with ASO titre. Discussion: The real pathology within the tonsil core is not always reflected in routine throat swab and bacteriology of recurrent tonsillitis may differ in different regions. ASO titre estimation adds up to the economic burden if rheumatic fever is not suspected. Judicious use of antibiotics based on true sensitivity pattern is encouraged. In the era of antibiotics Tonsillectomy still holds an important position in the management of recurrent attacks. Conclusion: Pseudomonas was found to be the most common pathogen in recurrent acute tonsillitis. Core tissue study remains the Gold standard in identifying the pathogenic organism. Oral third generation Cephalosporin was the most efficacious antibiotic for recurrent tonsillitis in our study population.

  9. Myoglobinuria following the use of succinylcholine.

    OpenAIRE

    Bhave C; Gadre K; Gharpure B

    1993-01-01

    Eight hours following tympanoplasty performed under general anaesthesia (sodium pentothal and trichloroethylene), a 30 year old male complained of muscular weakness and dark coloured urine. Urinalysis revealed myoglobin pigment. A rise in BUN (47mg%), serum creatinine (5.7mg%), creatinine phosphokinase (15,500 U/L) and CPK-MB fraction (4690 U/L) was noticed 36 hrs later. The patient developed acute renal failure, and recovered after haemodialysis. From a history of use of succin...

  10. Acute recurrent pancreatitis: Etiopathogenesis, diagnosis and treatment

    Science.gov (United States)

    Testoni, Pier Alberto

    2014-01-01

    Acute recurrent pancreatitis (ARP) refers to a clinical entity characterized by episodes of acute pancreatitis which occurs on more than one occasion. Recurrence of pancreatitis generally occurs in a setting of normal morpho-functional gland, however, an established chronic disease may be found either on the occasion of the first episode of pancreatitis or during the follow-up. The aetiology of ARP can be identified in the majority of patients. Most common causes include common bile duct stones or sludge and bile crystals; sphincter of oddi dysfunction; anatomical ductal variants interfering with pancreatic juice outflow; obstruction of the main pancreatic duct or pancreatico-biliary junction; genetic mutations; alcohol consumption. However, despite diagnostic technologies, the aetiology of ARP still remains unknown in up to 30% of cases: in these cases the term “idiopathic” is used. Because occult bile stone disease and sphincter of oddi dysfunction account for the majority of cases, cholecystectomy, and eventually the endoscopic biliary and/or pancreatic sphincterotomy are curative in most of cases. Endoscopic biliary sphincterotomy appeared to be a curative procedure per se in about 80% of patients. Ursodeoxycholic acid oral treatment alone has also been reported effective for treatment of biliary sludge. In uncertain cases toxin botulin injection may help in identifying some sphincter of oddi dysfunction, but this treatment is not widely used. In the last twenty years, pancreatic endotherapy has been proven effective in cases of recurrent pancreatitis depending on pancreatic ductal obstruction, independently from the cause of obstruction, and has been widely used instead of more aggressive approaches. PMID:25493002

  11. Changing clinical profile of acute rheumatic fever and rheumatic recurrence

    International Nuclear Information System (INIS)

    Sheikh, A.M.; Sadiq, M.; Rehman, A.U.

    2016-01-01

    Background: Clinical profile of acute rheumatic fever and rheumatic recurrence seems to have changed in countries where rheumatic fever is still endemic. The objectives of this study were to compare clinical profile and outcome of patients suffering initial and recurrent episodes of acute rheumatic fever in children. Methods: This prospective study was conducted in two tertiary care hospitals from January to June 2011. The diagnosis was based on the modified Jones criteria. Sixty children were included in the study, 15 having first episode of rheumatic fever and 45 with rheumatic recurrence. The severity of carditis was assessed by Clinical and echocardiography means. Results: Carditis was the commonest presentation in both first (80 percentage) and recurrent attacks (100 percentage). Arthritis was seen in 60 percentage of children with first episode and in 26.7 percentage with recurrence. The frequency of subcutaneous nodules, invariably associated with carditis, was very high (33.3 percentage in the first and 48.3 percentage in recurrent episodes). Carditis was generally mild during first episode (53.3 percentage) and severe with rheumatic recurrence (55.6 percentage). There was no death in either group. One patient with severe mitral regurgitation and rheumatic recurrence underwent mitral valve repair for intractable heart failure. Conclusion: Clinical profile of rheumatic recurrence and acute rheumatic fever has changed. Rheumatic recurrence is associated with severe carditis. Carditis is more common than arthritis even in the first attack. Sub-cutaneous nodules are a frequent finding invariably associated with carditis. (author)

  12. Etiology, Severity and Recurrence of Acute Pancreatitis in Southern Taiwan

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    Chun-Hao Chen

    2006-01-01

    Conclusion: Alcoholic pancreatitis was the major etiology of acute pancreatitis in southern Taiwan, exhibiting a strong male predominance and higher risk of severe CT grading. Abnormal serum triglyceride was independently associated with the severity of acute pancreatitis. Alcoholic pancreatitis had a higher risk of recurrence than other etiologies.

  13. Long-term recurrence and death rates after acute pancreatitis

    DEFF Research Database (Denmark)

    Lund, Helle; Tønnesen, Hanne; Tønnesen, Maja Hanne

    2006-01-01

    The aim of this study was to compare long-term recurrence and death rates after a first episode of acute pancreatitis in patients with and without gallstones. Additionally, it was of interest to find out if there were factors predictive of readmission or death.......The aim of this study was to compare long-term recurrence and death rates after a first episode of acute pancreatitis in patients with and without gallstones. Additionally, it was of interest to find out if there were factors predictive of readmission or death....

  14. High incidence of acute and recurrent patellar dislocations

    DEFF Research Database (Denmark)

    Gravesen, Kasper Skriver; Kallemose, Thomas; Blønd, Lars

    2017-01-01

    PURPOSE: The purpose of this study was to investigate the Danish population as a whole from 1994 to 2013 to find the incidence of acute and recurrent patellar dislocation. METHODS: The study was performed as a descriptive epidemiological study. The Danish National Patient Registry was retrospecti...

  15. Recurrent acute pancreatitis in anorexia and bulimia.

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    Morris, Luc G; Stephenson, Kathryn E; Herring, Sharon; Marti, Jennifer L

    2004-07-01

    Mild pancreatitis has been reported as a consequence of anorexia nervosa, bulimia nervosa, or what has been termed the "dietary chaos syndrome". Either chronic malnutrition, or refeeding after periods of malnutrition, may precipitate acute pancreatitis through several pathogenetic mechanisms. A 26-year-old woman with a ten-year history of anorexia and bulimia presented with a third episode of acute pancreatitis in three months. The patient had been abstinent from alcohol for many years. Imaging studies during all three admissions failed to identify any biliary disease, including gallstones or biliary sludge. A cholecystectomy was performed, with a normal intraoperative cholangiogram, and no abnormalities on pathologic examination of the gallbladder and bile. The patient was discharged on hospital day 10 with no pain, and she has begun to return to regular eating habits. Pancreatitis has not recurred after 6 months of follow up. We have identified 14 cases in the literature of acute pancreatitis associated with anorexia or bulimia. In the absence of evidence for gallstone, alcohol or metabolic etiologies, eating disorders may contribute to the pathophysiology of some idiopathic cases of pancreatitis.

  16. CD19/CD22 Chimeric Antigen Receptor T Cells and Chemotherapy in Treating Children or Young Adults With Recurrent or Refractory CD19 Positive B Acute Lymphoblastic Leukemia

    Science.gov (United States)

    2017-11-20

    B Acute Lymphoblastic Leukemia; CD19 Positive; Minimal Residual Disease; Philadelphia Chromosome Positive; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Lymphoblastic Leukemia; Refractory Acute Lymphoblastic Leukemia

  17. Albendazole Induced Recurrent Acute Toxic Hepatitis: A Case Report.

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    Bilgic, Yilmaz; Yilmaz, Cengiz; Cagin, Yasir Furkan; Atayan, Yahya; Karadag, Nese; Harputluoglu, Murat Muhsin Muhip

    2017-01-01

    Drug induced acute toxic hepatitis can be idiosyncratic. Albendazole, a widely used broad spectrum antiparasitic drug is generally accepted as a safe drug. It may cause asymptomatic transient liver enzyme abnormalities but acute toxic hepatitis is very rare. Case Report : Herein, we present the case of 47 year old woman with recurrent acute toxic hepatitis after a single intake of albendazole in 2010 and 2014. The patient was presented with symptoms and findings of anorexia, vomiting and jaundice. For diagnosis, other acute hepatitis etiologies were excluded. Roussel Uclaf Causality Assessment Method (RUCAM) score was calculated and found to be 10, which meant highly probable drug hepatotoxicity. Within 2 months, all pathological findings came to normal. There are a few reported cases of albendazole induced toxic hepatitis, but at adults, there is no known recurrent acute toxic hepatitis due to albendazole at this certainty according to RUCAM score. Physicians should be aware of this rare and potentially fatal adverse effect of albendazole. © Acta Gastro-Enterologica Belgica.

  18. Eosinophilic Pancreatitis: A Rare Cause of Recurrent Acute Pancreatitis

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    Jennifer Reppucci

    2017-03-01

    Full Text Available Eosinophilic pancreatitis is a rare form of recurrent acute pancreatitis that demonstrates distinct histologic features, including diffuse, periductal, acinar, and septal inflammatory infiltrates comprised of a pure or predominant population of eosinophils, eosinophilic phlebitis and arteritis, and localized eosinophilic infiltrates with pseudocyst formation. It is associated with elevated serum immunoglobulin E levels, an elevated eosinophil count with systemic manifestations, and eosinophilic infiltrates in other organs of the gastrointestinal tract. We present a case of eosinophilic pancreatitis in a 44-year-old man who was diagnosed after pancreatic resection for recurrent bouts of acute pancreatitis. While the gross and histologic evaluations matched other reported cases of eosinophilic pancreatitis, our patient had only minimal peripheral eosinophilia, no reported history of symptoms related to elevated eosinophilia or immunoglobulin E, and only mild eosinophilic infiltrates in his gallbladder.

  19. Vaginal microbiology of women with acute recurrent vulvovaginal candidiasis.

    OpenAIRE

    Sobel, J D; Chaim, W

    1996-01-01

    Alterations in the autochthonous vaginal microflora can predispose women to recurring attacks of Candida vaginitis. Quantitative aerobic and anaerobic cultures were obtained from 24 premenopausal women with acute recurrent vulvovaginal candidiasis and from 21 healthy asymptomatic premenopausal women. Lactobacillus species constituted the predominant flora in both groups, with a mean log10 CFU/ml of 8.7, a total isolation rate of 96%, and a mean of 1.6 Lactobacillus species isolated per patien...

  20. Recurrence of acute myeloid leukemia in cryptorchid testis: case report

    International Nuclear Information System (INIS)

    Góes, Luccas Santos Patto de; Lopes, Roberto Iglesias; Campos, Octavio Henrique Arcos; Oliveira, Luiz Carlos Neves de; Sant'Anna, Alexandre Crippa; Dall'Oglio, Marcos Francisco; Srougi, Miguel

    2014-01-01

    A 23-year-old male with a history of bone marrow transplant for acute myeloid leukemia. He presented a large mass in the right inguinal region 5 years ago. Upon physical examination, right-sided cryptorchidism was observed. The tumor markers alpha-fetoprotein and beta-HCG were within normalcy range and lactate dehydrogenase was raised. Computed tomography of the abdomen and pelvis revealed right testicular mass in contiguity with the inguinal canal to the ipsilateral retroperitoneum, associated with right hydronephrosis. Due to the risk of germ-cell tumor in undescended testicle, the patient underwent radical right orchiectomy. The pathological examination showed recurrence of acute myeloid leukemia in the testis. He was referred to oncology for adjuvant therapy. Our literature review found no similar cases described

  1. Colopancreatic Fistula: An Uncommon Complication of Recurrent Acute Pancreatitis

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    Mouhanna Abu Ghanimeh

    2018-01-01

    Full Text Available Colonic complications, including colopancreatic fistulas (CPFs, are uncommon after acute and chronic pancreatitis. However, they have been reported and are serious. CPFs are less likely to close spontaneously and are associated with a higher risk of complications. Therefore, more definitive treatment is required that includes surgical and endoscopic options. We present a case of a 62-year-old male patient with a history of heavy alcohol intake and recurrent acute pancreatitis who presented with a 6-month history of watery diarrhea and abdominal pain. His abdominal imaging showed a possible connection between the colon and the pancreas. A further multidisciplinary workup by the gastroenterology and surgery teams, including endoscopic ultrasound, endoscopic retrograde cholangiopancreatography, and colonoscopy, resulted in a diagnosis of CPF. A distal pancreatectomy and left hemicolectomy were performed, and the diagnosis of CPF was confirmed intraoperatively. The patient showed improvement afterward.

  2. Recurrence of acute myeloid leukemia in cryptorchid testis: case report

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    Góes, Luccas Santos Patto de [Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP (Brazil); Lopes, Roberto Iglesias [Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP (Brazil); Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); Campos, Octavio Henrique Arcos [Hospital do Servidor Público Municipal de São Paulo, São Paulo, SP (Brazil); Oliveira, Luiz Carlos Neves de; Sant' Anna, Alexandre Crippa; Dall' Oglio, Marcos Francisco; Srougi, Miguel [Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil)

    2014-07-01

    A 23-year-old male with a history of bone marrow transplant for acute myeloid leukemia. He presented a large mass in the right inguinal region 5 years ago. Upon physical examination, right-sided cryptorchidism was observed. The tumor markers alpha-fetoprotein and beta-HCG were within normalcy range and lactate dehydrogenase was raised. Computed tomography of the abdomen and pelvis revealed right testicular mass in contiguity with the inguinal canal to the ipsilateral retroperitoneum, associated with right hydronephrosis. Due to the risk of germ-cell tumor in undescended testicle, the patient underwent radical right orchiectomy. The pathological examination showed recurrence of acute myeloid leukemia in the testis. He was referred to oncology for adjuvant therapy. Our literature review found no similar cases described.

  3. Etiology, clinical features and management of acute recurrent pancreatitis.

    Science.gov (United States)

    Deng, Yi Yun; Wang, Rui; Wu, Hao; Tang, Cheng Wei; Chen, Xin Zu

    2014-10-01

    To study the etiology and clinical features of acute recurrent pancreatitis (ARP) and to determine its optimal management and outcomes. ARP cases among acute pancreatitis patients who were admitted to the West China Hospital, Sichuan University from January 2008 to December 2012 were retrospectively collected. Their etiology, clinical features, treatments and outcomes were analyzed. Of all pancreatitis patients, 8.9% were classified as ARP. The proportions of mild and severe diseases were 85.7% and 14.3%, respectively. The common etiological factors were biliogenic (31.0%), alcohol (26.2%), hyperlipidemia (21.4%) and pancreaticobiliary malformation (15.4%). At first 46 cases were cryptogenic and among them 36 were subsequently confirmed by endoscopic retrograde cholangiopancreatography (ERCP). Among the hyperlipidemic ARP patients, 72.2% failed to routinely monitor and control serum lipids. ERCP was performed in 88 cases, and 48 also required an endoscopic sphincterotomy or calculus removal. Twenty-two patients underwent cholangiopancreatic duct stent placement, and pancreatic necrosectomy was performed on eight severe cases. The overall outcomes indicate that 8.3% of the cases progressed to chronic pancreatitis and 33.3% of the cases receiving etiological treatment were recurrence-free. There were no deaths in this study. The etiological factors of ARP are similar to those of acute pancreatitis at the first attack. The management of ARP should be fully considered based on etiological investigation. © 2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

  4. Recurrent hypercalcemia in a patient with acute sarcoidosis

    International Nuclear Information System (INIS)

    Saavedra Ramirez, Publio Giovanni; Ramirez Palacios, Ivan; Cardona Tapias, Alejandro

    2007-01-01

    Sarcoidosis is a chronic granulomatous disease of unknown etiology characterized by the presence of noncaseating epithelioid granulomas that can take place in every organ or system of the human body. This disease can be acute or sub acute and self limited in presentation or can have a chronic course characterized by exacerbations and remissions. Hypercalcemia can be detected in 10 to 20 percent of the patients with the disease. It is caused by the over expression of vitamin D-receptor and 25-hydroxyvitamin D 1-? hydroxylase enzyme in monocytes and activated macrophages within the granuloma in a way that is resistant to the natural inhibition driven by high serum calcium Levels. This autonomous enzymatic activity leads to the overproduction of calcitriol which increase intestinal absorption of the calcium present in the diet and also increase the activity of osteoclast with consequent high bone turnover and hypercalcemia. In this report we present the case of a 49 years old man, black race, bilateral parotid gland enlargement, bilateral hilar lymphadenopathy, severe recurrent hypercaIcemia and acute renal failure in which sarcoidosis was documented as the cause of his symptoms

  5. Recurrent acute transverse myelopathy: association with antiphospholipid antibody syndrome.

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    Shaharao, Vijaya; Bartakke, Sandip; Muranjan, Mamta N; Bavdekar, Manisha S; Bavdekar, Sandeep B; Udani, Vrajesh P

    2004-06-01

    A seven-year-old boy presented with a second episode of acute transverse myelopathy. The first episode had responded dramatically to methylprednisolone. The manifestations of the second episode did not respond to methylprednisolone or IVIG. He showed persistently raised levels of antiphospholipid antibodies in the serum. Primary conditions like collagen vascular diseases, malignancy, exposure to drugs and HIV infection, which are known to be associated with the raised titers of these antibodies were ruled out clinically and by investigations. Recurrent transverse myelopathy is a rare event in childhood and reports of its association with Antiphospholipid Antibody Syndrome (APLAS) are scanty. The etiological role for these antibodies remains to be established. However, once the diagnosis is established, it may be prudent to treat the condition with agents and procedures to bring about a decrease in their titers. Long-term therapy to prevent thromboembolic complications of APLAS may also be instituted.

  6. Neisseria meningitidis presenting as acute abdomen and recurrent reactive pericarditis

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    Karolina Akinosoglou

    2016-11-01

    Full Text Available Meningococcal meningitis is a well established potential fatal infection characterized by fever, headache, petechial rash, and vomiting in the majority of cases. However, protean manifestations including abdominal pain, sore throat, diarrhea and cough, even though rare, should not be overlooked. Similarly, although disseminated infection could potentially involve various organ-targets, secondary immune related complications including joints or pericardium should be dealt with caution, since they remain unresponsive to appropriate antibiotic regimens. We hereby report the rare case of an otherwise healthy adult female, presenting with acute abdominal pain masking Neisseria meningitidis serotype B meningitis, later complicated with recurrent reactive pericarditis despite appropriate antibiotic treatment. There follows a review of current literature.

  7. Epidemiology of Recurrent Acute and Chronic Pancreatitis: Similarities and Differences.

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    Machicado, Jorge D; Yadav, Dhiraj

    2017-07-01

    Emerging data in the past few years suggest that acute, recurrent acute (RAP), and chronic pancreatitis (CP) represent a disease continuum. This review discusses the similarities and differences in the epidemiology of RAP and CP. RAP is a high-risk group, comprised of individuals at varying risk of progression. The premise is that RAP is an intermediary stage in the pathogenesis of CP, and a subset of RAP patients during their natural course transition to CP. Although many clinical factors have been identified, accurately predicting the probability of disease course in individual patients remains difficult. Future studies should focus on providing more precise estimates of the risk of disease transition in a cohort of patients, quantification of clinical events during the natural course of disease, and discovery of biomarkers of the different stages of the disease continuum. Availability of clinically relevant endpoints and linked biomarkers will allow more accurate prediction of the natural course of disease over intermediate- or long-term-based characteristics of an individual patient. These endpoints will also provide objective measures for use in clinical trials of interventions that aim to alter the natural course of disease.

  8. Chronic Recurrent Multifocal Osteomyelitis Causing an Acute Scoliosis

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    Alexander Armstrong

    2013-01-01

    Full Text Available Study Design. A Case Report. Objective. We present a 15-year-old girl with an acute atypical scoliosis secondary to chronic recurrent multifocal osteomyelitis (CRMO. Summary of Background Data. CRMO is a rare nonpyogenic inflammatory bone condition with unclear aetiology. CRMO mainly affects the metaphyses of long bones, the pelvis, shoulder girdle, and less commonly the spine. Methods. Our case presented with a 6-month history of worsening thoracic back pain, asymmetry of her shoulders and abnormal posture. Whole spine radiographs revealed a right atypical thoracic scoliosis. Magnetic Resonance Imaging showed abnormal signal on the short TI inversion recovery (STIR sequences in multiple vertebrae. A bone biopsy demonstrated evidence of fibrosis and chronic inflammatory changes. Interval MRI scans revealed new oedematous lesions and disappearance of old lesions. Symptoms improved. Results. It is important to consider CRMO as an acute cause of atypical scoliosis. Malignancy, pyogenic infections and atypical presentations of juvenile arthritis need excluding. Conclusion. This 24-month follow-up describes a rare cause of an atypical scoliosis and fortifies the small amount of the currently available literature. The case highlights the relapsing and remitting nature of CRMO with new lesions developing and older lesions burning out. We advise close radiological surveillance and symptomatic management.

  9. Recurrent acute pancreatitis: an approach to diagnosis and management.

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    Kedia, Saurabh; Dhingra, Rajan; Garg, Pramod Kumar

    2013-01-01

    Recurrent acute pancreatitis (RAP) is defined as more than two attacks of acute pancreatitis (AP) without any evidence of underlying chronic pancreatitis (CP). As the known causes of AP are generally taken care of, RAP usually occurs in the idiopathic group, which forms 20%-25% of cases of AP. The causes of idiopathic RAP (IRAP) can be mechanical, toxic-metabolic, anatomical, or miscellaneous. Microlithiasis commonly reported from the West is not a common cause of IRAP among Indian patients. Pancreas divisum (PD) is now believed as a cofactor, the main factor being associated genetic mutations. The role of Sphincter of Oddi dysfunction (SOD) as a cause of IRAP remains controversial. Malignancy should be ruled out in any patient with IRAP > 50 years of age. Early CP can present initially as RAP. The work-up of patients with IRAP includes a detailed history and investigations. Primary investigations include liver function tests (LFT), serum calcium and triglyceride, abdominal ultrasonography (USG) and contrast-ehhanced computed tomography (CECT) abdomen. Endoscopic ultrasound (EUS), magnetic resonance cholangiopancreatography (MRCP) and possibly endoscopic retrograde cholangiopancreatography (ERCP) are indicated in the secondary phase if the work-up is negative after the primary investigations. EUS is advised usually 6-8 weeks after an acute episode. Treatment of patients with IRAP is aimed at the specific aetiology. In general, empirical cholecystectomy should be discouraged with the availability and widespread use of EUS. Endoscopic sphincterotomy is advised if there is strong suspicion of SOD. Minor papilla sphincterotomy should be carried out in those with PD but with limited expectations. Regular follow-up of patients with IRAP is necessary because most patients are likely to develop CP in due course.

  10. Imaging findings of recurrent acute lymphoblastic leukemia in children and young adults, with emphasis on MRI

    International Nuclear Information System (INIS)

    Porter, Rosalyn P.; Kaste, Sue C.

    2004-01-01

    Acute lymphoblastic leukemia (ALL) is the most common of all childhood malignancies. Current remission rates approach 80%. Recurrent disease can present in a wide variety of ways. MR imaging plays a crucial role in the detection of disease relapse. Because other disorders can mimic recurrence of leukemia, it is important for the radiologist to judge recurrence from non-recurrence accurately in order to avoid unnecessary testing and emotional stress on the patient and family. (orig.)

  11. Imaging findings of recurrent acute lymphoblastic leukemia in children and young adults, with emphasis on MRI

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    Porter, Rosalyn P. [Department of Diagnostic Imaging, St. Jude Children' s Research Hospital, 332 N. Lauderdale, Memphis, TN 38105-2794 (United States); Kaste, Sue C. [Department of Diagnostic Imaging, St. Jude Children' s Research Hospital, 332 N. Lauderdale, Memphis, TN 38105-2794 (United States); Department of Radiology, University of Tennessee, College of Medicine, Memphis, Tennessee (United States)

    2004-05-01

    Acute lymphoblastic leukemia (ALL) is the most common of all childhood malignancies. Current remission rates approach 80%. Recurrent disease can present in a wide variety of ways. MR imaging plays a crucial role in the detection of disease relapse. Because other disorders can mimic recurrence of leukemia, it is important for the radiologist to judge recurrence from non-recurrence accurately in order to avoid unnecessary testing and emotional stress on the patient and family. (orig.)

  12. PEDIATRIC ACUTE RECURRENT AND CHRONIC PANCREATITIS: LESSONS FROM INSPPIRE

    Science.gov (United States)

    Kumar, Soma; Ooi, Chee Y.; Werlin, Steven; Abu-El-Haija, Maisam; Barth, Bradley; Bellin, Melena D.; Durie, Peter R.; Fishman, Douglas S.; Freedman, Steven D.; Gariepy, Cheryl; Giefer, Matthew J.; Gonska, Tanja; Heyman, Melvin B.; Himes, Ryan; Husain, Sohail Z.; Lin, Tom K.; Lowe, Mark E.; Morinville, Veronique; Palermo, Joseph J.; Pohl, John F.; Schwarzenberg, Sarah Jane; Troendle, David; Wilschanski, Michael; Zimmerman, M. Bridget; Uc, Aliye

    2017-01-01

    Importance Pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) are poorly understood. Objective To characterize and identify risk factors associated with ARP and CP in childhood. Design A multinational cross-sectional study of children with ARP or CP at the time of enrollment to INSPPIRE (International Study Group of Pediatric Pancreatitis: In Search for a CuRE) study. Setting Participant institutions of the INSPPIRE Consortium. Participants From September 2012 to February 2015, 155 children with ARP and 146 with CP (≤ 19 years of age) were enrolled. Their demographic and clinical information were entered into the REDCap database at fifteen centers. Interventions None. Main Outcomes and Measures A cross-sectional study of the cohort was performed to assess demographics, risk factors, abdominal pain and disease burden. Differences were analyzed using two-sample t-test or Wilcoxon-rank sum test for the continuous variables, and Pearson Chi-square or Fisher’s exact test for categorical variables. Disease burden variables (pain variables, hospital/ER visits, missed school days) were compared using Wilcoxon rank-sum test. Results The majority of children with CP reported prior recurrent episodes of acute pancreatitis. Gender distribution was similar between the groups. ARP was more common in Hispanics, CP in non-Hispanics. Forty-eight percent of patients with ARP versus 73% of patients with CP had at least one gene mutation in pancreatitis-related genes (p=0.0002). Children with PRSS1 or SPINK1 mutations were more likely to present with CP compared with ARP (ptoxic/metabolic risk factors (~20% of patients) did not differ between children with ARP or CP. Pancreatitis-related abdominal pain was a major complaint in 81% of children with ARP or CP within the last year. The disease burden was higher in CP compared with ARP (more ER visits, hospitalizations, missed school days, medical, endoscopic and surgical interventions). Conclusions and

  13. The Effects of Inhaled Steroids on Recurrent Wheeze After Acute Bronchiolitis

    Directory of Open Access Journals (Sweden)

    Patricia Green MD

    2015-07-01

    Full Text Available Background. Acute bronchiolitis infection during infancy is associated with an increased risk of asthma later in life. The objective of this study was to determine if inhaled steroids are effective in preventing the development of recurrent wheeze or asthma following acute bronchiolitis. Methods. Multiple databases and bibliographies of selected references were searched. Inclusion required (a a randomized controlled trial of inhaled steroids and control group, (b at least 2 weeks duration of therapy started during the acute phase of disease, and (c identification of the rate of recurrent wheeze or asthma at least 6 months after therapy. Results. Of 1410 studies reviewed, 8 reports were included in this meta-analysis (748 patients. The overall odds ratio for developing recurrent wheeze or asthma with treatment versus without treatment was 1.02 (95% confidence interval = 0.58-1.81. Conclusions. A course of inhaled steroids after acute bronchiolitis is not effective in preventing recurrent wheeze or asthma.

  14. Recurrent acute otitis media detracts from health-related quality of life.

    Science.gov (United States)

    Kujala, T; Alho, O-P; Kristo, A; Uhari, M; Renko, M; Pokka, T; Koivunen, P

    2017-02-01

    Acute otitis media causes discomfort to children and inconvenience to their parents. This study evaluated the quality of life in children with recurrent acute otitis media aged less than 24 months. Quality of life was evaluated in 149 children aged 10 to 24 months who were referred to the Oulu University Hospital on account of recurrent acute otitis media. The children were treated with or without surgery. Age-matched controls were selected randomly from the general child population. Parents completed the Child Health Questionnaire. The children with recurrent acute otitis media had a significantly poorer quality of life than control children. The control children with a history of a few acute otitis media episodes had a significantly poorer quality of life than those without any such history. The quality of life of the children with recurrent acute otitis media improved during the one-year follow up, regardless of the treatment, but did not reach the same level as healthy children. Acute otitis media detracted from quality of life when a generic measure was used. The mode of treatment used to prevent further recurrences of acute otitis media did not influence quality of life improvement.

  15. The Diagnosis, Evaluation and Treatment of Acute and Recurrent Pediatric Urinary Tract Infections

    Science.gov (United States)

    Becknell, Brian; Schober, Megan; Korbel, Lindsey; Spencer, John David

    2015-01-01

    Urinary tract infection is one of the most common bacterial infections encountered by pediatricians. Currently, the diagnosis and management of acute urinary tract infection and recurrent urinary tract infection in children remains controversial. Recently published guidelines and large clinical trials have attempted to clarify UTI diagnostic and management strategies. In this manuscript, we review the diagnosis and management of acute and recurrent urinary tract infection in the pediatric population. PMID:25421102

  16. Analysis of Recurrence Management in Patients Who Underwent Nonsurgical Treatment for Acute Appendicitis

    Science.gov (United States)

    Liang, Tsung-Jung; Liu, Shiuh-Inn; Tsai, Chung-Yu; Kang, Chi-Hsiang; Huang, Wei-Chun; Chang, Hong-Tai; Chen, I-Shu

    2016-01-01

    Abstract The recurrence rate for acute appendicitis treated nonoperatively varies between studies. Few studies have adequately evaluated the management of these patients when appendicitis recurs. We aimed to explore the recurrence rate and management of patients with acute appendicitis that were first treated nonoperatively. We identified patients in the Taiwan National Health Insurance Research Database who were hospitalized due to acute appendicitis for the first time between 2000 and 2010 and received nonsurgical treatment. The recurrence and its management were recorded. Data were analyzed to access the risk factors for recurrence and factors that influenced the management of recurrent appendicitis. Among the 239,821 patients hospitalized with acute appendicitis for the first time, 12,235 (5.1%) patients were managed nonoperatively. Of these, 864 (7.1%) had a recurrence during a median follow-up of 6.5 years. Appendectomy was performed by an open and laparoscopic approach in 483 (55.9%) and 258 (29.9%) patients, respectively. The remaining 123 (14.2%) patients were again treated nonsurgically. Recurrence was independently associated with young age, male sex, percutaneous abscess drainage, and medical center admission by multivariable analysis. In addition, age appendicitis, percutaneous abscess drainage, nor length of first time hospital stay had an influence on the selection of surgical approach. In conclusion, a laparoscopic appendectomy can be performed in recurrent appendicitis cases, and its application may not be related to previous appendicitis severity. PMID:27015200

  17. Influence of delayed cholecystectomy after acute gallstone pancreatitis on recurrence: consequences of lack of resources

    Directory of Open Access Journals (Sweden)

    Natalia Bejarano-González

    Full Text Available Introduction: Acute pancreatitis is often a relapsing condition, particularly when its triggering factor persists. Our goal is to determine the recurrence rate of acute biliary pancreatitis after an initial episode, and the time to relapse, as well as to identify the risk factors for recurrence. Material and method: We included all patients admitted for a first acute gallstone pancreatitis event during four years. Primary endpoints included readmission for recurrence and time to relapse. Results: We included 296 patients admitted on a total of 386 occasions. The incidence of acute biliary pancreatitis in our setting is 17.5/100,000 population/year. In all, 19.6% of pancreatitis were severe (22.6% of severe acute pancreatitis for first episodes versus 3.6% for recurring pancreatitis, with an overall mortality of 4.4%. Overall recurrence rate was 15.5%, with a median time to relapse of 82 days. In total, 14.2% of patients relapsed after an acute pancreatitis event without cholecystectomy or endoscopic retrograde cholangio-pancreatography. Severe acute pancreatitis recur in 7.2% of patients, whereas mild cases do so in 16.3%, this being the only risk factor for recurrence thus far identified. Conclusions: Patients admitted for pancreatitis should undergo cholecystectomy as soon as possible or be guaranteed priority on the waiting list. Otherwise, endoscopic retrograde cholangio-pancreatography with sphincterotomy may be an alternative to surgery for selected patients.

  18. Risk of Recurrent Pancreatitis and Progression to Chronic Pancreatitis After a First Episode of Acute Pancreatitis

    NARCIS (Netherlands)

    Ahmed Ali, Usama; Issa, Yama; Hagenaars, Julia C.; Bakker, Olaf J.; van Goor, Harry; Nieuwenhuijs, Vincent B.; Bollen, Thomas L.; van Ramshorst, Bert; Witteman, Ben J.; Brink, Menno A.; Schaapherder, Alexander F.; Dejong, Cornelis H.; Spanier, B. W. Marcel; Heisterkamp, Joos; van der Harst, Erwin; van Eijck, Casper H.; Besselink, Marc G.; Gooszen, Hein G.; van Santvoort, Hjalmar C.; Boermeester, Marja A.

    2016-01-01

    Patients with a first episode of acute pancreatitis can develop recurrent or chronic pancreatitis (CP). However, little is known about the incidence or risk factors for these events. We performed a cross-sectional study of 669 patients with a first episode of acute pancreatitis admitted to 15 Dutch

  19. Risk of Recurrent Pancreatitis and Progression to Chronic Pancreatitis After a First Episode of Acute Pancreatitis

    NARCIS (Netherlands)

    Ahmed Ali, Usama; Issa, Yama; Hagenaars, Julia C.; Bakker, Olaf J.; van Goor, Harry; Nieuwenhuijs, Vincent B.; Bollen, Thomas L.; van Ramshorst, Bert; Witteman, Ben J.; Brink, Menno A.; Schaapherder, Alexander F.; Dejong, Cornelis H.; Spanier, B. W Marcel; Heisterkamp, Joos; van der Harst, Erwin; van Eijck, Casper H.; Besselink, Marc G.; Gooszen, Hein G.; van Santvoort, Hjalmar C.; Boermeester, Marja A.

    2016-01-01

    Background & Aims: Patients with a first episode of acute pancreatitis can develop recurrent or chronic pancreatitis (CP). However, little is known about the incidence or risk factors for these events. Methods: We performed a cross-sectional study of 669 patients with a first episode of acute

  20. Risk of Recurrent Pancreatitis and Progression to Chronic Pancreatitis After a First Episode of Acute Pancreatitis

    NARCIS (Netherlands)

    Ali, U.A.; Issa, Y.; Hagenaars, J.C.; Bakker, O.J.; Goor, H. van; Nieuwenhuijs, V.B.; Bollen, T.L.; Ramshorst, B. van; Witteman, B.J.; Brink, M.A.; Schaapherder, A.F.; Dejong, C.H.; Spanier, B.W.; Heisterkamp, J.; Harst, E. van der; Eijck, C.H. van; Besselink, M.G.; Gooszen, H.G.; Santvoort, H.C. van; Boermeester, M.A.

    2016-01-01

    BACKGROUND & AIMS: Patients with a first episode of acute pancreatitis can develop recurrent or chronic pancreatitis (CP). However, little is known about the incidence or risk factors for these events. METHODS: We performed a cross-sectional study of 669 patients with a first episode of acute

  1. Magnetic resonance direct thrombus imaging differentiates acute recurrent ipsilateral deep vein thrombosis from residual thrombosis.

    Science.gov (United States)

    Tan, Melanie; Mol, Gerben C; van Rooden, Cornelis J; Klok, Frederikus A; Westerbeek, Robin E; Iglesias Del Sol, Antonio; van de Ree, Marcel A; de Roos, Albert; Huisman, Menno V

    2014-07-24

    Accurate diagnostic assessment of suspected ipsilateral recurrent deep vein thrombosis (DVT) is a major clinical challenge because differentiating between acute recurrent thrombosis and residual thrombosis is difficult with compression ultrasonography (CUS). We evaluated noninvasive magnetic resonance direct thrombus imaging (MRDTI) in a prospective study of 39 patients with symptomatic recurrent ipsilateral DVT (incompressibility of a different proximal venous segment than at the prior DVT) and 42 asymptomatic patients with at least 6-month-old chronic residual thrombi and normal D-dimer levels. All patients were subjected to MRDTI. MRDTI images were judged by 2 independent radiologists blinded for the presence of acute DVT and a third in case of disagreement. The sensitivity, specificity, and interobserver reliability of MRDTI were determined. MRDTI demonstrated acute recurrent ipsilateral DVT in 37 of 39 patients and was normal in all 42 patients without symptomatic recurrent disease for a sensitivity of 95% (95% CI, 83% to 99%) and a specificity of 100% (95% CI, 92% to 100%). Interobserver agreement was excellent (κ = 0.98). MRDTI images were adequate for interpretation in 95% of the cases. MRDTI is a sensitive and reproducible method for distinguishing acute ipsilateral recurrent DVT from 6-month-old chronic residual thrombi in the leg veins. © 2014 by The American Society of Hematology.

  2. Acute intracranial bleeding and recurrence after bur hole craniostomy for chronic subdural hematoma.

    Science.gov (United States)

    Pang, Chang Hwan; Lee, Soo Eon; Kim, Chang Hyeun; Kim, Jeong Eun; Kang, Hyun-Seung; Park, Chul-Kee; Paek, Sun Ha; Kim, Chi Heon; Jahng, Tae-Ahn; Kim, Jin Wook; Kim, Yong Hwy; Kim, Dong Gyu; Chung, Chun Kee; Jung, Hee-Won; Yoo, Heon

    2015-07-01

    There is inconsistency among the perioperative management strategies currently used for chronic subdural hematoma (cSDH). Moreover, postoperative complications such as acute intracranial bleeding and cSDH recurrence affect clinical outcome of cSDH surgery. This study evaluated the risk factors associated with acute intracranial bleeding and cSDH recurrence and identified an effective perioperative strategy for cSDH patients. A retrospective study of patients who underwent bur hole craniostomy for cSDH between 2008 and 2012 was performed. A consecutive series of 303 cSDH patients (234 males and 69 females; mean age 67.17 years) was analyzed. Postoperative acute intracranial bleeding developed in 14 patients (4.57%) within a mean of 3.07 days and recurrence was observed in 37 patients (12.21%) within a mean of 31.69 days (range 10-104 days) after initial bur hole craniostomy. The comorbidities of hematological disease and prior shunt surgery were clinical factors associated with acute bleeding. There was a significant risk of recurrence in patients with diabetes mellitus, but recurrence did not affect the final neurological outcome (p = 0.776). Surgical details, including the number of operative bur holes, saline irrigation of the hematoma cavity, use of a drain, and type of postoperative ambulation, were not significantly associated with outcome. However, a large amount of drainage was associated with postoperative acute bleeding. Bur hole craniostomy is an effective surgical procedure for initial and recurrent cSDH. Patients with hematological disease or a history of prior shunt surgery are at risk for postoperative acute bleeding; therefore, these patients should be carefully monitored to avoid overdrainage. Surgeons should consider informing patients with diabetes mellitus that this comorbidity is associated with an increased likelihood of recurrence.

  3. Should non acute and recurrent headaches have neuroimaging ...

    African Journals Online (AJOL)

    Method: Seventy-four cases that were referred to the specialist neurology clinic with complaints of chronic and recurrent headaches without focal neurological defi cit that had CT scan were reviewed consecutively using the short form of the International Classification of Headache Disorders second edition (ICHD 2) criteria ...

  4. The effect of ventilating tubes in Young children with recurrent acute otitis media

    DEFF Research Database (Denmark)

    Heidemann, Christian Hamilton; Homøe, Preben; Lous, Jørgen

    2017-01-01

    Purpose of Review. Ventilating tube treatment (VT) is a common surgical procedure in preschool children. Twenty to fifty percent of children treated with VT suffer from recurrent acute otitis media (RAOM). The aim of this review is to update current knowledge on the topic. Recent Findings. Therre...... is still controversy regarding the use of VT for children with RAOM. So far, only six randomized trials have been published. From the limited data pool, it seems that children with RAOM treated with VT experienced less time with acute otitis media and experienced less recurrence compared to controls...

  5. Recurrent episodic acute kidney injury as presenting manifestation of mitochondrial myopathy

    Directory of Open Access Journals (Sweden)

    T P Matthai

    2014-01-01

    Full Text Available Mitochondrial cytopathies (MC are a rare heterogenous group of disorders with frequent multisystem involvement including uncommon renal manifestations. Acute kidney injury (AKI as the primary manifestation of MC is extremely rare. Here, we report a case of recurrent episodic AKI in an adult male who was subsequently diagnosed to have mitochondrial disease.

  6. Studies on quantitative characters of pea varieties affected by acute and recurrent gamma irradiation

    International Nuclear Information System (INIS)

    Mazik-Toekei, K.; Fueredi, J.

    1991-01-01

    The influence of acute and recurrent gamma irradiation was investigated on the quantitative characters of Dukat, Paloma, BR 52, Ujmajor early and Marro pea varieties. All five varieties were irradiated with 25, 50, 75 and 100 Gy of gamma rays. The influence of recurrent irradiation was investigated in two and three subsequent generations. Varietal differences in radiation sensitivity were observed. The yield components of different varieties changed under similar dose conditions. The Dukat variety was found to be most sensitive to acute irradiation, so the quantitative characters of Dukat may be improved by using this method. Recurrent irradiation in two subsequent generations was succesful in the Paloma variety while treating three subsequent generations proved to be less succesful in improving yield components than in two generations. (author) 18 refs.; 3 tabs

  7. Recurrent acute low back pain secondary to lumbar epidural calcification

    Energy Technology Data Exchange (ETDEWEB)

    Ziade, M.; Zufferey, P.; So, A.K.L. [Centre Hospitalier Vaudois, Service de Rhumatologie, Lausanne (Switzerland)

    2007-06-15

    Epidural calcification is a rare cause of back pain, and spontaneous epidural calcification has not been reported previously. We describe a patient with acute low back pain and signs of lumbar nerve root compression due to epidural calcification, as demonstrated by CT-scan and MRI. Radiological signs of spondylodiscitis led to a search for an infectious cause, which was negative, and her symptoms responded rapidly to NSAID treatment alone. Her symptoms recurred 18 months later, and further imaging studies again revealed epidural calcification, but with a changed distribution. Her symptoms were relieved once more by NSAID treatment alone. We propose that epidural calcification secondary to aseptic spondylodiscitis is the main cause of acute back pain in this patient. A possible mechanism may be the pro-inflammatory effects of calcium pyrophosphate or hydroxyapatite crystal deposition within the epidural space. (orig.)

  8. [Initial subretinal localization of acute myeloblastic leukemia (AML5) recurrence].

    Science.gov (United States)

    Le Gall, S; François, S; Urier, N; Genevieve, F; d'Hermies, F; Rachieru, P; Ifrah, N

    2001-10-13

    Reduced visual acuity in patients with acute leucemia can result from many causes including an ocular localization. A patient previously treated for acute myeloblastic leucemia-5 (AML5) developed bilateral vision impairment related to a subretinal localization of the leucemia. Meningeal and bone marrow relapse followed. The subretinal localization responded only to massive systemic steroid treatment. Although asymptomatic, ocular localizations are frequent in leucemia. Their prognostic impact depends on the ocular structure involved and on the chronology of onset--early or late in the leucemia course. The underlying pathophysiological mechanism of ocular involvement remains unexplained but hyperleucocytosis at presentation may be a risk factor and would justify at least systematic specialized examinations and discussion of prophylactic treatment.

  9. Recurrent acute low back pain secondary to lumbar epidural calcification

    International Nuclear Information System (INIS)

    Ziade, M.; Zufferey, P.; So, A.K.L.

    2007-01-01

    Epidural calcification is a rare cause of back pain, and spontaneous epidural calcification has not been reported previously. We describe a patient with acute low back pain and signs of lumbar nerve root compression due to epidural calcification, as demonstrated by CT-scan and MRI. Radiological signs of spondylodiscitis led to a search for an infectious cause, which was negative, and her symptoms responded rapidly to NSAID treatment alone. Her symptoms recurred 18 months later, and further imaging studies again revealed epidural calcification, but with a changed distribution. Her symptoms were relieved once more by NSAID treatment alone. We propose that epidural calcification secondary to aseptic spondylodiscitis is the main cause of acute back pain in this patient. A possible mechanism may be the pro-inflammatory effects of calcium pyrophosphate or hydroxyapatite crystal deposition within the epidural space. (orig.)

  10. Recurrence of acute myeloid leukemia in cryptorchid testis: case report

    OpenAIRE

    Góes, Luccas Santos Patto de; Lopes, Roberto Iglesias; Campos, Octavio Henrique Arcos; Oliveira, Luiz Carlos Neves de; Sant’Anna, Alexandre Crippa; Dall’Oglio, Marcos Francisco; Srougi, Miguel

    2014-01-01

    A 23-year-old male with a history of bone marrow transplant for acute myeloid leukemia. He presented a large mass in the right inguinal region 5 years ago. Upon physical examination, right-sided cryptorchidism was observed. The tumor markers alpha-fetoprotein and beta-HCG were within normalcy range and lactate dehydrogenase was raised. Computed tomography of the abdomen and pelvis revealed right testicular mass in contiguity with the inguinal canal to the ipsilateral retroperitoneum, associat...

  11. Risk of Recurrent Pancreatitis and Progression to Chronic Pancreatitis After a First Episode of Acute Pancreatitis.

    Science.gov (United States)

    Ahmed Ali, Usama; Issa, Yama; Hagenaars, Julia C; Bakker, Olaf J; van Goor, Harry; Nieuwenhuijs, Vincent B; Bollen, Thomas L; van Ramshorst, Bert; Witteman, Ben J; Brink, Menno A; Schaapherder, Alexander F; Dejong, Cornelis H; Spanier, B W Marcel; Heisterkamp, Joos; van der Harst, Erwin; van Eijck, Casper H; Besselink, Marc G; Gooszen, Hein G; van Santvoort, Hjalmar C; Boermeester, Marja A

    2016-05-01

    Patients with a first episode of acute pancreatitis can develop recurrent or chronic pancreatitis (CP). However, little is known about the incidence or risk factors for these events. We performed a cross-sectional study of 669 patients with a first episode of acute pancreatitis admitted to 15 Dutch hospitals from December 2003 through March 2007. We collected information on disease course, outpatient visits, and hospital readmissions, as well as results from imaging, laboratory, and histology studies. Standardized follow-up questionnaires were sent to all available patients to collect information on hospitalizations and interventions for pancreatic disease, abdominal pain, steatorrhea, diabetes mellitus, medications, and alcohol and tobacco use. Patients were followed up for a median time period of 57 months. Primary end points were recurrent pancreatitis and CP. Risk factors were evaluated using regression analysis. The cumulative risk was assessed using Kaplan-Meier analysis. Recurrent pancreatitis developed in 117 patients (17%), and CP occurred in 51 patients (7.6%). Recurrent pancreatitis developed in 12% of patients with biliary disease, 24% of patients with alcoholic etiology, and 25% of patients with disease of idiopathic or other etiologies; CP occurred in 3%, 16%, and 10% of these patients, respectively. Etiology, smoking, and necrotizing pancreatitis were independent risk factors for recurrent pancreatitis and CP. Acute Physiology and Chronic Health Evaluation II scores at admission also were associated independently with recurrent pancreatitis. The cumulative risk for recurrent pancreatitis over 5 years was highest among smokers at 40% (compared with 13% for nonsmokers). For alcohol abusers and current smokers, the cumulative risks for CP were similar-approximately 18%. In contrast, the cumulative risk of CP increased to 30% in patients who smoked and abused alcohol. Based on a retrospective analysis of patients admitted to Dutch hospitals, a first

  12. Case report of recurrent acute appendicitis in a residual tip.

    LENUS (Irish Health Repository)

    O'Leary, Donal P

    2010-01-01

    INTRODUCTION: Residual appendicitis involving the stump of the appendix has been well described in the literature in the past. CASE REPORT: We report the case of a 43 year old male with acute onset of abdominal pain who had undergone an appendicectomy ten years previously. Ultrasound revealed the presence of an inflamed tubular structure. Subsequent laparotomy and histology confirmed that this structure was an inflamed residual appendiceal tip. CONCLUSION: Residual tip appendicitis has not been reported in the literature previously and should be considered in the differential diagnosis of localised peritonitis in a patient with a history of a previous open appendicectomy.

  13. Laparoscopic management of maldescended ovary presenting with recurrent acute abdomen

    Directory of Open Access Journals (Sweden)

    Eghoihunu Ireo

    2018-01-01

    Full Text Available Ovarian maldescent is an extremely rare gynecological phenomenon, usually associated with Müllerian abnormalities. We report a 27-year-old woman, presenting with acute, right-sided abdominal pain. She has a history of subfertility and repeated admissions with chronic pelvic pain. Previous hysterosalpingogram and laparoscopy demonstrated unicornuate uterus with absent right fallopian tube and ovary. A right-sided, ectopic ovary was identified on later imaging and suspected as the cause of her symptoms. She underwent laparoscopic excision of the maldescended ovary with remnant fimbrial end and gubernaculum. She was discharged the following day as she was pain-free and remains so 11 months later. This case report prompts a gynecologist to consider diagnosis of maldescended ovary in the women with uterine abnormalities and repeated episodes of abdominal pain. This is the first case report to the best of our knowledge where surgical management of ovarian maldescent was performed via minimal access approach, thus avoiding laparotomy in this acute setting.

  14. Defining a Therapeutic Program for Recurrent Acute Pancreatitis Patients with Unknown Etiology

    Directory of Open Access Journals (Sweden)

    Vincenzo Neri

    2014-07-01

    Full Text Available Aim To define a therapeutic program for mild-moderate acute pancreatitis (AP, often recurrent, which at the end of the diagnostic process remains of undefined etiology. Material and Methods In the period 2011-2012, we observed 64 cases of AP: 52 mild-moderate, 12 severe; biliary 39, biliary in alcoholic chronic pancreatitis 5, unexplained recurrent 20. The clinical and instrumental evaluation of the 20 cases of unexplained AP showed 6 patients with biliary sludge, 4 microlithiasis, 4 sphincter of Oddi dysfunction, and 6 cases that remained undefined. Results Among 20 patients with recurrent, unexplained AP at initial etiological assessment, we performed 10 video laparo cholecystectomies (VLCs, 2 open cholecystectomies and 4 endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomies (ERCP/ES in patients who had undergone previous cholecystectomy; 4 patients refused surgery. Among these 20 patients, 6 had AP that remained unexplained after second-level imaging investigations. For these patients, 4 VLCs and 2 ERCP/ES were performed. Follow-up after six months was negative for further recurrence. Conclusion The recurrence of unexplained acute pancreatitis could be treated with empirical cholecystectomy and/or ERCP/ES in cases of previous cholecystectomy.

  15. Recurrent Acute Myocardial Infarction in Patients with Immune Thrombocytopenic Purpura

    Directory of Open Access Journals (Sweden)

    Fengyi Shen

    2014-01-01

    Full Text Available Immune thrombocytopenic purpura (ITP, also known as idiopathic thrombocytopenic purpura, is an acquired immune-mediated disease of adults and children characterized by a transient or persistent decrease of platelets and, depending upon the degree of thrombocytopenia, an increased risk of bleeding. The use of standard treatments for acute myocardial infarction (AMI, such as antiplatelet agents and anticoagulants, pose serious problems in patients with ITP due to the potential higher risk of bleeding complications. There are no current guidelines available for management of ITP patients with AMI. In this brief review of the limited available literature, we discuss the proposed pathophysiological link between ITP and arterial thrombosis and the challenging medical and interventional treatment of these patients.

  16. Long-term hearing outcomes after recurrent acute otitis media during early childhood.

    Science.gov (United States)

    Krakau, Mattias; Dagöö, Britta Rynnel; Hellström, Sten; Granath, Anna

    2017-12-01

    To survey long-term hearing outcomes and middle ear pathology in a 30-year follow-up in individuals with onset of recurrent acute otitis media (rAOM) before three years of age. 28 adults, aged 30.1-31.8 years, who originally - at the age of 12-32 months - participated in a study on rAOM between 1979 and 1983, were re-examined regarding self-reported ear problems, current tympanic membrane changes and audiology. Thirteen subjects had suffered from rAOM during early childhood and 15 subjects served as a control group. Recurrent acute otitis media subjects reported hearing problems comparable to those of the controls. Pure tone audiometry, at 125-8000 Hz, did not differ between groups. The rAOM group had a trend for impaired high-frequency (9000-14,000 Hz) threshold levels (9000-14,000 Hz); implying that their cochlear function seemed to have deteriorated. Adults, who suffered from recurrent acute otitis media as infants, did not show any clinically significant hearing loss for pure tone audiometry when compared to controls, but there was a trend for impaired results regarding extended high frequency audiometry (9-14 kHz). Children suffering from rAOM will be at low risk of developing hearing loss and severe middle ear disease.

  17. Outcomes of Recurrent Acute Otitis Media in Children Treated for Dental Malocclusion: A Preliminary Report.

    Science.gov (United States)

    Bernkopf, Edoardo; Lovato, Andrea; Bernkopf, Giulia; Giacomelli, Luciano; De Vincentis, Giovanni Carlo; Macrì, Francesco; de Filippis, Cosimo

    2016-01-01

    Aim . To investigate the role of dental malocclusion treatment in the outcomes of Recurrent Acute Otitis Media (RAOM). Materials and Methods . The clinical outcome (number of acute recurrences in 12 months) of 61 consecutive children treated medically for RAOM was analysed. Children underwent an odontostomatologic evaluation, a fiberoptic endoscopy, and skin-prick tests. Results . 32 children (group A) were diagnosed with dental malocclusion and treated with a mandibular repositioning plate. Dental malocclusion was ruled out in the other 29 patients with RAOM, and they were used as controls (group B). The two groups were homogeneous in terms of sex, exposure to RAOM risk factors, skin test results, and adenoid hypertrophy, while age was significantly higher in group A. Age, sex, exposure to RAOM risk factors, adenoid hypertrophy, and skin test results were not associated with RAOM outcome. Children in group A treated for dental malocclusion were strongly associated with a lower number of acute episode recurrences at both univariate ( p children with dental malocclusion wearing a mandibular repositioning device. Dental malocclusion in children with RAOM may play a role in the pathogenesis of Eustachian tube dysfunction.

  18. WITHDRAWN: Grommets (ventilation tubes) for recurrent acute otitis media in children.

    Science.gov (United States)

    Lau, Loretta; Mick, Paul; Nunez, Desmond A

    2018-04-06

    This is an update of a Cochrane review first published in The Cochrane Library in Issue 4, 2008 and previously updated in 2011.Acute suppurative otitis media is one of the most common infectious diseases in childhood. Recurrent acute otitis media is defined for the purposes of this review as either three or more acute infections of the middle ear cleft in a six-month period, or at least four episodes in a year. Strategies for managing the condition include the assessment and modification of risk factors where possible, repeated courses of antibiotics for each new infection, antibiotic prophylaxis and the insertion of ventilation tubes (grommets). To establish whether grommet insertion reduces the frequency of episodes of recurrent acute otitis media and the proportion of symptomatic children. The Cochrane Ear, Nose and Throat Disorders Group (CENTDG) Trials Search Co-ordinator searched the CENTDG Trials Register; Central Register of Controlled Trials (CENTRAL 2014, Issue 10); PubMed; EMBASE; CINAHL; Web of Science; Clinicaltrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 6 November 2014. Randomised controlled trials comparing grommet insertion versus control (antibiotics/other treatments/no treatment) for recurrent acute otitis media in children aged from 0 to 16 years. Two authors independently selected studies. Three authors independently assessed study quality and extracted data. We synthesised data descriptively. Two randomised controlled trials with a total of 148 participants are included in this review. The overall risk of bias in the studies is unclear.The first study randomised 95 children to grommets or control (antibiotic treatment of acute otitis media episodes). For the primary outcome, this study showed that grommet insertion leads to a mean reduction of 1.5 episodes of acute otitis media in the first six months after treatment. In six months of follow-up significantly more children in the

  19. Analysis of Surgical Success in Preventing Recurrent Acute Exacerbations in Chronic Pancreatitis

    Science.gov (United States)

    Nealon, William H.; Matin, Sina

    2001-01-01

    Objective To determine whether surgical intervention prevents recurrent acute exacerbations in chronic pancreatitis (CP). Summary Background Data The primary goal of surgical intervention in the treatment of CP has been relief of chronic unrelenting abdominal pain. A subset of patients with CP have intermittent acute exacerbations, often with increasing frequency and often unrelated to ongoing ethanol abuse. Little data exist regarding the effectiveness of surgery to prevent acute attacks. Methods From 1985 to 1999, all patients identified with a diagnosis of CP were recruited to participate in an ongoing program of serial clinic visits and functional and clinical evaluations. Patients were offered surgery using standard criteria. Data were gathered regarding ethanol abuse, pain, narcotic use, and recurrent acute exacerbations requiring hospital admission before and after surgery. Patients were broadly categorized as having severe unrelenting pain alone (group 1), severe pain with intermittent acute exacerbations (group 2), and intermittent acute exacerbations only (group 3). Results Two hundred fifty-nine patients were recruited. One hundred eighty-five patients underwent 199 surgical procedures (124 modified Puestow procedure [LPJ], 29 distal pancreatectomies [DP], and 46 pancreatic head resections [PHR; 14 performed after failure of LPJ]). There were no deaths. The complication rate was 4% for LPJ, 15% for DP, and 27% for PHR. Ethanol abuse was causative in 238 patients (92%). Mean follow-up was 81 months. There were 104 patients in group 1 (86 who underwent surgery), 71 patients in group 2 (64 who underwent surgery), and 84 in group 3 (49 who underwent surgery). No patient without surgery had spontaneous resolution of symptoms. Postoperative pain relief (freedom from narcotic analgesics) was achieved in 153 of 185 patients (83%) overall: 106 of 124 (86%) for LPJ, 19 of 29 (67%) for DP, and 42 of 46 (91%) for PHR. The mean rate of acute exacerbations was 6.3

  20. Methotrexate: an option for preventing the recurrence of acute anterior uveitis.

    Science.gov (United States)

    Muñoz-Fernández, S; García-Aparicio, A M; Hidalgo, M V; Platero, M; Schlincker, A; Bascones, M L; Pombo, M; Morente, P; Sanpedro, J; Martín-Mola, E

    2009-05-01

    To evaluate the efficacy of methotrexate (MTX) in preventing the recurrence of acute anterior uveitis (AAU). This prospective, open, longitudinal study included patients from June 2002 to March 2005 who had either three or more episodes of AAU in the previous year, or a recurrence of AAU within 3 months before starting the trial. We excluded uveitis of infectious origin, masquerade syndromes, and patients with contraindications to MTX. The response criteria were defined as an absence of symptoms and the presence of a normal ophthalmologic examination. The study outcome compared the number of flare-ups of uveitis over an MTX-treated for 1 year to the number of flare-ups of the same group during the previous year without MTX. A total of 571 patients with uveitis were evaluated during the period of the study, and 10 fulfilled the inclusion criteria. One patient refused the treatment, and nine completed the study. The mean number of recurrences in the pre-MTX year was 3.4 (SD: 0.52), which was significantly reduced to 0.89 (SD: 1.17) in the year of treatment (P=0.011). MTX treatment seems to reduce the number of flare-ups in patients with recurrent AAU.

  1. Ansa Pancreatica: A Case Report of a Type of Ductal Variation in a Patient with Idiopathic Acute Recurrent Pancreatitis

    International Nuclear Information System (INIS)

    Kim, Hye Mi; Park, Jung Yup; Kim, Myeong Jin

    2010-01-01

    Ansa pancreatica is a rare type of pancreatic ductal variation. Recently, ansa pancreatic has been considered as a predisposing factor in patients with idiopathic acute pancreatitis. To the best of our knowledge, no previously published report in Korea has described ansa pancreatica. We report a case of acute recurrent pancreatitis with ansa pancreatica, which was revealed on magnetic resonance cholangiopancreatography (MRCP)

  2. Short-term mortality, readmission, and recurrence in treatment of acute diverticulitis with abscess formation

    DEFF Research Database (Denmark)

    Gregersen, Rasmus; Andresen, Kristoffer; Burcharth, Jakob

    2016-01-01

    PURPOSE: The aim of the study was to investigate short-term mortality, readmission, and recurrence in a national cohort of patients with Hinchey Ib-II diverticulitis. METHODS: The retrospective cohort-investigation was conducted using a database consisting of the entire Danish population (n = 6......, secondary outcomes were mortality, readmission, and recurrence within 30 days post-discharge. The study was reported using RECORD guidelines. RESULTS: A total of 3148 eligible patients were identified. The cohort had a mean age of 65.1 year, 25.6 % had previously been admitted with diverticulitis, and 48...... was associated with mortality with odds-ratio 1.49 (1.23-1.81) and readmission with odds-ratio 2.91 (1.24-6.80). CONCLUSION: Acute diverticulitis with abscess formation is a severe and life-threatening condition. Direct comparisons of treatment groups were not possible due to possible confounding by indication....

  3. Randomized controlled trial of juzen-taiho-to in children with recurrent acute otitis media.

    Science.gov (United States)

    Ito, Makoto; Maruyama, Yumiko; Kitamura, Ken; Kobayashi, Toshimitsu; Takahashi, Haruo; Yamanaka, Noboru; Harabuchi, Yasuaki; Origasa, Hideki; Yoshizaki, Tomokazu

    2017-08-01

    Recurrent acute otitis media (AOM) in young children is rapidly increasing worldwide. Repeated antibiotic use leads to antibiotic-resistant pathogen development. Complementary and alternative medicine approaches have been suggested as a supplemental treatment option to conventional antimicrobial medicine. This randomized, parallel-group, open-label, non-herbal medicine controlled trial assessed the efficacy of a traditional Japanese herbal medicine, juzen-taiho-to (JTT) for AOM prevention in otitis-prone children. Children prone to recurrent AOM aged 6-48 months were recruited from 26 otolaryngology clinics in Japan and received conventional AOM treatment based on Japanese guidelines with or without 2 daily oral doses of JTT (0.10-0.25g/kg/day). The mean number of AOM episodes, coryza episodes, and duration of total antibiotic administration per month were compared during 3-month intervention. At least one episode of AOM was diagnosed in 71% of JTT-group and 92% of control participants during follow-up. JTT administration reduced the frequency of AOM episodes by 57% compared with children who received conventional treatment alone (0.61±0.54 vs. 1.07±0.72 AOM instances/month; P=0.005) and also significantly decreased number of coryza episodes (P=0.015) and total antibiotic administration (P=0.024). This is the first report of recurrent AOM prevention by herbal medication. JTT appears to effectively prevent recurrent AOM in children. Subsequent double-blind studies are needed to confirm the beneficial effects of JTT on recurrent AOM and upper respiratory tract infections. Copyright © 2016. Published by Elsevier B.V.

  4. Recurrent acute pancreatitis and cholangitis in a patient with autosomal dominant polycystic kidney disease

    Directory of Open Access Journals (Sweden)

    Kambiz Yazdanpanah

    2013-01-01

    Full Text Available Autosomal dominant polycystic kidney disease (ADPKD is an inherited disorder associated with multiple cyst formation in the different organs. Development of pancreatic cyst in ADPKD is often asymptomatic and is associated with no complication. A 38-year-old man with ADPKD was presented with six episodes of acute pancreatitis and two episodes of cholangitis in a period of 12 months. Various imaging studies revealed multiple renal, hepatic and pancreatic cysts, mild ectasia of pancreatic duct, dilation of biliary system and absence of biliary stone. He was managed with conservative treatment for each attack. ADPKD should be considered as a potential risk factor for recurrent acute and/or chronic pancreatitis and cholangitis.

  5. PIDOTIMOD IN TREATMENT OF CHILDREN WITH ACUTE RESPIRATORY INFECTION WITH CONCOMITANT RECURRENT OBSTRUCTIVE SYNDROME

    Directory of Open Access Journals (Sweden)

    E. E. Lokshina

    2011-01-01

    Full Text Available Respiratory infections are frequent in children; consequently evaluation of prophylactic effectiveness of immunomodulators is needed. Objective: to evaluate of clinical, immunological efficacy and safety of pidotimod in complex treatment of children with acute respiratory infections (ARI and obstructive syndrome. Methods: patients 3–10 years old hospitalized with ARI and obstructive syndrome participated the study. Children from first group (n = 30 were treated with pidotimod 400 mg 2 times daily during 14 days, children from control group (n = 30 received standard treatment without immunomodulatory agent. Dynamics of clinical course of a disease, immunological indices of blood (IL 2, 4 and 8, interferon α  and γ, IgA, M, G and total IgЕ and swabs from mucous tunica of nasopharynx (sIgA was estimated. The cases of recurrent ARIs during 12 months after the beginning of a study were controlled. Results: treatment with pidotimod induced statistically significant decrease of cytokines levels (IL 2, IL 8, and interferon γ and increase of sIgA. The rate of recurrent ARIs during 12 months after the beginning of a study was lower than in control group. Recurrent episodes of bronchial obstruction occurred rarely. Conclusion: pidotimod has high clinical and immunological effectiveness and safety in treatment of children with ARI and concomitant obstructive syndrome.

  6. Recurrent intestinal volvulus in midgut malrotation causing acute bowel obstruction: A case report.

    Science.gov (United States)

    Sheikh, Fayed; Balarajah, Vickna; Ayantunde, Abraham Abiodun

    2013-03-27

    Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation can take place in adulthood. Recurrent bowel obstruction in patients with previous abdominal operation for midgut malrotation is mostly due to adhesions but very few reported cases have been due to recurrent volvulus. We present the case of a 22-year-old gentleman who had laparotomy in childhood for small bowel volvulus and then presented with acute bowel obstruction. Preoperative computerised tomography scan showed small bowel obstruction and features in keeping with midgut malrotation. Emergency laparotomy findings confirmed midgut malrotation with absent appendix, abnormal location of caecum, ascending colon and small bowel. In addition, there were small bowel volvulus and a segment of terminal ileal stricture. Limited right hemicolectomy was performed with excellent postoperative recovery. This case is presented to illustrate a rare occurrence and raise an awareness of the possibility of dreadful recurrent volvulus even several years following an initial Ladd's procedure for midgut malrotation. Therefore, one will need to exercise a high index of suspicion and this becomes very crucial in order to ensure prompt surgical intervention and thereby preventing an attendant bowel ischaemia with its associated high fatality.

  7. Recurrent seizures during acute acquired toxoplasmosis in an immunocompetent traveller returning from Africa.

    Science.gov (United States)

    Beltrame, Anna; Venturini, Sergio; Crichiutti, Giovanni; Meroni, Valeria; Buonfrate, Dora; Bassetti, Matteo

    2016-04-01

    We report an unusual case of acute acquired toxoplasmosis (AAT) presenting as lymphadenopathy and recurrent seizures in an immunocompetent 15-year-old boy. The patient reported an 18-day vacation to Africa (Ethiopia), 39 days prior to the first seizure. Electroencephalogram (EEG) showed sporadic single-spike or sharp-wave paroxysms and the magnetic resonance imaging (RMI) of the brain was negative. The serology for T. gondii was compatible with an acute infection defined as positive for both toxoplasma-specific IgG and IgM and a low avidity (6 %), confirmed by a reference laboratory. The patient reported other two episodes of seizures, occurring 7 days apart. He was treated with pyrimethamine plus sulfadiazine and leucovorin for 4 weeks, with an improvement of lymphadenitis and normalization of EEG. After 5 months, new seizures were reported and a diagnosis of epilepsy was done. Toxoplasma polymerase chain reaction (PCR) of cerebrospinal fluid (CSF) and blood were negative. A treatment with valproic acid was started, obtaining control of the neurological disease. Awareness of this neurologic manifestation by clinicians is required, also in immunocompetent patients. The relationship between toxoplasmosis and recurrent seizure needs to be investigated by new studies.

  8. Recurrent Acute Pancreatitis as A Manifestation of Sphincter of Oddi Dysfunction

    Directory of Open Access Journals (Sweden)

    Ira Laurentika

    2016-04-01

    Full Text Available Recurrent acute pancreatitis (RAP is defined as two or more occurance of acute pancreatitis with no evidence of underlying chronic pancreatitis. Prevalence of RAP varied from 10-30%. One of the postulated mechanism of this condition is sphincter of Oddi dysfunction (SOD which is a clinical biliary pain syndrome or acute pancreatitis (AP due to pancreatobiliary obstruction at the level of sphincter of Oddi. We reported a 29-year-old female patient who came to Cipto Mangunkusomo Hospital regarding upper quadrant abdominal pain with previously well documented history of AP in the last six months before admission. Laboratory findings showed elevated pancreatic enzyme level which was consistent with AP. The patient underwent magnetic resonance cholangio-pancreatography (MRCP and endoscopic ultrasound (EUS examination and both of the results showed dilatation of pancreatic duct which suggested SOD. Due to the lack of further diagnostic modality, manometry was not performed on this patient. However, after excluding other possible etiology of SOD, the patient underwent endoscopic retrograde cholangio-pamcreatograhy (ERCP and sphincterotomy was performed. The signs and symptoms of AP was relieved after sphincterotomy and not yet recurred.

  9. First report of a Staphylococcus caprae isolated from middle ear fluid of an infant with recurrent acute otitis media

    Directory of Open Access Journals (Sweden)

    Elżbieta Mazur

    2017-09-01

    Full Text Available Staphylococcus caprae was originally isolated from goat milk. This uncommon coagulase-negative staphylococcus, usually associated with animals, has only infrequently been detected in human clinical specimens. Its association with acute otitis media has not been demonstrated so far. The study reports the first isolation of S. caprae from the middle ear fluid of a 12-month-old infant with recurrent, bilateral acute otitis media. Biochemical traits and susceptibility pattern of the isolated strain are also presented

  10. Cellular Immune Response in Young Children Accounts for Recurrent Acute Otitis Media

    Science.gov (United States)

    Sharma, Sharad K.; Pichichero, Michael E.

    2013-01-01

    Acute otitis media (AOM) is a common disease in young children. Streptococcus pneumoniae(Spn) and Haemophilus influenzae (NTHi) are the two most common pathogens that cause AOM. Over the past 5 years our group has been studying the immunologic profile of children that experience repeated AOM infections despite tympanocentesis drainage of middle ear fluid and individualized antibiotic treatment; we call these children stringently-defined otitis-prone (sOP). Although protection against AOM is primarily mediated by ototpathogen-specific antibody, our recent studies suggest that suboptimal memory B-& T- cell responses and an immaturity in antigen presenting cells may play a significant role in the propensity to recurrent AOM infections. This review focuses on the studies performed to define immunologic dysfunction in sOP children. PMID:24022464

  11. Onset and Recurrence of Depression as Predictors of Cardiovascular Prognosis in Depressed Acute Coronary Syndrome Patients : A Systematic Review

    NARCIS (Netherlands)

    Zuidersma, Marij; Thombs, Brett D.; de Jonge, Peter

    2011-01-01

    Background: Depression after acute coronary syndrome (ACS) is associated with worse cardiac outcomes. This systematic review evaluated whether depressed ACS patients are at differential risk depending on the recurrence and timing of onset of depressive episodes. Methods: MEDLINE, EMBASE and PsycINFO

  12. Restricted Consonant Inventories of 2-Year-Old Finnish Children with a History of Recurrent Acute Otitis Media

    Science.gov (United States)

    Haapala, Sini; Niemitalo-Haapola, Elina; Raappana, Antti; Kujala, Tiia; Kujala, Teija; Jansson-Verkasalo, Eira

    2015-01-01

    Many children experience recurrent acute otitis media (RAOM) in early childhood. In a previous study, 2-year-old children with RAOM were shown to have immature neural patterns for speech sound discrimination. The present study further investigated the consonant inventories of these same children using natural speech samples. The results showed…

  13. Analysis of cystic fibrosis gener product (CFTR) function in patients with pancreas divisum and recurrent acute pancreatitis.

    Science.gov (United States)

    Gelrud, Andres; Sheth, Sunil; Banerjee, Subhas; Weed, Deborah; Shea, Julie; Chuttani, Ram; Howell, Douglas A; Telford, Jennifer J; Carr-Locke, David L; Regan, Meredith M; Ellis, Lynda; Durie, Peter R; Freedman, Steven D

    2004-08-01

    The mechanism by which pancreas divisum may lead to recurrent episodes of acute pancreatitis in a subset of individuals is unknown. Abnormalities of the cystic fibrosis gene product (CFTR) have been implicated in the genesis of idiopathic chronic pancreatitis. The aim of this study was to determine if CFTR function is abnormal in patients with pancreas divisum and recurrent acute pancreatitis (PD/RAP). A total of 69 healthy control subjects, 12 patients with PD/RAP, 16 obligate heterozygotes with a single CFTR mutation, and 95 patients with cystic fibrosis were enrolled. CFTR function was analyzed by nasal transepithelial potential difference testing in vivo. The outcomes of the PD/RAP patients following endoscopic and surgical treatments were concomitantly analyzed. Direct measurement of CFTR function in nasal epithelium in response to isoproterenol demonstrated that the values for PD/RAP were intermediate between those observed for healthy controls and cystic fibrosis patients. The median value was 13 mV for PD/RAP subjects, which was statistically different from healthy controls (22 mV, p= 0.001) and cystic fibrosis pancreatic sufficient (-1 mV, p < 0.0001) and pancreatic insufficient (-3 mV, p < 0.0001) patients. These results suggest a link between CFTR dysfunction and recurrent acute pancreatitis in patients with pancreas divisum and may explain why a subset of patients with pancreas divisum develops recurrent acute pancreatitis. Copyright 2004 American College of Gastroenterology

  14. Recurrent acute pulmonary oedema after aortic and mitral valve surgery due to trachea malacia and obstructive sleep apnoea syndrome

    NARCIS (Netherlands)

    Sankatsing, S. U. C.; Hanselaar, W. E. J. J.; van Steenwijk, R. P.; Van der Sloot, J. A. P.; Broekhuis, E.; Kok, W. E. M.

    2008-01-01

    In this report we describe a patient with recurrent episodes of acute pulmonary oedema after aortic and mitral valve surgery. The first episode of pulmonary oedema was caused by mitral valve dysfunction. The second episode of pulmonary oedema was not clearly associated with a mitral valve problem,

  15. High Efficacy of Methotrexate in Patients with Recurrent Idiopathic Acute Anterior Uveitis: a Prospective Study.

    Science.gov (United States)

    Bachta, Artur; Kisiel, Bartłomiej; Tłustochowicz, Mateusz; Raczkiewicz, Anna; Rękas, Marek; Tłustochowicz, Witold

    2017-02-01

    To evaluate prospectively the efficacy of methotrexate (MTX) in the treatment of recurrent idiopathic acute anterior uveitis (RIAAU). Nineteen out of 22 RIAAU patients completed the study (two patients withdrew their consent shortly after study initiation, one patient discontinued after 4 weeks because of the adverse effects). All patients were treated with MTX in a starting dose of 15 mg/week, increased to target dose of 25 mg/week after 4 weeks. In patients taking systemic corticosteroids (CS) the dose was gradually tapered (by 2.5 mg every week) until discontinuation. The mean follow-up period was 3.3 years (19-59 months). Sixteen patients (84 %) remained flare-free on MTX therapy. In the remaining three patients the mean interval between flares increased from 4.8 to 18.3 months. Systemic CS were tapered off in all patients. The number of acute anterior uveitis flares in the whole cohort decreased from 2.12 to 0.11/patient-year (p treatment of RIAAU.

  16. Acute hepatitis B in a patient with OLT during treatment with peg-interferon and ribavirin for hepatitis C recurrence.

    Science.gov (United States)

    Biliotti, Elisa; Zacharia, Sabu; Grieco, Stefania; Spaziante, Martina; Giusto, Michela; Merli, Manuela; Gallinaro, Valentina; Taliani, Gloria

    2012-12-01

    The course and outcome of acute viral hepatitis in liver transplanted patients with hepatitis C recurrence are unknown. Here we describe a patient who presented with acute hepatitis B infection while on treatment with peg-interferon and ribavirin for hepatitis C recurrence after liver transplantation. A nucleoside analogue was added (entecavir) and the patient cleared hepatitis C virus (HCV) infection and seroconverted to anti-HBs. In this case, the acute hepatitis B virus (HBV) infection might have contributed to the clearance of HCV, the concomitant immunosuppression might have lead to the slow clearance of HBV infection, and the combined antiviral therapy has helped in the resolution of both infections. Hepatitis B vaccination should be recommended in susceptible patients waiting for liver transplantation.

  17. Disease: H01290 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available s been reported that mutations in LPIN1 cause recurrent acute myoglobinuria in childhood. Inherited metaboli... ... Mutations in LPIN1 cause recurrent acute myoglobinuria in childhood. ... JOURNAL ... Am J Hum Genet 83:489-94 (2008) DOI:10.1016/j.ajhg.2008.09.002

  18. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis.

    Science.gov (United States)

    Doherty, Cailbhe; Bleakley, Chris; Delahunt, Eamonn; Holden, Sinead

    2017-01-01

    Ankle sprains are highly prevalent with high risk of recurrence. Consequently, there are a significant number of research reports examining strategies for treating and preventing acute and recurrent sprains (otherwise known as chronic ankle instability (CAI)), with a coinciding proliferation of review articles summarising these reports. To provide a systematic overview of the systematic reviews evaluating treatment strategies for acute ankle sprain and CAI. Overview of intervention systematic reviews. Individuals with acute ankle sprain/CAI. The primary outcomes were injury/reinjury incidence and function. 46 papers were included in this systematic review. The reviews had a mean score of 6.5/11 on the AMSTAR quality assessment tool. There was strong evidence for bracing and moderate evidence for neuromuscular training in preventing recurrence of an ankle sprain. For the combined outcomes of pain, swelling and function after an acute sprain, there was strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques. There was conflicting evidence regarding the efficacy of surgery and acupuncture for the treatment of acute ankle sprains. There was insufficient evidence to support the use of ultrasound in the treatment of acute ankle sprains. For the treatment of acute ankle sprain, there is strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques, for pain, swelling and function. Exercise therapy and bracing are supported in the prevention of CAI. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  19. Risk Factors Associated With Pediatric Acute Recurrent and Chronic Pancreatitis: Lessons From INSPPIRE.

    Science.gov (United States)

    Kumar, Soma; Ooi, Chee Y; Werlin, Steven; Abu-El-Haija, Maisam; Barth, Bradley; Bellin, Melena D; Durie, Peter R; Fishman, Douglas S; Freedman, Steven D; Gariepy, Cheryl; Giefer, Matthew J; Gonska, Tanja; Heyman, Melvin B; Himes, Ryan; Husain, Sohail Z; Lin, Tom K; Lowe, Mark E; Morinville, Veronique; Palermo, Joseph J; Pohl, John F; Schwarzenberg, Sarah Jane; Troendle, David; Wilschanski, Michael; Zimmerman, M Bridget; Uc, Aliye

    2016-06-01

    Pediatric acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) are poorly understood. To characterize and identify risk factors associated with ARP and CP in childhood. A multinational cross-sectional study of children with ARP or CP at the time of enrollment to the INSPPIRE (International Study Group of Pediatric Pancreatitis: In Search for a Cure) study at participant institutions of the INSPPIRE Consortium. From August 22, 2012, to February 8, 2015, 155 children with ARP and 146 with CP (aged ≤19 years) were enrolled. Their demographic and clinical information was entered into the REDCap (Research Electronic Data Capture) database at the 15 centers. Differences were analyzed using 2-sample t test or Wilcoxon rank sum test for continuous variables and Pearson χ2 test or Fisher exact test for categorical variables. Disease burden variables (pain variables, hospital/emergency department visits, missed school days) were compared using Wilcoxon rank sum test. Demographic characteristics, risk factors, abdominal pain, and disease burden. A total of 301 children were enrolled (mean [SD] age, 11.9 [4.5] years; 172 [57%] female); 155 had ARP and 146 had CP. The majority of children with CP (123 of 146 [84%]) reported prior recurrent episodes of acute pancreatitis. Sex distribution was similar between the groups (57% female in both). Hispanic children were less likely to have CP than ARP (17% vs 28%, respectively; odds ratio [OR] = 0.51; 95% CI, 0.29-0.92; P = .02). At least 1 gene mutation in pancreatitis-related genes was found in 48% of patients with ARP vs 73% of patients with CP (P toxic/metabolic risk factors were more common in children with ARP (21% overall; 26% in the ARP group and 15% in the CP group; OR = 0.55; 95% CI, 0.31-0.99; P = .046). Pancreatitis-related abdominal pain was a major symptom in 81% of children with ARP or CP within the last year. The disease burden was greater in the CP group compared with the ARP group

  20. Tailored central nervous system-directed treatment strategy for isolated CNS recurrence of adult acute myeloid leukemia.

    Science.gov (United States)

    Zheng, Changcheng; Liu, Xin; Zhu, Weibo; Cai, Xiaoyan; Wu, Jingsheng; Sun, Zimin

    2014-06-01

    The aim of this report was to investigate the tailored treatment strategies for isolated central nervous system (CNS) recurrence in adult patients with acute myeloid leukemia (AML). Isolated CNS recurrence was documented in 34 patients: there were 18, 6, and 10 patients with meningeal involvement type (type A), cranial nerve palsy type (type B), and myeloid sarcoma type (type C), respectively. For patients with type A, intrathecal chemotherapy was the predominant strategy. For type B, systemic HD-Ara-C with four cycles was the main treatment. For type C, cranial irradiation or craniospinal irradiation was adopted and two cycles of HD-Ara-C were given after the irradiation. The 5-year cumulative incidence of CNS recurrence was 12.8%. There was a significantly higher WBC count (32.6∼60.8 × 10(9)/l) in patients at first diagnosis who developed CNS recurrence (all of the three types) compared with patients with no CNS recurrence (10.1 × 10(9)/l) (P = 0.005). We found that a significantly more patients with AML-M5 and 11q23 abnormalities developed CNS recurrence in type A (P adult AML, but further studies are needed to improve the long-term survival.

  1. Risk factors for recurrent cystitis following acute cystitis in female patients.

    Science.gov (United States)

    Yoon, Byung Il; Kim, Sun Wook; Ha, U-Syn; Sohn, Dong Wan; Cho, Yong-Hyun

    2013-08-01

    We conducted a retrospective analysis of acute cystitis (AC) patients to evaluate the risk factors of recurrent cystitis (RC) patients following AC. The clinical records of 254 subjects with a confirmed diagnosis of AC and 90 healthy subjects who visited the Health Promotion Center between 2008 and 2012 were reviewed. A patient was diagnosed with RC if she was treated for three or more symptomatic episodes of cystitis over a 12-month period. Results were analyzed according to three groups: normal control (group A, n = 90), AC (group B, n = 121), and RC (group C, n = 133). Women in the cystitis groups (groups B and C) were more likely to have diabetes, be menopausal, have a history of catheterization or sexually transmitted infections (STI), have a low daily water intake, have frequent sexual intercourse, and to use contraception more frequently than the normal control group (P sexual intercourse more than four times per month, sexual intercourse in the last month, and the use of contraceptives (P < 0.05). The identification of these factors may help develop preventive, diagnostic, and therapeutic strategies for treating RC that has progressed from AC.

  2. Causal Evaluation of Acute Recurrent and Chronic Pancreatitis in Children: Consensus From the INSPPIRE Group.

    Science.gov (United States)

    Gariepy, Cheryl E; Heyman, Melvin B; Lowe, Mark E; Pohl, John F; Werlin, Steven L; Wilschanski, Michael; Barth, Bradley; Fishman, Douglas S; Freedman, Steven D; Giefer, Matthew J; Gonska, Tanja; Himes, Ryan; Husain, Sohail Z; Morinville, Veronique D; Ooi, Chee Y; Schwarzenberg, Sarah J; Troendle, David M; Yen, Elizabeth; Uc, Aliye

    2017-01-01

    Acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) have been diagnosed in children at increasing rates during the past decade. As pediatric ARP and CP are still relatively rare conditions, little quality evidence is available on which to base the diagnosis and determination of etiology. The aim of the study was to review the current state of the literature regarding the etiology of these disorders and to developed a consensus among a panel of clinically active specialists caring for children with these disorders to help guide the diagnostic evaluation and identify areas most in need of future research. A systematic review of the literature was performed and scored for quality, followed by consensus statements developed and scored by each individual in the group for level of agreement and strength of the supporting data using a modified Delphi method. Scores were analyzed for the level of consensus achieved by the group. The panel reached consensus on 27 statements covering the definitions of pediatric ARP and CP, evaluation for potential etiologies of these disorders, and long-term monitoring. Statements for which the group reached consensus to make no recommendation or could not reach consensus are discussed. This consensus helps define the minimal diagnostic evaluation and monitoring of children with ARP and CP. Even in areas in which we reached consensus, the quality of the evidence is weak, highlighting the need for further research. Improved understanding of the underlying cause will facilitate treatment development and targeting.

  3. Cerebral glycogen in humans following acute and recurrent hypoglycemia: Implications on a role in hypoglycemia unawareness.

    Science.gov (United States)

    Öz, Gülin; DiNuzzo, Mauro; Kumar, Anjali; Moheet, Amir; Khowaja, Ameer; Kubisiak, Kristine; Eberly, Lynn E; Seaquist, Elizabeth R

    2017-08-01

    Supercompensated brain glycogen levels may contribute to the development of hypoglycemia-associated autonomic failure (HAAF) following recurrent hypoglycemia (RH) by providing energy for the brain during subsequent periods of hypoglycemia. To assess the role of glycogen supercompensation in the generation of HAAF, we estimated the level of brain glycogen following RH and acute hypoglycemia (AH). After undergoing 3 hyperinsulinemic, euglycemic and 3 hyperinsulinemic, hypoglycemic clamps (RH) on separate occasions at least 1 month apart, five healthy volunteers received [1- 13 C]glucose intravenously over 80+ h while maintaining euglycemia. 13 C-glycogen levels in the occipital lobe were measured by 13 C magnetic resonance spectroscopy at ∼8, 20, 32, 44, 56, 68 and 80 h at 4 T and glycogen levels estimated by fitting the data with a biophysical model that takes into account the tiered glycogen structure. Similarly, prior 13 C-glycogen data obtained following a single hypoglycemic episode (AH) were fitted with the same model. Glycogen levels did not significantly increase after RH relative to after euglycemia, while they increased by ∼16% after AH relative to after euglycemia. These data suggest that glycogen supercompensation may be blunted with repeated hypoglycemic episodes. A causal relationship between glycogen supercompensation and generation of HAAF remains to be established.

  4. Duodenal duplication cyst (DDC) communicating with the pancreatobiliary duct--a rare cause of recurrent acute pancreatitis in adults.

    Science.gov (United States)

    Bong, Jan Jin; Spalding, Duncan

    2010-01-01

    Duodenal duplication cysts (DDC) are rare congenital anomalies that usually present in infancy and childhood. Acute presentation in adults is even rarer. We report a case of a 34-year-old man who presented with recurrent acute pancreatitis and was found to have a cystic lesion in the second part of his duodenum. Further investigations revealed communication between the cystic lesion and the distal common bile duct. We describe the details of the operative approach taken to resect the DDC. We describe the differential diagnoses and the criteria for diagnosing DDC. Management options for DDC are discussed along with our recommendations.

  5. Hospital cost of Clostridium difficile infection including the contribution of recurrences in French acute-care hospitals.

    Science.gov (United States)

    Le Monnier, A; Duburcq, A; Zahar, J-R; Corvec, S; Guillard, T; Cattoir, V; Woerther, P-L; Fihman, V; Lalande, V; Jacquier, H; Mizrahi, A; Farfour, E; Morand, P; Marcadé, G; Coulomb, S; Torreton, E; Fagnani, F; Barbut, F

    2015-10-01

    The impact of Clostridium difficile infection (CDI) on healthcare costs is significant due to the extra costs of associated inpatient care. However, the specific contribution of recurrences has rarely been studied. The aim of this study was to estimate the hospital costs of CDI and the fraction attributable to recurrences in French acute-care hospitals. A retrospective study was performed for 2011 on a sample of 12 large acute-care hospitals. CDI costs were estimated from both hospital and public insurance perspectives. For each stay, CDI additional costs were estimated by comparison to controls without CDI extracted from the national DRG (diagnosis-related group) database and matched on DRG, age and sex. When CDI was the primary diagnosis, the full cost of stay was used. A total of 1067 bacteriological cases of CDI were identified corresponding to 979 stays involving 906 different patients. Recurrence(s) were identified in 118 (12%) of these stays with 51.7% of them having occurred within the same stay as the index episode. Their mean length of stay was 63.8 days compared to 25.1 days for stays with an index case only. The mean extra cost per stay with CDI was estimated at €9,575 (median: €7,514). The extra cost of CDI in public acute-care hospitals was extrapolated to €163.1 million at the national level, of which 12.5% was attributable to recurrences. The economic burden of CDI is substantial and directly impacts healthcare systems in France. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  6. Genetic Analysis of Japanese Children With Acute Recurrent and Chronic Pancreatitis.

    Science.gov (United States)

    Saito, Nobutomo; Suzuki, Mitsuyoshi; Sakurai, Yumiko; Nakano, Satoshi; Naritaka, Nakayuki; Minowa, Kei; Sai, Jin K; Shimizu, Toshiaki

    2016-10-01

    Causes of acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP) are sometimes difficult to determine in children. In such patients, genetic analysis may prove helpful. The present study analyzed mutations of cationic trypsinogen (PRSS1), serine protease inhibitor Kazal type 1 (SPINK1), chymotrypsin C (CTRC), and carboxypeptidase A1 (CPA1) and investigated the clinical features of children with these mutations. Genetic analyses of mutations in these 4 genes were conducted in 128 patients with ARP or CP. Characteristics of the patients showing mutations were investigated using medical records. Fifty of the 128 (39.1%) subjects had at least 1 mutation (median age at onset, 7.6 years). Abdominal pain was the presenting symptom of pancreatitis in 48 of the 50 patients (96%). Fifteen of those 50 patients (30.0%) had a family history of pancreatitis. Gene mutations were present in PRSS1 in 26 patients, SPINK1 in 23, CTRC in 3, and CPA1 in 5. In the 31 patients with mutations in SPINK1, CTRC, or CPA1, 16 (51.6%) had homozygous or heterozygous mutations with other mutations. Three patients underwent surgery and another 4 patients underwent endoscopy to manage ARP or CP. Although 3 of the 7 patients complained of mild abdominal pain, none of those 7 patients experienced any obvious episode of ARP after treatment. In pediatric patients with idiopathic ARP and CP, genetic analysis is useful for identifying the cause of pancreatitis. Early endoscopic or surgical treatment prevents ARP by extending the interval between episodes of pancreatitis in this population.

  7. Nomothetic and idiographic symptom change trajectories in acute-phase cognitive therapy for recurrent depression.

    Science.gov (United States)

    Vittengl, Jeffrey R; Clark, Lee Anna; Thase, Michael E; Jarrett, Robin B

    2013-08-01

    We tested nomothetic and idiographic convergence and change in 3 symptom measures during acute-phase cognitive therapy (CT) for depression and compared outcomes among patients showing different change patterns. Outpatients (N = 362; 69% women; 85% White; age M = 43 years) with recurrent major depressive disorder according to criteria in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) completed the Hamilton Rating Scale for Depression (Hamilton, 1960), Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961), and Inventory for Depressive Symptomatology-Self-Report (Rush, Gullion, Basco, Jarrett, & Trivedi, 1996) on 14 occasions as well as pre/post-CT measures of social-interpersonal functioning and negative cognitive content. The 3 symptom measures marked the same severity and change constructs, and we offer improved formulas for intermeasure score conversions via their common factor. Pre/post-CT symptom reductions were large (ds = 1.71-1.92), and nomothetic symptom curves were log-linear (larger improvements earlier and smaller improvements later in CT). Nonetheless, only 30% of individual patients showed clear log-linear changes, whereas other patients showed linear (e.g., steady decreases; 20%), 1-step (e.g., a quick drop; 16%), and unclassified (34%) patterns. Log-linear, linear, and 1-step patients were generally similar to one another and superior to unclassified patients post-CT in symptom levels, response and stable remission rates, social-interpersonal functioning, and cognitive content (median d = 0.69). Reaching a low-symptom "destination" at the end of CT via any coherent "path" is more important in the short term than which path patients take. We discuss implications for theories of change, clinical monitoring of individuals' progress in CT, and the need to investigate long-term outcomes of patients with differing patterns of symptom change. PsycINFO Database Record

  8. Use of complementary and alternative medicine in children with recurrent acute otitis media in Italy.

    Science.gov (United States)

    Marchisio, P; Bianchini, S; Galeone, C; Baggi, E; Rossi, E; Albertario, G; Torretta, S; Pignataro, L; Esposito, S; Principi, N

    2011-01-01

    Controlling environmental factors, chemoprophylaxis, immunoprophylaxis and surgery are considered possible means of preventing recurrent acute otitis media (RAOM), but there are no available data concerning the paediatric use of complementary and alternative medicine (CAM). We evaluated the uses of CAM (homeopathy and/or herbal medicine) as means of preventing AOM in children with a history of RAOM. Eight hundred and forty Italian children with RAOM (≥3 episodes in six months) aged 1-7 years were surveyed in 2009 using a face-to-face questionnaire, filled by parents or caregivers, that explored the prevalence, determinants, reasons, cost, and perceived safety and efficacy of CAM. About one-half (46%) of the children used CAM, significantly more than the number who used immunoprophylaxis (influenza vaccine 15%; pUse of CAM in the family was the only important factor positively associated with the use of CAM in children (adjusted OR 7.94; 95% CI: 5.26-11.99). The main reasons for using CAM were a fear of the adverse effects of conventional medicine (40%) and to increase host defences (20%). CAM was widely seen as safe (95%) and highly effective (68%). CAM prescribers were paediatricians in 50.7% of cases; self-initiation was reported by 23% of respondents. CAM expenditure was between Euro 25 and Euro 50/month in 27.6% of cases and ≥ Euro 50/month in 16%. Children with RAOM should be considered among the categories of subjects likely to be using CAM. Together with the fact that paediatricians are the main prescribers, this is worrying because of the current lack of evidence regarding the efficacy, safety and cost-effectiveness of CAM in the prevention of RAOM.

  9. Targeted Gene Next-Generation Sequencing in Chinese Children with Chronic Pancreatitis and Acute Recurrent Pancreatitis.

    Science.gov (United States)

    Xiao, Yuan; Yuan, Wentao; Yu, Bo; Guo, Yan; Xu, Xu; Wang, Xinqiong; Yu, Yi; Yu, Yi; Gong, Biao; Xu, Chundi

    2017-12-01

    To identify causal mutations in certain genes in children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). After patients were enrolled (CP, 55; ARP, 14) and their clinical characteristics were investigated, we performed next-generation sequencing to detect nucleotide variations among the following 10 genes: cationic trypsinogen protease serine 1 (PRSS1), serine protease inhibitor, Kazal type 1 (SPINK1), cystic fibrosis transmembrane conductance regulator gene (CFTR), chymotrypsin C (CTRC), calcium-sensing receptor (CASR), cathepsin B (CTSB), keratin 8 (KRT8), CLAUDIN 2 (CLDN2), carboxypeptidase A1 (CPA1), and ATPase type 8B member 1 (ATP8B1). Mutations were searched against online databases to obtain information on the cause of the diseases. Certain novel mutations were analyzed using the SIFT2 and Polyphen-2 to predict the effect on protein function. There were 45 patients with CP and 10 patients with ARP who harbored 1 or more mutations in these genes; 45 patients had at least 1 mutation related to pancreatitis. Mutations were observed in the PRSS1, SPINK1, and CFTR genes in 17 patients, the CASR gene in 5 patients, and the CTSB, CTRC, and KRT8 genes in 1 patient. Mutations were not found in the CLDN, CPA1, or ATP8B1 genes. We found that mutations in SPINK1 may increase the risk of pancreatic duct stones (OR, 11.07; P = .003). The patients with CFTR mutations had a higher level of serum amylase (316.0 U/L vs 92.5 U/L; P = .026). Mutations, especially those in PRSS1, SPINK1, and CFTR, accounted for the major etiologies in Chinese children with CP or ARP. Children presenting mutations in the SPINK1 gene may have a higher risk of developing pancreatic duct stones. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Hyperparathyroidism as a cause of recurrent acute pancreatitis: A case report

    Directory of Open Access Journals (Sweden)

    Tešić-Rajković Snežana

    2016-01-01

    Full Text Available Introduction. One of the more uncommon etiological factors responsible for the development of acute pancreatitis (AP is hypercalcemia. Hyperparathyroidism (HPT, as a cause of hypercalcemia, is responsible for 1.5–13% of AP according to a number of studies. A mechanism of the development of AP in hyperparathyroidism is still unclear. Case report. We presented a 47-year-old female patient, who had five episodes of AP in total before the etiological factors were finally determined. The patient had certain comorbidities which were considered to be potential causes of AP. She had chronic renal insufficiency (she was on a regular hemodialysis program, systemic lupus erythematosus and mioma uteri. She used to regularly take an antiepileptic drug (combination of sodium valproate and valproic acid. During the fifth episode of AP, the serum calcium level was for the first time elevated to twice the normal value. Level of parathyroid hormone was several times higher. A static scintigraphy found hyperplasia or hyperfunctional adenoma of the right inferior and superior parathyroid glands. Abdominal multislice computed tomography (MSCT scan verified the enlargement of the entire pancreas, as well as the presence of heterogeneous structures with diffuse amorphous calcifications. The lytic lesions in the pelvic bones could be seen in both sides. Parathyroidectomy was being postponed by an endocrine surgeon because of the poor overall condition of the patient. In the next period the patient had five more episodes of AP. The condition was significantly contributed by increasingly more frequent and longer episodes of metrorrhagia. Despite all therapeutic measures that were taken, systemic inflammatory response syndrome (SIRS developed, and fatal outcome occurred. Conclusion. In case of recurrent pancreatitis, hyperparathyroidism is to be considered even if a significant elevation of serum calcium is not present. This is especially the case for patients with

  11. Hyperparathyroidism as a cause of recurrent acute pancreatitis: A case report.

    Science.gov (United States)

    Tešić-Rajković, Snežana; Radovanović-Dinić, Biljana; Mitić, Branka; Dinić-Radović, Violeta; Jovanović, Maja

    2016-11-01

    One of the more uncommon etiological factors responsible for the development of acute pancreatitis (AP) is hypercalcemia. Hyperparathyroidism (HPT), as a cause of hypercalcemia, is responsible for 1.5–13% of AP according to a number of studies. A mechanism of the development of AP in hyperparathyroidism is still unclear. We presented a 47-year-old female patient, who had five episodes of AP in total before the etiological factors were finally determined. The patient had certain comorbidities which were considered to be potential causes of AP. She had chronic renal insufficiency (she was on a regular hemodialysis program), systemic lupus erythematosus and mioma uteri. She used to regularly take an antiepileptic drug (combination of sodium valproate and valproic acid). During the fifth episode of AP, the serum calcium level was for the first time elevated to twice the normal value. Level of parathyroid hormone was several times higher. A static scintigraphy found hyperplasia or hyperfunctional adenoma of the right inferior and superior parathyroid glands. Abdominal multislice computed tomography (MSCT) scan verified the enlargement of the entire pancreas, as well as the presence of heterogeneous structures with diffuse amorphous calcifications. The lytic lesions in the pelvic bones could be seen in both sides. Parathyroidectomy was being postponed by an endocrine surgeon because of the poor overall condition of the patient. In the next period the patient had five more episodes of AP. The condition was significantly contributed by increasingly more frequent and longer episodes of metrorrhagia. Despite all therapeutic measures that were taken, systemic inflammatory response syndrome (SIRS) developed, and fatal outcome occurred. In case of recurrent pancreatitis, hyperparathyroidism is to be considered even if a significant elevation of serum calcium is not present. This is especially the case for patients with chronic renal insufficiency or impaired vitamin D

  12. Recurrent Acute Respiratory Infections in Children: Effectiveness and Safety of Phytotherapy

    Directory of Open Access Journals (Sweden)

    V. P. Vavilova

    2015-01-01

    Full Text Available Recurrent respiratory infections in children lead to physical development disorders, formation of chronic nidi of infection, failure of adaptive mechanisms and degradation o immunobiological resisting barriers; this causes development of new diseases. Results of the presented non interventional clinical study confirm high safety profile and effectiveness of a therapeutic phytopreparation for recurrent respiratory infections. 

  13. Long-term prognosis of acute lateral ankle ligamentous sprains: high incidence of recurrences and residual symptoms.

    Science.gov (United States)

    Kemler, Ellen; Thijs, Karin M; Badenbroek, Ilse; van de Port, Ingrid G L; Hoes, Arno W; Backx, Frank J G

    2016-12-01

    Acute lateral ankle ligamentous sprains (ALALS) are common injuries. This injury does not always have a favourable long-term outcome. Studies reporting the prognosis of ALALS after functional treatment are scarce. To determine the prognosis of functionally treated ALALS, in terms of recurrent ALALS and residual symptoms. Retrospective cohort study. Patients were recruited from 20 family practices, nine physical therapy practices, the emergency departments of a regional hospital and a university hospital. Adult patients with an ALALS caused by an inversion trauma were invited to participate in this study 2.5-5 years after their initial injury. Functional treatment of the initial ALALS. Acute lateral ankle ligamentous sprain recurrences and residual symptoms. A total of 44 patients were included, with an average follow-up period after the initial ankle sprain of 204 weeks (range 150-274 weeks). Eight patients (18.1%) had reinjured their ankle. Explicit pain around the ankle joint at physical examination was experienced by 45.5%. Clinical symptoms of anterior ankle impingement were present in 25% (all athletes), with radiologically confirmed tibiotalar osteophyte bone formation in 82% of them. A large proportion of patients with ALALS experience recurrences and persistent symptoms after their initial ankle injury. The high percentage of patients with anterior ankle impingement syndromes illustrates the need for early assessment of this impairment in patients with persistent complaints. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  14. Acute-Phase Blood Pressure Levels Correlate With a High Risk of Recurrent Strokes in Young-Onset Ischemic Stroke.

    Science.gov (United States)

    Mustanoja, Satu; Putaala, Jukka; Gordin, Daniel; Tulkki, Lauri; Aarnio, Karoliina; Pirinen, Jani; Surakka, Ida; Sinisalo, Juha; Lehto, Mika; Tatlisumak, Turgut

    2016-06-01

    High blood pressure (BP) in acute stroke has been associated with a poor outcome; however, this has not been evaluated in young adults. The relationship between BP and long-term outcome was assessed in 1004 consecutive young, first-ever ischemic stroke patients aged 15 to 49 years enrolled in the Helsinki Young Stroke Registry. BP parameters included systolic (SBP) and diastolic BP, pulse pressure, and mean arterial pressure at admission and 24 hours. The primary outcome measure was recurrent stroke in the long-term follow-up. Adjusted for demographics and preexisting comorbidities, Cox regression models were used to assess independent BP parameters associated with outcome. Of our patients (63% male), 393 patients (39%) had prestroke hypertension and 358 (36%) used antihypertensive treatment. The median follow-up period was 8.9 years (interquartile range 5.7-13.2). Patients with a recurrent stroke (n=142, 14%) had significantly higher admission SBP, diastolic BP, pulse pressure, and mean arterial pressure (Pstroke. Patients with SBP ≥160 mm Hg compared with those with SBP strokes (hazard ratio 3.3 [95% confidence interval, 2.05-4.55]; Pstroke, while the 24-hour BP levels were not. In young ischemic stroke patients, high acute phase BP levels are independently associated with a high risk of recurrent strokes. © 2016 American Heart Association, Inc.

  15. Recurrent focal choroidal excavation following multiple evanescent white dot syndrome (MEWDS) associated with acute idiopathic blind spot enlargement.

    Science.gov (United States)

    Jabbarpoor Bonyadi, Mohammad Hossein; Hassanpour, Kiana; Soheilian, Masoud

    2018-04-01

    To present a recurrent case of conforming focal choroidal excavation (FCE) following multiple evanescent white dot syndrome (MEWDS) in a 25-year-old woman. Following spontaneous MEWDS sings resolution our patient noted a recurrent decrease in vision. Repeated OCT revealed elevation and mild disruption of RPE layer at fovea without previous angiographic MEWDS signs. At this time, short-term systemic steroid therapy was started and visual acuity became normal. Following quiescence of the new-onset phase, the conforming type of FCE located in inferior macula appeared in OCT. In the following next 2 years recurrence of presumptive focal subfoveal choriocapillaritis occurred for three times presenting with blurred vision. During every acute attack, above-mentioned FCE disappeared and returned back again after resolution of presumptive focal choriocapillaritis. This is the first and unique case of recurrent type of FCE following MEWDS. It seems to disappear during active phase of presumptive focal choriocapillaritis and then returns after the eye has become quiescent.

  16. Heavy Smoking Is Associated With Lower Age at First Episode of Acute Pancreatitis and a Higher Risk of Recurrence.

    Science.gov (United States)

    Munigala, Satish; Conwell, Darwin L; Gelrud, Andres; Agarwal, Banke

    2015-08-01

    There is limited data on cigarette smoking and the risk of acute pancreatitis (AP). We evaluated the influence of cigarette smoking on AP risk and clinical presentation in a large cohort of Veteran's Administration (VA) patients. Retrospective study of VA patients from 1998 to 2007. Exclusion criteria included (1) history of chronic pancreatitis (n = 3222) or gallstones (n = 14,574) and (2) age younger than 15 years (n = 270). A 2-year washout period was used to exclude patients with pre-existing recurrent AP. The study included 484,624 patients. From 2001 to 2007, a total of 6799 (1.4%) patients had AP. Alcohol (risk ratio, 4.20) and smoking (risk ratio, 1.78) were independent significant risk factors of AP on multiple regression analysis. Smoking increased the risk of AP in both nonalcoholics (0.57% vs 1.1%) and alcoholics (2.6% vs 4.1%). Smoking was associated with younger mean age at first episode of AP and higher likelihood of recurrent AP (≥4 episodes) in both nonalcoholics and alcoholics. The interval between recurrent episodes was not altered by alcohol or smoking. In a large cohort of VA patients, smoking is an independent risk factor for AP and augmented the effect of alcohol on the risk, age of onset, and recurrence of AP.

  17. Rate of recurrence in Indian patients presenting with acute pancreatitis and identification of chronicity on follow up: Possible risk factors for progression.

    Science.gov (United States)

    Kalaria, Rishikesh; Abraham, Philip; Desai, Devendra C; Joshi, Anand; Gupta, Tarun

    2018-03-01

    To study the profile and long-term outcome of Indian patients presenting with acute pancreatitis and the possible risk factors for progression. Consecutive patients with acute or recurrent acute pancreatitis seen in our department during July 2013 to December 2014 were included. Details of past episodes were collected and patients were followed up till March 2015. In the 97 patients included (mean age 47.2 [SD 16.9] years; 74 men), gallstones (37 [38.1%]) and alcohol (19 [19.6%]) were the major identified etiologies; the idiopathic (31 [32%]) group constituted a third of patients. Recurrences were more common with idiopathic etiology (14 patients out of 30 had recurrences [46.7%]) as compared to alcoholic (5 out of 19 [26.3%]) and biliary (4 out of 37 [10.8%]) pancreatitis and with mild index episode. Following the episode of acute pancreatitis, identification of chronic pancreatitis was more common with alcoholic (6 out of 18 [33%]) and idiopathic (9 out of 30 [30%]) etiology as compared to other etiologies. Longer duration of follow up, but not number of recurrent episodes, was associated with identification of chronicity in patients presenting as acute pancreatitis. Out of 97 patients with acute pancreatitis, 27 (27.8%) developed recurrences with risk factors being idiopathic etiology and mild index episode. Eighteen of 97 (18.6%) patients had evidence of chronic pancreatitis on follow up, risk factors being the alcoholic and idiopathic varieties, and longer duration of follow up.

  18. Relief and Recurrence of Congestion During and After Hospitalization for Acute Heart Failure: Insights From Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARESS-HF).

    Science.gov (United States)

    Lala, Anuradha; McNulty, Steven E; Mentz, Robert J; Dunlay, Shannon M; Vader, Justin M; AbouEzzeddine, Omar F; DeVore, Adam D; Khazanie, Prateeti; Redfield, Margaret M; Goldsmith, Steven R; Bart, Bradley A; Anstrom, Kevin J; Felker, G Michael; Hernandez, Adrian F; Stevenson, Lynne W

    2015-07-01

    Congestion is the most frequent cause for hospitalization in acute decompensated heart failure. Although decongestion is a major goal of acute therapy, it is unclear how the clinical components of congestion (eg, peripheral edema, orthopnea) contribute to outcomes after discharge or how well decongestion is maintained. A post hoc analysis was performed of 496 patients enrolled in the Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF) trials during hospitalization with acute decompensated heart failure and clinical congestion. A simple orthodema congestion score was generated based on symptoms of orthopnea (≥2 pillows=2 points, fails to relieve orthodema during hospitalization or to prevent recurrence after discharge. URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00608491, NCT00577135. © 2015 American Heart Association, Inc.

  19. High Throughput Drug Sensitivity Assay and Genomics- Guided Treatment of Patients With Relapsed or Refractory Acute Leukemia

    Science.gov (United States)

    2018-02-28

    Acute Leukemia of Ambiguous Lineage; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Refractory Acute Myeloid Leukemia; Refractory Adult Acute Lymphoblastic Leukemia; Refractory Childhood Acute Lymphoblastic Leukemia

  20. Translocation (10;17)(p15;q21) is a recurrent anomaly in acute myeloblastic leukemia.

    Science.gov (United States)

    Tempescul, Adrian; Guillerm, Gaëlle; Douet-Guilbert, Nathalie; Morel, Frédéric; Le Bris, Marie-Josée; De Braekeleer, Marc

    2007-01-01

    We report here two cases of patients with acute myeloblastic leukemia, type M1 (FAB classification), associated with a t(10;17)(p15;q21). Fluorescence in situ hybridization with the LSI PML/RARA dual-color probe showed the breakpoint to be distal to the RARA locus. Four other patients with this translocation have been reported, three of them having acute undifferentiated or poorly differentiated leukemia.

  1. A Case with Repeated Recurrent Acute Coronary Syndrome due to Pseudoephedrine Use: Kounis Syndrome

    Directory of Open Access Journals (Sweden)

    Metin Çeliker

    2014-01-01

    Full Text Available Allergic reaction-associated acute coronary syndrome picture is defined as Kounis syndrome. Although drug use is the most common cause of allergic reaction, foods and environmental factors may also play a role in the etiology. Herein, a case with acute coronary syndrome that developed two times at 8-month interval due to pseudoephedrine use for upper respiratory tract infection is presented.

  2. Longitudinal social-interpersonal functioning among higher-risk responders to acute-phase cognitive therapy for recurrent major depressive disorder.

    Science.gov (United States)

    Vittengl, Jeffrey R; Clark, Lee Anna; Thase, Michael E; Jarrett, Robin B

    2016-07-15

    Social-interpersonal dysfunction increases disability in major depressive disorder (MDD). Here we clarified the durability of improvements in social-interpersonal functioning made during acute-phase cognitive therapy (CT), whether continuation CT (C-CT) or fluoxetine (FLX) further improved functioning, and relations of functioning with depressive symptoms and relapse/recurrence. Adult outpatients (N=241) with recurrent MDD who responded to acute-phase CT with higher risk of relapse (due to unstable or partial remission) were randomized to 8 months of C-CT, FLX, or pill placebo plus clinical management (PBO) and followed 24 additional months. We analyzed repeated measures of patients' social adjustment, interpersonal problems, dyadic adjustment, depressive symptoms, and major depressive relapse/recurrence. Large improvements in social-interpersonal functioning occurring during acute-phase CT (median d=1.4) were maintained, with many patients (median=66%) scoring in normal ranges for 32 months. Social-interpersonal functioning did not differ significantly among C-CT, FLX, and PBO arms. Beyond concurrently measured residual symptoms, deterioration in social-interpersonal functioning preceded and predicted upticks in depressive symptoms and major depressive relapse/recurrence. Results may not generalize to other patient populations, treatment protocols, or measures of social-interpersonal functioning. Mechanisms of risk connecting poorer social-interpersonal functioning with depression were not studied. Average improvements in social-interpersonal functioning among higher-risk responders to acute phase CT are durable for 32 months. After acute-phase CT, C-CT or FLX may not further improve social-interpersonal functioning. Among acute-phase CT responders, deteriorating social-interpersonal functioning provides a clear, measurable signal of risk for impending major depressive relapse/recurrence and opportunity for preemptive intervention. Copyright © 2016 Elsevier B

  3. Novel real-time polymerase chain reaction assay for simultaneous detection of recurrent fusion genes in acute myeloid leukemia.

    Science.gov (United States)

    Dolz, Sandra; Barragán, Eva; Fuster, Óscar; Llop, Marta; Cervera, José; Such, Esperanza; De Juan, Inmaculada; Palanca, Sarai; Murria, Rosa; Bolufer, Pascual; Luna, Irene; Gómez, Inés; López, María; Ibáñez, Mariam; Sanz, Miguel A

    2013-09-01

    The recent World Health Organization classification recognizes different subtypes of acute myeloid leukemia (AML) according to the presence of several recurrent genetic abnormalities. Detection of these abnormalities and other molecular changes is of increasing interest because it contributes to a refined diagnosis and prognostic assessment in AML and enables monitoring of minimal residual disease. These genetic abnormalities can be detected using single RT-PCR, although the screening is still labor intensive and costly. We have developed a novel real-time RT-PCR assay to simultaneously detect 15 AML-associated rearrangements that is a simple and easily applicable method for use in clinical diagnostic laboratories. This method showed 100% specificity and sensitivity (95% confidence interval, 91% to 100% and 92% to 100%, respectively). The procedure was validated in a series of 105 patients with AML. The method confirmed all translocations detected using standard cytogenetics and fluorescence in situ hybridization and some additional undetected rearrangements. Two patients demonstrated two molecular rearrangements simultaneously, with BCR-ABL1 implicated in both, in addition to RUNX1-MECOM in one patient and PML-RARA in another. In conclusion, this novel real-time RT-PCR assay for simultaneous detection of multiple AML-associated fusion genes is a versatile and sensitive method for reliable screening of recurrent rearrangements in AML. Copyright © 2013 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.

  4. A recurrent germline PAX5 mutation confers susceptibility to pre-B cell acute lymphoblastic leukemia

    NARCIS (Netherlands)

    Shah, S.; Schrader, K.A.; Waanders, E.; Timms, A.E.; Vijai, J.; Miething, C.; Wechsler, J.; Yang, J.; Hayes, J.; Klein, R.J.; Zhang, J.; Wei, L.; Wu, G.; Rusch, M.; Nagahawatte, P.; Ma, J; Chen, S.C.; Song, G.; Cheng, J.; Meyers, P.; Bhojwani, D.; Jhanwar, S.; Maslak, P.; Fleisher, M.; Littman, J.; Offit, L.; Rau-Murthy, R.; Fleischut, M.H.; Corines, M.; Murali, R.; Gao, X.; Manschreck, C.; Kitzing, T.; Murty, V.V.; Raimondi, S.C.; Kuiper, R.P.; Simons, A.; Schiffman, J.D.; Onel, K.; Plon, S.E.; Wheeler, D.A.; Ritter, D.; Ziegler, D.S.; Tucker, K.; Sutton, R.; Chenevix-Trench, G.; Li, J.; Huntsman, D.G.; Hansford, S.; Senz, J.; Walsh, T.; Lee (Helen Dowling Instituut), M. van der; Hahn, C.N.; Roberts, K.G.; King, M.C.; Lo, S.M.; Levine, R.L.; Viale, A.; Socci, N.D.; Nathanson, K.L.; Scott, H.S.; Daly, M.; Lipkin, S.M.; Lowe, S.W.; Downing, J.R.; Altshuler, D.; Sandlund, J.T.; Horwitz, M.S.; Mullighan, C.G.; Offit, K.

    2013-01-01

    Somatic alterations of the lymphoid transcription factor gene PAX5 (also known as BSAP) are a hallmark of B cell precursor acute lymphoblastic leukemia (B-ALL), but inherited mutations of PAX5 have not previously been described. Here we report a new heterozygous germline variant, c.547G>A

  5. [Role of gastroesophageal reflux in acute recurrent laryngeal dyspnea in children].

    Science.gov (United States)

    Andrieu-Guitrancourt, J; Dehesdin, D; Le Luyer, B; Fouin, M; Peron, J M

    1984-01-01

    Recurrent laryngeal croup (RLC) in children is rarely discussed unless permanent laryngeal obstruction is involved or there is an allergic basis. An atypical case is described where gastro-esophageal reflux (GER) was not only associated with but was also directly related to the provocation of each period. A series of 15 patients with RLC were investigated for the presence of GER, and this was confirmed in 7 cases. These findings suggest that GER may be responsible for the onset of RLC, as is now admitted for numerous respiratory manifestations in children. Moreover, GER may be implicated in the course of various laryngeal obstructive lesions, particularly subglottic angioma.

  6. IgG responses to Pneumococcal and Haemophilus influenzae protein antigens are not impaired in children with a history of recurrent acute otitis media.

    Science.gov (United States)

    Wiertsema, Selma P; Corscadden, Karli J; Mowe, Eva N; Zhang, Guicheng; Vijayasekaran, Shyan; Coates, Harvey L; Mitchell, Timothy J; Thomas, Wayne R; Richmond, Peter C; Kirkham, Lea-Ann S

    2012-01-01

    Vaccines including conserved antigens from Streptococcus pneumoniae and nontypeable Haemophilus influenzae (NTHi) have the potential to reduce the burden of acute otitis media. Little is known about the antibody response to such antigens in young children with recurrent acute otitis media, however, it has been suggested antibody production may be impaired in these children. We measured serum IgG levels against 4 pneumococcal (PspA1, PspA 2, CbpA and Ply) and 3 NTHi (P4, P6 and PD) proteins in a cross-sectional study of 172 children under 3 years of age with a history of recurrent acute otitis media (median 7 episodes, requiring ventilation tube insertion) and 63 healthy age-matched controls, using a newly developed multiplex bead assay. Children with a history of recurrent acute otitis media had significantly higher geometric mean serum IgG levels against NTHi proteins P4, P6 and PD compared with healthy controls, whereas there was no difference in antibody levels against pneumococcal protein antigens. In both children with and without a history of acute otitis media, antibody levels increased with age and were significantly higher in children colonised with S. pneumoniae or NTHi compared with children that were not colonised. Proteins from S. pneumoniae and NTHi induce serum IgG in children with a history of acute otitis media. The mechanisms in which proteins induce immunity and potential protection requires further investigation but the dogma of impaired antibody responses in children with recurrent acute otitis media should be reconsidered.

  7. IgG responses to Pneumococcal and Haemophilus influenzae protein antigens are not impaired in children with a history of recurrent acute otitis media.

    Directory of Open Access Journals (Sweden)

    Selma P Wiertsema

    Full Text Available BACKGROUND: Vaccines including conserved antigens from Streptococcus pneumoniae and nontypeable Haemophilus influenzae (NTHi have the potential to reduce the burden of acute otitis media. Little is known about the antibody response to such antigens in young children with recurrent acute otitis media, however, it has been suggested antibody production may be impaired in these children. METHODS: We measured serum IgG levels against 4 pneumococcal (PspA1, PspA 2, CbpA and Ply and 3 NTHi (P4, P6 and PD proteins in a cross-sectional study of 172 children under 3 years of age with a history of recurrent acute otitis media (median 7 episodes, requiring ventilation tube insertion and 63 healthy age-matched controls, using a newly developed multiplex bead assay. RESULTS: Children with a history of recurrent acute otitis media had significantly higher geometric mean serum IgG levels against NTHi proteins P4, P6 and PD compared with healthy controls, whereas there was no difference in antibody levels against pneumococcal protein antigens. In both children with and without a history of acute otitis media, antibody levels increased with age and were significantly higher in children colonised with S. pneumoniae or NTHi compared with children that were not colonised. CONCLUSIONS: Proteins from S. pneumoniae and NTHi induce serum IgG in children with a history of acute otitis media. The mechanisms in which proteins induce immunity and potential protection requires further investigation but the dogma of impaired antibody responses in children with recurrent acute otitis media should be reconsidered.

  8. Presentation of Neuromyelitis Optica with Recurrent Severe Myelitis and Acute Respiratory Failure in an Old Woman

    Directory of Open Access Journals (Sweden)

    Saeed Razmeh

    2017-06-01

    Full Text Available Neuromyelitis Optica (NMO is a rare disease of the central nervous system that causes optic nerve and spinal cord involvement. The our patient first developed acute paraplegia that was treated with intravenous methylprednisolone with diagnosis of acute thoracic myelitis according to magnetic resonance imaging (MRI finding , concurrently with tapering of oral prednisolone, again affected by quadriplegia and respiratory failure. She was seropositivity for NMO-IgG that was negative in first admission and MRI of spine shows hyperintense lesion in whole cervical and upper thoracic MRI. With considering the findings, NMO was diagnosed and the plasmapheresis starts for her. We report a case of this syndrome because it can increase the physician’s awareness of the unusual manifestations of this syndrome.

  9. PIDOTIMOD IN TREATMENT OF CHILDREN WITH ACUTE RESPIRATORY INFECTION WITH CONCOMITANT RECURRENT OBSTRUCTIVE SYNDROME

    OpenAIRE

    E. E. Lokshina; O. V. Kravchenko; O. V. Zaytseva

    2011-01-01

    Respiratory infections are frequent in children; consequently evaluation of prophylactic effectiveness of immunomodulators is needed. Objective: to evaluate of clinical, immunological efficacy and safety of pidotimod in complex treatment of children with acute respiratory infections (ARI) and obstructive syndrome. Methods: patients 3–10 years old hospitalized with ARI and obstructive syndrome participated the study. Children from first group (n = 30) were treated with pidotimod 400 mg 2 times...

  10. Comparison of carotid atherosclerotic plaque characteristics between patients with first-time and recurrent acute ischaemic stroke using B-mode ultrasound.

    Science.gov (United States)

    Li, Jin; Mi, Donghua; Pu, Yuehua; Zou, Xinying; Pan, Yuesong; Soo, Yannie; Leung, Thomas; Wang, Yilong; Wong, Ka Sing; Liu, Liping

    2015-06-23

    The differences between initial and recurrent stroke plaques are not defined. Hence, a nested case-control study was conducted to evaluate the association of stroke recurrence with the echogenic characteristics of carotid plaques in patients with ischaemic stroke. One hundred and four patients with 1-year recurrent acute ischaemic stroke were enrolled and compared with 104 control patients (first-time ischaemic stroke) matched for age, gender, stroke severity and treatment allocation. Based on the Mannheim Carotid Intima-Media Thickness Consensus (2004-2006), the number of carotid plaques and echogenicity between the two groups of patients were compared. As compared to patients with first-time stroke, those with recurrent stroke showed significantly higher prevalence of heart disease (13.46 vs 28.85%, P = 0.0066) and presence of intracranial stenosis (55.77 vs 89.90%, P stroke had a significantly higher rate of unstable plaques (80.41%) than patients with first-time stroke (64.21%, P = 0.036). Also, patients with recurrent stroke had a significantly larger number of plaques than patients with first-time stroke (P = 0.0152). Multivariate conditional logistic regression analysis (after adjustment for heart disease and intracranial stenosis) identified an association between 1-year stroke recurrence and the presence of unstable plaques (hazard ratio 3.077; 95% CI: 1.133-8.355). Stroke recurrence is related to advanced atherosclerosis defined by carotid plaque and its characteristics.

  11. Fasting triglycerides predict recurrent ischemic events in patients with acute coronary syndrome treated with statins.

    Science.gov (United States)

    Schwartz, Gregory G; Abt, Markus; Bao, Weihang; DeMicco, David; Kallend, David; Miller, Michael; Mundl, Hardi; Olsson, Anders G

    2015-06-02

    Most patients with acute coronary syndrome (ACS) are treated with statins, which reduce atherogenic triglyceride-rich lipoproteins. It is uncertain whether triglycerides predict risk after ACS on a background of statin treatment. This study examined the relationship of fasting triglyceride levels to outcomes after ACS in patients treated with statins. Long-term and short-term relationships of triglycerides to risk after ACS were examined in the dal-OUTCOMES trial and atorvastatin arm of the MIRACL (Myocardial Ischemia Reduction with Acute Cholesterol Lowering) trial, respectively. Analysis of dal-OUTCOMES included 15,817 patients (97% statin-treated) randomly assigned 4 to 12 weeks after ACS to treatment with dalcetrapib (a cholesteryl ester transfer protein inhibitor) or placebo and followed for a median 31 months. Analysis of MIRACL included 1,501 patients treated with atorvastatin 80 mg daily beginning 1 to 4 days after ACS and followed for 16 weeks. Fasting triglycerides at initial random assignment were related to risk of coronary heart disease death, nonfatal myocardial infarction, stroke, and unstable angina in models adjusted for age, sex, hypertension, smoking, diabetes, high-density lipoprotein cholesterol, and body mass index. Fasting triglyceride levels were associated with both long-term and short-term risk after ACS. In dal-OUTCOMES, long-term risk increased across quintiles of baseline triglycerides (p175/≤80 mg/dl) was 1.61 (95% confidence interval: 1.34 to 1.94). There was no interaction of triglycerides and treatment assignment on the primary outcome. In the atorvastatin group of MIRACL, short-term risk increased across tertiles of baseline triglycerides (p=0.03), with a hazard ratio of 1.50 [corrected] (95% confidence interval: 1.05 to 2.15) in highest/lowest tertiles (>195/≤135 mg/dl). The relationship of triglycerides to risk was independent of low-density lipoprotein cholesterol in both studies. Among patients with ACS treated effectively

  12. Extrahepatic portal venous system thrombosis in recurrent acute and chronic alcoholic pancreatitis is caused by local inflammation and not thrombophilia.

    Science.gov (United States)

    Rebours, Vinciane; Boudaoud, Larbi; Vullierme, Marie-Pierre; Vidaud, Dominique; Condat, Bertrand; Hentic, Olivia; Maire, Frédérique; Hammel, Pascal; Ruszniewski, Philippe; Lévy, Philippe

    2012-10-01

    Extrahepatic portal venous system thrombosis (EPVST) occurs in 13% of patients with either recurrent acute (AP) or chronic (CP) alcoholic pancreatitis. The role of thrombophilia has never been assessed in this entity. All consecutive patients with alcoholic AP or CP were included in a prospective study. All patients underwent a computerized tomography (CT) scan of the pancreas to evaluate EPVST as well as thorough testing for thrombophilia (protein C, S, and antithrombin deficiency, factor II, factor V, and JAK2 gene mutations, homocystein, biological antiphospholipid syndrome). A total of 119 patients (male, n=100 (84%); smokers, n=110 (92%)) were included. EPVST was found in 41 patients (35%). The portal, superior mesenteric, or splenic veins were involved in 34%, 24%, and 93% of patients, respectively. Thrombophilia was identified in 18% (n=22), including the biological antiphospholipid syndrome, factor V Leiden mutation, and factor II G20210A gene mutation in 21 (17.6%), 2 (1.6%), and 1 patient (0.8%), respectively. On univariate analysis, the factors associated with EPVST were smoking (RR=1.6 (1.38-1.85), P=0.03), pseudocysts (RR=2.91 (1.29-6.56), P=0.008), a pseudocyst in the pancreatic tail (P=0.03), a high CT severity index for AP (P=0.007), and pancreatic parenchymal necrosis (P=0.02). The presence of hemostatic risk factors was not associated with an increased risk of EPVST. On multivariate analysis, only pseudocysts were associated with EPVST (hazard ratio: 6.402; 95% confidence interval (1.59-26.54), P=0.009). EPVST is found in 35% of patients with acute/chronic alcoholic pancreatitis. Local inflammation appears to be the major predisposing condition. The presence of some form of thrombophilia does not increase the risk of EPVST and should not be systematically searched for in case of EPVST.

  13. Acute Kidney Injury, Recurrent Seizures, and Thrombocytopenia in a Young Patient with Lupus Nephritis: A Diagnostic Dilemma

    Directory of Open Access Journals (Sweden)

    Hector Alvarado Verduzco

    2016-01-01

    Full Text Available Introduction. Posterior reversible encephalopathy syndrome (PRES is a constellation of clinical and radiologic findings. Fluctuations in blood pressure, seizures, and reversible brain MRI findings mainly in posterior cerebral white matter are the main manifestations. PRES has been associated with multiple conditions such as autoimmune disorders, pregnancy, organ transplant, and thrombotic microangiopathy (TMA. Case Presentation. A 22-year-old woman with history of Systemic Lupus Erythematous complicated with chronic kidney disease secondary to lupus nephritis class IV presented with recurrent seizures and uncontrolled hypertension. She was found to have acute kidney injury and thrombocytopenia. Repeat kidney biopsy showed diffuse endocapillary and extracapillary proliferative and membranous lupus nephritis (ISN-RPS class IV-G+V and endothelial swelling secondary to severe hypertension but no evidence of TMA. Brain MRI showed reversible left frontal and parietal lesions that resolved after controlling the blood pressure, making PRES the diagnosis. Conclusion. PRES is an important entity that must be recognized and treated early due to the potential reversibility in the early stages. Physicians must have high suspicion for these unusual presentations. We present a case where performing kidney biopsy clinched the diagnosis in our patient with multiple confounding factors.

  14. Early-Onset Acute Recurrent and Chronic Pancreatitis Is Associated with PRSS1 or CTRC Gene Mutations.

    Science.gov (United States)

    Giefer, Matthew J; Lowe, Mark E; Werlin, Steven L; Zimmerman, Bridget; Wilschanski, Michael; Troendle, David; Schwarzenberg, Sarah Jane; Pohl, John F; Palermo, Joseph; Ooi, Chee Y; Morinville, Veronique D; Lin, Tom K; Husain, Sohail Z; Himes, Ryan; Heyman, Melvin B; Gonska, Tanja; Gariepy, Cheryl E; Freedman, Steven D; Fishman, Douglas S; Bellin, Melena D; Barth, Bradley; Abu-El-Haija, Maisam; Uc, Aliye

    2017-07-01

    To assess whether the age of onset was associated with unique features or disease course in pediatric acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). Demographic and clinical information on children with ARP or CP was collected at INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE) centers. The Cochran-Armitage trend test and Jonckheere-Terpstra test were used to examine for differences between pediatric age groups (pancreatitis, 111 (32%) were 6-11 years of age, and 102 (30%) were ≥12 years of age. Early-onset disease was associated with mutations in cationic trypsinogen (PRSS1) (P pancreatitis (P = .02), family history of CP (P chronic renal failure (P = .02). Later-onset disease was more commonly present with hypertriglyceridemia (P = .04), ulcerative colitis (P = .02), autoimmune diseases (P pancreatitis is associated strongly with PRSS1 or CTRC mutations and family history of pancreatitis. Children with later-onset disease are more likely to have nongenetic risk factors. Future studies are needed to investigate whether the disease course, response to therapy, or clinical outcomes differ relative to the timing of disease onset. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Preliminary pediatric clinical evaluation of the oral probiotic Streptococcus salivarius K12 in preventing recurrent pharyngitis and/or tonsillitis caused by Streptococcus pyogenes and recurrent acute otitis media

    Directory of Open Access Journals (Sweden)

    Di Pierro F

    2012-11-01

    Full Text Available Francesco Di Pierro,1 Guido Donato,2 Federico Fomia,3 Teresa Adami,4 Domenico Careddu,5 Claudia Cassandro,6 Roberto Albera61Scientific Department, Velleja Research, Milano, 2ASL 1, Cuneo, 3ASL 3, Brescia, 4Infective Diseases, Verona, 5ASL 13, Novara, 6Surgical Science Department, Università degli Studi, Torino, ItalyBackground: The oral probiotic Streptococcus salivarius K12 has been shown clearly to antagonize the growth of Streptococcus pyogenes, the most important bacterial cause of pharyngeal infections in humans, by releasing two bacteriocins named salivaricin A2 and salivaricin B. Unpublished observations indicate that it can also antagonize the growth of other bacteria involved in acute otitis media. Because of its ability to colonize the oral cavity and its safety profile, we have tested its efficacy in reducing the incidence of streptococcal pharyngitis and/or tonsillitis and episodes of acute otitis media.Methods: We enrolled 82 children, including 65 with and 17 without a recent diagnosis of recurrent oral streptococcal pathology. Of those with recurrent pathology, 45 were treated daily for 90 days with an oral slow-release tablet containing five billion colony-forming units of S. salivarius K12 (Bactoblis®, and the remaining 20 served as an untreated control group. The 17 children without a recent diagnosis of recurrent oral pathology were used as an additional control group. After 90 days of treatment, a 6-month follow-up period without treatment was included to evaluate a possible persistent protective role for the previously administered product.Results: The 41 children who completed the 90-day course of Bactoblis showed a reduction in their episodes of streptococcal pharyngeal infection (about 90% and/or acute otitis media (about 40%, calculated by comparing infection rates in the previous year. The 90-day treatment also reduced the reported incidence of pharyngeal and ear infections by about 65% in the 6-month follow-up period

  16. Association of CTRC and SPINK1 Gene Variants with Recurrent Hospitalizations for Pancreatitis or Acute Abdominal Pain in Lipoprotein Lipase Deficiency

    Directory of Open Access Journals (Sweden)

    Karine eTremblay

    2014-04-01

    Full Text Available Background: There are important inter-individual variations in the incidence and severity of acute pancreatitis in patients with severe hypertriglyceridemia. Several genes involved in triglyceride-rich lipoprotein metabolism or serine proteases pathways are known to influence the risk of pancreatitis. Aim: To evaluate the association between genes regulating serine proteases, chymotrypsin C (CTRC and serine peptidase inhibitor kazal type1 (SPINK1, and recurrence of hospitalizations for acute pancreatitis or severe abdominal pain in patients with Lipoprotein Lipase deficiency (LPLD, a rare and extreme monogenic model of severe hypertriglyceridemia and pancreatitis. Method: The CTRC and SPINK1 genes promoter and coding regions sequencing has been performed in a sample of 38 LPLD adults (22 men and 16 women and 100 controls (53 men and 47 women. Estimation of the association of CTRC and SPINK1 gene variants or combinations of variants with history of hospitalizations for pancreatitis or acute abdominal pain in LPLD was investigated using non parametric analyses with correction for multiple testing and logistic regression models controlling for age, gender, family history and life habits. Results: Gene sequencing followed by genotype-stratified analyses of the CTRC and SPINK1 genes in LPLD and controls revealed a positive association between recurrence of hospitalizations and the rs545634 (CTRC - rs11319 (SPINK1 combination (OR = 41.4 [CI: 2.0-848.0]; p=0.016. In all models, a positive family history of pancreatitis was a significant predictor of recurrent hospitalizations independently of the contribution of SPINK1 or CTRC (pConclusion: These results suggest that a positive family history of pancreatitis and genetic markers in the serine protease pathways could be associated with a risk of recurrent hospitalization for acute pancreatitis in severe hypertriglyceridemia due to LPLD.

  17. Recurrent gastrointestinal hemorrhage in treatment with dasatinib in a patient showing SMAD4 mutation with acute lymphoblastic leukemia Philadelphia positive and juvenile polyposis hereditary hemorrhagic telangiectasia syndrome

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    Chiara Sartor

    2013-07-01

    Full Text Available We report a case of a patient affected by juvenile polyposis and hereditary hemorrhagic telangiectasia linked to a SMAD4 mutation who developed acute lymphoblastic leukemia positive for the Philadelphia chromosome translocation and with a complex karyotype. During the treatment with the tyrosine kinase inhibitor dasatinib the patient presented recurrent severe gastrointestinal hemorrhages linked to the genetic background and aggravated by thrombocytopenia.

  18. A new assay to identify recurrent mutations in acute myeloid leukemia using next-generation sequencing

    Directory of Open Access Journals (Sweden)

    Coriu Daniel

    2014-03-01

    Full Text Available Introducere: Leucemia acută mieloblastică (LAM este o boală heterogenă caracterizată prin debut la vârstă avansată, fenotip agresiv şi prognostic nefavorabil în special în grupul de vârstă de peste 65 de ani. Pentru stratificarea pacienţilor în grupe de risc se utilizează citogenetica clasică împreună cu metodele moleculare pentru identificarea mutaţiilor punctiforme. În acest articol descriem o nouă metodă de identificare a mutaţiilor în 5 gene implicate în LAM: RUNX1, FLT3, DNMT3A, IDH1 şi IDH2 utilizând secvenţierea de nouă generaţie. Materiale şi metode: Au fost secvenţiate probe de la 40 de pacienţi cu LAM cu cariotip normal internaţi în Institutul Clinic Fundeni. Design-ul de primeri a fost efectuat utilizând LaserGene Genomics suit. Secvenţierea de nouă generaţie a fost efectuată pe platforma MiSeq de la Illumina. Rezultatele au fost analizate utilizând LaserGene Genomics suit. Rezultatele obţinute prin secvenţierea de nouă generaţie au fost comparate cu secvenţierea Sanger. Rezultate: Nu au fost identificate mutaţii adiţionale în probele de la nouă pacienţi pozitivi pentru mutaţiile FLT3-ITD şi / sau NPM1. În probele de la 25 din 31 de pacienţi, cu cariotip normal şi fără mutaţii FLT3-ITD şi NPM1, au fost identificate mutaţii în una din cele 5 gene studiate. Toate aceste mutaţii, identificate prin secvenţierea de nouă generaţie, au fost confirmate prin metoda de secvenţiere clasică Sanger. Concluzii: În acest studiu am validat o metodă de identificare a mutaţiilor apărute la pacienţii cu LAM utilizând secvenţierea de nouă generaţie. Această metodă prezintă o serie de avantaje: este mai ieftină ca in cazul secvenţierii Sanger, prezintă o sensibilitate crescută pentru detectarea mutaţiilor, a fost descrisă ca fiind cantitativă şi în cazul nostru a permis stratificarea în grupe de risc a majorităţii pacienţilor cu cariotip normal şi fără muta

  19. Early Recurrence and Cerebral Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation: Effect of Anticoagulation and Its Timing: The RAF Study.

    Science.gov (United States)

    Paciaroni, Maurizio; Agnelli, Giancarlo; Falocci, Nicola; Caso, Valeria; Becattini, Cecilia; Marcheselli, Simona; Rueckert, Christina; Pezzini, Alessandro; Poli, Loris; Padovani, Alessandro; Csiba, Laszló; Szabó, Lilla; Sohn, Sung-Il; Tassinari, Tiziana; Abdul-Rahim, Azmil H; Michel, Patrik; Cordier, Maria; Vanacker, Peter; Remillard, Suzette; Alberti, Andrea; Venti, Michele; Scoditti, Umberto; Denti, Licia; Orlandi, Giovanni; Chiti, Alberto; Gialdini, Gino; Bovi, Paolo; Carletti, Monica; Rigatelli, Alberto; Putaala, Jukka; Tatlisumak, Turgut; Masotti, Luca; Lorenzini, Gianni; Tassi, Rossana; Guideri, Francesca; Martini, Giuseppe; Tsivgoulis, Georgios; Vadikolias, Kostantinos; Liantinioti, Chrissoula; Corea, Francesco; Del Sette, Massimo; Ageno, Walter; De Lodovici, Maria Luisa; Bono, Giorgio; Baldi, Antonio; D'Anna, Sebastiano; Sacco, Simona; Carolei, Antonio; Tiseo, Cindy; Acciarresi, Monica; D'Amore, Cataldo; Imberti, Davide; Zabzuni, Dorjan; Doronin, Boris; Volodina, Vera; Consoli, Domenico; Galati, Franco; Pieroni, Alessio; Toni, Danilo; Monaco, Serena; Baronello, Mario Maimone; Barlinn, Kristian; Pallesen, Lars-Peder; Kepplinger, Jessica; Bodechtel, Ulf; Gerber, Johannes; Deleu, Dirk; Melikyan, Gayane; Ibrahim, Faisal; Akhtar, Naveed; Mosconi, Maria Giulia; Bubba, Valentina; Silvestri, Ilenia; Lees, Kennedy R

    2015-08-01

    The best time for administering anticoagulation therapy in acute cardioembolic stroke remains unclear. This prospective cohort study of patients with acute stroke and atrial fibrillation, evaluated (1) the risk of recurrent ischemic event and severe bleeding; (2) the risk factors for recurrence and bleeding; and (3) the risks of recurrence and bleeding associated with anticoagulant therapy and its starting time after the acute stroke. The primary outcome of this multicenter study was the composite of stroke, transient ischemic attack, symptomatic systemic embolism, symptomatic cerebral bleeding and major extracranial bleeding within 90 days from acute stroke. Of the 1029 patients enrolled, 123 had 128 events (12.6%): 77 (7.6%) ischemic stroke or transient ischemic attack or systemic embolism, 37 (3.6%) symptomatic cerebral bleeding, and 14 (1.4%) major extracranial bleeding. At 90 days, 50% of the patients were either deceased or disabled (modified Rankin score ≥3), and 10.9% were deceased. High CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesion and type of anticoagulant were predictive factors for primary study outcome. At adjusted Cox regression analysis, initiating anticoagulants 4 to 14 days from stroke onset was associated with a significant reduction in primary study outcome, compared with initiating treatment before 4 or after 14 days: hazard ratio 0.53 (95% confidence interval 0.30-0.93). About 7% of the patients treated with oral anticoagulants alone had an outcome event compared with 16.8% and 12.3% of the patients treated with low molecular weight heparins alone or followed by oral anticoagulants, respectively (P=0.003). Acute stroke in atrial fibrillation patients is associated with high rates of ischemic recurrence and major bleeding at 90 days. This study has observed that high CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesions, and type of anticoagulant administered

  20. Multicenter Approach to Recurrent Acute and Chronic Pancreatitis in the United States: The North American Pancreatitis Study 2 (NAPS2)

    Science.gov (United States)

    Whitcomb, David C.; Yadav, Dhiraj; Adam, Slivka; Hawes, Robert H.; Brand, Randall E.; Anderson, Michelle A.; Money, Mary E.; Banks, Peter A.; Bishop, Michele D.; Baillie, John; Sherman, Stuart; DiSario, James; Burton, Frank R.; Gardner, Timothy B.; Amann, Stephen T.; Gelrud, Andres; Lo, Simon K.; DeMeo, Mark T.; Steinberg, William M.; Kochman, Michael L.; Etemad, Babak; Forsmark, Christopher E.; Elinoff, Beth; Greer, Julia B.; O’Connell, Michael; Lamb, Janette; Barmada, M. Michael

    2008-01-01

    Background Recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) are complex syndromes associated with numerous etiologies, clinical variables and complications. We developed the North American Pancreatitis Study 2 (NAPS2) to be sufficiently powered to understand the complex environmental, metabolic and genetic mechanisms underlying RAP and CP. Methods Between August 2000 and September 2006, a consortium of 20 expert academic and private sites prospectively ascertained 1,000 human subjects with RAP or CP, plus 695 controls (spouse, family, friend or unrelated). Standardized questionnaires were completed by both the physicians and study subjects and blood was drawn for genomic DNA and biomarker studies. All data were double-entered into a database and systematically reviewed to minimize errors and include missing data. Results A total of 1,000 subjects (460 RAP, 540 CP) and 695 controls who completed consent forms and questionnaires and donated blood samples comprised the final dataset. Data were organized according to diagnosis, supporting documentation, etiological classification, clinical signs and symptoms (including pain patterns and duration, and quality of life), past medical history, family history, environmental exposures (including alcohol and tobacco use), medication use and therapeutic interventions. Upon achieving the target enrollment, data were organized and classified to facilitate future analysis. The approaches, rationale and datasets are described, along with final demographic results. Conclusion The NAPS2 consortium has successfully completed a prospective ascertainment of 1,000 subjects with RAP and CP from the USA. These data will be useful in elucidating the environmental, metabolic and genetic conditions, and to investigate the complex interactions that underlie RAP and CP. PMID:18765957

  1. Progression of recurrent acute and chronic pancreatitis: A short-term follow up study from a southern Indian centre.

    Science.gov (United States)

    Kamath, M Ganesh; Pai, C Ganesh; Kamath, Asha

    2016-11-01

    Little data exist on the progression of recurrent acute (RAP) and chronic pancreatitis (CP) from regions from where the entity of tropical chronic pancreatitis was originally described. The study aimed to follow up patients with RAP and CP seen at a southern Indian centre for progression of disease over time. Prospectively enrolled patients with RAP and CP were followed up, and the alcoholic and idiopathic subgroups were assessed for progression of structural and functional changes in the organ. One hundred and forty patients (RAP = 44; 31.4 %, CP = 96; 68.5 %) were followed up over a median 12.2 (interquartile range 12.0-16.8) months. The cause was alcohol in 31 (22.1 %) and not evident in 109 (77.8 %). The disease progressed from RAP to CP in 7 (15.9 %), 6 (16.2 %) out of 37 in the idiopathic and 1 (14.2 %; p = 1.00) out of 7 in the alcoholic subgroups. Three (42.8 %) and 1 (14.2 %) developed steatorrhea and diabetes mellitus (DM), respectively, and 2 (4.5 %) developed calcification. Established CP progressed in 19 (19.7 %), 1 (1.0 %), 5 (5.2 %), 2 (2.0 %) and 11 (11.4 %) newly developed DM, steatorrhea, calcification and duct dilation during follow up. Among the idiopathic and alcoholic CP, disease progression was seen in 15 (20.8 %) out of 72 and 4 (16.6 %) out of 24 respectively. Idiopathic RAP and CP progressed during the short-term follow up. This is similar to other etiological forms of pancreatitis, as described from elsewhere in the world.

  2. Bacteriotherapy with Streptococcus salivarius 24SMB and Streptococcus oralis 89a nasal spray for preventing recurrent acute otitis media in children: a real-life clinical experience

    Directory of Open Access Journals (Sweden)

    La Mantia I

    2017-06-01

    Full Text Available Ignazio La Mantia, Attilio Varricchio, Giorgio Ciprandi Associazione Italiana Vie Aeree Superiori, Naples, Italy Abstract: Recurrence of acute otitis media (RAOM is a relevant issue in the clinical practice. “Bacteriotherapy” has been proposed as an option in children with RAOM. Streptococcus salivarius 24SMB nasal spray has been previously demonstrated to reduce the risk of acute otitis media (AOM in otitis-prone children. The current retrospective and observational study aimed to confirm this outcome in a real-life setting, such as the common pediatric practice. Group A (108 children served as control; group B (159 children was treated with S. salivarius 24SMB and Streptococcus oralis 89a nasal spray after the first AOM episode. Active treatment consisted of 3 monthly courses: 2 puffs per nostril twice/day for a week. Group B showed a significant reduction of AOM episodes in comparison with group A (p<0.0001. Notably, all actively treated children with the highest AOM recurrence had a reduction of recurrence, whereas only 50% of the control group children had reduced RAOM (p<0.0001. Also, severity grade of AOM significantly diminished after the preventive bacteriotherapy (p<0.0001. In conclusion, the current retrospective and observational study demonstrated that S. salivarius 24SMB and S. oralis 89a nasal spray could be effective in the prevention of RAOM in a real-life setting. Keywords: recurrent acute otitis media, bacteriotherapy, Streptococcus salivarius 24SMB, Streptococcus oralis 89a, nasal spray, children

  3. Testicular regulation of neuronal glucose and monocarboxylate transporter gene expression profiles in CNS metabolic sensing sites during acute and recurrent insulin-induced hypoglycemia.

    Science.gov (United States)

    Vavaiya, Kamlesh V; Paranjape, Sachin A; Briski, Karen P

    2007-01-01

    Recurrent insulin-induced hypoglycemia (RIIH) impairs glucose counter-regulatory function in male humans and rodents and, in the latter, diminishes neuronal activation in CNS structures that monitor metabolic homeostasis, including the lateral hypothalamic area (LHA) and dorsal vagal complex (DVC). We investigated whether habituated neuronal reactivity in CNS sensing sites to hypoglycemia is correlated with modified monocarboxylate and/or glucose uptake by using quantitative real-time RT-PCR to analyze neuronal monocarboxylate transporter (MCT2) and glucose transporter variant (GLUT and GLUT4) gene expression profiles in the microdissected LHA, ventromedial nucleus hypothalamus (VMH), and DVC after one or multiple insulin injections. Because orchidectomy (ORDX) maintains uniform glycemic responses to RIIH in male rats, we also examined whether regional gene response patterns are testes dependent. In the intact male rat DVC, MCT2, GLUT3, and GLUT4 gene expression was not altered by acute hypoglycemia but was enhanced by RIIH. MCT2 and GLUT3 mRNA levels in the ORDX rat DVC did not differ among groups, but GLUT4 transcripts were progressively increased by acute and recurrent hypoglycemia. Precedent hypoglycemia decreased or increased basal MCT2 and GLUT4 gene expression, respectively, in the intact rat LHA; LHA GLUT3 transcription was augmented by RIIH in intact rats only. Acute hypoglycemia suppressed MCT2, GLUT3, and GLUT4 gene expression in the intact rat VMH, a response that was abolished by RIIH. In ORDX rats, VMH gene transcript levels were unchanged in response to one dose of insulin but were selectively diminished during RIIH. These data demonstrate site-specific, testes-dependent effects of acute and recurrent hypoglycemia on neuronal metabolic substrate transporter gene expression in characterized rat brain metabolic sensing loci and emphasize the need to assess the impact of potential alterations in glucose and lactate uptake during RIIH on general and

  4. HA-1 T TCR T Cell Immunotherapy for the Treating of Patients With Relapsed or Refractory Acute Leukemia After Donor Stem Cell Transplant

    Science.gov (United States)

    2018-04-30

    HLA-A*0201 HA-1 Positive Cells Present; Minimal Residual Disease; Recurrent Acute Biphenotypic Leukemia; Recurrent Acute Undifferentiated Leukemia; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Refractory Acute Myeloid Leukemia; Refractory Adult Acute Lymphoblastic Leukemia; Refractory Childhood Acute Lymphoblastic Leukemia

  5. A comparative analysis of predictors for 1-year recurrent acute coronary syndromes events, by age group: the Greek observational study of ACS (GREECS).

    Science.gov (United States)

    Panagiotakos, Demosthenes B; Notara, Venetia; Georgousopoulou, Ekavi N; Pitsavos, Christos; Antonoulas, Antonis; Kogias, Yannis; Mantas, Yannis; Stravopodis, Petros; Zombolos, Spyros; Stefanadis, Christodoulos

    2015-02-01

    To evaluate the potential differences in risk factors' profile for in-hospital mortality and up to 1-year prognosis, between younger and older patients with first acute coronary syndromes (ACS). From October 2003 to September 2004, 1323 patients with first ACS event from 6 urban and rural Greek hospitals were enrolled into the study, classified as those period of 6-months, the event-rate was higher among the younger patients (p < 0.001). Current smoking was associated with increased risk of 1-month recurrent events, in patients < 65 years (p < 0.05). Myocardial infarction and history of diabetes were associated with increased risk in older patients (p < 0.1). Age-specific identification of the risk factors for recurrent events may have important clinical and public health implications and lead to the development of more effective risk reduction strategies. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. Episodes of Guillain-Barré syndrome associated with the acute phase of HIV-1 infection and with recurrence of viremia

    Directory of Open Access Journals (Sweden)

    Castro Gleusa de

    2006-01-01

    Full Text Available We report a severe case of Guillain-Barré syndrome (GBS characterized by flaccid areflexive tetraplegia and signs of autonomic instability related to acute HIV-1 infection, and the occurrence of relapse episodes coinciding with the detection of HIV-1 RNA in blood during the phase of irregular treatment with antiretroviral agents. The patient has been asymptomatic for 3 years and has an HIV-1 load below the limit of detection. The recurrence of GBS in this case may be related to alterations of the immunologic response caused by disequilibrium in the host-HIV relationship due to the increase in HIV-1 viremia.

  7. Effect of telmisartan on functional outcome, recurrence, and blood pressure in patients with acute mild ischemic stroke: a PRoFESS subgroup analysis

    DEFF Research Database (Denmark)

    Bath, Philip M W; Martin, Reneé H; Palesch, Yuko

    2009-01-01

    BACKGROUND AND PURPOSE: High blood pressure (BP) is common in acute ischemic stroke and associated independently with a poor functional outcome. However, the management of BP acutely remains unclear because no large trials have been completed. METHODS: The factorial PRoFESS secondary stroke...... prevention trial assessed BP-lowering and antiplatelet strategies in 20 332 patients; 1360 were enrolled within 72 hours of ischemic stroke, with telmisartan (angiotensin receptor antagonist, 80 mg/d, n=647) vs placebo (n=713). For this nonprespecified subgroup analysis, the primary outcome was functional...... outcome at 30 days; secondary outcomes included death, recurrence, and hemodynamic measures at up to 90 days. Analyses were adjusted for baseline prognostic variables and antiplatelet assignment. RESULTS: Patients were representative of the whole trial (age 67 years, male 65%, baseline BP 147/84 mm Hg...

  8. A recurrence of Guillain-Barr and eacute; syndrome or a case of acute-onset chronic inflammatory demyelinating polyneuropathy in the course of chronic hepatitis B?

    Directory of Open Access Journals (Sweden)

    Guner Celik Koyuncu

    2016-12-01

    Full Text Available Chronic inflammatory demyelinating polyneuropathy is a demyelinating polyneuropathy characterized by distal/proximal weakness, which shows gradual progression over a period of 8 weeks or longer. Guillan-Barre Syndrome is a condition characterized by acute monophasic paralysis typically following an infectious assault, and it usually peaks in severity over 3-4 weeks at most. Although rare, there are acute-onset chronic inflammatory demyelinating polyneuropathy cases that show progression over a period shorter than 4 weeks, as is the case in Guillan-Barre Syndrome .This report discusses a case of chronic inflammatory demyelinating polyneuropathy in a HBsAg-positive patient, which started as Guillan-Barre Syndrome but showed 3 recurrences within 6 months, each with rapidly progressing quadriplegia, respiratory arrest, and elevated liver enzymes and HBV DNA. [Cukurova Med J 2016; 41(4.000: 782-786

  9. Are Improvements in Cognitive Content and Depressive Symptoms Correlates or Mediators during Acute-Phase Cognitive Therapy for Recurrent Major Depressive Disorder?

    Science.gov (United States)

    Vittengl, Jeffrey R; Clark, Lee Anna; Thase, Michael E; Jarrett, Robin B

    2014-01-09

    The cognitive model of depression posits that cognitive therapy's (CT) effect on depressive symptoms is mediated by changes in cognitive content (e.g., automatic negative thoughts dysfunctional attitudes, failure attributions). We tested improvement and normalization of cognitive content among outpatients ( N = 523) with recurrent major depressive disorder treated with acute-phase CT (Jarrett & Thase, 2010; Jarrett et al., 2013). We also tested whether improvement in cognitive content accounted for subsequent changes in depressive symptoms and vice versa. Five measures of content improved substantively from pre- to post-CT (median d = 0.96), and the proportions of patients scoring in "healthy" ranges increased (median 45% to 82%). Evidence for cognitive mediation of symptom reduction was limited (median r = .06), as was evidence for symptom mediation of cognitive content improvement (median r = .07). We discuss measurement and design issues relevant to detection of mediators and consider alternative theories of change.

  10. Neutrophil extracellular traps and bacterial biofilms in middle ear effusion of children with recurrent acute otitis media--a potential treatment target.

    Directory of Open Access Journals (Sweden)

    Ruth B Thornton

    Full Text Available BACKGROUND: Bacteria persist within biofilms on the middle ear mucosa of children with recurrent and chronic otitis media however the mechanisms by which these develop remain to be elucidated. Biopsies can be difficult to obtain from children and their small size limits analysis. METHODS: In this study we aimed to investigate biofilm presence in middle ear effusion (MEE from children with recurrent acute otitis media (rAOM and to determine if these may represent infectious reservoirs similarly to those on the mucosa. We examined this through culture, viability staining and fluorescent in situ hybridisation (FISH to determine bacterial species present. Most MEEs had live bacteria present using viability staining (32/36 and all effusions had bacteria present using the universal FISH probe (26/26. Of these, 70% contained 2 or more otopathogenic species. Extensive DNA stranding was also present. This DNA was largely host derived, representing neutrophil extracellular traps (NETs within which live bacteria in biofilm formations were present. When treated with the recombinant human deoxyribonuclease 1, Dornase alfa, these strands were observed to fragment. CONCLUSIONS: Bacterial biofilms, composed of multiple live otopathogenic species can be demonstrated in the MEEs of children with rAOM and that these contain extensive DNA stranding from NETs. The NETs contribute to the viscosity of the effusion, potentially contributing to its failure to clear as well as biofilm development. Our data indicates that Dornase alfa can fragment these strands and may play a role in future chronic OM treatment.

  11. Genetic polymorphisms in immunoresponse genes TNFA, IL6, IL10, and TLR4 are associated with recurrent acute otitis media

    NARCIS (Netherlands)

    Emonts, Marieke; Veenhoven, Reinier H.; Wiertsema, Selma P.; Houwing-Duistermaat, Jeanine J.; Walraven, Vanessa; de Groot, Ronald; Hermans, Peter W. M.; Sanders, Elisabeth A. M.

    2007-01-01

    OBJECTIVE. Cytokines and other inflammatory mediators are involved in the pathogenesis of otitis media. We hypothesized that polymorphisms in inflammatory response genes contribute to the increased susceptibility to acute otitis media in otitis-prone children. PATIENTS AND METHODS. DNA samples from

  12. Embolization of Acute Nonvariceal Upper Gastrointestinal Hemorrhage Resistant to Endoscopic Treatment: Results and Predictors of Recurrent Bleeding

    International Nuclear Information System (INIS)

    Loffroy, Romaric; Rao, Pramod; Ota, Shinichi; Lin Mingde; Kwak, Byung-Kook; Geschwind, Jean-Francois

    2010-01-01

    Acute nonvariceal upper gastrointestinal (UGI) hemorrhage is a frequent complication associated with significant morbidity and mortality. The most common cause of UGI bleeding is peptic ulcer disease, but the differential diagnosis is diverse and includes tumors; ischemia; gastritis; arteriovenous malformations, such as Dieulafoy lesions; Mallory-Weiss tears; trauma; and iatrogenic causes. Aggressive treatment with early endoscopic hemostasis is essential for a favorable outcome. However, severe bleeding despite conservative medical treatment or endoscopic intervention occurs in 5-10% of patients, requiring surgery or transcatheter arterial embolization. Surgical intervention is usually an expeditious and gratifying endeavor, but it can be associated with high operative mortality rates. Endovascular management using superselective catheterization of the culprit vessel, occlusion, or blind embolization has emerged as an alternative to emergent operative intervention for high-risk patients and is now considered the first-line therapy for massive UGI bleeding refractory to endoscopic treatment. Indeed, many published studies have confirmed the feasibility of this approach and its high technical and clinical success rates, which range from 69 to 100% and from 63 to 97%, respectively, even if the choice of the best embolic agent among coils, cyanaocrylate glue, gelatin sponge, or calibrated particles remains a matter of debate. However, factors influencing clinical outcome, especially predictors of early rebleeding, are poorly understood, and few studies have addressed this issue. This review of the literature will attempt to define the role of embolotherapy for acute nonvariceal UGI hemorrhage that fails to respond to endoscopic hemostasis and to summarize data on factors predicting angiographic and embolization failure.

  13. CD19/CD22 Chimeric Antigen Receptor T Cells and Chemotherapy in Treating Patients With Recurrent or Refractory CD19 Positive Diffuse Large B-Cell Lymphoma or B Acute Lymphoblastic Leukemia

    Science.gov (United States)

    2018-01-25

    B Acute Lymphoblastic Leukemia; CD19 Positive; Diffuse Large B-Cell Lymphoma Associated With Chronic Inflammation; Diffuse Large B-Cell Lymphoma, Not Otherwise Specified; Epstein-Barr Virus Positive Diffuse Large B-Cell Lymphoma of the Elderly; Minimal Residual Disease; Philadelphia Chromosome Positive; Recurrent Diffuse Large B-Cell Lymphoma; Recurrent Mediastinal (Thymic) Large B-Cell Cell Lymphoma; Refractory Diffuse Large B-Cell Lymphoma; Refractory Mediastinal (Thymic) Large B-Cell Cell Lymphoma; T-Cell/Histiocyte-Rich Large B-Cell Lymphoma

  14. Recurrent ischemia across the spectrum of acute coronary syndromes: prevalence and prognostic significance of (re-)infarction and ST-segment changes in a large contemporary registry.

    Science.gov (United States)

    Yan, Andrew T; Steg, Philippe Gabriel; Fitzgerald, Gordon; Feldman, Laurent J; Eagle, Kim A; Gore, Joel M; Anderson, Frederick A; López-Sendón, Jose; Gurfinkel, Enrique P; Brieger, David; Goodman, Shaun G

    2010-11-05

    There are limited recent data on the prevalence and potentially different adverse impact of the various types of recurrent ischemia (RI) in unselected patients with acute coronary syndromes(ACS). We examined the clinical features and treatment associated with, and the differential prognostic impact of, the various types of RI in unselected patients across the broad spectrum of ACS in the contemporary era. The Global Registry of Acute Coronary Events (GRACE) was a prospective, multinational registry of patients hospitalized for ACS. Data were collected on standardized case report forms. Of the 29,400 ACS patients enrolled in May 2000-March 2007, 21% developed RI; 2.4%, 4.9%, and 16% had myocardial (re-)infarction [(re-)MI], RI with ST-segment changes, and RI without ST-segment changes (not mutually exclusive), respectively. Rates of in-hospital mortality and complications, and 6-month mortality were significantly higher among patients with RI compared to those without; the rates were highest for patients who developed (re-)MI, followed by those with RI and ST-segment changes. After adjusting for other validated prognosticators in the GRACE risk score, all three types of RI retained an independent association with both higher in-hospital and post-discharge 6-month mortality. Early revascularization was associated with lower in-hospital mortality only in the group with (re-)MI (P for interaction=0.003). Despite the current use of intensive medical therapies, RI remains a common and serious consequence across the spectrum of ACS. Different types of RI confer a variable adverse prognostic impact. Re-MI is associated with the worst outcome, which appears to be mitigated by early revascularization. Our findings underscore the persistent need to improve the treatment of ACS. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

  15. Toxicidad hepática recurrente secundaria a metilprednisolona intravenosa Recurrent acute liver toxicity from intravenous methyprednisolone

    Directory of Open Access Journals (Sweden)

    M. Rivero Fernández

    2008-11-01

    Full Text Available Las reacciones adversas hepáticas relacionadas con la administración de fármacos (hepatotoxicidad son cuadros relativamente frecuentes que presentan una amplia variabilidad clínica e histológica. La identificación precoz de estos cuadros es fundamental en la práctica clínica debido a su potencial gravedad. En la mayoría de los casos la suspensión del fármaco desencadenante es suficiente para la resolución del cuadro clínico. A pesar de que los esteroides son utilizados en una amplia variedad de situaciones clínicas, la notificación de cuadros de hepatotoxicidad secundaria a esteroides intravenosos es excepcional. Presentamos el caso clínico de una mujer diagnosticada de esclerosis múltiple, que recibió metilprednisolona a altas dosis en forma de "pulsos" intravenosos como tratamiento de las reagudizaciones de su enfermedad y presentó 3 brotes recurrentes de hepatitis de predominio hepatocelular con un patrón clínico, analítico e histológico compatible con toxicidad hepática aguda secundaria a metilprednisolona intravenosa. En el tercer episodio se realizó una biopsia hepática que demostró un patrón de hepatitis aguda con necrosis líticas confluentes, histología no descrita previamente en pacientes tratados con esteroides intravenosos.Adverse drug reactions (hepatotoxicity are a frequent cause of acute liver injury with a wide clinical and histological spectrum. An early recognition of drug-related liver disease has been considered essential in clinical practice due to potential risks. In most cases exposure discontinuation improves the clinical picture. Steroids are used in a variety of clinical settings. However, intravenous steroids have rarely been associated with hepatotoxicity. We report the case of a middle-aged woman with multiple sclerosis who received a bolus of methylprednisolone on three occasions for the management of relapsing disease, with the development of repeated episodes of elevated liver enzymes

  16. Recurrent varicocele

    Directory of Open Access Journals (Sweden)

    Katherine Rotker

    2016-01-01

    Full Text Available Varicocele recurrence is one of the most common complications associated with varicocele repair. A systematic review was performed to evaluate varicocele recurrence rates, anatomic causes of recurrence, and methods of management of recurrent varicoceles. The PubMed database was evaluated using keywords "recurrent" and "varicocele" as well as MESH criteria "recurrent" and "varicocele." Articles were not included that were not in English, represented single case reports, focused solely on subclinical varicocele, or focused solely on a pediatric population (age <18. Rates of recurrence vary with the technique of varicocele repair from 0% to 35%. Anatomy of recurrence can be defined by venography. Management of varicocele recurrence can be surgical or via embolization.

  17. Sex-related differences in risk factors, type of treatment received and outcomes in patients with atrial fibrillation and acute stroke: Results from the RAF-study (Early Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation)

    OpenAIRE

    Antonenko, Kateryna; Paciaroni, Maurizio; Agnelli, Giancarlo; Falocci, Nicola; Becattini, Cecilia; Marcheselli, Simona; Rueckert, Christina; Pezzini, Alessandro; Poli, Loris; Padovani, Alessandro; Csiba, Laszló; Szabó, Lilla; Sohn, Sung-Il; Tassinari, Tiziana; Abdul-Rahim, Azmil H

    2016-01-01

    Introduction: Atrial fibrillation is an independent risk factor of thromboembolism. Women with atrial fibrillation are at a higher overall risk for stroke compared to men with atrial fibrillation. The aim of this study was to evaluate for sex differences in patients with acute stroke and atrial fibrillation, regarding risk factors, treatments received and outcomes.\\ud Methods Data were analyzed from the “Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibril...

  18. Recurrence of a t(8;21-Positive Acute Myeloid Leukemia in the Form of a Granulocytic Sarcoma Involving Cranial Bones: A Diagnostic and Therapeutic Challenge

    Directory of Open Access Journals (Sweden)

    Ambra Di Veroli

    2013-01-01

    Full Text Available Granulocytic sarcoma (GS is a rare extramedullary solid tumor defined as an accumulation of myeloblasts or immature myeloid cells. It can cooccur with or precede the acute myeloid leukemia (AML as well as following treated AML. The incidence of GS in AML patients is 3–8% but it significantly rises in M2 FAB subtype AML. This variety of AML harbors t(8;21 in up to 20–25% of cases (especially in children and black ones of African origin and, at a molecular level, it is characterized by the generation of a fusion gene known as RUNX1-RUNX1T1. Approximately 10% of M2 AML patients will develop GS, as a consequence, the t(8;21 and the relative transcript represent the most common cytogenetic and molecular abnormalities in GS. FLT3-ITD mutation was rarely described in AML patients presenting with GS. FLT3 ITD is generally strongly associated with poor prognosis in AML, and is rarely reported in patients with t(8;21. GS presentation is extremely variable depending on organs involved; in general, cranial bones and sinus are very rarely affected sites. We report a rare case of GS occurring as a recurrence of a previously treated t(8;21, FLT3-ITD positive AML, involving mastoid bones and paravertebral tissues.

  19. Is acute recurrent pancreatitis in children a precursor of chronic pancreatitis? A long-term follow-up study of 93 cases.

    Science.gov (United States)

    Poddar, Ujjal; Yachha, Surender K; Borkar, Vibhor; Srivastava, Anshu

    2017-07-01

    In view of paucity of literature we analyzed our experience of acute recurrent pancreatitis (ARP) to study clinical profile and long-term outcome. Over 13 years, 93 consecutive children (≤18 years) diagnosed to have ARP were included in this study. Magnetic resonance cholangiopancreatography was done at baseline and on follow-up. Common mutations for serine-protease-inhibitor (SPINK1 N34S), protease inhibitor (PRSS1 R122S) and cystic fibrosis transmembrane conductance regulator (CFTR deltaF508, 5T) were studied in 22 idiopathic cases. The median age of the children with ARP was 13 (10-14.5) years, 53 were males. Etiology included biliary in 14 (15%), pancreas divisum in 6 (7%), others in 3 (3.5%) and idiopathic in the remaining 70 (75%). SPINK1 mutation was found in 10/22 (45%) cases. Over a median follow-up of 25.5 (8.25-48) months, 37 (42%) of 88 (5 lost to follow-up) developed chronic pancreatitis (CP). On multivariate analysis idiopathic etiology (petiology and presence of genetic mutations. Hence, patients with ARP should be kept on regular follow-up to detect CP. Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  20. Recurrent Takotsubo Cardiomyopathy Related to Recurrent Thyrotoxicosis.

    Science.gov (United States)

    Patel, Keval; Griffing, George T; Hauptman, Paul J; Stolker, Joshua M

    2016-04-01

    Takotsubo cardiomyopathy, or transient left ventricular apical ballooning syndrome, is characterized by acute left ventricular dysfunction caused by transient wall-motion abnormalities of the left ventricular apex and mid ventricle in the absence of obstructive coronary artery disease. Recurrent episodes are rare but have been reported, and several cases of takotsubo cardiomyopathy have been described in the presence of hyperthyroidism. We report the case of a 55-year-old woman who had recurrent takotsubo cardiomyopathy, documented by repeat coronary angiography and evaluations of left ventricular function, in the presence of recurrent hyperthyroidism related to Graves disease. After both episodes, the patient's left ventricular function returned to normal when her thyroid function normalized. These findings suggest a possible role of thyroid-hormone excess in the pathophysiology of some patients who have takotsubo cardiomyopathy.

  1. Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Ki-Woong Nam

    Full Text Available Stroke in cancer patients is not rare but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. D-dimer could be a useful predictor because it can reflect both thromboembolic events and advanced stages of cancer.In this study, we evaluate the possibility of D-dimer as a predictor of 30-day mortality in stroke patients with active cancer.We included 210 ischemic stroke patients with active cancer. The 30-day mortality data were collected by reviewing medical records. We also collected follow-up D-dimer levels in 106 (50% participants to evaluate the effects of treatment response on D-dimer levels.Of the 210 participants, 30-day mortality occurred in 28 (13% patients. Higher initial NIHSS scores, D-dimer levels, and CRP levels as well as frequent cryptogenic mechanism, systemic metastasis, multiple vascular territory lesion, hemorrhagic transformation, and larger infarct volume were related to 30-day mortality. In the multivariate analysis, D-dimer [adjusted OR (aOR = 2.19; 95% CI, 1.46-3.28, P < 0.001] predicted 30-day mortality after adjusting for confounders. The initial NIHSS score (aOR = 1.07; 95% CI, 1.00-1.14, P = 0.043 and hemorrhagic transformation (aOR = 3.02; 95% CI, 1.10-8.29, P = 0.032 were also significant independent of D-dimer levels. In the analysis of D-dimer changes after treatment, the mortality group showed no significant decrease in D-dimer levels, despite treatment, while the survivor group showed the opposite response.D-dimer levels may predict 30-day mortality in acute ischemic stroke patients with active cancer.

  2. Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke.

    Science.gov (United States)

    Nam, Ki-Woong; Kim, Chi Kyung; Kim, Tae Jung; An, Sang Joon; Oh, Kyungmi; Mo, Heejung; Kang, Min Kyoung; Han, Moon-Ku; Demchuk, Andrew M; Ko, Sang-Bae; Yoon, Byung-Woo

    2017-01-01

    Stroke in cancer patients is not rare but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. D-dimer could be a useful predictor because it can reflect both thromboembolic events and advanced stages of cancer. In this study, we evaluate the possibility of D-dimer as a predictor of 30-day mortality in stroke patients with active cancer. We included 210 ischemic stroke patients with active cancer. The 30-day mortality data were collected by reviewing medical records. We also collected follow-up D-dimer levels in 106 (50%) participants to evaluate the effects of treatment response on D-dimer levels. Of the 210 participants, 30-day mortality occurred in 28 (13%) patients. Higher initial NIHSS scores, D-dimer levels, and CRP levels as well as frequent cryptogenic mechanism, systemic metastasis, multiple vascular territory lesion, hemorrhagic transformation, and larger infarct volume were related to 30-day mortality. In the multivariate analysis, D-dimer [adjusted OR (aOR) = 2.19; 95% CI, 1.46-3.28, P mortality after adjusting for confounders. The initial NIHSS score (aOR = 1.07; 95% CI, 1.00-1.14, P = 0.043) and hemorrhagic transformation (aOR = 3.02; 95% CI, 1.10-8.29, P = 0.032) were also significant independent of D-dimer levels. In the analysis of D-dimer changes after treatment, the mortality group showed no significant decrease in D-dimer levels, despite treatment, while the survivor group showed the opposite response. D-dimer levels may predict 30-day mortality in acute ischemic stroke patients with active cancer.

  3. Risk of recurrent acute lower urinary tract infections and prescription pattern of antibiotics in women with and without diabetes in primary care

    NARCIS (Netherlands)

    Gorter, Kees J.; Hak, Eelko; Zuithoff, Nicolaas P. A.; Hoepelman, Andy I. M.; Rutten, Guy E. H. M.

    Aim. To investigate diabetes characteristics associated with the risk of recurrent lower UTIs and the antibiotic prescription pattern. Methods. In an exploratory retrospective study involving 7063 women aged >= 30 years, we studied the incidence of recurrent UTI (relapses and reinfection) in women

  4. Recurrent Meningitis.

    Science.gov (United States)

    Rosenberg, Jon; Galen, Benjamin T

    2017-07-01

    Recurrent meningitis is a rare clinical scenario that can be self-limiting or life threatening depending on the underlying etiology. This review describes the causes, risk factors, treatment, and prognosis for recurrent meningitis. As a general overview of a broad topic, the aim of this review is to provide clinicians with a comprehensive differential diagnosis to aide in the evaluation and management of a patient with recurrent meningitis. New developments related to understanding the pathophysiology of recurrent meningitis are as scarce as studies evaluating the treatment and prevention of this rare disorder. A trial evaluating oral valacyclovir suppression after HSV-2 meningitis did not demonstrate a benefit in preventing recurrences. The data on prophylactic antibiotics after basilar skull fractures do not support their use. Intrathecal trastuzumab has shown promise in treating leptomeningeal carcinomatosis from HER-2 positive breast cancer. Monoclonal antibodies used to treat cancer and autoimmune diseases are new potential causes of drug-induced aseptic meningitis. Despite their potential for causing recurrent meningitis, the clinical entities reviewed herein are not frequently discussed together given that they are a heterogeneous collection of unrelated, rare diseases. Epidemiologic data on recurrent meningitis are lacking. The syndrome of recurrent benign lymphocytic meningitis described by Mollaret in 1944 was later found to be closely related to HSV-2 reactivation, but HSV-2 is by no means the only etiology of recurrent aseptic meningitis. While the mainstay of treatment for recurrent meningitis is supportive care, it is paramount to ensure that reversible and treatable causes have been addressed for further prevention.

  5. The effects of ventilation tubes versus no ventilation tubes for recurrent acute otitis media or chronic otitis media with effusion in 9 to 36 month old Greenlandic children, the SIUTIT trial

    DEFF Research Database (Denmark)

    Demant, Malene Nøhr; Jensen, Ramon Gordon; Jakobsen, Janus Christian

    2017-01-01

    BACKGROUND: The prevalence of otitis media in Greenlandic children is one of the highest in the world. International studies have shown that otitis-prone children may benefit from tubulation of the tympanic membrane. However, it is unknown whether these results can be applied to Greenlandic......) in Greenlandic children aged 9-36 months with chronic otitis media with effusion or recurrent acute otitis media. With randomization stratified by otitis media subtype and trial site, a type 1 error of 5% and a power of 80%, a total of 230 participants are needed to detect a decrease of two visits to a health...... clinic during 2 years, which is considered the minimal clinical relevant difference. The primary outcome measure will be assessed blindly by investigating medical records. Secondary outcome measures are number of episodes of acute otitis media, quality of life, number of episodes of antibiotics...

  6. A new recurrent inversion, inv(7)(p15q34), leads to transcriptional activation of HOXA10 and HOXA11 in a subset of T-cell acute lymphoblastic leukemias.

    Science.gov (United States)

    Speleman, F; Cauwelier, B; Dastugue, N; Cools, J; Verhasselt, B; Poppe, B; Van Roy, N; Vandesompele, J; Graux, C; Uyttebroeck, A; Boogaerts, M; De Moerloose, B; Benoit, Y; Selleslag, D; Billiet, J; Robert, A; Huguet, F; Vandenberghe, P; De Paepe, A; Marynen, P; Hagemeijer, A

    2005-03-01

    Chromosomal translocations with breakpoints in T-cell receptor (TCR) genes are recurrent in T-cell malignancies. These translocations involve the TCRalphadelta gene (14q11), the TCRbeta gene (7q34) and to a lesser extent the TCRgamma gene at chromosomal band 7p14 and juxtapose T-cell oncogenes next to TCR regulatory sequences leading to deregulated expression of those oncogenes. Here, we describe a new recurrent chromosomal inversion of chromosome 7, inv(7)(p15q34), in a subset of patients with T-cell acute lymphoblastic leukemia characterized by CD2 negative and CD4 positive, CD8 negative blasts. This rearrangement juxtaposes the distal part of the HOXA gene cluster on 7p15 to the TCRbeta locus on 7q34. Real time quantitative PCR analysis for all HOXA genes revealed high levels of HOXA10 and HOXA11 expression in all inv(7) positive cases. This is the first report of a recurrent chromosome rearrangement targeting the HOXA gene cluster in T-cell malignancies resulting in deregulated HOXA gene expression (particularly HOXA10 and HOXA11) and is in keeping with a previous report suggesting HOXA deregulation in MLL-rearranged T- and B cell lymphoblastic leukemia as the key factor in leukaemic transformation. Finally, our observation also supports the previous suggested role of HOXA10 and HOXA11 in normal thymocyte development.

  7. Effect of telmisartan on functional outcome, recurrence, and blood pressure in patients with acute mild ischemic stroke: a PRoFESS subgroup analysis

    DEFF Research Database (Denmark)

    Bath, Philip M W; Martin, Reneé H; Palesch, Yuko

    2009-01-01

    BACKGROUND AND PURPOSE: High blood pressure (BP) is common in acute ischemic stroke and associated independently with a poor functional outcome. However, the management of BP acutely remains unclear because no large trials have been completed. METHODS: The factorial PRoFESS secondary stroke preve...

  8. Recurrences of Bell's palsy.

    Science.gov (United States)

    Cirpaciu, D; Goanta, C M; Cirpaciu, M D

    2014-01-01

    Bell's palsy in known as the most common cause of facial paralysis, determined by the acute onset of lower motor neuron weakness of the facial nerve with no detectable cause. With a lifetime risk of 1 in 60 and an annual incidence of 11-40/100,000 population, the condition resolves completely in around 71% of the untreated cases. Clinical trials performed for Bell's palsy have reported some recurrences, ipsilateral or contralateral to the side affected in the primary episode of facial palsy. Only few data are found in the literature. Melkersson-Rosenthal is a rare neuromucocutaneous syndrome characterized by recurrent facial paralysis, fissured tongue (lingua plicata), orofacial edema. We attempted to analyze some clinical and epidemiologic aspects of recurrent idiopathic palsy, and to develop relevant correlations between the existing data in literature and those obtained in this study. This is a retrospective study carried out on a 10-years period for adults and a five-year period for children. A number of 185 patients aged between 4 and 70 years old were analyzed. 136 of them were adults and 49 were children. 22 of 185 patients with Bell's palsy (12%) had a recurrent partial or complete facial paralysis with one to six episodes of palsy. From this group of 22 cases, 5 patients were diagnosed with Melkersson-Rosenthal syndrome. The patients' age was between 4 and 70 years old, with a medium age of 27,6 years. In the group studied, fifteen patients, meaning 68%, were women and seven were men. The majority of patients in our group with more than two facial palsy episodes had at least one episode on the contralateral side. Our study found a significant incidence of recurrences of idiopathic facial palsy. Recurrent idiopathic facial palsy and Melkersson-Rosenthal syndrome is diagnosed more often in young females. Recurrence is more likely to occur in the first two years from the onset, which leads to the conclusion that we should have a follow up of patients

  9. Mycophenolate mofetil combined with systemic corticosteroids prevents progression to chronic recurrent inflammation and development of 'sunset glow fundus' in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada disease.

    Science.gov (United States)

    Abu El-Asrar, Ahmed M; Dosari, Mona; Hemachandran, Suhail; Gikandi, Priscilla W; Al-Muammar, Abdulrahman

    2017-02-01

    To evaluate the effectiveness and safety of mycophenolate mofetil (MMF) as first-line therapy combined with systemic corticosteroids in initial-onset acute uveitis associated with Vogt-Koyanagi-Harada (VKH) disease. This prospective study included 38 patients (76 eyes). The main outcome measures were final visual acuity, corticosteroid-sparing effect, progression to chronic recurrent granulomatous uveitis and development of complications, particularly 'sunset glow fundus'. The mean follow-up period was 37.0 ± 29.3 (range 9-120 months). Visual acuity of 20/20 was achieved by 93.4% of the eyes. Corticosteroid-sparing effect was achieved in all patients. The mean interval between starting treatment and tapering to 10 mg or less daily was 3.8 ± 1.3 months (range 3-7 months). Twenty-two patients (57.9%) discontinued treatment without relapse of inflammation. The mean time observed off of treatment was 28.1 ± 19.6 months (range 1-60 months). None of the eyes progressed to chronic recurrent granulomatous uveitis. The ocular complications encountered were glaucoma in two eyes (2.6%) and cataract in five eyes (6.6%). None of the eyes developed 'sunset glow fundus', and none of the patients developed any systemic adverse events associated with the treatment. Use of MMF as first-line therapy combined with systemic corticosteroids in patients with initial-onset acute VKH disease prevents progression to chronic recurrent granulomatous inflammation and development of 'sunset glow fundus'. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  10. Recurrent vulvovaginitis.

    Science.gov (United States)

    Powell, Anna M; Nyirjesy, Paul

    2014-10-01

    Vulvovaginitis (VV) is one of the most commonly encountered problems by a gynecologist. Many women frequently self-treat with over-the-counter medications, and may present to their health-care provider after a treatment failure. Vulvovaginal candidiasis, bacterial vaginosis, and trichomoniasis may occur as discreet or recurrent episodes, and have been associated with significant treatment cost and morbidity. We present an update on diagnostic capabilities and treatment modalities that address recurrent and refractory episodes of VV. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Recurrence in Major Depression: A Conceptual Analysis

    Science.gov (United States)

    Monroe, Scott M.; Harkness, Kate L.

    2011-01-01

    Theory and research on major depression have increasingly assumed a recurrent and chronic disease model. Yet not all people who become depressed suffer recurrences, suggesting that depression is also an acute, time-limited condition. However, few if any risk indicators are available to forecast which of the initially depressed will or will not…

  12. Heterogeneous breakpoints in patients with acute lymphoblastic leukemia and the dic(9;20)(p11-13;q11) show recurrent involvement of genes at 20q11.21.

    Science.gov (United States)

    An, Qian; Wright, Sarah L; Moorman, Anthony V; Parker, Helen; Griffiths, Mike; Ross, Fiona M; Davies, Teresa; Harrison, Christine J; Strefford, Jon C

    2009-08-01

    The dic(9;20)(p11-13;q11) is a recurrent chromosomal abnormality in patients with acute lymphoblastic leukemia. Although it results in loss of material from 9p and 20q, the molecular targets on both chromosomes have not been fully elucidated. From an initial cohort of 58 with acute lymphoblastic leukemia patients with this translocation, breakpoint mapping with fluorescence in situ hybridization on 26 of them revealed breakpoint heterogeneity of both chromosomes. PAX5 has been proposed to be the target gene on 9p, while for 20q, FISH analysis implicated the involvement of the ASXL1 gene, either by a breakpoint within (n=4) or centromeric (deletion, n=12) of the gene. Molecular copy-number counting, long-distance inverse PCR and direct sequence analysis identified six dic(9;20) breakpoint sequences. In addition to the three previously reported: PAX5-ASXL1, PAX5-C20ORF112 and PAX5-KIF3B; we identified three new ones in this study: sequences 3' of PAX5 disrupting ASXL1, and ZCCHC7 disrupted by sequences 3' of FRG1B and LOC1499503. This study provides insight into the breakpoint complexity underlying dicentric chromosomal formation in acute lymphoblastic leukemia and highlights putative target gene loci.

  13. Infection-triggered familial or recurrent cases of acute necrotizing encephalopathy caused by mutations in a component of the nuclear pore, RANBP2

    DEFF Research Database (Denmark)

    Neilson, Derek E; Adams, Mark D; Orr, Caitlin M D

    2009-01-01

    a susceptibility locus (ANE1) in a family segregating recurrent ANE as an incompletely penetrant, autosomal-dominant trait. We now report that all affected individuals and obligate carriers in this family are heterozygous for a missense mutation (c.1880C-->T, p.Thr585Met) in the gene encoding the nuclear pore...... protein Ran Binding Protein 2 (RANBP2). To determine whether this mutation is the susceptibility allele, we screened controls and other patients with ANE who are unrelated to the index family. Patients from 9 of 15 additional kindreds with familial or recurrent ANE had the identical mutation. It arose de...... novo in two families and independently in several other families. Two other patients with familial ANE had different RANBP2 missense mutations that altered conserved residues. None of the three RANBP2 missense mutations were found in 19 patients with isolated ANE or in unaffected controls. We conclude...

  14. Prediction of early recurrent thromboembolic event and major bleeding in patients with acute stroke and atrial fibrillation by a risk stratification schema: the ALESSA score study

    OpenAIRE

    Paciaroni, Maurizio; Agnelli, Giancarlo; Caso, Valeria; Tsivgoulis, Georgios; Furie, Karen L; Tadi, Prasanna; Becattini, Cecilia; Falocci, Nicola; Zedde, Marialuisa; Abdul-Rahim, Azmil H.; Lees, Kennedy R.; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D'Amore, Cataldo

    2017-01-01

    Background and Purposes—This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation.\\ud \\ud Methods—The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00–1.11) and severe atrial enlar...

  15. [Integral Care Guide for Early Detection and Diagnosis of Depressive Episodes and Recurrent Depressive Disorder in Adults. Integral Attention of Adults with a Diagnosis of Depressive Episodes and Recurrent Depressive Disorder: Part II: General Aspects of Treatment, Management of the Acute Phase, Continuation and Maintenance of Patients with a Depression Diagnosis].

    Science.gov (United States)

    Peñaranda, Adriana Patricia Bohórquez; Valencia, Jenny García; Guarín, Maritza Rodríguez; Borrero, Álvaro Enrique Arenas; Díaz, Sergio Mario Castro; de la Hoz Bradford, Ana María; Riveros, Patricia Maldonado; Jaramillo, Luis Eduardo; Brito, Enrique; Acosta, Carlos Alberto Palacio; Pedraza, Ricardo Sánchez; González-Pacheco, Juan; Gómez-Restrepo, Carlos

    2012-12-01

    This article presents recommendations based on evidence gathered to answer a series of clinical questions concerning the depressive episode and the recurrent depressive disorder, with emphasis on general treatment aspects, treatment in the acute phase and management of the continuation/maintenance, all intended to grant health care parameters based on the best and more updated available evidence for achieving minimum quality standards with adult patients thus diagnosed. A practical clinical guide was elaborated according to standards of the Methodological Guide of the Ministry of Social Protection. Recommendation from NICE90 and CANMAT guides were adopted and updated so as to answer the questions posed while de novo questions were developed. Recommendations 5-22 corresponding to management of depression are presented. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  16. A case of recurrent autoimmune hemolytic anemia during remission associated with acute pure red cell aplasia and hemophagocytic syndrome due to human parvovirus B19 infection successfully treated by steroid pulse therapy with a review of the literature.

    Science.gov (United States)

    Sekiguchi, Yasunobu; Shimada, Asami; Imai, Hidenori; Wakabayashi, Mutsumi; Sugimoto, Keiji; Nakamura, Noriko; Sawada, Tomohiro; Komatsu, Norio; Noguchi, Masaaki

    2014-01-01

    The patient was a 47-year-old man diagnosed as having autoimmune hemolytic anemia (AIHA) in April 2011. He also had a congenital chromosomal abnormality, a balanced translocation. Treatment with prednisolone (PSL) 60 mg/day resulted in resolution of the AIHA, and the treatment was completed in November 2011. While the patient no longer had anemia, the direct and indirect Coombs tests remained positive. In May 2013, he developed recurrent AIHA associated with acute pure red cell aplasia (PRCA) and hemophagocytic syndrome (HPS) caused by human parvovirus B19 (HPV B19) infection. Tests for anti-erythropoietin and anti-erythropoietin receptor antibodies were positive. Steroid pulse therapy resulted in resolution of the AIHA, PRCA, as well as HPS. The serum test for anti-erythropoietin antibodies also became negative after the treatment. However, although the serum was positive for anti-HPV B19 IgG antibodies, the patient continued to have a low CD4 lymphocyte count (CD4, B19 infection (HPV B19 DNA remained positive), suggesting the risk of recurrence and bone marrow failure.

  17. Fatores de risco para otite média aguda recorrente: onde podemos intervir? - uma revisão sistemática da literatura Systematic literature review of modifiable risk factors for recurrent acute otitis media in childhood

    Directory of Open Access Journals (Sweden)

    José Faibes Lubianca Neto

    2006-04-01

    Full Text Available OBJETIVO: Revisar evidências sobre fatores de risco modificáveis para otite média aguda recorrente. FONTE DOS DADOS: MEDLINE sem restrição de linguagem de janeiro de 1966 até julho de 2005, utilizando descritores "acute otitis media/risk factors". Obtiveram-se 257 artigos. Desses, incluíram-se ensaios clínicos randomizados, coortes, estudos de caso-controle e transversais que tiveram análise dos fatores de risco modificáveis para desenvolvimento de otite média aguda recorrente como objetivo principal e com amostras de indivíduos de até 18 anos. Excluíram-se, exceto quando relevantes, revisões não-sistemáticas, relatos de casos e série de casos, além de diretrizes de sociedades médicas. SÍNTESE DOS DADOS: Identificaram-se nove fatores de risco ligados ao hospedeiro e oito ligados ao ambiente. Do primeiro grupo, classificaram-se como modificáveis alergia, anormalidades craniofaciais, refluxo gastroesofágico e presença de adenóides. Na segunda categoria, incluíram-se infecção de vias aéreas superiores, cuidados em creches, presença de irmãos/tamanho da família, fumo passivo, aleitamento materno e uso de chupetas. Posteriormente, classificaram-se os fatores de risco de acordo com níveis de evidência. CONCLUSÕES: Os fatores de risco estabelecidos para otite média aguda recorrente e passíveis de intervenção foram uso de chupetas e cuidados em creche. Os fatores de risco prováveis foram privação do leite materno, presença de irmãos, anormalidades craniofaciais, fumo passivo e presença de adenóides. Nenhum fator modificável foi classificado como pouco provável. Entre os que precisam ser melhor estudados estão alergia, refluxo gastroesofágico e fumo passivo na gestação.OBJECTIVE: Review evidence about modifiable risk factors for recurrent acute otitis media. SOURCE OF DATA: MEDLINE with no language restriction, from January 1966 to July 2005, using descriptors "acute otitis media/risk factors". Two

  18. The molecular landscape of pediatric acute myeloid leukemia reveals recurrent structural alterations and age-specific mutational interactions | Office of Cancer Genomics

    Science.gov (United States)

    We present the molecular landscape of pediatric acute myeloid leukemia (AML) and characterize nearly 1,000 participants in Children’s Oncology Group (COG) AML trials. The COG–National Cancer Institute (NCI) TARGET AML initiative assessed cases by whole-genome, targeted DNA, mRNA and microRNA sequencing and CpG methylation profiling. Validated DNA variants corresponded to diverse, infrequent mutations, with fewer than 40 genes mutated in >2% of cases.

  19. Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients With Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study.

    Science.gov (United States)

    Paciaroni, Maurizio; Agnelli, Giancarlo; Caso, Valeria; Tsivgoulis, Georgios; Furie, Karen L; Tadi, Prasanna; Becattini, Cecilia; Falocci, Nicola; Zedde, Marialuisa; Abdul-Rahim, Azmil H; Lees, Kennedy R; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D'Amore, Cataldo; Mosconi, Maria Giulia; Cimini, Ludovica Anna; Procopio, Antonio; Bovi, Paolo; Carletti, Monica; Rigatelli, Alberto; Cappellari, Manuel; Putaala, Jukka; Tomppo, Liisa; Tatlisumak, Turgut; Bandini, Fabio; Marcheselli, Simona; Pezzini, Alessandro; Poli, Loris; Padovani, Alessandro; Masotti, Luca; Vannucchi, Vieri; Sohn, Sung-Il; Lorenzini, Gianni; Tassi, Rossana; Guideri, Francesca; Acampa, Maurizio; Martini, Giuseppe; Ntaios, George; Karagkiozi, Efstathia; Athanasakis, George; Makaritsis, Kostantinos; Vadikolias, Kostantinos; Liantinioti, Chrysoula; Chondrogianni, Maria; Mumoli, Nicola; Consoli, Domenico; Galati, Franco; Sacco, Simona; Carolei, Antonio; Tiseo, Cindy; Corea, Francesco; Ageno, Walter; Bellesini, Marta; Colombo, Giovanna; Silvestrelli, Giorgio; Ciccone, Alfonso; Scoditti, Umberto; Denti, Licia; Mancuso, Michelangelo; Maccarrone, Miriam; Orlandi, Giovanni; Giannini, Nicola; Gialdini, Gino; Tassinari, Tiziana; De Lodovici, Maria Luisa; Bono, Giorgio; Rueckert, Christina; Baldi, Antonio; D'Anna, Sebastiano; Toni, Danilo; Letteri, Federica; Giuntini, Martina; Lotti, Enrico Maria; Flomin, Yuriy; Pieroni, Alessio; Kargiotis, Odysseas; Karapanayiotides, Theodore; Monaco, Serena; Baronello, Mario Maimone; Csiba, Laszló; Szabó, Lilla; Chiti, Alberto; Giorli, Elisa; Del Sette, Massimo; Imberti, Davide; Zabzuni, Dorjan; Doronin, Boris; Volodina, Vera; Michel, Patrik; Vanacker, Peter; Barlinn, Kristian; Pallesen, Lars-Peder; Kepplinger, Jessica; Bodechtel, Ulf; Gerber, Johannes; Deleu, Dirk; Melikyan, Gayane; Ibrahim, Faisal; Akhtar, Naveed; Gourbali, Vanessa; Yaghi, Shadi

    2017-03-01

    This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation. The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00-1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08-2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P =0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30-1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632-0.763; P =0.0001) for ischemic outcome events and 0.585 (0.493-0.678; P =0.10) for major bleedings. The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529-0.763; P =0.009) for ischemic outcome events and 0.407 (0.275-0.540; P =0.14) for hemorrhagic outcome events. In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings. © 2017 American Heart Association, Inc.

  20. Neuronal antibody biomarkers for Sydenham's chorea identify a new group of children with chronic recurrent episodic acute exacerbations of tic and obsessive compulsive symptoms following a streptococcal infection.

    Science.gov (United States)

    Singer, Harvey S; Mascaro-Blanco, Adda; Alvarez, Kathy; Morris-Berry, Christina; Kawikova, Ivana; Ben-Pazi, Hilla; Thompson, Carol B; Ali, Syed F; Kaplan, Edward L; Cunningham, Madeleine W

    2015-01-01

    Several autoantibodies (anti-dopamine 1 (D1R) and 2 (D2R) receptors, anti-tubulin, anti-lysoganglioside-GM1) and antibody-mediated activation of calcium calmodulin dependent protein kinase II (CaMKII) signaling activity are elevated in children with Sydenham's chorea (SC). Recognizing proposed clinical and autoimmune similarities between SC and PANDAS (pediatric autoimmune neuropsychiatric disorder associated with a streptococcal infection), we sought to identify serial biomarker changes in a slightly different population. Antineuronal antibodies were measured in eight children (mean 11.3 years) with chronic, dramatic, recurrent tics and obsessive-compulsive disorder (OCD) associated with a group A β-hemolytic streptococcal (GABHS) respiratory tract infection, but differing because they lacked choreiform movements. Longitudinal serum samples in most subjects included two pre-exacerbation samples, Exac), one midst Exac (abrupt recurrence of tic/OCD; temporally association with a GABHS infection in six of eight subjects), and two post-Exac. Controls included four groups of unaffected children (n = 70; mean 10.8 years) obtained at four different institutions and published controls. Clinical exacerbations were not associated with a significant rise in antineuronal antibody titers. CaMKII activation was increased at the GABHS exacerbation point in 5/6 subjects, exceeded combined and published control's 95th percentile at least once in 7/8 subjects, and median values were elevated at each time point. Anti-tubulin and anti-D2R titers did not differ from published or combined control group's 95th percentile or median values. Differences in anti-lysoganglioside-GM1 and anti-D1R titers were dependent on the selected control. Variances in antibody titers and CaMKII activation were identified among the institutional control groups. Based on comparisons to published studies, results identify two groups of PANDAS: 1) a cohort, represented by this study, which lacks choreiform

  1. Neuronal antibody biomarkers for Sydenham's chorea identify a new group of children with chronic recurrent episodic acute exacerbations of tic and obsessive compulsive symptoms following a streptococcal infection.

    Directory of Open Access Journals (Sweden)

    Harvey S Singer

    Full Text Available Several autoantibodies (anti-dopamine 1 (D1R and 2 (D2R receptors, anti-tubulin, anti-lysoganglioside-GM1 and antibody-mediated activation of calcium calmodulin dependent protein kinase II (CaMKII signaling activity are elevated in children with Sydenham's chorea (SC. Recognizing proposed clinical and autoimmune similarities between SC and PANDAS (pediatric autoimmune neuropsychiatric disorder associated with a streptococcal infection, we sought to identify serial biomarker changes in a slightly different population. Antineuronal antibodies were measured in eight children (mean 11.3 years with chronic, dramatic, recurrent tics and obsessive-compulsive disorder (OCD associated with a group A β-hemolytic streptococcal (GABHS respiratory tract infection, but differing because they lacked choreiform movements. Longitudinal serum samples in most subjects included two pre-exacerbation samples, Exac, one midst Exac (abrupt recurrence of tic/OCD; temporally association with a GABHS infection in six of eight subjects, and two post-Exac. Controls included four groups of unaffected children (n = 70; mean 10.8 years obtained at four different institutions and published controls. Clinical exacerbations were not associated with a significant rise in antineuronal antibody titers. CaMKII activation was increased at the GABHS exacerbation point in 5/6 subjects, exceeded combined and published control's 95th percentile at least once in 7/8 subjects, and median values were elevated at each time point. Anti-tubulin and anti-D2R titers did not differ from published or combined control group's 95th percentile or median values. Differences in anti-lysoganglioside-GM1 and anti-D1R titers were dependent on the selected control. Variances in antibody titers and CaMKII activation were identified among the institutional control groups. Based on comparisons to published studies, results identify two groups of PANDAS: 1 a cohort, represented by this study, which lacks

  2. The effects of ventilation tubes versus no ventilation tubes for recurrent acute otitis media or chronic otitis media with effusion in 9 to 36 month old Greenlandic children, the SIUTIT trial: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Demant, Malene Nøhr; Jensen, Ramon Gordon; Jakobsen, Janus Christian; Gluud, Christian; Homøe, Preben

    2017-01-19

    The prevalence of otitis media in Greenlandic children is one of the highest in the world. International studies have shown that otitis-prone children may benefit from tubulation of the tympanic membrane. However, it is unknown whether these results can be applied to Greenlandic children and trials on the effects of ventilation tubes in high-risk populations have, to our knowledge, never been conducted. The trial is an investigator-initiated, multicentre, randomized, blinded superiority trial of bilateral ventilation tube insertion versus treatment as usual (no tube) in Greenlandic children aged 9-36 months with chronic otitis media with effusion or recurrent acute otitis media. With randomization stratified by otitis media subtype and trial site, a type 1 error of 5% and a power of 80%, a total of 230 participants are needed to detect a decrease of two visits to a health clinic during 2 years, which is considered the minimal clinical relevant difference. The primary outcome measure will be assessed blindly by investigating medical records. Secondary outcome measures are number of episodes of acute otitis media, quality of life, number of episodes of antibiotics administration and proportion of children with tympanic membrane perforations. This trial will provide evidence-based knowledge of the effects of ventilation tubes in children with middle ear infections from the high-risk Greenlandic population. Furthermore, this trial will improve the understanding of conducting randomized clinical trials in remote areas, where management of logistical aspects is particularly challenging. ClinicalTrials.gov, NCT02490332 . Registered on 14 February 2016.

  3. Therapeutic Endoscopic Retrograde Cholangiopancreatography in Pediatric Patients With Acute Recurrent and Chronic Pancreatitis: Data From the INSPPIRE (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) Study.

    Science.gov (United States)

    Troendle, David M; Fishman, Douglas S; Barth, Bradley A; Giefer, Matthew J; Lin, Tom K; Liu, Quin Y; Abu-El-Haija, Maisam; Bellin, Melena D; Durie, Peter R; Freedman, Steven D; Gariepy, Cheryl; Gonska, Tanja; Heyman, Melvin B; Himes, Ryan; Husain, Sohail Z; Kumar, Soma; Lowe, Mark E; Morinville, Veronique D; Ooi, Chee Y; Palermo, Joseph; Pohl, John F; Schwarzenberg, Sarah Jane; Werlin, Steven; Wilschanski, Michael; Zimmerman, M Bridget; Uc, Aliye

    2017-07-01

    The aim of this study was to characterize utilization and benefit of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). From August 2012 to February 2015, 301 children with ARP or CP were enrolled in the INSPPIRE (INternational Study group of Pediatric Pancreatitis: In search for a cuRE) study. Physicians reported utilization and benefit of therapeutic ERCP at enrollment. Differences were analyzed using appropriate statistical methods. One hundred seventeen children (38.9%) underwent at least 1 therapeutic ERCP. The procedure was more commonly performed in children with CP compared with those with ARP (65.8% vs 13.5%, P < 0.0001). Utility of therapeutic ERCP was reported to be similar between ARP and CP (53% vs 56%, P = 0.81) and was found to be helpful for at least 1 indication in both groups (53/99 patients [53.5%]). Predictors for undergoing therapeutic ERCP were presence of obstructive factors in ARP and CP, Hispanic ethnicity, or white race in CP. Therapeutic ERCP is frequently utilized in children with ARP or CP and may offer benefit in selected cases, specifically if ductal obstruction is present. Longitudinal studies are needed to clarify the efficacy of therapeutic ERCP and to explore subgroups that might have increased benefit from such intervention.

  4. Recurrence and Relapse in Bipolar Mood Disorder

    Directory of Open Access Journals (Sweden)

    S Gh Mousavi

    2004-06-01

    Full Text Available Background: Despite the effectiveness of pharmacotherapy in acute phase of bipolar mood disorder, patients often experience relapses or recurrent episodes. Hospitalization of patients need a great deal of financial and humanistic resources which can be saved through understanding more about the rate of relapse and factors affecting this rate. Methods: In a descriptive analytical study, 380 patients with bipolar disorder who were hospitalized in psychiatric emergency ward of Noor hospital, Isfahan, Iran, were followed. Each patient was considered for; the frequency of relapse and recurrence, kind of pharmachotherapy, presence of psychotherapeutic treatments, frequency of visits by psychiatrist and the rank of present episode. Results: The overall prevalence of recurrence was 42.2%. Recurrence was lower in patients using lithium carbonate or sodium valproate or combined therapy (about 40%, compared to those using carbamazepine (80%. Recurrence was higher in patients treated with only pharmacotherapy (44.5% compared to those treated with both pharmacotherapy and psychotherapy (22.2%. Patients who were visited monthy by psychiatrist had lower rate of recurrence compared to those who had irregular visits. Conclusion: The higher rate of recurrence observed in carbamazepine therapy may be due to its adverse reactions and consequently poor compliance to this drug. Lower rates of recurrence with psychotherapy and regular visits may be related to the preventive effects of these procedures and especially to the effective management of stress. Keywords: Bipolar Mood Disorder, Recurrence, Relapse.

  5. High-Dose Busulfan and High-Dose Cyclophosphamide Followed By Donor Bone Marrow Transplant in Treating Patients With Leukemia, Myelodysplastic Syndrome, Multiple Myeloma, or Recurrent Hodgkin or Non-Hodgkin Lymphoma

    Science.gov (United States)

    2010-08-05

    Accelerated Phase Chronic Myelogenous Leukemia; Adult Acute Lymphoblastic Leukemia in Remission; Adult Acute Megakaryoblastic Leukemia (M7); Adult Acute Monoblastic Leukemia (M5a); Adult Acute Monocytic Leukemia (M5b); Adult Acute Myeloblastic Leukemia With Maturation (M2); Adult Acute Myeloblastic Leukemia Without Maturation (M1); Adult Acute Myeloid Leukemia in Remission; Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With T(15;17)(q22;q12); Adult Acute Myeloid Leukemia With T(16;16)(p13;q22); Adult Acute Myeloid Leukemia With T(8;21)(q22;q22); Adult Acute Myelomonocytic Leukemia (M4); Adult Acute Promyelocytic Leukemia (M3); Adult Erythroleukemia (M6a); Adult Nasal Type Extranodal NK/T-cell Lymphoma; Adult Pure Erythroid Leukemia (M6b); Anaplastic Large Cell Lymphoma; Angioimmunoblastic T-cell Lymphoma; Burkitt Lymphoma; Childhood Acute Erythroleukemia (M6); Childhood Acute Lymphoblastic Leukemia in Remission; Childhood Acute Megakaryocytic Leukemia (M7); Childhood Acute Monoblastic Leukemia (M5a); Childhood Acute Monocytic Leukemia (M5b); Childhood Acute Myeloblastic Leukemia With Maturation (M2); Childhood Acute Myeloblastic Leukemia Without Maturation (M1); Childhood Acute Myeloid Leukemia in Remission; Childhood Acute Myelomonocytic Leukemia (M4); Childhood Acute Promyelocytic Leukemia (M3); Childhood Chronic Myelogenous Leukemia; Childhood Myelodysplastic Syndromes; Chronic Phase Chronic Myelogenous Leukemia; Cutaneous B-cell Non-Hodgkin Lymphoma; De Novo Myelodysplastic Syndromes; Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue; Hepatosplenic T-cell Lymphoma; Intraocular Lymphoma; Nodal Marginal Zone B-cell Lymphoma; Peripheral T-Cell Lymphoma; Post-transplant Lymphoproliferative Disorder; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent

  6. 5-Fluoro-2'-Deoxycytidine and Tetrahydrouridine in Treating Patients With Acute Myeloid Leukemia or Myelodysplastic Syndromes

    Science.gov (United States)

    2015-06-03

    Adult Acute Myeloid Leukemia; de Novo Myelodysplastic Syndromes; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Myeloid Leukemia; Secondary Acute Myeloid Leukemia; Secondary Myelodysplastic Syndromes; Untreated Adult Acute Myeloid Leukemia

  7. Biological Therapy in Treating Patients With Advanced Myelodysplastic Syndrome, Acute or Chronic Myeloid Leukemia, or Acute Lymphoblastic Leukemia Who Are Undergoing Stem Cell Transplantation

    Science.gov (United States)

    2017-03-27

    Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); B-cell Adult Acute Lymphoblastic Leukemia; B-cell Childhood Acute Lymphoblastic Leukemia; Childhood Chronic Myelogenous Leukemia; Childhood Myelodysplastic Syndromes; Chronic Myelomonocytic Leukemia; Essential Thrombocythemia; Polycythemia Vera; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Refractory Anemia With Excess Blasts; Refractory Anemia With Excess Blasts in Transformation; Relapsing Chronic Myelogenous Leukemia; Secondary Acute Myeloid Leukemia; T-cell Adult Acute Lymphoblastic Leukemia; T-cell Childhood Acute Lymphoblastic Leukemia

  8. Acute recurrent seizures in a dog

    International Nuclear Information System (INIS)

    Wheeler, S.J.

    1990-01-01

    A detailed account is given, in question and answer format, of the diagnosis of meningioma in the left cerebral cortex of a 9-year-old male Shetland sheepdog with a history of sudden onset of seizures. The seizures were controlled by phenobarbital. Surgery was also performed to debulk the tumour. One year later the dog's neurological condition deteriorated again. Meningioma was confirmed by PM examination

  9. Recurrent Intracerebral Hemorrhage

    DEFF Research Database (Denmark)

    Schmidt, Linnea Boegeskov; Goertz, Sanne; Wohlfahrt, Jan

    2016-01-01

    BACKGROUND: Intracerebral hemorrhage (ICH) is a disease with high mortality and a substantial risk of recurrence. However, the recurrence risk is poorly documented and the knowledge of potential predictors for recurrence among co-morbidities and medicine with antithrombotic effect is limited....... OBJECTIVES: 1) To estimate the short- and long-term cumulative risks of recurrent intracerebral hemorrhage (ICH). 2) To investigate associations between typical comorbid diseases, surgical treatment, use of medicine with antithrombotic effects, including antithrombotic treatment (ATT), selective serotonin...

  10. Vocal fold hemorrhage: factors predicting recurrence.

    Science.gov (United States)

    Lennon, Christen J; Murry, Thomas; Sulica, Lucian

    2014-01-01

    Vocal fold hemorrhage is an acute phonotraumatic injury treated with voice rest; recurrence is a generally accepted indication for surgical intervention. This study aims to identify factors predictive of recurrence based on outcomes of a large clinical series. Retrospective cohort. Retrospective review of cases of vocal fold hemorrhage presenting to a university laryngology service. Demographic information was compiled. Videostroboscopic exams were evaluated for hemorrhage extent, presence of varix, mucosal lesion, and/or vocal fold paresis. Vocal fold hemorrhage recurrence was the main outcome measure. Follow-up telephone survey was used to complement clinical data. Forty-seven instances of vocal fold hemorrhage were evaluated (25M:22F; 32 professional voice users). Twelve of the 47 (26%) patients experienced recurrence. Only the presence of varix demonstrated significant association with recurrence (P = 0.0089) on multivariate logistic regression. Vocal fold hemorrhage recurred in approximately 26% of patients. Varix was a predictor of recurrence, with 48% of those with varix experiencing recurrence. Monitoring, behavioral management and/or surgical intervention may be indicated to treat patients with such characteristics. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  11. Recurrent Guillain-Barre Syndrome- A Case Report

    Directory of Open Access Journals (Sweden)

    Dilesha WL

    2015-05-01

    Full Text Available Guillain-Barre syndrome (GBS manifests as acute flaccid weakness of limbs, and is considered a monophasic illness. But recurrences have been reported. Published case studies suggest that 1- 5% of patients who had GBS will have recurrent attacks. We describe a 66-year-old lady who presented with acute onset descending, symmetrical, areflexic, flaccid quadriparesis that progressed to respiratory failure. She had a history of GBS five years back of which she had made a complete recovery with no residual weakness. The diagnosis of recurrent GBS was made.

  12. Recurrent Wernicke's aphasia: migraine and not stroke!

    Science.gov (United States)

    Mishra, Nishant Kumar; Rossetti, Andrea O; Ménétrey, André; Carota, Antonio

    2009-05-01

    We report the clinical findings of a 40-year-old woman with recurrent migraine presenting with Wernicke's aphasia in accordance with the results of a standardized battery for language assessment (Boston Aphasia Diagnostic Examination). The patient had no evidence of parenchymal or vascular lesions on MRI and showed delta and theta slowing over the left posterior temporal leads on the EEG. Although the acute onset of a fluent aphasia suggested stroke as a likely etiology, the recurrence of aphasia as the initial symptom of migraine was related to cortical spreading depression and not to stroke.

  13. 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

  14. Recurrence in affective disorder

    DEFF Research Database (Denmark)

    Kessing, L V; Olsen, E W; Andersen, P K

    1999-01-01

    The risk of recurrence in affective disorder is influenced by the number of prior episodes and by a person's tendency toward recurrence. Newly developed frailty models were used to estimate the effect of the number of episodes on the rate of recurrence, taking into account individual frailty toward...... recurrence. The study base was the Danish psychiatric case register of all hospital admissions for primary affective disorder in Denmark during 1971-1993. A total of 20,350 first-admission patients were discharged with a diagnosis of major affective disorder. For women with unipolar disorder and for all...... kinds of patients with bipolar disorder, the rate of recurrence was affected by the number of prior episodes even when the effect was adjusted for individual frailty toward recurrence. No effect of episodes but a large effect of the frailty parameter was found for unipolar men. The authors concluded...

  15. Recurrent hamburger thyrotoxicosis

    Science.gov (United States)

    Parmar, Malvinder S.; Sturge, Cecil

    2003-01-01

    RECURRENT EPISODES OF SPONTANEOUSLY RESOLVING HYPERTHYROIDISM may be caused by release of preformed hormone from the thyroid gland after it has been damaged by inflammation (recurrent silent thyroiditis) or by exogenous administration of thyroid hormone, which might be intentional or surreptitious (thyrotoxicosis factitia). Community-wide outbreaks of “hamburger thyrotoxicosis” resulting from inadvertent consumption of beef contaminated with bovine thyroid gland have been previously reported. Here we describe a single patient who experienced recurrent episodes of this phenomenon over an 11-year period and present an approach to systematically evaluating patients with recurrent hyperthyroidism. PMID:12952802

  16. Persistent and recurrent hyperparathyroidism.

    Science.gov (United States)

    Guerin, Carole; Paladino, Nunzia Cinzia; Lowery, Aoife; Castinetti, Fréderic; Taieb, David; Sebag, Fréderic

    2017-06-01

    Despite remarkable progress in imaging modalities and surgical management, persistence or recurrence of primary hyperparathyroidism (PHPT) still occurs in 2.5-5% of cases of PHPT. The aim of this review is to expose the management of persistent and recurrent hyperparathyroidism. A literature search was performed on MEDLINE using the search terms "recurrent" or "persistent" and "hyperparathyroidism" within the past 10 years. We also searched the reference lists of articles identified by this search strategy and selected those we judged relevant. Before considering reoperation, the surgeon must confirm the diagnosis of PHPT. Then, the patient must be evaluated with new imaging modalities. A single adenoma is found in 68% of cases, multiglandular disease in 28%, and parathyroid carcinoma in 3%. Others causes (<1%) include parathyromatosis and graft recurrence. The surgeon must balance the benefits against the risks of a reoperation (permanent hypocalcemia and recurrent laryngeal nerve palsy). If surgery is necessary, a focused approach can be considered in cases of significant imaging foci, but in the case of multiglandular disease, a bilateral neck exploration could be necessary. Patients with multiple endocrine neoplasia syndromes are at high risk of recurrence and should be managed regarding their hereditary pathology. The cure rate of persistent-PHPT or recurrent-PHPT in expert centers is estimated from 93 to 97%. After confirming the diagnosis of PHPT, patients with persistent-PHPT and recurrent-PHPT should be managed in an expert center with all dedicated competencies.

  17. Recurrent unilateral facial nerve palsy in a child with dehiscent facial nerve canal

    Directory of Open Access Journals (Sweden)

    Christopher Liu

    2016-12-01

    Full Text Available Objective: The dehiscent facial nerve canal has been well documented in histopathological studies of temporal bones as well as in clinical setting. We describe clinical and radiologic features of a child with recurrent facial nerve palsy and dehiscent facial nerve canal. Methods: Retrospective chart review. Results: A 5-year-old male was referred to the otolaryngology clinic for evaluation of recurrent acute otitis media and hearing loss. He also developed recurrent left peripheral FN palsy associated with episodes of bilateral acute otitis media. High resolution computed tomography of the temporal bones revealed incomplete bony coverage of the tympanic segment of the left facial nerve. Conclusions: Recurrent peripheral FN palsy may occur in children with recurrent acute otitis media in the presence of a dehiscent facial nerve canal. Facial nerve canal dehiscence should be considered in the differential diagnosis of children with recurrent peripheral FN palsy.

  18. Vorinostat in Treating Patients With Acute Myeloid Leukemia

    Science.gov (United States)

    2014-04-30

    Adult Acute Erythroid Leukemia (M6); Adult Acute Megakaryoblastic Leukemia (M7); Adult Acute Minimally Differentiated Myeloid Leukemia (M0); Adult Acute Monoblastic Leukemia (M5a); Adult Acute Monocytic Leukemia (M5b); Adult Acute Myeloblastic Leukemia With Maturation (M2); Adult Acute Myeloblastic Leukemia Without Maturation (M1); Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Adult Acute Myelomonocytic Leukemia (M4); Adult Acute Promyelocytic Leukemia (M3); Recurrent Adult Acute Myeloid Leukemia; Refractory Cytopenia With Multilineage Dysplasia; Secondary Acute Myeloid Leukemia; Untreated Adult Acute Myeloid Leukemia

  19. Inhibition of Cyclooxygenase-2 Prevents Chronic and Recurrent Cystitis

    Directory of Open Access Journals (Sweden)

    Thomas J. Hannan

    2014-11-01

    Full Text Available The spread of multidrug-resistant microorganisms globally has created an urgent need for novel therapeutic strategies to combat urinary tract infections (UTIs. Immunomodulatory therapy may provide benefit, as treatment of mice with dexamethasone during acute UTI improved outcome by reducing the development of chronic cystitis, which predisposes to recurrent infection. Here we discovered soluble biomarkers engaged in myeloid cell development and chemotaxis that were predictive of future UTI recurrence when elevated in the sera of young women with UTI. Translation of these findings revealed that temperance of the neutrophil response early during UTI, and specifically disruption of bladder epithelial transmigration of neutrophils by inhibition of cyclooxygenase-2, protected mice against chronic and recurrent cystitis. Further, proteomics identified bladder epithelial remodeling consequent to chronic infection that enhances sensitivity to neutrophil damage. Thus, cyclooxygenase-2 expression during acute UTI is a critical molecular trigger determining disease outcome and drugs targeting cyclooxygenase-2 could prevent recurrent UTI.

  20. AR-42 and Decitabine in Treating Patients With Acute Myeloid Leukemia

    Science.gov (United States)

    2018-03-12

    Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Recurrent Adult Acute Myeloid Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Secondary Acute Myeloid Leukemia; Untreated Adult Acute Myeloid Leukemia

  1. RECURRENT CROUP IN CHILDREN

    Directory of Open Access Journals (Sweden)

    S. L. Piskunova

    2014-01-01

    Full Text Available The article presents the results of examination of 1849 children, entering children's infectioushospitalofVladivostokwith the clinical picture of croup of viral etiology. The clinical features of primary and recurrent croup are described. Frequency of recurrent croup inVladivostokis 8%. Children with a recurrent croup had the burdened premorbid background, and also persistent herpetic infections (cytomegalic infection in 42,9% cases, cytomegalic infection in combination with the herpes simplex virus -1. Frequency of croups substantially rose in the period of epidemic of influenza.

  2. Recurrent Vocal Fold Paralysis and Parsonage-Turner Syndrome

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius Pinto

    2013-01-01

    Full Text Available Background. Parsonage-Turner syndrome, or neuralgic amyotrophy (NA, is an acute brachial plexus neuritis that typically presents with unilateral shoulder pain and amyotrophy but also can affect other peripheral nerves, including the recurrent laryngeal nerve. Idiopathic vocal fold paralysis (VFP represents approximately 12% of the VFP cases and recurrence is extremely rare. Methods and Results. We report a man with isolated recurrent unilateral right VFP and a diagnosis of NA years before. Conclusions. We emphasize that shoulder pain and amyotrophy should be inquired in any patient suffering from inexplicable dysphonia, and Parsonage-Turner syndrome should be considered in the differential diagnosis of idiopathic VFP.

  3. Hyperhomocysteinemia in Recurrent Miscarriage

    International Nuclear Information System (INIS)

    Gaber, Kh.R.; Farag, M.K.; Soliman, S.Et.; Abd Al-Kaderm, M.A.

    2008-01-01

    Objective: An elevated total plasma homocysteine level has been suggested as a possible risk factor in women suffering from recurrent pregnancy loss. The current study was undertaken to assess the association between homocysteine, folate, cobalamin (vitamin B12) and the risk of recurrent pregnancy loss. Design: Case . control study Materials and Methods: The study included 57 non-pregnant Egyptian women. They were classified according to their obstetric history into 2 groups: 32 cases with at least two consecutive miscarriages (Study group), and 25 cases with normal obstetric history (Control group). All cases were tested for plasma total homocysteine, serum folate and cobalamin (vitamin B12). Results: The fasting total homocysteine was significantly higher in the study group as compared to the control group. While the median concentrations for the vitamins studied were significantly lower in women of the study group as compared to the controls. Elevated homocysteine and reduced vitamin B12 can be considered risk factors for recurrent miscarriage with odds ratio (OR) and 95% confidence intervals (95% CI) of 1.839 (1.286, 2.63) and 1.993 (1.346, 2.951) respectively in the group of recurrent miscarriages. The OR (95% CI) in the study population for low serum folate concentrations was 1.23 (0.776, 2.256). Conclusion: Elevated homocysteine and reduced serum vitamin B12 are risk factors for recurrent miscarriage. Low serum folate did not seem a risk factor for recurrent miscarriage. Testing for homocysteine levels in women suffering from unexplained recurrent miscarriage and pre-conceptional supplementation with vitamin B12 might be beneficial to improve pregnancy outcome

  4. Hyperhomocysteinemia in Recurrent Miscarriage

    Energy Technology Data Exchange (ETDEWEB)

    Gaber, Kh R; Farag, M K [Prenatal Diagnosis and Fetal Medicine Department, National Research Centre, Dokki, Giza (Egypt); Soliman, S Et [Radioisotope Department, Nuclear Research Centre, Atomic Energy Authority, Cairo (Egypt); Abd Al-Kaderm, M A [Obstetrics and Gynecology Department, Faculty of Medicine, Cairo University, Cairo (Egypt)

    2008-07-01

    Objective: An elevated total plasma homocysteine level has been suggested as a possible risk factor in women suffering from recurrent pregnancy loss. The current study was undertaken to assess the association between homocysteine, folate, cobalamin (vitamin B12) and the risk of recurrent pregnancy loss. Design: Case . control study Materials and Methods: The study included 57 non-pregnant Egyptian women. They were classified according to their obstetric history into 2 groups: 32 cases with at least two consecutive miscarriages (Study group), and 25 cases with normal obstetric history (Control group). All cases were tested for plasma total homocysteine, serum folate and cobalamin (vitamin B12). Results: The fasting total homocysteine was significantly higher in the study group as compared to the control group. While the median concentrations for the vitamins studied were significantly lower in women of the study group as compared to the controls. Elevated homocysteine and reduced vitamin B12 can be considered risk factors for recurrent miscarriage with odds ratio (OR) and 95% confidence intervals (95% CI) of 1.839 (1.286, 2.63) and 1.993 (1.346, 2.951) respectively in the group of recurrent miscarriages. The OR (95% CI) in the study population for low serum folate concentrations was 1.23 (0.776, 2.256). Conclusion: Elevated homocysteine and reduced serum vitamin B12 are risk factors for recurrent miscarriage. Low serum folate did not seem a risk factor for recurrent miscarriage. Testing for homocysteine levels in women suffering from unexplained recurrent miscarriage and pre-conceptional supplementation with vitamin B12 might be beneficial to improve pregnancy outcome.

  5. Alisertib in Combination With Vorinostat in Treating Patients With Relapsed or Recurrent Hodgkin Lymphoma, B-Cell Non-Hodgkin Lymphoma, or Peripheral T-Cell Lymphoma

    Science.gov (United States)

    2018-04-10

    Adult B Acute Lymphoblastic Leukemia; Adult T Acute Lymphoblastic Leukemia; Anaplastic Large Cell Lymphoma; Angioimmunoblastic T-Cell Lymphoma; Chronic Lymphocytic Leukemia; Extranodal Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue; Hepatosplenic T-Cell Lymphoma; Intraocular Lymphoma; Lymphomatous Involvement of Non-Cutaneous Extranodal Site; Mature T-Cell and NK-Cell Non-Hodgkin Lymphoma; Nodal Marginal Zone Lymphoma; Primary Cutaneous B-Cell Non-Hodgkin Lymphoma; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Burkitt Lymphoma; Recurrent Adult Grade III Lymphomatoid Granulomatosis; Recurrent Adult Hodgkin Lymphoma; Recurrent Adult Immunoblastic Lymphoma; Recurrent Adult Lymphoblastic Lymphoma; Recurrent Adult T-Cell Leukemia/Lymphoma; Recurrent Grade 1 Follicular Lymphoma; Recurrent Grade 2 Follicular Lymphoma; Recurrent Grade 3 Follicular Lymphoma; Recurrent Mantle Cell Lymphoma; Recurrent Marginal Zone Lymphoma; Recurrent Mycosis Fungoides and Sezary Syndrome; Recurrent Non-Hodgkin Lymphoma; Recurrent Primary Cutaneous T-Cell Non-Hodgkin Lymphoma; Recurrent Small Lymphocytic Lymphoma; Refractory Chronic Lymphocytic Leukemia; Refractory Hairy Cell Leukemia; Small Intestinal Lymphoma; Splenic Marginal Zone Lymphoma; T-Cell Large Granular Lymphocyte Leukemia; Testicular Lymphoma; Waldenstrom Macroglobulinemia

  6. Vorinostat and Decitabine in Treating Patients With Advanced Solid Tumors or Relapsed or Refractory Non-Hodgkin's Lymphoma, Acute Myeloid Leukemia, Acute Lymphocytic Leukemia, or Chronic Myelogenous Leukemia

    Science.gov (United States)

    2014-08-26

    Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Blastic Phase Chronic Myelogenous Leukemia; Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue; Nodal Marginal Zone B-cell Lymphoma; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Recurrent Adult Burkitt Lymphoma; Recurrent Adult Diffuse Large Cell Lymphoma; Recurrent Adult Diffuse Mixed Cell Lymphoma; Recurrent Adult Diffuse Small Cleaved Cell Lymphoma; Recurrent Adult Immunoblastic Large Cell Lymphoma; Recurrent Adult Lymphoblastic Lymphoma; Recurrent Grade 1 Follicular Lymphoma; Recurrent Grade 2 Follicular Lymphoma; Recurrent Grade 3 Follicular Lymphoma; Recurrent Mantle Cell Lymphoma; Recurrent Marginal Zone Lymphoma; Recurrent Small Lymphocytic Lymphoma; Secondary Acute Myeloid Leukemia; Splenic Marginal Zone Lymphoma; Stage III Adult Burkitt Lymphoma; Stage III Adult Diffuse Large Cell Lymphoma; Stage III Adult Diffuse Mixed Cell Lymphoma; Stage III Adult Diffuse Small Cleaved Cell Lymphoma; Stage III Adult Immunoblastic Large Cell Lymphoma; Stage III Adult Lymphoblastic Lymphoma; Stage III Grade 1 Follicular Lymphoma; Stage III Grade 2 Follicular Lymphoma; Stage III Grade 3 Follicular Lymphoma; Stage III Mantle Cell Lymphoma; Stage III Marginal Zone Lymphoma; Stage III Small Lymphocytic Lymphoma; Stage IV Adult Burkitt Lymphoma; Stage IV Adult Diffuse Large Cell Lymphoma; Stage IV Adult Diffuse Mixed Cell Lymphoma; Stage IV Adult Diffuse Small Cleaved Cell Lymphoma; Stage IV Adult Immunoblastic Large Cell Lymphoma; Stage IV Adult Lymphoblastic Lymphoma; Stage IV Grade 1 Follicular Lymphoma; Stage IV Grade 2 Follicular Lymphoma; Stage IV Grade 3 Follicular Lymphoma; Stage IV Mantle Cell Lymphoma; Stage IV Marginal Zone Lymphoma

  7. Subdural Hematoma Presenting as Recurrent Syncope.

    Science.gov (United States)

    Bruner, David I; Jamros, Christine; Cogar, William

    2015-09-01

    Syncope is a common emergency department (ED) complaint. Recurrent syncope is less common, but may be concerning for serious underlying pathology. It often requires a broad diagnostic evaluation that may include neurologic imaging. We present the case of a 75-year-old man with non-small-cell carcinoma who presented to the ED for recurrent syncope after coughing spells over the 2 weeks preceding his arrival at the ED. He had a normal cardiac evaluation, however, he had some subacute neurologic changes that prompted obtaining a computed tomography (CT) scan of the head. This led to the diagnosis of atraumatic subdural hematoma that was causing transient transtentorial herniation leading to the recurrent syncope. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be aware that recurrent syncope is a possible presentation of increased intracranial pressure that may be due to a mass lesion, particularly if the patient has any acute or subacute neurologic changes. Although this association with a subdual hematoma is rare, other cases of mass lesions leading to syncope after coughing spells have been reported in the literature. Published by Elsevier Inc.

  8. Recurrent parotitis in children

    Directory of Open Access Journals (Sweden)

    Bhattarai M

    2006-01-01

    Full Text Available Recurrent parotitis is an uncommon condition in children. Its etiological factors have not been proved till date although causes due to genetic inheritance, local autoimmune manifestation, allergy, viral infection and immunodeficiency have been suggested. The exact management of this disorder is not yet standardized, but a conservative approach is preferred and all affected children should be screened for Sjogren′s syndrome and immune deficiency including human immunodeficiency virus. We report a 12 years female child who presented with 12 episodes of non-painful recurrent swellings of the bilateral parotid gland in the past 3 years.

  9. Recurrent atrial myxoma.

    Science.gov (United States)

    Macarie, C; Stoica, E; Chioncel, O; Carp, A; Gherghiceanu, D; Stiru, O; Zarma, L; Herlea, V

    2004-01-01

    We have chosen this case of sporadic atrial myxoma for our presentation because it had a particular evolution, with recurrence at 8 years after surgical excision (echocardiography was performed every year) and a particular diagnostic means - at echocardiographic follow-up, the patient being asymptomatic. This presentation, together with a review of literature included in the article, emphasizes the importance of a careful postoperative follow-up of the patients and the existence of some particular aspects of the evolution and symptomatology of recurrent atrial myxoma.

  10. Rapid Evolution from the First Episode of Acute Pancreatitis to Chronic Pancreatitis in Human Subjects

    OpenAIRE

    Elie Aoun; Adam Slivka; Dionysios J Papachristou; David C Whitcomb; Ferga C Gleeson; Georgios I Papachristou

    2007-01-01

    Context Growing evidence suggests that recurrent acute pancreatitis leads to chronic pancreatitis, but this sequence is seldom reported in human subjects. The sentinel acute pancreatitis event hypothesis suggests that an initial episode of acute pancreatitis is the first step in a complicated series of events ultimately leading to chronic pancreatitis. Objective To identify patients who evolved from recurrent acute pancreatitis to chronic pancreatitis. Setting The Severity of Acute Pancreatit...

  11. The computed tomography appearance of recurrent and chronic appendicitis.

    Science.gov (United States)

    Rao, P M; Rhea, J T; Novelline, R A; McCabe, C J

    1998-01-01

    The objective of this study was to determine computed tomography (CT) appearance of recurrent and chronic appendicitis. In 100 consecutive appendiceal CT examinations of proven appendicitis, 18 patients met criteria for recurrent (multiple discrete episodes) or chronic (continuous symptoms > 3 weeks, pathological findings) appendicitis. CT findings were reviewed. Ten patients had recurrent appendicitis, 3 had chronic appendicitis, 3 had both, and 2 had pathological chronic appendicitis. CT findings in 18 recurrent/chronic cases were identical to 82 acute appendicitis cases, including pericecal stranding (both 100%), dilated (> 6 mm) appendix (88.9% versus 93.9%), apical thickening (66.7% versus 69.5%), adenopathy (66.7% versus 61.0%), appendolith(s) (50% versus 42.7%), arrowhead (27.8% versus 22.0%), abscess (11.1% versus 11.0%), phlegmon (11.1% versus 6.1%), and fluid (5.6% versus 19.5%). CT findings in recurrent and chronic appendicitis are the same as those in acute appendicitis. Appendiceal CT can be beneficial for evaluating patients with suspected recurrent or chronic appendicitis.

  12. Recurrent parotitis as a first manifestation in a child with primary Sjogren's syndrome.

    Science.gov (United States)

    Alp, H; Orbak, Z; Erdogan, T; Karabag, K; Gursan, N

    2011-12-01

    Recurrent parotitis is an acute, severe inflammation of one or both parotid glands, the major salivary glands in young children. We report the case of a seven-year old boy with Primary Sjogrens syndrome (PSS) who presented with 15 episodes of painful recurrent bilateral swellings of the parotid glands over a four-year period.

  13. Lung Cancer Indicators Recurrence

    Science.gov (United States)

    This study describes prognostic factors for lung cancer spread and recurrence, as well as subsequent risk of death from the disease. The investigators observed that regardless of cancer stage, grade, or type of lung cancer, patients in the study were more

  14. Recurrent diabetic ketoacidosis

    DEFF Research Database (Denmark)

    Skinner, T. Chas

    2002-01-01

    Longitudinal studies indicate that 20% of paediatric patients account for 80% of all admissions for diabetic ketoacidosis (DKA). The frequency of DKA peaks during adolescence and, although individuals generally go into remission, they may continue to have bouts of recurrent DKA in adulthood. The ...

  15. Recurrent infantile digital fibromatosis

    African Journals Online (AJOL)

    We present a case of an 8-year-old-boy with recurrent infantile digital fibromatosis (IDF) who presented with new ... Keywords: fibrous tumors, inclusion body fibromatosis, infantile digital fibromatosis, spindle cells, Reye tumor .... watch-and-wait strategy for patients with histologically confirmed IDF nodules that do not cause ...

  16. On Solving Linear Recurrences

    Science.gov (United States)

    Dobbs, David E.

    2013-01-01

    A direct method is given for solving first-order linear recurrences with constant coefficients. The limiting value of that solution is studied as "n to infinity." This classroom note could serve as enrichment material for the typical introductory course on discrete mathematics that follows a calculus course.

  17. Acute rhabdomyolysis

    Directory of Open Access Journals (Sweden)

    Pascale de Lonlay

    2015-01-01

    Full Text Available Rhabdomyolysis results from the rapid breakdown of skeletal muscle fibers, which leads to leakage of potentially toxic cellular contents into the systemic circulation. Acquired causes by direct injury to the sarcolemma are the most frequent. The inherited causes are: metabolic with failure of energy production, including mitochondrial fatty acid ß-oxidation defects, LPIN1 mutations, inborn errors of glycogenolysis and glycolysis, more rarely mitochondrial respiratory chain deficiency, purine defects and peroxysomalα-Methylacyl-CoA-racemase defect (AMACR; dystrophinopathies and myopathies; calcic causes with RYR1 mutations; inflammatory with myositis. Irrespective of the cause of rhabdomyolysis, the pathophysiologic events follow a common pathway, the ATP depletion leading to an increased intracellular calcium concentration and necrosis. Most episodes of rhabdomyolysis are triggered by an environmental stress, mostly fever. This condition is associated with two events, elevated temperature and high circulating levels of pro-inflammatory mediators such as cytokines and chemokines. We describe here an example of rhabdomyolysis related to high temperature, aldolase deficiency, in 3 siblings with episodic rhabdomyolysis without hemolytic anemia. Myoglobinuria was always triggered by febrile illnesses. We show that the underlying mechanism involves an exacerbation of aldolase A deficiency at high temperatures that affected myoblasts but not erythrocytes. Thermolability was enhanced in patient myoblasts compared to control. The aldolase A deficiency was rescued by arginine supplementation in vitro. Lipid droplets accumulated in patient myoblasts relative to control and this was increased by cytokines. Lipotoxicity may participate to myolysis. Our results expand the clinical spectrum of aldolase A deficiency to isolated temperature-dependent rhabdomyolysis, and suggest that thermolability may be tissue specific. We also propose a

  18. Chronic Recurrent Multifocal Osteomyelitis

    African Journals Online (AJOL)

    Administrator

    OBJECTIVE: To present a case and review the literature on chronic ... Successful treatment is difficult to achieve, though some ... named the syndrome “subacute and chronic ... An assessment of acute ... scans can cause a significant radiation.

  19. Prevention of recurrent urinary tract infections in women.

    Science.gov (United States)

    2013-06-01

    Around 40-50% of women experience at least one urinary tract infection (UTI) during their lifetime and 20-30% of these have a recurrence within 3-4 months of the initial infection.¹ Recurrent UTI (usually defined as three episodes in the last 12 months or two episodes in the last 6 months) can have a considerable impact on a woman's quality of life. Each episode of acute UTI in young women is typically associated with about 6 days of symptoms, 2.4 days of restricted activities and 0.4 days of bed rest.¹ Antibacterial prophylaxis is effective in preventing recurrent episodes, but at the expense of unwanted effects and a risk of promoting bacterial resistance. Here we assess the efficacy of different antibacterial regimens and non-antibacterial alternatives (cranberry, probiotics, oestrogens, immunostimulation, hyaluronic acid and chondroitin, acupuncture and herbs) in the prevention of recurrent uncomplicated UTIs in women.

  20. Coping with Fear of Recurrence

    Science.gov (United States)

    ... What Comes Next After Finishing Treatment Coping With Fear of Recurrence Having a Baby After Cancer: Pregnancy ... treatment and preparing for the future. Coping With Fear of Recurrence Learn ways to manage the fear ...

  1. Chaotic diagonal recurrent neural network

    International Nuclear Information System (INIS)

    Wang Xing-Yuan; Zhang Yi

    2012-01-01

    We propose a novel neural network based on a diagonal recurrent neural network and chaos, and its structure and learning algorithm are designed. The multilayer feedforward neural network, diagonal recurrent neural network, and chaotic diagonal recurrent neural network are used to approach the cubic symmetry map. The simulation results show that the approximation capability of the chaotic diagonal recurrent neural network is better than the other two neural networks. (interdisciplinary physics and related areas of science and technology)

  2. Different duration of Colchicine for preventing recurrence of Gouty arthritis

    Directory of Open Access Journals (Sweden)

    H Karimzadeh

    2006-05-01

    Full Text Available Background: Gout is a Common recurrent clinical syndrome characterized by increased serum uric acid and recurrent attacks of acute arthritis. Colchicine is used for Prophylaxis against recurrence of arthritis, but the duration of its administration has mentioned variable. In this study, optimal duration of prophylactic colchicine for prevention of gouty arthritis was assessed. Methods : In a clinical trial 190 patients with gouty arthritis divided randomly to group 1,2and 3 and received colchicine for 3 to 6, 7 to 9 and 10 to 12 months then colchicine discontinued and the patients followed one year for recurrence of arthritis. Result assessed by survival analysis with Kaplan –Meier method. Results: The probability of recurrence of arthritis (in order of duration of colchicine prophylaxis was 54%, 27.5% and 23%, respectively. The difference between group one and others was statistically significant, but between group 2 and 3 was not statistically significant. Conclusion: The most suitable duration of colchicine prophylaxis that accompanied with lower recurrence rate was 7-9 months, which seems more cost -effective than 10-12 months regimen. Key words: Gout, Colchicine, Arthritis, Recurrence

  3. Immunomodulators to treat recurrent miscarriage

    NARCIS (Netherlands)

    Prins, Jelmer R.; Kieffer, Tom E.C.; Scherjon, Sicco A.

    2014-01-01

    Recurrent miscarriage is a reproductive disorder affecting many couples. Although several factors are associated with recurrent miscarriage, in more than 50% of the cases the cause is unknown. Maladaptation of the maternal immune system is associated with recurrent miscarriage and could explain part

  4. Recurrent giant juvenile fibroadenoma

    Directory of Open Access Journals (Sweden)

    Kathryn S. King

    2017-11-01

    Full Text Available Breast masses in children, though rare, present a difficult clinical challenge as they can represent a wide variety of entities from benign fibroadenomas to phyllodes tumors. Rapidly growing or recurrent masses can be particularly concerning to patients, families and physicians alike. Clinical examination and conventional imaging modalities are not efficacious in distinguishing between different tumor types and surgical excision is often recommended for both final diagnosis and for treatment of large or rapidly growing masses. While surgical excision can result in significant long-term deformity of the breast there are some surgical techniques that can be used to limit deformity and/or aid in future reconstruction. Here we present a case of recurrent giant juvenile fibroadenoma with a review of the clinical presentation, diagnostic tools and treatment options.

  5. Recurrent Partial Words

    Directory of Open Access Journals (Sweden)

    Francine Blanchet-Sadri

    2011-08-01

    Full Text Available Partial words are sequences over a finite alphabet that may contain wildcard symbols, called holes, which match or are compatible with all letters; partial words without holes are said to be full words (or simply words. Given an infinite partial word w, the number of distinct full words over the alphabet that are compatible with factors of w of length n, called subwords of w, refers to a measure of complexity of infinite partial words so-called subword complexity. This measure is of particular interest because we can construct partial words with subword complexities not achievable by full words. In this paper, we consider the notion of recurrence over infinite partial words, that is, we study whether all of the finite subwords of a given infinite partial word appear infinitely often, and we establish connections between subword complexity and recurrence in this more general framework.

  6. Recurrent epileptic Wernicke aphasia.

    Science.gov (United States)

    Sahaya, Kinshuk; Dhand, Upinder K; Goyal, Munish K; Soni, Chetan R; Sahota, Pradeep K

    2010-04-15

    We report a patient with recurrent epileptic Wernicke aphasia who prior to this presentation, had been misdiagnosed as transient ischemic attacks for several years. This case report emphasizes the consideration of epileptic nature of aphasia when a clear alternate etiology is unavailable, even when EEG fails to show a clear ictal pattern. We also present a brief discussion of previously reported ictal aphasias. Copyright 2010 Elsevier B.V. All rights reserved.

  7. Training Recurrent Networks

    DEFF Research Database (Denmark)

    Pedersen, Morten With

    1997-01-01

    Training recurrent networks is generally believed to be a difficult task. Excessive training times and lack of convergence to an acceptable solution are frequently reported. In this paper we seek to explain the reason for this from a numerical point of view and show how to avoid problems when...... training. In particular we investigate ill-conditioning, the need for and effect of regularization and illustrate the superiority of second-order methods for training...

  8. Recurrent Tricuspid Insufficiency

    Science.gov (United States)

    Kara, Ibrahim; Koksal, Cengiz; Cakalagaoglu, Canturk; Sahin, Muslum; Yanartas, Mehmet; Ay, Yasin; Demir, Serdar

    2013-01-01

    This study compares the medium-term results of De Vega, modified De Vega, and ring annuloplasty techniques for the correction of tricuspid insufficiency and investigates the risk factors for recurrent grades 3 and 4 tricuspid insufficiency after repair. In our clinic, 93 patients with functional tricuspid insufficiency underwent surgical tricuspid repair from May 2007 through October 2010. The study was retrospective, and all the data pertaining to the patients were retrieved from hospital records. Functional capacity, recurrent tricuspid insufficiency, and risk factors aggravating the insufficiency were analyzed for each patient. In the medium term (25.4 ± 10.3 mo), the rates of grades 3 and 4 tricuspid insufficiency in the De Vega, modified De Vega, and ring annuloplasty groups were 31%, 23.1%, and 6.1%, respectively. Logistic regression analysis revealed that chronic obstructive pulmonary disease, left ventricular dysfunction (ejection fraction, tricuspid insufficiency. Medium-term survival was 90.6% for the De Vega group, 96.3% for the modified De Vega group, and 97.1% for the ring annuloplasty group. Ring annuloplasty provided the best relief from recurrent tricuspid insufficiency when compared with DeVega annuloplasty. Modified De Vega annuloplasty might be a suitable alternative to ring annuloplasty when rings are not available. PMID:23466680

  9. Multiplex Recurrence Networks

    Science.gov (United States)

    Eroglu, Deniz; Marwan, Norbert

    2017-04-01

    The complex nature of a variety of phenomena in physical, biological, or earth sciences is driven by a large number of degrees of freedom which are strongly interconnected. Although the evolution of such systems is described by multivariate time series (MTS), so far research mostly focuses on analyzing these components one by one. Recurrence based analyses are powerful methods to understand the underlying dynamics of a dynamical system and have been used for many successful applications including examples from earth science, economics, or chemical reactions. The backbone of these techniques is creating the phase space of the system. However, increasing the dimension of a system requires increasing the length of the time series in order get significant and reliable results. This requirement is one of the challenges in many disciplines, in particular in palaeoclimate, thus, it is not easy to create a phase space from measured MTS due to the limited number of available obervations (samples). To overcome this problem, we suggest to create recurrence networks from each component of the system and combine them into a multiplex network structure, the multiplex recurrence network (MRN). We test the MRN by using prototypical mathematical models and demonstrate its use by studying high-dimensional palaeoclimate dynamics derived from pollen data from the Bear Lake (Utah, US). By using the MRN, we can distinguish typical climate transition events, e.g., such between Marine Isotope Stages.

  10. Monoclonal Antibody Therapy in Treating Patients With Ovarian Epithelial Cancer, Melanoma, Acute Myeloid Leukemia, Myelodysplastic Syndrome, or Non-Small Cell Lung Cancer

    Science.gov (United States)

    2013-01-09

    Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Atypical Chronic Myeloid Leukemia, BCR-ABL1 Negative; Myelodysplastic/Myeloproliferative Neoplasm, Unclassifiable; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Myeloid Leukemia; Recurrent Melanoma; Recurrent Non-small Cell Lung Cancer; Recurrent Ovarian Epithelial Cancer; Stage IV Melanoma; Stage IV Non-small Cell Lung Cancer

  11. Predictors of recurrence in pheochromocytoma.

    Science.gov (United States)

    Press, Danielle; Akyuz, Muhammet; Dural, Cem; Aliyev, Shamil; Monteiro, Rosebel; Mino, Jeff; Mitchell, Jamie; Hamrahian, Amir; Siperstein, Allan; Berber, Eren

    2014-12-01

    The recurrence rate of pheochromocytoma after adrenalectomy is 6.5-16.5%. This study aims to identify predictors of recurrence and optimal biochemical testing and imaging for detecting the recurrence of pheochromocytoma. In this retrospective study we reviewed all patients who underwent adrenalectomy for pheochromocytoma during a 14-year period at a single institution. One hundred thirty-five patients had adrenalectomy for pheochromocytoma. Eight patients (6%) developed recurrent disease. The median time from initial operation to diagnosis of recurrence was 35 months. On multivariate analysis, tumor size >5 cm was an independent predictor of recurrence. One patient with recurrence died, 4 had stable disease, 2 had progression of disease, and 1 was cured. Recurrence was diagnosed by increases in plasma and/or urinary metanephrines and positive imaging in 6 patients (75%), and by positive imaging and normal biochemical levels in 2 patients (25%). Patients with large tumors (>5 cm) should be followed vigilantly for recurrence. Because 25% of patients with recurrence had normal biochemical levels, we recommend routine imaging and testing of plasma or urinary metanephrines for prompt diagnosis of recurrence. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. No. 250-Recurrent Urinary Tract Infection.

    Science.gov (United States)

    Epp, Annette; Larochelle, Annick

    2017-10-01

    To provide an update of the definition, epidemiology, clinical presentation, investigation, treatment, and prevention of recurrent urinary tract infections in women. Continuous antibiotic prophylaxis, post-coital antibiotic prophylaxis, and acute self-treatment are all efficient alternatives to prevent recurrent urinary tract infection. Vaginal estrogen and cranberry juice can also be effective prophylaxis alternatives. A search of PubMed and The Cochrane Library for articles published in English identified the most relevant literature. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date restrictions. This update is the consensus of the Sub-Committee on Urogynaecology of the Society of Obstetricians and Gynaecologists of Canada. Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care (Table 1). Recurrent urinary tract infections need careful investigation and can be efficiently treated and prevented. Different prophylaxis options can be selected according to each patient's characteristics. Copyright © 2017. Published by Elsevier Inc.

  13. Predictors and prognostic impact of recurrent myocardial infarction in patients with left ventricular dysfunction, heart failure, or both following a first myocardial infarction

    DEFF Research Database (Denmark)

    Thune, Jens Jakob; Signorovitch, James E; Kober, Lars

    2011-01-01

    recurrent MI in 10,599 patients with left ventricular dysfunction, heart failure, or both following a first MI from the Valsartan in Acute Myocardial Infarction Trial (VALIANT) cohort. During a median follow-up of 27.4 months, 861 patients (9.6%) had a recurrent MI. The median time to recurrence was 136...

  14. Severe hypertriglyceridemia due to two novel loss-of-function lipoprotein lipase gene mutations (C310R/E396V) in a Chinese family associated with recurrent acute pancreatitis.

    Science.gov (United States)

    Lun, Yu; Sun, Xiaofang; Wang, Ping; Chi, Jingwei; Hou, Xu; Wang, Yangang

    2017-07-18

    Lipoprotein lipase (LPL) is widely expressed in skeletal muscles, cardiac muscles as well as adipose tissue and involved in the catabolism of triglyceride. Herein we have systematically characterized two novel loss-of-function mutations in LPL from a Chinese family in which afflicted members were manifested by severe hypertriglyceridemia and recurrent pancreatitis. DNA sequencing revealed that the proband was a heterozygote carrying a novel c.T928C (p.C310R) mutation in exon 6 of the LPL gene. Another member of the family was detected to be a compound heterozygote who along with the c.T928C mutation also carried a novel missense mutation c.A1187T (p.E396V) in exon 8 of the LPL gene. Furthermore, COS-1 cells were transfected with lentiviruses containing the mutant LPL genes. While C310R markedly reduced the overall LPL protein level, COS-1 cells carrying E396V or double mutations contained similar overall LPL protein levels to the wild-type. The specific activity of the LPL mutants remained at comparable magnitude to the wild-type. However, few LPL were detected in the culture medium for the mutants, suggesting that both mutations caused aberrant triglyceride catabolism. More specifically, E396V and double mutations dampened the transport of LPL to the cell surface, while for the C310R mutation, reducing LPL protein level might be involved. By characterizing these two novel LPL mutations, this study has expanded our understanding on the pathogenesis of familial hypertriglyceridemia (FHTG).

  15. Recurrent cerebral thrombosis

    International Nuclear Information System (INIS)

    Iwamoto, Toshihiko; Abe, Shin-e; Kubo, Hideki; Hanyu, Haruo; Takasaki, Masaru

    1992-01-01

    Neuroradiological techniques were used to elucidate pathophysiology of recurrent cerebral thrombosis. Twenty-two patients with cerebral thrombosis who suffered a second attack under stable conditions more than 22 days after the initial stroke were studied. Hypertension, diabetes mellitus, and hypercholesterolemia were also seen in 20, 8, and 12 patients, respectively. The patients were divided into three groups according to their symptoms: (I) symptoms differed between the first and second strokes (n=12); (II) initial symptoms were suddenly deteriorated (n=6); and (III) symptoms occurring in groups I and II were seen (n=4). In group I, contralateral hemiparesis or suprabulbar palsy was often associated with the initial hemiparesis. The time of recurrent stroke varied from 4 months to 9 years. CT and MRI showed not only lacunae in both hemispheres, but also deep white-matter ischemia of the centrum semi-ovale. In group II, hemiparesis or visual field defect was deteriorated early after the initial stroke. In addition, neuroimaging revealed that infarction in the posterior cerebral artery was progressed on the contralateral side, or that white matter lesion in the middle artery was enlarged in spite of small lesion in the left cerebral hemisphere. All patients in group III had deterioration of right hemiparesis associated with aphasia. CT, MRI, SPECT, and angiography indicated deep white-matter ischemia caused by main trunk lesions in the left hemisphere. Group III seemed to be equivalent to group II, except for laterality of the lesion. Neuroradiological assessment of the initial stroke may help to predict the mode of recurrence, although pathophysiology of cerebral thrombosis is complicated and varies from patient to patient. (N.K.)

  16. Stress and recurrent miscarriage.

    Science.gov (United States)

    Craig, M

    2001-09-01

    Our current understanding into the role of stress in unexplained recurrent miscarriages comes from two different research strategies. The majority of research has examined the role of psychological support within this patient population. This support has been provided in a number of ways ranging from weekly interviews with a psychiatrist or gynaecologist and or visual re-assurance in the form of ultrasound scans. A comparison of psychological support with an absence of such intervention has found differences in successful pregnancy outcome varying from as great as 84 versus 26%, respectively. It has been assumed that psychological support reduces the miscarriage rate by reducing “stress”within this patient population. In addition it provides indirect support for a role of stress in the aetiology of unexplained recurrent miscarriage. Other studies have attempted to directly assess the effect of personality characteristics on miscarriage rate; these studies have yielded conflicting results.The mechanism by which stress may be causal in the aetiology of unexplained recurrent miscarriage has not been examined in humans. Animal studies, however, have found that psychological distress can alter immune parameters that may be intricately involved with implantation. These parameters include an elevation of the “abortive” cytokine TNF-a and a reduction in the “anti-abortive” cytokine TGF-P2. Cells that are involved in the release of TNF-a at the feto-maternal interface include T cells, macrophages and mast cells.Mechanisms through which stress may act on these cells are explored and an integrated model is postulated.

  17. Recurrent Bilateral Focal Myositis.

    Science.gov (United States)

    Nagafuchi, Hiroko; Nakano, Hiromasa; Ooka, Seido; Takakuwa, Yukiko; Yamada, Hidehiro; Tadokoro, Mamoru; Shimojo, Sadatomo; Ozaki, Shoichi

    This report describes a rare case of recurrent bilateral focal myositis and its successful treatment via methotrexate. A 38-year-old man presented myalgia of the right gastrocnemius in May 2005. Magnetic resonance imaging showed very high signal intensity in the right gastrocnemius on short-tau inversion recovery images. A muscle biopsy revealed inflammatory CD4+ cell-dominant myogenic change. Focal myositis was diagnosed. The first steroid treatment was effective. Tapering of prednisolone, however, repeatedly induced myositis relapse, which progressed to multiple muscle lesions of both lower limbs. Initiation of methotrexate finally allowed successful tapering of prednisolone, with no relapse in the past 4 years.

  18. Recurrent Pregnancy Loss

    Directory of Open Access Journals (Sweden)

    Véronique Piroux

    1997-01-01

    Full Text Available Antiphospholipid antibodies (APA are associated with thrombosis, thrombocytopenia and fetal loss but they occur in a variety of diseases. Despite many efforts, a correlation between the specificity of particular subgroups of APA and particular clinical situations remains to be established. The antigens at the origin of APA remain to be identified. We discuss here the possible links between cell apoptosis or necrosis, leading to plasma membrane alterations, and the occurrence of APA in response to sustained stimulation. The pathogenic potential of APA is also considered with respect to recurrent pregnancy loss.

  19. Equine recurrent airway obstruction

    Directory of Open Access Journals (Sweden)

    Artur Niedźwiedź

    2014-10-01

    Full Text Available Equine Recurrent Airway Obstruction (RAO, also known as heaves or broken wind, is one of the most common disease in middle-aged horses. Inflammation of the airway is inducted by organic dust exposure. This disease is characterized by neutrophilic inflammation, bronchospasm, excessive mucus production and pathologic changes in the bronchiolar walls. Clinical signs are resolved in 3-4 weeks after environmental changes. Horses suffering from RAO are susceptible to allergens throughout their lives, therefore they should be properly managed. In therapy the most importanthing is to eliminate dustexposure, administration of corticosteroids and use bronchodilators to improve pulmonary function.

  20. Rational management of acute keratoconus

    Directory of Open Access Journals (Sweden)

    Yu. B. Slonimskiy

    2014-01-01

    Full Text Available Acute keratoconus is a common and severe complication of advanced progressive keratoconus that occurs in more than 30 % of cases. Acute corneal edema in advanced progressive keratectasia is reffered to as acute corneal hydrops (hydrops corneae. It has been also reported in other ectatic disorders such as pellucid marginal degeneration. The most common misdiagnosis in hydrops is HSV disciform keratitis or acute bacterial keratitis. 126 corneal hydrops patients (79 men, 47 women aged 16‑63 (129 eyes were observed and treated over the last five years. 124 patients were diagnosed with acute keratoconus and 2 patients were diagnosed with pellucid marginal degeneration. Acute kereatoconus patientsrepresented a special and compromised cohort with systemic allergic diseases (neurodermatitis and various atopic disorders, n = 48, Down’s syndrome (n = 16 or mental disorders (n = 19. In many of these patients who vigorously rubbed their eyes, keratectasia progressed more rapidly. In 7 cases, acute keratoconus developed during pregnancy. 3 cases of recurrent keratoconus were reported — in a woman with Down’s syndrome (recurrence in 3 years, in a man with severe neurodermatitis (recurrence in 5 years, and in a man with anamnestic acute keratoconus (recurrence in 20 years. 3 patients experienced bilateral acute keratoconus. Acute keratoconus can be subdivided by the area of corneal edema into three categories, i.e., partial (6 mm or less, 52 eyes, subtotal (7‑10 mm, 56 eyes, and total (more than 10 mm, 21 eyes. Corneal edema ultimately disappeared, however, acute keratoconus resulted in a deep local scarring through the corneal layers. Slit lamp exam revealed Descemet’s membrane ruptures (so-called fish mouth. 73 eyes were referred to refractive penetrating keratoplasty (PKP. Corneal perforation was unusual even in severe corneal thinning (4 cases. In one case, descemetocele with a high risk of perforation was observed. 4 eyes

  1. Rational management of acute keratoconus

    Directory of Open Access Journals (Sweden)

    Yu. B. Slonimskiy

    2015-01-01

    Full Text Available Acute keratoconus is a common and severe complication of advanced progressive keratoconus that occurs in more than 30 % of cases. Acute corneal edema in advanced progressive keratectasia is reffered to as acute corneal hydrops (hydrops corneae. It has been also reported in other ectatic disorders such as pellucid marginal degeneration. The most common misdiagnosis in hydrops is HSV disciform keratitis or acute bacterial keratitis. 126 corneal hydrops patients (79 men, 47 women aged 16‑63 (129 eyes were observed and treated over the last five years. 124 patients were diagnosed with acute keratoconus and 2 patients were diagnosed with pellucid marginal degeneration. Acute kereatoconus patientsrepresented a special and compromised cohort with systemic allergic diseases (neurodermatitis and various atopic disorders, n = 48, Down’s syndrome (n = 16 or mental disorders (n = 19. In many of these patients who vigorously rubbed their eyes, keratectasia progressed more rapidly. In 7 cases, acute keratoconus developed during pregnancy. 3 cases of recurrent keratoconus were reported — in a woman with Down’s syndrome (recurrence in 3 years, in a man with severe neurodermatitis (recurrence in 5 years, and in a man with anamnestic acute keratoconus (recurrence in 20 years. 3 patients experienced bilateral acute keratoconus. Acute keratoconus can be subdivided by the area of corneal edema into three categories, i.e., partial (6 mm or less, 52 eyes, subtotal (7‑10 mm, 56 eyes, and total (more than 10 mm, 21 eyes. Corneal edema ultimately disappeared, however, acute keratoconus resulted in a deep local scarring through the corneal layers. Slit lamp exam revealed Descemet’s membrane ruptures (so-called fish mouth. 73 eyes were referred to refractive penetrating keratoplasty (PKP. Corneal perforation was unusual even in severe corneal thinning (4 cases. In one case, descemetocele with a high risk of perforation was observed. 4 eyes

  2. First or recurrent myocardial infarction. Do we treat all the myocardial infarction patients the same way?

    Czech Academy of Sciences Publication Activity Database

    Monhart, Z.; Reissigová, Jindra; Grünfeldová, H.; Janský, P.

    2010-01-01

    Roč. 12, Suppl. F (2010), F10-F11 ISSN 1520-765X. [Acute Cardiac Care 2010. Official Congress of the Work ing Group on Acute Cardiac Care /4./. 16.10.2010-19.10.2010, Copenhagen] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : myocardial infarction * acute pharmacotherapy * recurrence Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  3. Recurrent oral angioleiomyoma

    Directory of Open Access Journals (Sweden)

    V G Mahima

    2011-01-01

    Full Text Available Angioleiomyomas are vascular variant of leiomyomas which are benign tumors of smooth muscle. They are exceedingly rare in the oral cavity. Malignant transformation of these tumors has also been reported occasionally which warrants knowledge of this soft tissue tumor. A 57 year old male patient reported with a 15 day history of an asymptomatic growth that had started insidiously in his lower left back tooth region. Clinical examination revealed a solitary, oval, sessile growth in the mandibular left retro molar region. Excisional biopsy was suggestive of Angioleiomyoma. A recurrence of the same was noted two months later which was also histopathologically reported as Angioleiomyoma. The same was confirmed using special stains. This case reports an unusual presentation of Angioleiomyoma with regards to both recurrence as well as rapid growth. It is important to be well aware of this uncommon entity as these tumors often can mimic or transform into malignancy. Precise clinicopathological examinations are therefore invaluable in establishing an accurate diagnosis and delivering suitable treatment.

  4. [Rhabdomyolysis in acute cocaine poisoning. Presentation of 2 cases].

    LENUS (Irish Health Repository)

    Bernad, M

    1990-12-01

    Because the important increase of cocaine abuse and the frequent pathology associated, we present two cases of males who had a multiorganic failure cause by severe rabdomyolysis, renal failure with myoglobinuria and disseminated intravascular coagulation, after the cocaine consumption. In one case a pancreatitis associated was observed, this not being described before. Both cases are recovered.

  5. Clinical utility of real-time compression ultrasonography for diagnostic management of patients with recurrent venous thrombosis

    NARCIS (Netherlands)

    Heijboer, H.; Jongbloets, L. M.; Büller, H. R.; Lensing, A. W.; ten Cate, J. W.

    1992-01-01

    In the diagnostic management of patients with clinically suspected recurrent deep-vein thrombosis (DVT), there are potential limitations to all available diagnostic techniques. Since venous abnormalities may persist for some time after an acute thrombosis, the usefulness of compression

  6. Recurrent pregnancy loss

    DEFF Research Database (Denmark)

    Egerup, P; Kolte, A M; Larsen, E C

    2016-01-01

    STUDY QUESTION: Is there a different prognostic impact for consecutive and non-consecutive early pregnancy losses in women with secondary recurrent pregnancy loss (RPL)? SUMMARY ANSWER: Only consecutive early pregnancy losses after the last birth have a statistically significant negative prognostic...... impact in women with secondary RPL. WHAT IS KNOWN ALREADY: The risk of a new pregnancy loss increases with the number of previous pregnancy losses in patients with RPL. Second trimester losses seem to exhibit a stronger negative impact than early losses. It is unknown whether the sequence of pregnancy...... losses plays a role for the prognosis in patients with a prior birth. STUDY DESIGN, SIZE, DURATION: This retrospective cohort study of pregnancy outcome in patients with unexplained secondary RPL included in three previously published, Danish double-blinded placebo-controlled trials of intravenous...

  7. Recurrent Spatial Transformer Networks

    DEFF Research Database (Denmark)

    Sønderby, Søren Kaae; Sønderby, Casper Kaae; Maaløe, Lars

    2015-01-01

    We integrate the recently proposed spatial transformer network (SPN) [Jaderberg et. al 2015] into a recurrent neural network (RNN) to form an RNN-SPN model. We use the RNN-SPN to classify digits in cluttered MNIST sequences. The proposed model achieves a single digit error of 1.5% compared to 2.......9% for a convolutional networks and 2.0% for convolutional networks with SPN layers. The SPN outputs a zoomed, rotated and skewed version of the input image. We investigate different down-sampling factors (ratio of pixel in input and output) for the SPN and show that the RNN-SPN model is able to down-sample the input...

  8. Recurrent Aggressive Angiomyxoma*

    Directory of Open Access Journals (Sweden)

    Suelene Suassuna Silvestre de Alencar

    2013-10-01

    Full Text Available Introduction: aggressive angiomyxoma is a highly aggressive, rare neoplasm of the mesen- chymal tissue with a high recurrence rate. It represents an important differential diagnosis of pelvic tumors in women of reproductive age. This study aims to describe a case of ag- gressive angiomyxoma.Case report: woman, 37 years old, complained about a bulge on the right perianal region, and anal itching and burning, bleeding, tenesmus and incontinence. The proctologic examina- tion confirmed the perianal bulge and extrinsic compression of the posterior wall of the rectum. Computed tomography (CT of the pelvis showed a well-defined pelvic mass ex- tending to the right rectal area. Exploratory laparotomy showed a mass of fibro elastic con- sistency adjacent to the pelvic organs and closely attached to the distal rectum, and per- formed a resection of the pelvic tumor afterward. Anatomopathological analysis revealed an aggressive angiomyxoma. Magnetic resonance imaging (MRI of the pelvis showed signs of recurrence in the pelvic cavity on the right side of the rectum. A surgical procedure was performed to resect the lesion. After an asymptomatic period, the MRI showed solid growths located in the right ischiorectal fossa. A new surgical procedure identified only retention cysts in the pelvis and right ischiorectal fossa, only lysis of adhesions was per- formed. The patient is currently undergoing follow-up without disease recurrence. Resumo: Introdução: o angiomixoma agressivo é uma rara neoplasia do tecido mesenquimal de gran- de agressividade e alta taxa de recorrência. Representa um importante diagnóstico diferen- cial de tumorações pélvicas de mulheres em idade reprodutiva. Este estudo objetiva relatar um caso de angiomixoma agressivo.Relato de caso: mulher, 37 anos, com queixa de abaulamento em região perianal direita, além de prurido e ardor anal, sangramento, tenesmo e incontinência anal. Exame procto- lógico confirmou o abaulamento

  9. Analysis of Brain Recurrence

    Science.gov (United States)

    Frilot, Clifton; Kim, Paul Y.; Carrubba, Simona; McCarty, David E.; Chesson, Andrew L.; Marino, Andrew A.

    Analysis of Brain Recurrence (ABR) is a method for extracting physiologically significant information from the electroencephalogram (EEG), a non-stationary electrical output of the brain, the ultimate complex dynamical system. ABR permits quantification of temporal patterns in the EEG produced by the non-autonomous differential laws that govern brain metabolism. In the context of appropriate experimental and statistical designs, ABR is ideally suited to the task of interpreting the EEG. Present applications of ABR include discovery of a human magnetic sense, increased mechanistic understanding of neuronal membrane processes, diagnosis of degenerative neurological disease, detection of changes in brain metabolism caused by weak environmental electromagnetic fields, objective characterization of the quality of human sleep, and evaluation of sleep disorders. ABR has important beneficial implications for the development of clinical and experimental neuroscience.

  10. [Changes in serum YKL-40 level and humoral immune function and their significance in children with recurrent pneumonia].

    Science.gov (United States)

    Ma, Wei-Yin; Peng, Shao; Zhang, Ting

    2017-04-01

    To investigate the changes in serum YKL-40 level and humoral immune function and their significance in children with recurrent pneumonia. Blood samples were collected from 30 children with recurrent pneumonia (recurrent pneumonia group), 30 children with acute pneumonia (acute pneumonia group), and 30 healthy children (control group). Serum YKL-40 levels were measured by enzyme-linked immunosorbent assay. The correlation between serum YKL-40 level and laboratory indices related to humoral immune function was analyzed. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of serum YKL-40 level for recurrent pneumonia. The recurrent pneumonia group had a significantly higher serum YKL-40 level than the acute pneumonia and control groups (Ppneumonia group had a significantly higher serum YKL-40 level than the control group (Ppneumonia group were significantly lower than in the acute pneumonia group (Ppneumonia was 0.958 (95%CI: 0.921-0.994). Humoral immune function is low in children with recurrent pneumonia. Serum YKL-40 may be involved in the occurrence of recurrent pneumonia and can be used as a reference index for diagnosing recurrent pneumonia.

  11. Adult Acute Myeloid Leukemia Treatment (PDQ®)—Patient Version

    Science.gov (United States)

    Treatment options for adult acute myeloid leukemia (AML) include chemotherapy, radiation therapy, stem cell transplant, and other medications. Get detailed information about the treatment of new and recurrent AML in this expert-reviewed summary.

  12. Transethmoidal intranasal meningoencephalocele in an adult with recurrent meningitis.

    Science.gov (United States)

    Hasegawa, Takafumi; Sugeno, Naoto; Shiga, Yusei; Takeda, Atsushi; Karibe, Hiroshi; Tominaga, Teiji; Itoyama, Yasuto

    2005-08-01

    Intranasal meningoencephalocele is a rarely encountered congenital malformation. We report a case of transethmoidal intranasal meningoencephalocele in a 52-year old man with recurrent purulent meningitis. After treatment of the acute meningitis, frontal craniotomy followed by the removal of the stalk of the meningoencephalocele and repair of the bony defect was successfully performed. He has had no further meningitis or CSF rhinorrhea post-operatively. Detailed neuroradiological examination and appropriate surgical treatment are important to prevent fatal neurological complications of intranasal meningoencephalocele.

  13. Recurrent antecedent hypoglycemia alters neuronal oxidative metabolism in vivo.

    Science.gov (United States)

    Jiang, Lihong; Herzog, Raimund I; Mason, Graeme F; de Graaf, Robin A; Rothman, Douglas L; Sherwin, Robert S; Behar, Kevin L

    2009-06-01

    The objective of this study was to characterize the changes in brain metabolism caused by antecedent recurrent hypoglycemia under euglycemic and hypoglycemic conditions in a rat model and to test the hypothesis that recurrent hypoglycemia changes the brain's capacity to utilize different energy substrates. Rats exposed to recurrent insulin-induced hypoglycemia for 3 days (3dRH rats) and untreated controls were subject to the following protocols: [2-(13)C]acetate infusion under euglycemic conditions (n = 8), [1-(13)C]glucose and unlabeled acetate coinfusion under euglycemic conditions (n = 8), and [2-(13)C]acetate infusion during a hyperinsulinemic-hypoglycemic clamp (n = 8). In vivo nuclear magnetic resonance spectroscopy was used to monitor the rise of(13)C-labeling in brain metabolites for the calculation of brain metabolic fluxes using a neuron-astrocyte model. At euglycemia, antecedent recurrent hypoglycemia increased whole-brain glucose metabolism by 43 +/- 4% (P glucose utilization in neurons. Although acetate metabolism remained the same, control and 3dRH animals showed a distinctly different response to acute hypoglycemia: controls decreased pyruvate dehydrogenase (PDH) flux in astrocytes by 64 +/- 20% (P = 0.01), whereas it increased by 37 +/- 3% in neurons (P = 0.01). The 3dRH animals decreased PDH flux in both compartments (-75 +/- 20% in astrocytes, P neurons, P = 0.005). Thus, acute hypoglycemia reduced total brain tricarboxylic acid cycle activity in 3dRH animals (-37 +/- 4%, P = 0.001), but not in controls. Our findings suggest that after antecedent hypoglycemia, glucose utilization is increased at euglycemia and decreased after acute hypoglycemia, which was not the case in controls. These findings may help to identify better methods of preserving brain function and reducing injury during acute hypoglycemia.

  14. The Impact of Liver Graft Injury on Cancer Recurrence Posttransplantation.

    Science.gov (United States)

    Li, Chang-Xian; Man, Kwan; Lo, Chung-Mau

    2017-11-01

    Liver transplantation is the most effective treatment for selected patients with hepatocellular carcinoma. However, cancer recurrence, posttransplantation, remains to be the critical issue that affects the long-term outcome of hepatocellular carcinoma recipients. In addition to tumor biology itself, increasing evidence demonstrates that acute-phase liver graft injury is a result of hepatic ischemia reperfusion injury (which is an inevitable consequence during liver transplantation) and may promote cancer recurrence at late phase posttransplantation. The liver grafts from living donors, donors after cardiac death, and steatotic donors have been considered as promising sources of organs for liver transplantation and are associated with high incidence of liver graft injury. The acute-phase liver graft injury will trigger a series of inflammatory cascades, which may not only activate the cell signaling pathways regulating the tumor cell invasion and migration but also mobilize the circulating progenitor and immune cells to facilitate tumor recurrence and metastasis. The injured liver graft may also provide the favorable microenvironment for tumor cell growth, migration, and invasion through the disturbance of microcirculatory barrier function, induction of hypoxia and angiogenesis. This review aims to summarize the latest findings about the role and mechanisms of liver graft injury resulted from hepatic ischemia reperfusion injury on tumor recurrence posttransplantation, both in clinical and animal cohorts.

  15. Acute acquired comitant esotropia of childhood

    DEFF Research Database (Denmark)

    Hesgaard, Helena; Vinding, Troels

    2015-01-01

    acute onset of comitant esotropia, available data on ophthalmologic, orthoptic and neurologic examinations. Children with neurological signs, AACE recurrence or hyperopia followed. RESULTS...... no obvious neurological signs at onset. Four significant risk factors for intracranial disease were identified as follows: larger esodeviation at distance, recurrence of AACE, neuro signs (papilledema) and older age at onset (>6 years). CONCLUSION: In a large case series of children with AACE and by review...

  16. RECURRENT CORNEAL EROSION SYNDROME (a review

    Directory of Open Access Journals (Sweden)

    S. V. Trufanov

    2015-01-01

    Full Text Available Recurrent corneal erosion (RCE syndrome is characterized by episodes of recurrent spontaneous epithelial defects. Main clinical symptoms (pain, redness, photophobia, lacrimation occurred at night. Corneal lesions revealed by slit lamp exam vary depending on the presence of corneal epithelium raise, epithelial microcysts or epithelial erosions, stromal infiltrates and opacities. Microtraumas, anterior corneal dystrophies, and herpesvirus give rise to RCE. Other causes or factors which increase the risk of RCE syndrome include meibomian gland dysfunction, keratoconjunctivitis sicca, diabetes, and post-LASIK conditions. Basal membrane abnormalities and instability of epithelial adhesion to stroma play a key role in RCE pathogenesis. Ultrastructural changes in RCE include abnormalities of basal epithelial cells and epithelial basal membrane, absence or deficiency of semi-desmosomes, loss of anchor fibrils. Increase in matrix metalloproteinases and collagenases which contribute to basal membrane destruction results in recurrent erosions and further development of abnormal basal membrane. The goals of RCE therapy are to reduce pain (in acute stage, to stimulate re-epithelization, and to restore «adhesion complex» of basal membrane. In most cases, RCE responds to simple conservative treatment that includes lubricants, healing agents, and eye patches. RCEs that are resistant to simple treatment, require complex approach. Non-invasive methods include long-term contact lens use, instillations of autologous serum (eye drops, injections of botulinum toxin (induces ptosis, antiviral agent use or oral intake of metalloproteinase inhibitors. Cell membrane stabilizers, i.e., antioxidants, should be included into treatment approaches as well. Antioxidant effect of Emoxipine promotes tissue reparation due to the prevention of cell membrane lipid peroxidation as well as due to its anti-hypoxic, angioprotective, and antiplatelet effects. If conservative therapy

  17. Gene Expression Patterns in Peripheral Blood Leukocytes in Patients with Recurrent Ciguatera Fish Poisoning: Preliminary Studies.

    Science.gov (United States)

    Lopez, Maria-Cecilia; Ungaro, Ricardo F; Baker, Henry V; Moldawer, Lyle L; Robertson, Alison; Abbott, Margaret; Roberts, Sparkle M; Grattan, Lynn M; Morris, J Glenn

    2016-07-01

    Ciguatera fish poisoning (ciguatera) is a common clinical syndrome in areas where there is dependence on tropical reef fish for food. A subset of patients develops recurrent and, in some instances, chronic symptoms, which may result in substantial disability. To identify possible biomarkers for recurrent/chronic disease, and to explore correlations with immune gene expression, peripheral blood leukocyte gene expression in 10 ciguatera patients (7 recurrent, 3 acute) from the U.S. Virgin Islands, and 5 unexposed Florida controls were evaluated. Significant differences in gene expression were noted when comparing ciguatera patients and controls; however, it was not possible to differentiate between patients with acute and recurrent disease, possibly due to the small sample sizes involved.

  18. Recurrent vulvovaginal candidiasis.

    Science.gov (United States)

    Blostein, Freida; Levin-Sparenberg, Elizabeth; Wagner, Julian; Foxman, Betsy

    2017-09-01

    Recurrent vulvovaginal candidiasis (RVVC), multiple episodes of vulvovaginal candidiasis (VVC; vaginal yeast infection) within a 12-month period, adversely affects quality of life, mental health, and sexual activity. Diagnosis is not straightforward, as VVC is defined by the combination of often nonspecific vaginal symptoms and the presence of yeast-which is a common vaginal commensal. Estimating the incidence and prevalence is challenging: most VVC is diagnosed and treated empirically, the availability for purchase of effective therapies over the counter enables self-diagnosis and treatment, and the duration of the relatively benign VVC symptoms is short, introducing errors into any estimates relying on medical records or patient recall. We evaluate current estimates of VVC and RVVC and provide new prevalence estimates using data from a 2011 seven-country (n = 7345) internet panel survey on VVC conducted by Ipsos Health (https://www.ipsos.com/en). We also evaluate information on VVC-associated visits using the National Ambulatory Medical Care Survey. The estimated probability of VVC by age 50 varied widely by country (from 23% to 49%, mean 39%), as did the estimated probability of RVVC after VVC (from 14% to 28%, mean 23%). However estimated, the probability of RVVC was high suggesting RVVC is a common condition. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Recurrent Respiratory Papillomatosis or Laryngeal Papillomatosis

    Science.gov (United States)

    ... Home » Health Info » Voice, Speech, and Language Recurrent Respiratory Papillomatosis or Laryngeal Papillomatosis On this page: What ... find additional information about RRP? What is recurrent respiratory papillomatosis? Recurrent respiratory papillomatosis (RRP) is a disease ...

  20. Hypofractionated stereotactic radiation therapy for recurrent glioblastoma: single institutional experience

    International Nuclear Information System (INIS)

    Ciammella, Patrizia; Podgornii, Ala; Galeandro, Maria; D’Abbiero, Nunziata; Pisanello, Anna; Botti, Andrea; Cagni, Elisabetta; Iori, Mauro; Iotti, Cinzia

    2013-01-01

    Glioblastoma (GBM) is the most common malignant primary brain tumor in adults. Tumor control and survival have improved with the use of radiotherapy (RT) plus concomitant and adjuvant chemotherapy, but the prognosis remain poor. In most cases the recurrence occurs within 7–9 months after primary treatment. Currently, many approaches are available for the salvage treatment of patients with recurrent GBM, including resection, re-irradiation or systemic agents, but no standard of care exists. We analysed a cohort of patients with recurrent GBM treated with frame-less hypofractionated stereotactic radiation therapy with a total dose of 25 Gy in 5 fractions. Of 91 consecutive patients with newly diagnosed GBM treated between 2007 and 2012 with conventional adjuvant chemo-radiation therapy, 15 underwent salvage RT at recurrence. The median time interval between primary RT and salvage RT was 10.8 months (range, 6–54 months). Overall, patients undergoing salvage RT showed a longer survival, with a median survival of 33 vs. 9.9 months (p= 0.00149). Median overall survival (OS) from salvage RT was 9.5 months. No patients demonstrated clinically significant acute morbidity, and all patients were able to complete the prescribed radiation therapy without interruption. Our results suggest that hypofractionated stereotactic radiation therapy is effective and safe in recurrent GBM. However, until prospective randomized trials will confirm these results, the decision for salvage treatment should remain individual and based on a multidisciplinary evaluation of each patient

  1. Recurrent uncomplicated urinary tract infections in women: a review.

    Science.gov (United States)

    Nosseir, Sandy B; Lind, Lawrence R; Winkler, Harvey A

    2012-03-01

    Recurrent urinary tract infections most often present with symptoms of irritative voiding. In most cases, they are caused by reinfection with a previously isolated organism. Patients with one or more symptoms of uncomplicated recurrent urinary tract infection should undergo thorough examination and screening for underlying comorbidities that increase susceptibility. When frequent reinfections, empiric treatment relapse, persistent infections, or risk factors for complicated infections are encountered, patients may benefit from urodynamics, cystoscopy, renal ultrasound, intravenous urogram, or voiding cystourethrogram to evaluate for anatomic, functional, or metabolic abnormalities affecting the urinary tract (e.g., stones, stricture, obstruction, vesicoureteral reflux, lesions, detrusor underactivity). These patients may benefit from culture-guided empiric treatment and further evaluation by urology, nephrology, or infectious disease specialists. In patients with a history of uncomplicated urinary tract infections, empiric treatment guided by local antimicrobial resistance may efficiently treat a suspected recurrence. After successful treatment of the acute infection, postcoital prophylaxis, continuous prophylaxis, or self-start empiric treatment may be selected based on frequency of recurrent infections, temporal relation to intercourse, and patient characteristics. Ancillary measures such as probiotics, cranberry products, or local estrogen replacement may also be considered. This article will review the current definition, epidemiology, pathogenesis, diagnosis, work-up, treatment, treatment side effects, and prevention of recurrent urinary tract infections in women. A suggested algorithm for evaluation and treatment based on current literature is provided.

  2. Streptococcus pyogenes pharyngeal colonization resulting in recurrent, prepubertal vulvovaginitis.

    Science.gov (United States)

    Hansen, Megan T; Sanchez, Veronica T; Eyster, Kathleen; Hansen, Keith A

    2007-10-01

    Recurrent, prepubertal, vaginal infections are an uncommon, troublesome problem for the patient and her family. Failure of initial therapy to alleviate vulvovaginitis may be related to vulvar skin disease, foreign body, sexual abuse, pinworms, reactions to medications, anatomic anomalies, or allergies. This report describes a case of recurrent Streptococcus pyogenes vulvovaginitis secondary to presumed vaginal re-inoculation from pharyngeal colonization. A 4-yr-old presented with one year of culture proven, recurrent Streptococcus pyogenes vulvovaginitis. Her symptoms repeatedly resolved with penicillin therapy, but continued to recur following cessation of antibiotic therapy. Evaluation included physical examination, trans-abdominal pelvic ultrasound, and vaginoscopy which all revealed normal upper and lower genital tract anatomy. Both the patient and her mother demonstrated culture proven, Group A Streptococcus pharyngeal colonization. Because of the possibility of repeated inoculations of the vaginal area from the colonized pharynx, they were both treated for decolonization with a regimen of amoxicillin and rifampin for ten days. Following this therapy there was resolution of vaginal symptoms with no further recurrence. Follow-up pharyngeal culture done on both mother and child on their last visit were negative for Group A Streptococcus. This case demonstrated an unusual specific cause of recurrent vaginitis resulting from presumed self or maternal re-inoculation with group A beta-hemolytic streptococcus from pharyngeal colonization. Group A beta-hemolytic streptococcus are consistently sensitive to penicillin, but up to 25% of acute pharyngitis cases treated with penicillin having continued asymptomatic, bacterial carriage within the nasopharynx. Thus initial alleviation of symptoms in a patient with Group A beta-hemolytic vulvovaginitis treated with penicillin, can have continued asymptomatic pharyngeal colonization which can result in recurrence of the

  3. Management of recurrent depression.

    Science.gov (United States)

    Howell, Cate; Marshall, Charlotte; Opolski, Melissa; Newbury, Wendy

    2008-09-01

    Depression is a potentially recurring or chronic disorder. The provision of evidence based treatment and effective practice organisation is central to chronic disease management, and these principles can be applied to managing depression. This article outlines the principles of chronic disease management, including the use of management plans and a team care approach, and their application to the management of depression. Treatment approaches that systematically assist patients in managing their chronic disease are more effective than those based on acute care. Depression treatment guidelines are available, as well as primary care initiatives which facilitate comprehensive and long term mental health care, including relapse prevention strategies. A number of risk factors for depression relapse have been identified, and research has recommended that novel intensive relapse prevention programs need to be developed.

  4. Mondini dysplasia with recurrent meningitis.

    Science.gov (United States)

    Lu, M Y; Lee, P I; Lee, C Y; Hsu, C J

    1996-01-01

    Mondini dysplasia is a congenital malformation of the inner ear, commonly associated with hearing impairment, cerebrospinal fluid otorrhea/rhinorrhea and recurrent meningitis. Two such cases are described, with hearing impairment, cerebrospinal fluid rhinorrhea, and several episodes of meningitis. Diagnosis was confirmed by high-resolution computed tomography. After surgical correction of the malformation, there was no recurrent episode of meningitis at subsequent follow-up. To avoid the suffering and the sequelae of recurrent meningitis, an early diagnosis and prompt surgical intervention are crucial for such patients.

  5. Palliative reirradiation of recurrent rectal carcinoma

    International Nuclear Information System (INIS)

    Lingareddy, Vasudha; Ahmad, Neelofur; Mohiuddin, Mohammed

    1995-01-01

    PURPOSE: This report will summarize symptom palliation, complication rate, and survival outcome of an aggressive reirradiation policy for patients with recurrent rectal cancer. MATERIALS and METHODS: From 1987 - 1993, 83 patients with recurrent rectal adenocarcinoma following previous pelvic irradiation (RT) underwent reirradiation. Thirty-one patients were treated with radical intent, and underwent reirradiation followed by planned surgical resection. The remaining fifty-two patients underwent reirradiation alone and are the basis of this study. Median initial RT dose was 50.4 Gy (range 40.0 - 70.2 Gy), and median time to recurrence was 24 months. Reirradiation was delivered with two lateral fields (7x7 - 12x10 cm) encompassing recurrent tumor with a minimum of 2 cm margin and excluding all small bowel. Thirty patients received 1.8 - 2.0 Gy daily fractions, and 22 patients received 1.2 Gy BID fractions. Median reirradiation dose was 30.6 Gy (range 19.8 - 40.8 Gy). Median total cumulative dose was 84.6 Gy (range 66.6 - 104.9 Gy). Forty-seven of the 52 patients received concurrent 5-FU based chemotherapy. Median follow up for the entire group was 16 months (range 2 - 53 months). Eight patients who remain alive at the time of this study had a median follow up of 22 months (range 13 - 48 months). RESULTS: Patients' presenting symptoms included bleeding, pain and mass effect. Results of treatment are shown in Table 1. Treatment was well tolerated. Using the RTOG toxicity scale, 16 patients required a treatment break for grade 3 toxicity including severe diarrhea, moist desquamation, and mucositis. No patient developed grade 4 acute toxicity. Eighteen patients (35%) developed late grade 3 or 4 morbidity, including bowel obstruction in 9 patients, cystitis in 3 patients, fistula in 4 patients and skin ulceration in 1 patient. There was no difference in incidence of late complications by time to recurrence, reirradiation dose, or total cumulative dose. However, there was

  6. Premenopausal women with recurrent urinary tract infections have lower quality of life.

    Science.gov (United States)

    Ennis, Siobhan S; Guo, Huifang; Raman, Lata; Tambyah, Paul A; Chen, Swaine L; Tiong, Ho Yee

    2018-05-22

    To examine the impact on quality of life of recurrent acute uncomplicated urinary tract infection among premenopausal Singaporean women, and to determine the risk factors for lower quality of life among these patients. A total of 85 patients with recurrent acute uncomplicated urinary tract infection who were referred to the Urology Department at the National University Hospital, Singapore, were prospectively recruited over a 3-year period to complete the validated Short Form 36 Health Survey version 1. In addition, demographic and clinical details including symptomology and medical history were analyzed for factors impacting quality of life. Short Form 36 Health Survey version 1 results were compared with published population norms. After adjusting for age, gender and race, recurrent acute uncomplicated urinary tract infection patients had significantly lower quality of life on seven out of eight Short Form 36 Health Survey version 1 domains when compared with age-, gender- and race-adjusted population norms for Singapore. Among those with recurrent acute uncomplicated urinary tract infection, those who also reported caffeine consumption had significantly lower Short Form 36 Health Survey version 1 scores than those who did not. Those who reported chronic constipation also had consistently lower Short Form 36 Health Survey version 1 scores across all domains. Recurrent acute uncomplicated urinary tract infection has a negative impact on the quality of life of premenopausal, otherwise healthy women. Recurrent acute uncomplicated urinary tract infection patients who also have chronic constipation or consume caffeine have lower quality of life than those who do not. More studies are required to understand the relationships between these common problems and risk factors. © 2018 The Japanese Urological Association.

  7. Recurrent networks for wave forecasting

    Digital Repository Service at National Institute of Oceanography (India)

    Mandal, S.; Prabaharan, N.

    , merchant vessel routing, nearshore construction, etc. more efficiently and safely. This paper presents an application of the Artificial Neural Network, namely Backpropagation Recurrent Neural Network (BRNN) with rprop update algorithm for wave forecasting...

  8. Opioids and breast cancer recurrence

    DEFF Research Database (Denmark)

    Cronin-Fenton, Deirdre P; Heide-Jørgensen, Uffe; Ahern, Thomas P

    2015-01-01

    BACKGROUND: Opioids may alter immune function, thereby potentially affecting cancer recurrence. The authors investigated the association between postdiagnosis opioid use and breast cancer recurrence. METHODS: Patients with incident, early stage breast cancer who were diagnosed during 1996 through...... 2008 in Denmark were identified from the Danish Breast Cancer Cooperative Group Registry. Opioid prescriptions were ascertained from the Danish National Prescription Registry. Follow-up began on the date of primary surgery for breast cancer and continued until breast cancer recurrence, death......, emigration, 10 years, or July 31, 2013, whichever occurred first. Cox regression models were used to compute hazard ratios and 95% confidence intervals associating breast cancer recurrence with opioid prescription use overall and by opioid type and strength, immunosuppressive effect, chronic use (≥6 months...

  9. [Recurrent urinary tract infections should not be treated cavalierly. First verify the diagnosis!].

    Science.gov (United States)

    Wagenlehner, F M E; Naber, K G

    2003-10-23

    Acute uncomplicated cystitis (AUC) and acute uncomplicated pyelonephritis (AUP) are two common urinary tract infections (UTI) in otherwise healthy young women. Both weaknesses of the mucosal barrier and specific factors of uropathogenic bacteria must be present before the bacteria can adhere to the urothelium and give rise to an infection. These circumstances are also of relevance in recurrent UTI. Antibiotic treatment of AUC and AUP is based on the guidelines of the Infectious Diseases Society of America (IDSA). For the prevention of recurrent UTI, antibiotics, functional foods, injections, probiotic agents and other measures are recommended with varying potential for success.

  10. Diabetes due to recurrent pancreatitis secondary to hypercalcemia due to primary hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Sumit Kumar Chakrabarti

    2013-01-01

    Full Text Available Acute pancreatitis due to hypercalcemia associated with hyperparathyroidism (HPT is not very common. We herein report a case of a 21-year-old woman, who presented with acute pancreatitis. She had a past history of recurrent nephrolithiasis. Subsequent evaluation revealed hypercalcemia (serum calcium: 12.6 mg/dL; low phosphate (2.9 mg/dL with elevated parathyroid hormone (PTH, 156.7 pg/mL and HbA1c (6.9%. Diagnosis of primary HPT (PHPT was made. Recurrent pancreatitis due to hypercalcemia may have resulted in diabetes mellitus.

  11. Seasonal and recurrent intensive care unit admissions for acute ...

    African Journals Online (AJOL)

    Life-threatening attacks of asthma requiring intensive care unit (ICU) management at Red Cross War Memorial Children's Hospital in Cape Town were noted to occur in some patients in the same or adjacent months of different years. A retrospective case-controlled study was performed of 21 such 'seasonal' patients who ...

  12. Should non acute and recurrent headaches have neuroimaging ...

    African Journals Online (AJOL)

    Ramakantb

    if cases are reviewed first by a specialist Neurologist before cranial CT. Method: Seventy-four .... causes of chronic headaches with cranial CT was considerably high .... like space occupying lesions, subdural hematoma, and hydrocephalus ...

  13. Role of genetic disorders in acute recurrent pancreatitis

    OpenAIRE

    Keim, Volker

    2008-01-01

    There was remarkable progress in the understanding of the role genetic risk factors in chronic pancreatitis. These factors seem to be much more important than thought in the past. The rare autosomal-dominant mutations N29I and R122H of PRSS1 (cationic trypsinogen) as well as the variant N34S of SPINK1 (pancreatic secretory trypsin inhibitor) are associated to a disease onset in childhood or youth. Compared to chronic alcoholic pancreatitis the progression is slow so that for a long time only ...

  14. Rate of duodenal-biliary reflux increases in patients with recurrent common bile duct stones: evidence from barium meal examination.

    Science.gov (United States)

    Zhang, Rongchun; Luo, Hui; Pan, Yanglin; Zhao, Lina; Dong, Junqiang; Liu, Zhiguo; Wang, Xiangping; Tao, Qin; Lu, Guohua; Guo, Xuegang

    2015-10-01

    Stone recurrence is a common late adverse event after ERCP in patients with common bile duct stones (CBDS). Duodenal-biliary reflux (DBR) is considered a major cause of CBDS recurrence. However, specific evidence is still lacking. To investigate the DBR rate in patients with recurrent CBDS after ERCP. A prospective case-control study. A tertiary center. During follow-up, patients with a history of either recurrent CBDS (recurrence group) or nonrecurrent CBDS (control group) were invited to participate in the study. All patients had previously undergone successful CBDS removal by ERCP. Patients in the control group were matched with the recurrence group by age and gender in a 1:1 ratio. Patients with gallbladder stones, hepatolithiasis, remnant CBDS, CBD strictures, or stents were excluded. Standard barium meal examination, MRCP, and enhanced abdominal CT. DBR. Thirty-two patients with a history of recurrent CBDS and 32 matched control subjects were enrolled. Baseline characteristics and parameters regarding the first ERCP were comparable between the 2 groups. The DBR rate was significantly higher in the recurrent than in the control group (68.8% vs 15.6%, P < .001). Multivariate analysis indicated that DBR (OR, 9.59; 95% CI, 2.65-34.76) and acute distal CBD angulation (OR, 5.48; 95% CI, 1.52-19.78) were independent factors associated with CBDS recurrence. DBR rates in patients with no, single, or multiple recurrences were 15.6%, 60.9%, and 88.9%, respectively (P < .001). Intrahepatic bile duct reflux was more common in patients with multiple recurrences. Small sample size. DBR is correlated with CBDS recurrence in patients who had previously undergone ERCP. DBR and acute distal CBD angulation are 2 independent risk factors related to stone recurrence. ( NCT02329977.) Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  15. Risk of Severe Toxicity According to Site of Recurrence in Patients Treated With Stereotactic Body Radiation Therapy for Recurrent Head and Neck Cancer

    International Nuclear Information System (INIS)

    Ling, Diane C.; Vargo, John A.; Ferris, Robert L.; Ohr, James; Clump, David A.; Yau, Wai-Ying Wendy; Duvvuri, Umamaheswar; Kim, Seungwon; Johnson, Jonas T.; Bauman, Julie E.; Branstetter, Barton F.; Heron, Dwight E.

    2016-01-01

    Purpose: To report a 10-year update of our institutional experience with stereotactic body radiation therapy (SBRT) for reirradiation of locally recurrent head and neck cancer, focusing on predictors of toxicity. Methods and Materials: A retrospective review was performed on 291 patients treated with SBRT for recurrent, previously irradiated head and neck cancer between April 2002 and March 2013. Logistic regression analysis was performed to identify predictors of severe acute and late toxicity. Patients with <3 months of follow-up (n=43) or who died within 3 months of treatment (n=21) were excluded from late toxicity analysis. Results: Median time to death or last clinical follow-up was 9.8 months among the entire cohort and 53.1 months among surviving patients. Overall, 33 patients (11.3%) experienced grade ≥3 acute toxicity and 43 (18.9%) experienced grade ≥3 late toxicity. Compared with larynx/hypopharynx, treatment of nodal recurrence was associated with a lower risk of severe acute toxicity (P=.03), with no significant differences in severe acute toxicity among other sites. Patients treated for a recurrence in the larynx/hypopharynx experienced significantly more severe late toxicity compared with those with oropharyngeal, oral cavity, base of skull/paranasal sinus, salivary gland, or nodal site of recurrence (P<.05 for all). Sixteen patients (50%) with laryngeal/hypopharyngeal recurrence experienced severe late toxicity, compared with 6-20% for other sites. Conclusions: Salvage SBRT is a safe and effective option for most patients with previously irradiated head and neck cancer. However, patients treated to the larynx or hypopharynx experience significantly more late toxicity compared with others and should be carefully selected for treatment, with consideration given to patient performance status, pre-existing organ dysfunction, and goals of care. Treatment toxicity in these patients may be mitigated with more conformal plans to allow for increased

  16. Risk of Severe Toxicity According to Site of Recurrence in Patients Treated With Stereotactic Body Radiation Therapy for Recurrent Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ling, Diane C.; Vargo, John A. [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Ferris, Robert L. [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Ohr, James [Division of Medical Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Clump, David A.; Yau, Wai-Ying Wendy [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Duvvuri, Umamaheswar; Kim, Seungwon; Johnson, Jonas T. [Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Bauman, Julie E. [Division of Medical Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Branstetter, Barton F. [Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Heron, Dwight E., E-mail: herond2@umpc.edu [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (United States)

    2016-07-01

    Purpose: To report a 10-year update of our institutional experience with stereotactic body radiation therapy (SBRT) for reirradiation of locally recurrent head and neck cancer, focusing on predictors of toxicity. Methods and Materials: A retrospective review was performed on 291 patients treated with SBRT for recurrent, previously irradiated head and neck cancer between April 2002 and March 2013. Logistic regression analysis was performed to identify predictors of severe acute and late toxicity. Patients with <3 months of follow-up (n=43) or who died within 3 months of treatment (n=21) were excluded from late toxicity analysis. Results: Median time to death or last clinical follow-up was 9.8 months among the entire cohort and 53.1 months among surviving patients. Overall, 33 patients (11.3%) experienced grade ≥3 acute toxicity and 43 (18.9%) experienced grade ≥3 late toxicity. Compared with larynx/hypopharynx, treatment of nodal recurrence was associated with a lower risk of severe acute toxicity (P=.03), with no significant differences in severe acute toxicity among other sites. Patients treated for a recurrence in the larynx/hypopharynx experienced significantly more severe late toxicity compared with those with oropharyngeal, oral cavity, base of skull/paranasal sinus, salivary gland, or nodal site of recurrence (P<.05 for all). Sixteen patients (50%) with laryngeal/hypopharyngeal recurrence experienced severe late toxicity, compared with 6-20% for other sites. Conclusions: Salvage SBRT is a safe and effective option for most patients with previously irradiated head and neck cancer. However, patients treated to the larynx or hypopharynx experience significantly more late toxicity compared with others and should be carefully selected for treatment, with consideration given to patient performance status, pre-existing organ dysfunction, and goals of care. Treatment toxicity in these patients may be mitigated with more conformal plans to allow for increased

  17. Effect of Zinc supplementation on the Management of Acute ...

    African Journals Online (AJOL)

    Supplementing the treatment of acute watery diarrhea with Zinc in just 2 cases will prevent recurrence of diarrhea in one of the children in the following 12 weeks. Fourteen days supplementation of Zinc in the treatment of acute diarrhea in children significantly reduced the average number of watery stools and duration of ...

  18. Acute eosinophilic pneumonia: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Gyoo; Sik; Oh, Kyung Seung; Kim, Jong Min; Huh, Jin Do; Joh, Young Duk; Jang, Tae Won; Jung, Man Hong [Kosin Medical College, Busan (Korea, Republic of)

    1995-10-15

    Acute eosinophilic pneumonia is one of a recently described idiopathic eosinophilic lung disease, which differs from chronic eosinophilic pneumonia. Patients with acute eosinophilic pneumonia develop acute onset of dyspnea, hypoxemia, diffuse pulmonary infiltrates and pleural effusion on chest radiograph, and show an increase in number of eosinophils in bronchoalveolar lavage fluid or lung biopsy specimen. Prompt and complete response to corticosteroid therapy without any recurrence is characteristically seen in patient with this disease. Although the etiology of acute eosinophilic pneumonia is not known, it has been suggested to be related to a hypersensitivity phenomenon to an unidentified inhaled antigen. We report four cases of acute eosinophilic pneumonia presented with acute onset of dyspnea, diffuse pulmonary infiltrates on chest radiograph, and eosinophilia in bronchoalveolar lavage fluid in previously healthy adults.

  19. Acute eosinophilic pneumonia: a case report

    International Nuclear Information System (INIS)

    Jung, Gyoo; Sik; Oh, Kyung Seung; Kim, Jong Min; Huh, Jin Do; Joh, Young Duk; Jang, Tae Won; Jung, Man Hong

    1995-01-01

    Acute eosinophilic pneumonia is one of a recently described idiopathic eosinophilic lung disease, which differs from chronic eosinophilic pneumonia. Patients with acute eosinophilic pneumonia develop acute onset of dyspnea, hypoxemia, diffuse pulmonary infiltrates and pleural effusion on chest radiograph, and show an increase in number of eosinophils in bronchoalveolar lavage fluid or lung biopsy specimen. Prompt and complete response to corticosteroid therapy without any recurrence is characteristically seen in patient with this disease. Although the etiology of acute eosinophilic pneumonia is not known, it has been suggested to be related to a hypersensitivity phenomenon to an unidentified inhaled antigen. We report four cases of acute eosinophilic pneumonia presented with acute onset of dyspnea, diffuse pulmonary infiltrates on chest radiograph, and eosinophilia in bronchoalveolar lavage fluid in previously healthy adults

  20. Recurrence of anxiety disorders and its predictors

    NARCIS (Netherlands)

    Scholten, Willemijn D.; Batelaan, Neeltje M.; van Balkom, Anton J. L. M.; Penninx, Brenda; Smit, Johannes H.; van Oppen, Patricia

    Background: The chronic course of anxiety disorders and its high burden of disease are partly due to the recurrence of anxiety disorders after remission. However, knowledge about recurrence rates and predictors of recurrence is scarce. This article reports on recurrence rates of anxiety disorders

  1. Recurrence of anxiety disorders and its predictors

    NARCIS (Netherlands)

    Scholten, W.D.; Batelaan, N.M.; van Balkom, A.J.L.M.; Penninx, B.W.J.H.; Smit, J.H.; van Oppen, P.

    2013-01-01

    Background: The chronic course of anxiety disorders and its high burden of disease are partly due to the recurrence of anxiety disorders after remission. However, knowledge about recurrence rates and predictors of recurrence is scarce. This article reports on recurrence rates of anxiety disorders

  2. Recurrent pregnancy loss: current perspectives

    Directory of Open Access Journals (Sweden)

    El Hachem H

    2017-05-01

    Full Text Available Hady El Hachem,1,2 Vincent Crepaux,3 Pascale May-Panloup,4 Philippe Descamps,3 Guillaume Legendre,3 Pierre-Emmanuel Bouet3 1Department of Reproductive Medicine, Ovo Clinic, Montréal, QC, Canada; 2Department of Obstetrics and Gynecology, University of Montreal, Montréal, QC, Canada; 3Department of Obstetrics and Gynecology, Angers University Hopsital, Angers, France; 4Department of Reproductive Biology, Angers University Hospital, Angers, France Abstract: Recurrent pregnancy loss is an important reproductive health issue, affecting 2%–5% of couples. Common established causes include uterine anomalies, antiphospholipid syndrome, hormonal and metabolic disorders, and cytogenetic abnormalities. Other etiologies have been proposed but are still considered controversial, such as chronic endometritis, inherited thrombophilias, luteal phase deficiency, and high sperm DNA fragmentation levels. Over the years, evidence-based treatments such as surgical correction of uterine anomalies or aspirin and heparin for antiphospholipid syndrome have improved the outcomes for couples with recurrent pregnancy loss. However, almost half of the cases remain unexplained and are empirically treated using progesterone supplementation, anticoagulation, and/or immunomodulatory treatments. Regardless of the cause, the long-term prognosis of couples with recurrent pregnancy loss is good, and most eventually achieve a healthy live birth. However, multiple pregnancy losses can have a significant psychological toll on affected couples, and many efforts are being made to improve treatments and decrease the time needed to achieve a successful pregnancy. This article reviews the established and controversial etiologies, and the recommended therapeutic strategies, with a special focus on unexplained recurrent pregnancy losses and the empiric treatments used nowadays. It also discusses the current role of preimplantation genetic testing in the management of recurrent pregnancy

  3. Quantity of residual thrombus after successful catheter-directed thrombolysis for iliofemoral deep venous thrombosis correlates with recurrence.

    Science.gov (United States)

    Aziz, F; Comerota, A J

    2012-08-01

    Iliofemoral deep venous thrombosis (IFDVT) is an independent risk factor for recurrent DVT. It has been observed that recurrent DVT correlates with residual thrombus. This study evaluates whether risk of recurrence is related to the amount of residual thrombus following catheter-directed thrombolysis (CDT) for IFDVT. Patients who underwent CDT for IFDVT had their degree of lysis quantified by a reader blind to the patients' long-term clinical outcome. Patients were classified into two groups, ≥50% and thrombus. Recurrence was defined as a symptomatic presentation with image verification of new or additional thrombus. A total of 75 patients underwent CDT for IFDVT. Median follow-up was 35.9 months. Sixty-eight patients (91%) had no evidence of recurrence and seven (9%) developed recurrence. Of the patients who had ≥50% (mean 80%) residual thrombus, 50% (4/8) experienced recurrence, but in those with thrombus, only 5% (3/67) had recurrent DVT (P = 0.0014). The burden of residual thrombus at completion of CDT correlates with the risk of DVT recurrence. Patients having CDT for IFDVT had a lower risk of recurrence than expected. Successful clearing of acute clot in IFDVT patients significantly reduces the recurrence risk compared to patients with a large residual thrombus burden. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  4. Recurrent neck infection with branchial arch fistula in children.

    Science.gov (United States)

    Madana, J; Yolmo, Deeke; Kalaiarasi, R; Gopalakrishnan, S; Saxena, S K; Krishnapriya, S

    2011-09-01

    Acute suppurative neck infections associated with third or fourth branchial arch fistulas are frequently recurrent. Third and fourth branchial arch anomalies are much less common than those of second arch and usually present with left thyroid lobe inflammation. The authors present their experience with 15 cases of pyriform sinus fistulae (PSF) of third branchial arch origin and 3 cases of fourth arch origin, all of which presented as recurrent neck infection mainly on the left side. A retrospective review of 18 cases of third and fourth arch fistulae treated at JIPMER from 2005 to 2010. This study includes 18 patients with PSF diagnosed by the existence of fistulous tract radiologically and intraoperatively with pathological correlation. Neck exploration with excision of tract and left hemithyroidectomy was performed in all cases. The patients consisted of 7 males and 11 females, and the ages ranged from 3 to 15 years. All of them presented with recurrent episodes of neck infection. Investigations performed include computed tomography (CT) fistulography, barium swallow and ultrasound which were useful in delineating pyriform sinus fistulous tract preoperatively. All cases were on the left side and the fistula was identified by barium swallow in 14 cases (80%), while intraoperative and pathologic confirmation of the tract was possible in all cases (100%). Neck exploration with an emphasis on complete exposure of the recurrent laryngeal nerve and exposure of the pyriform sinus opening to facilitate complete fistulous tract excision with left hemithyroidectomy was successful in all patients. A follow up period of 1-3 years showed no recurrence. Recurrent neck infection in a child should alert the physician to the possibility of an underlying pyriform sinus fistula of branchial origin and CT fistulography should be performed after the resolution of the neck infection to delineate the tract anatomically. Crown Copyright © 2011. Published by Elsevier Ireland Ltd. All

  5. Stereotactic Body Radiation Therapy in Recurrent Hepatocellular Carcinoma

    International Nuclear Information System (INIS)

    Huang, Wen-Yen; Jen, Yee-Min; Lee, Meei-Shyuan; Chang, Li-Ping; Chen, Chang-Ming; Ko, Kai-Hsiung; Lin, Kuen-Tze; Lin, Jang-Chun; Chao, Hsing-Lung; Lin, Chun-Shu; Su, Yu-Fu; Fan, Chao-Yueh; Chang, Yao-Wen

    2012-01-01

    Purpose: To examine the safety and efficacy of Cyberknife stereotactic body radiation therapy (SBRT) and its effect on survival in patients of recurrent hepatocellular carcinoma (HCC). Methods and Materials: This was a matched-pair study. From January 2008 to December 2009, 36 patients with 42 lesions of unresectable recurrent HCC were treated with SBRT. The median prescribed dose was 37 Gy (range, 25 to 48 Gy) in 4–5 fractions over 4–5 consecutive working days. Another 138 patients in the historical control group given other or no treatments were selected for matched analyses. Results: The median follow-up time was 14 months for all patients and 20 months for those alive. The 1- and 2-year in-field failure-free rates were 87.6% and 75.1%, respectively. Out-field intrahepatic recurrence was the main cause of failure. The 2-year overall survival (OS) rate was 64.0%, and median time to progression was 8.0 months. In the multivariable analysis of all 174 patients, SBRT (yes vs. no), tumor size (≤4 cm vs. >4 cm), recurrent stage (stage IIIB/IV vs. I) and Child-Pugh classification (A vs. B/C) were independent prognostic factors for OS. Matched-pair analysis revealed that patients undergoing SBRT had better OS (2-year OS of 72.6% vs. 42.1%, respectively, p = 0.013). Acute toxicities were mild and tolerable. Conclusion: SBRT is a safe and efficacious modality and appears to be well-tolerated at the dose fractionation we have used, and its use correlates with improved survival in this cohort of patients with recurrent unresectable HCC. Out-field recurrence is the major cause of failure. Further studies of combinations of SBRT and systemic therapies may be reasonable.

  6. RECURRENT NOVAE IN M31

    Energy Technology Data Exchange (ETDEWEB)

    Shafter, A. W. [Department of Astronomy, San Diego State University, San Diego, CA 92182 (United States); Henze, M. [European Space Astronomy Centre, P.O. Box 78, E-28692 Villanueva de la Cañada, Madrid (Spain); Rector, T. A. [Department of Physics and Astronomy, University of Alaska Anchorage, 3211 Providence Dr., Anchorage, AK 99508 (United States); Schweizer, F. [Carnegie Observatories, 813 Santa Barbara St., Pasadena, CA 91101 (United States); Hornoch, K. [Astronomical Institute, Academy of Sciences, CZ-251 65 Ondřejov (Czech Republic); Orio, M. [Astronomical Observatory of Padova (INAF), I-35122 Padova (Italy); Pietsch, W. [Max Planck Institute for Extraterrestrial Physics, P.O. Box 1312, Giessenbachstr., D-85741, Garching (Germany); Darnley, M. J.; Williams, S. C.; Bode, M. F. [Astrophysics Research Institute, Liverpool John Moores University, Liverpool L3 5RF (United Kingdom); Bryan, J., E-mail: aws@nova.sdsu.edu [McDonald Observatory, Austin, TX 78712 (United States)

    2015-02-01

    The reported positions of 964 suspected nova eruptions in M31 recorded through the end of calendar year 2013 have been compared in order to identify recurrent nova (RN) candidates. To pass the initial screen and qualify as a RN candidate, two or more eruptions were required to be coincident within 0.′1, although this criterion was relaxed to 0.′15 for novae discovered on early photographic patrols. A total of 118 eruptions from 51 potential RN systems satisfied the screening criterion. To determine what fraction of these novae are indeed recurrent, the original plates and published images of the relevant eruptions have been carefully compared. This procedure has resulted in the elimination of 27 of the 51 progenitor candidates (61 eruptions) from further consideration as RNe, with another 8 systems (17 eruptions) deemed unlikely to be recurrent. Of the remaining 16 systems, 12 candidates (32 eruptions) were judged to be RNe, with an additional 4 systems (8 eruptions) being possibly recurrent. It is estimated that ∼4% of the nova eruptions seen in M31 over the past century are associated with RNe. A Monte Carlo analysis shows that the discovery efficiency for RNe may be as low as 10% that for novae in general, suggesting that as many as one in three nova eruptions observed in M31 arise from progenitor systems having recurrence times ≲100 yr. For plausible system parameters, it appears unlikely that RNe can provide a significant channel for the production of Type Ia supernovae.

  7. Acute pyelonephritis can have serious complications.

    Science.gov (United States)

    Shields, Joanne; Maxwell, Alexander P

    2010-04-01

    Urinary tract infection (UTI) may predominantly involve the lower urinary tract, i.e. acute cystitis, or upper urinary tract consisting of the renal pelvis and kidney,, i.e. acute pyelonephritis The incidence of acute pyelonephritis is higher in young women than in men but the incidence in men over 65 is similar to that in older women. Women have up to a 10% risk of recurrent acute pyelonephritis in the year following a first acute episode. The equivalent risk in men is 6%. Acute pyelonephritis may be uncomplicated and resolve without serious sequelae. A minority of episodes may be complicated by acute kidney injury, papillary necrosis, renal or perinephric abscess or the development of emphysematous pyelonephritis. Acute pyelonephritis is generally caused by microorganisms ascending from the urethra via the bladder into the upper urinary tract. Rarely the kidney may be seeded by blood-borne infection. Ecoli is the most common uropathogen causing pyelonephritis accounting for 70-90% of infections. Species of Enterococci, Klebsiella, Pseudomonas, Proteus and Staphylococci are responsible for the remaining infections. There is a rising incidence in the community of UTI with bacteria that produce extended spectrum beta-lactamase (ESBL) enzymes. These ESBL bacteria have developed resistance to antibiotics such as penicillin, cephalosporins and increasingly to quinolones. Risk factors for uncomplicated acute pyelonephritis include recent sexual intercourse, acute cystitis, stress incontinence and diabetes and for complicated acute pyelonephritis include pregnancy, diabetes, anatomical abnormalities of the urinary tract and renal calculi.

  8. A single-centre prospective, cohort study of the natural history of acute pancreatitis.

    Science.gov (United States)

    Cavestro, Giulia Martina; Leandro, Gioacchino; Di Leo, Milena; Zuppardo, Raffaella Alessia; Morrow, Olivia B; Notaristefano, Chiara; Rossi, Gemma; Testoni, Sabrina Gloria Giulia; Mazzoleni, Giorgia; Alessandri, Matteo; Goni, Elisabetta; Singh, Satish K; Giliberti, Aurore; Bianco, Margherita; Fanti, Lorella; Viale, Edi; Arcidiacono, Paolo Giorgio; Mariani, Alberto; Petrone, Maria Chiara; Testoni, Pier Alberto

    2015-03-01

    The natural history of acute pancreatitis is based on clinical studies that aim to elucidate the course of disease on the basis of predicted risk factors. To evaluate the long-term occurrence of recurrent acute pancreatitis and chronic pancreatitis in a cohort of patients following an initial episode of acute pancreatitis. 196 patients were enrolled consecutively and studied prospectively. Clinical characteristics, exogenously/endogenously-associated factors, and evolution to recurrent acute pancreatitis and chronic pancreatitis were analyzed. 40 patients developed recurrent acute pancreatitis 13 of whom developed chronic pancreatitis. In a univariate analysis, recurrent acute pancreatitis was associated with an idiopathic aetiology (pChronic pancreatitis was associated with a severe first episode of acute pancreatitis (p=0.048), PD (p=0.03), and cigarette smoking (p=0.038). By multivariate analysis, pancreas divisum was an independent risk factor for recurrent acute pancreatitis (OR 11.5, 95% CI 1.6-83.3). A severe first-episode of acute pancreatitis increased the risk of progressing to chronic pancreatitis by nine-fold. Special attention should be given to patients who experience a severe first attack of acute pancreatitis as there appears to be an increased risk of developing chronic pancreatitis over the long term. Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  9. SB-715992 in Treating Patients With Acute Leukemia, Chronic Myelogenous Leukemia, or Advanced Myelodysplastic Syndromes

    Science.gov (United States)

    2013-01-10

    Acute Undifferentiated Leukemia; Adult Acute Megakaryoblastic Leukemia (M7); Adult Acute Minimally Differentiated Myeloid Leukemia (M0); Adult Acute Monoblastic Leukemia (M5a); Adult Acute Monocytic Leukemia (M5b); Adult Acute Myeloblastic Leukemia With Maturation (M2); Adult Acute Myeloblastic Leukemia Without Maturation (M1); Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Adult Acute Myelomonocytic Leukemia (M4); Adult Acute Promyelocytic Leukemia (M3); Adult Erythroleukemia (M6a); Adult Pure Erythroid Leukemia (M6b); Blastic Phase Chronic Myelogenous Leukemia; de Novo Myelodysplastic Syndromes; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Refractory Anemia With Excess Blasts; Refractory Anemia With Excess Blasts in Transformation; Relapsing Chronic Myelogenous Leukemia; Secondary Acute Myeloid Leukemia; Secondary Myelodysplastic Syndromes; Untreated Adult Acute Myeloid Leukemia

  10. Recurrent Novae — A Review

    Directory of Open Access Journals (Sweden)

    K. Mukai

    2015-02-01

    Full Text Available In recent years, recurrent nova eruptions are often observed very intensely in wide range of wavelengths from radio to optical to X-rays. Here I present selected highlights from recent multi-wavelength observations. The enigma of T Pyx is at the heart of this paper. While our current understanding of CV and symbiotic star evolution can explain why certain subset of recurrent novae have high accretion rate, that of T Pyx must be greatly elevated compared to the evolutionary mean. At the same time, we have extensive data to be able to estimate how the nova envelope was ejected in T Pyx, and it turns to be a rather complex tale. One suspects that envelope ejection in recurrent and classical novae in general is more complicated than the textbook descriptions. At the end of the review, I will speculate that these two may be connected.

  11. Recurrent Candida albicans Ventriculitis Treated with Intraventricular Liposomal Amphotericin B

    Directory of Open Access Journals (Sweden)

    Demet Toprak

    2015-01-01

    Full Text Available Central nervous system (CNS infection with Candida is rare but significant because of its high morbidity and mortality. When present, it is commonly seen among immunocompromised and hospitalized patients. Herein, we describe a case of a four-year-old boy with acute lymphoblastic leukemia (ALL who experienced recurrent Candida albicans meningitis. The patient was treated successfully with intravenous liposomal amphotericin B at first attack, but 25 days after discharge he was readmitted to hospital with symptoms of meningitis. Candida albicans was grown in CFS culture again and cranial magnetic resonance imaging (MRI showed ventriculitis. We administered liposomal amphotericin B both intravenously and intraventricularly and favorable result was achieved without any adverse effects. Intraventricular amphotericin B may be considered for the treatment of recurrent CNS Candida infections in addition to intravenous administration.

  12. Recurrent episcleritis in relation to menstruation: a case report.

    Science.gov (United States)

    Rajoo, Sangeetha Govinda; Gandhewar, Jaishree

    2011-09-01

    To describe a case of recurrent episcleritis associated with a patient's menstrual cycle. A retrospective case review of a 39-year-old woman who presented with a 12-year history of recurrent episcleritis in relation to her menstruation. She was seen during an acute attack and started on a reducing regime of topical steroids for 5 weeks. She was then advised to use it a week before and after menstruation. Examination and investigations revealed episcleritis with a negative systems review. After starting the treatment, she was symptom free when reviewed at 4, 8, 14, and 33 weeks. Now, the patient uses topical steroids only 1 week before menstruation. Literature review revealed no recent case reports and provided insufficient evidence to understand this relationship. We recommend increased awareness and reporting because there is a need for more studies to understand this relationship and to provide evidence for management.

  13. Acute nephritic syndrome

    Science.gov (United States)

    Glomerulonephritis - acute; Acute glomerulonephritis; Nephritis syndrome - acute ... Acute nephritic syndrome is often caused by an immune response triggered by an infection or other disease. Common causes in children ...

  14. False-negative type-specific glycoprotein G antibody responses in STI clinic patients with recurrent HSV-1 or HSV-2 DNA positive genital herpes, The Netherlands

    NARCIS (Netherlands)

    van Rooijen, Martijn S.; Roest, Wim; Hansen, Gino; Kwa, David; de Vries, Henry J. C.

    2016-01-01

    Herpes simplex virus (HSV) type-discriminating antibody tests (glycoprotein G (gG) directed) are used to identify naïve persons and differentiate acute infections from recurrences. We studied test characteristics of three commercially available antibody tests in patients with recurrent (established

  15. Recurrence quantification analysis of chimera states

    International Nuclear Information System (INIS)

    Santos, M.S.; Szezech, J.D.; Batista, A.M.; Caldas, I.L.; Viana, R.L.; Lopes, S.R.

    2015-01-01

    Chimera states, characterised by coexistence of coherence and incoherence in coupled dynamical systems, have been found in various physical systems, such as mechanical oscillator networks and Josephson-junction arrays. We used recurrence plots to provide graphical representations of recurrent patterns and identify chimera states. Moreover, we show that recurrence plots can be used as a diagnostic of chimera states and also to identify the chimera collapse. - Highlights: • Chimera states have been found in various physical systems. • Recurrence plots is a graphical method useful to locate recurring patterns. • We used recurrence plots to identify the chimera states. • We show also the recurrence plots can identify the chimera collapse

  16. Recurrence quantification analysis of chimera states

    Energy Technology Data Exchange (ETDEWEB)

    Santos, M.S. [Pós-Graduação em Ciências/Física, Universidade Estadual de Ponta Grossa, 84030-900, Ponta Grossa, PR (Brazil); Szezech, J.D., E-mail: jdanilo@gmail.com [Departamento de Matemática e Estatística, Universidade Estadual de Ponta Grossa, 84030-900, Ponta Grossa, PR (Brazil); Batista, A.M., E-mail: antoniomarcosbatista@gmail.com [Departamento de Matemática e Estatística, Universidade Estadual de Ponta Grossa, 84030-900, Ponta Grossa, PR (Brazil); Caldas, I.L. [Instituto de Física, Universidade de São Paulo, 05315-970, São Paulo, SP (Brazil); Viana, R.L.; Lopes, S.R. [Departamento de Física, Universidade Federal do Paraná, 81531-990, Curitiba, PR (Brazil)

    2015-10-02

    Chimera states, characterised by coexistence of coherence and incoherence in coupled dynamical systems, have been found in various physical systems, such as mechanical oscillator networks and Josephson-junction arrays. We used recurrence plots to provide graphical representations of recurrent patterns and identify chimera states. Moreover, we show that recurrence plots can be used as a diagnostic of chimera states and also to identify the chimera collapse. - Highlights: • Chimera states have been found in various physical systems. • Recurrence plots is a graphical method useful to locate recurring patterns. • We used recurrence plots to identify the chimera states. • We show also the recurrence plots can identify the chimera collapse.

  17. Peer Influence and Addiction Recurrence

    OpenAIRE

    Paul Markdissi

    2009-01-01

    In this paper we highlight the role of peers in the recurrence of addictive behavior. To do so, we use a simple “forward looking” model with procrastination and peers influence. Our results show that while procrastination can explain the decision to postpone rehabilitation, peers influence is essential to explain the cyclical patterns of addiction-rehabilitation-addiction.

  18. Interpretation of Recurrent Neural Networks

    DEFF Research Database (Denmark)

    Pedersen, Morten With; Larsen, Jan

    1997-01-01

    This paper addresses techniques for interpretation and characterization of trained recurrent nets for time series problems. In particular, we focus on assessment of effective memory and suggest an operational definition of memory. Further we discuss the evaluation of learning curves. Various nume...

  19. Relativistic phase space: dimensional recurrences

    International Nuclear Information System (INIS)

    Delbourgo, R; Roberts, M L

    2003-01-01

    We derive recurrence relations between phase space expressions in different dimensions by confining some of the coordinates to tori or spheres of radius R and taking the limit as R→∞. These relations take the form of mass integrals, associated with extraneous momenta (relative to the lower dimension), and produce the result in the higher dimension

  20. Generalized Moshinsky bracket recurrence relations

    International Nuclear Information System (INIS)

    Bevelacqua, J.J.

    1979-01-01

    Recurrence relations for generalized Talmi-Moshinsky brackets are derived. These relations permit the generation of transformation brackets once appropriate starting brackets are determined. The savings in computer time, when compared with generating brackets individually, is at least a factor of 10 for brackets with radial quantum numbers as large as 9 and angular quantum numbers as large as 2. (author)

  1. Recurrent processing during object recognition

    Directory of Open Access Journals (Sweden)

    Randall C. O'Reilly

    2013-04-01

    Full Text Available How does the brain learn to recognize objects visually, and perform this difficult feat robustly in the face of many sources of ambiguity and variability? We present a computational model based on the biology of the relevant visual pathways that learns to reliably recognize 100 different object categories in the face of of naturally-occurring variability in location, rotation, size, and lighting. The model exhibits robustness to highly ambiguous, partially occluded inputs. Both the unified, biologically plausible learning mechanism and the robustness to occlusion derive from the role that recurrent connectivity and recurrent processing mechanisms play in the model. Furthermore, this interaction of recurrent connectivity and learning predicts that high-level visual representations should be shaped by error signals from nearby, associated brain areas over the course of visual learning. Consistent with this prediction, we show how semantic knowledge about object categories changes the nature of their learned visual representations, as well as how this representational shift supports the mapping between perceptual and conceptual knowledge. Altogether, these findings support the potential importance of ongoing recurrent processing throughout the brain's visual system and suggest ways in which object recognition can be understood in terms of interactions within and between processes over time.

  2. Ovarian irradiation in recurrent endometriosis

    International Nuclear Information System (INIS)

    Kochbati, L.; Chaari, N.; Besbes, M.; Maalej, M.; Neji, K.; Ben Amara, F.; Ben Romdhane, N.K.

    2005-01-01

    We describe a case of a young woman with a history of an aplastic anaemia in which pelvic radiotherapy was used successfully in the management of a recurrent and inoperable endometriosis. The use of therapeutic pelvic or ovarian irradiation in endometriosis may be considered, when surgical and medical treatments have been exhausted and have failed. (authors)

  3. Decitabine and Total-Body Irradiation Followed By Donor Bone Marrow Transplant and Cyclophosphamide in Treating Patients With Relapsed or Refractory Acute Myeloid Leukemia

    Science.gov (United States)

    2018-02-16

    Acute Myeloid Leukemia With Multilineage Dysplasia Following Myelodysplastic Syndrome; Adult Acute Myeloid Leukemia in Remission; Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); de Novo Myelodysplastic Syndromes; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Myeloid Leukemia; Secondary Acute Myeloid Leukemia

  4. Fifth International Symposium on Recurrence Plot

    CERN Document Server

    Riley, Michael; Giuliani, Alessandro; Webber, Charles; Jr, Jr; Translational Recurrences : From Mathematical Theory to Real-World Applications

    2014-01-01

    This book features 13 papers presented at the Fifth International Symposium on Recurrence Plots, held August 2013 in Chicago, IL. It examines recent applications and developments in recurrence plots and recurrence quantifi cation analysis (RQA) with special emphasis on biological and cognitive systems and the analysis of coupled systems using cross-recurrence methods. Readers will discover new applications and insights into a range of systems provided by recurrence plot analysis and new theoretical and mathematical developments in recurrence plots. Recurrence plot based analysis is a powerful tool that operates on real-world complex systems that are nonlinear, non-stationary, noisy, of any statistical distribution, free of any particular model type, and not particularly long. Quantitative analyses promote the detection of system state changes, synchronized dynamical regimes, or classifi cation of system states. Th e book will be of interest to an interdisciplinary audience of recurrence plot users and researc...

  5. Temperature, age, and recurrence of febrile seizure

    NARCIS (Netherlands)

    M. van Stuijvenberg (Margriet); E.W. Steyerberg (Ewout); G. Derksen-Lubsen (Gerarda); H.A. Moll (Henriëtte)

    1998-01-01

    textabstractOBJECTIVE: Prediction of a recurrent febrile seizure during subsequent episodes of fever. DESIGN: Study of the data of the temperatures, seizure recurrences, and baseline patient characteristics that were collected at a randomized placebo controlled trial of ibuprofen

  6. Recurrence of hypertensive disorders of pregnancy

    DEFF Research Database (Denmark)

    van Oostwaard, Miriam F; Langenveld, Josje; Schuit, Ewoud

    2015-01-01

    OBJECTIVE: We performed an individual participant data (IPD) metaanalysis to calculate the recurrence risk of hypertensive disorders of pregnancy (HDP) and recurrence of individual hypertensive syndromes. STUDY DESIGN: We performed an electronic literature search for cohort studies that reported ...

  7. Recurrent subdural hematoma secondary to headbanging: A case report.

    Science.gov (United States)

    Nitta, Naoki; Jito, Junya; Nozaki, Kazuhiko

    2015-01-01

    "Headbanging" is the slang term used to denote violent shaking of one's head in time with the music. This abrupt flexion-extension movement of the head to rock music extremely rarely causes a subdural hematoma. A 24-year-old female was admitted to our department because of right sided partial seizure and acute or subacute subdural hematoma over the left cerebral convexity. She had no history of recent head trauma but performed headbanging at a punk rock concert at 3 days before admission. Since, she had a previous acute subdural hematoma on the same side after an accidental fall from a baby buggy when she was 11 months old, the present was recurrent subdural hematoma probably due to headbanging. Headbanging has the hazardous potential to cause a subdural hematoma.

  8. Management of recurrent venous thromboembolism in patients with cancer: A review.

    Science.gov (United States)

    Piran, Siavash; Schulman, Sam

    2018-04-01

    Venous thromboembolism (VTE) occurs in 10-20%% of patients with cancer and is associated with significant mortality and morbidity in these patients. The current standard of care recommended by international guidelines is to use low-molecular-weight heparin (LMWH) for 6months for the management of cancer-associated thrombosis (CAT), which is based on evidence from randomized controlled trials demonstrating that LMWH significantly reduced the risk of recurrent VTE compared with vitamin K antagonists. However, patients with CAT have a high risk of VTE recurrence of up to 20% despite receiving anticoagulation. Reasons for recurrent VTE may include non-compliance, temporary cessation of therapy due to bleeding or for procedures, inadequate dosing, cancer progression, and the presence of heparin-induced thrombocytopenia. Management of patients with CAT and recurrent VTE is not well defined. Management strategies for recurrent VTE include switching to LMWH if an oral anticoagulant is employed, dose escalation of LMWH, or as a last resort option consider insertion of a vena cava filter. In this review, we discuss the acute, long-term, and extended management of CAT, risk factors for recurrent VTE, and management of recurrent VTE. Copyright © 2018 Elsevier Ltd. All rights reserved.

  9. 14 CFR 121.427 - Recurrent training.

    Science.gov (United States)

    2010-01-01

    ... procedures set forth in the certificate holder's approved low-altitude windshear flight training program and... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Recurrent training. 121.427 Section 121.427..., FLAG, AND SUPPLEMENTAL OPERATIONS Training Program § 121.427 Recurrent training. (a) Recurrent training...

  10. Decidability of uniform recurrence of morphic sequences

    OpenAIRE

    Durand , Fabien

    2012-01-01

    We prove that the uniform recurrence of morphic sequences is decidable. For this we show that the number of derived sequences of uniformly recurrent morphic sequences is bounded. As a corollary we obtain that uniformly recurrent morphic sequences are primitive substitutive sequences.

  11. Fatal rhabdomyolysis after acute sodium monensin (Rumensin® toxicity: case report Rabdomiólise fatal aguda pós-intoxicação por monensina sódica (Rumensin®: relato de caso

    Directory of Open Access Journals (Sweden)

    João Aris Kouyoumdjian

    2001-09-01

    Full Text Available Myoglobinuria or rhabdomyolysis occurs when myoglobin escapes into the blood and then into the urine after acute muscle necrosis. It can be a serious medical condition leading to renal failure and death. There are many causes including exertion, crush syndromes, ischaemia, metabolic disorders, exogenous toxins and drugs, heat stroke and hereditary disorders such as malignant hyperthermia. We report the case of a 17 year-old boy who developed myoglobinuria, renal failure and death 11 days after ingesting sodium monensin, possibly with the intention of developing muscles. Sodium monensin, the active principle of Rumensin®, is a dietary additive used as a growth promoter for confined cattle. There are no previous reports of human intoxication. Accidental or experimental sodium monensin intoxication in animals produces similar findings to those seen in this case.Mioglobinúria ou rabdomiólise refere-se a necrose muscular aguda com liberação de mioglobina na circulação e na urina podendo causar, na sua forma mais grave, insuficiência renal e óbito. A etiologia é ampla, incluindo exercício intenso, síndrome do esmagamento, isquemia, toxinas exógenas, anormalidades metabólicas, medicações, altas temperaturas, além de algumas condições herdadas como hipertermia maligna. Neste relato descreve-se o caso de um paciente jovem, do sexo masculino, que desenvolveu mioglobinúria, insuficiência renal e óbito, 11 dias após ingestão de monensina sódica, princípio ativo de Rumensin®, usado como aditivo alimentar para gado confinado; a ingestão possivelmente foi feita para desenvolvimento muscular. Não há relato na literatura de intoxicação humana e o quadro clínico nos animais com intoxicação experimental ou acidental pelo Rumensin® se assemelha àquele observado no presente caso.

  12. Recurrent impetigo herpetiformis: case report.

    Science.gov (United States)

    Wamalwa, Emmanuel Wekesa

    2017-01-01

    Impetigo herpetiformis (pustular psoriasis of pregnancy) is a rare dermatosis of pregnancy that typically starts in the 2 nd half of pregnancy and resolves postpartum. It may recur in subsequent pregnancies. I present a case of 23 year old female gravida 4 para 3 with recurrent impetigo herpetiformis at 26 weeks gestation. She presented with a one month history of pustular lesions which responded to treatment with prednisone. She delivered at term with a favourable outcome. The disease resolved one month postpartum. This was the second recurrence of the disease. She had her first episode of impetigo herpetiformis during the second pregnancy. The disease recurred in the 3 rd pregnancy and resulted in a still birth.

  13. Management of Recurrent Subdural Hematomas.

    Science.gov (United States)

    Desai, Virendra R; Scranton, Robert A; Britz, Gavin W

    2017-04-01

    Subdural hematomas commonly recur after surgical evacuation, at a rate of 2% to 37%. Risk factors for recurrence can be patient related, radiologic, or surgical. Patient-related risk factors include alcoholism, seizure disorders, coagulopathy, and history of ventriculoperitoneal shunt. Radiologic factors include poor brain reexpansion postoperatively, significant subdural air, greater midline shift, heterogeneous hematomas (layered or multi-loculated), and higher-density hematomas. Surgical factors include lack of or poor postoperative drainage. Most recurrent hematomas are managed successfully with burr hole craniostomies with postoperative closed-system drainage. Refractory hematomas may be managed with a variety of techniques, including craniotomy or subdural-peritoneal shunt placement. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Recurrent gossypiboma in the thigh

    International Nuclear Information System (INIS)

    Puri, Ajay; Anchan, Chetan; Agarwal, Manish G.; Jambhekar, Nirmala A.; Badwe, Rajendra A.

    2007-01-01

    Gossypiboma, an iatrogenic mass lesion caused by a retained surgical sponge is an extremely rare event following musculoskeletal procedures. This entity is therefore a very unusual experience and can create considerable confusion. Unsuspecting surgeons may thus be caught out by this unlikely presentation. We present our experience with a recurrent gossypiboma in the thigh occurring several years after surgical evacuation of a similar gossypiboma from the same anatomic location with interval resolution of symptoms. The purpose of this case report is to highlight the possibility of a ''recurrent'' soft tissue mass occurring for reasons other than a neoplasm. In the absence of a definitive biopsy diagnosis of tumor in patients who have undergone prior surgical procedures in that area, it may be more prudent to adopt a conservative surgical resection rather than a conventional radical resection as warranted by the dramatic clinical presentation mimicking a soft tissue sarcoma. (orig.)

  15. Recurrent Respiratory Infections in Children

    Directory of Open Access Journals (Sweden)

    F. Yurochko

    2012-02-01

    Full Text Available The paper covers a problem of recurrent respiratory infections (RRI in children. Their description, risk factors, diagnostic algorithm have been dwelt. A special attention is paid to the treatment. An optimal antibiotic in RRI of bacterial genesis is a high-dose amoxicillin/clavulanate (registered as Augmentin™ ES in Ukraine, the efficacy of which is 94.6–96.3 % according to different data.

  16. Recurrent spontaneous attacks of dizziness.

    Science.gov (United States)

    Lempert, Thomas

    2012-10-01

    This article describes the common causes of recurrent vertigo and dizziness that can be diagnosed largely on the basis of history. Ninety percent of spontaneous recurrent vertigo and dizziness can be explained by six disorders: (1) Ménière disease is characterized by vertigo attacks, lasting 20 minutes to several hours, with concomitant hearing loss, tinnitus, and aural fullness. Aural symptoms become permanent during the course of the disease. (2) Attacks of vestibular migraine may last anywhere from minutes to days. Most patients have a previous history of migraine headaches, and many experience migraine symptoms during the attack. (3) Vertebrobasilar TIAs affect older adults with vascular risk factors. Most attacks last less than 1 hour and are accompanied by other symptoms from the posterior circulation territory. (4) Vestibular paroxysmia is caused by vascular compression of the eighth cranial nerve. It manifests itself with brief attacks of vertigo that recur many times per day, sometimes with concomitant cochlear symptoms. (5) Orthostatic hypotension causes brief episodes of dizziness lasting seconds to a few minutes after standing up and is relieved by sitting or lying down. In older adults, it may be accompanied by supine hypertension. (6) Panic attacks usually last minutes, occur in specific situations, and are accompanied by choking, palpitations, tremor, heat, and anxiety. Less common causes of spontaneous recurrent vertigo and dizziness include perilymph fistula, superior canal dehiscence, autoimmune inner ear disease, otosclerosis, cardiac arrhythmia, and medication side effects. Neurologists need to venture into otolaryngology, internal medicine, and psychiatry to master the differential diagnosis of recurrent dizziness.

  17. Deep Gate Recurrent Neural Network

    Science.gov (United States)

    2016-11-22

    and Fred Cummins. Learning to forget: Continual prediction with lstm . Neural computation, 12(10):2451–2471, 2000. Alex Graves. Generating sequences...DSGU) and Simple Gated Unit (SGU), which are structures for learning long-term dependencies. Compared to traditional Long Short-Term Memory ( LSTM ) and...Gated Recurrent Unit (GRU), both structures require fewer parameters and less computation time in sequence classification tasks. Unlike GRU and LSTM

  18. MR investigation of recurrent cholesteatomas

    Energy Technology Data Exchange (ETDEWEB)

    Doyon, D.; Chan, K.Y.; Attia, M.; Halimi, P.; Sigal, R.; Bobin, S.; Sterkers, J.M.

    1989-03-01

    Nine cases of recurrent petrous cholesteatomas have been studied by a 1.5 T MR unit. Gadolinium was injected in 1 case. In all cases, comparison between MR, CT and clinical findings were made. MR allows for accurate topographic study and assessment of cholesteatomas extension, in particular in the posterior fossa and skull base. Relationships with the internal carotid artery and the jugular vein are clearly depicted.

  19. MR investigation of recurrent cholesteatomas

    International Nuclear Information System (INIS)

    Doyon, D.; Chan, K.Y.; Attia, M.; Halimi, P.; Sigal, R.; Bobin, S.; Sterkers, J.M.

    1989-01-01

    Nine cases of recurrent petrous cholesteatomas have been studied by a 1.5 T MR unit. Gadolinium was injected in 1 case. In all cases, comparison between MR, CT and clinical findings were made. MR allows for accurate topographic study and assessment of cholesteatomas extension, in particular in the posterior fossa and skull base. Relationships with the internal carotid artery and the jugular vein are clearly depicted [fr

  20. Recurrent Bleeding After Perimesencephalic Hemorrhage.

    Science.gov (United States)

    Kauw, Frans; Velthuis, Birgitta K; Kizilates, Ufuk; van der Schaaf, Irene C; Rinkel, Gabriel J E; Vergouwen, Mervyn D I

    2017-12-01

    Perimesencephalic hemorrhage (PMH) is a type of subarachnoid hemorrhage with excellent long-term outcomes. Only 1 well-documented case of in-hospital rebleeding after PMH is described in the literature, which occurred after initiating antithrombotic treatment because of myocardial ischemia. We describe a patient with PMH without antithrombotic treatment who had 2 episodes of recurrent bleeding on the day of ictus. To validate the radiologic findings, we conducted a case-control study. Six neuroradiologists and 2 neuroradiology fellows performed a blinded assessment of serial unenhanced head computed tomography (CT) scans of 8 patients with a perimesencephalic bleeding pattern (1 index patient, 6 patients with PMH, 1 patient with perimesencephalic bleeding pattern and basilar artery aneurysm) to investigate a potential increase in amount of subarachnoid blood. A 56-year-old woman with a perimesencephalic bleeding pattern and negative CT angiography had 2 episodes after the onset headache with a sudden increase of the headache. Blinded assessment of serial head CT scans of 8 patients with a perimesencephalic bleeding pattern identified the patient who was clinically suspected to have 2 episodes of recurrent bleeding to have an increased amount of subarachnoid blood on 2 subsequent CT scans. Recurrent bleeding after PMH may also occur in patients not treated with antithrombotics. Even after early rebleeding, the prognosis of PMH is excellent. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. [Recurrent benign cystic peritoneal mesothelioma].

    Science.gov (United States)

    Stroescu, C; Negulescu, Raluca; Herlea, V; David, L; Ivanov, B; Nitipir, Cornelia; Popescu, I

    2008-01-01

    The benign cystic peritoneal mesothelioma (BCPM) is a rare neoplasm affecting mainly females at reproductive age. The natural history and physiopathology of the BCPM are not entirely known. It is mainly characterized by the lack of malignant elements, no tendency to metastasis and by a pervasive tendency to generate local recurrences after surgical removal. The clinical manifestations are insidious, uncharacteristic; the benign cystic peritoneal mesothelioma is often discovered during a surgical procedure addressing another condition. Imaging tests can raise the suspicion of BCPM but the diagnostic can only be confirmed by histopathological examination corroborated with an immunohistochemical analysis. There are no long term studies dictating a single therapeutic attitude but a high risk of local recurrences and the possibility of transformation into malignant mesothelioma have lead to the current tendency towards an aggressive treatment of the tumor. We present the case of a recurrent benign cystic peritoneal mesothelioma in a 40 years old female patient, emphasizing the therapeutic approach and the role of radical surgery in the treatment of BPCM.

  2. MRI in recurrent nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Ng, S.H.; Ko, S.F.; Wan, Y.L.; Chang, J.T.C.; Chen, W.C.; Tang, L.M.

    1999-01-01

    In this study, we retrospectively reviewed the MRI features of recurrent nasopharyngeal carcinoma (NPC) in 72 patients who underwent MRI before and after gadolinium injection. Recurrent NPC exhibited a high degree of regional spread and a variety of signal intensities and contours. MRI showed a nasopharyngeal mass in 50 patients (69.4 %); other sites of involvement included the parapharyngeal space (44.4 %), nasal cavity (12.5 %), paranasal sinuses (27.8 %), oropharynx (4.2 %), orbit (8.3 %), infratemporal fossa (18.1 %), skull base (59.8 %), intracranial area (51.4 %) and regional lymph nodes (15.3 %). On T2-weighted images, the nasopharyngeal mass gave high signal in 9 of 50 cases (18 %), intermediate in 27 (54 %), mixed in 8 (16 %) and low signal in 6 (12 %). Contrast enhancement was strong in 12 cases (24 %), moderate in 29 (58 %) and heterogeneous in 9 (18 %). The lesion was convex in 31 cases (62 %) and concave or straight in 19 (38 %). Recognition of the distribution and the appearance of recurrent NPC on MRI is essential for timely diagnosis and appropriate treatment. (orig.)

  3. Ring enhancement in recurrent gliomas

    International Nuclear Information System (INIS)

    Ogashiwa, Motohide; Takeuchi, Kazuo; Akai, Keiichiro

    1981-01-01

    The clinical courses,CT scans, and postmortem reports for 6 glioma patients treated by surgery, radiation, and chemotherapy were reviewed. They underwent reoperation and/or retreatment with radiation or chemotherapy for recurrent tumors. CT scans taken at the time of recurrence or about one month prior to death showed ring enhancement of varied size and form after intensive treatment. The cases were examined histologically in correlation with the CT features and divided into two groups based on the pathological findings in the centers surrounded by areas of ring enhancement. The 1st group demonstrated a large necrotic area in the center, and the 2nd group, a cystic tumor. Tumor cells were found to have spread throughout the high-density areas around the necrotic area or cyst. However, gross differentiation between tumor and necrosis was difficult. In addition to an increase in cellularity, all cases demonstrated vascular proliferation, and dilatation of vessels in the sulci or sulci adjacent to gyri invaded by the tumor. The contrast enhancement corresponded well with the vascular proliferation in these areas. It is concluded that vascular proliferation or dilatation of vessels in and around the tumor is an important factor in demonstrating high-density areas in ring enhancement, while a cyst or necrosis in the tumor center is revealed as a low-density area in the CT scan of recurrent gliomas. (author)

  4. Ring enhancement in recurrent gliomas

    Energy Technology Data Exchange (ETDEWEB)

    Ogashiwa, M; Takeuchi, K; Akai, K [Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine

    1981-08-01

    The clinical courses,CT scans, and postmortem reports for 6 glioma patients treated by surgery, radiation, and chemotherapy were reviewed. They underwent reoperation and/or retreatment with radiation or chemotherapy for recurrent tumors. CT scans taken at the time of recurrence or about one month prior to death showed ring enhancement of varied size and form after intensive treatment. The cases were examined histologically in correlation with the CT features and divided into two groups based on the pathological findings in the centers surrounded by areas of ring enhancement. The 1st group demonstrated a large necrotic area in the center, and the 2nd group, a cystic tumor. Tumor cells were found to have spread throughout the high-density areas around the necrotic area or cyst. However, gross differentiation between tumor and necrosis was difficult. In addition to an increase in cellularity, all cases demonstrated vascular proliferation, and dilatation of vessels in the sulci or sulci adjacent to gyri invaded by the tumor. The contrast enhancement corresponded well with the vascular proliferation in these areas. It is concluded that vascular proliferation or dilatation of vessels in and around the tumor is an important factor in demonstrating high-density areas in ring enhancement, while a cyst or necrosis in the tumor center is revealed as a low-density area in the CT scan of recurrent gliomas.

  5. Acute Pancreatitis and Pregnancy

    Science.gov (United States)

    ... Pancreatitis Acute Pancreatitis and Pregnancy Acute Pancreatitis and Pregnancy Timothy Gardner, MD Acute pancreatitis is defined as ... pancreatitis in pregnancy. Reasons for Acute Pancreatitis and Pregnancy While acute pancreatitis is responsible for almost 1 ...

  6. Molecular Mechanisms to Control Post-Transplantation Hepatitis B Recurrence

    Directory of Open Access Journals (Sweden)

    Akinobu Takaki

    2015-07-01

    Full Text Available Hepatitis B often progresses to decompensated liver cirrhosis requiring orthotopic liver transplantation (OLT. Although newer nucleos(tide analogues result in >90% viral and hepatitis activity control, severely decompensated patients still need OLT because of drug-resistant virus, acute exacerbation, or hepatocellular carcinoma. Acute hepatitis B is also an indication for OLT, because it can progress to fatal acute liver failure. After OLT, the hepatitis B recurrence rate is >80% without prevention, while >90% of transplant recipients are clinically controlled with combined hepatitis B immunoglobulin (HBIG and nucleos(tide analogue treatment. However, long-term HBIG administration is associated with several unresolved issues, including limited availability and extremely high cost; therefore, several treatment protocols with low-dose HBIG, combined with nucleos(tide analogues, have been investigated. Another approach is to induce self-producing anti-hepatitis B virus (HBV antibodies using an HBV envelope (HBs antigen vaccine. Patients who are not HBV carriers, such as those with acutely infected liver failure, are good candidates for vaccination. For chronic HBV carrier liver cirrhosis patients, a successful vaccine response can only be achieved in selected patients, such as those treated with experimentally reduced immunosuppression protocols. The present protocol for post-OLT HBV control and the future prospects of newer treatment strategies are reviewed.

  7. Cyclosporine, Pravastatin Sodium, Etoposide, and Mitoxantrone Hydrochloride in Treating Patients With Relapsed or Refractory Acute Myeloid Leukemia

    Science.gov (United States)

    2017-06-27

    Adult Acute Megakaryoblastic Leukemia (M7); Adult Acute Minimally Differentiated Myeloid Leukemia (M0); Adult Acute Monoblastic Leukemia (M5a); Adult Acute Monocytic Leukemia (M5b); Adult Acute Myeloblastic Leukemia With Maturation (M2); Adult Acute Myeloblastic Leukemia Without Maturation (M1); Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Adult Acute Myelomonocytic Leukemia (M4); Adult Erythroleukemia (M6a); Adult Pure Erythroid Leukemia (M6b); Recurrent Adult Acute Myeloid Leukemia

  8. Pure Motor Stroke Secondary to Cerebral Infarction of Recurrent Artery of Heubner after Mild Head Trauma: A Case Report.

    Science.gov (United States)

    Yilmaz, Ali; Kizilay, Zahir; Ozkul, Ayca; Çirak, Bayram

    2016-03-15

    The recurrent Heubner's artery is the distal part of the medial striate artery. Occlusion of the recurrent artery of Heubner, classically contralateral hemiparesis with fasciobrachiocrural predominance, is attributed to the occlusion of the recurrent artery of Heubner and is widely known as a stroke syndrome in adults. However, isolated occlusion of the deep perforating arteries following mild head trauma also occurs extremely rarely in childhood. Here we report the case of an 11-year-old boy with pure motor stroke. The brain MRI showed an acute ischemia in the recurrent artery of Heubner supply area following mild head trauma. His fasciobrachial hemiparesis and dysarthria were thought to be secondary to the stretching of deep perforating arteries leading to occlusion of the recurrent artery of Heubner. Post-traumatic pure motor ischemic stroke can be secondary to stretching of the deep perforating arteries especially in childhood.

  9. Recurrent Kawasaki disease: USA and Japan.

    Science.gov (United States)

    Maddox, Ryan A; Holman, Robert C; Uehara, Ritei; Callinan, Laura S; Guest, Jodie L; Schonberger, Lawrence B; Nakamura, Yosikazu; Yashiro, Mayumi; Belay, Ermias D

    2015-12-01

    Descriptive epidemiologic studies of recurrent and non-recurrent Kawasaki disease (KD) may identify other potentially important differences between these illnesses. Data from the USA and Japan, the Centers for Disease Control and Prevention (CDC) national KD surveillance(1984-2008) and the 17th Japanese nationwide survey (2001-2002), respectively, were analyzed to examine recurrent KD patients <18 years of age meeting the CDC KD case or atypical KD case definition. These patients were compared with non-recurrent KD patients. Of the 5557 US KD patients <18 years of age during 1984-2008, 97 (1.7%) were identified as having had recurrent KD. Among the US Asian/Pacific Islander KD patients, 3.5% had recurrent KD, which was similar to the percentage identified among KD patients (3.5%) in the Japanese survey. Compared with non-recurrent KD patients, KD patients [with recurrent KD] were more likely to be older, fulfill the atypical KD case definition, and have coronary artery abnormalities (CAA) despite i.v. immunoglobulin (IVIG) treatment. Differences in the age, race, and frequency of CAA exist between recurrent and non-recurrent KD patients. The increased association of CAA with recurrent KD suggests that more aggressive treatment strategies in conjunction with IVIG may be indicated for the second episode of KD. © 2015 Japan Pediatric Society.

  10. Recurrent Kawasaki disease, United States and Japan

    Science.gov (United States)

    Maddox, Ryan A.; Holman, Robert C.; Uehara, Ritei; Callinan, Laura S.; Guest, Jodie L.; Schonberger, Lawrence B.; Nakamura, Yosikazu; Yashiro, Mayumi; Belay, Ermias D.

    2015-01-01

    Background Descriptive epidemiologic studies of recurrent and non-recurrent Kawasaki disease (KD) may identify other potentially important differences between these illnesses. Methods Data from the United States and Japan, the Centers for Disease Control and Prevention (CDC) national KD surveillance (1984–2008) and the 17th Japanese nationwide survey (2001–2002), respectively, were analyzed to examine recurrent KD patients <18 years of age meeting the CDC KD case or atypical KD case definition. These patients were compared to non-recurrent KD patients. Results Of the 5557 US KD patients <18 years of age during 1984–2008, 97 (1.7%) were identified as having had recurrent KD. Among the US Asian/Pacific Islander KD patients, 3.5% had recurrent KD, which was similar to the percentage identified among KD patients (3.5%) in the Japanese survey. Compared to non-recurrent KD patients, KD patients experiencing a recurrent KD episode were more likely to be older, fulfill the atypical KD case definition, and have coronary artery abnormalities (CAA) despite IVIG treatment. Conclusions Differences in the age, race, and frequency of CAA exist between recurrent and non-recurrent KD patients. The increased association of CAA with recurrent KD suggests that more aggressive treatment strategies in conjunction with IVIG may be indicated for the second episode of KD. PMID:26096590

  11. Risk factors of recurrent anal sphincter ruptures

    DEFF Research Database (Denmark)

    Jangö, Hanna; Langhoff-Roos, J; Rosthøj, Steen

    2012-01-01

    Please cite this paper as: Jangö H, Langhoff-Roos J, Rosthøj S, Sakse A. Risk factors of recurrent anal sphincter ruptures: a population-based cohort study. BJOG 2012;00:000-000 DOI: 10.1111/j.1471-0528.2012.03486.x. Objective  To determine the incidence and risk factors of recurrent anal sphincter...... were used to determine risk factors of recurrent ASR. Main outcome measures  The incidence of recurrent ASR and odds ratios for possible risk factors of recurrent ASR: age, body mass index, grade of ASR, birthweight, head circumference, gestational age, presentation, induction of labour, oxytocin...... augmentation, epidural, episiotomy, vacuum extraction, forceps, shoulder dystocia, delivery interval and year of second delivery. Results  Out of 159 446 women, 7336 (4.6%) experienced an ASR at first delivery, and 521 (7.1%) had a recurrent ASR (OR 5.91). The risk factors of recurrent ASR in the multivariate...

  12. FLAIR vascular hyperintensities predict early ischemic recurrence in TIA.

    Science.gov (United States)

    Nam, Ki-Woong; Kim, Chi Kyung; Kim, Tae Jung; Oh, Kyungmi; Han, Moon-Ku; Ko, Sang-Bae; Yoon, Byung-Woo

    2018-02-27

    To evaluate the relationship between fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH) and early ischemic lesion recurrence (follow-up diffusion-weighted imaging [FU-DWI] [+]) in patients with lesion-negative TIA. We recruited consecutive patients with lesion-negative TIA within 24 hours of symptom onset, who underwent follow-up MRI during the acute period. FVH was defined as a focal or serpentine high signal intensity on FLAIR images. Other potential confounders were adjusted to evaluate the relationship between FVH and FU-DWI (+). Furthermore, to compare clinical outcomes between the FU-DWI (+) and FU-DWI (-) groups, we assessed 1-year recurrent ischemic stroke or TIA. Among 392 patients with lesion-negative TIA, 82 patients had FU-DWI (+) on the follow-up MRI. In the multivariate analysis, FVH remained an independent predictor of FU-DWI (+) (adjusted odds ratio [aOR] = 4.77, 95% confidence interval [CI] 2.45-9.29, p TIA. As FU-DWI (+) frequently occurs during the acute period and has a subsequent worse outcome after discharge, additional radiologic or clinical markers for it are necessary. © 2018 American Academy of Neurology.

  13. Is it possible to evaluate true prophylactic efficacy of antidepressants in severely ill patients with recurrent depression?

    DEFF Research Database (Denmark)

    Licht, Rasmus W; Martiny, Klaus Per Juul

    2013-01-01

    BACKGROUND: We compared citalopram and clomipramine against placebo with respect to recurrence prevention as opposed to relapse prevention in patients with recurrent depression, independently of any acute response to the test drug(s). METHODS: Patients with recurrent depressive disorder...... and achieved sustained response. Out of these, only 59 patients (34%) could be randomised to placebo (n=22), citalopram (n=19) or clomipramine (n=22), with protocol violation and/or non-consent being the major reasons for non-randomisation. There were no between-group differences in outcome; almost half...

  14. Stress Reduction in Improving Quality of Life in Patients With Recurrent Gynecologic or Breast Cancer

    Science.gov (United States)

    2015-10-08

    Anxiety Disorder; Depression; Fatigue; Leydig Cell Tumor; Ovarian Sarcoma; Ovarian Stromal Cancer; Pain; Peritoneal Carcinomatosis; Pseudomyxoma Peritonei; Recurrent Breast Cancer; Recurrent Cervical Cancer; Recurrent Endometrial Carcinoma; Recurrent Fallopian Tube Cancer; Recurrent Gestational Trophoblastic Tumor; Recurrent Ovarian Epithelial Cancer; Recurrent Ovarian Germ Cell Tumor; Recurrent Primary Peritoneal Cavity Cancer; Recurrent Uterine Sarcoma; Recurrent Vaginal Cancer; Recurrent Vulvar Cancer

  15. Acupuncture for acute hordeolum

    Science.gov (United States)

    Cheng, Ke; Law, Andrew; Guo, Menghu; Wieland, L. Susan; Shen, Xueyong; Lao, Lixing

    2017-01-01

    Background Hordeolum is an acute, purulent inflammation of the eyelid margin usually caused by obstructed orifices of the sebaceous glands of the eyelid. The condition, which affects sebaceous glands internally or externally, is common. When the meibomian gland in the tarsal plate is affected, internal hordeolum occurs, while when the glands of Zeis or Moll associated with eyelash follicles are affected, external hordeolum, or stye occurs. The onset of hordeolum is usually self limited, and may resolve in about a week with spontaneous drainage of the abscess. When the condition is severe, it can spread to adjacent glands and tissues. Recurrences are very common. As long as an internal hordeolum remains unresolved, it can develop into a chalazion or generalized eyelid cellulitis. Acupuncture is a traditional Chinese medical therapy aimed to treat disease by using fine needles to stimulate specific points on the body. However, it is unclear if acupuncture is an effective and safe treatment for acute hordeolum. Objectives The objective of this review was to investigate the effectiveness and safety of acupuncture to treat acute hordeolum compared with no treatment, sham acupuncture, or other active treatment. We also compared the effectiveness and safety of acupuncture plus another treatment with that treatment alone. Search methods We searched CENTRAL, Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, Embase, PubMed, Latin American and Caribbean Health Sciences Literature Database (LILACS), three major Chinese databases, as well as clinical trial registers all through 7 June 2016. We reviewed the reference lists from potentially eligible studies to identify additional randomised clinical trials (RCTs). Selection criteria We included RCTs of people diagnosed with acute internal or external hordeola. We included RCTs comparing acupuncture with sham acupuncture or no treatment, other active treatments, or

  16. Acute pancreatitis.

    Science.gov (United States)

    Talukdar, Rupjyoti; Vege, Santhi S

    2015-09-01

    To summarize recent data on classification systems, cause, risk factors, severity prediction, nutrition, and drug treatment of acute pancreatitis. Comparison of the Revised Atlanta Classification and Determinant Based Classification has shown heterogeneous results. Simvastatin has a protective effect against acute pancreatitis. Young black male, alcohol, smoldering symptoms, and subsequent diagnosis of chronic pancreatitis are risk factors associated with readmissions after acute pancreatitis. A reliable clinical or laboratory marker or a scoring system to predict severity is lacking. The PYTHON trial has shown that oral feeding with on demand nasoenteric tube feeding after 72 h is as good as nasoenteric tube feeding within 24 h in preventing infections in predicted severe acute pancreatitis. Male sex, multiple organ failure, extent of pancreatic necrosis, and heterogeneous collection are factors associated with failure of percutaneous drainage of pancreatic collections. The newly proposed classification systems of acute pancreatitis need to be evaluated more critically. New biomarkers are needed for severity prediction. Further well designed studies are required to assess the type of enteral nutritional formulations for acute pancreatitis. The optimal minimally invasive method or combination to debride the necrotic collections is evolving. There is a great need for a drug to treat the disease early on to prevent morbidity and mortality.

  17. Sperm DNA fragmentation, recurrent implantation failure and recurrent miscarriage

    Directory of Open Access Journals (Sweden)

    Carol Coughlan

    2015-01-01

    Full Text Available Evidence is increasing that the integrity of sperm DNA may also be related to implantation failure and recurrent miscarriage (RM. To investigate this, the sperm DNA fragmentation in partners of 35 women with recurrent implantation failure (RIF following in vitro fertilization, 16 women diagnosed with RM and seven recent fathers (control were examined. Sperm were examined pre- and post-density centrifugation by the sperm chromatin dispersion (SCD test and the terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL assay. There were no significant differences in the age of either partner or sperm concentration, motility or morphology between three groups. Moreover, there were no obvious differences in sperm DNA fragmentation measured by either test. However, whilst on average sperm DNA fragmentation in all groups was statistically lower in prepared sperm when measured by the SCD test, this was not seen with the results from the TUNEL assay. These results do not support the hypothesis that sperm DNA fragmentation is an important cause of RIF or RM, or that sperm DNA integrity testing has value in such patients. It also highlights significant differences between test methodologies and sperm preparation methods in interpreting the data from sperm DNA fragmentation tests.

  18. [Recurrent herpes zoster with neuralgia].

    Science.gov (United States)

    Schwickert, Myriam; Saha, Joyonto

    2006-06-01

    We present the case of a 40-year-old female patient suffering from recurrent herpes zoster and postherpetic neuralgia. Herpes zoster has recurred several times per year for more than 15 years. At admission, rash localised on the right sacral region and accompanied by neuralgia had lasted for 3 months. Standard out-patient treatment remained unsuccessful. A multimodal integrative therapy regimen including fasting, hydrotherapy, leech application and treatment with autologous blood led to rapid healing of herpetic lesions and persistent pain relief. The case is discussed.

  19. Recurrent intussusception in children and infants

    Directory of Open Access Journals (Sweden)

    Amine Ksia

    2013-01-01

    Full Text Available Background: Recurrent intussusceptions in child and infants are problematic and there are controversies about its management. The aim of this study is to determine the details of the clinical diagnosis of recurrent intussusception and to determine the aetiology of recurrent intussusceptions. Patients and Methods: It′s a retrospective study of 28 cases of recurrent intussusception treated in the paediatric surgery department of Monastir (Tunisia between January 1998 and December 2011. Results: During the study period, 505 patients were treated for 544 episodes of intussusception; there were 39 episodes of recurrent intussusceptions in 28 patients; the rate of patients with recurrence was 5.5%. With comparison to the initial episode, clinical features were similar to the recurrent episode, except bloody stool that was absent in the recurrent group (P = 0,016. Only one patient had a pathologic local point. Conclusion: In recurrent intussusception, patients are less symptomatic and consult quickly. Systematic surgical exploration is not needed as recurrent intussusceptions are easily reduced by air or hydrostatic enema and are not associated with a high rate of pathologic leading points.

  20. Imipenem/cilastatin-induced acute eosinophilic pneumonia.

    Science.gov (United States)

    Foong, Kap Sum; Lee, Ashley; Pekez, Marijeta; Bin, Wei

    2016-03-04

    Drugs, toxins, and infections are known to cause acute eosinophilic pneumonia. Daptomycin and minocycline are the commonly reported antibiotics associated with acute eosinophilic pneumonia. In this study, we present a case of imipenem/cilastatin-induced acute eosinophilic pneumonia. The patient presented with fever, acute hypoxic respiratory distress, and diffuse ground-glass opacities on the chest CT a day after the initiation of imipenem/cilastatin. Patient also developed peripheral eosinophilia. A reinstitution of imipenem/cilastatin resulted in recurrence of the signs and symptoms. A bronchoscopy with bronchoalveolar lavage showed 780 nucleated cells/mm(3) with 15% eosinophil. The patient's clinical condition improved significantly after the discontinuation of imipenem/cilastatin therapy and the treatment with corticosteroid. 2016 BMJ Publishing Group Ltd.

  1. Recurrent vaginal discharge in children.

    Science.gov (United States)

    McGreal, Sharon; Wood, Paul

    2013-08-01

    Childhood vaginal discharge remains a frequent reason for referral from primary to secondary care. The Pediatric and Adolescent Gynecology (PAG) service at Kettering General Hospital was established in 1993 and provides a specialized service that meets the needs of children with gynaecological conditions. To investigate recurrent vaginal discharge noting symptomatology, defining pathogens, common and rarer causes, exploring management regimes, and any changes in practice over time. Retrospective review spanning 15 years identifying prepubertal children attending the outpatient PAG clinic with recurrent vaginal discharge. We reviewed the medical notes individually. 110 patients were identified; 85% were referred from primary care. The age distribution was bimodal at four and eight years. Thirty-five percent of our patients were discharged after the initial consultation. The commonest cause of discharge was vulvovaginitis (82%). Other important causes included suspected sexual abuse (5%), foreign body (3%), labial adhesions (3%), vaginal agenesis (2%). 35% of patients were admitted for vaginoscopy. Vaginal discharge is the most common gynecological symptom in prepubertal girls and can cause repeated clinical episodes. Vulvovaginitis is the most common cause and often responds to simple hygiene measures. Awareness of the less common causes of vaginal discharge is essential. Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  2. Lymphomatosis cerebri Presenting as a Recurrent Leukoencephalopathy

    Directory of Open Access Journals (Sweden)

    Floriane Courtois

    2012-11-01

    Full Text Available A 29-year-old immunocompetent woman was admitted in 2006 with ataxia, limb weakness, generalized dystonia, and vertical diplopia that developed after a febrile episode. Brain magnetic resonance imaging (MRI revealed the presence of extensive periventricular white matter lesions that did not enhance after gadolinium injection. As low titers of cytomegalovirus-IgM antibodies were found in the serum, a presumed diagnosis of postviral acute disseminated encephalomyelitis (ADEM was made, and the patient received a 5-day course of 1 g methylprednisolone. The clinical and radiological outcome was very rapidly favorable, and subsequent brain MRIs in 2007 and 2008 were normal. In March 2011, the patient was readmitted with the complaints of abnormal fatigue, imbalance, and speech disorder. The neurological examination showed fluctuating spatiotemporal disorientation with dyscalculia, verbal deafness, gait ataxia, right hemianopia, and pyramidal signs in the four limbs. The brain MRI demonstrated extensive T2 hyperintense white matter lesions predominating in the left temporal and parieto-occipital lobes, with a pseudotumoral aspect enhancing with gadolinium contrast. A clinical improvement was transiently noted after pulse steroid therapy, but after relapse and radiological worsening, the diagnosis of recurrent ADEM was challenged. The brain biopsy confirmed the presence of primary central nervous system lymphoma (PCNSL under the variant form of lymphomatosis cerebri. Despite a partial response to chemotherapy, the patient died 8 months after the diagnosis. We discuss the role of sentinel lesions that may precede PCNSL for several years and insist on the importance to consider early brain biopsy in the presence of extensive, non-enhancing white matter lesions, even in a young and immunocompetent patient.

  3. Acute Pancreatitis

    DEFF Research Database (Denmark)

    Bertilsson, Sara; Håkansson, Anders; Kalaitzakis, Evangelos

    2017-01-01

    Aims: We aimed to evaluate the potential relation between the incidence of (alcoholic and non-alcoholic) acute pancreatitis (AP) and alcohol consumption in the general population, and whether the occurrence of AP shows any seasonal variation, particularly in relation to periods with expected...... consumption in the general population do not appear to be related to changes in the incidence of AP and there are no significant seasonal differences in the occurrence of AP in Sweden. Short summary: The incidence of acute pancreatitis (AP) is increasing, and alcohol is still recognized as one of the most...

  4. [Acute pancreatitis associated with hypercalcaemia].

    Science.gov (United States)

    Tun-Abraham, Mauro Enrique; Obregón-Guerrero, Gabriela; Romero-Espinoza, Larry; Valencia-Jiménez, Javier

    2015-01-01

    Hypercalcaemia due to primary hyperparathyroidism is a rare cause of acute pancreatitis, with a reported prevalence of 1.5 to 8%. There is no clear pathophysiological basis, but elevated parathyroid hormone and high serum calcium levels could be responsible for calcium deposit in the pancreatic ducts and activation of pancreatic enzymes, which may be the main risk factor for developing acute pancreatitis. The aim of this report is to describe four cases. Four cases are reported of severe pancreatitis associated with hypercalcaemia secondary to primary hyperparathyroidism; three of them with complications (two pseudocysts and one pancreatic necrosis). Cervical ultrasound, computed tomography, and scintigraphy using 99mTc-Sestambi, studies showed the parathyroid adenoma. Surgical resection was the definitive treatment in all four cases. None of the patients had recurrent acute pancreatitis events during follow-up. Acute pancreatitis secondary to hypercalcaemia of primary hyperparathyroidism is rare; however, when it occurs it is associated with severe pancreatitis. It is suspected in patients with elevated serum calcium and high parathyroid hormone levels. Imaging techniques such as cervical ultrasound, computed tomography, and scintigraphy using 99mTc-Sestambi, should be performed, to confirm clinical suspicion. Surgical resection is the definitive treatment with excellent results. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  5. Recurrence plots of exchange rates of currencies

    OpenAIRE

    Sparavigna, Amelia Carolina

    2014-01-01

    Used to investigate the presence of distinctive recurrent behaviours in natural processes, the recurrence plots can be applied to the analysis of economic data, and, in particular, to the characterization of exchange rates of currencies too. In this paper, we will show that these plots are able to characterize the periods of oscillation and random walk of currencies and enhance their reply to news and events, by means of texture transitions. The examples of recurrence plots given here are obt...

  6. Recurrence of non-Hodgkin's lymphoma

    International Nuclear Information System (INIS)

    Watanabe, Toshikazu; Kiyono, Kunihiro; Niibe, Hideo; Horiuchi, Junichi; Kaneta, Koichi; Morita, Kozo; Masaki, Norie; Hayabuchi, Naofumi.

    1988-01-01

    563 patients with Stage I and II non-Hodgkin's lymphoma were treated by radiotherapy. 34 recurrences that occured after 3 years from initial treatment were seen in those patients. 15 (44 %) of 34 recurrences occured after 5 years. 20 patients (59 %) had remission by re-treatment, and 13 (38 %) survived more than 2 years. 20 (59 %) of recurrences were seen on head and neck lesions and superficial lymph nodes. (author)

  7. Equivalence of Equilibrium Propagation and Recurrent Backpropagation

    OpenAIRE

    Scellier, Benjamin; Bengio, Yoshua

    2017-01-01

    Recurrent Backpropagation and Equilibrium Propagation are algorithms for fixed point recurrent neural networks which differ in their second phase. In the first phase, both algorithms converge to a fixed point which corresponds to the configuration where the prediction is made. In the second phase, Recurrent Backpropagation computes error derivatives whereas Equilibrium Propagation relaxes to another nearby fixed point. In this work we establish a close connection between these two algorithms....

  8. Recurrent, giant subcutaneous leiomyosarcoma of the thigh

    Directory of Open Access Journals (Sweden)

    Gao Chuanping, MD

    2015-10-01

    Full Text Available We present a case of recurrent, massive subcutaneous leiomyosarcoma involving the left thigh in a 29-year-old male from Madagascar. The patient had earlier undergone local resection of subcutaneous leiomyosarcoma a half year before. After surgical intervention, local recurrence developed at this site and was rapidly growing. The patient was surgically treated with a 2-cm-wide margin local excision in our hospital. The patient has remained recurrence free at 1-year follow-up.

  9. Radiotherapy in Locoregional Recurrent Breast Carcinoma

    International Nuclear Information System (INIS)

    Ha, Sung Whan; Yang, Mi Gyoung; Chung, Woong Ki; Park, Charn Il; Bang, Yung Jue; Kim, Noe Kyung; Choe, Kuk Jin

    1988-01-01

    Thirty eight women with recurrent breast carcinoma involving chest wall and/or regional lymph nodes after surgery with or without systemic therapy were treated with radiation between 1979 and 1986. Among them, 5 patients were excluded from analysis because of incomplete treatment. The median follow up of survivors was 30 months (ranged 1-79 months). Fifteen (45%) patients had their disease confined to the chest wall and eighteen patients had lymph node involvement as some of their locoregional recurrent disease. Within 36 months after the initial treatment, 87% of recurrences manifested themselves. All patients had radiotherapy to at least the site of involvement. In 8 patients, recurrent tumors were treated with complete excision followed by radiation. Of the remaining 25 patients, 18(72%) had complete response (CR) following radiotherapy. The actuarial 3-year survival of all patients following locoregional recurrence was 50%. Three year survival was 24% in those 25 patients who had recurrences within 24 months of the initial treatment. For those 8 patients whose recurrences occurred after more than 24 month disease free interval, the 3-year survival was 100%. For those patients with recurrences confined to chest wall alone, 3-year survival was 57%. The patients who had lymph node involvement as part of their locoregional recurrences had a 43% 3-year survival. The majority of them developed distant metastases. Those patients who had a CR showed 63% 3-year survival. On the other hand, 1 year survival was only 33% for those patients who had a less than CR. Three patients developed carcinoma of the contralateral breast following radiotherapy. Three year survival following locoregional recurrence was 40% for patients whose initial treatment for their primary breast carcinoma was surgery and adjuvant systemic therapy. For those patients whose primary breast carcinoma was treated by surgery alone, the 3-year survival following locoregional recurrence was 71%. In

  10. A Paired Comparison of Initial and Recurrent Concussions Sustained by US High School Athletes Within a Single Athletic Season.

    Science.gov (United States)

    Currie, Dustin W; Comstock, R Dawn; Fields, Sarah K; Cantu, Robert C

    To compare initial and recurrent concussions regarding average number of days between concussions, acute concussion symptoms and symptom resolution time, and return to play time. High school athletes sustaining multiple concussions linked within sport seasons drawn from a large sports injury surveillance study. Retrospective analysis of longitudinal surveillance data. Number of days between concussions, number of symptoms endorsed, specific symptoms endorsed, symptom resolution time, return to play time. Median time between initial and recurrent concussions was 21 days (interquartile range = 10-43 days). Loss of consciousness, the only significant symptom difference, occurred more frequently in recurrent (6.8%) than initial (1.7%) concussions (P = .04). No significant difference was found in the number of symptoms (P = .84) or symptom resolution time (P = .74). Recurrent concussions kept athletes from play longer than initial concussions (P concussions were season ending. We found that athletes' initial and recurrent concussions had similar symptom presentations and resolution time. Despite these similarities, athletes were restricted from returning to play for longer periods following a recurrent concussion, indicating clinicians are managing recurrent concussions more conservatively. It is probable that concussion recognition and management are superior now compared with when previous studies were published, possibly improving recurrent concussion outcomes.

  11. Recurrent odontogenic keratocyst within the masticatory space

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Su Yeon; Huh, Kyung Hoe; Yi, Won Jin; Choi, Hyun Bae; Choi, Soon Chul [School of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    2008-06-15

    The odontogenic keratocyst (OKC) is a developmental odontogenic cyst typically occurring in the jaws. Since the first description of OKC was published in 1956, the lesion has been of particular interest because of its specific histopathologic features, high recurrence rate, and aggressive behavior. Recurrences most commonly arise within bone at the site of the original cyst. However, as lining cells may find their way into surrounding tissues either from implantation during surgery or from cortical perforation recurrences may arise at a distance from the original cyst. Here, we report a rare case of recurrent OKC which was first developed in mandible and recurred within the masticatory space.

  12. Recurrent odontogenic keratocyst within the masticatory space

    International Nuclear Information System (INIS)

    Lim, Su Yeon; Huh, Kyung Hoe; Yi, Won Jin; Choi, Hyun Bae; Choi, Soon Chul

    2008-01-01

    The odontogenic keratocyst (OKC) is a developmental odontogenic cyst typically occurring in the jaws. Since the first description of OKC was published in 1956, the lesion has been of particular interest because of its specific histopathologic features, high recurrence rate, and aggressive behavior. Recurrences most commonly arise within bone at the site of the original cyst. However, as lining cells may find their way into surrounding tissues either from implantation during surgery or from cortical perforation recurrences may arise at a distance from the original cyst. Here, we report a rare case of recurrent OKC which was first developed in mandible and recurred within the masticatory space.

  13. Generalised recurrence plot analysis for spatial data

    International Nuclear Information System (INIS)

    Marwan, Norbert; Kurths, Juergen; Saparin, Peter

    2007-01-01

    Recurrence plot based methods are highly efficient and widely accepted tools for the investigation of time series or one-dimensional data. We present an extension of the recurrence plots and their quantifications in order to study recurrent structures in higher-dimensional spatial data. The capability of this extension is illustrated on prototypical 2D models. Next, the tested and proved approach is applied to assess the bone structure from CT images of human proximal tibia. We find that the spatial structures in trabecular bone become more recurrent during the bone loss in osteoporosis

  14. Radiotherapy of Recurrent Uterine Cervical Cancer

    International Nuclear Information System (INIS)

    Ha, Sung Whan; Park, Charn Il; Chai, Kyu Young; Kang, Soon Beom; Lee, Hyo Pyo; Shin, Myon Woo

    1987-01-01

    Forty seven patients with locally recurrent uterine cerival cancer after surgery were treated with radiation during the 6 year period from 1979 through 1984 at the Department of Therapeutic Radiology of Seoul National University Hospital. In 30 out of the 47 patients, recurrence was diagnosed within 2 years after surgery. Site of recurrence was vagina in 19 patients, vagina and parametrium in 21 patients and parametrium only in 7 patients. Complete tumor control was achieved in 35 patients (74.5%) ; the complete response rates were 94.7% (18/19( in vaginal recurrences, 57.1% (12/21) in combined vaginal and parametrial recurrences and 71.4% (5/7) in parametrial recurrences. Overall and disease free survival rates at 4 years were 55.2 and 50.1 percent, respectively, for entire group. Overall 4 year survival rates were 77.0% for vaginal recurrences, 44.1% for vaginal and parametrial recurrences and 42.9% for parametrial recurrences. When the disease extent was classified in the same way as the staging system of FIGO, the 4 year survival was 80.4, 73.0, 25.0 and 0 percent for stage IIa, IIb and IVa, respectively

  15. Palbociclib Isethionate in Treating Younger Patients With Recurrent, Progressive, or Refractory Central Nervous System Tumors

    Science.gov (United States)

    2017-09-27

    Childhood Choroid Plexus Tumor; Childhood Ependymoblastoma; Childhood Grade III Meningioma; Childhood High-grade Cerebellar Astrocytoma; Childhood High-grade Cerebral Astrocytoma; Childhood Medulloepithelioma; Recurrent Childhood Anaplastic Astrocytoma; Recurrent Childhood Anaplastic Oligoastrocytoma; Recurrent Childhood Anaplastic Oligodendroglioma; Recurrent Childhood Brain Stem Glioma; Recurrent Childhood Cerebellar Astrocytoma; Recurrent Childhood Cerebral Astrocytoma; Recurrent Childhood Giant Cell Glioblastoma; Recurrent Childhood Glioblastoma; Recurrent Childhood Gliomatosis Cerebri; Recurrent Childhood Gliosarcoma; Recurrent Childhood Medulloblastoma; Recurrent Childhood Pineoblastoma; Recurrent Childhood Supratentorial Primitive Neuroectodermal Tumor

  16. Nontraumatic Exertional Rhabdomyolysis Leading to Acute Kidney Injury in a Sickle Trait Positive Individual on Renal Biopsy

    Directory of Open Access Journals (Sweden)

    Kalyana C. Janga

    2018-01-01

    Full Text Available A 26-year-old African American male with a history of congenital cerebral palsy, sickle cell trait, and intellectual disability presented with abdominal pain that started four hours prior to the hospital visit. The patient denied fever, chills, diarrhea, or any localized trauma. The patient was at a party at his community center last evening and danced for 2 hours, physically exerting himself more than usual. Labs revealed blood urea nitrogen (BUN level of 41 mg/dL and creatinine (Cr of 2.8 mg/dL which later increased to 4.2 mg/dL while still in the emergency room. Urinalysis revealed hematuria with RBC > 50 on high power field. Imaging of the abdomen revealed no acute findings for abdominal pain. With fractional excretion of sodium (FeNa > 3%, findings suggested nonoliguric acute tubular necrosis. Over the next couple of days, symptoms of dyspepsia resolved; however, BUN/Cr continued to rise to a maximum of 122/14 mg/dL. With these findings, along with stable electrolytes, urine output matching the intake, and prior use of proton pump inhibitors, medical decision was altered for the possibility of acute interstitial nephritis. Steroids were subsequently started and biopsy was taken. Biopsy revealed heavy deposits of myoglobin. Creatinine phosphokinase (CPK levels drawn ten days later after the admission were found to be elevated at 334 U/dl, presuming the levels would have been much higher during admission. This favored a diagnosis of acute kidney injury (AKI secondary to exertional rhabdomyolysis. We here describe a case of nontraumatic exertional rhabdomyolysis in a sickle cell trait (SCT individual that was missed due to findings of microscopic hematuria masking underlying myoglobinuria and fractional excretion of sodium > 3%. As opposed to other causes of ATN, rhabdomyolysis often causes FeNa < 1%. The elevated fractional excretion of sodium in this patient was possibly due to the underlying inability of SCT positive individuals

  17. The role of external drains and peritoneal conduits in the treatment of recurrent chronic subdural hematoma.

    Science.gov (United States)

    Santarius, Thomas; Qureshi, Hammad U; Sivakumaran, Ram; Kirkpatrick, Peter J; Kirollos, Ramez W; Hutchinson, Peter J

    2010-06-01

    A considerable body of evidence supporting the use of external drainage after evacuation of primary chronic subdural hematoma (CSDH) exists in the literature. However, no systematic study of the value of postoperative drainage in the treatment of recurrent CSDH has been published. The aim of the study was to investigate external drains and subdural-to-peritoneal conduit in the treatment of recurrent CSDH. A retrospective review of cases of CSDH treated in our institution between October 2002 and October 2006 was conducted. During the study period, 408 patients had burr hole evacuation. Sixty-four patients (15.9%) had treatment for recurrence. One patient had craniotomy, and the remaining 63 had another burr hole evacuation: 36 without placement of a drain (BHO), 14 with external drainage (SED), and 13 with placement of subdural-peritoneal catheter (SPC). Fifteen patients (24%) developed a secondary recurrence requiring a third drainage procedure. Postoperative drainage (SED or SPC) was associated with a significantly lower secondary recurrence rate when compared to BHO: 3/27 (11%) versus 12/36 (33%) (χ(2), P=.040). There was no significant difference in recurrence rates between SED and SPC. Postoperative complications included acute subdural hematoma (2), subdural empyema (2), brain edema (2), pneumonia (3), and in-hospital death (2). None of the complications was associated with the use of a specific technique. The results indicate that, as in the treatment of primary CSDHs, the use of drain (SED or SPC) with burr hole evacuation is safe and is associated with lower recurrence rate. Further investigation is needed to clarify the indications of currently available surgical techniques in the treatment of recurrent CSDH. Copyright © 2010 Elsevier Inc. All rights reserved.

  18. Ischemic Stroke in Young Adults of Northern China: Characteristics and Risk Factors for Recurrence.

    Science.gov (United States)

    Li, Fang; Yang, Li; Yang, Rui; Xu, Wei; Chen, Fu-Ping; Li, Nan; Zhang, Jin-Biao

    2017-01-01

    Young adults accounted for 10-14% of ischemic stroke patients. The risk factors may differ in this population from elder patients. In addition, the factors associated with stroke recurrence in this population have not been well investigated. The study aimed to investigate the characteristics and risk factors associated with recurrence of ischemic stroke in young adults. Clinical data of 1,395 patients of age 18-45 years who were treated between 2008 and 2014 in 3 centers located in northern China was reviewed. The first onset of stroke was taken as the initial events and recurrent stroke as the end point events. The end point events, age, gender, duration after first onset of stroke, history of disease, National Institutes of Health Stroke Scale (NIHSS) score at admission, Trial of Org 10172 in Acute Stroke Treatment classifications of the cause of stroke and adherence to medication were recorded. These factors were analyzed and compared between recurrence and non-recurrence group. Information about recurrent stroke was collected through clinical (readmission to hospital with ischemic stroke) or telephone follow-up survey. Logistic regression was used to analyze the risk factors of recurrence. The most common causes of stroke were large vessel atherosclerosis and small vessel occlusion, followed by cardioembolism. NIHSS score at admission (OR 1.088; 95% CI 1.028-1.152; p = 0.004) were associated with recurrence. Vascular disease, especially premature atherosclerosis, is the major risk factor for ischemic stroke in the young adult population of northern China. Timely screening of the cause of stroke with severe NIHSS score needs further attention. © 2017 The Author(s) Published by S. Karger AG, Basel.

  19. Orbital periods of recurrent novae

    International Nuclear Information System (INIS)

    Schaefer, B.E.

    1990-01-01

    The class of recurrent novae (RN) with thermonuclear runaways contains only three systems (T Pyx, U Sco, and V394 CrA), for which no orbital periods are known. This paper presents a series of photometric observations where the orbital periods for all three systems are discovered. T Pyx is found to have sinusoidal modulation with an amplitude of 0.08 mag and a period of 2.3783 h (with a possible alias of 2.6403 h). U Sco is found to be an eclipsing system with an eclipse amplitude of roughly 1.5 mag and an orbital period of 1.2344 days. V394 CrA is found to have sinusoidal modulation with an amplitude of 0.5 mag and a period of 0.7577 days. Thus two out of three RN with thermonuclear runaways (or five out of six for all RN) have evolved companions. 16 refs

  20. Recurrent Priapism from Therapeutic Quetiapine

    Directory of Open Access Journals (Sweden)

    Omeed Saghafi

    2014-02-01

    Full Text Available Priapism is rarely related to use of non-erectile related medications. The objective was to educate about the multiple possible causes of priapism and to provide treatment recommendations for the different types of priapism. We present the case of a 43 year-old African American male with a history of schizoaffective disorder who presented to our emergency department multiple times over a three year period with priapism, each episode related to the ingestion of quetiapine. Following penile aspiration and intercavernosal injection of phenylephrine, this patient had resolution of his priapism. This case demonstrates an unusual case of recurrent priapism. [West J Emerg Med. 2014;15(1:114–116.

  1. Chronic recurrent multifocal osteomyelitis (CRMO)

    International Nuclear Information System (INIS)

    Schilling, F.

    1998-01-01

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

  2. Recurrent Primary Spinal Hydatid Cyst

    Directory of Open Access Journals (Sweden)

    Okan Turk

    2015-03-01

    Full Text Available Primary hydatid disease of spine is rare and spinal hydatitosis constitute only 1% of all hydatitosis. We report a case of recurrent primary intraspinal extradural hydatid cyst of the thoracic region causing progressive paraparesis. The patient was operated 16 years ago for primary spinal hydatid disease involvement and was instrumented dorsally for stabilization. The magnetic resonance imaging (MRI of thoracic spine showed a cystic lesion at T11-12 level and compressed spinal cord posterolaterally. Intraspinal cyst was excised through T11-12 laminectomy which made formerly. The early postoperative period showed a progressive improvement of his neurological deficit and he was discharged with antihelmintic treatment consisting of albendazole and amoxicillin-sulbactam combination. [Cukurova Med J 2015; 40(Suppl 1: 84-89

  3. Treatment of locally recurrent rectal cancer

    International Nuclear Information System (INIS)

    Kococik, Z.; Kococik, M.

    2007-01-01

    The suggested classifications of locally recurrent rectal cancer are based on the presence of symptoms and the degree of tumour fixation to the pelvic wall, or, otherwise, account for factor T in the TMN system. Although the results of rectal cancer treatment have improved, which may be attributed to total meso rectal excision and application of perioperative radiotherapy and radiochemotherapy, the ratio of cases of locally recurrent rectal cancer still amount from several to over a dozen percent. Among the available diagnostic methods for detecting locally recurrent rectal cancer after anterior rectal resection, endorectal sonography is of special importance. In the estimation of prognostic factors the lack of vascular invasion in recurrent cancer and the long period between the treatment of primary rectal cancer and the development of recurrence are a sign of good prognosis, while pain prior to recurrence treatment and male sex diminish the chances for cure. Locally recurrent rectal cancer impairs the patient's quality of life in all measurable aspects, but even after complete recovery we observe severe disturbances of sexual activity in most patients, and a number of patients require hygiene pads or suffer from chronic pain. Local recurrence of rectal cancer is more commonly qualified for excision after surgical treatment only, than after preoperative radiotherapy. The probability of total recurrent rectal cancer excision increases when the patient is younger, the primary tumours was less advanced and the first operation was sphincter-sparing surgery. Progress in the surgical treatment of recurrent rectal cancer was brought on by the introduction of the composite musculocutaneous flap to compensate the loss of perineal tissue. The application of intraoperative radiotherapy improves treatment results of recurrent rectal cancer, however at the cost of more frequent, serious postoperative complications and intense pain. In inoperable cases high dose regional

  4. Differential diagnosis of recurrent bronchitis in children

    Directory of Open Access Journals (Sweden)

    I. I. Zakirov

    2016-01-01

    Full Text Available The interest of the doctors — pediatricians to recurrent bronchitis is caused by its high specific weight in the structure of bronchopulmonary pathology in children, the complexity and the need to search the differential selection of an individual regimen and prevention. Recurrent bronchitis with bronchoobstructive syndromes patient is regarded as a predictor of asthma, however, erroneously consider these nosological forms as the stages of a single pathophysiological chain as congenital and acquired diseases of respiratory system, pathology of gastro-intestinal tract, cardio-vascular system can masquerade as recurrent bronchitis. The aim of this work — to analyze the current medical literature on the problem of differential search causes leading recurrent respiratory syndrome in children. Materials and methods. The review publications domestic and foreign authors studied data from clinical and epidemiological studies. Results and its discussion. Anatomical physiological characteristics of the respiratory tract, complicated premorbid background, the re-infection of the child respiratory infection contribute to the recurrent course of bronchitis. The most common recurrent bronchitis is transient, recurrent bronchitis episodes completely stoped with the age of the child. Recurrent respiratory infections can fix bronchial hyperreactivity and with the presence of aggravated allergic history lead to the development of asthma. Severe bronchitis, resistance to standard scheme of therapy, the frequent recurrence of respiratory syndrome dictate the need to expand the diagnostic research to clarify the leading cause of recurrent bronchitis. Conclusion. Recurrent bronchitis is considered as a separate nosological form. At the same time, by repeated episodes of respiratory infection may be masked by malformations, hereditary diseases of respiratory system, bronchus foreign body microaspiration syndrome, pathology of the cardio-vascular system. 

  5. Chemoradiotherapy response in recurrent rectal cancer

    International Nuclear Information System (INIS)

    Yu, Stanley K T; Bhangu, Aneel; Tait, Diana M; Tekkis, Paris; Wotherspoon, Andrew; Brown, Gina

    2014-01-01

    The efficacy of response to preoperative chemoradiotherapy (CRT) in recurrent versus primary rectal cancer has not been investigated. We compared radiological downsizing between primary and recurrent rectal cancers following CRT and determined the optimal size reduction threshold for response validated by survival outcomes. The proportional change in tumor length for primary and recurrent rectal cancers following CRT was compared using the independent sample t-test. Overall survival (OS) was calculated using the Kaplan–Meier product limit method and differences between survival for tumor size reduction thresholds of 30% (response evaluation criteria in solid tumors [RECIST]), 40%, and 50% after CRT in primary and recurrent rectal cancer groups. A total of 385 patients undergoing CRT were analyzed, 99 with recurrent rectal cancer and 286 with primary rectal cancer. The mean proportional reduction in maximum craniocaudal length was significantly higher for primary rectal tumors (33%) compared with recurrent rectal cancer (11%) (P < 0.01). There was no difference in OS for either primary or recurrent rectal cancer when ≤30% or ≤40% definitions were used. However, for both primary and recurrent tumors, significant differences in median 3-year OS were observed when a RECIST cut-off of 50% was used. OS was 99% versus 77% in primary and 100% versus 42% in recurrent rectal cancer (P = 0.002 and P = 0.03, respectively). Only patients that demonstrated >50% size reduction showed a survival benefit. Recurrent rectal cancer appears radioresistant compared with primary tumors for tumor size after CRT. Further investigation into improving/intensifying chemotherapy and radiotherapy for locally recurrent rectal cancer is justified

  6. Recurrent atypical hemolytic uremic syndrome after renal transplantation: treatment with eculizumab

    Directory of Open Access Journals (Sweden)

    Ana B. Latzke

    2018-04-01

    Full Text Available Atypical hemolytic uremic syndrome (aHUS is a rare entity. It is characterized by a thrombotic microangiopathy (nonimmune hemolytic anemia, thrombocytopenia, and acute renal failure, with a typical histopathology of thickening of capillary and arteriolar walls and an obstructive thrombosis of the vascular lumen. The syndrome is produced by a genetic or acquired deregulation of the alternative pathway of the complement system, with high rates of end stage renal disease, post-transplant recurrence, and high mortality. Mutations associated with factor H, factor B and complement C3 show the worst prognosis. Even though plasma therapy is occasionally useful, eculizumab is effective both for treatment and prevention of post-transplant recurrence. We describe here an adult case of congenital aHUS (C3 mutation under preventive treatment with eculizumab after renal transplantation, with neither disease recurrence nor drug-related adverse events after a 36-months follow-up.

  7. An Adult Case of Recurrent Guillain-Barré Syndrome with Anti-galactocerebroside Antibodies

    Science.gov (United States)

    Takahashi, Hisashi; Kimura, Tadashi; Yuki, Natsuko; Yoshioka, Akira

    2017-01-01

    A 79-year-old woman with a history of Guillain-Barré syndrome (GBS) developed somnolence and tetraparesis after pneumonia. Based on clinical and laboratory findings, she was diagnosed with complications of acute inflammatory demyelinating polyneuropathy (AIDP) and acute disseminated encephalomyelitis (ADEM). Anti-galactocerebroside (Gal-C) IgG antibodies were detected in her serum. Cases of recurrent GBS in patients who are positive for this antibody are extremely rare. The anti-Gal-C IgG antibodies likely played an important role in the pathogenesis of the AIDP and ADEM. PMID:29093388

  8. Childhood Acute Myeloid Leukemia Treatment (PDQ®)—Health Professional Version

    Science.gov (United States)

    Acute myeloid leukemia (AML), juvenile myelomonocytic leukemia (JMML), acute promyelocytic leukemia (APL) and chronic myeloid leukemia (CML) account for about 20% of childhood myeloid leukemias. Other myeloid malignancies include transient abnormal myelopoiesis and myelodysplastic syndrome. Get detailed information about the classification, clinical presentation, diagnostic and molecular evaluation, prognosis, and treatment of newly diagnosed and recurrent disease in this summary for clinicians.

  9. Predictors for Recurrence of Chronic Subdural Hematoma.

    Science.gov (United States)

    Hammer, Alexander; Tregubow, Alexander; Kerry, Ghassan; Schrey, Michael; Hammer, Christian; Steiner, Hans-Herbert

    2017-01-01

    This prospective study was designed to analyze the dependence of different factors on the recurrence rate of chronic subdural hematoma (cSDH) after surgical treatment. Seventy-three consecutive patients, who were surgically treated at our department due to cSDH between 2009 and 2012, were included. The following parameters were analyzed: patient age and gender, occurrence of trauma, time between trauma and admission, neurological symptoms, presence of minor diseases, intake of anticoagulation medication. We classified the results of diagnostic imaging and determined the space-consuming effect via the cerebral midline shift. In addition, we scrutinized intraoperative findings and the dependence of the position of subdural drainage on the recurrence rate of cSDH. In our patient group, cSDH recurrence was significantly associated with aphasia (p=0.008). Moreover an increased cSDH recurrence rate was observed in the patient group that had a separated manifestation of the cSDH in the preoperative diagnostic imaging (p=0.048) and received no drainage implant (p=0.016). Homogeneous isodense cSDH was associated with no apparent recurrence (p=0.037). Within the scope of this study, we detected aphasia and separated cSDH as predictors of cSDH recurrence. Homogeneous isodense cSDH seems to be a good prognostic sign regarding the risk of recurrence development. Furthermore, our data clearly emphasize the importance of surgically applied drainage implants to prevent a recurrence of cSDH.

  10. Recurrent gastric lactobezoar in an infant

    OpenAIRE

    Castro, Leonor; Berenguer, Alberto; Pilar, Carla; Gon?alves, Rute; Nunes, Jos? L.

    2014-01-01

    Lactobezoars are a type of bezoar composed of undigested milk and mucus. The aetiology is likely multifactorial, being classically described in association with pre-term, low-birth weight infants fed with hyperconcentrated formula. The authors present a case of lactobezoar recurrence in a pre-term infant with oesophageal atresia. To our knowledge, this is the first report of recurrence of lactobezoar.

  11. 14 CFR 91.1107 - Recurrent training.

    Science.gov (United States)

    2010-01-01

    ..., as appropriate, including low-altitude windshear training and training on operating during ground... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Recurrent training. 91.1107 Section 91.1107... Management § 91.1107 Recurrent training. (a) Each program manager must ensure that each crewmember receives...

  12. Surgical Management of Recurrent Odontogenic Keratocyst

    OpenAIRE

    Semi, Ravinder Singh; Thapliyal, G. K.; Menon, Suresh

    2010-01-01

    The odontogenic keratocyst is a distinct entity arising from odontogenic epithelium. The unique histopathological appearance and the propensity for recurrence has made it management controversial in terms of the conservatism to be followed. This article describes the management of a case of recurrent odontogenic keratocyst with an aggressive therapy being adopted due to the nature of the pathology.

  13. Therapeutic resistance and cancer recurrence mechanisms

    Indian Academy of Sciences (India)

    Cancer recurrence is believed to be one of the major reasons for the failure of cancer treatment strategies. Thisbiological phenomenon could arise from the incomplete eradication of tumour cells after chemo- and radiotherapy.Recent developments in the design of models reflecting cancer recurrence and in vivo imaging ...

  14. Association of recurrent pregnancy loss with chromosomal ...

    African Journals Online (AJOL)

    EB

    for recurrent pregnancy loss and these patients are the best candidates for offering prenatal genetic diagnosis by the help of which there is a possibility of obtaining a better reproductive outcome. Key words: chromosomal abnormality, recurrent pregnancy loss, thrombophilia. African Health Sciences 2013; 13(2): 447 - 452 ...

  15. Recurrent midgut volvulus following a Ladd procedure

    International Nuclear Information System (INIS)

    Panghaal, Vikash; Levin, Terry L.; Han, Bokyung

    2008-01-01

    We present a case of recurrent midgut volvulus in a 3-year-old girl with a history of midgut volvulus repair as an infant. Awareness of the possibility of recurrence even several years following an initial Ladd procedure is crucial to ensure prompt treatment in these children. (orig.)

  16. Recurrent midgut volvulus following a Ladd procedure

    Energy Technology Data Exchange (ETDEWEB)

    Panghaal, Vikash; Levin, Terry L.; Han, Bokyung [Montefiore Medical Center, Department of Radiology, Bronx, NY (United States)

    2008-04-15

    We present a case of recurrent midgut volvulus in a 3-year-old girl with a history of midgut volvulus repair as an infant. Awareness of the possibility of recurrence even several years following an initial Ladd procedure is crucial to ensure prompt treatment in these children. (orig.)

  17. Local Recurrence After Uveal Melanoma Proton Beam Therapy: Recurrence Types and Prognostic Consequences

    Energy Technology Data Exchange (ETDEWEB)

    Caujolle, Jean-Pierre, E-mail: ncaujolle@aol.com [Department of Ophthalmology, Saint Roch Hospital, Nice Teaching Hospital, Nice (France); Paoli, Vincent [Department of Ophthalmology, Saint Roch Hospital, Nice Teaching Hospital, Nice (France); Chamorey, Emmanuel [Department of Radiation Oncology, Protontherapy Center, Centre Antoine Lacassagne, Nice (France); Department of Biostatistics and Epidemiology, Centre Antoine Lacassagne, Nice (France); Maschi, Celia; Baillif, Stéphanie [Department of Ophthalmology, Saint Roch Hospital, Nice Teaching Hospital, Nice (France); Herault, Joël [Department of Radiation Oncology, Protontherapy Center, Centre Antoine Lacassagne, Nice (France); Gastaud, Pierre [Department of Ophthalmology, Saint Roch Hospital, Nice Teaching Hospital, Nice (France); Hannoun-Levi, Jean Michel [Department of Radiation Oncology, Protontherapy Center, Centre Antoine Lacassagne, Nice (France)

    2013-04-01

    Purpose: To study the prognosis of the different types of uveal melanoma recurrences treated by proton beam therapy (PBT). Methods and Materials: This retrospective study analyzed 61 cases of uveal melanoma local recurrences on a total of 1102 patients treated by PBT between June 1991 and December 2010. Survival rates have been determined by using Kaplan-Meier curves. Prognostic factors have been evaluated by using log-rank test or Cox model. Results: Our local recurrence rate was 6.1% at 5 years. These recurrences were divided into 25 patients with marginal recurrences, 18 global recurrences, 12 distant recurrences, and 6 extrascleral extensions. Five factors have been identified as statistically significant risk factors of local recurrence in the univariate analysis: large tumoral diameter, small tumoral volume, low ratio of tumoral volume over eyeball volume, iris root involvement, and safety margin inferior to 1 mm. In the local recurrence-free population, the overall survival rate was 68.7% at 10 years and the specific survival rate was 83.6% at 10 years. In the local recurrence population, the overall survival rate was 43.1% at 10 years and the specific survival rate was 55% at 10 years. The multivariate analysis of death risk factors has shown a better prognosis for marginal recurrences. Conclusion: Survival rate of marginal recurrences is superior to that of the other recurrences. The type of recurrence is a clinical prognostic value to take into account. The influence of local recurrence retreatment by proton beam therapy should be evaluated by novel studies.

  18. Local Recurrence After Uveal Melanoma Proton Beam Therapy: Recurrence Types and Prognostic Consequences

    International Nuclear Information System (INIS)

    Caujolle, Jean-Pierre; Paoli, Vincent; Chamorey, Emmanuel; Maschi, Celia; Baillif, Stéphanie; Herault, Joël; Gastaud, Pierre; Hannoun-Levi, Jean Michel

    2013-01-01

    Purpose: To study the prognosis of the different types of uveal melanoma recurrences treated by proton beam therapy (PBT). Methods and Materials: This retrospective study analyzed 61 cases of uveal melanoma local recurrences on a total of 1102 patients treated by PBT between June 1991 and December 2010. Survival rates have been determined by using Kaplan-Meier curves. Prognostic factors have been evaluated by using log-rank test or Cox model. Results: Our local recurrence rate was 6.1% at 5 years. These recurrences were divided into 25 patients with marginal recurrences, 18 global recurrences, 12 distant recurrences, and 6 extrascleral extensions. Five factors have been identified as statistically significant risk factors of local recurrence in the univariate analysis: large tumoral diameter, small tumoral volume, low ratio of tumoral volume over eyeball volume, iris root involvement, and safety margin inferior to 1 mm. In the local recurrence-free population, the overall survival rate was 68.7% at 10 years and the specific survival rate was 83.6% at 10 years. In the local recurrence population, the overall survival rate was 43.1% at 10 years and the specific survival rate was 55% at 10 years. The multivariate analysis of death risk factors has shown a better prognosis for marginal recurrences. Conclusion: Survival rate of marginal recurrences is superior to that of the other recurrences. The type of recurrence is a clinical prognostic value to take into account. The influence of local recurrence retreatment by proton beam therapy should be evaluated by novel studies

  19. 6th International Symposium on Recurrence Plots

    CERN Document Server

    Jr, Jr; Ioana, Cornel; Marwan, Norbert

    2016-01-01

    The chapters in this book originate from the research work and contributions presented at the Sixth International Symposium on Recurrence Plots held in Grenoble, France in June 2015. Scientists from numerous disciplines gathered to exchange knowledge on recent applications and developments in recurrence plots and recurrence quantification analysis. This meeting was remarkable because of the obvious expansion of recurrence strategies (theory) and applications (practice) into ever-broadening fields of science. It discusses real-world systems from various fields, including mathematics, strange attractors, applied physics, physiology, medicine, environmental and earth sciences, as well as psychology and linguistics. Even readers not actively researching any of these particular systems will benefit from discovering how other scientists are finding practical non-linear solutions to specific problems. The book is of interest to an interdisciplinary audience of recurrence plot users and researchers interested in time...

  20. Acute abdomen

    Directory of Open Access Journals (Sweden)

    Wig J

    1978-01-01

    Full Text Available 550 cases of acute abdomen have been analysed in detail includ-ing their clinical presentation and operative findings. Males are more frequently affected than females in a ratio of 3: 1. More than 45% of patients presented after 48 hours of onset of symptoms. Intestinal obstruction was the commonest cause of acute abdomen (47.6%. External hernia was responsible for 26% of cases of intestinal obstruction. Perforated peptic ulcer was the commonest cause of peritonitis in the present series (31.7% while incidence of biliary peritonitis was only 2.4%.. The clinical accuracy rate was 87%. The mortality in operated cases was high (10% while the over-all mortality rate was 7.5%.

  1. Patients at high risk of tuberculosis recurrence

    Directory of Open Access Journals (Sweden)

    Mehdi Mirsaeidi

    2018-01-01

    Full Text Available Recurrent tuberculosis (TB continues to be a significant problem and is an important indicator of the effectiveness of TB control. Recurrence can occur by relapse or exogenous reinfection. Recurrence of TB is still a major problem in high-burden countries, where there is lack of resources and no special attention is being given to this issue. The rate of recurrence is highly variable and has been estimated to range from 4.9% to 47%. This variability is related to differences in regional epidemiology of recurrence and differences in the definitions used by the TB control programs. In addition to treatment failure from noncompliance, there are several key host factors that are associated with high rates of recurrence. The widely recognized host factors independent of treatment program that predispose to TB recurrence include gender differences, malnutrition; comorbidities such as diabetes, renal failure, and systemic diseases, especially immunosuppressive states such as human immunodeficiency virus; substance abuse; and environmental exposures such as silicosis. With improved understanding of the human genome, proteome, and metabolome, additional host-specific factors that predispose to recurrence are being identified. Information on temporal and geographical trends of TB cases as well as studies with whole-genome sequencing might provide further information to enable us to fully understand TB recurrence and discriminate between reactivation and new infection. The recently launched World Health Organization End TB Strategy emphasizes the importance of integrated, patient-centered TB care. Continued improvement in diagnosis, treatment approaches, and an understanding of host-specific factors are needed to fully understand the clinical epidemiological and social determinants of TB recurrence.

  2. Patients at high risk of tuberculosis recurrence.

    Science.gov (United States)

    Mirsaeidi, Mehdi; Sadikot, Ruxana T

    2018-01-01

    Recurrent tuberculosis (TB) continues to be a significant problem and is an important indicator of the effectiveness of TB control. Recurrence can occur by relapse or exogenous reinfection. Recurrence of TB is still a major problem in high-burden countries, where there is lack of resources and no special attention is being given to this issue. The rate of recurrence is highly variable and has been estimated to range from 4.9% to 47%. This variability is related to differences in regional epidemiology of recurrence and differences in the definitions used by the TB control programs. In addition to treatment failure from noncompliance, there are several key host factors that are associated with high rates of recurrence. The widely recognized host factors independent of treatment program that predispose to TB recurrence include gender differences, malnutrition; comorbidities such as diabetes, renal failure, and systemic diseases, especially immunosuppressive states such as human immunodeficiency virus; substance abuse; and environmental exposures such as silicosis. With improved understanding of the human genome, proteome, and metabolome, additional host-specific factors that predispose to recurrence are being identified. Information on temporal and geographical trends of TB cases as well as studies with whole-genome sequencing might provide further information to enable us to fully understand TB recurrence and discriminate between reactivation and new infection. The recently launched World Health Organization End TB Strategy emphasizes the importance of integrated, patient-centered TB care. Continued improvement in diagnosis, treatment approaches, and an understanding of host-specific factors are needed to fully understand the clinical epidemiological and social determinants of TB recurrence.

  3. Chemoradiotherapy response in recurrent rectal cancer.

    Science.gov (United States)

    Yu, Stanley K T; Bhangu, Aneel; Tait, Diana M; Tekkis, Paris; Wotherspoon, Andrew; Brown, Gina

    2014-02-01

    The efficacy of response to preoperative chemoradiotherapy (CRT) in recurrent versus primary rectal cancer has not been investigated. We compared radiological downsizing between primary and recurrent rectal cancers following CRT and determined the optimal size reduction threshold for response validated by survival outcomes. The proportional change in tumor length for primary and recurrent rectal cancers following CRT was compared using the independent sample t-test. Overall survival (OS) was calculated using the Kaplan-Meier product limit method and differences between survival for tumor size reduction thresholds of 30% (response evaluation criteria in solid tumors [RECIST]), 40%, and 50% after CRT in primary and recurrent rectal cancer groups. A total of 385 patients undergoing CRT were analyzed, 99 with recurrent rectal cancer and 286 with primary rectal cancer. The mean proportional reduction in maximum craniocaudal length was significantly higher for primary rectal tumors (33%) compared with recurrent rectal cancer (11%) (P rectal cancer when ≤30% or ≤40% definitions were used. However, for both primary and recurrent tumors, significant differences in median 3-year OS were observed when a RECIST cut-off of 50% was used. OS was 99% versus 77% in primary and 100% versus 42% in recurrent rectal cancer (P = 0.002 and P = 0.03, respectively). Only patients that demonstrated >50% size reduction showed a survival benefit. Recurrent rectal cancer appears radioresistant compared with primary tumors for tumor size after CRT. Further investigation into improving/intensifying chemotherapy and radiotherapy for locally recurrent rectal cancer is justified. © 2013 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  4. Acute Blindness.

    Science.gov (United States)

    Meekins, Jessica M

    2015-09-01

    Sudden loss of vision is an ophthalmic emergency with numerous possible causes. Abnormalities may occur at any point within the complex vision pathway, from retina to optic nerve to the visual center in the occipital lobe. This article reviews specific prechiasm (retina and optic nerve) and cerebral cortical diseases that lead to acute blindness. Information regarding specific etiologies, pathophysiology, diagnosis, treatment, and prognosis for vision is discussed. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Patterns and determinants of acute psychiatric readmissions | Behr ...

    African Journals Online (AJOL)

    Patterns and determinants of acute psychiatric readmissions. Graham Michael Behr, Cathy Christie, Neil Soderlund, Tennyson Lee. Abstract. Objectives. Deinstitutionalisation and shortage of psychiatric beds worldwide has led to extensive research into the risk factors and interventions associated with rapid and recurrent ...

  6. Apixaban with antiplatelet therapy after acute coronary syndrome

    NARCIS (Netherlands)

    Alexander, J.H.; Lopes, R.D.; James, S.; Kilaru, R.; He, Y.; Mohan, P.; Bhatt, D.L.; Goodman, S.; Verheugt, F.W.A.; Flather, M.; Huber, K.; Liaw, D.; Husted, S.E.; Lopez-Sendon, J.; De Caterina, R.; Jansky, P.; Darius, H.; Vinereanu, D.; Cornel, J.H.; Cools, F.; Atar, D.; Leiva-Pons, J.L.; Keltai, M.; Ogawa, H.; Pais, P.; Parkhomenko, A.; Ruzyllo, W.; Diaz, R.; White, H.; Ruda, M.; Geraldes, M.; Lawrence, J.; Harrington, R.A.; Wallentin, L.

    2011-01-01

    BACKGROUND: Apixaban, an oral, direct factor Xa inhibitor, may reduce the risk of recurrent ischemic events when added to antiplatelet therapy after an acute coronary syndrome. METHODS: We conducted a randomized, double-blind, placebo-controlled clinical trial comparing apixaban, at a dose of 5 mg

  7. Recurrent Childhood Animal Cruelty and Its Link to Recurrent Adult Interpersonal Violence.

    Science.gov (United States)

    Trentham, Caleb E; Hensley, Christopher; Policastro, Christina

    2018-06-01

    In the early 1960s, researchers began to examine the potential link between childhood animal cruelty and future interpersonal violence. Findings since then have been inconsistent in establishing a relationship between the two. This may be due to researchers failing to measure the recurrency of childhood animal abuse and the recurrency of later violent acts committed in adulthood. The current study, using data from 257 inmates at a medium-security prison in a Southern state, is a replication of research conducted by Tallichet and Hensley, and Hensley, Tallichet, and Dutkiewicz, which examined this recurrency issue. The only statistically significant predictor of recurrent adult interpersonal violence in this study was recurrent childhood animal cruelty. Inmates who engaged in recurrent childhood animal cruelty were more likely to commit recurrent adult interpersonal violence. Respondents' race, education, and childhood residence were not significant predictors of the outcome variable.

  8. CURRENT STATUS OF PROBLEM: CHILDREN WITH RECURRENT RESPIRATORY INFECTIONS

    Directory of Open Access Journals (Sweden)

    V.A. Bulgakova

    2007-01-01

    Full Text Available The article deals with children suffered from recurrent respiraatory infections. The authors attempted to summarize the literature data on the research findings of inosine pranobex application (Isoa prinosine, Teva, Israel in complex therapy against virulent and inflammatory diseases. Within recent years, many experts emphaasize the persistence of viruses and other pathogenic microorganaisms in the human body, which leads to changes in reactivity and emergence of the chronic diseases. These disorders are especially urgent for sickly children, suffering from respiratory infections, what well justifies the application of bacteriogenic immunomodulaa tors, interferon synthesis inductors, expediency for incorporating immunomodulators with antiviral action into complex therapy along with special vaccination against flu, pneumococcus and etc.Key words: sickly children, acute respiratory infections, immunomodulators, inosine pranobex.

  9. Aneurysm Recurrence Volumetry Is More Sensitive than Visual Evaluation of Aneurysm Recurrences.

    Science.gov (United States)

    Schönfeld, M H; Schlotfeldt, V; Forkert, N D; Goebell, E; Groth, M; Vettorazzi, E; Cho, Y D; Han, M H; Kang, H-S; Fiehler, J

    2016-03-01

    Considerable inter-observer variability in the visual assessment of aneurysm recurrences limits its use as an outcome parameter evaluating new coil generations. The purpose of this study was to compare visual assessment of aneurysm recurrences and aneurysm recurrence volumetry with an example dataset of HydroSoft coils (HSC) versus bare platinum coils (BPC). For this retrospective study, 3-dimensional time-of-flight magnetic resonance angiography datasets acquired 6 and 12 months after endovascular therapy using BPC only or mainly HSC were analyzed. Aneurysm recurrence volumes were visually rated by two observersas well as quantified by subtraction of the datasets after intensity-based rigid registration. A total of 297 aneurysms were analyzed (BPC: 169, HSC: 128). Recurrences were detected by aneurysm recurrence volumetry in 9 of 128 (7.0 %) treated with HSC and in 24 of 169 (14.2 %) treated with BPC (odds ratio: 2.39, 95 % confidence interval: 1.05-5.48; P = 0.039). Aneurysm recurrence volumetry revealed an excellent correlation between observers (Cronbach's alpha = 0.93). In contrast, no significant difference in aneurysm recurrence was found for visual assessment (3.9 % in HSC cases and 4.7 % in BPC cases). Recurrences were observed in aneurysms smaller than the sample median in 10 of 33 (30.3 %) by aneurysm recurrence volumetry and in 1 of 13 (7.7 %) by visual assessment. Aneurysm recurrences were detected more frequently by aneurysm recurrence volumetry when compared with visual assessment. By using aneurysm recurrence volumetry, differences between treatment groups were detected with higher sensitivity and inter-observer validity probably because of the higher detection rate of recurrences in small aneurysms.

  10. Salvage Re-Irradiation for Recurrent Head and Neck Cancer

    International Nuclear Information System (INIS)

    Lee, Nancy; Chan, Kelvin; Bekelman, Justin E.; Zhung, Joanne; Mechalakos, James; Narayana, Ashwatha; Wolden, Suzanne; Venkatraman, Ennapadam S.; Pfister, David; Kraus, Dennis; Shah, Jatin; Zelefsky, Michael J.

    2007-01-01

    Purpose: To present a retrospective review of treatment outcomes for recurrent head and neck (HN) cancer patients treated with re-irradiation (re-RT) at a single medical center. Methods and Materials: From July 1996-September 2005, 105 patients with recurrent HN cancer underwent re-RT at our institution. Sites included were: the neck (n = 21), nasopharynx (n 21), paranasal sinus (n = 18), oropharynx (n = 16), oral cavity (n = 9), larynx (n = 10), parotid (n = 6), and hypopharynx (n = 4). The median prior RT dose was 62 Gy. Seventy-five patients received chemotherapy with their re-RT (platinum-based in the majority of cases). The median re-RT dose was 59.4 Gy. In 74 (70%), re-RT utilized intensity-modulated radiation therapy (IMRT). Results: With a median follow-up of 35 months, 18 patients were alive with no evidence of disease. The 2-year loco-regional progression-free survival (LRPFS) and overall survival rates were 42% and 37%, respectively. Patients who underwent IMRT, compared to those who did not, had a better 2-year LRPF (52% vs. 20%, p < 0.001). On multivariate analysis, non-nasopharynx and non-IMRT were associated with an increased risk of loco-regional (LR) failure. Patients with LR progression-free disease had better 2-year overall survival vs. those with LR failure (56% vs. 21%, p < 0.001). Acute and late Grade 3-4 toxicities were reported in 23% and 15% of patients. Severe Grade 3-4 late complications were observed in 12 patients, with a median time to development of 6 months after re-RT. Conclusions: Based on our data, achieving LR control is crucial for improved overall survival in this patient population. The use of IMRT predicted better LR tumor control. Future aggressive efforts in maximizing tumor control in the recurrent setting, including dose escalation with IMRT and improved chemotherapy, are warranted

  11. Can anaesthetic and analgesic techniques affect cancer recurrence or metastasis?

    LENUS (Irish Health Repository)

    Heaney, A

    2012-12-01

    Summary Cancer is a leading cause of morbidity and mortality worldwide and the ratio of incidence is increasing. Mortality usually results from recurrence or metastases. Surgical removal of the primary tumour is the mainstay of treatment, but this is associated with inadvertent dispersal of neoplastic cells into the blood and lymphatic systems. The fate of the dispersed cells depends on the balance of perioperative factors promoting tumour survival and growth (including surgery per se, many anaesthetics per se, acute postoperative pain, and opioid analgesics) together with the perioperative immune status of the patient. Available evidence from experimental cell culture and live animal data on these factors are summarized, together with clinical evidence from retrospective studies. Taken together, current data are sufficient only to generate a hypothesis that an anaesthetic technique during primary cancer surgery could affect recurrence or metastases, but a causal link can only be proved by prospective, randomized, clinical trials. Many are ongoing, but definitive results might not emerge for a further 5 yr or longer. Meanwhile, there is no hard evidence to support altering anaesthetic technique in cancer patients, pending the outcome of the ongoing clinical trials.

  12. Elevated Neutrophil Lymphocyte Ratio in Recurrent Optic Neuritis

    Directory of Open Access Journals (Sweden)

    Hande Guclu

    2015-01-01

    Full Text Available Purpose. To demonstrate the relation between optic neuritis (ON and systemic inflammation markers as neutrophil lymphocyte ratio (N/L ratio, platelet count, mean platelet volume (MPV, and red cell distribution width (RDW and furthermore to evaluate the utilization of these markers to predict the frequency of the ON episodes. Methods. Forty-two patients with acute ON and forty healthy subjects were enrolled into the study. The medical records were reviewed for age, sex, hemoglobin (Hb, Haematocrit (Htc, RDW, platelet count, MPV, white blood cell count (WBC, neutrophil and lymphocyte count, and neutrophil lymphocyte ratio (N/L ratio. Results. The mean N/L ratio, platelet counts, and RDW were significantly higher in ON group (p=0.000, p=0.048, and p=0.002. There was a significant relation between N/L ratio and number of episodes (r=0.492, p=0.001. There was a statistically significant difference for MPV between one episode group and recurrent ON group (p=0.035. Conclusions. Simple and inexpensive laboratory methods could help us show systemic inflammation and monitor ON patients. Higher N/L ratio can be a useful marker for predicting recurrent attacks.

  13. RECURRENT CORNUAL ECTOPIC PREGNANCY – A CASE REPORT

    Directory of Open Access Journals (Sweden)

    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.

  14. Recurrent laughter-induced syncope.

    Science.gov (United States)

    Gaitatzis, Athanasios; Petzold, Axel

    2012-07-01

    Syncope is a common presenting complaint in Neurology clinics or Emergency departments, but its causes are sometimes difficult to diagnose. Apart from vasovagal attacks, other benign, neurally mediated syncopes include "situational" syncopes, which occur after urination, coughing, swallowing, or defecation. A healthy 42-year-old male patient presented to the neurology clinic with a long history of faints triggered by spontaneous laughter, especially after funny jokes. Physical and neurological examination, and electroencephalography and magnetic resonance imaging were unremarkable. There was no evidence to suggest cardiogenic causes, epilepsy, or cataplexy and a diagnosis of laughing syncope was made. Laughter-induced syncope is usually a single event in the majority of cases, but may present as recurrent attacks as in our case. Some cases occur in association with underlying neurological conditions. Prognosis is good in the case of neurally mediated attacks. Laughter may not be recognized by physicians as a cause of syncope, which may lead to unnecessary investigations or misdiagnosis, and affect patients' quality of life.

  15. MDX-010 in Treating Patients With Recurrent or Refractory Lymphoma

    Science.gov (United States)

    2014-05-22

    Adult Grade III Lymphomatoid Granulomatosis; B-cell Chronic Lymphocytic Leukemia; Cutaneous B-cell Non-Hodgkin Lymphoma; Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue; Intraocular Lymphoma; Nodal Marginal Zone B-cell Lymphoma; Recurrent Adult Burkitt Lymphoma; Recurrent Adult Diffuse Large Cell Lymphoma; Recurrent Adult Diffuse Mixed Cell Lymphoma; Recurrent Adult Diffuse Small Cleaved Cell Lymphoma; Recurrent Adult Grade III Lymphomatoid Granulomatosis; Recurrent Adult Hodgkin Lymphoma; Recurrent Adult Immunoblastic Large Cell Lymphoma; Recurrent Adult Lymphoblastic Lymphoma; Recurrent Grade 1 Follicular Lymphoma; Recurrent Grade 2 Follicular Lymphoma; Recurrent Mantle Cell Lymphoma; Recurrent Marginal Zone Lymphoma; Refractory Hairy Cell Leukemia; Small Intestine Lymphoma; Splenic Marginal Zone Lymphoma; Testicular Lymphoma; Waldenström Macroglobulinemia

  16. Inguinal hernia recurrence: Classification and approach

    Directory of Open Access Journals (Sweden)

    Campanelli Giampiero

    2006-01-01

    Full Text Available The authors reviewed the records of 2,468 operations of groin hernia in 2,350 patients, including 277 recurrent hernias updated to January 2005. The data obtained - evaluating technique, results and complications - were used to propose a simple anatomo-clinical classification into three types which could be used to plan the surgical strategy:Type R1: first recurrence ′high,′ oblique external, reducible hernia with small (< 2 cm defect in non-obese patients, after pure tissue or mesh repairType R2: first recurrence ′low,′ direct, reducible hernia with small (< 2 cm defect in non-obese patients, after pure tissue or mesh repairType R3: all the other recurrences - including femoral recurrences; recurrent groin hernia with big defect (inguinal eventration; multirecurrent hernias; nonreducible, linked with a controlateral primitive or recurrent hernia; and situations compromised from aggravating factors (for example obesity or anyway not easily included in R1 or R2, after pure tissue or mesh repair.

  17. Acute ankle sprain: conservative or surgical approach?

    Science.gov (United States)

    Al-Mohrej, Omar A.; Al-Kenani, Nader S.

    2016-01-01

    Ankle sprains fall into two main categories: acute ankle sprains and chronic ankle instability, which are among the most common recurrent injuries during occupational activities, athletic events, training and army service. Acute ankle sprain is usually managed conservatively and functional rehabilitation failure by conservative treatment leads to development of chronic ankle instability, which most often requires surgical intervention. Enhancing the in-depth knowledge of the ankle anatomy, biomechanics and pathology helps greatly in deciding the management options. Cite this article: Al-Mohrej OA, Al-Kenani NS. Acute ankle sprain: conservative or surgical approach? EFORT Open Rev 2016;1:34-44. DOI: 10.1302/2058-5241.1.000010. PMID:28461926

  18. Agranulocytosis occurrence following recent acute infectious mononucleosis.

    Science.gov (United States)

    Massoll, Anthony F; Powers, Stanlyn C; Betten, David P

    2017-05-01

    Infectious mononucleosis secondary to Epstein-Barr virus typically follows a relatively benign and self-limited course. A small subset of individuals may develop further progression of disease including hematologic, neurologic, and cardiac abnormalities. A mild transient neutropenia occurring during the first weeks of acute infection is a common finding however in rare cases a more profound neutropenia and agranulocytosis may occur up to 6weeks following the onset of initial symptoms. We describe the case of an 18-year-old woman who presented 26days following an acute infectious mononucleosis diagnosis with agranulocytosis and fever. No source of infection was identified and the patient had rapid improvement in her symptoms and resolution of her neutropenia. The presence of fever recurrence and other non-specific symptoms in individuals 2-6weeks following acute infectious mononucleosis symptom onset may warrant further assessment for this uncommon event. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. The effect of external beam radiotherapy volume on locoregional control in patients with locoregionally advanced or recurrent nonanaplastic thyroid cancer

    International Nuclear Information System (INIS)

    Kim, Tae Hyun; Kim, Sang Soo; Cho, Kwan Ho; Shin, Kyung Hwan; Chung, Ki-Wook; Lee, You Jin; Park, Chan Sung; Lee, Eun Kyung; Kim, Tae Sung; Kim, Seok Ki; Jung, Yoo Seok; Ryu, Jun Sun

    2010-01-01

    We evaluated outcomes of patients treated with external beam radiotherapy (EBRT) for locoregionally advanced or recurrent nonanaplastic thyroid cancer and analyzed the effect of EBRT volume on locoregional control. This study included 23 patients with locoregionally advanced or recurrent nonanaplastic thyroid cancer who were treated with EBRT. Two different EBRT target volumes were executed as follows: 1) limited field (LF, n = 11) included the primary (involved lobe) or recurrent tumor bed and the positive nodal area; 2) elective field (EF, n = 12) included the primary (involved lobe) or recurrent tumor bed and the regional nodal areas in the cervical neck and upper mediastinum. Clinical parameters, such as gender, age, histologic type, recurrence, stage, thyroglobulin level, postoperative residuum, radioiodine treatment, and EBRT volume were analyzed to identify prognostic factors associated with locoregional control. There were no significant differences in the clinical parameter distributions between the LF and EF groups. In the LF group, six (55%) patients developed locoregional recurrence and three (27%) developed distant metastasis. In the EF group, one (8%) patient developed locoregional recurrence and one (8%) developed a distant metastasis. There was a significant difference in locoregional control rate at 5 years in the LF and EF groups (40% vs. 89%, p = 0.041). There were no significant differences in incidences of acute and late toxicities between two groups (p >0.05). EBRT with EF provided significantly better locoregional control than that of LF; however, further larger scaled studies are warranted

  20. Factors associated with recurrent bacterial empyema thoracis

    Directory of Open Access Journals (Sweden)

    Apichat Tantraworasin

    2018-07-01

    Full Text Available Summary: Background: Empyema thoracis (ET is one of the common thoracic diseases frequently found in developing countries. In the past, only a few studies have analyzed recurrent ET, and none had clearly identified the prognostic factors for recurrence. The aim of this study is to identify the prognostic factors of recurrent ET in Northern Thailand. Methods: A retrospective cohort study was conducted. All patients diagnosed with Stage II and III ET at Maharaj Nakorn Chiang Mai Hospital (a tertiary-care hospital in northern Thailand between January 1, 2007 and November 31, 2012 were enrolled in this study. All clinical data were extracted from the medical recording system. The primary outcome was recurrent disease. Multivariable Cox’s proportion hazard model was used to identify the independent prognostic factors for recurrence. Results: There were 382 patients enrolled in this study, and 34 patients (8.9% had recurrent disease. The most common gram-positive and gram-negative pathogens found were Staphylococcus aureus and Acinetobacter baumannii, respectively. Three independent prognostic factors for recurrent disease were nonsepsis status prior to the surgery [hazard ratio (HR = 12.3; 95% confidence interval (CI, 4.25–35.43], nonperforming decortication (HR = 5.4; 95% CI, 1.82–15.92, and persistent pleural spaces (HR = 4.1; 95% CI, 1.93–8.68. Conclusions: Clinical characteristics, surgical procedure, and persistent pleural spaces were independent prognostic factors for ET recurrence in this study. Decortication and early thoracoplasty in patients who had persistent pleural space should be considered. Large cohort studies are warranted to support these findings. Keywords: empyema thoracis, incidence, prognostic factor, pyothorax, recurrence

  1. Salvage photodynamic therapy for recurrent nasopharyngeal carcinoma.

    Science.gov (United States)

    Succo, Giovanni; Rosso, S; Fadda, G L; Fantini, M; Crosetti, Erika

    2014-06-01

    To evaluate the feasibility of photodynamic therapy (NP-PDT) in the palliative management of recurrent/persistent nasopharyngeal cancer (NFC). Six patients with persistent/recurrent NPC underwent PDT with palliative intent. NP-PDT was delivered by three different methods depending on the localization, size and depth of the lesion: type I NP-PDT: transnasal direct illumination of postero-superior recurrence; type II NP-PDT: transnasal direct illumination of the whole nasopharynx; type III NP-PDT: transoral direct or interstitial illumination of lateral recurrence. In this case, the ENT-magnetic navigation system (MNS) was extremely useful in identifying the tumor and its distance from the ICA. Both patients treated with NP-PDT type I are free from disease at 38 and 71 months after treatment; both patients treated with NP-PDT type II experienced further local and loco-regional recurrence of disease within 16 months; one died of the disease while the second underwent a second palliative treatment, NP-PDT type I, and is currently living with the disease; of the two patients who underwent NP-PDT type III, one died as a result of regional and systemic recurrence without local recurrence while the second experienced a superficial recurrence. He underwent a second NP-PDT type III treatment and is currently free from disease at 21 months. NP-PDT is a non-invasive and simple treatment modality that may have an important role in the treatment of selected cases of persistent/recurrent NPC in its early stage, not suitable for a conventional therapeutic protocol. Coupling NP-PDT with the ENT-MNS can be an effective strategy to obtain more precise light delivery within the tumor, particularly in lateral and parapharyngeal localization. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  2. Risk factors for recurrent spontaneous epistaxis.

    Science.gov (United States)

    Abrich, Victor; Brozek, Annabelle; Boyle, Timothy R; Chyou, Po-Huang; Yale, Steven H

    2014-12-01

    To identify risk factors associated with spontaneous recurrent epistaxis. This was a retrospective cohort study assessing patients in the Marshfield Clinic system diagnosed as having epistaxis between January 1, 1991, and January 1, 2011. There were 461 cases with at least 2 episodes of spontaneous epistaxis within 3 years and 912 controls with only 1 episode in the same time frame. More than 50 potential risk factors were investigated, including demographic features, substance use, nasal anatomical abnormalities, nasal infectious and inflammatory processes, medical comorbidities, medications, and laboratory values. A Cox proportional hazards regression modeling approach was used to calculate hazard ratios of epistaxis recurrence. Traditional risk factors for epistaxis, including nasal perforation, nasal septum deviation, rhinitis, sinusitis, and upper respiratory tract infection, did not increase the risk of recurrence. Significant risk factors for recurrent epistaxis included congestive heart failure, diabetes mellitus, hypertension, and a history of anemia. Warfarin use increased the risk of recurrence, independent of international normalized ratio. Aspirin and clopidogrel were not found to increase the risk of recurrence. Few major adverse cardiovascular events were observed within 30 days of the first epistaxis event. Congestive heart failure is an underappreciated risk factor for recurrent epistaxis. Hypertension and diabetes mellitus may induce atherosclerotic changes in the nasal vessels, making them friable and more at risk for bleeding. Patients with recurrent epistaxis may also be more susceptible to developing anemia. Physicians should promote antiplatelet and antithrombotic medication adherence despite an increased propensity for recurrent epistaxis to prevent major adverse cardiovascular events. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  3. Aspirin resistance are associated with long-term recurrent stroke events after ischaemic stroke.

    Science.gov (United States)

    Zhang, Ning; Wang, Zhenhua; Zhou, Lihong

    2017-09-01

    To investigate the prevalent of aspirin resistance (AR) in stroke and its association with recurrent stroke in 214 patients with ischemic stroke who were receiving aspirin before the stroke onset. Two hundreds and fourteen acute stroke patients who previously received aspirin therapy (100mg/day for ≥7days) were enrolled. Whole blood samples were collected for platelet aggregation testing. The result is expressed in aspirin reaction units (ARU). A cutoff of 550 ARU was used to determine the presence of AR. A follow-up period of 1year was performed to record stroke recurrence events. In this study, the median age was 68 years (IQR, 60-77 years), and 118 (55.1%) were men. A total of 43 of 214 enrolled patients (20.1%) were AR. ARU levels were significantly higher in patients with recurrence than those without (514[IQR: 466-592] vs. 454[IQR: 411-499]; P <0.001). The stroke recurrence distribution across the ARU quartiles ranged between 7.41% (first quartile) to 40.74% (fourth quartile). In multivariate analyses, the 3th and 4th quartile of ARU was significantly associated with stroke recurrence during the observation period compared to the 1st quartile group, and the adjusted risk increased by 215% (OR=3.15 [95% CI 1.96-4.33], P=0.007) and 322% (4.22[2.56-7.16], P<0.001). In multivariate logistic regression analysis, AR was associated with a higher risk of stroke recurrence, and the adjusted risk increased by 365% (OR=4.65; 95% CI=2.99-8.16; P<0.001). In conclusion, AR is not uncommon in Chinese stroke patients who receive anti-platelet medications. Patients with AR may have a greater risk of suffering stroke recurrence events. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Intensity-Modulated Radiation Therapy in the Salvage of Locally Recurrent Nasopharyngeal Carcinoma

    International Nuclear Information System (INIS)

    Qiu Sufang; Lin Shaojun; Tham, Ivan W.K.; Pan Jianji; Lu Jun; Lu, Jiade J.

    2012-01-01

    Purpose: Local recurrences of nasopharyngeal carcinoma (NPC) may be salvaged by reirradiation with conventional techniques, but with significant morbidity. Intensity-modulated radiation therapy (IMRT) may improve the therapeutic ratio by reducing doses to normal tissue. The aim of this study was to address the efficacy and toxicity profile of IMRT for a cohort of patients with locally recurrent NPC. Methods and Materials: Between August 2003 and June 2009, 70 patients with radiologic or pathologically proven locally recurrent NPC were treated with IMRT. The median time to recurrence was 30 months after the completion of conventional radiation to definitive dose. Fifty-seven percent of the tumors were classified asrT3–4. The minimum planned doses were 59.4 to 60 Gy in 1.8- to 2-Gy fractions per day to the gross disease with margins, with or without chemotherapy. Results: The median dose to the recurrent tumor was 70 Gy (range, 50–77.4 Gy). Sixty-five patients received the planned radiation therapy; 5 patients received between 50 and 60 Gy because of acute side effects. With a median follow-up time of 25 months, the rates of 2-year locoregional recurrence-free survival, disease-free survival, and overall survival were 65.8%, 65.8%, and 67.4%, respectively. Moderate to severe late toxicities were noted in 25 patients (35.7%). Eleven patients (15.7%) had posterior nasal space ulceration, 17 (24.3%) experienced cranial nerve palsies, 12 (17.1%) had trismus, and 12 (17.1%) experienced deafness. Extended disease-free interval (relative risk 2.049) and advanced T classification (relative risk 3.895) at presentation were adverse prognostic factors. Conclusion: Reirradiation with IMRT provides reasonable long-term control in patients with locally recurrent NPC.

  5. Association between atherogenic dyslipidemia and recurrent stroke risk in patients with different subtypes of ischemic stroke.

    Science.gov (United States)

    Zhao, Lu; Wang, Ruihao; Song, Bo; Tan, Song; Gao, Yuan; Fang, Hui; Lu, Jie; Xu, Yuming

    2015-07-01

    The association between atherogenic dyslipidemia and stroke recurrence remains unclear, and may be influenced by different subtypes of ischemic stroke. We aimed to investigate whether atherogenic dyslipidemia contributed to stroke recurrence in ischemic stroke patients and in those with certain subtypes of ischemic stroke. We conducted a prospective hospital-based study enrolling patients with acute ischemic stroke. Atherogenic dyslipidemia was defined as high-density lipoprotein cholesterol dyslipidemia and stroke recurrence was analyzed by using multivariable Cox regression model. In the 510 ischemic stroke patients, 64 patients (12·5%) had atherogenic dyslipidemia, and 66 patients (12·9%) experienced stroke recurrence events within 24 months. Kaplan-Meier analysis revealed that stroke recurrence rate was significantly higher in patients with atherogenic dyslipidemia than those without in all the stroke patients (20·3% vs. 11·9%; P = 0·048), and more evident in those of large-artery atherosclerosis subtype (31·0% vs. 14·1%; P = 0·014), but not in the other subtypes. Multivariable Cox regression analysis revealed that atherogenic dyslipidemia was associated with higher stroke recurrence risk among stroke patients of large-artery atherosclerosis subtype (hazard ratio, 2·79; 95% confidence interval, 1·24-6·28), but not significant in all the stroke patients (hazard ratio, 1·69; 95% confidence interval, 0·85-3·37). Atherogenic dyslipidemia is associated with higher risk of stroke recurrence in ischemic stroke patients. Such association might be more pronounced in large-artery atherosclerosis subtype and needs further investigation to establish such relationship. © 2015 World Stroke Organization.

  6. Recurrence determinism and Li-Yorke chaos for interval maps

    OpenAIRE

    Špitalský, Vladimír

    2017-01-01

    Recurrence determinism, one of the fundamental characteristics of recurrence quantification analysis, measures predictability of a trajectory of a dynamical system. It is tightly connected with the conditional probability that, given a recurrence, following states of the trajectory will be recurrences. In this paper we study recurrence determinism of interval dynamical systems. We show that recurrence determinism distinguishes three main types of $\\omega$-limit sets of zero entropy maps: fini...

  7. Acute Appendicitis

    DEFF Research Database (Denmark)

    Tind, Sofie; Qvist, Niels

    2017-01-01

    and treatment of AA it is important that the classifications are consistent. Furthermore, in the clinical settings, incorrect classification might lead to over diagnosing and a prolonged antibiotic treatment. The aim of our study was to investigate the concordance between perioperative diagnosis made......BACKGROUND: The classification of acute appendicitis (AA) into various grades is not consistent, partly because it is not clear whether the perioperative or the histological findings should be the foundation of the classification. When comparing results from the literature on the frequency...

  8. Morbidity and injury recurrence in victims of firearm injuries.

    Science.gov (United States)

    Ponzer, S; Bergman, B; Brismar, B

    1996-01-01

    Civilian violence has become an increasing problem in the industrial world. Gunshot wounds, fatal or non-fatal, are often considered as acute trauma episodes. However, our previous study, based on 820 firearm injuries, showed that this group of patients was characterized by a high mortality rate and a pronounced involvement in criminality when compared to a control group. The aim of this study was to determine the general morbidity in the same group of firearm victims. Our hypotheses were that these patients consume a considerable amount of hospital care due to recurring trauma episodes and that their general morbidity is raised. Information was collected concerning all episodes of in-patient care for victims of firearm injuries from 1972-1992 in Stockholm, Sweden. The victims were compared with a sex- and age-matched control group. During the study period, 69.9% of the 820 firearm victims were treated for other reasons than gunshot injuries, compared to 45.5% of the 820 controls. The former group was hospitalized 3,703 times and the latter on 1,512 occasions. The firearm injury group showed an higher morbidity in almost all diagnostic subgroups according to ICD-9. The trauma recurrence rate was high and suicide, homicide and assault were relatively more common in this group. We suggest that the gunshot episode may be regarded as one expression of a "chronic trauma syndrome'. Patients exhibiting this "syndrome' are characterized by recurrent episodes of trauma, a risk-taking and destructive behavior, high morbidity and mortality as well as anti-social traits. Medical, social and legal complications are common making these patients extremely costly for society and their identification a matter of concern. It is probable that this "syndrome' also exists in other groups of trauma patients. Since hospitalization affords a unique opportunity of reaching patients who have a "chronic trauma syndrome' risk profile, we believe, that these patients should not only be treated

  9. Ethanol ablation of predominantly cystic thyroid nodules: Evaluation of recurrence rate and factors related to recurrence

    International Nuclear Information System (INIS)

    Suh, C.H.; Baek, J.H.; Ha, E.J.; Choi, Y.J.; Lee, J.H.; Kim, J.K.; Chung, K.-W.; Kim, T.Y.; Kim, W.B.; Shong, Y.K.

    2015-01-01

    Aim: To evaluate recurrence rate and associated risk factors for recurrence after ethanol ablation (EA) in patients with predominantly cystic thyroid nodules. Materials and methods: This observational study was approved by the Ethics Committee of the Institutional Review Board and informed consent for procedures was obtained. From April 2009 to April 2013, 107 consecutive patients with predominantly cystic nodules were treated using EA. Recurrence was defined as nodules showing a residual solid portion with internal vascularity, cosmetic problems remaining, or persistent symptoms, and patients who requested additional therapy to resolve their symptomatic or cosmetic problems. Delayed recurrence was defined as treated nodules that showed no recurrent features at 1 month, but showed newly developed recurrent features during the longer follow-up period. Multivariate analysis was used for variables to demonstrate the independent factors related to volume reduction. Results: One month after EA, 18.7% of patients (20/107) showed recurrence. Among 87 patients with non-recurrence, 24.1% (21/87) showed delayed recurrence. The total recurrence rate was 38.3% (41/107). Patients with recurrence (n = 41) were treated using radiofrequency ablation (n = 28), second EA (n = 4), and refused further treatment (n = 9). These patients responded well to repeat EA and radiofrequency ablation. Multivariate analysis demonstrated that the initial nodule volume (>20 ml; p < 0.036) and vascularity (grade >1; p < 0.049) were independent predictors of volume reduction at last follow-up. Conclusions: The results revealed that although EA seemed to be effective during the initial period, delayed recurrence should be considered during longer-term follow-up. The independent predictors of recurrence were initial volume (>20 ml) and vascularity. - Highlights: • Ethanol ablation showed unsatisfactory results in 18.7% of patient at one month. • Delayed recurrence was observed in 24

  10. Poincaré recurrences of DNA sequences

    Science.gov (United States)

    Frahm, K. M.; Shepelyansky, D. L.

    2012-01-01

    We analyze the statistical properties of Poincaré recurrences of Homo sapiens, mammalian, and other DNA sequences taken from the Ensembl Genome data base with up to 15 billion base pairs. We show that the probability of Poincaré recurrences decays in an algebraic way with the Poincaré exponent β≈4 even if the oscillatory dependence is well pronounced. The correlations between recurrences decay with an exponent ν≈0.6 that leads to an anomalous superdiffusive walk. However, for Homo sapiens sequences, with the largest available statistics, the diffusion coefficient converges to a finite value on distances larger than one million base pairs. We argue that the approach based on Poncaré recurrences determines new proximity features between different species and sheds a new light on their evolution history.

  11. Surgical treatment for residual or recurrent strabismus

    Directory of Open Access Journals (Sweden)

    Tao Wang

    2014-12-01

    Full Text Available Although the surgical treatment is a relatively effective and predictable method for correcting residual or recurrent strabismus, such as posterior fixation sutures, medial rectus marginal myotomy, unilateral or bilateral rectus re-recession and resection, unilateral lateral rectus recession and adjustable suture, no standard protocol is established for the surgical style. Different surgical approaches have been recommended for correcting residual or recurrent strabismus. The choice of the surgical procedure depends on the former operation pattern and the surgical dosages applied on the patients, residual or recurrent angle of deviation and the operator''s preference and experience. This review attempts to outline recent publications and current opinion in the management of residual or recurrent esotropia and exotropia.

  12. Mitochondrial trifunctional protein deficiency with recurrent rhabdomyolysis

    NARCIS (Netherlands)

    Scheuerman, Oded; Wanders, Ronald J. A.; Waterham, Hans R.; Dubnov-Raz, Gal; Garty, Ben-Zion

    2009-01-01

    Rhabdomyolysis is an important clinical diagnosis. The differential diagnosis is extensive and includes various etiologies, such as infection, inflammation, trauma, endocrinopathies, and congenital muscular and metabolic disorders. Reported here is the case of an infant with recurrent rhabdomyolysis

  13. Recurrence quantification analysis theory and best practices

    CERN Document Server

    Jr, Jr; Marwan, Norbert

    2015-01-01

    The analysis of recurrences in dynamical systems by using recurrence plots and their quantification is still an emerging field.  Over the past decades recurrence plots have proven to be valuable data visualization and analysis tools in the theoretical study of complex, time-varying dynamical systems as well as in various applications in biology, neuroscience, kinesiology, psychology, physiology, engineering, physics, geosciences, linguistics, finance, economics, and other disciplines.   This multi-authored book intends to comprehensively introduce and showcase recent advances as well as established best practices concerning both theoretical and practical aspects of recurrence plot based analysis.  Edited and authored by leading researcher in the field, the various chapters address an interdisciplinary readership, ranging from theoretical physicists to application-oriented scientists in all data-providing disciplines.

  14. Recurrent encephalic hemorrhage associated with cocaine abuse

    International Nuclear Information System (INIS)

    Pumar, J.; Otero, E.; Castineira, A.; Arrojo, L.; Linares, M.; Castineira, J.A.; Vidal, J.

    1994-01-01

    We report a case of recurrent intracerebral hemorrhage secondary to cocaine abuse in a patient with no other predisposing factors. The hemorrhages were located both supra- and infratentorially. (orig.)

  15. Ocean wave forecasting using recurrent neural networks

    Digital Repository Service at National Institute of Oceanography (India)

    Mandal, S.; Prabaharan, N.

    , merchant vessel routing, nearshore construction, etc. more efficiently and safely. This paper describes an artificial neural network, namely recurrent neural network with rprop update algorithm and is applied for wave forecasting. Measured ocean waves off...

  16. Postoperative recurrence after VATS for spontaneous pneumothorax

    International Nuclear Information System (INIS)

    Katsuno, Gotaro; Tsumura, Makoto; Kokudo, Yasutaka; Muraoka, Atsushi; Tsuruno, Masaki

    2003-01-01

    A total of 88 cases of 81 patients with spontaneous pneumothorax treated at the hospital from March 1992 to August 2001 were subjected to a study of examining preoperative chest CT and thoracographic findings from the standpoint of postoperative recurrence. Preoperative chest CT and thoracography were conducted in 82 cases and 41 cases (including 25 cases with continuous air leakage), respectively. Eight (9.1%) patients developed recurrence of pneumothorax, and three patients of them underwent reoperation. Considering the intraoperative findings, newly formed bullae appeared to be a cause of recurrence. Resulting from these examinations, we conclude that it is difficult to predict the risk factor for postoperative recurrence at this time, in addition, it is important that the area of air leakage can be confirmed by thoracoscopic findings. (author)

  17. Recurrent LDL-receptor mutation causes familial ...

    African Journals Online (AJOL)

    1995-05-05

    May 5, 1995 ... 3. eaudet . New. Recurrent LDL-receptor mutation causes familial hypercholesterolaemia in ... amplification refractory mutation system (ARMS)" and single- strand conformation .... Location. Afrikaner. Mixed race. ApaLl.

  18. Recurrent autoassociative networks and holistic computations

    NARCIS (Netherlands)

    Stoianov, [No Value; Amari, SI; Giles, CL; Gori, M; Piuri,

    2000-01-01

    The paper presents an experimental study of holistic computations over distributed representations (DRs) of sequences developed by the Recurrent Autoassociative Networks (KAN). Three groups of holistic operators are studied: extracting symbols at fixed position, extracting symbols at a variable

  19. Studies on recurrence of colorectal carcinoma

    International Nuclear Information System (INIS)

    Kobayashi, Masayuki; Nosaki, Tadaharu; Murai, Tomoya; Ooshita, Ikuo; Kobayashi, Suzuo

    1989-01-01

    Recurrence patterns of colorectal carcinoma were studied in 402 patients followed up for 5 years or more after surgery. Recurrence was observed in 23% for colon cancer and 38% for rectal canccer. The most frequent site of recurrence or relapse in cases of colon cancer was the liver, followed by multiple organs and a local region; and in the case of rectal cancer, it was multiple organs, followed by a local region, the liver, lung, and bone. The rate of recurrence or relapse tended to be higher in patients with lymph node metastases or more advanced clinical stage. Liver relapse was seen in 13% for colon cancer and 12% for rectal cancer, occurring within 48 months after surgery. Since CT can detect liver relapse within 24 months, abdominal CT and chest plain roentgenography should be performed in the first 6 months, 12 months, and 24 months after surgery. (Namekawa, K)

  20. ON SOME RECURRENCE TYPE SMARANDACHE SEQUENCES

    OpenAIRE

    MAJUMDAR, A.A.K.; GUNARTO, H.

    2000-01-01

    In this paper, we study some properties of ten recurrence type Smarandache sequences, namely, the Smarandache odd, even, prime product, square product, higher-power product, permutation, consecutive, reverse, symmetric, and pierced chain sequences.

  1. Things Fall Apart: A Recurrence of Tiling

    Science.gov (United States)

    Rogers, Douglas G.

    2005-01-01

    A study investigates recurrence relations, sequences in which each term is determined by one or more previous terms. Results provide another approach to the problem of finding closed forms for recursively-defined sequences.

  2. Errata :Chromosomal Abnormalities in Couples with Recurrent ...

    African Journals Online (AJOL)

    Chromosomal Abnormalities in Couples with Recurrent Abortions in Lagos, Nigeria. Akinde OR, Daramola A O, Taiwo I A, Afolayan M O and Akinsola Af. Sonographic Mammary Gland Density Pattern in Women in Selected ommunities of Southern Nigeria.

  3. [Synchronous acute cholecystolithiasis and perforated acute appendicitis. Case report].

    Science.gov (United States)

    Padrón-Arredondo, Guillermo; de Atocha Rosado-Montero, Manuel

    2016-01-01

    Acute appendicitis and acute cholecystitis are among the most common diagnoses that general surgeons operate on. However, it is rarely described in its synchronous form. A 43 year-old woman attending the clinic for right upper quadrant pain of 11 days duration. The patient refers to intermittent radiating pain in the right side, with positive Murphy, tachycardia, and fever. The laboratory results showed white cells 16,200/mm(3), glucose 345 mg/dl, abnormal liver function tests. Acute cholecystitis was reported with ultrasound. A Masson-type incision was made, noting an enlarged pyogenic gallbladder with thickened walls, sub-hepatic abscess of approximately 300 ml, greenish-yellow colour, and foetid. An anterograde subtotal cholecystectomy is performed due to difficulty in identifying elements of Calot triangle due to the inflammatory process, opening it and extracting stones. The right iliac fossa is reviewed, finding a plastron and a sub-serous retrocaecal appendix perforated in its middle third with free fecalith and an abscess in the pelvic cavity. An anterograde appendectomy was performed and the patient progressed satisfactorily, later being discharged due to improvement. In this patient, with a history of recurrent episodes of gallbladder pain and disseminated acute abdominal pain without peritoneal irritation, clinical suspicion was exacerbated cholecystitis with probable empyema of the gallbladder. Open surgery approach for this patient allowed access to both the appendix and gallbladder in order to perform a complete exploration of the abdominal cavity. The synchronous presentation of cholecystolithiasis and complicated appendicitis has not been reported in the literature. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  4. Hyaluronan in vaginal secretions: association with recurrent vulvovaginal candidiasis.

    Science.gov (United States)

    Lev-Sagie, Ahinoam; Nyirjesy, Paul; Tarangelo, Nicholas; Bongiovanni, Ann Marie; Bayer, Cynthia; Linhares, Iara M; Giraldo, Paulo C; Ledger, William J; Witkin, Steven S

    2009-08-01

    We evaluated whether vaginal concentrations of hyaluronan were altered in women with recurrent vulvovaginal candidiasis (RVVC). Lavage samples from 17 women with acute RVVC, 27 women who were receiving a maintenance antifungal regimen, and 24 control women were tested for hyaluronan and interleukin (IL)-6, IL-12, and IL-23 by enzyme-linked immunosorbent assay. Median vaginal hyaluronan concentrations were 33.8 ng/mL (range, 21.6-66.3 ng/mL) in women with acute RVVC, 15.0 ng/mL (range, 11.2-50.6 ng/mL) in women who were receiving maintenance therapy, and 4.2 ng/mL (range, 3.6-12.0 ng/mL) in control subjects (P vaginal hyaluronan concentration was 27.4 ng/mL (range, 15.4-37.7 ng/mL) when Candida was detected by microscopy and 9.5 ng/mL (range, 7.7-14.6 ng/mL) in microscopy-negative cases (P = .0354). Elevated hyaluronan levels were associated with itching plus burning (40.7 ng/mL) or itching plus discharge (42.1 ng/mL), as opposed to itching only (6.2 ng/mL; P = .0152). Hyaluronan and IL-6 levels were correlated (P = .0009). Hyaluronan release is a component of the host response to a candidal infection and may contribute to symptoms.

  5. Recurrent Syncope Attributed to Left Main Coronary Artery Severe Stenosis

    Directory of Open Access Journals (Sweden)

    Min Li

    2015-01-01

    Full Text Available Patients with acute coronary syndrome (ACS rarely manifest as recurrent syncope due to malignant ventricular arrhythmia. We report a case of a 56-year-old Chinese male with complaints of paroxysmal chest burning sensation and distress for 2 weeks as well as loss of consciousness for 3 days. The electrocardiogram (ECG revealed paroxysmal multimorphologic ventricular tachycardia during attack and normal heart rhythm during intervals. Coronary angiograph showed 90% stenosis in left main coronary artery and 80% stenosis in anterior descending artery. Two stents sized 4.0*18 mm and 2.75*18 mm were placed at left main coronary artery and anterior descending artery, respectively, during percutaneous coronary intervention (PCI. The patient was discharged and never had ventricular arrhythmia again during a 3-month follow-up since the PCI. This indicated that ventricular tachycardia was correlated with persistent severe myocardial ischemia. Coronary vasospasm was highly suspected to be the reason of the sudden attack and acute exacerbation. PCI is recommended in patients with both severe coronary artery stenosis and ventricular arrhythmia. Removing myocardial ischemia may stop or relieve ventricular arrhythmia and prevent cardiac arrest.

  6. Recurrent Bilateral Breast Abscesses after Sternotomy

    Directory of Open Access Journals (Sweden)

    Hamza Cinar

    2012-01-01

    Full Text Available Median sternotomy is the most commonly used incision in cardiothoracic procedures. Development of breast abscess after sternotomy is a very rare situation. We present a case of sternal wound infection with recurrent bilateral breast abscess after sternotomy. Our case is the first and only case in the literature due to the presence of sternal wound infection with recurrent bilateral breast abscess after sternotomy.

  7. Recurrence of non-Hodgkin's lymphoma

    International Nuclear Information System (INIS)

    Watanabe, Toshikazu; Oguchi, Masahiko; Niibe, Hideo; Horiuchi, Junichi; Kaneta, Koichi; Morita, Kozo; Masaki, Norie; Hayabuchi, Naofumi.

    1988-01-01

    From 1972 to 1982, 563 patients with Stage I and II non-Hodgkin's lymphoma received radiation therapy in the department of radiology which belongs to the JLRTS group. Local control failures were seen in only 5 cases (0.9 %). The regional recurrences were found in 30 cases (5 %). 17 of recurrences occured during the first 5 years. 17 cases had remissions again, and 5 cases had 5 year survivals. (author)

  8. Current surgery of retinal detachment recurrence. Review

    Directory of Open Access Journals (Sweden)

    V. D. Zakharov

    2012-01-01

    Full Text Available this review presents a detailed analysis and an experience of surgical treatment of retinal detachment recurrence associated with light silicone oil tamponade of vitreous cavity. Approaches and variants of treatment were described in the historical aspect and till now. there are considered general and particular issues in case of retinal detachment recurrence appearance, expediency and volume of intraoperative manipulations, time of operation and choice of temporary substitute of vitreous body for a purpose of postoperative tamponade of vitreous cavity.

  9. Recurrence risk of ictal asystole in epilepsy.

    Science.gov (United States)

    Hampel, Kevin G; Thijs, Roland D; Elger, Christian E; Surges, Rainer

    2017-08-22

    To determine the recurrence risk of ictal asystole (IA) and its determining factors in people with epilepsy. We performed a systematic review of published cases with IA in 3 databases and additionally searched our local database for patients with multiple seizures simultaneously recorded with ECG and EEG and at least one IA. IA recurrence risk was estimated by including all seizures without knowledge of the chronological order. Various clinical features were assessed by an individual patient data meta-analysis. A random mixed effect logistic regression model was applied to estimate the average recurrence risk of IA. Plausibility of the calculated IA recurrence risk was checked by analyzing the local dataset with available information in chronological order. Eighty patients with 182 IA in 537 seizures were included. Recurrence risk of IA amounted to 40% (95% confidence interval [CI] 32%-50%). None of the clinical factors (age, sex, type and duration of epilepsy, hemispheric lateralization, duration of IA per patient) appeared to have a significant effect on the short-term recurrence risk of IA. When considering the local dataset only, IA recurrence risk was estimated to 30% (95% CI 14%-53%). Information whether IA coincided with symptoms (i.e., syncope) or not was given in 60 patients: 100 out of 142 IAs were symptomatic. Our data suggest that in case of clinically suspected IA, the recording of 1 or 2 seizures is not sufficient to rule out IA. Furthermore, the high short-term recurrence risk favors aggressive treatment, including pacemaker implantation if seizure freedom cannot be achieved. Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

  10. To the non-recurrence nature

    International Nuclear Information System (INIS)

    Somsikov, V.

    1999-01-01

    On the example of a hard-disk system the non-recurrence problem have been investigated. Some of the properties of differential equation for the motion of hard-disk system have been analyzed. Using the suggestions of all disk pairs occur simultaneously within a rather small period τ, asymptotic properties of the non-equilibrium hard-disk system when t→∞ have been studied. The explanation of non-recurrence nature have been submitted. (author)

  11. Recurrence of amblyopia after occlusion therapy.

    Science.gov (United States)

    Bhola, Rahul; Keech, Ronald V; Kutschke, Pamela; Pfeifer, Wanda; Scott, William E

    2006-11-01

    To determine the stability of visual acuity (VA) after a standardized occlusion regimen in children with strabismic and/or anisometropic amblyopia. Retrospective, population-based, consecutive observational case series. Four hundred forty-nine patients younger than 10 years who underwent an occlusion trial for amblyopia and were observed until there was a recurrence of amblyopia or for a maximum of 1 year after decrease or cessation of occlusion therapy. We performed a retrospective chart review of all patients treated by occlusion therapy for strabismic and/or anisometropic amblyopia at our institution over a 34-year period. Of the 1621 patients identified in our database, 449 met the eligibility criteria and were included in this study. Patients having at least a 2 logarithm of the minimum angle of resolution (logMAR)-level improvement in VA by optotypes or a change from unmaintained to maintained fixation preference during the course of occlusion therapy were included. A recurrence of amblyopia was defined as > or =2 logMAR levels of VA reduction or reversal of fixation preference within 1 year after a decrease or cessation of occlusion therapy. Recurrence of amblyopia after a decrease or cessation of occlusion therapy and its relationship with patient age and VA of the amblyopic eye at the time of decrease or cessation of occlusion therapy. Of 653 occlusion trials, 179 (27%) resulted in recurrence of amblyopia. The recurrence was found to be inversely correlated with patient age. There was no statistically significant association between the recurrence of amblyopia and VA of the amblyopic eye at the end of maximal occlusion therapy. There is a clinically important risk of amblyopia recurrence when occlusion therapy is decreased before the age of 10 years. The risk of recurrence is inversely correlated with age (P<0.0001).

  12. Prevention of Recurrent Staphylococcal Skin Infections

    OpenAIRE

    Creech, C. Buddy; Al-Zubeidi, Duha N.; Fritz, Stephanie A.

    2015-01-01

    Staphylococcus aureus infections pose a significant health burden. The emergence of community-associated methicillin-resistant S. aureus has resulted in an epidemic of skin and soft tissue infections (SSTI), and many patients experience recurrent SSTI. As S. aureus colonization is associated with subsequent infection, decolonization is recommended for patients with recurrent SSTI or in settings of ongoing transmission. S. aureus infections often cluster within households and asymptomatic carr...

  13. Heterogeneous recurrence monitoring and control of nonlinear stochastic processes

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Hui, E-mail: huiyang@usf.edu; Chen, Yun [Complex Systems Monitoring, Modeling and Analysis Laboratory, University of South Florida, Tampa, Florida 33620 (United States)

    2014-03-15

    Recurrence is one of the most common phenomena in natural and engineering systems. Process monitoring of dynamic transitions in nonlinear and nonstationary systems is more concerned with aperiodic recurrences and recurrence variations. However, little has been done to investigate the heterogeneous recurrence variations and link with the objectives of process monitoring and anomaly detection. Notably, nonlinear recurrence methodologies are based on homogeneous recurrences, which treat all recurrence states in the same way as black dots, and non-recurrence is white in recurrence plots. Heterogeneous recurrences are more concerned about the variations of recurrence states in terms of state properties (e.g., values and relative locations) and the evolving dynamics (e.g., sequential state transitions). This paper presents a novel approach of heterogeneous recurrence analysis that utilizes a new fractal representation to delineate heterogeneous recurrence states in multiple scales, including the recurrences of both single states and multi-state sequences. Further, we developed a new set of heterogeneous recurrence quantifiers that are extracted from fractal representation in the transformed space. To that end, we integrated multivariate statistical control charts with heterogeneous recurrence analysis to simultaneously monitor two or more related quantifiers. Experimental results on nonlinear stochastic processes show that the proposed approach not only captures heterogeneous recurrence patterns in the fractal representation but also effectively monitors the changes in the dynamics of a complex system.

  14. Molecular Mapping to Species Level of the Tonsillar Crypt Microbiota Associated with Health and Recurrent Tonsillitis

    Science.gov (United States)

    Jensen, Anders; Fagö-Olsen, Helena; Sørensen, Christian Hjort; Kilian, Mogens

    2013-01-01

    The human palatine tonsils, which belong to the central antigen handling sites of the mucosal immune system, are frequently affected by acute and recurrent infections. This study compared the microbiota of the tonsillar crypts in children and adults affected by recurrent tonsillitis with that of healthy adults and children with tonsillar hyperplasia. An in-depth 16S rRNA gene based pyrosequencing approach combined with a novel strategy that included phylogenetic analysis and detection of species-specific sequence signatures enabled identification of the major part of the microbiota to species level. A complex microbiota consisting of between 42 and 110 taxa was demonstrated in both children and adults. This included a core microbiome of 12 abundant genera found in all samples regardless of age and health status. Yet, Haemophilus influenzae, Neisseria species, and Streptococcus pneumoniae were almost exclusively detected in children. In contrast, Streptococcus pseudopneumoniae was present in all samples. Obligate anaerobes like Porphyromonas, Prevotella, and Fusobacterium were abundantly present in children, but the species diversity of Porphyromonas and Prevotella was larger in adults and included species that are considered putative pathogens in periodontal diseases, i.e. Porphyromonas gingivalis, Porphyromonas endodontalis, and Tannerella forsythia. Unifrac analysis showed that recurrent tonsillitis is associated with a shift in the microbiota of the tonsillar crypts. Fusobacterium necrophorum, Streptococcus intermedius and Prevotella melaninogenica/histicola were associated with recurrent tonsillitis in adults, whereas species traditionally associated with acute tonsillitis like pyogenic streptococci and Staphylococcus aureus were scarce. The findings suggest that recurrent tonsillitis is a polymicrobial infection in which interactions within consortia of taxa play an etiologic role. The study contributes to the human microbiome data, to the understanding of the

  15. Molecular mapping to species level of the tonsillar crypt microbiota associated with health and recurrent tonsillitis.

    Directory of Open Access Journals (Sweden)

    Anders Jensen

    Full Text Available The human palatine tonsils, which belong to the central antigen handling sites of the mucosal immune system, are frequently affected by acute and recurrent infections. This study compared the microbiota of the tonsillar crypts in children and adults affected by recurrent tonsillitis with that of healthy adults and children with tonsillar hyperplasia. An in-depth 16S rRNA gene based pyrosequencing approach combined with a novel strategy that included phylogenetic analysis and detection of species-specific sequence signatures enabled identification of the major part of the microbiota to species level. A complex microbiota consisting of between 42 and 110 taxa was demonstrated in both children and adults. This included a core microbiome of 12 abundant genera found in all samples regardless of age and health status. Yet, Haemophilus influenzae, Neisseria species, and Streptococcus pneumoniae were almost exclusively detected in children. In contrast, Streptococcus pseudopneumoniae was present in all samples. Obligate anaerobes like Porphyromonas, Prevotella, and Fusobacterium were abundantly present in children, but the species diversity of Porphyromonas and Prevotella was larger in adults and included species that are considered putative pathogens in periodontal diseases, i.e. Porphyromonas gingivalis, Porphyromonas endodontalis, and Tannerella forsythia. Unifrac analysis showed that recurrent tonsillitis is associated with a shift in the microbiota of the tonsillar crypts. Fusobacterium necrophorum, Streptococcus intermedius and Prevotella melaninogenica/histicola were associated with recurrent tonsillitis in adults, whereas species traditionally associated with acute tonsillitis like pyogenic streptococci and Staphylococcus aureus were scarce. The findings suggest that recurrent tonsillitis is a polymicrobial infection in which interactions within consortia of taxa play an etiologic role. The study contributes to the human microbiome data, to the

  16. Medically Treated Diverticular Abscess Associated With High Risk of Recurrence and Disease Complications.

    Science.gov (United States)

    Devaraj, Bikash; Liu, Wendy; Tatum, James; Cologne, Kyle; Kaiser, Andreas M

    2016-03-01

    The best management for diverticulitis with abscess formation remains unknown. The purpose of this study was to determine the natural course and outcomes of patients with medically treated diverticular abscess. We conducted a retrospective review of all patients at our institution with diverticular abscess confirmed by CT from 2004 to 2014. This study was conducted in a tertiary referral hospital. A total of 1194 patients were treated for acute diverticulitis in 10 years; 210 patients with CT-documented diverticular abscess were analyzed (140 men (66.7%) and 70 women (33.3%); median age 45 years; range, 23-84 years). Overall recurrence and disease complication rates, as well as the need for subsequent operation after initial successful nonsurgical management, were measured, along with analysis of the whole cohort and the subgroup of patients with percutaneous drainage for diverticular abscess. During the initial presentation, 25 patients failed nonoperative management and required an urgent operation. A total of 185 patients were initially successfully managed without surgery and were discharged from the hospital. Of these, recurrent diverticulitis developed in 112 (60.5%) after an average time interval of 5.3 months (range, 0.8-20.0 months); 47 patients (42%) experienced more than 1 episode. The modified Hinchey stage at time of recurrence (compared with index stay) increased in 51 patients (45.6%). Seventy one (63%) of 112 recurrences showed local disease complications (recurrent abscess, fistula, stricture, or peritonitis). Fistula formation (colovesicular/colovaginal/colocutaneous) and recurrent abscess were the 2 most frequent complications. Twenty nine (26%) of 112 recurrences required an urgent operation; overall, 66 (59%) of 112 patients eventually underwent surgery at our institution. The original abscess size in patients who later developed recurrences was significantly larger than in patients who did not develop recurrence (5.3 vs 3.2 cm; p disease

  17. Recurrence interval analysis of trading volumes.

    Science.gov (United States)

    Ren, Fei; Zhou, Wei-Xing

    2010-06-01

    We study the statistical properties of the recurrence intervals τ between successive trading volumes exceeding a certain threshold q. The recurrence interval analysis is carried out for the 20 liquid Chinese stocks covering a period from January 2000 to May 2009, and two Chinese indices from January 2003 to April 2009. Similar to the recurrence interval distribution of the price returns, the tail of the recurrence interval distribution of the trading volumes follows a power-law scaling, and the results are verified by the goodness-of-fit tests using the Kolmogorov-Smirnov (KS) statistic, the weighted KS statistic and the Cramér-von Mises criterion. The measurements of the conditional probability distribution and the detrended fluctuation function show that both short-term and long-term memory effects exist in the recurrence intervals between trading volumes. We further study the relationship between trading volumes and price returns based on the recurrence interval analysis method. It is found that large trading volumes are more likely to occur following large price returns, and the comovement between trading volumes and price returns is more pronounced for large trading volumes.

  18. Recurrence quantity analysis based on matrix eigenvalues

    Science.gov (United States)

    Yang, Pengbo; Shang, Pengjian

    2018-06-01

    Recurrence plots is a powerful tool for visualization and analysis of dynamical systems. Recurrence quantification analysis (RQA), based on point density and diagonal and vertical line structures in the recurrence plots, is considered to be alternative measures to quantify the complexity of dynamical systems. In this paper, we present a new measure based on recurrence matrix to quantify the dynamical properties of a given system. Matrix eigenvalues can reflect the basic characteristics of the complex systems, so we show the properties of the system by exploring the eigenvalues of the recurrence matrix. Considering that Shannon entropy has been defined as a complexity measure, we propose the definition of entropy of matrix eigenvalues (EOME) as a new RQA measure. We confirm that EOME can be used as a metric to quantify the behavior changes of the system. As a given dynamical system changes from a non-chaotic to a chaotic regime, the EOME will increase as well. The bigger EOME values imply higher complexity and lower predictability. We also study the effect of some factors on EOME,including data length, recurrence threshold, the embedding dimension, and additional noise. Finally, we demonstrate an application in physiology. The advantage of this measure lies in a high sensitivity and simple computation.

  19. Recurrence relations for spin foam vertices

    International Nuclear Information System (INIS)

    Bonzom, Valentin; Livine, Etera R; Speziale, Simone

    2010-01-01

    We study recurrence relations for various Wigner 3nj-symbols and the non-topological 10j-symbol. For the 6j- and the 15j-symbols which correspond to basic amplitudes of 3d and 4d topological spin foam models, recurrence relations are obtained from the invariance under Pachner moves and can be interpreted as quantizations of the constraints of the underlying classical field theories. We also derive recurrences from the action of holonomy operators on spin network functionals, making a more precise link between the topological Pachner moves and the classical constraints. Interestingly, our recurrence relations apply to any SU(2) invariant symbol, depending on the cycles of the corresponding spin network graph. Another method is used for non-topological objects such as the 10j-symbol and pseudo-isosceles 6j-symbols. The recurrence relations are also interpreted in terms of elementary geometric properties. Finally, we discuss the extension of the recurrences to take into account boundary states which leads to equations similar to Ward identities for correlation functions in the Barrett-Crane model.

  20. Acute lower extremity ischaemia

    African Journals Online (AJOL)

    Acute lower extremity ischaemia. Acute lower limb ischaemia is a surgical emergency. ... is ~1.5 cases per 10 000 persons per year. Acute ischaemia ... Table 2. Clinical features discriminating embolic from thrombotic ALEXI. Clinical features.

  1. Acute kidney failure

    Science.gov (United States)

    ... Renal failure - acute; ARF; Kidney injury - acute Images Kidney anatomy References Devarajan P. Biomarkers for assessment of renal function during acute kidney injury. In: Alpern RJ, Moe OW, Caplan M, ...

  2. Longitudinal analysis of vaginal microbiome dynamics in women with recurrent bacterial vaginosis: recognition of the conversion process.

    Directory of Open Access Journals (Sweden)

    Janet A Lambert

    Full Text Available Bacterial vaginosis (BV affects ∼ 30% of women of reproductive age, has a high rate of recurrence, and is associated with miscarriage, preterm birth, and increased risk of acquiring other sexually transmitted infections, including HIV-1. Little is known of the daily changes in the vaginal bacterial composition as it progresses from treatment to recurrence, or whether any of these might be useful in its prediction or an understanding of its causes. We used phylogenetic branch-inclusive quantitative PCR (PB-qPCR and Lactobacillus blocked/unblocked qPCR (Lb-qPCR to characterize longitudinal changes in the vaginal microbiota in sequential vaginal self-swabs from five women with recurrent BV, from diagnosis through remission to recurrence. Both patients with acute BV samples dominated by G. vaginalis recurred during the study with similar profiles, whereas the three patients with acute BV samples dominated by other anaerobes did not recur or recurred to an intermediate Nugent score. L. iners dominated remission phases, with intermittent days of abnormal microbial profiles typically associated with menses. The exception was a newly discovered phenomenon, a sustained period of abnormal profiles, termed conversion, which preceded symptomatic acute BV. Species known to have antagonistic activity towards Lactobacillus were detected in pre-conversion samples, possibly contributing to the decline in Lactobacillus. Lb-qPCR scores define two categories of response in the initial post-treatment visit samples; scores 8 may predict delayed or no recurrence. Amsel criteria or Nugent scores did not have this potential predictive capability. Larger studies are warranted to evaluate the prognostic potential of detecting conversion and poor Lb-qPCR scores at the post-treatment visit of recurrent BV patients.

  3. Recurrence of hepatitis C virus genotype- 4 infection following orthotopic liver transplantation: natural history and predictors of outcome

    International Nuclear Information System (INIS)

    Mudawi, Hatim; Helmy, Ahmed; Kamel, Yasser; AlSaghier, Mohammed; AlSofayan, Mohammed; AlSebayel, Mohammed; Khalaf, Hatem; AlBahili, Hamad; Alhiek, Yasser; Alawi, Khalil; Mohamed, Hazem; AlJedai, Ahmed; AlHamoudi, Waleed; Abdo, Ayman

    2007-01-01

    There are few reports on hepatitis C virus genotype 4 (HCV-4) recurrences after orthotopic liver transplantation (OLT). Therefore, we undertook a study to determine the epidemiological, clinical and virological characteristics of patients with biopsy-proven recurrent HCV infection and analyzed the factors that influence recurrent disease severity. We also compared disease recurrence and outcomes between HCV-4 and other genotypes. All patients who underwent OLT (locally or abroad) for HCV related hepatic cirrhosis from 1991 to 2006 and had recurrent HCV infection were identified. Clinical, laboratory and pathological data before and after OLT were collected and analyzed. Of 116 patients who underwent OLT for hepatitis C, 46 (39.7%) patients satisfied the criteria of recurrent hepatitis C. Twenty-nine (63%) patients were infected with HCV genotype 4. Mean (SD) for age was 54.9 (10.9) years. Nineteen of the HCV genotype 4 patients (65.5%) were males, 21 (72.4%) received deceased donor grafts, and 7 (24.1%) developed > - 1 acute rejection episodes. Pathologically, 7 (24.1%) and 4 (13.8%) patients had inflammation grade 3-4 and fibrosis stage 3-4, respectively. Follow-up biopsy in 9 (31%) HCV genotype 4 patients showed stable, worse and improved fibrosis stage in 5, 2 and 2 patients, respectively. Of the 7 patients in the recurrent HCV group who died, 6 were infected with genotype 4 and 4 of them died of HCV-related disease. This analysis suggests that HCV recurrence following OLT in HCV-4 patients is not significantly different from its recurrence for other genotypes. (author)

  4. An evaluation of factors predicting breast recurrence and prognosis after recurrence, on distinguishing intramammary and extramammary recurrence, in breast-conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko [Kumamoto City Hospital (Japan)] (and others)

    2001-06-01

    Recurrence of cancer in the breast is an important problem in breast-conserving therapy. We evaluated risk factors for recurrence from the viewpoint of recurrence type and outcome after recurrence. Of 533 cases of breast cancer treated with breast-conserving surgery from April 1989 through July 2000, disease in 66 recurred (12.4%) and were classified as 23 cases of breast recurrence only, 16 cases of both breast recurrence and distant metastasis, and 27 cases of distant metastasis only. The clinical factors examined included age, lymphatic invasion, nodal status, extensive intraductal component (EIC), proliferative activity, and estrogen receptor (ER) status. Of the 39 cases of breast recurrence, 19 had intramammary tumors and 20 had extramammary tumors of the skin, subcutaneous tissue, or muscle, including 8 cases with inflammatory breast recurrence. Multivariate analysis showed that factors correlated with breast recurrence were age, ER status, proliferative activity, and surgical margin. EIC-comedo was related to intramammary recurrence, whereas lymphatic invasion and nodal status were related to extramammary recurrence. Postoperative irradiation was an effective treatment for tumors in young women and tumors with positive margins or a comedo component. Outcome after breast recurrence depended on nodal status at primary operation, and survival rates were worst in patients with inflammatory breast recurrence. In conclusion, age, EIC-comedo status, the surgical margin, and negative ER status were correlated with breast recurrence. Countermeasures against these factors should be investigated. (author)

  5. An evaluation of factors predicting breast recurrence and prognosis after recurrence, on distinguishing intramammary and extramammary recurrence, in breast-conserving surgery

    International Nuclear Information System (INIS)

    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko

    2001-01-01

    Recurrence of cancer in the breast is an important problem in breast-conserving therapy. We evaluated risk factors for recurrence from the viewpoint of recurrence type and outcome after recurrence. Of 533 cases of breast cancer treated with breast-conserving surgery from April 1989 through July 2000, disease in 66 recurred (12.4%) and were classified as 23 cases of breast recurrence only, 16 cases of both breast recurrence and distant metastasis, and 27 cases of distant metastasis only. The clinical factors examined included age, lymphatic invasion, nodal status, extensive intraductal component (EIC), proliferative activity, and estrogen receptor (ER) status. Of the 39 cases of breast recurrence, 19 had intramammary tumors and 20 had extramammary tumors of the skin, subcutaneous tissue, or muscle, including 8 cases with inflammatory breast recurrence. Multivariate analysis showed that factors correlated with breast recurrence were age, ER status, proliferative activity, and surgical margin. EIC-comedo was related to intramammary recurrence, whereas lymphatic invasion and nodal status were related to extramammary recurrence. Postoperative irradiation was an effective treatment for tumors in young women and tumors with positive margins or a comedo component. Outcome after breast recurrence depended on nodal status at primary operation, and survival rates were worst in patients with inflammatory breast recurrence. In conclusion, age, EIC-comedo status, the surgical margin, and negative ER status were correlated with breast recurrence. Countermeasures against these factors should be investigated. (author)

  6. A lifetime approach to major depressive disorder: The contributions of psychological interventions in preventing relapse and recurrence.

    Science.gov (United States)

    Bockting, Claudi L; Hollon, Steven D; Jarrett, Robin B; Kuyken, Willem; Dobson, Keith

    2015-11-01

    Major depressive disorder (MDD) is highly disabling and typically runs a recurrent course. Knowledge about prevention of relapse and recurrence is crucial to the long-term welfare of people who suffer from this disorder. This article provides an overview of the current evidence for the prevention of relapse and recurrence using psychological interventions. We first describe a conceptual framework to preventive interventions based on: acute treatment; continuation treatment, or; prevention strategies for patients in remission. In brief, cognitive-behavioral interventions, delivered during the acute phase, appear to have an enduring effect that protects patients against relapse and perhaps others from recurrence following treatment termination. Similarly, continuation treatment with either cognitive therapy or perhaps interpersonal psychotherapy appears to reduce risk for relapse and maintenance treatment appears to reduce risk for recurrence. Preventive relapse strategies like preventive cognitive therapy or mindfulness based cognitive therapy (MBCT) applied to patients in remission protects against subsequent relapse and perhaps recurrence. There is some preliminary evidence of specific mediation via changing the content or the process of cognition. Continuation CT and preventive interventions started after remission (CBT, MBCT) seem to have the largest differential effects for individuals that need them the most. Those who have the greatest risk for relapse and recurrence including patients with unstable remission, more previous episodes, potentially childhood trauma, early age of onset. These prescriptive indications, if confirmed in future research, may point the way to personalizing prevention strategies. Doing so, may maximize the efficiency with which they are applied and have the potential to target the mechanisms that appear to underlie these effects. This may help make this prevention strategies more efficacious. Copyright © 2015 Elsevier Ltd. All rights

  7. Investigation on feasibility of recurrence quantification analysis for ...

    African Journals Online (AJOL)

    The RQA parameters such as percent recurrence (REC), trapping time (TT), percent laminarity (LAM) and entropy (ENT), and also the recurrence plots color patterns for different flank wear, can be used in detecting insert wear in face milling. Keywords: milling, flank wear, recurrence plot, recurrence quantification analysis.

  8. Young patient's age determines pterygium recurrence after surgery.

    African Journals Online (AJOL)

    2014-03-01

    Mar 1, 2014 ... and degree of fleshiness, and laterality were compared between recurrent and no recurrent pterygia. ... was performed to determine the predictors of pterygium recurrence. Recurrence rates after surgery were compared between. CAT and LCAT. Results. ... obstruction of vision, disfigurement, or frequent.

  9. Recurrent IVF failure and hereditary thrombophilia.

    Science.gov (United States)

    Safdarian, Leila; Najmi, Zahra; Aleyasin, Ashraf; Aghahosseini, Marzieh; Rashidi, Mandana; Asadollah, Sara

    2014-07-01

    The largest percentage of failed invitro fertilization (IVF (cycles, are due to lack of implantation. As hereditary thrombophilia can cause in placentation failure, it may have a role in recurrent IVF failure. Aim of this case-control study was to determine whether hereditary thrombophilia is more prevalent in women with recurrent IVF failures. Case group comprised 96 infertile women, with a history of recurrent IVF failure. Control group was comprised of 95 healthy women with proven fertility who had conceived spontaneously. All participants were assessed for the presence of inherited thrombophilias including: factor V Leiden, methilen tetrahydrofolate reductase (MTHFR) mutation, prothrombin mutation, homocystein level, protein S and C deficiency, antithrombin III (AT-III) deficiency and plasminogen activator inhibitor-1 (PAI-1) mutation. Presence of thrombophilia was compared between groups. Having at least one thrombophilia known as a risk factor for recurrent IVF failure (95% CI=1.74-5.70, OR=3.15, p=0.00). Mutation of factor V Leiden (95% CI=1.26-10.27, OR=3.06, P=0.01) and homozygote form of MTHFR mutation (95% CI=1.55-97.86, OR=12.33, p=0.05) were also risk factors for recurrent IVF failure. However, we could not find significant difference in other inherited thrombophilia's. Inherited thrombophilia is more prevalent in women with recurrent IVF failure compared with healthy women. Having at least one thrombophilia, mutation of factor V Leiden and homozygote form of MTHFR mutation were risk factors for recurrent IVF failure.

  10. Twenty years' delay of fellow eye involvement in herpes simplex virus type 2-associated bilateral acute retinal necrosis syndrome

    NARCIS (Netherlands)

    Schlingemann, R. O.; Bruinenberg, M.; Wertheim-van Dillen, P.; Feron, E.

    1996-01-01

    PURPOSE: To describe a case of acute retinal necrosis with concurrent encephalitis and determine the causative virus. The patient had a history of presumed acute retinal necrosis in the left eye at the age of 8 years and recurrent genital herpes. METHODS: Diagnostic anterior chamber puncture of the

  11. Stereotactic body radiotherapy for lung metastases as oligo-recurrence: a single institutional study.

    Science.gov (United States)

    Aoki, Masahiko; Hatayama, Yoshiomi; Kawaguchi, Hideo; Hirose, Katsumi; Sato, Mariko; Akimoto, Hiroyoshi; Miura, Hiroyuki; Ono, Shuichi; Takai, Yoshihiro

    2016-01-01

    The purpose of this study was to investigate clinical outcomes following stereotactic body radiotherapy (SBRT) for lung metastases as oligo-recurrence. From May 2003 to June 2014, records for 66 patients with 76 oligo-recurrences in the lungs treated with SBRT were retrospectively reviewed. Oligo-recurrence primary sites and patient numbers were as follows: lungs, 31; colorectal, 13; head and neck, 10; esophagus, 3; uterus, 3; and others, 6. The median SBRT dose was 50 Gy (range, 45-60 Gy) administered in a median of 5 (range, 5-9) fractions. All patients received SBRT, with no acute toxicity. Surviving patients had a median follow-up time of 36.5 months. The 3-year rates of local control, overall survival and disease-free survival were 90.6%, 76.0% and 53.7%, respectively. Longer disease-free interval from initial treatment to SBRT, and non-colorectal cancer were both associated with favorable outcomes. Disease progression after SBRT occurred in 31 patients, most with distant metastases (n = 24) [among whom, 87.5% (n = 21) had new lung metastases]. Among these 21 patients, 12 were judged as having a second oligo-recurrence. Additional SBRT was performed for these 12 patients, and all 12 tumors were controlled without disease progression. Three patients (4.5%) developed Grade 2 radiation pneumonitis. No other late adverse events of Grade ≥2 were identified. Thus, SBRT for oligo-recurrence achieved acceptable tumor control, with additional SBRT also effective for selected patients with a second oligo-recurrence after primary SBRT. © The Author 2015. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

  12. Reirradiation on recurrent cervical cancer case: Treatment response and side effects

    Science.gov (United States)

    Siregar, M. F.; Supriana, N.; Nuranna, L.; Prihartono, J.

    2017-08-01

    Management of recurrent cervical cancer by reirradiation after radiation treatment remains controversial. In Indonesia, there is currently no data about reirradiation tumor response and side effects. This study aims to assess the tumor response to and side effects of reirradiation, the effect of time interval between first radiation treatment and cancer recurrence on the tumor response and side effects, and the effect of tumor size on tumor response. A cohort retrospective study with no comparison was done with the Radiotherapy Department at Cipto Mangunkusumo General Hospital, Jakarta. Participants were recurrent cervical cancer patients undergoing reirradiation. Data was collected from patients’ medical records and follow-up phone calls. Twenty-two patients participated in this study. Nine patients (40.9%) had complete responses, 10 patients (45.5%) had partial responses, 1 patient (4.5%) had a stable response, and 2 patients (9.1%) had tumor progressions. In general, 15 patients (68.2%) had no to light side effects (grade 0-2 RTOG) and 7 patients (31.8%) had severe side effects (grade 3-4 RTOG). Four patients (18.1%) had severe gastrointestinal acute side effects, 6 patients (27.3%) had severe gastrointestinal late side effects, 2 patients (9.1%) had severe urogenital side effects, and there were no patients had severe urogenital late side effects. There was no significant difference in tumor response between patients with time interval between first radiation treatment and recurrence of 4 cm. Reirradiation can be considered as a modality in recurrent cervical cancer management since good tumor response was achieved and the majority of patients had no to light side effects (grade 0-2 RTOG). This study found no correlation between tumor response, side effects, and time gap between first radiation treatment and recurrence of 4 cm.

  13. Carbon-Ion Radiation Therapy for Pelvic Recurrence of Rectal Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, Shigeru, E-mail: s_yamada@nirs.go.jp [Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Kamada, Tadashi [Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Ebner, Daniel K. [Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Brown University Alpert Medical School, Providence, Rhode Island (United States); Shinoto, Makoto [Ion Beam Therapy Center, SAGA HIMAT Foundation, Saga (Japan); Terashima, Kotaro [Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Isozaki, Yuka; Yasuda, Shigeo; Makishima, Hirokazu; Tsuji, Hiroshi; Tsujii, Hirohiko [Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba (Japan); Isozaki, Tetsuro; Endo, Satoshi [Graduate School of Medicine, Chiba University, Chiba (Japan); Takahashi, Keiichi [Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome, Tokyo (Japan); Sekimoto, Mitsugu [National Hospital Organization Osaka National Hospital, Osaka (Japan); Saito, Norio [National Cancer Center Hospital East, Kashiwa, Chiba (Japan); Matsubara, Hisahiro [Graduate School of Medicine, Chiba University, Chiba (Japan)

    2016-09-01

    Purpose: Investigation of the treatment potential of carbon-ion radiation therapy in pelvic recurrence of rectal cancer. Methods and Materials: A phase 1/2 dose escalation study was performed. One hundred eighty patients (186 lesions) with locally recurrent rectal cancer were treated with carbon-ion radiation therapy (CIRT) (phase 1/2: 37 and 143 patients, respectively). The relapse locations were 71 in the presacral region, 82 in the pelvic sidewalls, 28 in the perineum, and 5 near the colorectal anastomosis. A 16-fraction in 4 weeks dose regimen was used, with total dose ranging from 67.2 to 73.6 Gy(RBE); RBE-weighted absorbed dose: 4.2 to 4.6 Gy(RBE)/fraction. Results: During phase 1, the highest total dose, 73.6 Gy(RBE), resulted in no grade >3 acute reactions in the 13 patients treated at that dose. Dose escalation was halted at this level, and this dose was used for phase 2, with no other grade >3 acute reactions observed. At 5 years, the local control and survival rates at 73.6 Gy(RBE) were 88% (95% confidence interval [CI], 80%-93%) and 59% (95% CI, 50%-68%), respectively. Conclusion: Carbon-ion radiation therapy may be a safe and effective treatment option for locally recurrent rectal cancer and may serve as an alternative to surgery.

  14. Severe hypertriglyceridemia-related acute pancreatitis.

    Science.gov (United States)

    Stefanutti, Claudia; Labbadia, Giancarlo; Morozzi, Claudia

    2013-04-01

    Acute pancreatitis is a potentially life-threatening complication of severe hypertriglyceridemia. In some cases, inborn errors of metabolism such as lipoprotein lipase deficiency, apoprotein C-II deficiency, and familial hypertriglyceridemia have been reported as causes of severe hypertriglyceridemia. More often, severe hypertriglyceridemia describes various clinical conditions characterized by high plasma levels of triglycerides (>1000 mg/dL), chylomicron remnants, or intermediate density lipoprotein like particles, and/or chylomicrons. International guidelines on the management of acute pancreatitis are currently available. Standard therapeutic measures are based on the use of lipid-lowering agents (fenofibrate, gemfibrozil, niacin, Ω-3 fatty acids), low molecular weight heparin, and insulin in diabetic patients. However, when standard medical therapies have failed, non-pharmacological approaches based upon the removal of triglycerides with therapeutic plasma exchange can also provide benefit to patients with severe hypertriglyceridemia and acute pancreatitis. Plasma exchange could be very helpful in reducing triglycerides levels during the acute phase of hyperlipidemic pancreatitis, and in the prevention of recurrence. The current evidence on management of acute pancreatitis and severe hypertriglyceridemia, focusing on symptoms, treatment and potential complications is reviewed herein. © 2013 The Authors. Therapeutic Apheresis and Dialysis © 2013 International Society for Apheresis.

  15. Outcome of the Pediatric Patients with Portal Cavernoma: The Retrospective Study for 10 Years Focusing on Recurrent Variceal Bleeding

    Directory of Open Access Journals (Sweden)

    Hongjie Guo

    2016-01-01

    Full Text Available Background. Portal cavernoma (PC is the most critical condition with risk or variceal hemorrhage in pediatric patients. We retrospectively investigated the patients with PC focusing on the predictors for recurrent variceal bleeding. Methods. Between July 2003 and June 2013, we retrospectively enrolled all consecutive patients admitted to our department with a diagnosis of PC without abdominal malignancy or liver cirrhosis. The primary endpoint of this observational study was recurrent variceal bleeding. Independent predictors of recurrent variceal bleeding were identified using the logistic regression model. Results. A total of 157 patients were enrolled in the study. During the follow-up period, 24 patients exhibited onset of recurrent variceal bleeding. Acute variceal bleeding was subjected to conservative symptomatic treatment and emergency endoscopic sclerotherapy. Surgical procedure selection was based on the severity of vascular dilation and collateral circulation. Multivariate logistic regression analysis demonstrated that the presence of ascites, collateral circulation, and portal venous pressure were independent prognostic factors of recurrent variceal bleeding for patients with portal cavernoma. Conclusions. The presence of ascites, collateral circulation, and portal venous pressure evaluation are important and could predict the postsurgical recurrent variceal bleeding in patients with portal cavernoma.

  16. Meningeal infiltration in recurrent nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Chong, V.F.H.; Fan, Y.-F.

    2000-01-01

    Permeative infiltration of the meninges appears to be a distinct form of recurrent nasopharyngeal carcinoma (NPC). The present report of eight patients with recurrent NPC illustrates meningeal infiltration following basal foramina extension. Seven of the eight patients (88%) showed jugular foramen involvement. Three patients had concomitant infiltration of the foramen magnum. There was one patient showing spread through the foramen lacerum. Only four (50%) of these patients had clinically detectable tumour in the nasopharynx, while the other half showed deep submucosal recurrence with endoscopically unremarkable findings. Permeative meningeal infiltration appears to be a distinct form of NPC recurrence. It is important to recognize this phenomenon so as to optimize the treatment options. The imaging studies were reviewed and the following features were recorded: local nasopharyngeal recurrence, the manner of intracranial spread and site of meningeal infiltration. Four patients had only MRI, two had only CT and two patients had both CT and MRI. The presence or absence of intracranial tumour before treatment was also recorded. Two observers reviewed the images and results were arrived at by consensus. Copyright (1999) Blackwell Science Pty Ltd

  17. CT findings in recurrent pyogenic cholangitis

    International Nuclear Information System (INIS)

    Jung, Seung Hye; Lim, Jae Hoon; Ko, Young Tae; Lee, Dong Ho

    1991-01-01

    Recurrent pyogenic cholangitis is characterized clinically by recurrent attacks of right upper abdominal pain, fever and jaundice, and pathologically by chronic inflammation of the bile ducts with or without pigment bile duct stones. We analyzed the CT findings of 33 cases with recurrent pyogenic cholangitis. Twenty-four cases were confirmed by operation, and 9 cases were diagnosed clinically and cholangiographically. The CT findings of recurrent pyogenic cholangitis were dilatation of the intrahepatic ducts (n = 30), dilatation of the extrahepatic ducts (n = 24) intrahepatic stones (n = 16), extrahepatic stones (n = 12), stricture of the bile ducts (n = 10), wall enhancement of the bile ducts (n = 8), gallstones (n = 8), segmental atrophy of the liver (n = 7), pneumobilia (n = 4), abscess (n = 3), and segmental enhancement (n = 1) of the liver. A CT is considered helpful when sectional imaging is needed, but sonographic findings are equivocal or not confirmative; space-occupying lesions complicated with recurrent pyogenic cholangitis: hepatic resection is planned; and imaging guidance is needed for complex drainage procedures

  18. Local recurrence risk after previous salvage mastectomy.

    Science.gov (United States)

    Tanabe, M; Iwase, T; Okumura, Y; Yoshida, A; Masuda, N; Nakatsukasa, K; Shien, T; Tanaka, S; Komoike, Y; Taguchi, T; Arima, N; Nishimura, R; Inaji, H; Ishitobi, M

    2016-07-01

    Breast-conserving surgery is a standard treatment for early breast cancer. For ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery, salvage mastectomy is the current standard surgical procedure. However, it is not rare for patients with IBTR who have received salvage mastectomy to develop local recurrence. In this study, we examined the risk factors of local recurrence after salvage mastectomy for IBTR. A total of 118 consecutive patients who had histologically confirmed IBTR without distant metastases and underwent salvage mastectomy without irradiation for IBTR between 1989 and 2008 were included from eight institutions in Japan. The risk factors of local recurrence were assessed. The median follow-up period from salvage mastectomy for IBTR was 4.6 years. Patients with pN2 or higher on diagnosis of the primary tumor showed significantly poorer local recurrence-free survival than those with pN0 or pN1 at primary tumor (p mastectomy for IBTR. Further research and validation studies are needed. (UMIN-CTR number UMIN000008136). Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Recurrent urinary tract infections in women.

    Science.gov (United States)

    Aydin, Abdullatif; Ahmed, Kamran; Zaman, Iftikhar; Khan, Muhammad Shamim; Dasgupta, Prokar

    2015-06-01

    Recurrent urinary tract infections (UTIs) are more common in women and are frequently defined as ≥2 episodes in the last 6 months or ≥3 episodes in the last 12 months. In a primary care setting, 53 % of women above the age of 55 years and 36 % of younger women report a recurrence within 1 year. Thus, management and prevention of recurrent UTI is of utmost significance. This review aims to highlight the latest research in prevention strategies and suggest a management pathway. A search was conducted on MEDLINE, Embase and the Cochrane Database of Systematic Reviews databases for the latest systematic reviews and high-quality randomized controlled trials. Special emphasis was placed on the remit "recurrent" and strongly adhered to. Furthermore, a Google search was conducted for current guidelines on the management of UTIs. Current prevention strategies include eliminating risk factors that increase the risk of acquiring recurrent UTI and continuous, post-coital and self-initiated antimicrobial prophylaxis. Other prospective preventative strategies, currently under trial, include use of vaccinations, D-mannose and lactobacillus (probiotics). Although risk factors should be identified and addressed accordingly, individualized antibiotic prophylaxis remains the most effective method of management. Non-antibiotic prevention strategies such as cranberry, vitamin C and methenamine salts lack strong evidence to be introduced as routine management options and as alternatives to antibiotics. Based on current evidence and guidelines, a management pathway is recommended. Emerging therapies require further evaluation before they can be recommended.

  20. Learning State Space Dynamics in Recurrent Networks

    Science.gov (United States)

    Simard, Patrice Yvon

    Fully recurrent (asymmetrical) networks can be used to learn temporal trajectories. The network is unfolded in time, and backpropagation is used to train the weights. The presence of recurrent connections creates internal states in the system which vary as a function of time. The resulting dynamics can provide interesting additional computing power but learning is made more difficult by the existence of internal memories. This study first exhibits the properties of recurrent networks in terms of convergence when the internal states of the system are unknown. A new energy functional is provided to change the weights of the units in order to the control the stability of the fixed points of the network's dynamics. The power of the resultant algorithm is illustrated with the simulation of a content addressable memory. Next, the more general case of time trajectories on a recurrent network is studied. An application is proposed in which trajectories are generated to draw letters as a function of an input. In another application of recurrent systems, a neural network certain temporal properties observed in human callosally sectioned brains. Finally the proposed algorithm for stabilizing dynamics around fixed points is extended to one for stabilizing dynamics around time trajectories. Its effects are illustrated on a network which generates Lisajous curves.

  1. Characteristics and dynamics of cognitive impairment in patients with primary and recurrent cerebral ischemic hemispheric stroke

    Directory of Open Access Journals (Sweden)

    A. A. Kozyolkin

    2014-08-01

    Full Text Available Acute cerebrovascular disease is a global medical and social problem of the modern angioneurology, occupying leading positions in the structure of morbidity and mortality among adult population of the world. Ischemic stroke – is one of the most common pathology. Today this disease took out the world pandemic. More than 16 million new cases of cerebral infarction recorded in the world each year and it “kills” about 7 million of people. About 111,953 cases of cerebral stroke were registered in 2013 in Ukraine. Cognitive impairment, t hat significantly disrupt daily activities and life of the patient, is one of the most significant post-stroke complications that have social, medical and biological significance. Aim. The purpose of this investigation was to study features and dynamics of cognitive impairments in patients with primary and recurrent cerebral hemispheric ischemic stroke (CHIS in the acute stage of the disease. Materials and methods. To achieve the aim, and the decision of tasks in the clinic of nervous diseases Zaporozhye State Medical University (supervisor - Doctor of Medicine, Professor Kozelkin A. based on the department of acute cerebrovascular disease were performed comparative, prospective cohort study, which included comprehensive clinical and paraclinical examinations of 41 patients (26 men and 15 women aged 45 to 85 years (mean age 66,4 ± 1,4 years with acute left-hemispheric (2 patients and right - hemispheric (39 patients CHIS . First up was a group of 28 patients (19 men and 9 women, mean age 65,6 ± 1,6 years, who suffered from primary CHIS. The second group consisted of 13 patients (7 men and 6 women, mean age 68,1 ± 2,5 years with recurrent CHIS. The groups were matched by age, sex, localization of the lesion and the initial level of neurological deficit. All patients underwent physical examination, neurological examination. Dynamic clinical neurological examination assessing the severity of stroke was conducted

  2. A thermolabile aldolase A mutant causes fever-induced recurrent rhabdomyolysis without hemolytic anemia.

    Directory of Open Access Journals (Sweden)

    Asmaa Mamoune

    2014-11-01

    Full Text Available Aldolase A deficiency has been reported as a rare cause of hemolytic anemia occasionally associated with myopathy. We identified a deleterious homozygous mutation in the ALDOA gene in 3 siblings with episodic rhabdomyolysis without hemolytic anemia. Myoglobinuria was always triggered by febrile illnesses. We show that the underlying mechanism involves an exacerbation of aldolase A deficiency at high temperatures that affected myoblasts but not erythrocytes. The aldolase A deficiency was rescued by arginine supplementation in vitro but not by glycerol, betaine or benzylhydantoin, three other known chaperones, suggesting that arginine-mediated rescue operated by a mechanism other than protein chaperoning. Lipid droplets accumulated in patient myoblasts relative to control and this was increased by cytokines, and reduced by dexamethasone. Our results expand the clinical spectrum of aldolase A deficiency to isolated temperature-dependent rhabdomyolysis, and suggest that thermolability may be tissue specific. We also propose a treatment for this severe disease.

  3. Acute Pancreatitis in acute viral hepatitis

    Directory of Open Access Journals (Sweden)

    S K.C.

    2011-03-01

    Full Text Available Introduction: The association of acute viral hepatitis and acute pancreatitis is well described. This study was conducted to find out the frequency of pancreatic involvement in acute viral hepatitis in the Nepalese population. Methods: Consecutive patients of acute viral hepatitis presenting with severe abdominal pain between January 2005 and April 2010 were studied. Patients with history of significant alcohol consumption and gall stones were excluded. Acute viral hepatitis was diagnosed by clinical examination, liver function test, ultrasound examination and confirmed by viral serology. Pancreatitis was diagnosed by clinical presentation, biochemistry, ultrasound examination and CT scan. Results: Severe abdominal pain was present in 38 of 382 serologically-confirmed acute viral hepatitis patients. Twenty five patients were diagnosed to have acute pancreatitis. The pancreatitis was mild in 14 and severe in 11 patients. The etiology of pancreatitis was hepatitis E virus in 18 and hepatitis A virus in 7 patients. Two patients died of complications secondary to shock. The remaining patients recovered from both pancreatitis and hepatitis on conservative treatment. Conclusions: Acute pancreatitis occurred in 6.5 % of patients with acute viral hepatitis. Cholelithiasis and gastric ulcers are the other causes of severe abdominal pain. The majority of the patients recover with conservative management. Keywords: acute viral hepatitis, acute pancreatitis, pain abdomen, hepatitis E, hepatitis A, endemic zone

  4. Acute abdomen

    International Nuclear Information System (INIS)

    Beger, H.G.; Kern, E.

    1987-01-01

    The book first presents the anatomy and physiology of the abdomen and continues with chapters discussing clinical and laboratory aspects and a suitable order of diagnostic examinations with reference to the acute processes, explaining the diagnostic tools: ultrasonography, radiography including angiography and CT, tapping techniques and endoscopy together with their basic principles, examination techniques, and diagnosis. One chapter presents a complete survey of the processes involving the entire abdomen - as e.g. peritonitis, ileus, abdominal trauma, intraperitoneal hemorrage. This chapter profoundly discusses the diagnostics and therapies including emergency measures and surgery. Problems requiring consultation among varous specialists, in internal medicine, gynecology, urology, or pediatrics, are discussed in great detail. Information for the anesthetist is given for cases of emergency. More than one third of the book is devoted to organ-specific information, dicussing the pathogenesis, diagnostics, and therapy of the oesophagus, stomach, large and small intestine, bile ducts, pankreas, liver, spleen, and the abdominal vessels and the abdominal wall. (orig.) With 153 figs., 90 tabs [de

  5. Exaggerated inflammatory response after use of recombinant bone morphogenetic protein in recurrent unicameral bone cysts.

    Science.gov (United States)

    MacDonald, Kevin M; Swanstrom, Morgan M; McCarthy, James J; Nemeth, Blaise A; Guliani, Teresa A; Noonan, Kenneth J

    2010-03-01

    Recurrent unicameral bone cysts (UBCs) can result in significant morbidity during a child's physical and emotional development. Multiple treatment options are available and a review of the literature fails to clearly define the optimal treatment for UBCs. Recombinant bone morphogenetic protein (BMP) has been used with success in other disorders of poor bone formation. This manuscript is the first to report on the use of recombinant BMP in the treatment of UBCs. Three patients with recurrent UBCs underwent revision surgery with recombinant BMP. Radiographic and medical review was performed and is reported here. In these patients, the use of BMP failed to fully resolve their UBC; 2 patients had complete recurrence that required further surgery. In addition to poor radiographic results, all patients developed exaggerated inflammatory responses in the acute postoperative period. Each child developed clinically significant limb swelling and pain that mimicked infection. On the basis of our poor radiographic results and a paradoxical clinical result, we no longer recommend the use of recombinant BMP in the manner reported here for the treatment of recurrent UBCs. Level IV, case series.

  6. Treatment by radiotherapy alone of uterine cervix carcinoma recurrent in the pelvis

    International Nuclear Information System (INIS)

    Bignardi, M.; Bardelli, D.; Tordiglione, M.; Bertoni, F.

    1988-01-01

    The best way to treat locally recurrent carcinoma of the uterine cervix has not been established. This retrospective study refers to 37 consecutive patients, with recurrence in the pelvis, treated by radiotherapy alone. Thirty patients were treated by external beam therapy alone; intracavitary brachitherapy alone was adopted in 3 patients and a combination of both techniques in 4 patients. The total radiation dose exceeded 60 Gy in 62% of cases. A complete clinical response was observed in 54% of patiens and a partial response in 32.4%. Overall crude survival was 70.3%, 28.9% and 23.2% at 1, 3 and 5 years respectively. In patients with recurrent tumors less than 40 mm in diameter a threefold 3-year survival was achieved (48.6% vs. 14.5%, p<0.025). With total doses higher than 60 Gy the 3-year survival resulted to be far better than with lower doses (39.1% vs. 10%, p<0.025). A significant advantage was also observed in the ''complete responders'' group (44% vs. 11.8%), but this difference can be explained by the link between response and the above-mentioned basic prognostic factors. Acute side effects and late complications were moderate and did not correlate with the type of primary treatment. A significant percentage (about 25%) of patients with locally recurrent cervix carcinoma may reach medium-term survival; better results can be achieved in selected groups with favourable prognostsc factors and with adequate radiotherapic treatment

  7. Relapsing acute disseminated encephalomyelitis associated with chronic Epstein-Barr virus infection: MRI findings

    International Nuclear Information System (INIS)

    Shoji, H.; Kusuhara, T.; Honda, Y.; Hino, H.; Kojima, K.; Abe, T.; Watanabe, M.

    1992-01-01

    A 25-year-old women had a fever, left cervical lymphadenopathy, neurological symptoms and signs, CSF pleocytosis and persistent high serum antibodies to the Epstein-Barr virus (EBV); she had a recurrence 1 year later. She was thought to have relapsing acute disseminated encephalomyelitis associated with chronic EBV infection. MRI revealed abnormalities, mainly in the right basal ganglia and left midbrain. At the time of the recurrence, further abnormalities appeared in the opposite basal ganglia and right cerebral white matter. (orig.)

  8. Relapsing acute disseminated encephalomyelitis associated with chronic Epstein-Barr virus infection: MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Shoji, H.; Kusuhara, T.; Honda, Y.; Hino, H. (1. Dept. (Neurology) of Internal Medicine, Kurume Univ. School of Medicine (Japan)); Kojima, K.; Abe, T. (Dept. of Radiology, Kurume Univ. School of Medicine (Japan)); Watanabe, M. (Dept. of Neurosurgery, Koyanagi Hospital, Saga (Japan))

    1992-08-01

    A 25-year-old women had a fever, left cervical lymphadenopathy, neurological symptoms and signs, CSF pleocytosis and persistent high serum antibodies to the Epstein-Barr virus (EBV); she had a recurrence 1 year later. She was thought to have relapsing acute disseminated encephalomyelitis associated with chronic EBV infection. MRI revealed abnormalities, mainly in the right basal ganglia and left midbrain. At the time of the recurrence, further abnormalities appeared in the opposite basal ganglia and right cerebral white matter. (orig.).

  9. Recurrent intramedullary epidermoid cyst of conus medullaris.

    LENUS (Irish Health Repository)

    Fleming, Christina

    2011-01-01

    Spinal intramedullary epidermoid cyst is a rare condition. Recurrent epidermoid cyst in the spine cord is known to occur. The authors describe a case of recurrent conus medullaris epidermoid cyst in a 24-year-old female. She initially presented at 7 years of age with bladder disturbance in the form of diurnal enuresis and recurrent urinary tract infection. MRI lumbar spine revealed a 4 cm conus medullaris epidermoid cyst. Since the initial presentation, the cyst had recurred seven times in the same location and she underwent surgical intervention in the form of exploration and debulking. This benign condition, owing to its anatomical location, has posed a surgical and overall management challenge. This occurrence is better managed in a tertiary-care centre requiring multi-disciplinary treatment approach.

  10. Recurrence analysis of ant activity patterns.

    Directory of Open Access Journals (Sweden)

    Felipe Marcel Neves

    Full Text Available In this study, we used recurrence quantification analysis (RQA and recurrence plots (RPs to compare the movement activity of individual workers of three ant species, as well as a gregarious beetle species. RQA and RPs quantify the number and duration of recurrences of a dynamical system, including a detailed quantification of signals that could be stochastic, deterministic, or both. First, we found substantial differences between the activity dynamics of beetles and ants, with the results suggesting that the beetles have quasi-periodic dynamics and the ants do not. Second, workers from different ant species varied with respect to their dynamics, presenting degrees of predictability as well as stochastic signals. Finally, differences were found among minor and major caste of the same (dimorphic ant species. Our results underscore the potential of RQA and RPs in the analysis of complex behavioral patterns, as well as in general inferences on animal behavior and other biological phenomena.

  11. Recurrence quantification analysis of global stock markets

    Science.gov (United States)

    Bastos, João A.; Caiado, Jorge

    2011-04-01

    This study investigates the presence of deterministic dependencies in international stock markets using recurrence plots and recurrence quantification analysis (RQA). The results are based on a large set of free float-adjusted market capitalization stock indices, covering a period of 15 years. The statistical tests suggest that the dynamics of stock prices in emerging markets is characterized by higher values of RQA measures when compared to their developed counterparts. The behavior of stock markets during critical financial events, such as the burst of the technology bubble, the Asian currency crisis, and the recent subprime mortgage crisis, is analyzed by performing RQA in sliding windows. It is shown that during these events stock markets exhibit a distinctive behavior that is characterized by temporary decreases in the fraction of recurrence points contained in diagonal and vertical structures.

  12. Recurrent Hypothenar Hammer Syndrome: A Case Report.

    Science.gov (United States)

    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.

  13. Laparoscopic Surgery for Recurrent Crohn's Disease

    Directory of Open Access Journals (Sweden)

    Antonino Spinelli

    2012-01-01

    Full Text Available In spite of the recent improvements in drug therapy, surgery still represents the most frequent treatment for Crohn's disease (CD complications. Laparoscopy has been widely applied over the last twenty years in colorectal surgery and was associated with lower postoperative pain, shorter hospitalization, faster return to daily activities, and better cosmetic results. Laparoscopy experienced a slower diffusion in inflammatory bowel disease surgery than in oncologic colorectal surgery, but proved to be safe and effective, and is currently considered the gold standard for the treatment of primary uncomplicated ileocolic CD. Indications for laparoscopy in CD have recently been widened to embrace more complicated or recurrent CD. This paper reviews the available data on the subset of recurrent CD patients. The reported results indicate that laparoscopy may be safely applied even in selected recurrent CD cases in hands of IBD surgeons with broad laparoscopic experience.

  14. Recurrent Admissions for Diabetic Foot Complications

    Directory of Open Access Journals (Sweden)

    Ang CL

    2013-07-01

    Full Text Available Diabetic foot complications are a significant source of morbidity and mortality. Patients who undergo recurrent admissions for the same diabetic foot problems represent a difficult subgroup to treat. From July 2007 to June 2008, there were 38 such patients who were admitted recurrently. Eighteen patients (47% were re-admitted because of previous refusal of surgical treatment. Eighteen patients (47% received treatment as necessary but were still readmitted for recurrent infection at the same wound site. Assessment of patients’ compliance to outpatient treatment was found to be generally lacking. As a significant proportion were re-admitted because of previous refusal of surgery, a trained counselor may be suitable in counselling patients for debridement or amputation surgery.

  15. Divergent clonal selection dominates medulloblastoma at recurrence

    Science.gov (United States)

    Morrissy, A. Sorana; Garzia, Livia; Shih, David J. H.; Zuyderduyn, Scott; Huang, Xi; Skowron, Patryk; Remke, Marc; Cavalli, Florence M. G.; Ramaswamy, Vijay; Lindsay, Patricia E.; Jelveh, Salomeh; Donovan, Laura K.; Wang, Xin; Luu, Betty; Zayne, Kory; Li, Yisu; Mayoh, Chelsea; Thiessen, Nina; Mercier, Eloi; Mungall, Karen L.; Ma, Yusanne; Tse, Kane; Zeng, Thomas; Shumansky, Karey; Roth, Andrew J. L.; Shah, Sohrab; Farooq, Hamza; Kijima, Noriyuki; Holgado, Borja L.; Lee, John J. Y.; Matan-Lithwick, Stuart; Liu, Jessica; Mack, Stephen C.; Manno, Alex; Michealraj, K. A.; Nor, Carolina; Peacock, John; Qin, Lei; Reimand, Juri; Rolider, Adi; Thompson, Yuan Y.; Wu, Xiaochong; Pugh, Trevor; Ally, Adrian; Bilenky, Mikhail; Butterfield, Yaron S. N.; Carlsen, Rebecca; Cheng, Young; Chuah, Eric; Corbett, Richard D.; Dhalla, Noreen; He, An; Lee, Darlene; Li, Haiyan I.; Long, William; Mayo, Michael; Plettner, Patrick; Qian, Jenny Q.; Schein, Jacqueline E.; Tam, Angela; Wong, Tina; Birol, Inanc; Zhao, Yongjun; Faria, Claudia C.; Pimentel, José; Nunes, Sofia; Shalaby, Tarek; Grotzer, Michael; Pollack, Ian F.; Hamilton, Ronald L.; Li, Xiao-Nan; Bendel, Anne E.; Fults, Daniel W.; Walter, Andrew W.; Kumabe, Toshihiro; Tominaga, Teiji; Collins, V. Peter; Cho, Yoon-Jae; Hoffman, Caitlin; Lyden, David; Wisoff, Jeffrey H.; Garvin, James H.; Stearns, Duncan S.; Massimi, Luca; Schüller, Ulrich; Sterba, Jaroslav; Zitterbart, Karel; Puget, Stephanie; Ayrault, Olivier; Dunn, Sandra E.; Tirapelli, Daniela P. C.; Carlotti, Carlos G.; Wheeler, Helen; Hallahan, Andrew R.; Ingram, Wendy; MacDonald, Tobey J.; Olson, Jeffrey J.; Van Meir, Erwin G.; Lee, Ji-Yeoun; Wang, Kyu-Chang; Kim, Seung-Ki; Cho, Byung-Kyu; Pietsch, Torsten; Fleischhack, Gudrun; Tippelt, Stephan; Ra, Young Shin; Bailey, Simon; Lindsey, Janet C.; Clifford, Steven C.; Eberhart, Charles G.; Cooper, Michael K.; Packer, Roger J.; Massimino, Maura; Garre, Maria Luisa; Bartels, Ute; Tabori, Uri; Hawkins, Cynthia E.; Dirks, Peter; Bouffet, Eric; Rutka, James T.; Wechsler-Reya, Robert J.; Weiss, William A.; Collier, Lara S.; Dupuy, Adam J.; Korshunov, Andrey; Jones, David T. W.; Kool, Marcel; Northcott, Paul A.; Pfister, Stefan M.; Largaespada, David A.; Mungall, Andrew J.; Moore, Richard A.; Jabado, Nada; Bader, Gary D.; Jones, Steven J. M.; Malkin, David; Marra, Marco A.; Taylor, Michael D.

    2016-01-01

    The development of targeted anti-cancer therapies through the study of cancer genomes is intended to increase survival rates and decrease treatment-related toxicity. We treated a transposon–driven, functional genomic mouse model of medulloblastoma with ‘humanized’ in vivo therapy (microneurosurgical tumour resection followed by multi-fractionated, image-guided radiotherapy). Genetic events in recurrent murine medulloblastoma exhibit a very poor overlap with those in matched murine diagnostic samples (sequencing of 33 pairs of human diagnostic and post-therapy medulloblastomas demonstrated substantial genetic divergence of the dominant clone after therapy (recurrence). In both mice and humans, the dominant clone at recurrence arose through clonal selection of a pre-existing minor clone present at diagnosis. Targeted therapy is unlikely to be effective in the absence of the target, therefore our results offer a simple, proximal, and remediable explanation for the failure of prior clinical trials of targeted therapy. PMID:26760213

  16. Recurrent conjunctival atypical fibroxanthoma in Pigmentosum Xeroderma.

    Science.gov (United States)

    Cerdà-Ibáñez, M; Barreiro-González, A; Barranco González, H; Aviñó Martínez, J; Évole-Buselli, M; Harto-Castaño, M Á

    2018-02-01

    A 7 year-old boy with Xeroderma Pigmentosum (XP) and who presents a recurrent conjunctival atypical fibroxanthoma after two surgeries. This is the third procedure and the patient is treated with a surgical excision of the tumour and cryotherapy at the surgical bed. Due to the risk of recurrence, topical Mitomycin C 0,02% was added at post-operative care achieving a good clinical outcome. Surgical exeresis with cryotherapy and topical Mitomycin C is an effective treatment for a case of an atypical fibroxanthoma with a high potential for recurrence and invasion. An ophthalmologic follow-up is required for these patients, as well as general paediatric care and support aids. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Pain recurrence after shaving of rectovaginal endometriosis

    DEFF Research Database (Denmark)

    Heide, Mathias Gottschalck; Forman, Axel

    Background: Surgical treatment of rectovaginal endometriosis varies from shaving of the nodule off the rectal wall without perforation, over discoid excision to routine rectal resection. Of these methods, shaving involves the lowest rate of serious complications but leaves endometriosis tissue...... on the bowel with risk of recurrence. This could motivate a change into more radical surgery. In the present study we therefore assessed recurrence of pain after shaving of rectovaginal endometriosis performed 2001-2009. Methods: Retrospective follow-up study. Questionnaires were sent to 212 women of whom 174...... OCs and gestagen IUD showed a trend towards a protective effect against menstrual pain (p=0.06). There was found no significant association between recurrence of pain and anterior rectal wall involvement. Conclusion: Shaving of rectovaginal endometriosis shows a high risk of postoperative pain...

  18. Prevention of Recurrent Staphylococcal Skin Infections

    Science.gov (United States)

    Creech, C. Buddy; Al-Zubeidi, Duha N.; Fritz, Stephanie A.

    2015-01-01

    Synopsis Staphylococcus aureus infections pose a significant health burden. The emergence of community-associated methicillin-resistant S. aureus has resulted in an epidemic of skin and soft tissue infections (SSTI), and many patients experience recurrent SSTI. As S. aureus colonization is associated with subsequent infection, decolonization is recommended for patients with recurrent SSTI or in settings of ongoing transmission. S. aureus infections often cluster within households and asymptomatic carriers serve as reservoirs for transmission; therefore, a household approach to decolonization is more effective than measures performed by individuals alone. Other factors, such as environmental surface contamination, may also be considered. Novel strategies for the prevention of recurrent SSTI are needed. PMID:26311356

  19. Imaging symptomatics in recurrent facial nerve neuritis

    International Nuclear Information System (INIS)

    Slavchev, D.

    2001-01-01

    Gaining better insight into the etiology and pathogenesis of recurrent facial nerve neuritis requires the use of an appropriate imaging modality of examination. This is retrospective analysis of 106 patients with recurrent n. facialis neuritis, studied by conventional x-ray methods, including: segment roentgenography according to Schuller, Stenverse, Biezalski (in children), and hypocyloidal directly enlarged polytomography, with emphasis laid on their role in the diagnostic algorithm of study. Assessment is done of the Fallopian canal width and course, with a special reference to adjacent bony structures, having essential practical bearing on planning interventions for decompression of the nerve and chronic otomastoiditis treatment. In 30 % of the patients are observed inflammatory changes in the parafacial bony structures as an expression of inflammatory otogenic etiology of recurrent n. facialis neuritis, and in 7 % - eburneization of bony structures. The symptom of improved Fallopian canal visibility is documented in cases presenting chronic inflammatory processes involving parafacial cellular structures. (author)

  20. Surgical Treatment of Acute Pancreatitis.

    Science.gov (United States)

    Werner, Jens; Uhl, Waldemar; Büchler, Markus W.

    2003-10-01

    Patients with predicted severe necrotizing pancreatitis as diagnosed by C-reactive protein (>150 mg/L) and/or contrast-enhanced computed tomography should be managed in the intensive care unit. Prophylactic broad-spectrum antibiotics reduce infection rates and survival in severe necrotizing pancreatitis. Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy is a causative therapy for gallstone pancreatitis with impacted stones, biliary sepsis, or obstructive jaundice. Fine needle aspiration for bacteriology should be performed to differentiate between sterile and infected pancreatic necrosis in patients with sepsis syndrome. Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for surgery. Patients with sterile pancreatic necrosis should be managed conservatively. Surgery in patients with sterile necrosis may be indicated in cases of persistent necrotizing pancreatitis and in the rare cases of "fulminant acute pancreatitis." Early surgery, within 14 days after onset of the disease, is not recommended in patients with necrotizing pancreatitis. The surgical approach should be organ-preserving (debridement/necrosectomy) and combined with a postoperative management concept that maximizes postoperative evacuation of retroperitoneal debris and exudate. Minimally invasive surgical procedures have to be regarded as an experimental approach and should be restricted to controlled trials. Cholecystectomy should be performed to avoid recurrence of gallstone-associated acute pancreatitis.

  1. Urinary NGAL deficiency in recurrent urinary tract infections.

    Science.gov (United States)

    Forster, Catherine S; Johnson, Kathryn; Patel, Viral; Wax, Rebecca; Rodig, Nancy; Barasch, Jonathan; Bachur, Richard; Lee, Richard S

    2017-06-01

    Children with recurrent urinary tract infections (rUTI) often show no identifiable cause of their infections. Neutrophil gelatinase-associated lipocalin (NGAL) is known to be upregulated within the uroepithelium and kidney of patients with UTI and exhibits a localized bacteriostatic effect through iron chelation. We hypothesize that some patients with rUTI without an identifiable cause of their recurrent infections have locally deficient NGAL production. We therefore explored whether a lack of NGAL production may be a factor in the pathogenesis of rUTI. Patients seen in the urology clinic for rUTI who were tract, or other reasons that predispose to UTI, such as neurogenic bladder, the need for intermittent catheterization, or unrepaired posterior urethral valves. Control patients were healthy children enrolled from the emergency department with no history of UTI or renal dysfunction, normal urinalysis at the time of enrollment, and presenting no diagnosis associated with increased NGAL levels, such as acute kidney injury or infection. NGAL was measured by immunoblot. Fifteen cases and controls were enrolled. Median urinary NGAL levels were significantly decreased in rUTI patients compared with controls [15 (14-29) ng/ml vs 30 (27-61) ng/ml; p = 0.002)] Although comparatively diminished, measurable NGAL levels were present in all patients with rUTI. Urinary NGAL is significantly decreased in patients with compared with patients without rUTI. These data suggest that some patients with rUTI may be predisposed to UTI because of a relative local deficiency in urinary NGAL production.

  2. [Recurrent aseptic meningitis secondary to taking ibuprofen and ketorolac].

    Science.gov (United States)

    Cano Vargas-Machuca, E; Mondéjar-Marín, B; Navarro-Muñoz, S; Pérez-Molina, I; Garrido-Robres, J A; Alvarez-Tejerina, A

    Aseptic meningitis is a process that is characterised by an inflammatory reaction of the meninges that is not due to any infectious agent. Its aetiology is varied and is most frequently caused by rheumatologic and/or autoimmune processes, chemical or medication-induced meningitis, the most notable drugs involved being antibiotics and non-steroidal anti-inflammatory drugs (NSAI). We report the case of a 70-year-old male, with no relevant history, who was admitted to hospital five times over a period of 16 months because of acute meningitis with polymorphonuclear pleocytosis, high protein levels in cerebrospinal fluid and normal glucose in cerebrospinal fluid. No evidence of an infectious causation, chemical meningitis, carcinomatosis or autoimmune disease was found and the patient was diagnosed with recurrent aseptic meningitis. It was found that the patient had taken ibuprofen or ketorolac on several occasions, a few hours before the appearance of symptoms. These episodes were quickly resolved after withdrawal of this medication. A number of NSAI have been reported as inducers of aseptic meningitis, one of the most notable being ibuprofen. We report the case of a patient who, as a consequence of taking ibuprofen and ketorolac, presented episodes of recurrent aseptic meningitis. To our knowledge this side effect of ketorolac has not been reported before. Its clinical features are impossible to differentiate from those of infectious meningitis. Diagnosis is reached by exclusion and a careful pharmacological study, including over-the-counter drugs like some of the NSAI, must be performed in patients with this condition, since it is a problem that can easily be solved by withdrawing the drug that causes it.

  3. Prediction and prognosis of ventricular tachycardia recurrence after catheter ablation with remote magnetic navigation for electrical storm in patients with ischemic cardiomyopathy.

    Science.gov (United States)

    Jin, Qi; Jacobsen, Peter Karl; Pehrson, Steen; Chen, Xu

    2017-11-01

    Ventricular tachycardia (VT) recurrence after catheter ablation for electrical storm is commonly seen in patients with ischemic cardiomyopathy (ICM). We hypothesized that VT recurrence can be predicted and be related to the all-cause death after VT storm ablation guided by remote magnetic navigation (RMN) in patients with ICM. A total of 54 ICM patients (87% male; mean age, 65 ± 7.1 years) presenting with VT storm undergoing acute ablation using RMN were enrolled. Acute complete ablation success was defined as noninducibility of any sustained monomorphic VT at the end of the procedure. Early VT recurrence was defined as the occurrence of sustained VT within 1 month after the first ablation. After a mean follow-up of 17.1 months, 27 patients (50%) had freedom from VT recurrence. Sustained VT recurred in 12 patients (22%) within 1 month following the first ablation. In univariate analysis, VT recurrence was associated with incomplete procedural success (hazard ratio [HR]: 6.25, 95% confidence interval [CI]: 1.20-32.47, P = 0.029), lack of amiodarone usage before ablation (HR: 4.71, 95% CI: 1.12-19.7, P = 0.034), and a longer procedural time (HR: 1.023, 95% CI: 1.00-1.05, P = 0.05). The mortality of patients with early VT recurrence was higher than that of patients without recurrence (P storm guided by RMN is the strongest predictor of VT recurrence. ICM patients who have early recurrences after VT storm ablation are at high risk of all-cause death. © 2017 Wiley Periodicals, Inc.

  4. Recurrent thyrotoxicosis after I-131 induced hypothyroidism

    International Nuclear Information System (INIS)

    Liu, L.; Borowski, G.D.; Shtasel, P.; Rose, L.I.

    1984-01-01

    The first clinically and biochemically documented case of recurrent thyrotoxicosis after I-131 induced hypothyroidism in a patient with Graves' disease is reported. Two months after the administration of 9.2 mCi of I-131, the subject developed hypothyroidism. One month later, the patient became euthyroid. Then, nine months following ablation, the patient again developed thyrotoxicosis. A second dose of I-131 of 12.5 mCi was required to finally produce permanent hypothyroidism. This case illustrates the recurrence of hypothyroidism after what had seemed to have been adequate I-131 radiation

  5. Recurrent Shoulder Dystocia: Risk Factors and Counseling.

    Science.gov (United States)

    Gurewitsch Allen, Edith D

    2016-12-01

    A prior history of delivery complicated by shoulder dystocia confers a 6-fold to nearly 30-fold increased risk of shoulder dystocia recurrence in a subsequent vaginal delivery, with most reported rates between 12% and 17%. Whereas prevention of shoulder dystocia in the general population is neither feasible nor cost-effective, directing intervention efforts at the particular subgroup of women with a prior history of shoulder dystocia has merit. Potentially modifiable risk factors and individualized management strategies that may reduce shoulder dystocia recurrence and its associated significant morbidities are reviewed.

  6. Immunologic Abnormalities, Treatments, and Recurrent Pregnancy Loss

    DEFF Research Database (Denmark)

    Wang, Nathalie F; Kolte, Astrid M; Larsen, Elisabeth C

    2016-01-01

    Recurrent pregnancy loss, depending on the definition, affects 1% to 3% of women aiming to have a child. Little is known about the direct causes of recurrent pregnancy loss, and the condition is considered to have a multifactorial and complex pathogenesis. The aim of this review was to summarize ...... the evaluation and the management of the condition with specific emphasis on immunologic biomarkers identified as risk factors as well as current immunologic treatment options. The review also highlights and discusses areas in need of further research....

  7. [Recurrent vulvovaginitis: diagnostic assessment and therapeutic management].

    Science.gov (United States)

    Ramírez-Santos, A; Pereiro, M; Toribio, J

    2008-04-01

    Recurrent vulvovaginitis is a common problem in clinical practice. Management is often complicated by a long history of inappropriate treatments based on tentative diagnoses after an incomplete diagnostic workup. We review the most common causes of recurrent vulvovaginitis; the appropriate steps with which to establish a diagnosis, from the medical history through to the additional tests needed; and, finally, the best therapeutic options. We will focus on infectious, irritant, allergic, and hormonal causes as the ones of most interest to the dermatologist. Given that infection is the most frequent cause of these processes and also a common reason for inopportune treatment, we will pay particular attention to infectious etiologies and their differential diagnosis.

  8. Harris Recurrence and MCMC: A Simplified Approach

    DEFF Research Database (Denmark)

    Asmussen, Søren; Glynn, Peter W.

    A key result underlying the theory of MCMC is that any η-irreducible Markov chain having a transition density with respect to η and possessing a stationary distribution is automatically positive Harris recurrent. This paper provides a short self-contained proof of this fact.......A key result underlying the theory of MCMC is that any η-irreducible Markov chain having a transition density with respect to η and possessing a stationary distribution is automatically positive Harris recurrent. This paper provides a short self-contained proof of this fact....

  9. Approach to the child with recurrent infections

    Directory of Open Access Journals (Sweden)

    Suzan A AlKhater

    2009-01-01

    Full Text Available Children with a history of recurrent, severe, or unusual infections present a diagnostic challenge. It is important to maintain a high index of suspicion for the diagnosis of immunodeficiency, for early diagnosis and treatment can improve outcome. Differentiation between infections caused by common risk factors, or immune dysfunction should be based on a detailed history and physical examination and, if indicated, followed by appropriate laboratory studies. This paper aims at providing guidelines for the evaluation of children with recurrent infections. It provides an overview of the diagnostic approach including important details required from the history, physical examination, and an appropriate choice of screening test to be ordered.

  10. Managing recurrent genital herpes with acyclovir

    Directory of Open Access Journals (Sweden)

    Bedi T

    1995-01-01

    Full Text Available Seventy five patients of recurrent genital herpes (RGH treated with oral or topical acyclovir and placebo were compared and followed for periods ranging 4 to 8 years in a prospective study. Oral acyclovir definitely helps RGH patients; it shortens healing time; postpones recurrences and instills confidence in the patients. There is sufficient evidence that RGH dies a natural death with time as seen after 8 years follow up in placebo group patients. Topical use of acyclovir cream is not as useful as believed.

  11. Prolapse Recurrence after Transvaginal Mesh Removal.

    Science.gov (United States)

    Rawlings, Tanner; Lavelle, Rebecca S; Coskun, Burhan; Alhalabi, Feras; Zimmern, Philippe E

    2015-11-01

    We determined the rate of pelvic organ prolapse recurrence after transvaginal mesh removal. Following institutional review board approval a longitudinally collected database of women undergoing transvaginal mesh removal for complications after transvaginal mesh placement with at least 1 year minimum followup was queried for pelvic organ prolapse recurrence. Recurrent prolapse was defined as greater than stage 1 on examination or the need for reoperation at the site of transvaginal mesh removal. Outcome measures were based on POP-Q (Pelvic Organ Prolapse Quantification System) at the last visit. Patients were grouped into 3 groups, including group 1--recurrent prolapse in the same compartment as transvaginal mesh removal, 2--persistent prolapse and 3--prolapse in a compartment different than transvaginal mesh removal. Of 73 women 52 met study inclusion criteria from 2007 to 2013, including 73% who presented with multiple indications for transvaginal mesh removal. The mean interval between insertion and removal was 45 months (range 10 to 165). Overall mean followup after transvaginal mesh removal was 30 months (range 12 to 84). In group 1 (recurrent prolapse) the rate was 15% (6 of 40 patients). Four women underwent surgery for recurrent prolapse at a mean 7 of months (range 5 to 10). Two patients elected observation. The rate of persistent prolapse (group 2) was 23% (12 of 52 patients). Three women underwent prolapse reoperation at a mean of 10 months (range 8 to 12). In group 3 (de novo/different compartment prolapse) the rate was 6% (3 of 52 patients). One woman underwent surgical repair at 52 months. At a mean 2.5-year followup 62% of patients (32 of 52) did not have recurrent or persistent prolapse after transvaginal mesh removal and 85% (44 of 52) did not undergo any further procedure for prolapse. Specifically for pelvic organ prolapse in the same compartment as transvaginal mesh removal 12% of patients had recurrence, of whom 8% underwent prolapse repair

  12. Recurrent breast sparganosis: Clinical and radiological findings

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ji Yoon; Woo, Ok Hee [Dept. of Radiology, Korea University Guro Hospital, Seoul (Korea, Republic of); Cho, Kyu Ran; Seo, Bo Kyoung [Korea University Anam Hospital, Seoul (Korea, Republic of)

    2015-09-15

    We report a case of recurrent sparganosis of the breast within 6 months following surgical removal of worms from the breast. The patient was referred to our hospital with a palpable mass in the right breast. On admission, breast ultrasonography revealed a tortuous tubular hypoechoic lesion with indistinct margins within a surrounding hyperechoic area, which strongly suggested sparganosis. We performed surgical excision and confirmed sparganosis. After 6 months, the patient detected a new mass in her right breast and visited our hospital. Breast ultrasonography revealed similar features in a different area of the same breast. We confirmed recurrent sparganosis surgically.

  13. Differential recurrence formulae for orthogonal polynomials

    Directory of Open Access Journals (Sweden)

    Anton L. W. von Bachhaus

    1995-11-01

    Full Text Available Part I - By combining a general 2nd-order linear homogeneous ordinary differential equation with the three-term recurrence relation possessed by all orthogonal polynomials, it is shown that sequences of orthogonal polynomials which satisfy a differential equation of the above mentioned type necessarily have a differentiation formula of the type: gn(xY'n(x=fn(xYn(x+Yn-1(x. Part II - A recurrence formula of the form: rn(xY'n(x+sn(xY'n+1(x+tn(xY'n-1(x=0, is derived using the result of Part I.

  14. Intervention radiology in postoperative recurrent goiter

    International Nuclear Information System (INIS)

    Galkin, E.V.

    1995-01-01

    Roentgenoendovascular functional thyroidectomy was used to suppress the pathological activity of the thyroid in postoperative recurrent goiter. The method consists in vascular isolation of hyperplastic stump of the thyroid by catheterization of the left and right thyroid arteries, followed by their material occlusion. For embolization, a wide spectrum of nonlyzed synthetic, organic, and inorganic materials were used. The results of roentgenoendovascular functional thyroidectomy in 14 patients with postoperative recurrent goiter are analyzed. The advantages of roentgenoendovascular occlusion of the thyroid arteries before subtotal thyroidectomy are emphasized. A stabile clinical and hormonal remission and reduction of the thyroid in size to stage 1 were observed during three years following roentgenoendovascular intervention [ru

  15. Event dependent sampling of recurrent events

    DEFF Research Database (Denmark)

    Kvist, Tine Kajsa; Andersen, Per Kragh; Angst, Jules

    2010-01-01

    The effect of event-dependent sampling of processes consisting of recurrent events is investigated when analyzing whether the risk of recurrence increases with event count. We study the situation where processes are selected for study if an event occurs in a certain selection interval. Motivation...... retrospective and prospective disease course histories are used. We examine two methods to correct for the selection depending on which data are used in the analysis. In the first case, the conditional distribution of the process given the pre-selection history is determined. In the second case, an inverse...

  16. Acute otitis externa

    OpenAIRE

    Hui, Charles PS

    2013-01-01

    Acute otitis externa, also known as ‘swimmer’s ear’, is a common disease of children, adolescents and adults. While chronic suppurative otitis media or acute otitis media with tympanostomy tubes or a perforation can cause acute otitis externa, both the infecting organisms and management protocol are different. This practice point focuses solely on managing acute otitis externa, without acute otitis media, tympanostomy tubes or a perforation being present.

  17. Percutaneous Endoscopic Colostomy: A New Technique for the Treatment of Recurrent Sigmoid Volvulus

    Science.gov (United States)

    Al-Alawi, Ibrahim K.

    2010-01-01

    Sigmoid volvulus is a common cause of large bowel obstruction in western countries and Africa. It accounts for 25% of the patients admitted to the hospital for large bowel obstruction. The acute management of sigmoid volvulus is sigmoidoscopic decompression. However, the recurrence rate can be as high as 60% in some series. Recurrent sigmoid volvulus in elderly patients who are not fit for definitive surgery is difficult to manage. The percutaneous endoscopic placement of two percutaneous endoscopic colostomy tube placement is a simple and relatively safe procedure. The two tubes should be left open to act as vents for the colon from over-distending. In our opinion, this aspect is key to its success as it keeps the sigmoid colon deflated until adhesions form between the colon and the abdominal wall. PMID:20339184

  18. Role of Electrophysiological Study and Catheter Ablation for Recurrent Ventricular Tachycardia Complicating Myocarditis

    Directory of Open Access Journals (Sweden)

    Emanuele Cecchi

    2012-01-01

    Full Text Available Here we report the case of a 31-year-old man admitted to our hospital with echocardiografic and Cardiac Magnetic Resonance signs of myocarditis complicated by ventricular tachycardia, initially resolved with direct current shock. After the recurrence of ventricular tachycardia the patient was submitted to electrophysiological study revealing a re-entrant circuit at the level of the medium segment of interventricular septum, successfully treated with transcatheter ablation. This case highlights how the presence of recurrent ventricular arrhythmias at the onset of acute myocarditis, suspected or proven, could be associated with a pre-existing arrhythmogenic substrate, therefore these patients should be submitted to electrophysiological study in order to rule out the presence of arrhythmogenic focuses that can be treated with transcatheter ablation.

  19. [Chronic recurrent volvulus of the colonic splenic flexure associated with the eventration of left diaphragm].

    Science.gov (United States)

    Kim, Hee Sun; Yoo, Jeong Seon; Han, Seok Joo; Park, Hyojin

    2007-01-01

    The eventration of diaphragm is usually found incidentally on chest X-ray or sometimes presented as acute gastric volvulus. However, colonic volvulus on splenic flexure area complicated by diaphragmatic eventration is extremely rare. A 25 year old man complained of upper abdominal pain for three days. He had a history of brain injury during infant period, and had epilepsy and mental retardation. Plain chest X-ray showed left diaphragmatic eventration and marked dilatation of colon on splenic flexure area which had not been changed for last three years. Barium enema showed bird beak appearance on distal colon near the splenic flexure. Colonoscopic reduction failed. After decompression with rectal and nasogastric tubes, colonic volvulus was relieved. To prevent the recurrence of volvulus, we performed segmental resection of left colon including splenic flexure area and repaired the left diaphragmatic eventration. After the operation, the patient had no further recurrent episode of volvulus although ileus persisted.

  20. Morphological classification of mobile plaques and their association with early recurrence of stroke.

    Science.gov (United States)

    Ogata, Toshiyasu; Yasaka, Masahiro; Wakugawa, Yoshiyuki; Kitazono, Takanari; Okada, Yasushi

    2010-01-01

    The present study investigated the frequency and morphological characteristics of carotid mobile plaques and examined the relationship between carotid mobile plaques and recurrent strokes. The study included 94 consecutive acute stroke patients with large-artery atherosclerosis associated with extracranial carotid stenosis. We investigated the presence of mobile plaques by carotid ultrasonography and classified patients into two groups (mobile group and non-mobile group). We compared backgrounds, MRI and ultrasonographic findings, neurological severity on admission and at discharge, and the rate of early recurrent stroke between both groups. Mobile plaques were detected in 12 patients (12.8%). There were four types of mobile plaques: (1) the jellyfish-type plaque, in which the fibrous cap fluctuated like a jellyfish; (2) the streaming-band-type plaque, in which the string attached to the plaque was swaying; (3) the mobile-thrombus-type plaque, in which a mobile mass was attached to the plaque surface, and (4) the fluctuating-ulcer-type plaque, which contained a mobile substance in the plaque ulcer. Although National Institutes of Health Stroke Scale (NIHSS) scores on admission were less severe in the mobile group than in the non-mobile group (median 1 vs. 4, respectively; p = 0.004), the rate of early recurrent stroke was significantly higher in the mobile group than in the non-mobile group (33.3 vs. 7.3%, respectively; p = 0.022). There were no significant differences in NIHSS scores at discharge between groups. Morphologically, several types of mobile plaques were detected in consecutive patients with acute stroke associated with carotid stenosis. Mobile plaques are strongly associated with an early recurrence of stroke. Copyright © 2010 S. Karger AG, Basel.

  1. USE OF IMMUNOMODULATORS IN ACUTE RESPIRATORY INFECTION TREATMENT IN FREQUENTLY ILL CHILDREN

    Directory of Open Access Journals (Sweden)

    M.I. Ivardava

    2011-01-01

    Full Text Available Respiratory infections, relapses of ear, nose, throat infections, acute and chronic bronchial infections — these are the most common infantile infections. Regardless the wide range of medications, treatment of recurrent ENT and respiratory infections is not always effective especially in the group of frequently ill children. This article contains analysis of the necessity of immunomodulation therapy of recurrent respiratory infections as a part of complex prophylaxis and treatment of infants.Key words: children, acute respiratory infection, polyoxidonium, treatment.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2011; 10 (3: 103–107

  2. Duration of off-loading and recurrence rate in Charcot osteo-arthropathy treated with less restrictive regimen with removable walker

    DEFF Research Database (Denmark)

    Christensen, Tomas M; Gade-Rasmussen, Birthe; Pedersen, Lis W

    2013-01-01

    Recent literature on acute diabetic Charcot osteoarthropathy (CA) reports unusually long periods of off-loading. Data suggest that this might increase the re-currence rate. Subsequently we evaluated the influence of duration of off-loading on the risk of required re-casting....

  3. Toll-like receptor 9 gene expression in the post-thrombotic syndrome, residual thrombosis and recurrent deep venous thrombosis: A case-control study

    NARCIS (Netherlands)

    Cheung, Y. Whitney; Bouman, Annemieke C.; Castoldi, Elisabetta; Wielders, Simone J.; Spronk, Henri M. H.; ten Cate, Hugo; ten Cate-Hoek, Arina J.; ten Wolde, Marije

    2016-01-01

    Animal models suggest that toll-like receptor 9 (TLR9) promotes thrombus resolution after acute deep venous thrombosis (DVT). We hypothesized that TLR9 expression is lower in patients with post-thrombotic syndrome (PTS) and investigated the role of TLR9 in residual thrombosis (RT) and recurrence.

  4. Frequent carriage of resistance mechanisms to beta-lactams and biofilm formation in Haemophilus influenzae causing treatment failure and recurrent otitis media in young children

    NARCIS (Netherlands)

    Garcia-Cobos, Silvia; Moscoso, Miriam; Pumarola, Felix; Arroyo, Margarita; Lara, Noelia; Perez-Vazquez, Maria; Aracil, Belen; Oteo, Jesus; Garcia, Ernesto; Campos, Jose

    Objectives: Non-typeable Haemophilus influenzae are a major cause of acute otitis media (AOM), including chronic and recurrent otitis in young children. The objective of this study was to determine whether non-typeable H. influenzae isolates causing these infections produce biofilms and carry

  5. C-Reactive Protein Is an Important Biomarker for Prognosis Tumor Recurrence and Treatment Response in Adult Solid Tumors: A Systematic Review.

    LENUS (Irish Health Repository)

    Shrotriya, Shiva

    2015-01-01

    A systematic literature review was done to determine the relationship between elevated CRP and prognosis in people with solid tumors. C-reactive protein (CRP) is a serum acute phase reactant and a well-established inflammatory marker. We also examined the role of CRP to predict treatment response and tumor recurrence.

  6. Use of recurrence plot and recurrence quantification analysis in Taiwan unemployment rate time series

    Science.gov (United States)

    Chen, Wei-Shing

    2011-04-01

    The aim of the article is to answer the question if the Taiwan unemployment rate dynamics is generated by a non-linear deterministic dynamic process. This paper applies a recurrence plot and recurrence quantification approach based on the analysis of non-stationary hidden transition patterns of the unemployment rate of Taiwan. The case study uses the time series data of the Taiwan’s unemployment rate during the period from 1978/01 to 2010/06. The results show that recurrence techniques are able to identify various phases in the evolution of unemployment transition in Taiwan.

  7. Stereological analysis of nuclear volume in recurrent meningiomas

    DEFF Research Database (Denmark)

    Madsen, C; Schrøder, H D

    1994-01-01

    A stereological estimation of nuclear volume in recurrent and non-recurrent meningiomas was made. The aim was to investigate whether this method could discriminate between these two groups. We found that the mean nuclear volumes in recurrent meningiomas were all larger at debut than in any...... of the control tumors. The mean nuclear volume of the individual recurrent tumors appeared to change with time, showing a tendency to diminish. A relationship between large nuclear volume at presentation and number of or time interval between recurrences was not found. We conclude that measurement of mean...... nuclear volume in meningiomas might help identify a group at risk of recurrence....

  8. Recurrence quantification analysis in Liu's attractor

    International Nuclear Information System (INIS)

    Balibrea, Francisco; Caballero, M. Victoria; Molera, Lourdes

    2008-01-01

    Recurrence Quantification Analysis is used to detect transitions chaos to periodical states or chaos to chaos in a new dynamical system proposed by Liu et al. This system contains a control parameter in the second equation and was originally introduced to investigate the forming mechanism of the compound structure of the chaotic attractor which exists when the control parameter is zero

  9. Variceal recurrence, rebleeding and survival after injection ...

    African Journals Online (AJOL)

    This study tested the validity of the hypothesis that eradication of oesophageal varices by repeated injection sclerotherapy would reduce recurrent variceal bleeding and death from bleeding oesophageal varices in a high risk cohort of patients with portal hypertension and cirrhosis. Patients and Methods: 306 alcoholic ...

  10. CASE REPORT A recurrent gestational choriocarcinoma case ...

    African Journals Online (AJOL)

    Admin

    molar pregnancy (Luna Russo et al., 2015). To our knowledge recurrence resulting in rupture 14 month following a live pregnancy is an extremely rare event. Management of gestational trophoblastic disease in our setup poses multiple challenges as seen in this particular case. Serum β-HCG follow up for these patients ...

  11. Pregnancy recurrence in adolescents in Southern Brazil

    Directory of Open Access Journals (Sweden)

    Mariza Zanchi

    Full Text Available Summary Objective: To determine the pregnancy recurrence among adolescents and young people in a city located in the extreme south of Brazil and to identify associated factors. Method: One hundred and twelve (112 women participated, having delivered their children in 2010, while adolescents. The sample was stratified in two stages, being the first a census of the whole population of the city and the second a convenience sample. For statistical analysis, Pearson Chi-square test was used, with a significance level of 5%. Results: The recurrence rate was 53.6%, with an average of 28.6 months. At the time of delivery, in 2010, recurrence was significantly associated with level of education (p=0.044 as well as not being in school (p=0.036. In 2014, the factors associated were level of education (p<0.001, transcript of grades (p=0.030 and income (p=0.030. Conclusion: Recurrence of teenage pregnancy represents a lack of importance given to formal education, a fact that mitigates the opportunities and hinders insertion in the labor market, creating a cycle of social inequality. Multidisciplinary efforts involving schools, health services and the youth in educational activities are thus vital, aiming at critical thinking to transform reality.

  12. Laterality of Symptomatic Recurrent Calcium Nephrolithiasis | Ketata ...

    African Journals Online (AJOL)

    Objective: Although it is presumed that both kidneys excrete similar urinary constituents, it is a general observation that the majority of patients present with unilateral stone disease. The aim of this work was to study the laterality of recurrence in calcium stone formers. Patients and Methods: In a retrospective study of 154 ...

  13. Numerically satisfactory solutions of Kummer recurrence relations

    NARCIS (Netherlands)

    J. Segura (Javier); N.M. Temme (Nico)

    2008-01-01

    textabstractPairs of numerically satisfactory solutions as $n\\rightarrow \\infty$ for the three-term recurrence relations satisfied by the families of functions $_1\\mbox{F}_1(a+\\epsilon_1 n; b +\\epsilon_2 n;z)$, $\\epsilon_i \\in {\\mathbb Z}$, are given. It is proved that minimal solutions always

  14. 14 CFR 135.351 - Recurrent training.

    Science.gov (United States)

    2010-01-01

    ... appropriate, including low-altitude windshear training and training on operating during ground icing... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Recurrent training. 135.351 Section 135.351... AND ON DEMAND OPERATIONS AND RULES GOVERNING PERSONS ON BOARD SUCH AIRCRAFT Training § 135.351...

  15. A comprehensive profile of recurrent glioblastoma

    DEFF Research Database (Denmark)

    Campos, B.; Olsen, Lars Rønn; Urup, T.

    2016-01-01

    In spite of relentless efforts to devise new treatment strategies, primary glioblastomas invariably recur as aggressive, therapy-resistant relapses and patients rapidly succumb to these tumors. Many therapeutic agents are first tested in clinical trials involving recurrent glioblastomas. Remarkab...... 2016; doi:10.1038/onc.2016.85....

  16. Recurrent otorrhea in chronic suppurative otitis media

    DEFF Research Database (Denmark)

    Jensen, Ramon Gordon; Johansen, Helle Krogh; Bjarnsholt, Thomas

    2017-01-01

    Dispersal of bacteria from a biofilm in the middle ear, serving as a bacterial reservoir, could explain the recurrent and chronic nature of chronic suppurative otitis media (CSOM). The objective of this study is to investigate if the same strains of bacteria could be detected in repeated episodes...

  17. Families of Linear Recurrences for Catalan Numbers

    Science.gov (United States)

    Gauthier, N.

    2011-01-01

    Four different families of linear recurrences are derived for Catalan numbers. The derivations rest on John Riordan's 1973 generalization of Catalan numbers to a set of polynomials. Elementary differential and integral calculus techniques are used and the results should be of interest to teachers and students of introductory courses in calculus…

  18. Interpersonal mechanisms in recurrence of depression

    NARCIS (Netherlands)

    Bos, Elisabeth Henriëtte

    2005-01-01

    Depression is serious disease, also because of its recurrent nature. Many people who have become depressed once, will become depressed more often. Moreover, the risk of depression seems to increase with every further episode. These observations underline the importance of gaining a better

  19. Recurrent shoulder dystocia: is it predictable?

    Science.gov (United States)

    Kleitman, Vered; Feldman, Roi; Walfisch, Asnat; Toledano, Ronen; Sheiner, Eyal

    2016-11-01

    To examine the course and outcome of deliveries occurring in women who previously experienced shoulder dystocia. In addition, recurrent shoulder dystocia risk factors were assessed. A retrospective cohort analysis comparing all singleton deliveries with and without shoulder dystocia in their preceding delivery was conducted. Independent predictors of recurrent shoulder dystocia were investigated using a multiple logistic regression model. Of the 201,422 deliveries included in the analysis, 307 occurred in women with a previous shoulder dystocia (0.015 %). Women with a history of shoulder dystocia were more likely to be older, experienced higher rates of gestational diabetes mellitus, polyhydramnios, prolonged second stage, operative delivery and macrosomia (>4000 g) in the following delivery. Previous shoulder dystocia was found to be an independent risk factor for recurrent shoulder dystocia (OR = 6.1, 95 % CI 3.2-11.8, p value dystocia is an independent risk factor for recurrent shoulder dystocia. Deliveries in women with a history of shoulder dystocia are characterized by higher rates of operative delivery, prolonged second stage of labor and macrosomia.

  20. Periodic and recurrent variations of cosmic rays

    International Nuclear Information System (INIS)

    Somogyi, A.J.

    1981-12-01

    The new results achieved in the field of periodic and recurrent variations of the intensity of 10 9 to 10 13 eV cosmic rays are reviewed. Particular emphasis is given to developments in understanding the fluctuations of corotation-type anisotropies as well as to the structure of the heliosphere and its temporal changes. (author)