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Sample records for severe hidradenitis suppurativa

  1. Cyclosporine treatment of severe Hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Anderson, Marianne D; Zauli, Stefania; Bettoli, Vincenzo

    2016-01-01

    Background: Hidradenitis suppurativa (HS) is an overlooked but common disease severely affecting both genders. HS is generally perceived as difficult to treat and although a number of treatments are available, the need for more effective treatment is apparent. Objectives: Cyclosporine A (CsA) has...

  2. Hidradenitis suppurativa.

    NARCIS (Netherlands)

    Buimer, M.G.; Wobbes, T.; Klinkenbijl, J.H.G.

    2009-01-01

    BACKGROUND: Hidradenitis suppurativa is a chronic, recurrent, suppurative cutaneous disease. Despite its incidence, optimal medical or surgical treatment remains unclear. This review describes the disease, ranging from pathogenesis to treatment and prognosis. METHODS: Articles were sourced from

  3. Hidradenitis suppurativa

    NARCIS (Netherlands)

    Buimer, M. G.; Wobbes, T.; Klinkenbijl, J. H. G.

    2009-01-01

    Hidradenitis suppurativa is a chronic, recurrent, suppurative cutaneous disease. Despite its incidence, optimal medical or surgical treatment remains unclear. This review describes the disease, ranging from pathogenesis to treatment and prognosis. Articles were sourced from PubMed and Medline, using

  4. Hidradenitis Suppurativa

    Science.gov (United States)

    ... of acne. People who have it develop painful red bumps or sores in places where they grow hair. This includes the armpits, groin, genitals, and anal ... hidradenitis suppurativa The main symptom of HS is red bumps that are ... sweat glands and hair follicle openings become blocked. Doctors don’t know ...

  5. Hidradenitis Suppurativa

    Science.gov (United States)

    ... for severe acne, offers modest help for moderately bad cases. There is medical control, but not cure for hidradenitis. Surgery is the most effective treatment for recalcitrant hidradenitis. Aggressive surgery will cure an ...

  6. AISI: A New Disease Severity Assessment Tool for Hidradenitis Suppurativa.

    Science.gov (United States)

    Chiricozzi, Andrea; Faleri, Sara; Franceschini, Chiara; Caro, Raffaele Dante Caposiena; Chimenti, Sergio; Bianchi, Luca

    2015-10-01

    Hidradenitis suppurativa (HS) is a chronic, disabling, skin disorder. Because of renewed scientific interest in HS, different aspects of the condition, such as disease severity assessment, are being investigated and better defined. The aim of this study is to provide a novel tool for the assessment of disease severity. An HS-tailored, composite, dynamic score, named the Acne Inversa Severity Index (AISI) was designed to include a physician-rated assessment that considers the type of lesions occurring and the affected body sites. Additionally, a 0-10 visual analog scale (VAS), named Illness-VAS, was created to assess a patient's pain, discomfort, and disability due to HS. The authors compared AISI with other validated measurements, namely the Hurley staging classification, modified Sartorius score, and the Dermatology Life Quality Index (DLQI). The AISI was tested in 46 patients with HS, demonstrating a significant correlation with Hurley staging (r: 0.70856; P = 0.0021), modified Sartorius score (r: 0.9730; P = less than 0.00001), and DLQI (r: 0.8257; P = 0.0221). According to AISI cut-offs, HS may be defined as mild (AISI less than 10), moderate (AISI 10 > 18), and severe (AISI > 18). Additionally, comparing the 2 dynamic scores, AISI and Sartorius, AISI proved significantly faster than the Sartorius score (46.44 ± 19.24 seconds vs 83.2 ± 19.04 seconds; P =1.31 x 10-6). Being simple, fast, dynamic, and accurate, the AISI could represent the ideal measurement for HS severity in both real-life and clinical trial settings.

  7. Experience with ustekinumab for the treatment of moderate to severe Hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Gulliver, W.P.; Baker, K.A.; Jemec, G.B.E.

    2012-01-01

    Background Hidradenitis suppurativa (HS) is a severe chronic inflammatory follicular disease characterized by nodules and abscesses affecting apocrine gland-bearing regions. HS is not well-controlled with conventional medical therapies such as topical therapy, oral antibiotics and retinoids, howe...

  8. Psychosocial impact of hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Esmann, S.; Jemec, G.B.E.

    2011-01-01

    Hidradenitis suppurativa influences patients' lives in many ways. It is therefore necessary to focus on the effects of the disease on daily life in order better to define patient-related outcomes in hidradenitis suppurativa studies. Interviews were conducted with 12 patients with hidradenitis...... suppurativa. Initial single interviews were followed by semi-structured and structured qualitative focus group interviews in order to improve the richness of the data and obtain in-depth understanding of the impact of the topics. Important topics were found to relate to aspects of interpersonal contact......, especially in relation to smell and appearance, various emotional reactions, and feelings of lack of control. It was found that hidra-denitis suppurativa has a great emotional impact on patients and promotes isolation due to fear of stigmati-zation. Shame and irritation are frequent and relate to smell...

  9. Genetics Home Reference: hidradenitis suppurativa

    Science.gov (United States)

    ... Garin S. Clinical characteristics of a series of 302 French patients with hidradenitis suppurativa, with an analysis of ... 2010 Oct 7. Citation on PubMed More from Genetics Home Reference Bulletins March is Trisomy Awareness Month ...

  10. Hidradenitis Suppurativa/Acne Inversa

    DEFF Research Database (Denmark)

    Zouboulis, Christos C.; Del Marmol, Véronique; Mrowietz, Ulrich

    2015-01-01

    BACKGROUND: Hidradenitis suppurativa/acne inversa (HS) is a chronic, inflammatory, recurrent, debilitating disease, which inflicts a significant burden on patients and is associated with comorbid disorders, such as significantly reduced quality of life, depression, stigmatization, inactivity...

  11. An Update on Hidradenitis Suppurativa (Part I): Epidemiology, Clinical Aspects, and Definition of Disease Severity.

    Science.gov (United States)

    Martorell, A; García-Martínez, F J; Jiménez-Gallo, D; Pascual, J C; Pereyra-Rodriguez, J; Salgado, L; Vilarrasa, E

    2015-11-01

    Hidradenitis suppurativa is a chronic inflammatory disorder that has attracted increasing attention in recent years due to underestimations of prevalence and the considerable impact of the condition on interpersonal relationships, physical appearance, self-esteem, and body image. Although hidradenitis suppurative has a significant psychological impact on patients and can even cause physical limitations when thick scarring results in limb mobility limitation, until very recently little evidence was available relating to its epidemiology, etiology, or pathogenesis. In this review, we highlight the latest advances in our understanding of the epidemiological and clinical aspects of hidradenitis suppurativa. We will also look at the different classification systems for hidradenitis suppurativa and discuss the emergence of skin ultrasound as a promising technique for monitoring the course of this chronic inflammatory disease. Copyright © 2015 Elsevier España, S.L.U. and AEDV. All rights reserved.

  12. Surgery under general anaesthesia in severe hidradenitis suppurativa : a study of 363 primary operations in 113 patients

    NARCIS (Netherlands)

    Blok, J. L.; Boersma, M.; Terra, J. B.; Spoo, J. R.; Leeman, F. W. J.; van den Heuvel, E. R.; Huizinga, J.; Jonkman, M. F.; Horvath, B.

    BackgroundTreatment of hidradenitis suppurativa (HS) is a difficult undertaking, especially as there is no consensus on what surgical technique is preferred. At our centre severe HS (Hurley II/III) is operated under general anaesthesia, mostly with the STEEP procedure. ObjectivesTo investigate

  13. The ABC of Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Lipsker, Dan; Severac, François; Freysz, Marie

    2016-01-01

    BACKGROUND: The precise clinical description of skin lesions observed in some patients with hidradenitis suppurativa (HS) can be extremely difficult. OBJECTIVE: Establishing a validated glossary of terms allowing the best possible description of lesions observed in HS patients. MATERIAL AND METHO...

  14. Recognizing syndromic hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Gasparic, J; Theut Riis, P; Jemec, G B

    2017-01-01

    may inform the search for aetiological factors in HS. PubMed, Ovid and Web of Science were systematically searched using '(hidradenitis OR acne invers*) AND (syndrome OR KID OR PASS OR PAPA OR PASH OR SAPHO OR bazex-dupre OR 'dowling degos' OR triad OR tetrad)' and Cochrane Library using 'hidradenitis...

  15. Adalimumab for the treatment of moderate to severe hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Kimball, A.B.; Kerdel, F.; Adams, D.

    2012-01-01

    with moderate to severe HS. Design: Phase 2, parallel, randomized, placebo-controlled trial consisting of a blinded 16-week period (period 1) and an open-label 36-week period (period 2). All study personnel, investigators, and patients remained blinded to treatment group throughout the study. (Clinical......Trials.gov: NCT00918255) Setting: 26 academic and private practice medical centers in the United States and Europe. Patients: 154 adult patients with moderate to severe HS who were unresponsive or intolerant to oral antibiotics. Intervention: Patients were assigned in a 1:1:1 ratio to adalimumab, 40 mg...

  16. Adalimumab for the treatment of moderate to severe hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Kimball, A.B.; Kerdel, F.; Adams, D.

    2012-01-01

    Trials.gov: NCT00918255) Setting: 26 academic and private practice medical centers in the United States and Europe. Patients: 154 adult patients with moderate to severe HS who were unresponsive or intolerant to oral antibiotics. Intervention: Patients were assigned in a 1:1:1 ratio to adalimumab, 40 mg...

  17. [Update of hidradenitis suppurativa in Primary Care].

    Science.gov (United States)

    García-Martínez, F J; Pascual, J C; López-Martín, I; Pereyra-Rodríguez, J J; Martorell Calatayud, A; Salgado-Boquete, L; Labandeira-García, J

    Hidradenitis suppurativa is a prevalent disease that is noted for its clinical variability and by its severe impact on quality of life. A meticulous scientific literature review is presented in this article in order to give an update on what is known on this condition. Primary Care physicians obviously play an important role in the early diagnosis and management of hidradenitis suppurativa. This review aims to provide a current and practical overview about this disease in order to optimise the healthcare for these patients by making the best use of available resources. Copyright © 2015 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  18. The Influence of Body Weight on the Prevalence and Severity of Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Kromann, Charles B; Ibler, Kristina S; Kristiansen, Viggo B

    2014-01-01

    . The number of patients reporting HS symptoms after weight loss decreased by 35% and the mean number of involved sites was reduced from 1.93 to 1.22 following weight loss (p = 0.003). The prevalence of HS appears higher in the obese than in the background population, and a weight loss of more than 15......The prevalence of hidradenitis suppurativa (HS) has been estimated to be 1% of the population. Obesity is considered a co-morbidity, but the prevalence of HS in obese population is not known. A retrospective questionnaire was distributed to 383 patients over 2 years after bariatric surgery. Data...... on pre- and post-surgery HS symptoms and disease severity were studied. Disease severity was assessed by number of involved sites. General skin problems rated numerically on an anchored 1-10 scale. Valid responses were obtained from 249/383 (65%). A point prevalence of 18.1% (45/249) HS was found...

  19. Dapsone therapy for hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Yazdanyar, S.; Jemec, G.B.E.; Boer, J.

    2011-01-01

    Background: Hidradenitis suppurativa (HS) is an inflammatory skin disease with a chronic intermittent course. HS is difficult to treat, and the evidence for the effect of most treatments consists of smaller open studies. The use of dapsone in the treatment of HS is based on a few published cases...... successfully treated. Objective: To evaluate the potential of dapsone treatment for HS in an open case series. Methods: An exploratory and retrospective review of case notes from HS patients treated with dapsone was performed. Patients were included irrespective of treatment outcome. Prior to the treatment...... the level of glucose-6-phosphate dehydrogenase in the blood was tested for all patients. Results: A total of 24 HS patients were included and treated with dapsone. Improvement was seen in 9 out of 24 (38%) treated patients, whereas 15 out of 24 (62%) did not experience any improvement. None of the 4 cases...

  20. Association of Metabolic Syndrome and Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Miller, Iben Marie; Ellervik, Christina; Vinding, Gabrielle Randskov

    2014-01-01

    IMPORTANCE An association between the metabolic syndrome (MetS) and chronic inflammatory diseases, such as psoriasis or rheumatoid arthritis, has been suggested.Hidradenitis suppurativa (HS), a more localized chronic inflammation of the skin, has been speculated to have a similar association......,predominantly female, and more often smokers compared with the non-HS group.EXPOSURE Hidradenitis suppurativa.MAIN OUTCOMES AND MEASURES Metabolic syndrome and its components of diabetes mellitus, hypertension, dyslipidemia, and obesity.RESULTS When compared with the non-HS group, the odds ratios (ORs...

  1. Renal amyloid A amyloidosis as a complication of hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Schandorff, Kristine D; Miller, Iben M; Krustrup, Dorrit

    2016-01-01

    Rheumatic disease is the dominant cause of amyloid A (AA) amyloidosis, but other chronic inflammatory diseases may have similar consequences. Hidradenitis suppurativa (HS) is a relatively common, but little known skin disease characterized by chronic inflammation. Here we present a case of chroni...... HS leading to biopsy-verified severe renal AA amyloidosis and dialysis dependency....

  2. Hidradenitis suppurativa and perianal Crohn disease: differential diagnosis.

    Science.gov (United States)

    Bassas-Vila, J; González Lama, Y

    2016-09-01

    The first description of perianal fistulas and complications in Crohn disease was made 75 years ago by Penner and Crohn. Published studies have subsequently confirmed that perianal fistulas are the most common manifestations of fistulising Crohn disease. Hidradenitis suppurativa was described in 1854 by a French surgeon, Aristide Verneuil. It is a chronic, inflammatory, recurrent and debilitating disease of the pilosebaceous follicle, that usually manifests after puberty with deep, painful and inflamed lesions in the areas of the body with apocrine glands, usually the axillary, inguinal and anogenital regions. The differential diagnosis between hidradenitis suppurativa and Crohn disease can be challenging, especially when the disease is primarily perianal. When they occur simultaneously, hidradenitis suppurativa and Crohn disease show severe phenotypes and patients can respond to anti-tumour necrosis factor therapy, although adalimumab is currently the only treatment with demonstrated efficacy in hidradenitis suppurativa and Crohn disease. In addition, there is sometimes a need for different complementary surgical procedures. Copyright © 2016 Elsevier España, S.L.U. y AEDV. All rights reserved.

  3. Hidradenitis Suppurativa in Children and Adolescents

    DEFF Research Database (Denmark)

    Mikkelsen, Peter Riis; Jemec, Gregor B E

    2014-01-01

    Hidradenitis suppurativa (HS) is a burdensome disease and has the potential to affect the life course of patients. It is a rare disease in children, and the recorded literature is correspondingly scarce. This article reviews the therapeutic options for HS in children and adolescents, and highlights...

  4. New treatment strategies for hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Andersen, R.; Jemec, G. B.E.

    2016-01-01

    Hidradenitis suppurativa (HS) is difficult to treat. Official guidelines have only recently been developed, and suggest that patients should be provided with both adjuvant, medical and surgical therapy. The guidelines are the result of resurgent interest in this disease, in which etiology and pat...

  5. HiSCR (Hidradenitis Suppurativa Clinical Response)

    DEFF Research Database (Denmark)

    Kimball, B. A.; Sobell, J. M.; Zouboulis, C C

    2016-01-01

    Background: Determining treatment response for patients with hidradenitis suppurativa (HS) can be challenging due to limitations of current disease activity evaluations. Objective: Evaluate the novel, validated endpoint, Hidradenitis Suppurativa Clinical Response (HiSCR) and its utility as an out......Background: Determining treatment response for patients with hidradenitis suppurativa (HS) can be challenging due to limitations of current disease activity evaluations. Objective: Evaluate the novel, validated endpoint, Hidradenitis Suppurativa Clinical Response (HiSCR) and its utility...... as an outcome measure. Methods: Patients with baseline total abscess and inflammatory nodule count (AN count) of at least three and draining fistula count of 20 or fewer comprised the post hoc subpopulation analysed. HiSCR (at least a 50% reduction in total AN count, with no increase in abscess count...... week, or placebo (1 : 1 : 1). Results: The subpopulation included 132 (85.7%) patients; 70.5% women and 73.5% white. At week 16, HiSCR was achieved by 54.5% receiving weekly adalimumab, 33.3% every other week, and 25.6% placebo and HS-PGA Response was achieved by 20.5% receiving weekly adalimumab, 6...

  6. Autoinflammatory syndromes associated with hidradenitis suppurativa and/or acne

    DEFF Research Database (Denmark)

    Vinkel, Caroline; Thomsen, Simon F

    2017-01-01

    have been reported in the literature including pyoderma gangrenosum, acne, and pyogenic arthritis (PAPA), pyoderma gangrenosum, acne, and hidradenitis suppurativa (PASH), pyoderma gangrenosum, acne, and spondyloarthritis (PASS), pyoderma gangrenosum, acne, pyogenic arthritis, and hidradenitis...

  7. Depression in patients with hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Onderdijk, A J; van der Zee, H H; Esmann, S

    2013-01-01

    is more common in HS patients than among other dermatological patients. OBJECTIVES: To evaluate the prevalence of depression in patients with HS. METHODS: In total 211 HS patients were included in the study and 233 were dermatological control patients. Their QoL and depression scores were assessed using......BACKGROUND: Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory skin disease with abscess formation and scarring predominantly in the inverse areas. The disease is often difficult to treat and patients experience a decreased quality of life (QoL). It is hypothesized that depression...... the Dermatology Life Quality Index (DLQI) and the Major Depression Inventory (MDI) questionnaires. HS severity was recorded with a questionnaire and Hurley stages were extracted from the case records. RESULTS: The DLQI was significantly higher for HS patients than for the control patients, 8.4 ± 7.5 vs. 4.3 ± 5...

  8. Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser.

    Science.gov (United States)

    Madan, V; Hindle, E; Hussain, W; August, P J

    2008-12-01

    Hidradenitis suppurativa (HS) is a chronic and often a recalcitrant inflammatory skin condition. To present the results of carbon dioxide (CO2) laser treatment of recalcitrant HS in nine patients who had failed to improve on medical and other surgical treatments. HS lesions consisting of abscesses, sinuses and granulation tissue were completely excised using the cutting mode of a CO2 laser, leaving only healthy residual subcutaneous fat. The wounds were closed by primary intention where possible and left to granulate otherwise. Outcomes were determined by clinical review and questionnaire. Twenty-seven sites were treated in 19 sessions on nine patients. Seven procedures were performed under general anaesthesia and 12 under local. All patients rated their postoperative discomfort as less or equal to their preoperative state. Seven of the nine patients had complete remission for 12 months or longer after their last laser treatment and ceased all medications. High levels of patient satisfaction were reported with CO2 laser treatment. The main complication was axillary scar contracture in two patients but this was insufficient to limit limb movement. CO2 laser treatment should be considered as a treatment option in recalcitrant HS, where multiple medical treatments have been ineffective.

  9. Disutility in Patients with Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Riis, Peter Theut; Vinding, Gabrielle Randskov; Ring, Hans Christian

    2016-01-01

    Disutility reflects the disability caused by a disease. The EuroQoL-5D (EQ-5D) questionnaire is a measure of health-related overall utility. The questionnaire has only been applied previously to a small number of patients with hidradenitis. In this study a survey of 421 patients with hidradenitis...... suppurativa was conducted using the EQ-5D questionnaire. Questions regarding pain, maodour and pruritus were included to determine quantitatively whether these factors are associated with low EQ-5D index and visual analogue scale (VAS) scores. The index and VAS scores obtained were compared with reference...

  10. The Association between Hidradenitis Suppurativa and Crohn's Disease

    DEFF Research Database (Denmark)

    van der Zee, Hessel H; Horvath, Barbara; Jemec, Gregor B E

    2016-01-01

    Hidradenitis suppurativa is a chronic, autoinflammatory skin disease. Shalom et al. demonstrate in a large cross-sectional study an association between Crohn's disease and hidradenitis suppurativa, but not with ulcerative colitis. This association supports the hypothesis that a similar pathogenic...

  11. Two phase 3 trials of adalimumab for hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Kimball, Alexa Boer; Okun, Martin; Williams, David A

    2016-01-01

    BACKGROUND Hidradenitis suppurativa is a painful, chronic inflammatory skin disease with few options for effective treatment. In a phase 2 trial, adalimumab, an antibody against tumor necrosis factor á, showed efficacy against hidradenitis suppurativa. METHODS PIONEER I and II were similarly desi...

  12. Serum Anticytokine Autoantibody Levels Are Not Increased in Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Theut Riis, Peter; Von Stemann, Jakob Hjorth; Kjærsgaard Andersen, Rune

    2017-01-01

    Background: Hidradenitis suppurativa is a skin disease of recurrent episodes of inflammatory nodules, abscesses, and scarring of the intertriginous regions, e.g. the axillae and groin. A dysregulated immune response to one or more unknown antigens in hidradenitis suppurativa has been suggested. O...

  13. Therapeutic approach to Crohn disease: possible parallels with hidradenitis suppurativa.

    Science.gov (United States)

    González Lama, Y; Marín-Jiménez, I

    2016-09-01

    The current controversy in the setting of dermatology surrounding the treatment of inflammatory diseases, and specifically hidradenitis suppurativa, bears strong similarities with the debate concerning inflammatory bowel disease (IBD) that took place several years ago. That debate led to new perspectives on this disease and, in particular, its treatment after the development of biological agents. Copyright © 2016 Elsevier España, S.L.U. y AEDV. All rights reserved.

  14. Epidemiology of hidradenitis suppurativa and inflammatory bowel disease: are these two disease associated?

    Science.gov (United States)

    Salgado-Boquete, L; Romaní, J; Carrión, L; Marín-Jiménez, I

    2016-09-01

    Hidradenitis suppurativa and inflammatory bowel disease are chronic inflammatory diseases mainly affecting young people. Their aetiology is complex and multifactorial and numerous case series have shown that the two diseases can manifest concurrently, although the strength of this association varies widely among distinct reports. An additional problem is the difficulty of distinguishing between cutaneous Crohn disease and hidradenitis. In the last few years, epidemiological cohort studies have revealed that 1.2%-23% of inflammatory bowel disease patients also have hidradenitis suppurativa. This wide variability is influenced by geographical variables and the biases inherent in the distinct data collection methods, among other factors. There is a clear predominance of Crohn disease over ulcerative colitis. When hidradenitis suppurativa and inflammatory bowel disease manifest concurrently, the bowel disease is more severe and shows a predominance of colon involvement. Copyright © 2016 Elsevier España, S.L.U. y AEDV. All rights reserved.

  15. The role of interleukin-17 in the pathogenesis of hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Yao, Yiqiu; Thomsen, Simon Francis

    2017-01-01

    Hidradenitis suppurativa is a chronic inflammatory skin condition affecting primarily the axillary, perianal, and inguinal areas. Patients with hidradenitis suppurativa present with occlusion and subsequent rupture of follicular ducts, profound abscesses, fistulae, odorous discharge, fibrosis, an...

  16. Intralesional triamcinolone for flares of hidradenitis suppurativa (HS)

    DEFF Research Database (Denmark)

    Riis, Peter Theut; Boer, Jurr; Prens, Errol P

    2016-01-01

    BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the hair follicle. Standard practice of managing acute flares with corticosteroid injection lacks scientific evidence. OBJECTIVE: We sought to assess the outcomes of routine treatment using intralesional triamcinolone ...

  17. Pathogenesis: common pathways between hidradenitis suppurativa and Crohn disease.

    Science.gov (United States)

    García Martínez, F J; Menchén, L

    2016-09-01

    Both hidradenitis suppurativa and Crohn disease are considered chronic inflammatory diseases due to immune dysregulation. The high prevalence of Crohn disease patients diagnosed with hidradenitis suppurativa suggests the existence of common pathogenic links. The present literature review analyses the similarities and differences in the pathogenesis of the two diseases, in the search for new research and knowledge targets. Copyright © 2016 Elsevier España, S.L.U. y AEDV. All rights reserved.

  18. Hidradenitis suppurativa: Mammographic and sonographic manifestations in two cases

    OpenAIRE

    Newman, Tiffany M.; Sheth, Monica M.; Levy, Allison; Babagbemi, Kemi

    2015-01-01

    Hidradenitis suppurativa is a chronic debilitating disorder of the skin manifested by recurrent, painful, inflammatory, subcutaneous nodules. The lesions occur most commonly in the apocrine-gland-bearing skin sites such as the axillae and inguinal regions; they cause scarring and disfigurement from the formation of multiple abscesses and fistulous tracts within the skin. We report the radiologic manifestations of two cases of hidradenitis suppurativa in women who presented for breast imaging.

  19. Improving quality of life in patients with hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Dufour, D.N.; Esmann, S.; Jemec, G.B.

    2012-01-01

    Hidradenitis suppurativa is a chronic recurrent inflammatory skin disease with abscess formation and scarring predominantly in the inverse areas. The disease is often difficult to treat and patients experience a decreased quality of life (QoL) and related psychosocial morbidity. Current knowledge...... on improving QoL in patients with hidradenitis suppurativa is therefore reviewed. The literature is limited but indicates that there are two ways of improving patients' QoL: therapy of the somatic disease or psychosocial interventions....

  20. An Atypical Localized Form of Hidradenitis Suppurativa of the Jawline and Neck Mimicking Severe Cystic Acne on Presentation.

    Science.gov (United States)

    Castrillón Velásquez, María Adriana; Kim, Minhee; Tan, Mei-Heng; Tran, Kim; Murrell, Dedee F

    2017-10-01

    Hidradenitis suppurativa (HS) is a chronic and debilitating suppurative disease primarily affecting the axillae, perineum, and inframammary regions, where apocrine sweat glands are present. However, HS can occur in atypical locations. We present an interesting case of a 40-year-old man who developed chronic painful subcutaneous nodules, deep sinus tracts, and abscesses involving the jawline and the anterior aspect of the neck as the only parts of the body affected and who responded satisfactorily to adalimumab and laser hair removal treatment. This case is relevant because it helps clinicians to remember that HS may be isolated to atypical locations, such as the anterior aspect of the neck and chin. It also supports another possible HS pathogenesis which consists of the occlusion of terminal hair follicles rather than being essentially a disorder of the apocrine glands.

  1. Association of Hidradenitis Suppurativa With Body Image.

    Science.gov (United States)

    Schneider-Burrus, Sylke; Jost, Agata; Peters, Eva Milena Johanna; Witte-Haendel, Ellen; Sterry, Wolfram; Sabat, Robert

    2018-02-21

    Hidradenitis suppurativa (HS) leads to disfigurement and painful eruptions in terminal hair follicles of the intertriginous skin, mainly of axillary, genitofemoral, and perianal sites. It is associated with an excessive impairment of quality of life, psychiatric disorders, and sexual distress. Body image impairment has been linked to depression and anxiety and has been described for some dermatologic disorders but has not yet been investigated in patients with HS. To investigate whether body image is diminished in patients with HS and whether disease severity, age at onset, disease duration, obesity, depression, and anxiety are linked to body image impairment. This 12-month (August 1, 2009, to August 31, 2010) case-control study with a prospective, observational, cross-sectional design recruited 47 consecutive patients with HS entering a tertiary care center and 45 healthy control individuals matched for age, sex, and body mass index (BMI). One patient and 4 controls failed to complete the questionnaire and were excluded from the evaluation. Data analysis was performed from December 1, 2013, to February 15, 2014. The Frankfurt Body Concept Scale (FKKS) and the Hospital Anxiety and Depression Scale (HADS) were given to patients and controls. Correlations among FKKS, HADS, and disease features were calculated. Of the 46 patients and 41 controls included in the evaluation (mean [SD] age, 35.6 [1.6] years; 40 [46%] male and 47 [54%] female), HS significantly reduced body image (mean FKKS score, 234.2 [5.4] in patients and 276.9 [5.7] in controls; P < .001), even when controlled for BMI. A correlation was found for the extent of body image disruption and BMI (r = -0.589; P < .001), HADS-depression score (r = -0.619; P < .001), and HADS-anxiety score (r = -0.340; P = .03). No association was found for the body image score and the severity of HS, age at onset of disease, and duration of disease. The body contact subscale score was the only

  2. Long-term efficacy of a single course of infliximab in hidradenitis suppurativa

    NARCIS (Netherlands)

    Mekkes, J. R.; Bos, J. D.

    2008-01-01

    BACKGROUND: Hidradenitis suppurativa is a chronic inflammatory skin disease characterized by abscess formation, predominantly in the axillae and groins. The disease is difficult to treat and has a severe impact on quality of life. Recently, several case reports have been published describing

  3. Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesity

    DEFF Research Database (Denmark)

    Sartorius, K; Emtestam, L; Jemec, G B E

    2009-01-01

    BACKGROUND: Hidradenitis suppurativa (HS) is a long-standing disease with abscess and often fistula formation, predominantly in the axillae and groins. The disease is difficult to treat and has a severe impact on quality of life. A clinically relevant system for scoring disease severity is lackin...

  4. Improving quality of life in patients with hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Dufour, D.N.; Esmann, S.; Jemec, G.B.

    2012-01-01

    Hidradenitis suppurativa is a chronic recurrent inflammatory skin disease with abscess formation and scarring predominantly in the inverse areas. The disease is often difficult to treat and patients experience a decreased quality of life (QoL) and related psychosocial morbidity. Current knowledge...

  5. Increased Suicide Risk in Patients with Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Thorlacius, Linnea; Cohen, Arnon D; Gislason, Gunnar H

    2018-01-01

    Patients with skin disorders are considered at a higher risk of depression and anxiety than the background population. Patients with hidradenitis suppurativa (HS) may be particularly affected. We explored the association between HS and depression, anxiety, and completed suicides in the Danish nat...

  6. New insights into the diagnosis of hidradenitis suppurativa

    DEFF Research Database (Denmark)

    van der Zee, Hessel H; Jemec, Gregor B E

    2015-01-01

    Current classifications for hidradenitis suppurativa (HS), such as the Hurley staging system, are not very specific. The absence of rigorous classifications is incongruous with the clinical variability of the condition. There is no pathognomonic sign for HS that leads to a diagnosis that is unque...

  7. Bacterial biofilm in chronic lesions of Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Ring, H C; Bay, L; Nilsson, M

    2017-01-01

    BACKGROUND: Chronic non-healing or recurrent inflammatory lesions, reminiscent of infection but recalcitrant to antibiotic therapy generally characterize biofilm driven-diseases. Chronic lesions of Hidradenitis Suppurativa (HS) exhibit several aspects, which are compatible with well-known biofilm...... infections. OBJECTIVE: To determine and quantify the potential presence of bacterial aggregates in chronic HS lesions. METHODS: In 42 consecutive HS patients suffering from chronic lesions, biopsies were obtained from lesional as well as from perilesional skin. Samples were investigated using Peptide Nucleic...... (aggregates > 50 μm in diameter) were situated in sinus tracts (63%) or in the infundibulum (37%). The majority of the sinus tract samples (73%) contained active bacterial cells, which were associated with inflammation. CONCLUSION: This study suggests that biofilm is associated with inflammation of chronic HS...

  8. Dapsone therapy for hidradenitis suppurativa: a series of 24 patients.

    Science.gov (United States)

    Yazdanyar, Shiva; Boer, Jurr; Ingvarsson, Gisli; Szepietowski, Jacek C; Jemec, Gregor B E

    2011-01-01

    Hidradenitis suppurativa (HS) is an inflammatory skin disease with a chronic intermittent course. HS is difficult to treat, and the evidence for the effect of most treatments consists of smaller open studies. The use of dapsone in the treatment of HS is based on a few published cases successfully treated. To evaluate the potential of dapsone treatment for HS in an open case series. An exploratory and retrospective review of case notes from HS patients treated with dapsone was performed. Patients were included irrespective of treatment outcome. Prior to the treatment the level of glucose-6-phosphate dehydrogenase in the blood was tested for all patients. A total of 24 HS patients were included and treated with dapsone. Improvement was seen in 9 out of 24 (38%) treated patients, whereas 15 out of 24 (62%) did not experience any improvement. None of the 4 cases with severe disease experienced improvement. Side effects leading to discontinuation of the treatment occurred in 2 of 24 patients (8%). Recurrence of disease at the cessation of treatment was described as rapid. The study is limited by lacking a control group. Therapy with dapsone for patients with HS is possible, particularly in milder cases. The effect may be due to either antibacterial or anti-inflammatory effects of the drug, or both. Rapid recurrence after stopping treatment however suggests that anti-inflammatory effects may predominate. The effect appears to be smaller than that reported with combination therapy using clindamycin and rifampicin. To clarify the true effect of dapsone future randomized controlled trials are necessary. Copyright © 2011 S. Karger AG, Basel.

  9. Hidradenitis Suppurativa and Crohn’s Disease: A Case Series

    LENUS (Irish Health Repository)

    Kirthi, S

    2017-09-01

    Hidradenitis Suppurativa (HS) is characterized by chronic recurrent abscesses, nodules and draining sinus tracts with scar formation. Cutaneous Crohn’s Disease (CD) may also present similarly. We wished to identify and describe an Irish cohort with combined HS and CD, with a view to a better recognition of clinical manifestations and understanding of the pathophysiology underlying these two overlapping conditions. Cases were identified using the HIPE Code at Tallaght Hospital from 1990-2014 and retrospective review was performed. Seven patients with both HS and CD were identified, 5(71%) female. The median age of diagnosis with both conditions was 37 years. In all cases, CD had preceded the diagnosis of HS. All patients smoked. Six had an increased BMI and 43% had additional autoimmune conditions. All patients required treatment with a TNF-alpha inhibitor for HS with 5 of 6 subjects having reduced frequency of flare ups and clinically less active HS on follow up

  10. Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

    NARCIS (Netherlands)

    W.P. Gulliver (Wayne P.); C.C. Zouboulis (Christos C.); E.P. Prens (Errol); G.B.E. Jemec (Gregor); T. Tzellos (Thrasivoulos)

    2016-01-01

    textabstractHidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by painful, recurrent nodules and abscesses that rupture and lead to sinus tracts and scarring. To date, an evidence-based therapeutic approach has not been the standard of care and this is

  11. Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Gulliver, Wayne; Zouboulis, Christos C.; Prens, Errol

    2016-01-01

    Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by painful, recurrent nodules and abscesses that rupture and lead to sinus tracts and scarring. To date, an evidence-based therapeutic approach has not been the standard of care and this is likely due...

  12. A 3D ultrasound study of sinus tract formation in hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Wortsman, Ximena; Jemec, Gregor

    2013-01-01

    and characterization of the morphological changes in hidradenitis, which include the variable degrees of involvement of the hair follicles and the appearance of fluid collections and sinus tracts. Knowledge of this anatomical information may allow the identification of lesions that can benefit from medical or surgical......Imaging of hidradenitis suppurativa allows the study of both the lesion morphology and evolution. Hidradenitis lesions of different stages were studied using 3D ultrasound in a cross sectional pilot study. A total of 25 HS patients (18 female/ 7 male, aged 18-46 year-old) and 10 healthy controls (5...

  13. Review of Current Immunologic Therapies for Hidradenitis Suppurativa

    Directory of Open Access Journals (Sweden)

    Victoria K. Shanmugam

    2017-01-01

    Full Text Available Hidradenitis suppurativa (HS is a chronic, recurrent, inflammatory disease of apocrine gland-bearing skin which affects approximately 1–4% of the population. The disease is more common in women and patients of African American descent and approximately one-third of patients report a family history. Obesity and smoking are known risk factors, but associations with other immune disorders, especially inflammatory bowel disease, are also recognized. The pathogenesis of HS is poorly understood and host innate or adaptive immune response, defective keratinocyte function, and the microbial environment in the hair follicle and apocrine gland have all been postulated to play a role in disease activity. While surgical interventions can be helpful to reduce disease burden, there is a high recurrence rate. Increasingly, data supports targeted immune therapy for HS, and longitudinal studies suggest benefit from these agents, both when used alone and as an adjunct to surgical treatments. The purpose of this review is to outline the current data supporting use of targeted immune therapy in HS management.

  14. Prevalence and Risk of Inflammatory Bowel Disease in Patients with Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Egeberg, Alexander; Jemec, Gregor B.E.; Kimball, Alexa B.

    2017-01-01

    Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. In small studies, inflammatory bowel disease has been associated with the increased prevalence of HS, but the data on the concurrence of inflammatory bowel disease in patients with HS are limited. We therefore investigated the ...

  15. Clinical experience of the use of adalimumab in the management of hidradenitis suppurativa. Comparison of response rates with Crohn disease.

    Science.gov (United States)

    Moyano, B; Clemente, A; Marín-Jiménez, I; Martorell, A

    2016-09-01

    The recent approval of adalimumab as the first treatment to be approved for the management of hidradenitis suppurativa has represented a before and after in the control of this chronic inflammatory disease. Given the inflammatory burden of this cutaneous disease, in the last few years hidradenitis suppurativa has been compared with inflammatory bowel disease, particularly with Crohn disease, to the point of considering hidradenitis suppurativa as "Crohn disease of the skin". These two chronic inflammatory diseases show sufficient similarities to consider whether treatment response based on the inflammatory load could also be similar. The present article aims to analyse the efficacy of adalimumab in hidradenitis suppurativa in comparison with a truly comparable disease, Crohn disease, with a view to evaluating therapeutic response rates and to drawing conclusions on the therapeutic success obtained in this disabling cutaneous disease. Copyright © 2016 Elsevier España, S.L.U. y AEDV. All rights reserved.

  16. Improvement of overlapping hidradenitis suppurativa and ankylosing spondylitis after the introduction of adalimumab.

    Science.gov (United States)

    Bosnić, Dubravka; Žarković, Branimir; Barešić, Marko; Zarkovic, Maja; Anić, Branimir

    2016-01-01

    Hidradenitis suppurativa is a chronic inflammatory disorder characterized by occlusion of the follicular pilosebaceous units of the skin. The treatment options are sometimes very limited and unpleasant odor and abundant drainage complicate the disease. Ankylosing spondylitis is a form of seronegative spondyloarthritis with predominantly axial but also peripheral joint involvement. Both of the conditions lower the patient's quality of life and affect everyday activities. We describe a 39-year-old male patient with both diseases treated with different medications with only a modest result. After the initiation of a tumor necrosis factor α (TNF-α) inhibitor (adalimumab) the patient experienced first the musculoskeletal and later on the skin improvement. The introduction of TNF-α inhibitors should be considered early in the treatment of overlapping hidradenitis suppurativa and the spondyloarthritis spectrum of conditions. Available medical data confirm the positive results and beneficial effect on disease course, activity and, most importantly, quality of life.

  17. Longitudinal observational study of hidradenitis suppurativa: impact of surgical intervention with adjunctive biologic therapy.

    Science.gov (United States)

    Shanmugam, Victoria K; Mulani, Shaunak; McNish, Sean; Harris, Sarah; Buescher, Teresa; Amdur, Richard

    2018-01-01

    Hidradenitis supppurativa (HS) is a chronic inflammatory disease of the apocrine sweat glands affecting 1-4% of the population. While surgical excision is a mainstay of therapy, lesions often recur. Biologic therapies, including tumor necrosis factor-α and IL-12/23 inhibitors, are effective for mild to moderate HS. However, longitudinal studies investigating biologic therapy in conjunction with surgery are limited. The purpose of this analysis was to investigate impact of surgery and biologic therapy on HS disease activity. Data from 68 HS patients were analyzed. Outcome measures included hidradenitis suppurativa Sartorius Score (HSS), active nodule (AN) count, Hurley stage, and probability of achieving 75% reduction in active nodule count (AN75). Mean age was 40 ± 14 years; 66% were female and 72% were African American. Mean disease duration was 10 years, and Hurley stage III disease was seen in 63% of patients. Patients who received biologics had a larger drop in HSS and AN count than those who never received biologics (P = 0.002). Biologic treatment was associated with average reduction in 22 (15-29) HSS points (P biologics was greater in patients who also underwent surgery (P = 0.013). Timing of biologics relative to surgery did not impact efficacy. Patients who received HS surgery with biologic therapy were most likely to achieve the AN75 (P = 0.017). In this diverse cohort of patients with severe HS, biologic therapy was associated with a more rapid decline in disease activity, with the greatest effect in patients who also underwent HS surgery. © 2017 The International Society of Dermatology.

  18. Resorcinol peels as a possible self-treatment of painful nodules in hidradenitis suppurativa.

    Science.gov (United States)

    Boer, J; Jemec, G B E

    2010-01-01

    Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease characterized by abscess formation localized to apocrine sweat gland-bearing skin. The most important factor in patients' overall assessment of disease severity is pain. The duration of abscesses takes days to weeks and are always painful. To assess the efficacy of self-treatment with topical 15% resorcinol in an open study. The case notes of 12 women with stage 1 or 2 HS treated with topical resorcinol and followed up for at least 1 year were reviewed. The patients rated the efficacy of treatment on global maximum pain of nodules and abscesses on a visual analogue scale (VAS) and by self-report of the mean duration (days) of a painful lesion. All patients experienced a significant decrease in pain as assessed by VAS and reported a reduction in mean duration of the painful abscesses. Topical treatment with 15% resorcinol reduced pain from painful nodules in all patients with HS. Further trials are warranted to confirm these results.

  19. Pain and inflammation in hidradenitis suppurativa correspond to morphological changes identified by high-frequency ultrasound.

    Science.gov (United States)

    Zarchi, K; Yazdanyar, N; Yazdanyar, S; Wortsman, X; Jemec, G B E

    2015-03-01

    Hidradenitis suppurativa (HS) is an inflammatory skin disease with a chronic intermittent course. The current classification systems used to categorize disease severity provide limited insight into the degree of inflammation and pain, which are key symptoms of the disease. We sought to investigate the correlation and validity of simple patient- and investigator-assessed items related to inflammation with morphological changes identified by high-frequency ultrasound in HS. Twenty patients with the clinical diagnosis of HS were enrolled in this study. All patients underwent clinical examinations during which one representative inflammatory nodule was selected in each patient based on the anamnestic information, patient experience and clinical presentation. Tenderness and flare activity of the representative nodule were graded by the patients and erythema by the investigator. Subsequently, all patients underwent high-resolution ultrasound scanning of their representative nodule. We found significant associations between the size of the representative nodule (the diameter in the transverse plane) and patient assessments of flare activity and tenderness. Moreover, we found a marked association between the size of the nodules and investigator assessment of erythema. Patient assessments of flare activity and pain, and investigator assessment of erythema are strongly associated with morphological changes identified using ultrasound, suggesting that these patient- and investigator-assessed items might be strong indicators of the degree of present inflammation in HS. © 2014 European Academy of Dermatology and Venereology.

  20. Hidradenitis suppurativa gains increasing interest on World Wide Web: a source for patient information?

    Science.gov (United States)

    Hessam, Schapoor; Salem, Johannes; Bechara, Falk G; Haferkamp, Axel; Heidenreich, Axel; Paffenholz, Pia; Sand, Michael; Tsaur, Igor; Borgmann, Hendrik

    2017-07-01

    Gathering health information from Internet websites is increasingly utilized by patients. No data exist about hidradenitis suppurativa (HS)-related online health information. Thus, we aimed to study the quality, popularity, readability, and timeliness of the most frequented websites on HS. Google Trends was used to evaluate the public interest in HS. An Internet search on Google was performed for the terms "hidradenitis suppurativa," "acne inversa," and "Verneuil's disease." Readability scores, HONcode quality certification, Alexa popularity rank, and content were assessed. Google search queries on HS have steadily risen in the last 10 years. The website analysis revealed 39 unique websites, which were difficult to read. Ten websites (26%) had HONcode quality certification, and the median (IQR) Alexa popularity rank was 48871 (2333-361275). Thirteen websites (33%) yielded disease-specific photos with a median rating between "quite useful" and "uncertain." A therapy option with adalimumab was mentioned on 11 websites (28%). In addition to an increasing interest, we found a broad variation in the quality, readability, popularity, and timeliness of content on HS-related websites. Improvement of the quality and readability of HS-related websites is desirable to potentially raise disease awareness and contribute to an earlier presentation of patients suffering with undiagnosed HS. © 2017 The International Society of Dermatology.

  1. Medical Infrared Thermography assistance in the surgical treatment of axillary Hidradenitis Suppurativa: A case report.

    Science.gov (United States)

    Polidori, G; Renard, Y; Lorimier, S; Pron, H; Derruau, S; Taiar, R

    2017-01-01

    The purpose of this case report is to highlight for the first time the way Medical Infrared Thermography can be a helpful tool to assist the surgeon in the surgical treatment of Hidradenitis Suppurativa inflammatory disease. A 36-year-old man with a 7-year history of Hidradenitis Suppurativa presented inflammatory nodules in the left axilla area corresponding to Hurley stage II. Choice is made to surgically treat this patient using a wide excision protocol combined with a postoperative second intention healing. For the study purpose, an IR FLIR SC620 camera (FLIR Systems, Wilsonville, OR), having a high resolution pixel detector of 640×480 pixels for greater accuracy and higher resolution, has been used. For the first time in the literature, this case report on HS disease supports the idea that real-time medical infrared thermography may be helpful in establishing the true extent of disease preoperatively in the surgical room and in a similar manner, that this technique allows the surgeon to ensure all diseased lesions are removed during surgery. At least, medical infrared thermography seems to be a powerful tool to control the final wide surgical wound, in order to minimize recurrence risk of such a disease. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  2. Clinical features of hidradenitis suppurativa and Crohn disease: what do these two entities have in common?

    Science.gov (United States)

    Vilarrasa Rull, E; González Lama, Y

    2016-09-01

    Hidradenitis suppurativa (HS) and Crohn disease (CD) are chronic, recurrent inflammatory diseases. They share certain clinical characteristics and flares are common in both. Both entities are usually diagnosed between the second and third decades of life and share risk factors such as smoking and overweight. In CD, as in HS, acute untreated episodes of inflammation can lead to sequels such as abscesses, fistulas and stenosis. Consequently, early management is of the utmost importance. Some patients have both diseases. The estimated prevalence of SH in CD patients is 12.4%-17.9%, while the prevalence of CD in HS patients is around 3%. The presence of HS in patients with inflammatory bowel disease (IBD) is associated with an earlier onset of IBD and with more frequent need for anti-TNF-alpha therapy and surgical resection. Copyright © 2016 Elsevier España, S.L.U. y AEDV. All rights reserved.

  3. Scientific evidence for the use of current traditional systemic therapies in patients with hidradenitis suppurativa.

    Science.gov (United States)

    Alhusayen, Raed; Shear, Neil H

    2015-11-01

    Traditional systemic therapies are frequently prescribed for the treatment of hidradenitis suppurativa (HS). Clinicians consider antibiotics, retinoids, antiandrogens, immunosuppressants, and less common treatment, such as fumarates, in the management of HS. Different classes of medications have been selected to treat HS based on their ability to target various pathways of the condition. Concerns about infection, such as infection with Clostridium difficile, necessitates switching therapy or shortening the course of therapy with specific antibiotics. This review explores the outcomes with the use of numerous medical therapies and postulates explanations for their efficacy or lack of response. Data on long-term safety and efficacy with traditional systemic therapies are lacking. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  4. Preliminary findings suggest hidradenitis suppurativa may be due to defective follicular support

    DEFF Research Database (Denmark)

    Danby, F W; Jemec, G B E; Marsch, W Ch

    2013-01-01

    BACKGROUND: The initial pathology in hidradenitis suppurativa (HS)/acne inversa takes place in the folliculopilosebaceous unit (FPSU) and its surrounding tissue. The process involves follicular hyperkeratosis, inflammation and perifolliculitis. Identification of the exact origin of inflammation m...... 2-3+ positivity irrespective of any inflammation present. The distribution of inflammatory cells around the sebofollicular junction occurred predominantly in areas of BMZ thinning. CONCLUSIONS: The BMZ PAS positivity of clinically uninvolved FPSUs of patients with HS appears to be wispy...... or not present at all. It is speculated that this may explain the apparent fragility of the sebofollicular junction. There is an increased concentration of inflammatory cells adjacent to these areas, while inflammatory cells are scarce in areas where the PAS-positive material is intact. It is hypothesized...

  5. Extended split superior gluteus maximus musculocutaneous flap and reconstruction after resection of perianal and lower gluteal hidradenitis suppurativa.

    Science.gov (United States)

    Kishi, Kazuo; Nakajima, Hideo; Imanishi, Nobuaki; Nakajima, Tatsuo

    2009-08-01

    Various modifications of the gluteus maximus musculocutaneous flap have been reported. Among them, the split gluteus maximus musculocutaneous flap is easy to prepare and does not leave ambulatory insufficiency. However, the safety of extending the skin portion beyond the margin of the muscle has not yet been clarified. Angiography was performed systemically on 11 fresh cadavers, and the distance the margin of the gluteus maximus muscle could be extended was observed. Based on these anatomical data, reconstruction after total skin resection of perianal and lower gluteal hidradenitis suppurativa was performed with an extended split superior gluteal maximus musculocutaneous flap. Surgery was performed on three sides of two patients. From the anatomical results, we found that it is possible to extend the flap beyond the iliac crest several centimetres superiorly, and to the gluteal fold inferiorly, and several centimetres laterally. We designed the flap such that the extended area is situated in these areas. All flaps took well and did not show any congestion or necrosis. There were no recurrences at least 1 year after surgery. When reconstructing the lower part of the buttock, an extended split superior gluteus maximus musculocutaneous flap is easy to raise and leaves aesthetically satisfactory results. Thus it may be the first choice for reconstruction of the lower buttock.

  6. Update on Hidradenitis Suppurative (Part II): Treatment.

    Science.gov (United States)

    Martorell, A; García, F J; Jiménez-Gallo, D; Pascual, J C; Pereyra-Rodríguez, J; Salgado, L; Villarrasa, E

    2015-11-01

    Although hidradenitis suppurativa is a common and serious skin condition, its treatment is not well established. It is now accepted that the moderate and severe forms of the disease are associated with marked systemic inflammation. The goal of treatment in hidradenitis suppurative is therefore to achieve systemic control of inflammation. In some cases, surgery may also be necessary to reduce the severity of the manifestations of cutaneous inflammation. Recent advances in our understanding of hidradenitis suppurativa have been accompanied by the emergence of novel approaches to its treatment, including the use of certain biologic drugs. Several clinical trials have been undertaken to test the effects of biologics (mainly adalimumab) in this setting. In this review, we analyze the different treatments available for hidradenitis suppurativa. Copyright © 2015 Elsevier España, S.L.U. and AEDV. All rights reserved.

  7. Novel surgical approach for axillary hidradenitis suppurativa using a bilayer dermal regeneration template: a retrospective case study.

    Science.gov (United States)

    Gonzaga, Teresa A; Endorf, Frederick W; Mohr, William J; Ahrenholz, David H

    2013-01-01

    Hidradenitis suppurativa (HS) is a chronic debilitating disease of apocrine gland-bearing skin characterized by recurrent abscesses with subsequent rupture, scarring, and draining sinus tracts, most frequently affecting the axillary, inguinal, and anogenital regions. Conservative and temporizing treatment methods have been used to treat mild to moderate disease, but wide local excision of affected tissue is necessary for advanced disease. This creates a large soft tissue defect for which there is no consensus for reconstruction. Recovery is hampered by disease recurrence, tissue necrosis, and reoperation. The authors have described in this case study an alternative surgical approach to treat severe HS. All surgical procedures were performed by dedicated burn surgeons at a regional burn center using a two-stage surgical approach. The first stage is a wide local excision of all affected axillary tissue with immediate placement of a bilayer dermal regeneration template to cover the defect. This is secured with a negative pressure wound therapy dressing. The second stage uses a thin split thickness skin graft to close the wound. Results of four patients are presented. There were no recurrences of HS. Two patients required reoperations to address granulation tissue overgrowth and small areas of autograft loss. One patient experienced skin substitute loss as a result of infection. Inadequate excision of HS is the leading cause of disease recurrence. Using a bilayer dermal regeneration template with subsequent skin graft, surgeons can be aggressive in their excision of HS, achieving satisfactory functional and cosmetic results and minimizing axillary recurrence.

  8. Hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Dufour, Deirdre Nathalie; Emtestam, Lennart; Jemec, Gregor B

    2014-01-01

    pain, work disability and overall poor quality of life. Although the clinical signs of the disease can often be hidden by clothing, active HS is associated with a malodorous discharge that contributes to the disabling social stigma. Risk factors include smoking and obesity. Comorbidities include...

  9. Hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Jemec, G.B.E.

    2012-01-01

    A 36-year-old woman has recurrent boils under both arms and in the groin. They flare premenstrually, causing pain, suppuration, and an offensive odor. Scarring has developed in the groin area, and chronically draining sinus tracts are interspersed with normal skin. Treatment with short courses...... of antibiotics or with incision and drainage has had no apparent effect, and she has become socially isolated because of embarrassment about her condition. How would you manage this case?...

  10. Hidradenitis Suppurativa

    Science.gov (United States)

    ... it occurs after puberty, hormones likely play a role. The person’s immune system also seems to play a role. It is possible that HS develops when the person’s immune system overreacts. HS begins in the hair follicles (where ...

  11. Anoperineal disease in Hidradenitis suppurativa: MR imaging distinction from perianal Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Monnier, Louise; Amara, Nedjoua; Hoeffel, Christine [Hopital Maison Blanche, Department of Radiology, Reims (France); Dohan, Anthony [Hopital Lariboisiere, Assistance Publique-Hopitaux de Paris, Department of Radiology, Paris (France); Universite Paris-Diderot, Sorbonne Paris Cite, Paris (France); Zagdanski, Anne-Marie [Saint Louis Hospital, Department of Radiology, Paris (France); Drame, Moustapha [Hopital Robert Debre, Department of Statistics, Reims (France); Soyer, Philippe [Universite Paris-Diderot, Sorbonne Paris Cite, Paris (France)

    2017-10-15

    To determine whether Hidradenitis suppurativa (HS)-related anoperineal disease can be distinguished from Crohn's disease (CD) using MRI. Pelvic MRI of 23 HS and 46 CD patients with anoperineal disease between 2007 and 2014 were independently analysed by two radiologists. For diagnosis of HS, sensitivity, specificity and positive likelihood ratios (LRs) of inflammatory features and of their anatomical distribution were calculated and compared to those of CD. In HS, fistulae were less present (P =.033) and less frequently involved the sphincters (P =.001) than in CD. Granulomas were more frequent (P =.0005). For anterior/inguinal and posterior localizations, sensitivity, specificity and LR for diagnosis of HS were 70% (49.1, 84.4), 87% (74.3, 93.9), 5.3 (2.41, 11.79) and 57% (36.8, 74.4), 93% (82.5, 97.8), 8.67 (2.74, 27.41), respectively. Combination of signs including posterior involvement, absence of rectal wall thickening and bilaterality of features yielded specificity of 100% (95% CI: 92.3-100) for HS. Although MRI presentations of anoperineal disease may overlap between CD and HS, specific diagnosis of HS is possible with a combination of three features: absence of features' predominance in perianal area, absence of rectal wall thickening and bilaterality of features. (orig.)

  12. Gene expression of sphingolipid metabolism pathways is altered in hidradenitis suppurativa.

    Science.gov (United States)

    Dany, Mohammed; Elston, Dirk

    2017-08-01

    Hidradenitis suppurativa (HS) is a debilitating skin disease characterized by painful recurrent nodules and abscesses caused by chronic inflammation. Early events in the development of HS are believed to occur in the folliculopilosebaceous unit; however, the signaling pathways behind this mechanism are unknown. Sphingolipids, such as ceramide, are essential components of the skin and appendages and have important structural and signaling roles. We sought to explore whether the gene expression of enzymes involved in sphingolipid metabolic pathways is altered in HS. A microarray data set including 30 samples was used to compare the expression of sphingolipid-related enzymes in inflammatory skin lesions from HS patients (n = 17) with the expression in clinically healthy skin tissue (n = 13). Differential expression of sphingolipid metabolism-related genes was analyzed using Gene Expression Omnibus 2R. HS lesional skin samples have significantly decreased expression of enzymes generating ceramide and sphingomyelin, increased expression of enzymes catabolizing ceramide to sphingosine, and increased expression of enzymes converting ceramide to galactosylceramide and gangliosides. Limitations of this study include assessing the expression of sphingolipid-related enzymes without assessing the levels of the related sphingolipids. Our study suggests that sphingolipid metabolism is altered in HS lesional skin compared with normal skin. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  13. Quality of Life and Psychosocial Implications in Patients with Hidradenitis Suppurativa.

    Science.gov (United States)

    Kouris, Anargyros; Platsidaki, Eftychia; Christodoulou, Christos; Efstathiou, Vasiliki; Dessinioti, Clio; Tzanetakou, Vasiliki; Korkoliakou, Panagiota; Zisimou, Chrisa; Antoniou, Christina; Kontochristopoulos, George

    2016-01-01

    Hidradenitis suppurativa (HS) is a long-term skin disorder associated with high levels of psychological distress and significant life impact. To evaluate the quality of life, depression, anxiety, loneliness, and self-esteem in patients with HS. Ninety-four patients with HS were enrolled in the study. The quality of life, depression, anxiety, loneliness, and self-esteem of the patients were assessed using the Dermatology Life Quality Index (DLQI), the Hospital Anxiety and Depression Scale (HADS), the UCLA Loneliness Scale (UCLA-Version 3), and the Rosenberg Self-Esteem Scale (RSES), respectively. The DLQI mean score was 11.43 ± 6.61 in patients with HS. The patients with HS presented statistically significantly higher anxiety (6.41 ± 3.31 vs. 5.00 ± 1.59, p loneliness and social isolation scores (42.86 ± 8.63 vs. 35.57 ± 6.17, p < 0.001) and lower self-esteem scores (18.91 ± 1.79 vs. 19.77 ± 2.53, p = 0.008) than the healthy controls. HS is a distressing, recurrent disease that impairs quality of life. We can suggest services that allow an integrated approach, which includes psychosocial support, offering the patients relief from isolation and an opportunity to share common experiences. © 2017 S. Karger AG, Basel.

  14. Recurrence of hidradenitis suppurativa after surgical management: A systematic review and meta-analysis.

    Science.gov (United States)

    Mehdizadeh, Ali; Hazen, Paul G; Bechara, Falk G; Zwingerman, Nora; Moazenzadeh, Marzyeh; Bashash, Morteza; Sibbald, R Gary; Alavi, Afsaneh

    2015-11-01

    Hidradenitis suppurativa (HS) is a chronic inflammatory disease of apocrine-bearing skin. Treatment is challenging and long-standing. Surgery is one of the treatment options with varying reported success rates. This study provides a comprehensive systematic review of surgical approaches in the management of HS. A systematic literature search and meta-analysis of proportions were performed on the included studies. Of a total of 1147 retrieved articles, 22 were included in the analysis. These were the estimated average recurrences: wide excision, 13.0% (95% confidence interval [CI], 5.0-22.0%); local incision, 22.0% (95% CI, 10.0-37.0%); and deroofing, 27.0% (95% CI, 23.0-31.0%). In the wide excision group, recurrence rates were as follows: 15% (95% CI, 0-72%) for primary closure, 8% (95% CI, 2.0-16.0%) for using flaps, and 6.0% (95% CI, 0.0-24.0%) for grafting. The secondary intention healing option was most commonly chosen after local excision and deroofing. There was poor quality evidence and potential improper reporting of the results. This systematic review found lower recurrence rates with wide excision, using skin flaps or skin grafts as the closure methods. The heterogeneity of the patient populations was high and statistically significant within and across all types of excisions. Copyright © 2015 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  15. Incidence of hidradenitis suppurativa in the United States: A sex- and age-adjusted population analysis.

    Science.gov (United States)

    Garg, Amit; Lavian, Jonathan; Lin, Gloria; Strunk, Andrew; Alloo, Allireza

    2017-07-01

    The true incidence of hidradenitis suppurativa (HS) is unknown. To determine standardized incidence estimates for HS in the United States. We used a retrospective cohort analysis, including incident HS cases identified using electronic health records data for a demographically heterogeneous population-based sample of >48 million unique patients across all 4 census regions. We calculated standardized 1- and 10-year cumulative incidences for the overall population and for sex-, age-, and race-specific groups. There were 5410 new HS diagnoses over a 1-year period, with an incidence of 11.4 (95% confidence interval [CI], 11.1-11.8) cases per 100,000 population. One-year incidence in women was 16.1 (95% CI, 15.5-16.6) per 100,000, more than twice that of men [6.8 (95% CI, 6.5-7.2) per 100,000; P 2.5 times that of whites [11.7 (95% CI, 11.3-12.2) per 100,000; P population. The use of deidentified claims prevented validation for a larger case subset. HS incidence has increased over the past decade and disproportionately involves women, young adults, and African Americans. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  16. Topical 5-aminolevulinic acid photodynamic therapy improved refractory acne conglobata and perifolliculitis capitis abscedens et suffodiens rather than hidradenitis suppurativa

    Directory of Open Access Journals (Sweden)

    Linglin Zhang

    2016-01-01

    Full Text Available Acne conglobata (AC, perifolliculitis capitis abscedens et suffodiens (PCAS and hidradenitis suppurativa (HS are uncommon refractory chronic, inflammatory, scarring diseases but cause serious damage to the quality of life. These three diseases are associated with follicular occlusion. Several studies indicated topical 5-aminolevulinic acid photodynamic therapy (ALA-PDT improved follicular occlusion besides acne treatment. So we attempted to apply ALA-PDT to medicine resistant AC, PCAS and HS. Topical ALA-PDT was applied to 10 patients with AC, seven patients with PCAS and three patients with HS for more than three sessions. All the patients completed the dermatology life quality index (DLQI questionnaire and were assessed for the efficacy at the baseline and on two weeks after each treatment. Adverse effects were recorded at each visit. The results showed 25.5% (5/20, two cases of AC and three cases of PCAS of patients achieved excellent improvement after three sessions of PDT and another 60.0% (12/20, eight cases of AC and four cases of PCAS of patients achieved good improvement. 15.0% (3/20, three cases of HS got poor response (< 20% lesions clearance. Another five cases (three cases of AC and two cases of PCAS also achieved excellent response after 5–7 sessions of PDT. We also found that papular/nodular, cyst/abscess showed higher clearance rate than sinus/fistula (88.5%, 86.1% versus 11.1%. DLQI was reduced after three sessions of PDT in AC and PCAS patients rather than HS patients. 5-ALA-PDT could improve refractory AC and PCAS but could not lead to improvement in late stage of HS. The efficacy increased with more treatment sessions.

  17. A double-blind placebo-controlled randomized trial of adalimumab in the treatment of hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Miller, I; Lynggaard, C D; Lophaven, S

    2011-01-01

    the outcomes were blinded to group assignment. The primary efficacy endpoints were changes in the HS scores (Sartorius and Hurley scoring systems). Secondary efficacy endpoints included changes in pain (visual analogue scale), days with lesions and Dermatology Life Quality Index, and evaluation of scarring......BACKGROUND: Hidradenitis suppurativa (HS) has an impact on patients' quality of life. Treatment of HS is generally unsatisfactory, thus new treatments are needed. OBJECTIVES: To test the efficacy of adalimumab in HS. METHODS: This was a prospective, randomized, double-blinded, placebo...... subcutaneously (s.c.) at baseline followed by 40 mg s.c. every other week for 12 weeks. Placebo-treated patients received identical-looking injections with no active ingredient. The medicine was dispensed in sequentially numbered computer-randomized containers. Participants, care givers and those assessing...

  18. Title: Opioid, Alcohol, and Cannabis Misuse Among Patients with Hidradenitis Suppurativa: a population-based analysis in the United States.

    Science.gov (United States)

    Garg, Amit; Papagermanos, Vassiliki; Midura, Margaretta; Strunk, Andrew; Merson, Jonathan

    2018-02-27

    Patients with hidradenitis suppurativa (HS) experience chronic pain and have significant physical, emotional and psychological disease impact. These patients may be at risk for substance abuse. To evaluate substance use disorder (SUD) among HS patients in the United States. Cross-sectional analysis of adult HS patients (n = 32,625) identified using electronic health records data from a population-based sample of over 50 million patients. The prevalence of SUD among patients with HS was 4.0% (1,315/32,625), compared to 2.0% (195,260/9,581,640) for patients without HS (p<0.001). The most common forms of substance misuse among HS patients were alcohol (630/1,315; 47.9% of SUD cases), followed by opioids (430/1,315, 32.7% of SUD cases) and cannabis (430/1,315, 29.7% of SUD cases). HS patients had 1.50 [95% CI 1.42-1.59] times the adjusted odds of SUD compared to patients without HS. HS patients had significantly greater odds of SUD across demographic subgroups. The association between HS and SUD was generally stronger for patients aged 45-64 years, non-whites, privately-insured, and those without depressive or anxiety disorder. SUD may not be accurately diagnosed. Patients with HS have higher odds of SUD and may benefit from periodic screening for substance abuse. Copyright © 2018. Published by Elsevier Inc.

  19. Sex- and Age-Adjusted Population Analysis of Prevalence Estimates for Hidradenitis Suppurativa in the United States.

    Science.gov (United States)

    Garg, Amit; Kirby, Joslyn S; Lavian, Jonathan; Lin, Gloria; Strunk, Andrew

    2017-08-01

    The true prevalence of hidradenitis suppurativa (HS) is unknown. To establish standardized overall and group-specific prevalence estimates for HS in the United States. This retrospective analysis included a demographically heterogeneous population-based sample of more than 48 million unique patients across all US census regions. As of October 27, 2016, a total of 47 690 patients with HS were identified using electronic health record data. Standardized overall point prevalence for HS and sex-, age-, and race-specific prevalence estimates of HS in the general US population. Of the 47 690 patients with HS (26.2% men and 73.8% women), the overall HS prevalence in the US population sample was 0.10%, or 98 per 100 000 persons (95% CI, 97-99 per 100 000 persons). The adjusted prevalence in women was 137 per 100 000 (95% CI, 136-139 per 100 000), more than twice that of men (58 per 100 000; 95% CI, 57-59 per 100 000; P United States that disproportionately affects female patients, young adults, and African American and biracial patients.

  20. Hidradenitis Suppurativa and electrocardiographic changes - a cross-sectional population study

    DEFF Research Database (Denmark)

    Juhl, C R; Miller, I M; Jemec, G B

    2018-01-01

    changes associated with HS, which recently have been associated with significant cardiovascular burden. METHODS: Data were derived from the cross-sectional population study, The Danish General Population Study (GESUS). HS diagnosis was based on a validated self-reported questionnaire and 404 individuals...... met the HS diagnosis criteria and 19,001 controls without HS were identified in the population. Severity of HS was staged according to a modified Hurley score. The electrocardiographic parameters, Heart Rate (HR), PR-interval, QRS-duration, JTc-interval and QTc-interval, were obtained from 12-lead....... This article is protected by copyright. All rights reserved....

  1. Topical treatments of skin pain: a general review with a focus on hidradenitis suppurativa with topical agents.

    Science.gov (United States)

    Scheinfeld, Noah

    2014-07-15

    Hidradenitis Supprurativa (HS) is a painful chronic follicular disease. Few papers have addressed pain control for this debilitating condition. Possible topical agents include tricyclic antidepressants, opioids, anticonvulsants, NSAIDs, NMDA receptor antagonists, local anesthetics and other agents. The first line agents for the topical treatment of the cutaneous pain of HS are diclonefac gel 1% and liposomal xylocaine 4% and 5% cream or 5% ointment. The chief advantage of topical xylocaine is that is quick acting i.e. immediate however with a limited duration of effect 1-2 hours. The use of topical ketamine, which blocks n-methyl-D-aspartate receptors in a non-competitive fashion, might be a useful tool for the treatment of HS pain. Topical doxepin, which available in a 5% commercially preparation (Zonalon®) , makes patients drowsy and is not useful for controlling the pain of HS . Doxepin is available in a 3% or 3.3% concentration (which causes less drowsiness) from compounding pharmacies and can be used in compounded analgesic preparations with positive effect. Topical doxepin is preferred over use of topical amitriptyline because topical doxepin is more effective. Nevertheless, topical amitriptyline increase of the tactile and mechanical nociceptive thresholds and can be used for topical pain control in compound mixture of analgesics . Gabapentin and pregablin can also be used compounded with other agents in topical analgesic preparations with positive topical anesthetic effect. Capsaicin is not useful for topical treatment of the pain of HS. Sometimes compounded of anesthetics medications such as ketamine 10%, bupivacaine 1%, diclofenac 3%, doxepin 3% or 3.3%, and gabapentin 6% can extend the duration of effect so that medication only needs to be used 2 or 3 times a day. Still in my experience the easiest to get and most patient requested agent is topical diclonefac 1% gel.

  2. Coagulation Status in Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Miller, Iben Marie; Johansen, Maria Egede; Mogensen, Ulla B

    2015-01-01

    performed a hospital- and population-based cross-sectional study investigating the coagulation status (thrombocytes, mean platelet volume [MPV], international normalized ratio [INR] and activated partial thromboplastin time [APTT]). RESULTS: 32 hospital HS subjects, 430 population HS subjects and 20.......3432). CONCLUSION: We did not find an association between HS and prothrombotic/hypercoagulable status. Thus, thrombocytes may not be activated in HS. Furthermore, INR may not be affected in HS, suggesting that intrinsic and vitamin K-dependent coagulation factors appear unaffected....

  3. [Surgical treatment of suppurative axillary hidradenitis: value of a musculocutaneous island flap of the latissimus dorsi. Apropos of 3 cases].

    Science.gov (United States)

    Blanc, D; Tropet, Y; Balmat, P

    1990-01-01

    We report our experience of the surgical management of severe, extensive, medically intractable axillary Hidradenitis suppurativa in three male patients. Under general anaesthesia, all patients underwent large, deep and full excision of the disease prone areas, i. e. zones of apocrine sweat gland distribution and not only of the skin involved at the time of surgery, for the best possible prevention of recurrence. The operation was bilateral in two patients and unilateral in one. In all cases closure was achieved using the latissimus dorsi flap technique. In the two patients with bilateral lesions surgery was carried out in two steps at about two months' interval. At present, after a follow-up of about two years, none of the patients have relapsed and their shoulder mobility is perfectly preserved with a normal abduction allowed by the total absence of axillary scar contracture. The latissimus dorsi flap technique consists of transplanting into the recipient's axillary defect the pedicellated lateral margin of the latissimus dorsi muscle with (2 patients) or without (1 patient) a cover of attached skin palette vascularized by the underlying muscle tissue. Mainly used hitherto for reconstructive mammary surgery, this technique perfectly fits axillary diseases, such as Hidradenitis suppurativa, which can only be cured by creating wide surgical skin defects. It is particularly reliable: covering of the defect is easy and the immediate muscle interposition effectively protects the otherwise widely exposed neurovascular pedicle. The need for a skin palette cover associated with the latissimus dorsi flap is discussed.

  4. Hidradenitis suppurativa: epidemiological study of cases diagnosed at a dermatological reference center in the city of Bauru, in the Brazilian southeast State of São Paulo, between 2005 and 2015.

    Science.gov (United States)

    Andrade, Tatiana Cristina Pedro Cordeiro de; Vieira, Bruna Cortinóvis; Oliveira, Agnes Mayumi Nakano; Martins, Tábata Yamasaki; Santiago, Tatiane Meira; Martelli, Antônio Carlos Ceribelli

    2017-01-01

    Hidradenitis is a chronic inflammatory disease of the hair follicles. A treatment is necessary due to chronicity and psychological changes that patient present. To investigate epidemiological aspects and elaborate a risk group profile, promote early diagnosis and contribute to the knowledge about the disease. This cross-sectional descriptive study with retrospective analysis of medical records of 194 patients diagnosed with hidrosadenitis in a dermatological reference center in the city of Bauru (SP) between 2005 and 2015. Females accounted for 74% of cases. The age at diagnosis ranged from 10 to 67 years and the majority was within the 3rd and 4th decade of life. It occurred Association with diabetes mellitus in 33%, obesity in 55% and smoking in 61% was observed. Mean time between the onset of the disease and diagnosis was nine years. Hurley stage II was the most common at diagnosis. The therapeutic option mostly used in Hurley I and II was systemic antibiotics and in Hurley III was surgery. the main limitation of this study is its retrospective design, which does not allow the true clinical confirmation of the disease by investigators. we outlined the following profile: women, caucasian, between 3rd and 4th decade of life, associated with obesity, smoking, late diagnosis and multiple potential therapeutic modalities. We highlight the importance of studies like this in order to identify risk groups and encourage early diagnosis.

  5. What happens after a single surgical intervention for hidradenitis suppurativa?

    DEFF Research Database (Denmark)

    Jemec, Gregor B E; Guérin, Annie; Kaminsky, Michael

    2016-01-01

    costs were compared using multivariate regressions. Results Overall, 46% of HS patients had ≥1 indicator of non-curative surgery. The incidences of inpatient, emergency department, and outpatient visits were 88%, 40%, and 30% higher, respectively, for patients with non-curative surgery vs patients...

  6. Body composition and basal metabolic rate in Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Miller, I M; Rytgaard, Helene Charlotte; Mogensen, U B

    2016-01-01

    composition (e.g. abdominal fat) may be more so. Basal metabolic rate (BMR) is an expression of resting metabolism and may serve as a complementary tool when assessing the possibly underlying metabolism behind a persons' body composition. OBJECTIVE: To investigate the body composition and basal metabolic rate.......70-105.56) (P basal metabolic rate (BMR) in HS patients may reflect...... a dysfunctional metabolism contributing to the high-fat-body composition....

  7. Disease severity scoring systems in dermatology

    Directory of Open Access Journals (Sweden)

    Cemal Bilaç

    2016-06-01

    Full Text Available Scoring systems have been developed to interpret the disease severity objectively by evaluating the parameters of the disease. Body surface area, visual analogue scale, and physician global assessment are the most frequently used scoring systems for evaluating the clinical severity of the dermatological diseases. Apart from these scoring systems, many specific scoring systems for many dermatological diseases, including acne (acne vulgaris, acne scars, alopecia (androgenetic alopecia, tractional alopecia, bullous diseases (autoimmune bullous diseases, toxic epidermal necrolysis, dermatitis (atopic dermatitis, contact dermatitis, dyshidrotic eczema, hidradenitis suppurativa, hirsutismus, connective tissue diseases (dermatomyositis, skin involvement of systemic lupus erythematosus (LE, discoid LE, scleroderma, lichen planoplaris, mastocytosis, melanocytic lesions, melasma, onychomycosis, oral lichen planus, pityriasis rosea, psoriasis (psoriasis vulgaris, psoriatic arthritis, nail psoriasis, sarcoidosis, urticaria, and vitiligo, have also been developed. Disease severity scoring methods are ever more extensively used in the field of dermatology for clinical practice to form an opinion about the prognosis by determining the disease severity; to decide on the most suitable treatment modality for the patient; to evaluate the efficacy of the applied medication; and to compare the efficiency of different treatment methods in clinical studies.

  8. The follicular skin microbiome in patients with hidradenitis suppurativa and healthy controls

    DEFF Research Database (Denmark)

    Ring, Hans Christian; Thorsen, Jonathan; Saunte, Ditte M.

    2017-01-01

    differs significantly from that in healthy controls in lesional and nonlesional skin. Overall, the following 5 microbiome types were identified: Corynebacterium species (type I), Acinetobacter and Moraxella species (type II), Staphylococcus epidermidis (type III), Porphyromonas and Peptoniphilus species...

  9. Normal Skin Microbiota is Altered in Pre-clinical Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Ring, Hans Christian; Bay, Lene; Kallenbach, Klaus

    2017-01-01

    were used in combination with confocal laser scanning microscopy. Significant differences were found in both distribution and quantity of the cutaneous microbiota in clinically non-affected axillary skin of patients with HS compared with healthy controls. Surprisingly, we detected fewer bacteria...

  10. Leukocyte Profile in Peripheral Blood and Neutrophil-Lymphocyte Ratio in Hidradenitis Suppurativa

    DEFF Research Database (Denmark)

    Miller, Iben Marie; Ring, Hans Christian; Prens, Errol P.

    2016-01-01

    .0001) and monocyte (p = 0.0014, p = 0.0004) levels in the HS groups compared with controls. Conclusion: The hs-CRP levels associated with HS appear to be intermediate (2.2-5.1 mg/l), implying systemic inflammation rather than infection. The peripheral blood leukocytosis in HS was dominated by neutrophils...... to the inflammatory state in HS. Objective: To investigate the status of inflammation and leukocyte profile in the peripheral blood of HS patients. Materials and Methods: Using a comparative cross-sectional study design, we investigated blood samples of high-sensitivity C-reactive protein (hs-CRP) and leukocyte...... odds of leukocytosis when compared to controls with an odds ratio for the HS-HOSP group of 4.38 (95% CI = 2.18-8.80; p neutrophil (p

  11. Protocol for the development of a core domain set for hidradenitis suppurativa trial outcomes

    DEFF Research Database (Denmark)

    Thorlacius, Linnea; Ingram, John R; Garg, Amit

    2017-01-01

    of candidate items will be obtained by combining three data sets: (1) a systematic review of the literature, (2) US and Danish qualitative interview studies involving patients with HS and (3) an online healthcare professional (HCP) item generation survey. To reach consensus on the COS, 4 anonymous online...... Delphi rounds are then planned together with 2 face-to-face consensus meetings (1 in Europe and 1 in the USA) to ensure global representation. ETHICS AND DISSEMINATION: The study will be performed according to the Helsinki declaration. All results from the study, including inconclusive or negative...

  12. Hedgehog pathway does not play a role in hidradenitis suppurativa pathogenesis

    DEFF Research Database (Denmark)

    Mozeika, E.; Jemec, G.B.E.; Nürnberg, B.M.

    2011-01-01

    in normal embryonic skin, hair follicle, sebaceous and sweat gland development. Mutations of hedgehog pathway in adult skin have previously been found in basal cell carcinomas and in alopecia as well as in epidermal cysts and in odontogenic keratocysts. Therefore, we suggested that the hedgehog pathway...

  13. [Emotions and bodily experience in Hidradenitis Suppurative-Acne Inversa].

    Science.gov (United States)

    Tugnoli, S; Bettoli, V; Agnoli, C; Caracciolo, S

    2016-01-01

    Hidradenitis Suppurative-Acne Inversa is one of the most debilitating chronic skin diseases. It seriously affects the emotional and relational life of the patient, it has a significant psychiatric comorbidity and it impairs the quality of life. We present the report of a clinical situation with onset of the illness in a young woman during pregnancy, a case characterized by particular evolution, severe systemic involvement, strong psycho-emotional impact on the patient and impairment of subjective well-being of the caregiver. The clinical evaluation highlights mainly the relevance of the bodily experience, that stands out as a central issue in the sufference of the patient. She feels an uncanny foreignness to herself and a lacerating wound of her identity, related to her desirability, her femininity and her motherhood. Specific personality factors, which are likely to have influenced and guided the experience of illness and the quality of the relationship with the treatment team, are also evaluated. This case exemplifies, at different levels, the clinical complexity of Hidradenitis Suppurative-Acne Inversa and its impact on individual subjectivity. This disease requires an integrated intervention by a multidisciplinary team, providing for the assessment, the treatment and the evaluation of outcomes. It is necessary an effective operational link between different competences, in order to promote the patient compliance and to activate and develop the best care and the right psychological support.

  14. ACRODERMATITIS CONTINUA SUPPURATIVA HALLOPEAU IN COMBINATION WITH LOCALIZED PSORIASIS VULGARIS

    Directory of Open Access Journals (Sweden)

    E. V. Sokolovskiy

    2017-01-01

    Full Text Available А clinical case of a rare form of pustular psoriasis, known as “acrodermatitis continua suppurativa Hallopeau” is described. The involvement of the distal phalanges of the fingers and toes in combination with localized psoriasis vulgaris is observed. Specific features of this case are the presence of two different forms of the disease and comorbidities, that limits treatment options. The article provides current data on the clinical features and management of acrodermamtitis continua suppurativa Hallopeau. An acceptable personalized treatment with systemic retinoids and topical substances containing betamethasone dipropionate and calcipotriol has been proposed.

  15. Recurrence rate and patient satisfaction of CO2 laser evaporation of lesions in patients with hidradenitis suppurativa

    DEFF Research Database (Denmark)

    Mikkelsen, Peter Riis; Dufour, Deirde Nathalie; Zarchi, Kian

    2015-01-01

    : To determine the recurrence rate, time to recurrence, and factors influencing disease recurrence in skin treated with CO2 laser evaporation, and healing by secondary intention; and patients' satisfaction with treatment. METHODS: Fifty-eight patients treated with CO2 laser evaporation were interviewed regarding...

  16. Pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH)--a new autoinflammatory syndrome distinct from PAPA syndrome.

    Science.gov (United States)

    Braun-Falco, Markus; Kovnerystyy, Oleksandr; Lohse, Peter; Ruzicka, Thomas

    2012-03-01

    PAPA syndrome is a recently identified hereditary autoinflammatory syndrome clinically characterized by pyogenic arthritis, severe acne, and pyoderma gangrenosum. It is caused by mutations in the PSTPIP1 gene and may be closely linked to the aseptic abscesses syndrome, which has been shown to be associated with CCTG repeat amplification in the promoter region of PSTPIP1. We describe two unrelated patients with a clinical presentation quite similar to, yet distinct from, PAPA syndrome. Both patients had pyoderma gangrenosum and acute or remittent acne conglobata, but, in contrast to PAPA syndrome, lacked any episodes of pyogenic arthritis. Instead, they had suppurative hidradenitis. Mutations in PSTPIP1 exons 1 to 15 were excluded. In the promoter region, an increased repetition of the CCTG microsatellite motif was present on one allele in both patients. Alterations of the most commonly affected exons of the MEFV, NLRP3, and TNFRSF1A genes also were not detectable. One patient was treated with the interleukin (IL)-1 receptor antagonist anakinra and responded well, although without complete remission. This implies that IL-1ß may be of pathogenetic importance. Small number of patients, no gene mutation identified, and unclear efficacy of therapy are limitations. The clinical triad of pyoderma gangrenosum, acne, and suppurative hidradenitis represents a new disease entity within the spectrum of autoinflammatory syndromes, similar to PAPA and aseptic abscesses syndrome. For this disease, we propose the acronym "PASH" syndrome. PASH syndrome may respond to IL-1ß blockade. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  17. Quality of life measurement in acne. Position Paper of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa

    NARCIS (Netherlands)

    Chernyshov, P. V.; Zouboulis, C. C.; Tomas-Aragones, L.; Jemec, G. B.; Manolache, L.; Tzellos, T.; Sampogna, F.; Evers, A. W. M.; Dessinioti, C.; Marron, S. E.; Bettoli, V.; van Cranenburgh, O. D.; Svensson, A.; Liakou, A. I.; Poot, F.; Szepietowski, J. C.; Salek, M. S.; Finlay, A. Y.

    2017-01-01

    Acne causes profound negative psychological and social effects on the quality of life (QoL) of patients. The European Dermatology Forum S3-Guideline for the Treatment of Acne recommended adopting a QoL measure as an integral part of acne management. Because of constantly growing interest in

  18. Quality of life measurement in acne. Position Paper of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa

    NARCIS (Netherlands)

    Chernyshov, P. V.; Zouboulis, C. C.; Tomas-Aragones, L.; Jemec, G. B.; Manolache, L.; Tzellos, T.; Sampogna, F.; Evers, A. W. M.; Dessinioti, C.; Marron, S. E.; Bettoli, V.; van Cranenburgh, O. D.; Svensson, A.; Liakou, A. I.; Poot, F.; Szepietowski, J. C.; Salek, M. S.; Finlay, A. Y.

    2018-01-01

    Acne causes profound negative psychological and social effects on the quality of life (QoL) of patients. The European Dermatology Forum S3-Guideline for the Treatment of Acne recommended adopting a QoL measure as an integral part of acne management. Because of constantly growing interest in

  19. A Proposal for a Study on Treatment Selection and Lifestyle Recommendations in Chronic Inflammatory Diseases

    DEFF Research Database (Denmark)

    Andersen, Vibeke; Holmskov, Uffe; Sørensen, Signe Bek

    2017-01-01

    Chronic inflammatory diseases (CIDs), including Crohn's disease and ulcerative colitis (inflammatory bowel diseases, IBD), rheumatoid arthritis, psoriasis, psoriatic arthritis, spondyloarthritides, hidradenitis suppurativa, and immune-mediated uveitis, are treated with biologics targeting the pro...

  20. Impairment of Sexual Life in 3,485 Dermatological Outpatients From a Multicentre Study in 13 European Countries

    DEFF Research Database (Denmark)

    Sampogna, Francesca; Abeni, Damiano; Gieler, Uwe

    2017-01-01

    Quality Index was used to collect information on sexual impact of several skin conditions in 13 European countries. Among 3,485 patients, 23.1% reported sexual problems. The impairment was particularly high in patients with hidradenitis suppurativa, prurigo, blistering disorders, psoriasis, urticaria......, eczema, infections of the skin, or pruritus. Sexual impact was strongly associated with depression, anxiety, and suicidal ideation. It was generally more frequent in younger patients and was positively correlated with clinical severity and itch. It is important to address the issue of sexual well......-being in the evaluation of patients with skin conditions, since it is often linked to anxiety, depression, and even suicidal ideation....

  1. The nature and consequence of Karl Marx's skin disease.

    Science.gov (United States)

    Shuster, S

    2008-01-01

    From an analysis of the original correspondence, it has been possible to establish that Karl Marx's incapacitating skin disease was hidradenitis suppurativa, not 'boils' as was universally assumed at the time and since; the psychological effect of this illness on the man and his work appears to have been considerable.

  2. [What's new in dermatological therapy?

    Science.gov (United States)

    Ezzedine, K

    2016-12-01

    Over the last year there has been major publications related to therapeutic trials in infectious dermatology, not only with regard to Herpes zoster subunit vaccine but also for the treatment of uncomplicated abscesses or scabies. In addition, biological treatments continue to be on the forefront, not only in the treatment of psoriasis but also in other chronic inflammatory dermatologic diseases such as atopic dermatitis and hidradenitis suppurativa, two diseases that significantly impact quality of life and for which there are to date, few therapeutic alternatives in moderate to severe forms. In addition, the treatment of cyclin-resistant papulopustular rosacea was also the subject of a large French controlled randomized controlled trial that could modify our therapeutic approach by the use of isotretinoin. Finally, the prevention of rashes induced by erlotinib with oral doxycyline is also part of this 2016 "what's new in dermatological therapeutics". © 2016 Elsevier Masson SAS. Tous droits réservés.

  3. Sever's Disease

    Science.gov (United States)

    ... into mature bone. Sever's disease is similar to Osgood-Schlatter disease, a condition that affects the bones in ... Bones, Muscles, and Joints Common Childhood Orthopedic Conditions Osgood-Schlatter Disease Problems With Legs and Feet Cool Cast ...

  4. Severity investigation

    NARCIS (Netherlands)

    Rooij, M.R. de; Godart, B.

    2013-01-01

    From the confirmation inspection and its subsequent test results the presence of AAR has either been confirmed or eliminated. Assuming the first outcome, the next step is to investigate the severity of the situation, see Figure 23. One should keep in mind that it is possible that some evidence of

  5. Photodynamic Therapy and Skin Appendage Disorders: A Review.

    Science.gov (United States)

    Megna, Matteo; Fabbrocini, Gabriella; Marasca, Claudio; Monfrecola, Giuseppe

    2017-01-01

    Photodynamic therapy (PDT) is a noninvasive treatment that utilizes light treatment along with application of a photosensitizing agent. In dermatology, PDT is commonly used and approved for the treatment of oncological conditions such as actinic keratosis, Bowen disease and superficial basal cell carcinoma. In the last 2 decades however, PDT has also been used for the treatment of several nonneoplastic dermatological diseases. The present review summarizes published data on PDT application in skin appendage disorders. Our literature review shows that: (a) PDT may be a suitable treatment for acne, folliculitis decalvans, hidradenitis suppurativa, nail diseases, and sebaceous hyperplasia; (b) there is a lack of agreement on PDT features (type, concentrations and incubation period of used substances, number and frequency of PDT sessions, optimal parameters of light sources, and patient characteristics [e.g., failure to previous treatments, disease severity, body surface area involved, etc.] which should guide PDT use in these diseases); (c) further research is needed to establish international guidelines helping dermatologists to choose PDT for the right patient at the right time.

  6. Unconventional Use of Intense Pulsed Light

    Directory of Open Access Journals (Sweden)

    D. Piccolo

    2014-01-01

    Full Text Available According to the literature, intense pulsed light (IPL represents a versatile tool in the treatment of some dermatological conditions (i.e., pigmentation disorders, hair removal, and acne, due to its wide range of wavelengths. The authors herein report on 58 unconventional but effective uses of IPL in several cutaneous diseases, such as rosacea (10 cases, port-wine stain (PWS (10 cases, disseminated porokeratosis (10 cases, pilonidal cyst (3 cases, seborrheic keratosis (10 cases, hypertrophic scar (5 cases and keloid scar (5 cases, Becker’s nevus (2 cases, hidradenitis suppurativa (2 cases, and sarcoidosis (1 case. Our results should suggest that IPL could represent a valid therapeutic support and option by providing excellent outcomes and low side effects, even though it should be underlined that the use and the effectiveness of IPL are strongly related to the operator’s experience (acquired by attempting at least one specific course on the use of IPL and one-year experience in a specialized centre. Moreover, the daily use of these devices will surely increase clinical experience and provide new information, thus enhancing long-term results and improving IPL effectiveness.

  7. [Severe rhabdomyolysis secondary to severe hypernatraemic dehydration].

    Science.gov (United States)

    Mastro-Martínez, Ignacio; Montes-Arjona, Ana María; Escudero-Lirio, Margarita; Hernández-García, Bárbara; Fernández-Cantalejo Padial, José

    2015-01-01

    Rhabdomyolysis is a rare paediatric condition. The case is presented of a patient in whom this developed secondary to severe hypernatraemic dehydration following acute diarrhoea. Infant 11 months of age who presented with vomiting, fever, diarrhoea and anuria for 15 hours. Parents reported adequate preparation of artificial formula and oral rehydration solution. He was admitted with malaise, severe dehydration signs and symptoms, cyanosis, and low reactivity. The laboratory tests highlighted severe metabolic acidosis, hypernatraemia and pre-renal kidney failure (Sodium [Na] plasma 181 mEq/L, urine density> 1030). He was managed in Intensive Care Unit with gradual clinical and renal function improvement. On the third day, slight axial hypotonia and elevated cell lysis enzymes (creatine phosphokinase 75,076 IU/L) were observed, interpreted as rhabdomyolysis. He was treated with intravenous rehydration up to 1.5 times the basal requirements, and he showed a good clinical and biochemical response, being discharged 12 days after admission without motor sequelae. Severe hypernatraemia is described as a rare cause of rhabdomyolysis and renal failure. In critically ill patients, it is important to have a high index of suspicion for rhabdomyolysis and performing serial determinations of creatine phosphokinase for early detection and treatment. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Palmer Drought Severity Index

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — PDSI from the Dai dataset. The Palmer Drought Severity Index (PDSI) is devised by Palmer (1965) to represent the severity of dry and wet spells over the U.S. based...

  9. Increased prevalence of metabolic syndrome in patients with acne inversa.

    Directory of Open Access Journals (Sweden)

    Robert Sabat

    Full Text Available BACKGROUND: Acne inversa (AI; also designated as Hidradenitis suppurativa is a common chronic inflammatory skin disease, localized in the axillary, inguinal and perianal skin areas that causes painful, fistulating sinuses with malodorous purulence and scars. Several chronic inflammatory diseases are associated with the metabolic syndrome and its consequences including arteriosclerosis, coronary heart disease, myocardial infraction, and stroke. So far, the association of AI with systemic metabolic alterations is largely unexplored. METHODS AND FINDINGS: A hospital-based case-control study in 80 AI patients and 100 age- and sex-matched control participants was carried out. The prevalence of central obesity (odds ratio 5.88, hypertriglyceridemia (odds ratio 2.24, hypo-HDL-cholesterolemia (odds ratio 4.56, and hyperglycemia (odds ratio 4.09 in AI patients was significantly higher than in controls. Furthermore, the metabolic syndrome, previously defined as the presence of at least three of the five alterations listed above, was more common in those patients compared to controls (40.0% versus 13.0%; odds ratio 4.46, 95% confidence interval 2.02 to 9.96; P<0.001. AI patients with metabolic syndrome also had more pronounced metabolic alterations than controls with metabolic syndrome. Interestingly, there was no correlation between the severity or duration of the disease and the levels of respective parameters or the number of criteria defining the metabolic syndrome. Rather, the metabolic syndrome was observed in a disproportionately high percentage of young AI patients. CONCLUSIONS: This study shows for the first time that AI patients have a high prevalence of the metabolic syndrome and all of its criteria. It further suggests that the inflammation present in AI patients does not have a major impact on the development of metabolic alterations. Instead, evidence is given for a role of metabolic alterations in the development of AI. We recommend

  10. Severe Asthma in Children.

    Science.gov (United States)

    Chipps, Bradley E; Parikh, Neil G; Maharaj, Sheena K

    2017-04-01

    The aim of this study is to characterize, diagnose, evaluate, and treat severe childhood asthma. Understanding the occurrence of the physiologic and clinical presentations of childhood severe asthma, the treatment and response may be predicted by biomarkers, but the patient's response is highly variable. The onset of severe asthma occurs early and is primarily predicted by severity of viral infection and coexistence of the atopic state.

  11. Pharmacotherapy of severe asthma

    Science.gov (United States)

    Firszt, Rafael; Kraft, Monica

    2013-01-01

    Severe asthma is a complex and heterogeneous phenotype where management can be challenging. While many patients with severe asthma respond to high-dose inhaled corticosteroids in combination with a long-acting β-agonist, there remains a significant subset of patients that require oral corticosteroids to control symptoms. Alternative therapies are needed to help reduce the need for continuous oral corticosteroids; however, there are currently very few effective options. Several new alternatives to oral corticosteroids have been evaluated in severe asthma as add-on to conventional therapy. These include macrolide antibiotics, omalizumab, tumor necrosis factor-α inhibitors, cytokine receptor antagonists, and bronchial thermoplasty. The challenge with these entities is determining the appropriate phenotype of severe asthma where effectiveness is demonstrated, given the significant heterogeneity of the disease. Therefore, there is a crucial need to better understand the mechanisms and pathophysiology of severe asthma so more effective immunomodulators and biologic therapies can emerge. PMID:20462794

  12. Severe accident phenomena

    International Nuclear Information System (INIS)

    Jokiniemi, J.; Kilpi, K.; Lindholm, I.; Maekynen, J.; Pekkarinen, E.; Sairanen, R.; Silde, A.

    1995-02-01

    Severe accidents are nuclear reactor accidents in which the reactor core is substantially damaged. The report describes severe reactor accident phenomena and their significance for the safety of nuclear power plants. A comprehensive set of phenomena ranging from accident initiation to containment behaviour and containment integrity questions are covered. The report is based on expertise gained in the severe accident assessment projects conducted at the Technical Research Centre of Finland (VTT). (49 refs., 32 figs., 12 tabs.)

  13. Management of severe preeclampsia.

    Science.gov (United States)

    Brichant, G; Dewandre, P Y; Foidart, J M; Brichant, J F

    2010-01-01

    Features of severe preeclampsia include severe proteinuric hypertension and symptoms of central nervous system dysfunction, hepatocellular injury, thrombocytopenia, oliguria, pulmonary oedema, cerebrovascular accident and severe intrauterine growth restriction. Women with severe preeclampsia must be hospitalized to confirm the diagnosis, to assess the severity of the disease, to monitor the progression of the disease and to try to stabilize the disease. Severe preeclampsia may be managed expectantly, in selected cases. The objective of expectant management in these patients is to improve neonatal outcome. Expectant management is based on antihypertensive treatment and prevention of end organ dysfunction. Antihypertensive treatment improves maternal outcome but has the potential to be deleterious for the foetus. Plasma volume expansion has been suggested for severe preeclampsia but trials failed to show any benefit. Magnesium sulfate is the anticonvulsivant of choice to treat or prevent eclampsia when indicated. Antenatal corticosteroids are recommended in severely preeclamptic women with 26-34 weeks gestation. Timing of delivery is based upon gestational age, severity of preeclampsia, maternal and foetal risks.

  14. Successful treatment of PASH syndrome with infliximab, cyclosporine and dapsone.

    Science.gov (United States)

    Staub, J; Pfannschmidt, N; Strohal, R; Braun-Falco, M; Lohse, P; Goerdt, S; Leverkus, M

    2015-11-01

    The group of autoinflammatory syndromes associated with Pyoderma gangrenosum, Acne, and Suppurative Hidradenitis are poorly defined and difficult to control with currently available treatment modalities. We describe a patient with PASH syndrome and report about the successful multimodal treatment with infliximab, cyclosporine, and dapsone. A review of the available literature to date about this group of autoinflammatory diseases was performed. We performed genetic analysis for PSTPIP1 mutations associated with PAPA syndrome. A 22-year-old woman presented to our department with pyoderma gangrenosum, concomitant acne, and suppurative hidradenitis. She had previously been treated unsuccessfully with etanercept, adalimumab, fumaric acid and the IL-1 receptor antagonist (IL-1RA) anakinra without prolonged remission. Treatment with intravenous infliximab in combination with cyclosporine and dapsone lead to sudden and prolonged improvement of the clinical symptoms that we classified as PASH syndrome. We review the literature about this group of diseases and report the third case of PASH syndrome to date. PASH syndrome and associated diseases should be considered whenever hidradenitis suppurativa is found in association with pyoderma gangrenosum. We provide a systematic overview about PASH syndrome and suggest a novel multimodal therapeutic regimen beyond isolated inhibition of TNF or IL-1. © 2014 European Academy of Dermatology and Venereology.

  15. De-severing distance

    DEFF Research Database (Denmark)

    Jensen, Hanne Louise; de Neergaard, Maja

    2016-01-01

    De-severing Distance This paper draws on the growing body of mobility literature that shows how mobility can be viewed as meaningful everyday practices (Freudendal –Pedersen 2007, Cresswell 2006) this paper examines how Heidegger’s term de-severing can help us understand the everyday coping with ...

  16. Allergy in severe asthma

    NARCIS (Netherlands)

    Del Giacco, Stefano R.; Bakirtas, A.; Bel, E.; Custovic, A.; Diamant, Z.; Hamelmann, E.; Heffler, E.; Kalayci, O.; Saglani, S.; Sergejeva, S.; Seys, S.; Simpson, A.; Bjermer, Leif

    It is well recognized that atopic sensitization is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term 'Severe Asthma' encompasses a highly heterogeneous group of patients who require treatment on steps

  17. Severe childhood malnutrition

    DEFF Research Database (Denmark)

    Bhutta, Zulfiqar A; Berkley, James A; Bandsma, Robert H J

    2017-01-01

    The main forms of childhood malnutrition occur predominantly in children middle-income countries and include stunting, wasting and kwashiorkor, of which severe wasting and kwashiorkor are commonly referred to as severe acute malnutrition. Here, we use...... nutritional status and suboptimal nutritional intake in infancy and early childhood. Children with severe malnutrition have an increased risk of serious illness and death, primarily from acute infectious diseases. International growth standards are used for the diagnosis of severe malnutrition and provide...... and metabolic functions in children with malnutrition is challenging, and children remain at high risk of relapse and death. Further research is urgently needed to improve our understanding of the pathophysiology of severe malnutrition, especially the mechanisms causing kwashiorkor, and to develop new...

  18. Currency flaw severity. [Banknotes

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, C.; Burnett, M.; Goodman, C.; Sherrod, R.; Schmoyer, R.; Harrison, C.; Uppuluri, R.

    1986-01-01

    A survey of currency flaw severity was carried out using 300 banknotes and 37 judges. Each judge assigned each note to one of five flaw severity categories. These categories correspond to severity grades of 1 to 5 with 1 equivalent to ''always accepted'' and 5 ''never accepted.'' An average flaw severity grade for each note was obtained by taking the mean of the severity grades assigned to that note by the 37 judges. Thus, each note has a single numerical real-number flaw grade between 1 and 5. Mathematical modeling of the currency flaw survey results is continuing with some very promising initial results. Our present model handles common excess ink and missing ink flaw types quite well. We plan to extend the model to ink level, mash, setoff and blanket impression flaw types.

  19. Severe accident insights report

    International Nuclear Information System (INIS)

    Pratt, W.T.

    1988-04-01

    This report describes the conditions and events that nuclear power plant personnel may encounter during the latter stages of a severe core damage accident and what the consequences might be of actions they may take during these latter stages. The report also describes what can be expected of the performance of the key barriers to fission product release (primarily containment systems), what decisions the operating staff may face during the course of a severe accident, and what could result from these decisions based on our current state of knowledge of severe accident phenomena. 9 refs

  20. Severe malaria in Europe

    DEFF Research Database (Denmark)

    Kurth, Florian; Develoux, Michel; Mechain, Matthieu

    2017-01-01

    BACKGROUND: Malaria remains one of the most serious infections for travellers to tropical countries. Due to the lack of harmonized guidelines a large variety of treatment regimens is used in Europe to treat severe malaria. METHODS: The European Network for Tropical Medicine and Travel Health (Trop......Net) conducted an 8-year, multicentre, observational study to analyse epidemiology, treatment practices and outcomes of severe malaria in its member sites across Europe. Physicians at participating TropNet centres were asked to report pseudonymized retrospective data from all patients treated at their centre...... for microscopically confirmed severe Plasmodium falciparum malaria according to the 2006 WHO criteria. RESULTS: From 2006 to 2014 a total of 185 patients with severe malaria treated in 12 European countries were included. Three patients died, resulting in a 28-day survival rate of 98.4%. The majority of infections...

  1. Allergy in severe asthma.

    Science.gov (United States)

    Del Giacco, S R; Bakirtas, A; Bel, E; Custovic, A; Diamant, Z; Hamelmann, E; Heffler, E; Kalayci, Ö; Saglani, S; Sergejeva, S; Seys, S; Simpson, A; Bjermer, L

    2017-02-01

    It is well recognized that atopic sensitization is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term 'Severe Asthma' encompasses a highly heterogeneous group of patients who require treatment on steps 4-5 of GINA guidelines to prevent their asthma from becoming 'uncontrolled', or whose disease remains 'uncontrolled' despite this therapy. Epidemiological studies on emergency room visits and hospital admissions for asthma suggest the important role of allergy in asthma exacerbations. In addition, allergic asthma in childhood is often associated with severe asthma in adulthood. A strong association exists between asthma exacerbations and respiratory viral infections, and interaction between viruses and allergy further increases the risk of asthma exacerbations. Furthermore, fungal allergy has been shown to play an important role in severe asthma. Other contributing factors include smoking, pollution and work-related exposures. The 'Allergy and Asthma Severity' EAACI Task Force examined the current evidence and produced this position document on the role of allergy in severe asthma. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Severe childhood malnutrition.

    Science.gov (United States)

    Bhutta, Zulfiqar A; Berkley, James A; Bandsma, Robert H J; Kerac, Marko; Trehan, Indi; Briend, André

    2017-09-21

    The main forms of childhood malnutrition occur predominantly in children malnutrition. Here, we use the term 'severe malnutrition' to describe these conditions to better reflect the contributions of chronic poverty, poor living conditions with pervasive deficits in sanitation and hygiene, a high prevalence of infectious diseases and environmental insults, food insecurity, poor maternal and fetal nutritional status and suboptimal nutritional intake in infancy and early childhood. Children with severe malnutrition have an increased risk of serious illness and death, primarily from acute infectious diseases. International growth standards are used for the diagnosis of severe malnutrition and provide therapeutic end points. The early detection of severe wasting and kwashiorkor and outpatient therapy for these conditions using ready-to-use therapeutic foods form the cornerstone of modern therapy, and only a small percentage of children require inpatient care. However, the normalization of physiological and metabolic functions in children with malnutrition is challenging, and children remain at high risk of relapse and death. Further research is urgently needed to improve our understanding of the pathophysiology of severe malnutrition, especially the mechanisms causing kwashiorkor, and to develop new interventions for prevention and treatment.

  3. [Severe childhood atopic dermatitis].

    Science.gov (United States)

    Mahfoudh, Anis; Zaraa, Inès; Amara, Thouraya; Zribi, Hela; El Euch, Dalenda; Mokni, Mourad; Ben Osman, Amel

    2014-04-01

    Atopic dermatitis (AD) is a chronic relapsing eczematous skin disease. It represents one of the symptoms of atopic diathesis. DA affects usually infants and children. aim : The aim of our study is to draw up the epidemiological, clinical features, treatment and outcome of severe childhood AD through a hospital series. methods: A retrospective study of 24 cases of severe childhood AD hospitalized in the Dermatology Department of La Rabta hospital of Tunis was conducted during a 28 year-period (1981 - 2009). results: The hospital incidence of severe childhood AD was 0,085‰. Patient's mean age at the beginning was 14 months. The sex ratio H/F was 1.66. Cutaneous manifestations occurred preferentially in face (75%). Generalized eczema was observed in 37.5% of cases. Pruritus and xerosis were constant. The mean duration of hospitalization was 11 days. Topical corticosteroids was the most effective method of treating severe DA, associated with antiseptic solutions emollient and antihistaminic drugs. Infectious complications were noted in 50% of cases. Ocular complications were observed in 16.7% of cases. Recurrences were reported in 9 cases. Conclusion :AD is an inflammatory, chronically relapsing, and pruritic skin disorder developing in a xerotic skin. Severe AD in childhood is rare in Tunisia. It requires a good understanding of therapeutic modalities by the patient and his family. It is a cause of important morbidity and it may have a bad impact on quality of life.

  4. Epidemiology of severe sepsis

    Science.gov (United States)

    Mayr, Florian B; Yende, Sachin; Angus, Derek C

    2014-01-01

    Severe sepsis is a leading cause of death in the United States and the most common cause of death among critically ill patients in non-coronary intensive care units (ICU). Respiratory tract infections, particularly pneumonia, are the most common site of infection, and associated with the highest mortality. The type of organism causing severe sepsis is an important determinant of outcome, and gram-positive organisms as a cause of sepsis have increased in frequency over time and are now more common than gram-negative infections. Recent studies suggest that acute infections worsen pre-existing chronic diseases or result in new chronic diseases, leading to poor long-term outcomes in acute illness survivors. People of older age, male gender, black race, and preexisting chronic health conditions are particularly prone to develop severe sepsis; hence prevention strategies should be targeted at these vulnerable populations in future studies. PMID:24335434

  5. Severe Combined Immunodeficiency Disorders.

    Science.gov (United States)

    Chinn, Ivan K; Shearer, William T

    2015-11-01

    Severe combined immunodeficiency disorders represent pediatric emergencies due to absence of adaptive immune responses to infections. The conditions result from either intrinsic defects in T-cell development (ie, severe combined immunodeficiency disease [SCID]) or congenital athymia (eg, complete DiGeorge anomaly). Hematopoietic stem cell transplant provides the only clinically approved cure for SCID, although gene therapy research trials are showing significant promise. For greatest survival, patients should undergo transplant before 3.5 months of age and before the onset of infections. Newborn screening programs have yielded successful early identification and treatment of infants with SCID and congenital athymia in the United States. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Severe malaria in Europe

    DEFF Research Database (Denmark)

    Kurth, Florian; Develoux, Michel; Mechain, Matthieu

    2017-01-01

    BACKGROUND: Malaria remains one of the most serious infections for travellers to tropical countries. Due to the lack of harmonized guidelines a large variety of treatment regimens is used in Europe to treat severe malaria. METHODS: The European Network for Tropical Medicine and Travel Health (Trop......Net) conducted an 8-year, multicentre, observational study to analyse epidemiology, treatment practices and outcomes of severe malaria in its member sites across Europe. Physicians at participating TropNet centres were asked to report pseudonymized retrospective data from all patients treated at their centre...

  7. Severe storms forecast systems

    Science.gov (United States)

    Kaplan, M.; Zack, J.

    1980-01-01

    Two research tasks are described: (1) the improvement and enhancement of an existing mesoscale numerical simulation system, and (2) numerical diagnostic studies associated with an individual case of severe storm development (April 10, 1979 in the Red River Valley of Texas and Oklahoma).

  8. The Severe Cardiorenal Syndrome

    NARCIS (Netherlands)

    Bongartz, L.G.

    2011-01-01

    In this thesis we investigated the interactions between heart and kidneys in disease in a longitudinal and integrative fashion. We developed two different rat models of the Severe Cardiorenal Syndrome and studied the effects of different interventions on progression of cardiorenal failure and on

  9. Dengue and Severe Dengue

    Science.gov (United States)

    ... both human health and the global and national economies. Before 1970, only 9 countries had experienced severe dengue epidemics. The disease is now endemic in more than 100 countries in the WHO regions of Africa, the Americas, the Eastern Mediterranean, South-East Asia ...

  10. Asthma heterogeneity and severity

    OpenAIRE

    Carr, Tara F.; Bleecker, Eugene

    2016-01-01

    Asthma is a common, chronic inflammatory airways disease characterized by a clinical syndrome of bronchial hyperresponsiveness, inflammation, and reversible airflow obstruction. Individuals with asthma can vary widely in clinical presentation, severity, and pathobiology. The incident factors, pathogenesis, prognosis, and treatment of asthma remain incompletely understood. Utilizing measurable characteristics of asthmatic patients, including demographic, physiologic, and biologic markers, can ...

  11. Imitators of severe preeclampsia.

    Science.gov (United States)

    Sibai, Baha M

    2007-04-01

    There are several obstetric, medical, and surgical disorders that share many of the clinical and laboratory findings of patients with severe preeclampsia-hemolysis, elevated liver enzymes, and low platelets syndrome. Imitators of severe preeclampsia-hemolysis, elevated liver enzymes, and low platelets syndrome are life-threatening emergencies that can develop during pregnancy or in the postpartum period. These conditions are associated with high maternal mortality, and survivors may face long-term sequelae. Perinatal mortality and morbidity also remain high in many of these conditions. The pathophysiologic abnormalities in many of these disorders include thrombotic microangiopathy, thrombocytopenia, and hemolytic anemia. Some of these disorders include acute fatty liver of pregnancy, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, and acute exacerbation of systemic lupus erythematosus. Because of the rarity of these conditions during pregnancy and postpartum, the available literature includes only case reports and case series describing these syndromes. Consequently, there are no systematic reviews or randomized trials on these subjects. Differential diagnosis may be difficult due to the overlap of several clinical and laboratory findings of these syndromes. It is important that the clinician make the accurate diagnosis when possible because the management and complications from these syndromes may be different. For example, severe preeclampsia and acute fatty liver of pregnancy are treated by delivery, whereas it is possible to continue pregnancy in those with thrombotic thrombocytopenic purpura-hemolytic uremic syndrome and exacerbation of systemic lupus erythematosus. This review focuses on diagnosis, management, and counseling of women who develop these syndromes based on results of recent studies.

  12. Management of severe hypospadias

    Directory of Open Access Journals (Sweden)

    Massimo Catti

    2008-01-01

    Full Text Available Many classifications of hypospadias have been published, mainly based on the position of the ectopic meatus, which is an insufficient criterion to define the severity of this malformation. What really marks the proximal landmark of this malformation is the level of division of the corpus spongiosum, which is always proximal to the ectopic meatus. In this article, we will focus on the most severe forms of hypospadias which include those with a proximal division of corpus spongiosum (below the midshaft, important chordee and a poor development of the ventral radius, reflecting a marked hypovirilization of the genital tubercle, and cripple hypospadias resulting from several previous failed surgical procedures. The principle of hypospadias surgery will be reviewed together with the outcome of the current surgical techniques. Furthermore, common complications will be outlined. There is no minor or major hypospadias and all forms require a solid experience of the surgeon, as minor looking hypospadias may turn out to be far more complex to repair than they appear once the ventral radius of the penis has been dissected.

  13. Epidemiology of severe trauma.

    Science.gov (United States)

    Alberdi, F; García, I; Atutxa, L; Zabarte, M

    2014-12-01

    Major injury is the sixth leading cause of death worldwide. Among those under 35 years of age, it is the leading cause of death and disability. Traffic accidents alone are the main cause, fundamentally in low- and middle-income countries. Patients over 65 years of age are an increasingly affected group. For similar levels of injury, these patients have twice the mortality rate of young individuals, due to the existence of important comorbidities and associated treatments, and are more likely to die of medical complications late during hospital admission. No worldwide, standardized definitions exist for documenting, reporting and comparing data on severely injured trauma patients. The most common trauma scores are the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS) and the Trauma and Injury severity Score (TRISS). Documenting the burden of injury also requires evaluation of the impact of post-trauma impairments, disabilities and handicaps. Trauma epidemiology helps define health service and research priorities, contributes to identify disadvantaged groups, and also facilitates the elaboration of comparable measures for outcome predictions. Copyright © 2014 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  14. Management of severe accidents

    International Nuclear Information System (INIS)

    Jankowski, M.W.

    1987-01-01

    The definition and the multidimensionality aspects of accident management have been reviewed. The suggested elements in the development of a programme for severe accident management have been identified and discussed. The strategies concentrate on the two tiered approaches. Operative management utilizes the plant's equipment and operators capabilities. The recovery managment concevtrates on preserving the containment, or delaying its failure, inhibiting the release, and on strategies once there has been a release. The inspiration for this paper was an excellent overview report on perspectives on managing severe accidents in commercial nuclear power plants and extending plant operating procedures into the severe accident regime; and by the most recent publication of the International Nuclear Safety Advisory Group (INSAG) considering the question of risk reduction and source term reduction through accident prevention, management and mitigation. The latter document concludes that 'active development of accident management measures by plant personnel can lead to very large reductions in source terms and risk', and goes further in considering and formulating the key issue: 'The most fruitful path to follow in reducing risk even further is through the planning of accident management.' (author)

  15. Preparedness for severe malaria.

    Science.gov (United States)

    Heggheim, Åsmund; Blomberg, Bjørn; Mørch, Kristine

    2015-03-24

    About 60 patients with malaria are admitted to Norwegian hospitals every year. The prescription figures for malaria medication may suggest that Norwegians are increasingly exposed to malaria infection. All Norwegian hospitals with a department of internal medicine were sent an electronic questionnaire for reporting the available methods for diagnosing and treating malaria. There was a 100% response (48/48). Microscopy for malaria diagnosis was available at 92% (44/48) and a rapid test for detecting malaria antigen at 67% (32/48), while 6% (3/48) had no malaria detection test available. Artesunate and quinine for intravenous treatment were both available at 6% (3/48), only artesunate at 27% (13/48) and only quinine at 27% (13/48) of the hospitals. Drugs for intravenous treatment of severe malaria were not available at 40% (19/48) of the hospitals. More than a third of Norwegian hospitals lack preparedness for treating severe malaria, and some hospitals lack diagnostic procedures. Severe malaria is a condition that may rapidly become life-threatening and is treated with artesunate or quinine intravenously. All Norwegian hospitals should have procedures for emergency treatment of the disease.

  16. Management of severe accidents

    International Nuclear Information System (INIS)

    Jankowski, M.W.

    1988-01-01

    The definition and the multidimensionality aspects of accident management have been reviewed. The suggested elements in the development of a programme for severe accident management have been identified and discussed. The strategies concentrate on the two tiered approaches. Operative management utilizes the plant's equipment and operators capabilities. The recovery management concentrates on preserving the containment, or delaying its failure, inhibiting the release, and on strategies once there has been a release. The inspiration for this paper was an excellent overview report on perspectives on managing severe accidents in commercial nuclear power plants and extending plant operating procedures into the severe accident regime; and by the most recent publication of the International Nuclear Safety Advisory Group (INSAG) considering the question of risk reduction and source term reduction through accident prevention, management and mitigation. The latter document concludes that active development of accident management measures by plant personnel can lead to very large reductions in source terms and risk, and goes further in considering and formulating the key issue: The most fruitful path to follow in reducing risk even further is through the planning of accident management

  17. Several real variables

    CERN Document Server

    Kantorovitz, Shmuel

    2016-01-01

    This undergraduate textbook is based on lectures given by the author on the differential and integral calculus of functions of several real variables. The book has a modern approach and includes topics such as: •The p-norms on vector space and their equivalence •The Weierstrass and Stone-Weierstrass approximation theorems •The differential as a linear functional; Jacobians, Hessians, and Taylor's theorem in several variables •The Implicit Function Theorem for a system of equations, proved via Banach’s Fixed Point Theorem •Applications to Ordinary Differential Equations •Line integrals and an introduction to surface integrals This book features numerous examples, detailed proofs, as well as exercises at the end of sections. Many of the exercises have detailed solutions, making the book suitable for self-study. Several Real Variables will be useful for undergraduate students in mathematics who have completed first courses in linear algebra and analysis of one real variable.

  18. Severe service sealing solutions

    International Nuclear Information System (INIS)

    Metcalfe, R.; Wensel, R.

    1994-09-01

    Successful sealing usually requires much more than initial leak-tightness. Friction and wear must also be acceptable, requiring a good understanding of tribology at the sealing interface. This paper describes various sealing solutions for severe service conditions. The CAN2A and CAN8 rotary face seals use tungsten carbide against carbon-graphite to achieve low leakage and long lifetime in nuclear main coolant pumps. The smaller CAN6 seal successfully uses tungsten carbide against silicon carbide in reactor water cleanup pump service. Where friction in CANDU fuelling machine rams must be essentially zero, a hydrostatic seal using two silicon carbide faces is the solution. In the NRU reactor moderator pumps, where pressure is much lower, eccentric seals that prevent boiling at the seal faces are giving excellent service. All these rotary face seals rely on supplementary elastomer seals between their parts. An integrated engineering approach to high performance sealing with O-rings is described. This is epitomized in critical Space Shuttle applications, but is increasingly being applied in CANDU plants. It includes gland design, selection and qualification of material, quality assurance, detection of defects and the effects of lubrication, surface finish, squeeze, stretch and volume constraints. In conclusion, for the severe service applications described, customized solutions have more than paid for themselves by higher reliability, lower maintenance requirements and reduced outage time. (author)

  19. Several crimes solved

    CERN Document Server

    Relations with the Host States Service

    2007-01-01

    A member of a contractor's personnel suspected of having committed several thefts in and around Building 180 has recently been questioned by the French police. He was immediately tried by the court in Bourg-en-Bresse and sentenced to six months in prison, with a requirement to serve at least three months. His arrest was facilitated, among other things, by a video recording, fast and detailed statements to the CERN Fire Brigade and close collaboration between the members of the personnel concerned, the Reception and Access Control Service and the police. Several laptops and other items of electronic equipment were seized during a search of the culprit's home. A stolen digital camera has yet to be returned to its owner as he has not reported the theft to the CERN Fire Brigade and the police. The person concerned is therefore requested to go to the Gendarmerie in Saint-Genis-Pouilly with the necessary proof of ownership. In addition, the French authorities have informed CERN that the presumed authors of the a...

  20. One reason, several logics

    Directory of Open Access Journals (Sweden)

    Evandro Agazzi

    2011-06-01

    Full Text Available Humans have used arguments for defending or refuting statements long before the creation of logic as a specialized discipline. This can be interpreted as the fact that an intuitive notion of "logical consequence" or a psychic disposition to articulate reasoning according to this pattern is present in common sense, and logic simply aims at describing and codifying the features of this spontaneous capacity of human reason. It is well known, however, that several arguments easily accepted by common sense are actually "logical fallacies", and this indicates that logic is not just a descriptive, but also a prescriptive or normative enterprise, in which the notion of logical consequence is defined in a precise way and then certain rules are established in order to maintain the discourse in keeping with this notion. Yet in the justification of the correctness and adequacy of these rules commonsense reasoning must necessarily be used, and in such a way its foundational role is recognized. Moreover, it remains also true that several branches and forms of logic have been elaborated precisely in order to reflect the structural features of correct argument used in different fields of human reasoning and yet insufficiently mirrored by the most familiar logical formalisms.

  1. Artemether for severe malaria.

    Science.gov (United States)

    Esu, Ekpereonne; Effa, Emmanuel E; Opie, Oko N; Uwaoma, Amirahobu; Meremikwu, Martin M

    2014-09-11

    In 2011 the World Health Organization (WHO) recommended parenteral artesunate in preference to quinine as first-line treatment for people with severe malaria. Prior to this recommendation, many countries, particularly in Africa, had begun to use artemether, an alternative artemisinin derivative. This review evaluates intramuscular artemether compared with both quinine and artesunate. To assess the efficacy and safety of intramuscular artemether versus any other parenteral medication in treating severe malaria in adults and children. We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE and LILACS, ISI Web of Science, conference proceedings and reference lists of articles. We also searched the WHO clinical trial registry platform, ClinicalTrials.gov and the metaRegister of Controlled Trials (mRCT) for ongoing trials up to 9 April 2014. Randomized controlled trials (RCTs) comparing intramuscular artemether with intravenous or intramuscular antimalarial for treating severe malaria. The primary outcome was all-cause death.Two authors independently assessed trial eligibility, risk of bias and extracted data. We summarized dichotomous outcomes using risk ratios (RR) and continuous outcomes using mean differences (MD), and presented both measures with 95% confidence intervals (CI). Where appropriate, we combined data in meta-analyses and assessed the quality of the evidence using the GRADE approach. We included 18 RCTs, enrolling 2662 adults and children with severe malaria, carried out in Africa (11) and in Asia (7). Artemether versus quinine For children in Africa, there is probably little or no difference in the risk of death between intramuscular artemether and quinine (RR 0.96, 95% CI 0.76 to 1.20; 12 trials, 1447 participants, moderate quality evidence). Coma recovery may be about five hours shorter with artemether (MD -5.45, 95% CI -7.90 to -3.00; six trials, 358 participants, low quality evidence

  2. Measurement by phase severance

    International Nuclear Information System (INIS)

    Noyes, H.P.

    1987-03-01

    It is claimed that the measurement process is more accurately described by ''quasi-local phase severance'' than by ''wave function collapse''. The approach starts from the observation that the usual route to quantum mechanics starting from the Hamilton-Jacobi equations throws away half the degrees of freedom, namely, the classical initial state parameters. To overcome this difficulty, the full set of Hamilton-Jacobi equations is interpreted as operator equations acting on a state vector. The measurement theory presented is based on the conventional S-matrix boundary condition of N/sub A/ free particles in the distant past and N/sub B/ free particles in the distant future and taking the usual free particle wave functions, multiplied by phase factors

  3. LEAD SEVERING CONTRIVANCE

    Science.gov (United States)

    Widmaier, W.

    1958-04-01

    A means for breaking an electrical circuit within an electronic tube during the process of manufacture is described. Frequently such circuits must be employed for gettering or vapor coating purposes, however, since an external pair of corector pins having no use after manufacture, is undesirable, this invention permits the use of existing leads to form a temporary circuit during manufacture, and severing it thereafter. One portion of the temporary circuit, made from a springy material such as tungsten, is spot welded to a fusable member. To cut the circuit an external radiant heat source melts the fusable member, allowing the tensed tungsten spring to contract and break the circuit. This inexpensive arrangement is particularly useful when the tube has a great many external leads crowded into the tube base.

  4. Several Mediological Principles

    Directory of Open Access Journals (Sweden)

    Alexandra Crăciun

    2011-01-01

    Full Text Available The article presents several new perspectives on the contemporary civilization provided by means of a new discipline entitled “Mediology”. This new science that the French professor Regis Debray proposes presents the characteristics of the contemporary society in relation to models of some previous stages. This article proposes a critical perspective on the model proposed by Regis Debray as compared to other sources envisaging the analysis of the evolution of the cultural models in time, such as, for instance, the perspective proposed by Giambattista Vico on the evolution of the linguistic and cultural codes. The aim of the article is that of providing an integrated perspective, allowing a better understanding of the changes underlying the informational society.

  5. Severe Measles Infection

    Science.gov (United States)

    Rafat, Cédric; Klouche, Kada; Ricard, Jean-Damien; Messika, Jonathan; Roch, Antoine; Machado, Sonia; Sonneville, Romain; Guisset, Olivier; Pujol, Wilfried; Guérin, Claude; Teboul, Jean-Louis; Mrozek, Natacha; Darmon, Michaël; Chemouni, Frank; Schmidt, Matthieu; Mercier, Emmanuelle; Dreyfuss, Didier

    2013-01-01

    Abstract France has recently witnessed a nationwide outbreak of measles. Data on severe forms of measles in adults are lacking. We sought to describe the epidemiologic, clinical, treatment, and prognostic aspects of the disease in adult patients who required admission to an intensive care unit (ICU). We performed a retrospective analysis of a cohort of 36 adults admitted to a total of 64 ICUs throughout France for complications of measles from January 1, 2009, to December 31, 2011. All cases of measles were confirmed by serologic testing and/or reverse transcription polymerase chain reaction. The cohort consisted of 21 male and 15 female patients, with a median age of 29.2 years (25th–75th interquartile range [IQR], 27.2–34.2 yr) and a median Simplified Acute Physiology Score (SAPS II) of 13 (IQR, 9–18). Among the 26 patients whose measles vaccination status was documented, none had received 2 injections. One patient had developed measles during childhood. Underlying comorbid conditions included chronic respiratory disease in 9 patients, immunosuppression in 7 patients, and obesity in 3 patients, while measles affected 5 pregnant women. Respiratory complications induced by measles infection led to ICU admission in 32 cases, and measles-related neurologic complications led to ICU admission in 2 cases. Two patients were admitted due to concurrent respiratory and neurologic complications. Bacterial superinfection of measles-related airway infection was suspected in 28 patients and was documented in 8. Four cases of community-acquired pneumonia, 6 cases of ventilator-associated pneumonia, 1 case of tracheobronchitis, and 2 cases of sinusitis were microbiologically substantiated. Of 11 patients who required mechanical ventilation, 9 developed acute respiratory distress syndrome (ARDS). Among the patients with ARDS, extraalveolar air leak complications occurred in 4 cases. Five patients died, all of whom were severely immunocompromised. On follow-up, 1 patient had

  6. Nutrition in Severe Dementia

    Directory of Open Access Journals (Sweden)

    Glaucia Akiko Kamikado Pivi

    2012-01-01

    Full Text Available An increasing proportion of older adults with Alzheimer's disease or other dementias are now surviving to more advanced stages of the illness. Advanced dementia is associated with feeding problems, including difficulty in swallowing and respiratory diseases. Patients become incompetent to make decisions. As a result, complex situations may arise in which physicians and families decide whether artificial nutrition and hydration (ANH is likely to be beneficial for the patient. The objective of this paper is to present methods for evaluating the nutritional status of patients with severe dementia as well as measures for the treatment of nutritional disorders, the use of vitamin and mineral supplementation, and indications for ANH and pharmacological therapy.

  7. Severe limb ischemia syndrome.

    Science.gov (United States)

    Suchý, T

    1991-01-01

    In the course of the study of the syndrome of severe limb ischemia (SLI) in a representative clinical material of 300 patients and a number of experimental studies, we arrived to the proposal of this optimal methodical procedure for acute vascular closures of traumatic and non-traumatic origin in the limbs: a) In every injury and sudden pain with a change of the function of the limb, it is necessary to think of the SLI syndrome and to search targetedly for it. b) In injuries connected with bleeding our first-rate task is the control of this bleeding. For a temporary arrest of the bleeding it is necessary to prefer more physiological methods sparing collateral circulation to the still most used tourniquet. For this purpose a new device for temporary hemostasis called Hemostop has proved itself, designed by the author and attested both experimentally and clinically, protected as a Czechoslovak patent. From surgical measures have acquitted themselves from this viewpoint the insertion of vascular clamp, ligature of the vessel or its temporary cannulation. c) To set the diagnosis of SLI, it usually suffices a careful anamnesis and clinical examination, advantageous is the investigation by ultrasound. The angiography because of time consumption should be used only in indicated cases. d) The time factor--"race against the time"--has to be always borne on our mind. It is necessary to achieve the recovery of blood circulation in the limb up to 6 or at the latest up to 10 hours from the onset of injury or closure. e) For shortening of the period of tissue hypoxia it is of advantage to use the temporary cannulation of injured vessels. This should be used always, whenever because of any reasons, it is not possible to execute the final reconstructive operation up to 10 hours since the injury, e. g. in polytraumatism, transport difficulties and the like. f) In isolated vascular injuries without bleeding (about 45%) and in all non-traumatic SLI the patients must be efficiently

  8. [New populations at increased cardiovascular risk: Cardiovascular disease in dermatological diseases].

    Science.gov (United States)

    Godoy-Gijón, Elena; Meseguer-Yebra, Carmen; Palacio-Aller, Lucía; Godoy-Rocati, Diego Vicente; Lahoz-Rallo, Carlos

    2016-01-01

    The increased cardiovascular risk in some dermatological diseases has been demonstrated in recent decades. Diseases such as psoriasis and systemic lupus erythematosus are currently included in the guidelines for prevention of cardiovascular disease. Other diseases such as androgenic alopecia, polycystic ovary syndrome, hidradenitis suppurativa or lichen planus have numerous studies that point to an increased risk, however, they have not been included in these guidelines. In this article we review the evidence supporting this association, in order to alert the clinician to the need for greater control in cardiovascular risk factors in these patients. Copyright © 2015 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  9. St Anne's Private Nursing Home, Sonnagh, Charlestown, Mayo.

    LENUS (Irish Health Repository)

    Kirthi, S

    2017-09-01

    Hidradenitis Suppurativa (HS) is characterized by chronic recurrent abscesses, nodules and draining sinus tracts with scar formation. Cutaneous Crohn’s Disease (CD) may also present similarly. We wished to identify and describe an Irish cohort with combined HS and CD, with a view to a better recognition of clinical manifestations and understanding of the pathophysiology underlying these two overlapping conditions. Cases were identified using the HIPE Code at Tallaght Hospital from 1990-2014 and retrospective review was performed. Seven patients with both HS and CD were identified, 5(71%) female. The median age of diagnosis with both conditions was 37 years. In all cases, CD had preceded the diagnosis of HS. All patients smoked. Six had an increased BMI and 43% had additional autoimmune conditions. All patients required treatment with a TNF-alpha inhibitor for HS with 5 of 6 subjects having reduced frequency of flare ups and clinically less active HS on follow up

  10. Smoking and skin disease

    DEFF Research Database (Denmark)

    Thomsen, S F; Sørensen, L T

    2010-01-01

    suggest that tobacco smoking is a contributing factor in systemic lupus erythematosus, psoriasis, palmoplantar pustulosis, cutaneous squamous cell carcinoma, hidradenitis suppurativa, and genital warts. In contrast, smoking may confer some protective effects and mitigate other skin diseases, notably......Tobacco smoking is a serious and preventable health hazard that can cause or exacerbate a number of diseases and shorten life expectancy, but the role of smoking as an etiologic factor in the development of skin disease is largely unknown. Although epidemiological evidence is sparse, findings...... pemphigus vulgaris, pyoderma gangrenosum, aphthous ulcers, and Behçet's disease. Various degenerative dermatologic conditions are also impacted by smoking, such as skin wrinkling and dysregulated wound healing, which can result in post-surgical complications and delayed or even arrested healing of chronic...

  11. Smoking and skin disease

    DEFF Research Database (Denmark)

    Thomsen, S F; Sørensen, L T

    2010-01-01

    Tobacco smoking is a serious and preventable health hazard that can cause or exacerbate a number of diseases and shorten life expectancy, but the role of smoking as an etiologic factor in the development of skin disease is largely unknown. Although epidemiological evidence is sparse, findings...... suggest that tobacco smoking is a contributing factor in systemic lupus erythematosus, psoriasis, palmoplantar pustulosis, cutaneous squamous cell carcinoma, hidradenitis suppurativa, and genital warts. In contrast, smoking may confer some protective effects and mitigate other skin diseases, notably...... pemphigus vulgaris, pyoderma gangrenosum, aphthous ulcers, and Behçet's disease. Various degenerative dermatologic conditions are also impacted by smoking, such as skin wrinkling and dysregulated wound healing, which can result in post-surgical complications and delayed or even arrested healing of chronic...

  12. Severe Weather Data Inventory (SWDI)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Severe Weather Data Inventory (SWDI) is an integrated database of severe weather records for the United States. SWDI enables a user to search through a variety...

  13. Severe rosacea: A case report

    Directory of Open Access Journals (Sweden)

    Ebrahim Shirzadeh

    2017-01-01

    Conclusion: Rosacea can be extremely severe and disfiguring, and it can be misdiagnosed as the pathognomonic butterfly rash of LE. Demodex carriage in rosacea is consistent and may play a significant role in the severe forms.

  14. Severe Weather Forecast Decision Aid

    Science.gov (United States)

    Bauman, William H., III; Wheeler, Mark M.; Short, David A.

    2005-01-01

    This report presents a 15-year climatological study of severe weather events and related severe weather atmospheric parameters. Data sources included local forecast rules, archived sounding data, Cloud-to-Ground Lightning Surveillance System (CGLSS) data, surface and upper air maps, and two severe weather event databases covering east-central Florida. The local forecast rules were used to set threat assessment thresholds for stability parameters that were derived from the sounding data. The severe weather events databases were used to identify days with reported severe weather and the CGLSS data was used to differentiate between lightning and non-lightning days. These data sets provided the foundation for analyzing the stability parameters and synoptic patterns that were used to develop an objective tool to aid in forecasting severe weather events. The period of record for the analysis was May - September, 1989 - 2003. The results indicate that there are certain synoptic patterns more prevalent on days with severe weather and some of the stability parameters are better predictors of severe weather days based on locally tuned threat values. The results also revealed the stability parameters that did not display any skill related to severe weather days. An interactive web-based Severe Weather Decision Aid was developed to assist the duty forecaster by providing a level of objective guidance based on the analysis of the stability parameters, CGLSS data, and synoptic-scale dynamics. The tool will be tested and evaluated during the 2005 warm season.

  15. Chronic obstructive pulmonary disease severity is associated with severe pneumonia

    Directory of Open Access Journals (Sweden)

    Jung Seop Eom

    2015-01-01

    Full Text Available CONTEXT: Chronic obstructive pulmonary disease (COPD is a heterogeneous disorder, and various aspects of COPD may be associated with the severity of pneumonia in such patients. AIMS: We examined the risk factors associated with severe pneumonia in a COPD population. MATERIALS AND METHODS: We performed a retrospective observational study using a prospectively collected database of pneumonia patients who were admitted to our hospital through emergency department between 2008 and 2012. Patients with hospital-acquired pneumonia and those with an immunocompromised status were excluded. RESULTS: Of 148 pneumonia patients with COPD for whom chest computed tomography (CT scans were available, 106 (71.6% and 42 (28.4% were classified as non-severe and severe pneumonia, respectively. Multivariate logistic regression analysis revealed that the severity of airflow limitation [odds ratio (OR, 2.751; 95% confidence interval (CI, 1.074-7.050; P = 0.035] and the presence of emphysema on a chest CT scan (OR, 3.366; 95% CI, 1.104-10.265; P = 0.033 were independently associated with severe pneumonia in patients with COPD. CONCLUSIONS: The severity of COPD including the airflow limitation grade and the presence of pulmonary emphysema were independently associated with the development of severe pneumonia.

  16. Current concepts of severe asthma

    Science.gov (United States)

    Raundhal, Mahesh; Oriss, Timothy B.; Ray, Prabir; Wenzel, Sally E.

    2016-01-01

    The term asthma encompasses a disease spectrum with mild to very severe disease phenotypes whose traditional common characteristic is reversible airflow limitation. Unlike milder disease, severe asthma is poorly controlled by the current standard of care. Ongoing studies using advanced molecular and immunological tools along with improved clinical classification show that severe asthma does not identify a specific patient phenotype, but rather includes patients with constant medical needs, whose pathobiologic and clinical characteristics vary widely. Accordingly, in recent clinical trials, therapies guided by specific patient characteristics have had better outcomes than previous therapies directed to any subject with a diagnosis of severe asthma. However, there are still significant gaps in our understanding of the full scope of this disease that hinder the development of effective treatments for all severe asthmatics. In this Review, we discuss our current state of knowledge regarding severe asthma, highlighting different molecular and immunological pathways that can be targeted for future therapeutic development. PMID:27367183

  17. Accident management for severe accidents

    International Nuclear Information System (INIS)

    Bari, R.A.; Pratt, W.T.; Lehner, J.; Leonard, M.; Disalvo, R.; Sheron, B.

    1988-01-01

    The management of severe accidents in light water reactors is receiving much attention in several countries. The reduction of risk by measures and/or actions that would affect the behavior of a severe accident is discussed. The research program that is being conducted by the US Nuclear Regulatory Commission focuses on both in-vessel accident management and containment and release accident management. The key issues and approaches taken in this program are summarized. 6 refs

  18. Probiotics and Severe Acute Pancreatitis

    OpenAIRE

    Raffaele Pezzilli; Lorenzo Fantini

    2006-01-01

    Severe acute pancreatitis is frequently associated with necrosis of the gland, and the principal late complication is infection of the necrosis. The gut barrier plays an important role in severe acute pancreatitis; in fact, gut barrier integrity prevents bacteria translocation resulting from an atrophic and leaky gut, and reduces the systemic inflammatory syndrome of the pancreatitis from gut atrophy. The maintenance of gut barrier integrity is one of the goals in the treatment of severe acut...

  19. Psychological Impact of Severe Obesity.

    Science.gov (United States)

    Collins, Jennifer; Meng, Chelsea; Eng, Anna

    2016-12-01

    The causes of severe obesity are multifactorial and include metabolic, dietary, physical, and psychological aspects. Additionally, the impact of severe obesity affects more than one's physical health. This article attempts to explore the psychological impact of severe obesity specifically in the areas of mood, eating disorders, sleep disturbance, chronic pain, and quality of life. Additionally, obesity treatment options of lifestyle modification and bariatric surgery that include psychological assessment and/or cognitive behavioral intervention are discussed.

  20. Statistics of severe tornadoes and severe tornado outbreaks

    Directory of Open Access Journals (Sweden)

    B. D. Malamud

    2012-09-01

    Full Text Available The standard measures of the intensity of a tornado in the USA and many other countries are the Fujita and Enhanced Fujita scales. These scales are based on the damage that a tornado causes. Another measure of the strength of a tornado is its path length of touchdown, L. In this study we consider severe tornadoes, which we define as L≥10 km, in the continental USA (USA Storm Prediction Center Severe Weather Database. We find that for the period 1982–2011, for individual severe tornadoes (L≥10 km: (i There is a strong linear scaling between the number of severe tornadoes in a year and their total path length in that year. (ii The cumulative frequency path length data suggests that, not taking into account any changing trends over time, we would expect in a given year (on average one severe tornado with a path length L≥115 km and in a decade (on average one severe tornado with a path length L≥215 km. (iii The noncumulative frequency-length statistics of severe tornado touchdown path lengths, 20<L<200 km, is well approximated by an inverse power-law relationship with exponent near 3. We then take the total path length of severe tornadoes in a convective day (12:00–12:00 UTC, LD, as a measure of the strength of a 24-h USA tornado outbreak. We find that: (i For 1982–2011, the number of severe tornadoes in a USA convective day outbreak has a strong power-law relationship (exponent 0.80 on the convective day total path length, LD. (ii For 1952–2011, the cumulative frequency path length data for severe tornado outbreaks suggests that we would expect in a given year (on average one daily severe tornado outbreak with total path length LD≥480 km and in a decade (on average one daily severe tornado outbreak with a total path length LD≥1200 km. (iii For 1982–2011, the noncumulative frequency-length statistics of tornado

  1. Severe anemia in Malawian children

    NARCIS (Netherlands)

    Calis, Job Cj; Phiri, Kamija S.; Faragher, E. Brian; Brabin, Bernard J.; Bates, Imelda; Cuevas, Luis E.; de Haan, Rob J.; Phiri, Ajib I.; Malange, Pelani; Khoka, Mirriam; Hulshof, Paul Jm; van Lieshout, Lisette; Beld, Marcel Ghm; teo, Yik Y.; Rockett, Kirk A.; Richardson, Anna; Kwiatkowski, Dominic P.; Molyneux, Malcolm E.; van Hensbroek, Michaël Boele

    2016-01-01

    Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied. We conducted a case-control study of 381 preschool children with severe anemia (hemoglobin concentration, <5.0 g per deciliter) and 757 preschool

  2. Traditional Therapies for Severe Asthma.

    Science.gov (United States)

    Wang, Eileen; Hoyte, Flavia C L

    2016-08-01

    Severe asthma is a complex and heterogeneous disease. The European Respiratory Society and American Thoracic Society guidelines define severe asthma for patients 6 years or older as "asthma which requires treatment with high-dose inhaled corticosteroids…plus a second controller or systemic corticosteroids to prevent it from becoming 'uncontrolled' or which remains 'uncontrolled' despite this therapy." This article reviews available traditional therapies, data behind their uses in severe asthma, and varying recommendations. As various asthma endotypes and phenotypes are better understood and characterized, targeted therapies should help improve disease outcomes, efficacy, and cost-effectiveness. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Severe pulmonary manifestation of leptospirosis.

    Science.gov (United States)

    Helmerhorst, H J F; van Tol, E N; Tuinman, P R; de Vries, P J; Hartskeerl, R A; Grobusch, M P; Hovius, J W

    2012-06-01

    Based on increasing incidence and the occurrence of worldwide outbreaks, leptospirosis is recognised as an emerging zoonosis. Severe manifestations are associated with high morbidity and mortality rates and may therefore pose an important risk to public health, especially in certain high prevalence areas. A considerable number of infections progress to a severe form, which can present as the well-known triad of jaundice, impaired renal function and haemorrhage, known as Weil's disease. The severe pulmonary form of leptospirosis (SPFL) is a less known entity and is characterised by intra-alveolar haemorrhage and can lead to acute respiratory failure and death when adequate treatment fails. Prognostic factors correlating with severity and survival of leptospirosis include indicators of renal failure, pulmonary involvement and electrolyte imbalances. We report an imported case of SPFL in a returning traveller, and review the literature discussing epidemiology, clinical manifestations, prognostic factors and treatment of this resurgent disease.

  4. Runway incursion severity risk analysis.

    Science.gov (United States)

    2012-09-14

    Runway incursions are defined as the unauthorized presence of a vehicle, pedestrian, or aircraft on a runway. Identifying situations or conditions in which runway incursions are more likely to be severe can suggest policy implications and areas for f...

  5. Treatment of severe rheumatoid arthritis

    International Nuclear Information System (INIS)

    Wright, V.

    1986-01-01

    Current practices in treating severe rheumatoid arthritis are reviewed, including remarks on controlled trials of methotrexate, total lymphatic irradiation trials at Stanford and Harvard, and total body irradiation trials. U.K

  6. Severe acute respiratory syndrome (SARS)

    Science.gov (United States)

    ... their fever and other symptoms are gone. Hand hygiene is the most important part of SARS prevention. ... Coronaviruses, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). In: Bennett JE, Dolin ...

  7. Severe metabolic alkalosis in pregnancy

    Science.gov (United States)

    Frise, Charlotte; Noori, Muna

    2013-01-01

    Summary Metabolic alkalosis is uncommon in pregnancy and is most often the result of severe vomiting. If this is present at the time of delivery, transient metabolic derangement in the fetus can occur, potentially requiring additional organ support. A 22-year-old woman is described, who presented at 37 weeks gestation with a severe metabolic alkalosis, vomiting and acute renal and hepatic impairment. The investigations, management options and maternal and fetal outcome are described. PMID:27708709

  8. Severe ASR damaged concrete bridges

    DEFF Research Database (Denmark)

    Antonio Barbosa, Ricardo; Gustenhoff Hansen, Søren

    2015-01-01

    Technical University of Denmark (DTU) and University of Southern Denmark (SDU) have conducted several full-scale experiments with severe ASR deteriorated bridges. This paper presents few and preliminary results from both the shear tests and the measuring of the material properties. The shear test...... show that the shear capacity is almost unaffected of ASR despite significant reduction in compressive concrete strength. Furthermore, measurements show a significant tensile reinforcement strain developed due to ASR expansion....

  9. Bronchial thermoplasty for severe asthma.

    Science.gov (United States)

    Thomson, Neil C; Bicknell, Stephen; Chaudhuri, Rekha

    2012-06-01

    Bronchial thermoplasty, which involves the delivery of radio frequency energy to the airways to reduce airway smooth muscle mass, has been recently introduced for the treatment of severe asthma. This review summarizes the preclinical development, efficacy and adverse effects of bronchial thermoplasty. In addition, the potential mechanisms of action and place in management of severe asthma are discussed. The efficacy and adverse profile of bronchial thermoplasty has been assessed in three randomized controlled trials, the first two of which showed clinical benefits of bronchial thermoplasty compared with usual care in patients with moderate or severe asthma. The third trial reports the results of a comparison with sham bronchial thermoplasty in 288 adults with severe asthma. Bronchial thermoplasty improved asthma quality of life questionnaire scores compared with sham bronchial thermoplasty; in the posttreatment period, there were fewer severe exacerbations and emergency department visits. Bronchial thermoplasty causes short-term increases in asthma-related morbidity. Follow-up data to date support the long-term safety of the procedure. Bronchial thermoplasty has a role in the management of patients with severe asthma who have uncontrolled symptoms despite current therapies. Future studies need to identify factors that predict a beneficial clinical response.

  10. Severe forms of food allergy.

    Science.gov (United States)

    Sarinho, Emanuel; Lins, Maria das Graças Moura

    To guide the diagnostic and therapeutic management of severe forms of food allergy. Search in the Medline database using the terms "severe food allergy," "anaphylaxis and food allergy," "generalized urticaria and food allergy," and "food protein-induced enterocolitis syndrome" in the last ten years, searching in the title, abstract, or keyword fields. Food allergy can be serious and life-threatening. Milk, eggs, peanuts, nuts, walnuts, wheat, sesame seeds, shrimp, fish, and fruit can precipitate allergic emergencies. The severity of reactions will depend on associated cofactors such as age, drug use at the onset of the reaction, history and persistence of asthma and/or severe allergic rhinitis, history of previous anaphylaxis, exercise, and associated diseases. For generalized urticaria and anaphylaxis, intramuscular epinephrine is the first and fundamental treatment line. For the treatment in acute phase of food-induced enterocolitis syndrome in the emergency setting, prompt hydroelectrolytic replacement, administration of methylprednisolone and ondansetron IV are necessary. It is important to recommend to the patient with food allergy to maintain the exclusion diet, seek specialized follow-up and, in those who have anaphylaxis, to emphasize the need to carry epinephrine. Severe food allergy may occur in the form of anaphylaxis and food-protein-induced enterocolitis syndrome, which are increasingly observed in the pediatric emergency room; hence, pediatricians must be alert so they can provide the immediate diagnosis and treatment. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  11. The treatment of severe malaria.

    Science.gov (United States)

    Dondorp, Arjen M; Day, Nick P J

    2007-07-01

    In the SEAQUAMAT trial, parenteral artesunate was shown to be associated with a considerably lower mortality than quinine, and is now the recommended treatment for severe malaria in low-transmission areas and in the second and third trimesters of pregnancy. A trial is underway to establish its role in African children. The development of artesunate suppositories may provide the means to treat patients with severe disease in remote rural settings, potentially buying the time needed to reach a health care facility. The increasing availability of basic intensive care facilities in developing countries also has the potential to further reduce mortality.

  12. Surgical Management of Severe Epistaxis.

    Science.gov (United States)

    Lin, Giant; Bleier, Benjamin

    2016-06-01

    Many patients with severe epistaxis benefit from endoscopic intervention for control of bleeding. Critical maneuvers to improve endoscopic visualization during surgery include head-of-bed elevation, application of topical vasoconstrictors, and local injection of vasonstrictors. Controlled, hypotensive anesthesia may also decrease intraoperative blood loss and improve visualization during surgery. Intractable posterior epistaxis can be controlled with high rates of success with endoscopic sphenopalatine artery ligation. Although less common, intractable anterior epistaxis may be controlled by anterior ethmoid artery ligation once this artery is identified as the primary source. Less common sources of severe epistaxis are also discussed in this article. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. A retrospective analysis of real-life practice of off-label photodynamic therapy using methyl aminolevulinate (MAL-PDT) in 20 Italian dermatology departments. Part 1: inflammatory and aesthetic indications.

    Science.gov (United States)

    Calzavara-Pinton, Pier Giacomo; Rossi, Maria Teresa; Aronson, Erica; Sala, Raffaella

    2013-01-01

    Experimental investigations have demonstrated that photodynamic therapy (PDT) with methyl aminolevulinate (MAL) may be a useful treatment in several inflammatory skin disorders and aesthetic indications. To assess the effectiveness, tolerability and safety of off-label MAL-PDT in daily clinical practice in 20 Italian hospital centers, a retrospective observational study of medical records of patients treated for off-label inflammatory and aesthetic indications was carried out. In all patients standard treatment options had been either ineffective, unacceptably toxic, or medically contraindicated. Clinical data regarding 221 patients affected by 22 different diseases were collected. The most common off-label indication was acne vulgaris, with >75% improvement in 72.8% of patients. Other disorders of the sebaceous gland, i.e. acne rosacea, hidradenitis suppurativa and sebaceous hyperplasia, were less responsive. Alopecia areata did not show any improvement. Granuloma annulare and necrobiosis lipoidica showed marked or moderate response in the majority of treated patients. The rate of patients with complete remission was lower for inflammatory skin disorders with hyperkeratosis, i.e. psoriasis (6/17) and porokeratosis (3/16). The efficacy for lichenoid dermatoses was dependent on the clinical variant (erosive and scleroatrophic were more responsive than hypertrophic). Only 1 of 6 patients with Zoon balanitis had a marked improvement. MAL-PDT of venous leg ulcers, photo-aging and hypertrophic scars led to a marked remission in 3/5, 3/6 and 5/8 patients, respectively. The treatment had to be interrupted because of strong pain and burning in 24 patients. Long term adverse events were not registered. Most patients with marked improvement had lasting remission with overall excellent cosmetic outcomes. The present findings demonstrate a high interest in off-label uses of MAL-PDT for inflammatory skin disorders. According to the observed clinical responses, safety, and

  14. Severe forms of food allergy

    Directory of Open Access Journals (Sweden)

    Emanuel Sarinho

    2017-11-01

    Conclusion: Severe food allergy may occur in the form of anaphylaxis and food‐protein‐induced enterocolitis syndrome, which are increasingly observed in the pediatric emergency room; hence, pediatricians must be alert so they can provide the immediate diagnosis and treatment.

  15. Severe pulmonary manifestation of leptospirosis

    NARCIS (Netherlands)

    Helmerhorst, H. J. F.; van Tol, E. N.; Tuinman, P. R.; de Vries, P. J.; Hartskeerl, R. A.; Grobusch, M. P.; Hovius, J. W.

    2012-01-01

    Based on increasing incidence and the occurrence of worldwide outbreaks, leptospirosis is recognised as an emerging zoonosis. Severe manifestations are associated with high morbidity and mortality rates and may therefore pose an important risk to public health, especially in certain high prevalence

  16. Nigel: A Severe Auditory Dyslexic

    Science.gov (United States)

    Cotterell, Gill

    1976-01-01

    Reported is the case study of a boy with severe auditory dyslexia who received remedial treatment from the age of four and progressed through courses at a technical college and a 3-year apprenticeship course in mechanics by the age of eighteen. (IM)

  17. Several topics in complex variables

    NARCIS (Netherlands)

    Smit, I.M.

    2015-01-01

    This thesis is based on three articles in the field of Several Complex Variables. The first article, which is joint work with M. El Kadiri, defines and studies the concept of maximality for plurifinely plurisubharmonic functions. Its main result is that a finite plurifinely plurisubharmonic function

  18. Stuttering severity and educational attainment.

    Science.gov (United States)

    O'Brian, Sue; Jones, Mark; Packman, Ann; Menzies, Ross; Onslow, Mark

    2011-06-01

    This study investigated the relationship between self-reported stuttering severity ratings and educational attainment. Participants were 147 adults seeking treatment for stuttering. At pretreatment assessment, each participant reported the highest educational level they had attained and rated their typical and worst stuttering severity on a 9-point scale for a range of speaking situations. These included: (1) talking with a family member, (2) talking with a familiar person, not a family member, (3) talking in a group of people, (4) talking with a stranger, (5) talking with an authority figure such as a work manager or teacher, (6) talking on the telephone, (7) ordering food or drink, and (8) giving their name and address. There was a significant negative relationship between highest educational achievement and mean self-reported stuttering severity rating for the eight situations. Future research is needed to investigate how this result should be addressed in educational institutions. The reader will be able to: (1) describe the negative effects of stuttering through childhood to adulthood; (2) identify some of the negative consequences associated with stuttering on peer and teacher relationships, and academic performance at school; and (3) summarise the relationship between stuttering severity and educational attainment. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. Severe Acute Respiratory Syndrome- SARS

    Indian Academy of Sciences (India)

    Table of contents. Severe Acute Respiratory Syndrome- SARS · PowerPoint Presentation · Slide 3 · Global pattern of SARS epidemic · Slide 5 · SARS – clinical features · Radiological features of lungs-showing progression of disease · cT Scan of SARS lungs · Imaging type,cost,therapy · SARS – Lung Pathology.

  20. Management of severe acute malnutrition

    African Journals Online (AJOL)

    should be considered.[4,8,15,17,26]. Provide sensory stimulation, emotional support and follow-up after recovery. In severe malnutrition, there is delayed mental and behavioural development. A cheerful and stimulating environment should be provided for the patient, with provision of structured play therapy for 30 minutes ...

  1. Pseudohypoparathyroidism presenting as severe Parkinsonism.

    OpenAIRE

    Pearson, D. W.; Durward, W. F.; Fogelman, I.; Boyle, I. T.; Beastall, G.

    1981-01-01

    A case of pseudohypoparathyroidism in a middle-aged female presenting with severe Parkinsonism is reported. Correction of serum calcium led to marked clinical improvement suggesting that symptoms and signs were exacerbated by hypocalcaemia and tetanic spasm. Calcification of the basal ganglia was not detected on skull X-ray but was revealed by computerized axial tomography.

  2. Positive lightning and severe weather

    Science.gov (United States)

    Price, C.; Murphy, B.

    2003-04-01

    In recent years researchers have noticed that severe weather (tornados, hail and damaging winds) are closely related to the amount of positive lightning occurring in thunderstorms. On 4 July 1999, a severe derecho (wind storm) caused extensive damage to forested regions along the United States/Canada border, west of Lake Superior. There were 665,000 acres of forest destroyed in the Boundary Waters Canoe Area Wilderness (BWCAW) in Minnesota and Quetico Provincial Park in Canada, with approximately 12.5 million trees blown down. This storm resulted in additional severe weather before and after the occurrence of the derecho, with continuous cloud-to-ground (CG) lightning occurring for more than 34 hours during its path across North America. At the time of the derecho the percentage of positive cloud-to-ground (+CG) lightning measured by the Canadian Lightning Detection Network (CLDN) was greater than 70% for more than three hours, with peak values reaching 97% positive CG lightning. Such high ratios of +CG are rare, and may be useful indicators for short-term forecasts of severe weather.

  3. Severe thunderstorms and climate change

    Science.gov (United States)

    Brooks, H. E.

    2013-04-01

    As the planet warms, it is important to consider possible impacts of climate change on severe thunderstorms and tornadoes. To further that discussion, the current distribution of severe thunderstorms as a function of large-scale environmental conditions is presented. Severe thunderstorms are much more likely to form in environments with large values of convective available potential energy (CAPE) and deep-tropospheric wind shear. Tornadoes and large hail are preferred in high-shear environments and non-tornadic wind events in low shear. Further, the intensity of tornadoes and hail, given that they occur, tends to be almost entirely a function of the shear and only weakly depends on the thermodynamics. Climate model simulations suggest that CAPE will increase in the future and the wind shear will decrease. Detailed analysis has suggested that the CAPE change will lead to more frequent environments favorable for severe thunderstorms, but the strong dependence on shear for tornadoes, particularly the strongest ones, and hail means that the interpretation of how individual hazards will change is open to question. The recent development of techniques to use higher-resolution models to estimate the occurrence of storms of various kinds is discussed. Given the large interannual variability in environments and occurrence of events, caution is urged in interpreting the observational record as evidence of climate change.

  4. Bioimpedance in Severely Malnourished Children

    DEFF Research Database (Denmark)

    Girma Nigatu, Tsinuel

    Worldwide severe acute malnutrition (SAM) affects millions of children and considerably contributes to under-five mortality, mainly in low-income settings. Among children with SAM, deaths occur largely in those with oedema and during early phase of treatment often aggravated by infection. Treatment...

  5. Stuttering Severity and Educational Attainment

    Science.gov (United States)

    O'Brian, Sue; Jones, Mark; Packman, Ann; Menzies, Ross; Onslow, Mark

    2011-01-01

    Purpose: This study investigated the relationship between self-reported stuttering severity ratings and educational attainment. Method: Participants were 147 adults seeking treatment for stuttering. At pretreatment assessment, each participant reported the highest educational level they had attained and rated their typical and worst stuttering…

  6. Severe combined immune deficiency syndrome

    International Nuclear Information System (INIS)

    Saleem, A.F.; Khawaja, R.D.A.; Shaikh, A.S.; Ali, S.A.; Zaidi, A.K.M.

    2013-01-01

    To determine the clinico-demographic features and laboratory parameters of children with severe combined immunodeficiency (SCID). Study Design: Case series. Place and Duration of Study: Department of Paediatrics and Child Health, the Aga Khan University, Karachi, from July 2006 to July 2011. Methodology: Thirteen infants who were discharged with a diagnosis of SCID were inducted in the study. Their clinicodemographic features and laboratory parameters were determined. Descriptive statistics has been used for computing frequency and percentage. Results: The median age at diagnosis was five months; 5 infants presented within 3 months of life. Three-fourth (77%) were males. Most of the infants were severely malnourished (85%) at the time of presentation. More than two-thirds (69%) were products of consanguineous marriages. All subjects had severe lymphopenia (absolute lymphocyte count (ALC) ranging between 170 – 2280) and low T and B lymphocyte counts. Conclusion: SCID should be considered in infants presenting with severe and recurrent infections. Low ALC (< 2500/mm3), is a reliable diagnostic feature of SCID. These infants should be promptly referred to a facility where stem cell transplant can be done. (author)

  7. Containment severe accident thermohydraulic phenomena

    International Nuclear Information System (INIS)

    Frid, W.

    1991-08-01

    This report describes and discusses the containment accident progression and the important severe accident containment thermohydraulic phenomena. The overall objective of the report is to provide a rather detailed presentation of the present status of phenomenological knowledge, including an account of relevant experimental investigations and to discuss, to some extent, the modelling approach used in the MAAP 3.0 computer code. The MAAP code has been used in Sweden as the main tool in the analysis of severe accidents. The dependence of the containment accident progression and containment phenomena on the initial conditions, which in turn are heavily dependent on the in-vessel accident progression and phenomena as well as associated uncertainties, is emphasized. The report is in three parts dealing with: * Swedish reactor containments, the severe accident mitigation programme in Sweden and containment accident progression in Swedish PWRs and BWRs as predicted by the MAAP 3.0 code. * Key non-energetic ex-vessel phenomena (melt fragmentation in water, melt quenching and coolability, core-concrete interaction and high temperature in containment). * Early containment threats due to energetic events (hydrogen combustion, high pressure melt ejection and direct containment heating, and ex-vessel steam explosions). The report concludes that our understanding of the containment severe accident progression and phenomena has improved very significantly over the parts ten years and, thereby, our ability to assess containment threats, to quantify uncertainties, and to interpret the results of experiments and computer code calculations have also increased. (au)

  8. Severe congenital neutropenia (Kostmann Syndrome)

    African Journals Online (AJOL)

    Severe congenital neutropenia (SCN), Kostmann syndrome is a heterogenous disorder of myelopoiesis characterized by ... in the bone marrow; and associated with serious recurrent bacterial infections from early infancy. Sepsis mortality is ... neutrophil elastase ELA2. Myelodysplastic syndrome and acute myeloid leukemia.

  9. Severe forms of food allergy

    Directory of Open Access Journals (Sweden)

    Emanuel Sarinho

    Full Text Available Abstract Objectives: To guide the diagnostic and therapeutic management of severe forms of food allergy. Data sources: Search in the Medline database using the terms “severe food allergy,” “anaphylaxis and food allergy,” “generalized urticaria and food allergy,” and “food protein-induced enterocolitis syndrome” in the last ten years, searching in the title, abstract, or keyword fields. Summary of data: Food allergy can be serious and life-threatening. Milk, eggs, peanuts, nuts, walnuts, wheat, sesame seeds, shrimp, fish, and fruit can precipitate allergic emergencies. The severity of reactions will depend on associated cofactors such as age, drug use at the onset of the reaction, history and persistence of asthma and/or severe allergic rhinitis, history of previous anaphylaxis, exercise, and associated diseases. For generalized urticaria and anaphylaxis, intramuscular epinephrine is the first and fundamental treatment line. For the treatment in acute phase of food-induced enterocolitis syndrome in the emergency setting, prompt hydroelectrolytic replacement, administration of methylprednisolone and ondansetron IV are necessary. It is important to recommend to the patient with food allergy to maintain the exclusion diet, seek specialized follow-up and, in those who have anaphylaxis, to emphasize the need to carry epinephrine. Conclusion: Severe food allergy may occur in the form of anaphylaxis and food-protein-induced enterocolitis syndrome, which are increasingly observed in the pediatric emergency room; hence, pediatricians must be alert so they can provide the immediate diagnosis and treatment.

  10. Large errors and severe conditions

    CERN Document Server

    Smith, D L; Van Wormer, L A

    2002-01-01

    Physical parameters that can assume real-number values over a continuous range are generally represented by inherently positive random variables. However, if the uncertainties in these parameters are significant (large errors), conventional means of representing and manipulating the associated variables can lead to erroneous results. Instead, all analyses involving them must be conducted in a probabilistic framework. Several issues must be considered: First, non-linear functional relations between primary and derived variables may lead to significant 'error amplification' (severe conditions). Second, the commonly used normal (Gaussian) probability distribution must be replaced by a more appropriate function that avoids the occurrence of negative sampling results. Third, both primary random variables and those derived through well-defined functions must be dealt with entirely in terms of their probability distributions. Parameter 'values' and 'errors' should be interpreted as specific moments of these probabil...

  11. Severe acute malnutrition and infection

    Science.gov (United States)

    Jones, Kelsey D J; Berkley, James A

    2014-01-01

    Severe acute malnutrition (SAM) is associated with increased severity of common infectious diseases, and death amongst children with SAM is almost always as a result of infection. The diagnosis and management of infection are often different in malnourished versus well-nourished children. The objectives of this brief are to outline the evidence underpinning important practical questions relating to the management of infectious diseases in children with SAM and to highlight research gaps. Overall, the evidence base for many aspects covered in this brief is very poor. The brief addresses antimicrobials; antipyretics; tuberculosis; HIV; malaria; pneumonia; diarrhoea; sepsis; measles; urinary tract infection; nosocomial Infections; soil transmitted helminths; skin infections and pharmacology in the context of SAM. The brief is structured into sets of clinical questions, which we hope will maximise the relevance to contemporary practice. PMID:25475887

  12. Midodrine for severe orthostatic hypotension.

    Science.gov (United States)

    2016-05-01

    Midodrine (Bramox-Brancaster Pharma Limited) was authorised in the UK by the Medicines and Healthcare products Regulatory Agency (MHRA) in March 2015 for "the treatment of severe orthostatic hypotension due to autonomic dysfunction in adults when corrective factors have been ruled out and other forms of treatment are inadequate".(1) Previously, midodrine had only been available in the UK as an unlicensed product used on a named-patient basis. It is the first drug to be licensed in the UK for the treatment of orthostatic hypotension. Here we consider the evidence for midodrine in the treatment of severe orthostatic hypotension and how it fits with current management strategies. 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/

  13. Gender differences in addiction severity.

    Science.gov (United States)

    Díaz-Mesa, Eva M; García-Portilla, Paz; Fernández-Artamendi, Sergio; Sáiz, Pilar A; Bobes Bascarán, Teresa; Casares, María José; Fonseca, Eduardo; Al-Halabí, Susana; Bobes, Julio

    2016-06-14

    Gender has been associated with substance use disorders (SUD). However, there are few studies that have evaluated gender differences in a global and a standardized way, and with a large sample of patients with SUD. Our goal is to analyze the role of gender in addiction severity throughout multiple life domains, using the Addiction Severity Index-6 (ASI-6). A naturalistic, multicenter and prospective study was conducted. A total of 221 patients with SUD (80.1% men) were interviewed with the ASI-6. Our results indicate that the Recent Summary Scores (RSSs) of men and women are similar, with the exception of Psychiatric and Partner- Problems, where women showed higher severity (p = .017 and p = .013, respectively). Statistically significant gender differences were found in certain aspects of the ASI-6 domains: men have more problems of physical health, legal issues, and alcohol and other substance use; and woman score higher in problems of mental health, social network, subjective evaluations of SUD consequences, and treatment needs. These results should be taken into account to improve the identification, prevention, and treatment of SUD.

  14. CANDU safety under severe accidents

    International Nuclear Information System (INIS)

    Snell, V.G.; Howieson, J.Q.; Alikhan, S.; Frescura, G.M.; King, F.; Rogers, J.T.; Tamm, H.

    1996-01-01

    The characteristics of the CANDU reactor relevant to severe accidents are set first by the inherent properties of the design, and second by the Canadian safety/licensing approach. The pressure-tube concept allows the separate, low-pressure, heavy-water moderator to act as a backup heat sink even if there is no water in the fuel channels. Should this also fail, the calandria shell itself can contain the debris, with heat being transferred to the water-filled shield tank around the core. Should the severe core damage sequence progress further, the shield tank and the concrete reactor vault significantly delay the challenge to containment. Furthermore, should core melt lead to containment overpressure, the containment behaviour is such that leaks through the concrete containment wall reduce the possibility of catastrophic structural failure. The Canadian licensing philosophy requires that each accident, together with failure of each safety system in turn, be assessed (and specified dose limits met) as part of the design and licensing basis. In response, designers have provided CANDUs with two independent dedicated shutdown systems, and the likelihood of Anticipated Transients Without Scram is negligible. Probabilistic safety assessment studies have been performed on operating CANDU plants, and on the 4 x 880 MW(e) Darlington station now under construction; furthermore a scoping risk assessment has been done for a CANDU 600 plant. They indicate that the summed severe core damage frequency is of the order of 5 x 10 -6 /year. 95 refs, 3 tabs

  15. Bariatric surgery for severe obesity.

    Science.gov (United States)

    Sugerman, H J

    2001-07-01

    Severe obesity is associated with multiple comorbidities and is refractory to dietary management with or without behavioral or drug therapies. There are a number of surgical procedures for the treatment of morbid obesity, including purely gastric restrictive, a combination of malabsorption and gastric restriction or primary malabsorption. The purely gastric restrictive procedures, including vertical banded gastroplasty and laparoscopic adjustable silicone gastric banding, do not provide adequate weight loss. African-American patients do especially poorly after the banding procedure with the loss of only 11% of excess weight in one study. Gastric bypass (GBP) is associated with the loss of 66% of excess weight at 1 to 2 years after surgery, 60% at 5 years and 50% at 10 years. For unknown reasons, African-American patients lose significantly less weight than Caucasians after GBP. There is a risk of micronutrient deficiencies after GBP, including iron deficiency anemia in menstruating women, vitamin B12, and calcium deficiencies. Prophylactic supplementation of these nutrients is necessary. Recurrent vomiting after bariatric surgery may be associated with a severe polyneuropathy and must be aggressively treated with endoscopic dilatation before this complication is allowed to develop. The malabsorptive procedures include the partial biliopancreatic bypass (BPD) and BPD with duodenal switch (BPD/DS). The BPD appears to cause severe protein-calorie malnutrition in American patients; the BPD/DS may be associated with less malnutrition. Weight loss failure after GBP does not respond to tightening a dilated gastrojejunal stoma or reducing the size of the gastric pouch. These patients may require conversion to a malabsorptive distal GBP, similar to the BPD. However, because of the risk of severe protein-calorie malnutrition and calcium deficiency BPD should be reserved for patients with severe obesity comorbidity. The risk of death following bariatric surgery is between 1

  16. Prognosis after severe head injury.

    Science.gov (United States)

    Jennett, B; Teasdale, G; Knill-Jones, R

    1975-01-01

    Prognosis depends on establishing a relationship between the patient's state in the early stages and the ultimate outcome. Both the severity of the initial damage (including early complications) and the degree of recovery need to be defined, but practical and statistical considerations impose a limit on the number of variables which can be manipulated. Variables chosen should be those likely to be relevant, and pilot studies are more reliable than intuition in indicating which items should be included. Data chosen should be of a kind likely to be readily available for most patients and should not therefore depend on complex laboratory investigation. The most reliable indicant of initial severity appears to be the depth and duration of coma or altered consciousness, and a scale has been devised for measuring these. Measures of outcome should include separate assessment of mental and physical disability as well as the overall social consequence of the brain damage. Prognosis should be expressed as the probability (mathematically expressed) that a patient will reach certain defined outcome categories, five of which are recognized in the present study. Predictions should begin only after initial resuscitative measures are complete (say six hours after ictus); they need not be limited to the early stages but can include estimates of the degree of further improvement expected in the light of progress in the early weeks after injuries. New methods of management cannot be critically assessed unless factors influencing prognosis are reliably identified and can be matched in comparative patient groups. An estimate of prognosis is also required for the selection of patients for intensive treatment, both in the acute and in the rehabilitation stage. Without such data there is a tendency to deploy an unduly high proportion of scarce resources on patients who have little prospect of recovery; this may deny the best chance of recovery to patients with severe, but less

  17. Treatment of severe acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Praznik Ivan

    2014-01-01

    Full Text Available Acute pancreatitis is an acute inflammatory process of the pancreas with variable involvement of other regional tissues or other organ systems. The severe form of the disease occurs in 10-20% of cases, and usually requires prolonged hospitalization due to a frequent local and systemic complications. Additionally, considerable mortality despite diagnostic and therapeutic advances, makes this disease a serious health problem nowadays. The aim of this study was to conduct a review of randomized controlled trials to determine differences in the efficiency between standard methods of treatment for severe acute pancreatitis and new treatment ways in terms of decreased mortality. Search of the 'Medline' database of original scientific papers and systematic review articles was made, using a combination of the following keywords: acute pancreatitis, treatment, mortality. In total 914 papers were found, published in the last 13 years; 14 of 64 randomized controlled clinical trials met the selection criteria and were eligible for inclusion. From a total of 16 papers, the conservative treatment was related to 11, which includes some of the new treatment methods, while the effects of new methods of treatment have been the subject of research in the four studies. Combined endoscopic and surgical treatment was applied in only one study. The largest sample of 290 patients was included in the study with platelet activation factor antagonist, while the smallest sample of 22 patients was used in the study that compared total parenteral with enteral nutrition. Continuous regional arterial infusion of protease inhibitors in combination with antibiotics, intravenous supplementation of alanyl-glutamine dipeptide and the early, high-volume continuous veno-venous hemofiltration showed the best results in the treatment of patients with severe acute pancreatitis. Also, the use of low molecular weight heparin and enteral nutrition significantly reduced mortality.

  18. SEVERAL MEASURES OF BUDGETARY POLICY

    Directory of Open Access Journals (Sweden)

    Ioan Dan Morar

    2012-12-01

    Full Text Available Budget policy for the funding and sometimes care about the public sector, certain actions and utilities on the private sector within limits set by the strategies, tactics and operational deciyiile promoted executive. Phenomenon budget includes both revenues and expenditure side edge contained in the public budget. Often, perhaps excessive zeal in translating domain-specific phrases are even officially speak about "fiscal policy measures", with reference to all areas of the budget, containing and thus the budget expenditure. Budgetary policy has several specific policy budget subdomains like Cookie fiscal policy, budget expenditure allocation Polti, policy and public loans.

  19. Severe hyponatremia associated with escitalopram

    Directory of Open Access Journals (Sweden)

    Gautam Rawal

    2017-01-01

    Full Text Available Hyponatremia is a rare but potentially fatal complication of selective serotonin reuptake inhibitor (SSRI therapy with only limited cases of escitalopram as the causative drug. We report the case of a 54-year-old hypertensive female who was admitted to the hospital with seizure episode and subsequently diagnosed to have severe hyponatremia due to SSRI-induced syndrome of inappropriate antidiuretic hormone (SIADH with the cause attributed to the short history of intake of escitalopram for depression. All SSRIs, including escitalopram, can cause SIADH and should be used with caution in the depressive patients with regular monitoring of electrolytes, especially in the elderly.

  20. Pneumothorax in severe thoracic traumas

    International Nuclear Information System (INIS)

    Camassa, N.W.; Boccuzzi, F.; Diettorre, E.; Troilo, A.

    1988-01-01

    The authors reviewed CT scans and supine chest X-ray of 47 patients affected by severe thoracic trauma, examined in 1985-86. The sensibility of the two methodologies in the assessment of pneumothorax was compared. CT detected 25 pneumothorax, whereas supine chest X-ray allowed a diagnosis in 18 cases only. In 8 of the latter (44.4%) the diagnosis was made possible by the presence of indirect signs of pneumothorax only - the most frequent being the deep sulcus sign. The characterization of pneumothorax is important especially in the patients who need to be treated with mechanical ventilation therapy, or who are to undergo surgery in total anaesthesia

  1. Towards a Flood Severity Index

    Science.gov (United States)

    Kettner, A.; Chong, A.; Prades, L.; Brakenridge, G. R.; Muir, S.; Amparore, A.; Slayback, D. A.; Poungprom, R.

    2017-12-01

    Flooding is the most common natural hazard worldwide, affecting 21 million people every year. In the immediate moments following a flood event, humanitarian actors like the World Food Program need to make rapid decisions ( 72 hrs) on how to prioritize affected areas impacted by such an event. For other natural disasters like hurricanes/cyclones and earthquakes, there are industry-recognized standards on how the impacted areas are to be classified. Shake maps, quantifying peak ground motion, from for example the US Geological Survey are widely used for assessing earthquakes. Similarly, cyclones are tracked by Joint Typhoon Warning Center (JTWC) and Global Disaster Alert and Coordination System (GDACS) who release storm nodes and tracks (forecasted and actual), with wind buffers and classify the event according to the Saffir-Simpson Hurricane Wind Scale. For floods, the community is usually able to acquire unclassified data of the flood extent as identified from satellite imagery. Most often no water discharge hydrograph is available to classify the event into recurrence intervals simply because there is no gauging station, or the gauging station was unable to record the maximum discharge due to overtopping or flood damage. So, the question remains: How do we methodically turn a flooded area into classified areas of different gradations of impact? Here, we present a first approach towards developing a global applicable flood severity index. The flood severity index is set up such that it considers relatively easily obtainable physical parameters in a short period of time like: flood frequency (relating the current flood to historical events) and magnitude, as well as land cover, slope, and where available pre-event simulated flood depth. The scale includes categories ranging from very minor flooding to catastrophic flooding. We test and evaluate the postulated classification scheme against a set of past flood events. Once a severity category is determined, socio

  2. [Severe candidiasis in heroin addicts].

    Science.gov (United States)

    Badillet, G; Puissant, A; Colliard, H

    1984-01-01

    Seven cases of severe candida infection in heroin addicts are reported. The principal features of this condition which arose in 1980, apparently due to a particular quality of heroin, are described, Candida albicans was the only pathogenic agent isolated from mainly scalp nodular and pustular lesions. These cutaneous lesions were associated in half the cases with ocular lesions, which sometimes had a poor prognosis despite active therapy. Osteo-articular complications were less common. Ketoconazole therapy alone gave good results in this series. The precise reasons for this dissemination of Candida albicans and for these localisations are still not clearly understood.

  3. [Management of severe alcoholic hepatitis].

    Science.gov (United States)

    Wieser, Verena; Tilg, Herbert

    2014-01-01

    Severe alcoholic hepatitis is still associated with high mortality and presence of liver failure manifested by jaundice, coagulopathy and encephalopathy is a poor prognostic indicator. The management of these patients includes at first hand several supportive measures as treatment of alcohol withdrawal, administration of fluid and vitamins and admission to an intensive care unit in the unstable patient. Glucocorticoids have been since decades the most intensively studied therapy in alcoholic hepatitis and are effective in certain subgroups. Indication for such a therapy is usually defined on a Maddrey Discriminant Function > 32. The Lille score at day 7 is used to decide whether corticosteroid therapy should be stopped or continued for a 1 month course. Nutritional supplementation is also likely to be beneficial. The main progress in better understanding its pathophysiology has come from cytokine studies. Various proinflammatory cytokines such as tumor necrosis factor-alpha (TNFα) or interleukin-1 (IL-1) have been proposed to play a role in this disease. This advancement has recently led to pilot studies investigating anti-TNF drugs such as pentoxifylline, infliximab (anti-TNF antibody) or etanercept in the treatment of this disease. These studies revealed besides for pentoxifylline rather negative results. Despite this fact, targeting of certain cytokines such as IL-1 remains an attractive treatment concept for this devastating disorder in the future.

  4. Emerging therapies for severe asthma

    Science.gov (United States)

    2011-01-01

    Many patients with asthma have poorly controlled symptoms, and particularly for those with severe disease, there is a clear need for improved treatments. Two recent therapies licensed for use in asthma are omalizumab, a humanized monoclonal antibody that binds circulating IgE antibody, and bronchial thermoplasty, which involves the delivery of radio frequency energy to the airways to reduce airway smooth muscle mass. In addition, there are new therapies under development for asthma that have good potential to reach the clinic in the next five years. These include biological agents targeting pro-inflammatory cytokines such as interleukin-5 and interleukin-13, inhaled ultra long-acting β2-agonists and once daily inhaled corticosteroids. In addition, drugs that block components of the arachidonic acid pathway that targets neutrophilic asthma and CRTH2 receptor antagonists that inhibit the proinflammatory actions of prostaglandin D2 may become available. We review the recent progress made in developing viable therapies for severe asthma and briefly discuss the idea that development of novel therapies for asthma is likely to increasingly involve the assessment of genotypic and/or phenotypic factors. PMID:21896202

  5. Emerging therapies for severe asthma

    Directory of Open Access Journals (Sweden)

    Spears Mark

    2011-09-01

    Full Text Available Abstract Many patients with asthma have poorly controlled symptoms, and particularly for those with severe disease, there is a clear need for improved treatments. Two recent therapies licensed for use in asthma are omalizumab, a humanized monoclonal antibody that binds circulating IgE antibody, and bronchial thermoplasty, which involves the delivery of radio frequency energy to the airways to reduce airway smooth muscle mass. In addition, there are new therapies under development for asthma that have good potential to reach the clinic in the next five years. These include biological agents targeting pro-inflammatory cytokines such as interleukin-5 and interleukin-13, inhaled ultra long-acting β2-agonists and once daily inhaled corticosteroids. In addition, drugs that block components of the arachidonic acid pathway that targets neutrophilic asthma and CRTH2 receptor antagonists that inhibit the proinflammatory actions of prostaglandin D2 may become available. We review the recent progress made in developing viable therapies for severe asthma and briefly discuss the idea that development of novel therapies for asthma is likely to increasingly involve the assessment of genotypic and/or phenotypic factors.

  6. CANDU safety under severe accidents

    International Nuclear Information System (INIS)

    Snell, V.G.; Howieson, J.Q.; Frescura, G.M.; King, F.; Rogers, J.T.; Tamm, H.

    1988-01-01

    The characteristics of the CANDU reactor relevant to severe accidents are set first by the inherent properties of the design, and second by the Canadian safety/licensing approach. Probabilistic safety assessment studies have been performed on operating CANDU plants, and on the 4 x 880 MW(e) Darlington station now under construction; furthermore a scoping risk assessment has been done for a CANDU 600 plant. They indicate that the summed severe core damage frequency is of the order of 5 x 10 -6 /year. CANDU nuclear plant designers and owner/operators share information and operational experience nationally and internationally through the CANDU Owners' Group (COG). The research program generally emphasizes the unique aspects of the CANDU concept, such as heat removal through the moderator, but it has also contributed significantly to areas generic to most power reactors such as hydrogen combustion, containment failure modes, fission product chemistry, and high temperature fuel behaviour. Abnormal plant operating procedures are aimed at first using event-specific emergency operating procedures, in cases where the event can be diagnosed. If this is not possible, generic procedures are followed to control Critical Safety Parameters and manage the accident. Similarly, the on-site contingency plans include a generic plan covering overall plant response strategy, and a specific plan covering each category of contingency

  7. The management of severe accidents

    International Nuclear Information System (INIS)

    Pelce, J.; Brignon, P.

    1987-01-01

    In considering severe accidents in water power reactors, a major problem that arises is how to manage them in such a way that the situation can be controlled as well as possible, from the aspects both of preventing serious damage to the core of limiting the discharge of radioactivity. A number of countries have announced provisions in the field of accident management, some already set up, others planned, but these mainly apply to preventing damage to the core. Part of this report deals with this aspect, to show that there is a fairly wide consensus on how problems should be approached. Attitudes vary, on the other hand, in the approach to mitigate radioactive release. In fact, few countries have proposed concrete steps to manage severe accidents in the final stages when the core is seriously damaged. Since it is difficult to compare different approaches, only the French approach is described. This description is however very brief, because in the five or six years since it was defined, the approach has been presented many times. The stress is placed more on the comments which this type of approach suggests, to make the subsequent general discussion easier

  8. Common paths to ASD severity and PTSD severity

    DEFF Research Database (Denmark)

    Hansen, Maj; Armour, Cherie; Wittmann, Lutz

    Numerous studies have identified risk factors for acute and long term posttraumatic symptoms following traumatic exposure. However, little is known about possible common pathways to the development of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). Research suggests that a c......Numerous studies have identified risk factors for acute and long term posttraumatic symptoms following traumatic exposure. However, little is known about possible common pathways to the development of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). Research suggests...... that a common pathway to ASD and PTSD may lie in peritraumatic responses and cognitions. Using structural equation modeling we examined the role of three peritraumatic factors (tonic immobility, panic and dissociation) and three cognitive factors (anxiety sensitivity, negative cognitions about the world......, and negative cognitions about self ) on the development of ASD and PTSD severity in a national study of Danish bank robbery victims (N = 450). Peritraumatic panic, anxiety sensitivity, and negative cognitions about self were found to be significant common risk factors, whereas peritraumatic dissociation...

  9. Therapeutic options for severe asthma

    Science.gov (United States)

    Mathew, Jilcy; Chandy, Dipak

    2012-01-01

    As the overall prevalence of asthma has escalated in the past decades, so has the population of patients with severe asthma. This condition is often difficult to manage due to the relative limitation of effective therapeutic options for the physician and the social and economic burden of the disease on the patient. Management should include an evaluation and elimination of modifiable risk factors such as smoking, allergen exposure, obesity and non-adherence, as well as therapy for co-morbidities like gastro-esophageal reflux disease and obstructive sleep apnea. Current treatment options include conventional agents such as inhalational corticosteroids, long acting β2 agonists, leukotriene antagonists, and oral corticosteroids. Less conventional treatment options include immunotherapy with methotrexate, cyclosporine and tacrolimus, biological drugs like monoclonal antibodies, tumor necrosis factor-α blockers and oligonucleotides, phosphodiesterase inhibitors, antimicrobials and bronchial thermoplasty. PMID:23056066

  10. Bioimpedance in Severely Malnourished Children

    DEFF Research Database (Denmark)

    Girma Nigatu, Tsinuel

    Worldwide severe acute malnutrition (SAM) affects millions of children and considerably contributes to under-five mortality, mainly in low-income settings. Among children with SAM, deaths occur largely in those with oedema and during early phase of treatment often aggravated by infection. Treatment...... outcome could be improved by enhancing monitoring of body hydration (the proportion of water in tissues) during treatment. We studied 351children between 0.5 and 14 years admitted to Jimma University Specialized Hospital with SAM. We recorded weight, height and grade of oedema. Further we measured...... bioimpedance which is the resistance of the body to an imperceptible current of electricity and in healthy individuals this method is used to estimate total body water. Finally we estimated amount of total body water (TBW) using deuterium dilution method on a subset of 35 children. There were two important...

  11. Severe accident simulation at Olkiuoto

    Energy Technology Data Exchange (ETDEWEB)

    Tirkkonen, H.; Saarenpaeae, T. [Teollisuuden Voima Oy (TVO), Olkiluoto (Finland); Cliff Po, L.C. [Micro-Simulation Technology, Montville, NJ (United States)

    1995-09-01

    A personal computer-based simulator was developed for the Olkiluoto nuclear plant in Finland for training in severe accident management. The generic software PCTRAN was expanded to model the plant-specific features of the ABB Atom designed BWR including its containment over-pressure protection and filtered vent systems. Scenarios including core heat-up, hydrogen generation, core melt and vessel penetration were developed in this work. Radiation leakage paths and dose rate distribution are presented graphically for operator use in diagnosis and mitigation of accidents. Operating on an graphically for operator use in diagnosis and mitigation of accidents. Operating on an 486 DX2-66, PCTRAN-TVO achieves a speed about 15 times faster than real-time. A convenient and user-friendly graphic interface allows full interactive control. In this paper a review of the component models and verification runs are presented.

  12. Severe rhabdomyolysis after excessive bodybuilding.

    Science.gov (United States)

    Finsterer, J; Zuntner, G; Fuchs, M; Weinberger, A

    2007-12-01

    A 46-year-old male subject performed excessive physical exertion during 4-6 h in a studio for body builders during 5 days. He was not practicing sport prior to this training and denied the use of any aiding substances. Despite muscle aching already after 1 day, he continued the exercises. After the last day, he recognized tiredness and cessation of urine production. Two days after discontinuation of the training, a Herpes simplex infection occurred. Because of acute renal failure, he required hemodialysis. There were absent tendon reflexes and creatine kinase (CK) values up to 208 274 U/L (normal: <170 U/L). After 2 weeks, CK had almost normalized and, after 4 weeks, hemodialysis was discontinued. Excessive muscle training may result in severe, hemodialysis-dependent rhabdomyolysis. Triggering factors may be prior low fitness level, viral infection, or subclinical metabolic myopathy.

  13. Genotyping for severe drug hypersensitivity.

    Science.gov (United States)

    Karlin, Eric; Phillips, Elizabeth

    2014-03-01

    Over the past decade, there have been significant advances in our understanding of the immunopathogenesis and pharmacogenomics of severe immunologically-mediated adverse drug reactions. Such T-cell-mediated adverse drug reactions such as Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), drug-induced liver disease (DILI) and other drug hypersensitivity syndromes have more recently been shown to be mediated through interactions with various class I and II HLA alleles. Key examples have included the associations of HLA-B*15:02 and carbamazepine induced SJS/TEN in Southeast Asian populations and HLA-B*57:01 and abacavir hypersensitivity. HLA-B*57:01 screening to prevent abacavir hypersensitivity exemplifies a successful translational roadmap from pharmacogenomic discovery through to widespread clinical implementation. Ultimately, our increased understanding of the interaction between drugs and the MHC could be used to inform drug design and drive pre-clinical toxicity programs to improve drug safety.

  14. Cinacalcet effect on severe hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Al Saran Khalid

    2010-01-01

    Full Text Available To determine the efficacy and safety of cinacalcet, a calcimimetic drug that suppress parathyroid hormone (PTH production, we studied its effect on 20 patients (13 males on maintenance hemodialysis (HD, 80% of them have persistent high PTH levels (i.e. more than 80 pmol/L, the remaining patients had PTH levels more than 60 pmol/L. Five of 20 (25% patients dropped out from the study (2 because of severe GIT upset, one showed severe myalgia and arthralgia, one patient due to non compliance and one died at home due to cardiac arrest. The remaining 15 patients (10 males had a mean age of 40 ± 12.86 years and dialysis duration of 29.13 ± 18.27 months. The follow-up period on cinacalcet was 4 months with a single daily oral dose started with 30 mg/day and increased gradually according to the PTH levels. Nine (60% pa-tients were on concomitant active vitamin D during the study period with a mean dose of 7.33 ± 3.39 μg/week. There was a significant decrease in the serum PTH levels at the end the study compared to that at the start (46.4 ± 4.7 pmol/L versus 93.3 ± 25.6 pmol/L, respectively, P< 0.000, and the target PTH level (< 31.6 pmol/L was achieved in 54% of patients. No significant changes in serum Ca and phosphorous levels were observed. We conclude that cinacalcet is an effective therapy to suppress the serum PTH levels and allows favorable management of the serum calcium and phosphorus levels in HD patients. The drug was well tolerated; however, GIT discomfort is a significant side effect that may necessitate drug withdrawal in some patients.

  15. Diarrhea in severely burned children.

    Science.gov (United States)

    Thakkar, Kalpesh; Kien, C Lawrence; Rosenblatt, Judah I; Herndon, David N

    2005-01-01

    Diarrhea is a common problem in critically ill patients. Our patients are fed a high-carbohydrate enteral formula. We hypothesized that diarrhea in our patients may be related to the osmotic effects of unabsorbed carbohydrate in the small intestine and colon. We studied 19 patients, 3 months to 17 years, with burns >40% total body surface area. Each subject was studied weekly for up to 4 weeks postburn. Breath H2 concentration was measured. For the 24-hour period before the breath H2 measurement, the enteral carbohydrate intake, stool volume, and total enteral fluid volume were recorded. At each of several weekly intervals for each subject, the times when stool volume and enteral carbohydrate intake were each maximal were noted. Maximal stool volume ranged from 12 to 69 mL/kg/d. At the time point of maximal carbohydrate intake, diarrhea (stool volume >10 mL/kg/d) occurred in 18 of 19 patients, and maximal stool volume occurred in 10 of 19. Breath H2 concentration (ppm/5% CO2; mean +/- SEM) was 5.5 +/- 3.5 at the time of maximal carbohydrate intake, and was 25 +/- 20 at maximal stool volume. There were no correlations among breath H2 concentration, stool volume, enteral fluid intake, and enteral carbohydrate intake. Almost all the subjects had diarrhea over several weeks postburn. The lack of correlation of either carbohydrate intake or breath H2 with stool volume suggests that diarrhea in these patients may be caused by factors other than carbohydrate malabsorption. These data do not support altering nutrition support because of watery diarrhea.

  16. Severe accident research in France

    International Nuclear Information System (INIS)

    Duco, J.; Reocreux, M.; Tattegrain, A.

    1988-01-01

    French PWR power plant design relies basically on a deterministic approach. Nevertheless, an overall safety objective was issued in 1977 by the safety authority which set an upper probability limit for having unacceptable consequences; this resulted, in particular, in the elaboration of the ''H'' procedures, aimed at reducing significantly the risk of core uncovery subsequent to the loss of redunbant safety-related systems. The U1 symptom-oriented procedure, based on the nuclear steam supply system ''cooling states'', was introduced later, in order to prevent core melting in situations where the operating crew was confused by multiple failures and/or inappropriate previous actions. In the event that a core-melt should occur, the ultimate procedures U2, U4 and U5 - the latter providing a venting of the containment through a filtration system - should enable the radioactive releases to be limited to characteristics compatible with the feasibility of the off-site emergency plans. Such emergency management procedures necessitate a significant study effort in order to be elaborated and qualified; this also presupposes that an adequate level of scientific knowledge has been gained as regards the response of specific components of a PWR under beyond-design conditions. The purpose of severe accident research in France is to attain a level of basic knowledge such that emergency procedures may be conceived and ultimately tested

  17. Pregnancy-associated severe sepsis.

    Science.gov (United States)

    Oud, Lavi

    2016-04-01

    This article examines the contemporary knowledge and uncertainties about the burden of pregnancy-associated severe sepsis (PASS), and its manifestations, management, and outcomes. There are relatively sparse data on PASS, related in part to infrequent reports and varying use of terminology and case definitions. PASS remains rare, although its incidence appears to be rapidly rising in some high-resource countries, affecting especially women with limited resources, minorities, and those with chronic illness. High level of clinician vigilance and rapid initiation of appropriate antimicrobial therapy, coupled with effective systemic support for organ dysfunction and correction of occult and overt hypoperfusion are the keys to limit adverse outcomes. However, timely diagnosis and provision of effective care remain a challenge, with reported prevalent delay in recognition and delivery of time-sensitive care interventions among maternal decedents. The mortality rate of PASS has been rising and its case fatality, although relatively low, has remained unchanged, in contrast to the outcome gains in the general population. The long-term sequelae of PASS remain unknown. The relatively limited contemporary data on PASS suggest a rising public health hazard in the obstetric population in high-resource countries, with ongoing challenges in assuring consistent provision of time-sensitive care.

  18. Severe Anaemia during Late Pregnancy

    Directory of Open Access Journals (Sweden)

    Mahenaz Akhtar

    2012-01-01

    Full Text Available Vitamin B12 deficiency is uncommon in pregnancy, it occurs in 10–28% of uncomplicated pregnancies, and is associated with a few complications. We present a case report of a 21-year-old patient with severe anaemia during late pregnancy caused by vitamin B12 deficiency. At 38 weeks gestation and with a BMI of 48.9, a history of rupture of membranes was given but not confirmed. On examination, she appeared pale and therefore full blood counts were done. Interestingly her haemoglobin (Hb levels were 3.7 g/dL. Folate and vitamin B12 levels were also found to be low, and the diagnosis of anaemia caused by vitamin B12 deficiency was made. After treatment with vitamin B12 injections, folic acid and blood transfusions, the patient’s haemoglobin levels improved from 3.7 g/dL to 10.7 g/dL. The conclusion is that effective history taking, diagnosis, and management can prevent many complications that are usually associated with vitamin B12 deficiency anaemia.

  19. Severe Accident Recriticality Analyses (SARA)

    Energy Technology Data Exchange (ETDEWEB)

    Frid, W. [Swedish Nuclear Power Inspectorate, Stockholm (Sweden); Hoejerup, F. [Risoe National Lab. (Denmark); Lindholm, I.; Miettinen, J.; Puska, E.K. [VTT Energy, Helsinki (Finland); Nilsson, Lars [Studsvik Eco and Safety AB, Nykoeping (Sweden); Sjoevall, H. [Teoliisuuden Voima Oy (Finland)

    1999-11-01

    Recriticality in a BWR has been studied for a total loss of electric power accident scenario. In a BWR, the B{sub 4}C control rods would melt and relocate from the core before the fuel during core uncovery and heat-up. If electric power returns during this time-window unborated water from ECCS systems will start to reflood the partly control rod free core. Recriticality might take place for which the only mitigating mechanisms are the Doppler effect and void formation. In order to assess the impact of recriticality on reactor safety, including accident management measures, the following issues have been investigated in the SARA project: 1. the energy deposition in the fuel during super-prompt power burst, 2. the quasi steady-state reactor power following the initial power burst and 3. containment response to elevated quasi steady-state reactor power. The approach was to use three computer codes and to further develop and adapt them for the task. The codes were SIMULATE-3K, APROS and RECRIT. Recriticality analyses were carried out for a number of selected reflooding transients for the Oskarshamn 3 plant in Sweden with SIMULATE-3K and for the Olkiluoto 1 plant in Finland with all three codes. The core state initial and boundary conditions prior to recriticality have been studied with the severe accident codes SCDAP/RELAP5, MELCOR and MAAP4. The results of the analyses show that all three codes predict recriticality - both superprompt power bursts and quasi steady-state power generation - for the studied range of parameters, i. e. with core uncovery and heat-up to maximum core temperatures around 1800 K and water flow rates of 45 kg/s to 2000 kg/s injected into the downcomer. Since the recriticality takes place in a small fraction of the core the power densities are high which results in large energy deposition in the fuel during power burst in some accident scenarios. The highest value, 418 cal/g, was obtained with SIMULATE-3K for an Oskarshamn 3 case with reflooding

  20. Severe chronic allergic (and related) diseases

    DEFF Research Database (Denmark)

    Bousquet, J; Anto, J M; Demoly, P

    2012-01-01

    Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-u...

  1. Anchoring the Panic Disorder Severity Scale

    Science.gov (United States)

    Keough, Meghan E.; Porter, Eliora; Kredlow, M. Alexandra; Worthington, John J.; Hoge, Elizabeth A.; Pollack, Mark H.; Shear, M. Katherine; Simon, Naomi M.

    2012-01-01

    The Panic Disorder Severity Scale (PDSS) is a clinician-administered measure of panic disorder symptom severity widely used in clinical research. This investigation sought to provide clinically meaningful anchor points for the PDSS both in terms of clinical severity as measured by the Clinical Global Impression-Severity Scale (CGI-S) and to extend…

  2. Insights into disease severity in adult asthma

    NARCIS (Netherlands)

    Amelink, M.

    2014-01-01

    In this thesis we investigated and associated several new insights into disease severity in adult asthma. First we identified several clusters of adult-onset asthma and in addition to this we showed that severe disease is mostly associated with persistent eosinophilia and ENT disease. Also we showed

  3. 16 CFR 455.7 - Severability.

    Science.gov (United States)

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Severability. 455.7 Section 455.7 Commercial Practices FEDERAL TRADE COMMISSION TRADE REGULATION RULES USED MOTOR VEHICLE TRADE REGULATION RULE § 455.7 Severability. The provisions of this part are separate and severable from one another. If any provision is...

  4. Computed tomography in severe protein energy malnutrition.

    OpenAIRE

    Househam, K C; de Villiers, J F

    1987-01-01

    Computed tomography of the brain was performed on eight children aged 1 to 4 years with severe protein energy malnutrition. Clinical features typical of kwashiorkor were present in all the children studied. Severe cerebral atrophy or brain shrinkage according to standard radiological criteria was present in every case. The findings of this study suggest considerable cerebral insult associated with severe protein energy malnutrition.

  5. Surviving severe traumatic brain injury in Denmark

    DEFF Research Database (Denmark)

    Odgaard, Lene; Poulsen, Ingrid; Kammersgaard, Lars Peter

    2015-01-01

    PURPOSE: To identify all hospitalized patients surviving severe traumatic brain injury (TBI) in Denmark and to compare these patients to TBI patients admitted to highly specialized rehabilitation (HS-rehabilitation). PATIENTS AND METHODS: Patients surviving severe TBI were identified from...... severe TBI were admitted to HS-rehabilitation. Female sex, older age, and non-working status pre-injury were independent predictors of no HS-rehabilitation among patients surviving severe TBI. CONCLUSION: The incidence rate of hospitalized patients surviving severe TBI was stable in Denmark...

  6. Development of New Therapies for Severe Asthma

    Science.gov (United States)

    Fajt, Merritt L.

    2017-01-01

    Persistent asthma has long been treated with inhaled corticosteroids (CSs), as the mainstay of therapy. However, their efficacy in patients with more severe disease is limited, which led to the incorporation of poor response to ICSs (and thereby use of high doses of ICS) into recent definitions of severe asthma. Several studies have suggested that severe asthma might consist of several different phenotypes, each with ongoing symptoms and health care utilization, despite the use of high doses of ICS, usually in combination with a second or third controller. Several new therapies have been approved for severe asthma. Long-acting muscarinic agents have recently been approved as an additional controller agent and appear to improve lung function, although their effect on symptoms and exacerbations is less. Although bronchial thermoplasty (BT) has emerged as a therapy for severe asthma, little is understood regarding the appropriate selection of these patients. Considerable data have emerged to support the presence of a group of patients with severe asthma who have ongoing Type 2 inflammation. These patients appear to respond to targeted biologic approaches which are at the current time mostly investigational. In contrast, few effective therapies for patients with less or no evidence for Type 2 inflammation have emerged. Many new and exciting therapies are at the forefront for severe asthma therapy and, in conjunction with precision medicine approaches to identify the group of patients likely to respond to these approaches, will change the way we think about treating severe asthma. PMID:27826957

  7. [Severe depression : which concept ? which criteria].

    Science.gov (United States)

    Pélissolo, A

    2009-12-01

    Depression is a common disorder considered to be a serious public health problem although clinicians encounter very different levels of severity and the treatment strategies are tailored according to this variability. There are however no consensus criteria to define severe depression. This review presents and discusses the different possible qualitative and quantitative options. In the international classifications there are three levels of severity of episodes of major depression (mild, moderate, severe), which are defined above all on the number of diagnostic criteria found. There are other more qualitative severity factors : the presence of psychotic symptoms, melancholia and the presence of endogenous signs. Pronounced psychomotor retardation and risk of suicide are amongst the main clinical severity markers. Quantitative assessment scales for the severity of depression can also define severity thresholds for use for example in clinical studies. These thresholds are still poorly defined and vary between studies. Specific severity scales for melancholic depression or depression with psychomotor retardation can also be used in clinical studies for these factors, which are central to the concept of severe depression. Overall, the inclusion criteria for most studies combine severe depression with qualitative (clinicians' judgement) and quantitative (minimum score on a scale) aspects. Copyright 2009 L'Encéphale. Published by Elsevier Masson SAS.. All rights reserved.

  8. Occupational rhinitis affects occupational asthma severity.

    Science.gov (United States)

    Moscato, Gianna; Pala, Gianni; Folletti, Ilenia; Siracusa, Andrea; Quirce, Santiago

    2016-06-16

    The strong interactions between asthma and rhinitis, and the influence of rhinitis in the severity and/or control of asthma, have clearly been demonstrated. Nevertheless, no specific study has been conducted in the occupational setting. The aim of the study was to assess the severity of occupational asthma and rhinitis and evaluate whether rhinitis is a predictor for increased asthma severity. We retrospectively reviewed the clinical charts of 72 patients who received a diagnosis of allergic occupational asthma, with or without associated occupational rhinitis. Our findings suggested that persistent asthma tended to be more common in subjects with associated occupational asthma and rhinitis, and occupational asthma severity was associated with occupational rhinitis severity. Moderate-severe persistent occupational rhinitis is a risk factor for persistent occupational asthma. We demonstrated, for the first time in the occupational setting, a significant association between occupational rhinitis and asthma severity.

  9. Reporting Severe Hypoglycemia in Type 1 Diabetes

    DEFF Research Database (Denmark)

    Pedersen-Bjergaard, Ulrik; Thorsteinsson, Birger

    2017-01-01

    PURPOSE OF REVIEW: To describe potential factors influencing reporting of severe hypoglycemia in adult patients with type 1 diabetes and to analyze their effect on reported rates of severe hypoglycemia. RECENT FINDINGS: Reported rates of severe hypoglycemia defined as need for third party...... by partners report higher rates of severe hypoglycemia. There is a large variation between studies reporting incidence and prevalence of severe hypoglycemia in patients with type 1 diabetes, mainly explained by definition of severity, methods of reporting, and patient selection. These findings call...... hypoglycemia are 0.02-0.5 events per patient-year and 1-29%, respectively. When subjects with recurrent severe hypoglycemia in the past or suffering from impaired hypoglycemia awareness are excluded from participation in studies, lower rates are reported. Studies applying anonymous reporting or reporting...

  10. Toward characterization and definition of fibromyalgia severity

    Directory of Open Access Journals (Sweden)

    Yeh Yating

    2010-04-01

    Full Text Available Abstract Background There are no standard criteria for defining or assessing severity of fibromyalgia (FM as a condition as fibromyalgia is associated with multiple symptom domains. The objective of this study was to evaluate whether patient self-reported severity of FM is associated with severity of pain and sleep interference and the presence of core co-morbidities. Methods We recruited individuals ≥ 18 years of age with a clinician-confirmed diagnosis of FM ≥ 3 months and a current pain rating >2 on a 0-10 numeric rating scale (NRS. Patients completed a questionnaire by mail in which they self-rated their FM severity (very mild, mild, moderate, and severe, their current pain severity and extent of sleep interference (NRS; mild, 0-3; moderate, 4-6, severe, 7-10, and provided information (yes/no on the presence of core comorbidities (symptoms of depression, anxiety, sleep problems, back pain, neck pain and medication use for FM. The core symptoms of FM were stratified to assist with patient characterization. Analysis of variance (ANOVA was used to explore the relationship between self-reported FM severity and continuous variables (pain severity and sleep interference, and Mantel-Haenszel chi-square analysis was used to evaluate the trend in the proportions of patients reporting use of medications and core symptoms of FM by severity of FM. To complement patient-reported FM severity and to understand physicians' perspectives, a survey was performed among 28 physician specialists (rheumatology, neurology, anesthesiology/pain management, family practice, internal medicine, and psychiatry to determine what they assessed when evaluating FM severity in clinical practice. Results The population (N = 129 of FM patients was predominantly female (89.1%, with a mean age of 49.4 ± 11.0 years, and 81.4% reported duration ≥ 2 years. Self-reported FM severity was moderate/severe in 86.0% of patients; mean current pain score was 6.40 ± 2.19 (moderate

  11. Severe Hypertriglyceridemia Induced Pancreatitis in Pregnancy

    OpenAIRE

    Natasha Gupta; Seema Ahmed; Lemuel Shaffer; Paula Cavens; Josef Blankstein

    2014-01-01

    Acute pancreatitis caused by severe gestational hypertriglyceridemia is a rare complication of pregnancy. Acute pancreatitis has been well associated with gallstone disease, alcoholism, or drug abuse but rarely seen in association with severe hypertriglyceridemia. Hypertriglyceridemia may occur in pregnancy due to normal physiological changes leading to abnormalities in lipid metabolism. We report a case of severe gestational hypertriglyceridemia that caused acute pancreatitis at full term an...

  12. State energy severance taxes, 1985-1993

    International Nuclear Information System (INIS)

    1995-09-01

    This report analyzes changes in aggregate and State-level energy severance taxes for 1985 through 1993. Data are presented for crude oil, natural gas, and coal. The report highlights trends in severance tax receipts relative to energy prices and production, using severance tax data published by the Bureau of the Census of the US Department of Commerce and production data published by the Energy Information Administration

  13. Severe Accident Research Program plan update

    International Nuclear Information System (INIS)

    1992-12-01

    In August 1989, the staff published NUREG-1365, ''Revised Severe Accident Research Program Plan.'' Since 1989, significant progress has been made in severe accident research to warrant an update to NUREG-1365. The staff has prepared this SARP Plan Update to: (1) Identify those issues that have been closed or are near completion, (2) Describe the progress in our understanding of important severe accident phenomena, (3) Define the long-term research that is directed at improving our understanding of severe accident phenomena and developing improved methods for assessing core melt progression, direct containment heating, and fuel-coolant interactions, and (4) Reflect the growing emphasis in two additional areas--advanced light water reactors, and support for the assessment of criteria for containment performance during severe accidents. The report describes recent major accomplishments in understanding the underlying phenomena that can occur during a severe accident. These include Mark I liner failure, severe accident scaling methodology, source term issues, core-concrete interactions, hydrogen transport and combustion, TMI-2 Vessel Investigation Project, and direct containment heating. The report also describes the major planned activities under the SARP over the next several years. These activities will focus on two phenomenological issues (core melt progression, and fuel-coolant interactions and debris coolability) that have significant uncertainties that impact our understanding and ability to predict severe accident phenomena and their effect on containment performance SARP will also focus on severe accident code development, assessment and validation. As the staff completes the research on severe accident issues that relate to current generation reactors, continued research will focus on efforts to independently evaluate the capability of new advanced light water reactor designs to withstand severe accidents

  14. Screening for severe combined immunodeficiency in neonates

    OpenAIRE

    Kelly, Brian T; Tam, Jonathan S; Verbsky, James W; Routes, John M

    2013-01-01

    Brian T Kelly,1 Jonathan S Tam,1 James W Verbsky,1,2 John M Routes1,2 1Department of Pediatrics, 2Department of Microbiology and Molecular Genetics, Medical College of Wisconsin, Milwaukee, WI, USA Abstract: Severe combined immunodeficiency (SCID) is a rare disease that severely affects the cellular and humoral immune systems. Patients with SCID present with recurrent or severe infections and often with chronic diarrhea and failure to thrive. The disease is uniformly fatal, making early diag...

  15. Two cases of severe acute pancreatitis

    International Nuclear Information System (INIS)

    Tanaka, Yutaka; Takada, Shinichi; Morita, Yoku; Taoka, Yoshio

    1987-01-01

    We report two cases of severe acute pancreatitis; a 53-year-old man (Case 1) and a 60-year-old woman (Case 2). Case 1 was classified as ''severe'' according to the Ranson's criteria and he died of MOF on the 21st hospital day. Case 2 was classified as ''moderate'', but a large pancreatic abscess was observed by CT scan. She died of this abscess complicated with duodenal perforation on the 33rd hospital day. CT findings showed that this case was not ''moderate'' but ''severe''. Therefore, we believe that the findings of CT scan are an important factor for assessment of the severity of acute pancreatitis. (author)

  16. Prevalence of exchange blood transfusion in severe ...

    African Journals Online (AJOL)

    Background: Exchange blood transfusion (EBT) is carried out for the treatment of conditions presenting with severe hyperbilirubinaemia and anaemia, such as ABO incompatibility, sepsis, prematurity and birth trauma among others. While it is fast being abandoned as treatment modality for severe neonatal jaundice in the ...

  17. Euthanasia of Severely Handicapped Infants: Ethical Issues.

    Science.gov (United States)

    Cohen, Libby

    Ethical decisions are involved in life and death decisions for severely handicapped infants. Although it has become common practice for physicians not to treat severely handicapped infants, the ethical considerations involved in euthanasia are complex. A review of the literature reveals that concerns center around the quality of life of the…

  18. Severe interpersonal violence against children in sport

    NARCIS (Netherlands)

    Vertommen, Tine; Kampen, Jarl; Schipper-van Veldhoven, Nicolette; Uzieblo, Kasia; Eede, Van Den Filip

    2018-01-01

    In a recent large-scale prevalence study of interpersonal violence (IV) against child athletes in the Netherlands and Belgium we found that 9% of adult respondents who participated in organized sports before the age of 18 had experienced severe psychological violence, 8% severe physical violence,

  19. Association between severity of chronic obstructive pulmonary ...

    African Journals Online (AJOL)

    The statistical analysis was performed by SPSS software and the Kendall's tau-b correlation test. Results: The mean age (±standard deviation) was 64.3 ± 11.3 years. Twelve percent were female and 88 percent were male. The COPD severity, according to the ATS criteria, was mild in 16%, moderate in 48%, severe in 32% ...

  20. Severe hypothyroidism masquerading as renal impairment

    DEFF Research Database (Denmark)

    Bistrup, C; Jensen, Dorte Møller; Kvetny, J

    1996-01-01

    A case of severe hypothyroidism in a 51-year old male is presented. The patient was especially complaining of weakness, stiffness and moderate pain in the proximal muscle groups together with rhinorrhea and nasal stenosis. Because of severely elevated S-creatine-kinase combined with reduced...

  1. ORIGINAL ARTICLES Severe acute maternal morbidity and ...

    African Journals Online (AJOL)

    enough sample has been collected, but the time taken to achieve this might invalidate the conclusions as circumstances may have changed during the collection period. Severe acute maternal morbidity (SAMM), also known as. 'near miss', has been defined by Mantel et al.' If a woman has severe organ dysfunction or organ ...

  2. Premenstrual Syndrome: Prevalence, Pattern and Severity Among ...

    African Journals Online (AJOL)

    There was a statistically significant association between severity of symptoms and treatment between the age of respondents and use of oral contraceptive pills with severity of symptoms. Conclusion: PMS is a very common but poorly understood condition in our environment. More local studies are advocated on this subject ...

  3. Nutrition of patients with severe neurologic impairment

    Directory of Open Access Journals (Sweden)

    Orel Anija

    2017-12-01

    Full Text Available Commercial enteral formulas are generally recommended for gastrostomy feeding in patients with severe neurologic impairment. However, pureed food diets are still widely used and even gaining popularity among certain groups. We tried to compare the effectiveness of gastrostomy feeding for treatment of severe malnutrition with either enteral formulas or pureed feeds.

  4. Severe Hypertriglyceridemia Induced Pancreatitis in Pregnancy

    Directory of Open Access Journals (Sweden)

    Natasha Gupta

    2014-01-01

    Full Text Available Acute pancreatitis caused by severe gestational hypertriglyceridemia is a rare complication of pregnancy. Acute pancreatitis has been well associated with gallstone disease, alcoholism, or drug abuse but rarely seen in association with severe hypertriglyceridemia. Hypertriglyceridemia may occur in pregnancy due to normal physiological changes leading to abnormalities in lipid metabolism. We report a case of severe gestational hypertriglyceridemia that caused acute pancreatitis at full term and was successfully treated with postpartum therapeutic plasma exchange. Patient also developed several other complications related to her substantial hypertriglyceridemia including preeclampsia, chylous ascites, retinal detachment, pleural effusion, and chronic pericarditis. This patient had no previous family or personal history of lipid abnormality and had four successful prior pregnancies without developing gestational hypertriglyceridemia. Such a severe hypertriglyceridemia is usually seen in patients with familial chylomicronemia syndromes where hypertriglyceridemia is exacerbated by the pregnancy, leading to fatal complications such as acute pancreatitis.

  5. Instrumentation and severe accident plant status interpretation

    International Nuclear Information System (INIS)

    Chao, J.; Machiels, A.J.; Oehlberg, R.N.; Negin, C.A.; James, R.

    1992-01-01

    EPRI is conducting a project related to instrumentation and severe accident plant status interpretation. The project will recognize the facts that (i) instrument responses during severe accidents do not need to be as accurate as during normal operation, and (ii) not all instrument loops will see a severe environment. In particular, the proposed work is to provide technology to get the most information from the existing instrumentation under severe accident conditions by developing (1) calculational aids to determine actual plant parameters based on severe-accident-affected instrument readings, and (2) means to utilize indications from operational instruments to infer parameters values for failed instruments, or where no instrument may exist. Specific deliverables for this project are (i) an instrumentation data base that will include both instrumentation failures and successes under severe conditions, and contain instrument performance information from both nuclear and non-nuclear industry situations; (ii) methods to assess the validity of instrument signals and estimate the performance of individual instrument loops; and (iii) calculational aids to estimate and interpret instrument readings under severe accident conditions, including the ability to extrapolate readings from functioning instruments to locations where instruments have failed. (orig.)

  6. Monitoring severe accidents using AI techniques

    International Nuclear Information System (INIS)

    No, Young Gyu; Ahn, Kwang Il; Kim, Ju Hyun; Na, Man Gyun; Lim, Dong Hyuk

    2012-01-01

    After the Fukushima nuclear accident in 2011, there has been increasing concern regarding severe accidents in nuclear facilities. Severe accident scenarios are difficult for operators to monitor and identify. Therefore, accurate prediction of a severe accident is important in order to manage it appropriately in the unfavorable conditions. In this study, artificial intelligence (AI) techniques, such as support vector classification (SVC), probabilistic neural network (PNN), group method of data handling (GMDH), and fuzzy neural network (FNN), were used to monitor the major transient scenarios of a severe accident caused by three different initiating events, the hot-leg loss of coolant accident (LOCA), the cold-leg LOCA, and the steam generator tube rupture in pressurized water reactors (PWRs). The SVC and PNN models were used for the event classification. The GMDH and FNN models were employed to accurately predict the important timing representing severe accident scenarios. In addition, in order to verify the proposed algorithm, data from a number of numerical simulations were required in order to train the AI techniques due to the shortage of real LOCA data. The data was acquired by performing simulations using the MAAP4 code. The prediction accuracy of the three types of initiating events was sufficiently high to predict severe accident scenarios. Therefore, the AI techniques can be applied successfully in the identification and monitoring of severe accident scenarios in real PWRs.

  7. [Severe hypertension: definition and patients profiles].

    Science.gov (United States)

    Mourad, Jean-Jacques

    2013-05-01

    Severe arterial hypertension gathers relatively different clinical situations explained by the heterogeneity of the definitions of this clinical setting. From a medical point of view, severe hypertension is a short course situation defined by very high values of blood pressure corresponding to grade 3 hypertension. In France, until 2011, the social security also included in the definition of severe HTA chronic situations characterized by moderate blood pressure values requiring at least triple anthihypertensive therapies associated with a clinical or infraclinical target organ damages. These clinical profiles, much more frequent than grade 3 hypertension, allowed the full reimbursement of care costs for these patients. In France, it is estimated that 10% of hypertensive patients present a severe form with an annual incidence of 50,000 patients. The patients with severe hypertension have an increased cardiovascular morbidity justifying a closer clinical monitoring. From an economic point of view, these severe forms of hypertension have a higher cost of care, explained primarily by a more frequent need of specialized referrals, radiological exams and hospitalizations. This excess cost justified the existence of a full coverage of induced costs by the social security, since the incidence of severe hypertension is more frequent in the low social categories, and in patients with economic fragility.

  8. Impact of pavement conditions on crash severity.

    Science.gov (United States)

    Li, Yingfeng; Liu, Chunxiao; Ding, Liang

    2013-10-01

    Pavement condition has been known as a key factor related to ride quality, but it is less clear how exactly pavement conditions are related to traffic crashes. The researchers used Geographic Information System (GIS) to link Texas Department of Transportation (TxDOT) Crash Record Information System (CRIS) data and Pavement Management Information System (PMIS) data, which provided an opportunity to examine the impact of pavement conditions on traffic crashes in depth. The study analyzed the correlation between several key pavement condition ratings or scores and crash severity based on a large number of crashes in Texas between 2008 and 2009. The results in general suggested that poor pavement condition scores and ratings were associated with proportionally more severe crashes, but very poor pavement conditions were actually associated with less severe crashes. Very good pavement conditions might induce speeding behaviors and therefore could have caused more severe crashes, especially on non-freeway arterials and during favorable driving conditions. In addition, the results showed that the effects of pavement conditions on crash severity were more evident for passenger vehicles than for commercial vehicles. These results provide insights on how pavement conditions may have contributed to crashes, which may be valuable for safety improvement during pavement design and maintenance. Readers should notice that, although the study found statistically significant effects of pavement variables on crash severity, the effects were rather minor in reality as suggested by frequency analyses. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Function theory of several complex variables

    CERN Document Server

    Krantz, Steven G

    2001-01-01

    The theory of several complex variables can be studied from several different perspectives. In this book, Steven Krantz approaches the subject from the point of view of a classical analyst, emphasizing its function-theoretic aspects. He has taken particular care to write the book with the student in mind, with uniformly extensive and helpful explanations, numerous examples, and plentiful exercises of varying difficulty. In the spirit of a student-oriented text, Krantz begins with an introduction to the subject, including an insightful comparison of analysis of several complex variables with th

  10. Severe falciparum malaria: A case report

    Science.gov (United States)

    Arcelia, F.; Asymida, F.; Lubis, N. F. M.; Pasaribu, A. P.

    2018-03-01

    Plasmodium parasites caused Malaria. Indonesia is one of the countries in Southeast Asia that endemic to malaria. The burden of malaria is more in the eastern part of Indonesia than the Western part as well as the endemicity. Some cases of malaria will develop to severe form. Usually, the manifestation of children and adult are different. We reported a severe case of malaria in a 14-year-old boy who develops several manifestations such as anemia, hypoglycemia, sepsis and black water fever. We successfully treated the patient with Artesunate intravenous and continued with Dihydroartemisinin-piperaquine.

  11. Hand eczema severity and quality of life

    DEFF Research Database (Denmark)

    Agner, Tove; Andersen, Klaus E; Brandao, Francisco M

    2008-01-01

    Background and Objectives: Hand eczema is a chronic disease with negative impact on quality of life (QoL). In this study, QoL in hand eczema patients is assessed and related to age, sex, severity, and diagnostic subgroups. Methods: A total of 416 patients with hand eczema from 10 European patch...... test clinics participated in the study. Data on QoL were obtained from a self-administered questionnaire using the Dermatology Life Quality Index (DLQI). Severity was assessed by a scoring system (Hand Eczema Severity Index, HECSI) as well as frequency of eruptions and sick leave due to hand eczema...

  12. Postpartum Depression After Mild and Severe Preeclampsia

    NARCIS (Netherlands)

    Hoedjes, Meeke; Berks, Durk; Vogel, Ineke; Franx, Arie; Bangma, Meike; Darlington, Anne-Sophie E.; Visser, Willy; Duvekot, Johannes J.; Habbema, J. Dik F.; Steegers, Eric A. P.; Raat, Hein

    2011-01-01

    Objective: To describe the prevalence of postpartum depressive symptoms after preeclampsia, to assess the extent to which the prevalence of postpartum depressive symptoms differs after mild and severe preeclampsia, and to investigate which factors contribute to such differences. Methods: Women

  13. Selected Geomagnetic Measurements From Several Satellites

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — More than 17 million selected magnetic observations from several orbiting low-altitude satellites are contained in this digital collection. Except for MAGSAT, all...

  14. Staphylococcus aureus and hand eczema severity

    DEFF Research Database (Denmark)

    Haslund, P; Bangsgaard, N; Jarløv, J O

    2009-01-01

    BACKGROUND: The role of bacterial infections in hand eczema (HE) remains to be assessed. OBJECTIVES: To determine the prevalence of Staphylococcus aureus in patients with HE compared with controls, and to relate presence of S. aureus, subtypes and toxin production to severity of HE. METHODS......: Bacterial swabs were taken at three different visits from the hand and nose in 50 patients with HE and 50 controls. Staphylococcus aureus was subtyped by spa typing and assigned to clonal complexes (CCs), and isolates were tested for exotoxin-producing S. aureus strains. The Hand Eczema Severity Index...... was used for severity assessment. RESULTS: Staphylococcus aureus was found on the hands in 24 patients with HE and four controls (P aureus was found to be related to increased severity of the eczema (P aureus types on the hands...

  15. Bariatric surgery for severely obese adolescents.

    Science.gov (United States)

    Fitzgerald, Dominic A; Baur, Louise

    2014-09-01

    Severe obesity is increasing in adolescents and is associated with cardiovascular disease, type 2 diabetes mellitus, obstructive sleep apnoea, polycystic ovarian syndrome and a range of musculoskeletal problems. Premature death is the inevitable outcome of persistent severe obesity in adolescents. In adults with severe obesity, medical and lifestyle interventions have been shown to be expensive and less effective in terms of weight loss than has bariatric surgery. The single completed randomised controlled trial in adolescents shows the same outcome. This is supported by meta analyses of bariatric surgery in adolescent subjects. A more aggressive approach to severe obesity, utilising bariatric surgery in selected cases, within the context of a multi-disciplinary team, is required. Copyright © 2014. Published by Elsevier Ltd.

  16. Severe asthma and quality of life.

    Science.gov (United States)

    Hossny, Elham; Caraballo, Luis; Casale, Thomas; El-Gamal, Yehia; Rosenwasser, Lanny

    2017-01-01

    Severe asthma has a great impact on the quality of life (QOL) of patients and their families. The magnitude of this morbidity is affected by several personal factors including age. Appropriate asthma control and modifications of social roles and activities are expected to improve QOL. Biologics, primarily monoclonal antibodies, have been developed to target specific pathways and molecules important in the pathogenesis of asthma. The use of biologics has shown some promising effects on the QOL of patients with severe recalcitrant asthma. Other potential measures involve targeting risk factors and comorbidities and improving the levels of adherence to therapy. This article briefly reviews the impact of severe asthma on QOL and the potential methods to combat this morbidity including the available therapeutic biologics.

  17. Lightning and severe thunderstorms in event management.

    Science.gov (United States)

    Walsh, Katie M

    2012-01-01

    There are a few national position stands/guidelines that address environmental conditions in athletics, yet they do not govern all outdoor sports. Extreme heat and cold, lightning, and severe wind can all be fatal, yet the majority of outdoor sports have no published guidelines addressing these conditions in relation to activity. Available research on extreme heat and cold conditions in athletics provides prevention strategies, to include acclimatization. Lightning and severe wind are two environmental conditions to which humans cannot accommodate, and they both can be deadly. There are strong positions on extreme heat/cold and lightning safety in athletics, but none affiliated with severe winds. Medical personnel involved in planning large outdoor sporting events must know of the presence of nationally published weather-related documents and apply them to their event. In addition, research needs to be expanded in the realm of establishing guidelines for safety to participants and spectators in severe wind conditions.

  18. Dysautonomia after severe traumatic brain injury.

    NARCIS (Netherlands)

    Hendricks, H.T.; Heeren, J.H.M.; Vos, P.E.

    2010-01-01

    BACKGROUND: Dysautonomia after traumatic brain injury (TBI) is characterized by episodes of increased heart rate, respiratory rate, temperature, blood pressure, muscle tone, decorticate or decerebrate posturing, and profuse sweating. This study addresses the incidence of dysautonomia after severe

  19. Severe accidents in Nuclear Power Plants

    International Nuclear Information System (INIS)

    Valle Cepero, R.; Castillo Alvarez, J.; Ramon Fuente, J.

    1996-01-01

    For the assessment of the safety of nuclear power plants it is of great importance the analyses of severe accidents since they allow to estimate the possible failure models of the containment, and also permit knowing the magnitude and composition of the radioactive material that would be released to the environment in case of an accident upon population and the environment. This paper presents in general terms the basic principles for conducting the analysis of severe accidents, the fundamental sources in the generation of radionuclides and aerosols, the transportation and deposition processes, and also makes reference to de main codes used in the modulation of severe accidents. The final part of the paper contents information on how severe accidents are dialed with the regulatory point view in different countries

  20. Thromboelastography in patients with severe sepsis

    DEFF Research Database (Denmark)

    Haase, Nicolai; Ostrowski, Sisse Rye; Wetterslev, Jørn

    2015-01-01

    PURPOSE: To investigate the association between consecutively measured thromboelastographic (TEG) tracings and outcome in patients with severe sepsis. METHODS: Multicentre prospective observational study in a subgroup of the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) Trial (NCT00962156......) comparing hydroxyethyl starch (HES) 130/0.42 vs. Ringer's acetate for fluid resuscitation in severe sepsis. TEG (standard and functional fibrinogen) was measured consecutively for 5 days, and clinical data including bleeding and death was retrieved from the trial database. Statistical analyses included Cox...... bleeding [HR 2.43 (1.16-5.07)] and possibly explained the excess bleeding with HES in the 6S trial. CONCLUSIONS: In our cohort of patients with severe sepsis, progressive hypocoagulability defined by TEG variables was associated with increased risk of death and increased risk of bleeding....

  1. Rater Severity Drift in Peer Assessment

    Directory of Open Access Journals (Sweden)

    Bengü BÖRKAN

    2017-12-01

    Full Text Available There are not enough psychometrically sound studies about the validity and reliability of the scores obtained from peer assessment. This study examined degree of rater severity drift, a rater effect, in peer assessment. The college students’ presentations were scored by 29 peers in the class using a rating scale. Nine presentations were held on four separate days, two presentations on each of the first three days and three presentations on the fourth day. Drift was investigated with two many-facet Rasch measurement models (separate models and dummy time MFRM. Standardized differences were calculated from the estimates obtained with separate models and interaction terms were calculated with the dummy time MFRM. In drift analysis, shifts in estimations were examined from Day-1 which is a baseline to other three days. Results showed that peer raters varied according to their level of severity and they tend to be lenient. Statistics showed that the quality of the scale was acceptable and its items behaved as expected. In drift analysis, standardized differences and interaction term provided very similar results. Between Day-1 and 2, there was no statistically significant difference in the estimates of the rater severity. Between Day-1 and 3, the percentage of scorers with significant drift in the estimates was 38.10%. The raters’ severity shifts on the average of about 0.14 logit and they displayed more severe scoring behavior. Between Day-1 and 4, the number of raters who had significant shifts in their estimates was three according to the standardized difference method, while one according to interaction method. On the average, the raters became more severe. Among three comparison, Day-4 had the largest rater severity drift on the average; Day 3, however, has the highest number of raters with rater severity drift.

  2. Predicting Severe Pneumonia Outcomes in Children.

    Science.gov (United States)

    Williams, Derek J; Zhu, Yuwei; Grijalva, Carlos G; Self, Wesley H; Harrell, Frank E; Reed, Carrie; Stockmann, Chris; Arnold, Sandra R; Ampofo, Krow K; Anderson, Evan J; Bramley, Anna M; Wunderink, Richard G; McCullers, Jonathan A; Pavia, Andrew T; Jain, Seema; Edwards, Kathryn M

    2016-10-01

    Substantial morbidity and excessive care variation are seen with pediatric pneumonia. Accurate risk-stratification tools to guide clinical decision-making are needed. We developed risk models to predict severe pneumonia outcomes in children (<18 years) by using data from the Etiology of Pneumonia in the Community Study, a prospective study of community-acquired pneumonia hospitalizations conducted in 3 US cities from January 2010 to June 2012. In-hospital outcomes were organized into an ordinal severity scale encompassing severe (mechanical ventilation, shock, or death), moderate (intensive care admission only), and mild (non-intensive care hospitalization) outcomes. Twenty predictors, including patient, laboratory, and radiographic characteristics at presentation, were evaluated in 3 models: a full model included all 20 predictors, a reduced model included 10 predictors based on expert consensus, and an electronic health record (EHR) model included 9 predictors typically available as structured data within comprehensive EHRs. Ordinal regression was used for model development. Predictive accuracy was estimated by using discrimination (concordance index). Among the 2319 included children, 21% had a moderate or severe outcome (14% moderate, 7% severe). Each of the models accurately identified risk for moderate or severe pneumonia (concordance index across models 0.78-0.81). Age, vital signs, chest indrawing, and radiologic infiltrate pattern were the strongest predictors of severity. The reduced and EHR models retained most of the strongest predictors and performed as well as the full model. We created 3 risk models that accurately estimate risk for severe pneumonia in children. Their use holds the potential to improve care and outcomes. Copyright © 2016 by the American Academy of Pediatrics.

  3. Climate change effects on drought severity

    OpenAIRE

    Loukas, A.; Vasiliades, L.; Tzabiras, J.

    2008-01-01

    This paper evaluates climate change effects on drought severity in the region of Thessaly, Greece. The Standardized Precipitation Index (SPI) has been used for estimation of drought severity. A geographical information system is applied for the division of Thessaly region to twelve hydrological homogeneous areas based on their geomorphology. Mean monthly precipitation values from 50 precipitation stations of Thessaly for the hydrological period October 1960–September 1990 were used for the es...

  4. Severe allergic reactions to guinea pig

    OpenAIRE

    Zacharisen, Michael C; Levy, Michael B; Shaw, Jeffrey L; Kurup, Viswanath P

    2005-01-01

    Abstract Background Allergic sensitization and reactions to guinea pig (Cavia porcellus) have been well documented in laboratory animal handlers, primarily manifesting as rhinitis, conjunctivitis, and asthma. Severe allergic reactions, however, are rare. Methods We report two patients with severe allergic reactions following non-occupational exposure to guinea pigs. The first patient, an 11-year-old female, developed ocular, nasal, skin and laryngeal edema symptoms immediately after handling ...

  5. Model for predicting the injury severity score.

    Science.gov (United States)

    Hagiwara, Shuichi; Oshima, Kiyohiro; Murata, Masato; Kaneko, Minoru; Aoki, Makoto; Kanbe, Masahiko; Nakamura, Takuro; Ohyama, Yoshio; Tamura, Jun'ichi

    2015-07-01

    To determine the formula that predicts the injury severity score from parameters that are obtained in the emergency department at arrival. We reviewed the medical records of trauma patients who were transferred to the emergency department of Gunma University Hospital between January 2010 and December 2010. The injury severity score, age, mean blood pressure, heart rate, Glasgow coma scale, hemoglobin, hematocrit, red blood cell count, platelet count, fibrinogen, international normalized ratio of prothrombin time, activated partial thromboplastin time, and fibrin degradation products, were examined in those patients on arrival. To determine the formula that predicts the injury severity score, multiple linear regression analysis was carried out. The injury severity score was set as the dependent variable, and the other parameters were set as candidate objective variables. IBM spss Statistics 20 was used for the statistical analysis. Statistical significance was set at P  Watson ratio was 2.200. A formula for predicting the injury severity score in trauma patients was developed with ordinary parameters such as fibrin degradation products and mean blood pressure. This formula is useful because we can predict the injury severity score easily in the emergency department.

  6. Severe Brachial Plexus Injuries in American Football.

    Science.gov (United States)

    Daly, Charles A; Payne, S Houston; Seiler, John G

    2016-11-01

    This article reports a series of severe permanent brachial plexus injuries in American football players. The authors describe the mechanisms of injury and outcomes from a more contemporary treatment approach in the form of nerve transfer tailored to the specific injuries sustained. Three cases of nerve transfer for brachial plexus injury in American football players are discussed in detail. Two of these patients regained functional use of the extremity, but 1 patient with a particularly severe injury did not regain significant function. Brachial plexus injuries are found along a spectrum of brachial plexus stretch or contusion that includes the injuries known as "stingers." Early identification of these severe brachial plexus injuries allows for optimal outcomes with timely treatment. Diagnosis of the place of a given injury along this spectrum is difficult and requires a combination of imaging studies, nerve conduction studies, and close monitoring of physical examination findings over time. Although certain patients may be at higher risk for stingers, there is no evidence to suggest that this correlates with a higher risk of severe brachial plexus injury. Unfortunately, no equipment or strengthening program has been shown to provide a protective effect against these severe injuries. Patients with more severe injuries likely have less likelihood of functional recovery. In these patients, nerve transfer for brachial plexus injury offers the best possibility of meaningful recovery without significant morbidity. [ Orthopedics. 2016; 39(6):e1188-e1192.]. Copyright 2016, SLACK Incorporated.

  7. Class II malocclusion occlusal severity description

    Directory of Open Access Journals (Sweden)

    Guilherme Janson

    2010-08-01

    Full Text Available OBJECTIVES: It is well known that the efficacy and the efficiency of a Class II malocclusion treatment are aspects closely related to the severity of the dental anteroposterior discrepancy. Even though, sample selection based on cephalometric variables without considering the severity of the occlusal anteroposterior discrepancy is still common in current papers. In some of them, when occlusal parameters are chosen, the severity is often neglected. The purpose of this study is to verify the importance given to the classification of Class II malocclusion, based on the criteria used for sample selection in a great number of papers published in the orthodontic journal with the highest impact factor. MATERIAL AND METHODS: A search was performed in PubMed database for full-text research papers referencing Class II malocclusion in the history of the American Journal of Orthodontics and Dentofacial Orthopedics (AJO-DO. RESULTS: A total of 359 papers were retrieved, among which only 72 (20.06% papers described the occlusal severity of the Class II malocclusion sample. In the other 287 (79.94% papers that did not specify the anteroposterior discrepancy severity, description was considered to be crucial in 159 (55.40% of them. CONCLUSIONS: Omission in describing the occlusal severity demands a cautious interpretation of 44.29% of the papers retrieved in this study.

  8. Use of biologics in severe food allergies.

    Science.gov (United States)

    Fiocchi, Alessandro; Pecora, Valentina; Valluzzi, Rocco L; Fierro, Vincenzo; Mennini, Maurizio

    2017-06-01

    Severe cases of food allergy account for the majority of the burden in terms of risks, quality of life, and resource expenditure. The traditional approach to these forms has been strict avoidance. More recently, Oral ImmunoTherapy (OIT) has gained a role in their management. However, in severe food allergies OIT is often infeasible. Case reports, observational, and prospective studies have recently proposed different approaches to severe food allergy. The majority of them include the use of biologics. Omalizumab has been the most studied drug for severe food allergies, and its role as adjuvant treatment to OIT is well established. Interest has been raised on other biologics, as dupilumab, reslizumab, and mepolizumab. Toll-like receptor agonists, and gene therapy using adeno-associated virus coding for Omalizumab are promising alternatives. The recent studies are deeply influencing the clinical practice. We review the modifications of the clinical approach to severe food allergies so far available. We indicate the possible evolutions of treatment with biologics in severe food allergies.

  9. Severe accident testing of electrical penetration assemblies

    International Nuclear Information System (INIS)

    Clauss, D.B.

    1989-11-01

    This report describes the results of tests conducted on three different designs of full-size electrical penetration assemblies (EPAs) that are used in the containment buildings of nuclear power plants. The objective of the tests was to evaluate the behavior of the EPAs under simulated severe accident conditions using steam at elevated temperature and pressure. Leakage, temperature, and cable insulation resistance were monitored throughout the tests. Nuclear-qualified EPAs were produced from D. G. O'Brien, Westinghouse, and Conax. Severe-accident-sequence analysis was used to generate the severe accident conditions (SAC) for a large dry pressurized-water reactor (PWR), a boiling-water reactor (BWR) Mark I drywell, and a BWR Mark III wetwell. Based on a survey conducted by Sandia, each EPA was matched with the severe accident conditions for a specific reactor type. This included the type of containment that a particular EPA design was used in most frequently. Thus, the D. G. O'Brien EPA was chosen for the PWR SAC test, the Westinghouse was chosen for the Mark III test, and the Conax was chosen for the Mark I test. The EPAs were radiation and thermal aged to simulate the effects of a 40-year service life and loss-of-coolant accident (LOCA) before the SAC tests were conducted. The design, test preparations, conduct of the severe accident test, experimental results, posttest observations, and conclusions about the integrity and electrical performance of each EPA tested in this program are described in this report. In general, the leak integrity of the EPAs tested in this program was not compromised by severe accident loads. However, there was significant degradation in the insulation resistance of the cables, which could affect the electrical performance of equipment and devices inside containment at some point during the progression of a severe accident. 10 refs., 165 figs., 16 tabs

  10. Cost per severe accident as an index for severe accident consequence assessment and its applications

    International Nuclear Information System (INIS)

    Silva, Kampanart; Ishiwatari, Yuki; Takahara, Shogo

    2014-01-01

    The Fukushima Accident emphasizes the need to integrate the assessments of health effects, economic impacts, social impacts and environmental impacts, in order to perform a comprehensive consequence assessment of severe accidents in nuclear power plants. “Cost per severe accident” is introduced as an index for that purpose. The calculation methodology, including the consequence analysis using level 3 probabilistic risk assessment code OSCAAR and the calculation method of the cost per severe accident, is proposed. This methodology was applied to a virtual 1,100 MWe boiling water reactor. The breakdown of the cost per severe accident was provided. The radiation effect cost, the relocation cost and the decontamination cost were the three largest components. Sensitivity analyses were carried out, and parameters sensitive to cost per severe accident were specified. The cost per severe accident was compared with the amount of source terms, to demonstrate the performance of the cost per severe accident as an index to evaluate severe accident consequences. The ways to use the cost per severe accident for optimization of radiation protection countermeasures and for estimation of the effects of accident management strategies are discussed as its applications. - Highlights: • Cost per severe accident is used for severe accident consequence assessment. • Assessments of health, economic, social and environmental impacts are included. • Radiation effect, relocation and decontamination costs are important cost components. • Cost per severe accident can be used to optimize radiation protection measures. • Effects of accident management can be estimated using the cost per severe accident

  11. Regression of severe tricuspid regurgitation after mitral balloon valvotomy for severe mitral stenosis

    Directory of Open Access Journals (Sweden)

    Mohamed Eid Fawzy

    2014-03-01

    Conclusions: Regression of significant TR after successful MBV in patients with severe mitral stenosis was observed in patients who had severe pulmonary hypertension. This improvement in TR occurred even in the presence of organic tricuspid valve disease.

  12. Occurrence and severity of agitated behavior after severe traumatic brain injury

    DEFF Research Database (Denmark)

    Moth Wolffbrandt, Mia; Poulsen, Ingrid; Engberg, Aase W

    2013-01-01

    To investigate the occurrence and severity of agitation in patients after severe traumatic brain injury (TBI), to identify predictors of agitation and to study interrater reliability for a translated version of the Agitated Behavior Scale (ABS)....

  13. Use of simulators in severe accident management

    International Nuclear Information System (INIS)

    Evans, R.C.

    1994-01-01

    The U.S. nuclear utility industry is moving in a deliberate fashion through a coordinated industry severe accident working group to study and augment, where appropriate, the existing utility organizational and emergency planning structure to address accident and severe accident management. Full-scope simulators are used extensively to train licensed operators for their initial license examinations and continually thereafter in licensed operator requalification training and yearly examinations. The goal of the training (both initial and requalification) is to ensure that operators possess adequate knowledge, skills and abilities to prevent an event from progressing to core damage. The use of full-scope simulators in severe accident management training is in large part viewed by the industry as being premature. The working group study has not progressed to the point where the decision to employ full-scope simulators can be logically considered. It is not however premature to consider part-task or work station simulators as invaluable research tools to support the industry's study. These simulators could be employed, subject to limitations in the current state of knowledge regarding severe accident progression and phenomenological responses, in the validation and verification (V and V) of severe accident models or codes as they are developed. The U.S. nuclear utility industry has made substantial strides in the past 12 years in the accident prevention, mitigation and management arena. These strides are a product of the industry's preference for a logical and systematic approach to change. (orig.)

  14. Severe acute renal failure in malaria.

    Directory of Open Access Journals (Sweden)

    Mehta K

    2001-01-01

    Full Text Available BACKGROUND: We have noticed a recent rise in the incidence and severity of acute renal failure (ARF in malaria. AIM: To study the incidence, severity and outcome of ARF in malaria. SETTING and DESIGN: It is a retrospective analysis of data of one year from a tertiary medical centre in a metropolitan city. MATERIALS AND METHODS: Patients with ARF and smear positive malaria were evaluated. STATISTICAL ANALYSIS: Results were expressed as mean, range and standard deviation. RESULTS: Out of 402 detected smear positive malaria, 24 had ARF. Eighteen were of the age group 21-40 years. Plasmodium falciparum (PF was detected in 16, Plasmodium vivax in three, and mixed infection in five. Non-oliguric ARF was seen in 14. Eighteen showed severe ARF (Serum creatinine >5 mg%. Twenty-two patients needed dialysis. Prolonged ARF lasting for 2-6 weeks was seen in eight. Seventeen patients recovered completely, while seven showed fatal combination of disseminated intravascular coagulation (DIC, acute respiratory distress syndrome (ARDS, severe ARF and PF malaria. No response was seen to chloroquine and artesunate given alone and twenty patients required quinine. CONCLUSION: ARF necessitating dialysis was seen in 92% of patients with ARF in malaria. PF infection, severe ARF, DIC and ARDS were poor prognostic factors. Resistance was noted to both chloroquine and artesunate.

  15. Kiss-induced severe anaphylactic reactions

    Directory of Open Access Journals (Sweden)

    Atanasković-Marković Marina

    2010-01-01

    Full Text Available Introduction. Ingestion is the principal route for food allergens to trigger allergic reaction in atopic persons. However, in some highly sensitive patients severe symptoms may develop upon skin contact and by inhalation. The clinical spectrum ranges from mild facial urticaria and angioedema to life-threatening anaphylactic reactions. Outline of Cases. We describe cases of severe anaphylactic reactions by skin contact, induced by kissing in five children with prior history of severe anaphylaxis caused by food ingestion. These cases were found to have the medical history of IgE mediated food allergy, a very high total and specific serum IgE level and very strong family history of allergy. Conclusion. The presence of tiny particles of food on the kisser's lips was sufficient to trigger an anaphylactic reaction in sensitized children with prior history of severe allergic reaction caused by ingestion of food. Allergic reaction provoked with food allergens by skin contact can be a risk factor for generalized reactions. Therefore, extreme care has to be taken in avoiding kissing allergic children after eating foods to which they are highly allergic. Considering that kissing can be a cause of severe danger for the food allergic patient, such persons should inform their partners about the risk factor for causing their food hypersensitivity.

  16. Persistence of muscle catabolism after severe burn.

    Science.gov (United States)

    Hart, D W; Wolf, S E; Mlcak, R; Chinkes, D L; Ramzy, P I; Obeng, M K; Ferrando, A A; Wolfe, R R; Herndon, D N

    2000-08-01

    The hypermetabolic response to severe burn is characterized by muscle protein catabolism. Current opinion states that the hypermetabolic state resolves soon after complete wound closure. Clinically, we have witnessed that burned children appear to be hypermetabolic and catabolic long after full healing of their wounds. Our goal in this study was to determine scientifically if burn-associated hypermetabolism persists after full wound healing. To determine the duration of muscle catabolism and systemic hypermetabolism after severe burn in children, patients with > 40% total body surface area burns were enrolled in a prospective, longitudinal study; resting energy expenditure was measured by indirect calorimetry, muscle protein kinetics were determined by using stable isotopic methodology, and body composition was measured by dual-energy x-ray absorptiometry imaging. Data were collected at 6, 9, and 12 months after injury. The mean total body surface area burned was 65% +/- 13%, and the mean age was 7.6 +/- 1. 5 years. Resting energy expenditure was elevated above the predicted age-matched levels from the Harris-Benedict equation and incrementally declined throughout the 12-month study. The net protein balance and lean mass reflected catabolic persistence at 6 and 9 months after severe burn. Between 9 and 12 months, protein breakdown decreased, net protein balance improved, and lean body mass increased. In severely burned children, hypermetabolism and catabolism remain exaggerated for at least 9 months after injury. This suggests that therapeutic attempts to manipulate the catabolic and hypermetabolic response to severe injury should be continued long after injury.

  17. Management of severe odontogenic infections in pregnancy.

    Science.gov (United States)

    Wong, D; Cheng, A; Kunchur, R; Lam, S; Sambrook, P J; Goss, A N

    2012-12-01

    The objective of this study was to review the management of patients presenting with severe odontogenic infections and who are also pregnant. A retrospective clinical audit was conducted of all female patients admitted to the Royal Adelaide Hospital by the Oral and Maxillofacial Surgery Unit from 1999 to 2009 with severe odontogenic infections. Pregnant patients were identified and their age, medical history, previous obstetric and gynaecological history, stage of current pregnancy, presenting infection, diagnosis and management were recorded, as well as the outcome of the pregnancy. A total of 346 female patients were admitted to the Royal Adelaide Hospital under the care of the Oral and Maxillofacial Surgery Unit with an admission diagnosis of severe odontogenic infection and five were pregnant. Besides surgical and anaesthetic assessment, mother and foetus were assessed by the Obstetric and Gynaecology Unit. In all, five with severe infection were successfully resolved and four proceeded to a normal delivery with a healthy child. The remaining patient had an already planned therapeutic abortion. Pregnant patients with severe odontogenic infections require urgent referral to a tertiary hospital with full surgical, anaesthetic and obstetric services. This allows appropriate management of the complex requirements of mother and foetus. © 2012 Australian Dental Association.

  18. Aetiology and treatment of severe postpartum haemorrhage

    DEFF Research Database (Denmark)

    Edwards, Hellen

    2017-01-01

    delivery. Occurrence and development of PPH are, however, unpredictable and can sometimes give rise to massive haemorrhage or even hysterectomy and maternal death. Severe haemorrhage can lead to coagulopathy causing further haemorrhage and requiring substitution with blood transfusions. The aim...... of this thesis was to investigate causes of severe PPH and investigate methods of early prevention. The first study was a randomised controlled double-blinded trial investigating the effect of treatment with pre-emptive fibrinogen on women with severe PPH. The primary outcome was the need for red blood cell...... had a cardiac arrest, and a total of 128 women (52%) required a hysterectomy. Hysterectomy was associated with increased blood loss, increased number of blood transfusions, a higher fresh frozen plasma to red blood cell ratio (p=0.010), and an increased number of red blood cells before first platelet...

  19. FOXN1 deficient nude severe combined immunodeficiency.

    Science.gov (United States)

    Rota, Ioanna A; Dhalla, Fatima

    2017-01-11

    Nude severe combined immunodeficiency is a rare inherited disease caused by autosomal recessive loss-of-function mutations in FOXN1. This gene encodes a transcription factor essential for the development of the thymus, the primary lymphoid organ that supports T-cell development and selection. To date nine cases have been reported presenting with the clinical triad of absent thymus resulting in severe T-cell immunodeficiency, congenital alopecia universalis and nail dystrophy. Diagnosis relies on testing for FOXN1 mutations, which allows genetic counselling and guides therapeutic management. Options for treating the underlying immune deficiency include HLA-matched genoidentical haematopoietic cell transplantation containing mature donor T-cells or thymus tissue transplantation. Experience from other severe combined immune deficiency syndromes suggests that early diagnosis, supportive care and definitive management result in better patient outcomes. Without these the prognosis is poor due to early-onset life threatening infections.

  20. NPP Krsko Severe Accident Management Guidelines Upgrade

    International Nuclear Information System (INIS)

    Mihalina, Mario; Spalj, Srdjan; Glaser, Bruno; Jalovec, Robi; Jankovic, Gordan

    2014-01-01

    Nuclear Power Plant Krsko (NEK) has decided to take steps for upgrade of safety measures to prevent severe accidents, and to improve the means to successfully mitigate their consequences. The content of the program for the NEK Safety Upgrade is consistent with the nuclear industry response to Fukushima accident, which revealed many new insights into severe accidents. Therefore, new strategies and usage of new systems and components should be integrated into current NEK Severe Accident Management Guidelines (SAMG's). SAMG's are developed to arrest the progression of a core damage accident and to limit the extent of resulting releases of fission products. NEK new SAMG's revision major changes are made due to: replacement of Electrical Recombiners by Passive Autocatalytic Recombiners (PARs) and the installation of Passive Containment Filtered Vent System (PCFV); to handle a fuel damage situation in Spent Fuel Pool (SFP) and to assess risk of core damage situation during shutdown operation. (authors)

  1. Severe metabolic acidosis following assault chemical burn

    Science.gov (United States)

    Roock, Sophie D; Deleuze, Jean-Paul; Rose, Thomas; Jennes, Serge; Hantson, Philippe

    2012-01-01

    Assault chemical burns are uncommon in northern Europe. Besides local toxicity, systemic manifestations are possible after strong acid exposure. A 40-year-old woman was admitted 1 h after a criminal assault with sulfuric acid. The total burned surface area was 35%, third degree. Injury was due to sulfuric acid (measured pH 0.9) obtained from a car battery. Immediate complications were obstructive dyspnea and metabolic acidosis. The admission arterial pH was 6.92, with total bicarbonate 8.6 mEq/l and base deficit 23.4 mEq/l. The correction of metabolic acidosis was achieved after several hours by the administration of bicarbonate and lactate buffers. The patient developed several burns-related complications (sepsis and acute renal failure). Cutaneous projections of strong acids may cause severe metabolic acidosis, particularly when copious irrigation and clothes removal cannot be immediately performed at the scene. PMID:22787349

  2. Decompressive surgery for severe brain edema.

    Science.gov (United States)

    Diedler, Jennifer; Sykora, Marek; Blatow, Maria; Jüttler, Eric; Unterberg, Andreas; Hacke, Werner

    2009-01-01

    Decompressive surgery has since long been a promising therapeutic approach for patients with acute severe brain injury at risk to develop severe brain edema. The underlying rationale of removing part of the cranium is to create space for the expanding brain to prevent secondary damage to vital brain tissue. However, until recently, randomized controlled trials that demonstrate the efficacy of decompressive surgery or benefit for outcome were missing. This has changed since the results of 3 randomized trials on hemicraniectomy in malignant infarction of the middle cerebral artery have been published in 2007. In this article, the current evidence for decompressive surgery in the treatment of cerebral ischemia, intracranial hemorrhage, traumatic brain injury, inflammatory diseases, or severe metabolic derangements is reviewed. Although there is increasing evidence for the efficacy of decompressive surgery in reducing intracranial pressure and even mortality, a critical point remains the definition of good or acceptable outcome.

  3. Severe metabolic acidosis following assault chemical burn

    Directory of Open Access Journals (Sweden)

    Sophie De Roock

    2012-01-01

    Full Text Available Assault chemical burns are uncommon in northern Europe. Besides local toxicity, systemic manifestations are possible after strong acid exposure. A 40-year-old woman was admitted 1 h after a criminal assault with sulfuric acid. The total burned surface area was 35%, third degree. Injury was due to sulfuric acid (measured pH 0.9 obtained from a car battery. Immediate complications were obstructive dyspnea and metabolic acidosis. The admission arterial pH was 6.92, with total bicarbonate 8.6 mEq/l and base deficit 23.4 mEq/l. The correction of metabolic acidosis was achieved after several hours by the administration of bicarbonate and lactate buffers. The patient developed several burns-related complications (sepsis and acute renal failure. Cutaneous projections of strong acids may cause severe metabolic acidosis, particularly when copious irrigation and clothes removal cannot be immediately performed at the scene.

  4. Eating disorder severity and functional impairment

    DEFF Research Database (Denmark)

    Davidsen, Annika Helgadóttir; Hoyt, William T.; Poulsen, Stig Bernt

    2017-01-01

    Purpose: The aim was to examine duration of illness and body mass index as possible moderators of the relationship between eating disorder severity and functional impairment, as well as psychological distress as a possible mediator of this relationship. Methods: The study included 159 patients...... diagnosed with bulimia nervosa, binge eating disorder or eating disorder not otherwise specified. Regression analysis was applied to assess the effect of the hypothesized moderators and mediators. Eating disorder severity was measured with the Eating Disorder Examination Questionnaire, functional impairment...... was measured with the Sheehan Disability Scale, and psychological distress was measured with the Symptom Check List-90-R. Duration of illness and body mass index were assessed clinically. Results: Duration of illness significantly moderated the relationship between eating disorder severity and functional...

  5. Harmonic and complex analysis in several variables

    CERN Document Server

    Krantz, Steven G

    2017-01-01

    Authored by a ranking authority in harmonic analysis of several complex variables, this book embodies a state-of-the-art entrée at the intersection of two important fields of research: complex analysis and harmonic analysis. Written with the graduate student in mind, it is assumed that the reader has familiarity with the basics of complex analysis of one and several complex variables as well as with real and functional analysis. The monograph is largely self-contained and develops the harmonic analysis of several complex variables from the first principles. The text includes copious examples, explanations, an exhaustive bibliography for further reading, and figures that illustrate the geometric nature of the subject. Each chapter ends with an exercise set. Additionally, each chapter begins with a prologue, introducing the reader to the subject matter that follows; capsules presented in each section give perspective and a spirited launch to the segment; preludes help put ideas into context. Mathematicians and...

  6. Severe accident testing of a personnel airlock

    International Nuclear Information System (INIS)

    Clauss, D.B.; Parks, M.B.; Julien, J.T.; Peters, S.W.

    1988-01-01

    Sandia National Laboratories (Sandia) is investigating the leakage potential of mechanical penetrations as part of a research program on containment integrity under severe accident loads for the U.S. Nuclear Regulatory Commission (NRC). Barnes et al. (1984) and Shackelford et al. (1985) identified leakage from personnel airlocks as an important failure mode of containments subject to severe accident loads. However, these studies were based on relatively simple analysis methods. The complex structural interaction between the door, gasket, and bulkhead in personnel airlocks makes analytical evaluation of leakage difficult. In order to provide data to validate methods for evaluating the leakage potential, a full-size personnel airlock was subject to simulated severe accident loads consisting of pressure and temperature up to 300 psig and 800 degrees F. The test was conducted at Chicago Bridge and Iron under contract to Sandia. The authors provide a detailed report on the test program

  7. [Severe vaginal discharge following rectal surgery].

    Science.gov (United States)

    Burg, L C; Bremers, A J A; Heesakkers, J P F A; Kluivers, K B

    2018-01-01

    Almost 50% of women who have had rectal surgery subsequently develop vaginal discharge. Due to the recurrent and unexpected nature of this heavy discharge, they often experience it as very distressing. Many of these women undergo extensive diagnostic tests that are mainly focused on identifying fistula formation. If no fistula is found, in most cases no other cause for severe vaginal discharge can be demonstrated. In our practice, we saw three patients (49-, 54- and 74-years-old, respectively) with similar severe vaginal discharge after rectal surgery and in whom no explanation for the vaginal discharge could be found. For this reason we conducted a literature search into this condition. Anatomical changes appear to be responsible for heavy vaginal discharge following rectal surgery. Changes in pelvic floor muscles and compression of the distal part of the vagina may lead to pooling of fluid in the proximal part of the vagina, resulting in severe discharge. Symptomatic treatment may reduce the symptoms.

  8. Management of severe hypertension in the newborn.

    Science.gov (United States)

    Dionne, Janis M; Flynn, Joseph T

    2017-12-01

    Blood pressure is considered a vital sign, as values too low or too high can be related with serious morbidity and mortality. In neonates, normal blood pressure values undergo rapid changes, especially in premature infants, making the recognition of abnormal blood pressures more challenging. Severe hypertension can occur in neonates and infants and is a medical emergency, often manifesting with congestive heart failure or other life-threatening complications. The cause or risk factors for the hypertension can usually be identified and may guide management. Most classes of antihypertensive medications have been used in the neonatal population. For severe hypertension, intravenous short-acting medications are preferred for a controlled reduction of blood pressure. In this article, we focus on identification, aetiology and management of severe hypertension in the newborn. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  9. Severe odontogenic infection: An emergency. Case report.

    Science.gov (United States)

    Guzmán-Letelier, Marcelo; Crisosto-Jara, Claudia; Diaz-Ricouz, Camilo; Peñarrocha-Diago, Miguel; Peñarrocha-Oltra, David

    2017-02-01

    Odontogenic infections (OI) are a major reason for consultation in dental practice. They affect people of all ages, and most of them respond well to current medical and surgical treatments. However, some OI can spread to vital and deep structures, overcome the host immune system - especially in diabetic, immunocompromised or weakened patients - and even prove fatal. Ludwig's angina is a severe form of diffuse cellulitis that can have an acute onset and spread very rapidly, bilaterally affecting areas of the head and neck, and may prove life threatening. A case of severe dental infection is presented in which emphasis is placed on the importance of airway maintenance, followed by surgical decompression under adequate antibiotic coverage. Key words: Ludwig's angina, severe odontogenic infection, surgical decompression, dental infection.

  10. Current management of severe dengue infection.

    Science.gov (United States)

    Lee, Tau Hong; Lee, Linda Kay; Lye, David Chien; Leo, Yee Sin

    2017-01-01

    Traditionally a disease mainly affecting the pediatric population, dengue burden has increased significantly in recent decades and adults with severe disease may become more common. There is currently no effective anti-viral agent available for the treatment of dengue and supportive care is the mainstay of management. Areas covered: We present a review of current literature on dengue severity classification systems and the management of severe dengue in adults. In particular, emphasis was placed on organ impairment in dengue and management of elderly individuals with multiple medical problems. Expert commentary: There is an urgent need to search for an effective anti-viral agent to treat infected individuals. The commercial availability of a dengue vaccine in older children has provided optimism in reducing the disease burden but long term efficacy and safety are unknown. The results from phase III trials of two new candidate vaccines are eagerly awaited.

  11. Long-term outcomes after severe shock.

    Science.gov (United States)

    Pratt, Cristina M; Hirshberg, Eliotte L; Jones, Jason P; Kuttler, Kathryn G; Lanspa, Michael J; Wilson, Emily L; Hopkins, Ramona O; Brown, Samuel M

    2015-02-01

    Severe shock is a life-threatening condition with very high short-term mortality. Whether the long-term outcomes among survivors of severe shock are similar to long-term outcomes of other critical illness survivors is unknown. We therefore sought to assess long-term survival and functional outcomes among 90-day survivors of severe shock and determine whether clinical predictors were associated with outcomes. Seventy-six patients who were alive 90 days after severe shock (received ≥1 μg/kg per minute of norepinephrine equivalent) were eligible for the study. We measured 3-year survival and long-term functional outcomes using the Medical Outcomes Study 36-Item Short-Form Health Survey, the EuroQOL 5-D-3L, the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised, and an employment instrument. We also assessed the relationship between in-hospital predictors and long-term outcomes. The mean long-term survival was 5.1 years; 82% (62 of 76) of patients survived, of whom 49 were eligible for follow-up. Patients who died were older than patients who survived. Thirty-six patients completed a telephone interview a mean of 5 years after hospital admission. The patients' Physical Functioning scores were below U.S. population norms (P shock had a high 3-year survival rate. Patients' long-term physical and psychological outcomes were similar to those reported for cohorts of less severely ill intensive care unit survivors. Anxiety and depression were relatively common, but only a few patients had symptoms of posttraumatic stress disorder. This study supports the observation that acute illness severity does not determine long-term outcomes. Even extremely critically ill patients have similar outcomes to general intensive care unit survivor populations.

  12. Speech rate according to stuttering severity.

    Science.gov (United States)

    Arcuri, Cláudia Fassin; Osborn, Ellen; Schiefer, Ana Maria; Chiari, Brasília Maria

    2009-01-01

    Speech duration has been the subject of acoustic studies due to its relationship with rhythm and speech rate. The speech analysis of stutterers has revealed data which often differs from that found in non-stutterers. These differences most likely stem from timing disturbances related to speech motor control. To compare the speech rates of individuals presenting different stuttering severity levels. Participants were 6 adult stutterers with the following severity levels: 2 with mild stuttering; 2 with moderate stuttering and 2 with severe stuttering. The words 'cavalo' (horse), 'pipoca' (popcorn) and 'tapete' (carpet) were introduced in a carrier phrase, 'Digo......baixinho' (Say ......in a low voice). Each phrase was uttered by the researcher and then repeated aloud 3 times by the participants while being recorded in a computer. Utterances containing speech disruptions were discarded. Subsequently, timing measurements were made, using the Praat 4.2 software. Utterances were divided into segments delimited by two consecutive voice onsets, and speech rate was then calculated (number of vowel-vowel segments divided by the total sum of duration of the segments). The data were analyzed statistically using ANOVA. The group with mild/moderate stuttering presented higher and similar speech rates, differing statistically from the group with severe stuttering, therefore indicating that the higher the severity of stuttering, the lower the speech rate. This difference seems to be related to difficulties in motor programming, affecting mainly the rhythm and the timing of discourse. The rate of fluent speech during a repetition task differentiated the studied individuals according to the severity of stuttering.

  13. Climate change effects on drought severity

    Directory of Open Access Journals (Sweden)

    A. Loukas

    2008-06-01

    Full Text Available This paper evaluates climate change effects on drought severity in the region of Thessaly, Greece. The Standardized Precipitation Index (SPI has been used for estimation of drought severity. A geographical information system is applied for the division of Thessaly region to twelve hydrological homogeneous areas based on their geomorphology. Mean monthly precipitation values from 50 precipitation stations of Thessaly for the hydrological period October 1960–September 1990 were used for the estimation of mean areal precipitation. These precipitation timeseries have been used for the estimation of Standardized Precipitation Index (SPI for multiple time scales (1-, 3-, 6-, 9-, and 12-months for each sub-basin or area. The outputs of Global Circulation Model CGCM2 were applied for two socioeconomic scenarios, namely, SRES A2 and SRES B2 for the assessment of climate change impact on droughts. The GCM outputs were downscaled to the region of Thessaly using a statistical methodology to estimate precipitation time series for two future periods 2020–2050 and 2070–2100. A method has been proposed for the estimation of annual cumulative drought severity-time scale-frequency curves. These curves integrate the drought severity and frequency for various types of drought. The SPI timeseries and annual weighted cumulative drought severity were estimated and compared with the respective timeseries and values of the historical period 1960–1990. The results showed that the annual drought severity is increased for all hydrological areas and SPI time scales, with the socioeconomic scenario SRES A2 being the most extreme.

  14. Urine methanol concentration and alcohol hangover severity.

    Science.gov (United States)

    Mackus, M; Van de Loo, A J A E; Korte-Bouws, G A H; Van Neer, R H P; Wang, X; Nguyen, T T; Brookhuis, K A; Garssen, J; Verster, J C

    2017-03-01

    Congeners are substances, other than ethanol, that are produced during fermentation. Previous research found that the consumption of congener-rich drinks contributes to the severity of alcohol hangover. Methanol is such a congener that has been related to alcohol hangover. Therefore, the aim of this study was to examine the relationship between urine methanol concentration and alcohol hangover severity. N = 36 healthy social drinkers (22 females, 14 males), aged 18-30 years old, participated in a naturalistic study, comprising a hangover day and a control day (no alcohol consumed the previous day). N = 18 of them had regular hangovers (the hangover group), while the other N = 18 claimed to be hangover-immune (hangover-immune group). Overall hangover severity was assessed, and that of 23 individual hangover symptoms. Urine methanol concentrations on the hangover and control days were compared, and correlated to hangover (symptom) severity. Urine methanol concentration was significantly higher on hangover days compared to control days (p = 0.0001). No significant differences in urine methanol concentration were found between the hangover group and hangover-immune group. However, urine methanol concentration did not significantly correlate with overall hangover severity (r = -0.011, p = 0.948), nor with any of the individual hangover symptoms. These findings were observed also when analyzing the data separately for the hangover-immune group. In the hangover group, a significant correlation with urine methanol concentration was found only with vomiting (r = 0.489, p = 0.037). No significant correlation was observed between urine methanol concentration and hangover severity, nor with individual core hangover symptoms. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Idiopathic Polyhydramnios: Severity and Perinatal Morbidity.

    Science.gov (United States)

    Wiegand, Samantha L; Beamon, Carmen J; Chescheir, Nancy C; Stamilio, David

    2016-06-01

    Objective To estimate the association between the severity of idiopathic polyhydramnios and adverse outcomes. Study Design Retrospective cohort study of deliveries at one hospital from 2000 to 2012 with an amniotic fluid index (AFI) measurement ≥24 + 0 weeks' gestation. Pregnancies complicated by diabetes, multiples, or fetal anomalies were excluded. Exposure was the degree of polyhydramnios: normal (AFI 5-24 cm), mild (≥ 24-30 cm), and moderate-severe (> 30 cm). Primary outcomes were perinatal mortality, neonatal intensive care unit (NICU) admission, and postpartum hemorrhage. Results There were 10,536 pregnancies: 10,188 with a normal AFI, 274 mild (78.74%), and 74 moderate-severe polyhydramnios (21.26%). Adverse outcomes were increased with idiopathic polyhydramnios: NICU admission (adjusted odds ratio [AOR] 3.71, 95% confidence interval [CI] 2.77-4.99), postpartum hemorrhage (AOR 15.81, 95% CI 7.82-31.96), macrosomia (AOR 3.41, 95% CI 2.61-4.47), low 5-minute Apgar score (AOR 2.60, 95% CI 1.57-4.30), and cesarean (AOR 2.16, 95% CI 1.74-2.69). There were increasing odds of macrosomia (mild: AOR 3.19, 95% CI 2.36-4.32; moderate-severe: AOR 4.44, 95% CI 2.53-7.79) and low 5-minute Apgar score (mild: AOR 2.24, 95% CI 1.23-4.08; moderate-severe: AOR 3.93, 95% CI 1.62-9.55) with increasing severity of polyhydramnios. Conclusion Idiopathic polyhydramnios is independently associated with increased risks of morbidity. There appears to be a dose-response relationship for neonatal macrosomia and low 5-minute Apgar score risks. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  16. Postpartum depression after mild and severe preeclampsia.

    Science.gov (United States)

    Hoedjes, Meeke; Berks, Durk; Vogel, Ineke; Franx, Arie; Bangma, Meike; Darlington, Anne-Sophie E; Visser, Willy; Duvekot, Johannes J; Habbema, J Dik F; Steegers, Eric A P; Raat, Hein

    2011-10-01

    To describe the prevalence of postpartum depressive symptoms after preeclampsia, to assess the extent to which the prevalence of postpartum depressive symptoms differs after mild and severe preeclampsia, and to investigate which factors contribute to such differences. Women diagnosed with preeclampsia (n=161) completed the Edinburgh Postnatal Depression Scale (EPDS) at 6, 12, or 26 weeks postpartum. Multiple logistic regression analysis was used to investigate the association between severity of preeclampsia, contributing factors and postpartum depression (PPD) (1) at any time during the first 26 weeks postpartum and (2) accounting for longitudinal observations at three time points. After mild preeclampsia, 23% reported postpartum depressive symptoms at any time up to 26 weeks postpartum compared to 44% after severe preeclampsia (unadjusted odds ratio [OR] 2.65, 95% confidence interval [CI] 1.16-6.05) for depression at any time up to 26 weeks postpartum (unadjusted OR 2.57, 95% CI, 1.14-5.76) while accounting for longitudinal observations. Admission to the neonatal intensive care unit (NICU) (adjusted OR 3.19, 95% CI 1.15-8.89) and perinatal death (adjusted OR 2.96, 95% CI 1.09-8.03) contributed to this difference. It appears that not the severity of preeclampsia itself but rather the consequences of the severity of the disease (especially admission to the NICU and perinatal death) cause postpartum depressive symptoms. Obstetricians should be aware of the high risk of postpartum depressive symptoms after severe preeclampsia, particularly among women whose infant has been admitted to the NICU or has died.

  17. [Severe Raynaud's syndrome treated by lumbar sympathectomy].

    Science.gov (United States)

    Thomsen, Thomas Laden; Roeder, Ole

    2016-03-28

    Avoiding exposure of extremities to cold combined with pharmacologic treatment usually suffice in the attempt to suppress the related symptoms of Raynaud's syndrome. This case report describes a severe case of Raynaud's syndrome affecting the lower extremities of a 16-year-old female. She was referred to a centre of vascular surgery with severe vasospasms of the feet. After failed attempts of pharmacologic treatment, a laparoscopic lumbar sympathectomy was performed with no complications and a slight reduction of symptoms three years post-surgically.

  18. Lectures on counterexamples in several complex variables

    CERN Document Server

    Fornæss, John Erik

    2007-01-01

    Counterexamples are remarkably effective for understanding the meaning, and the limitations, of mathematical results. Fornæss and Stensønes look at some of the major ideas of several complex variables by considering counterexamples to what might seem like reasonable variations or generalizations. The first part of the book reviews some of the basics of the theory, in a self-contained introduction to several complex variables. The counterexamples cover a variety of important topics: the Levi problem, plurisubharmonic functions, Monge-Ampère equations, CR geometry, function theory, and the \\bar\\

  19. Severe Hyperlipidemia Induced Hemorrhagic Pancreatitis during Pregnancy

    Directory of Open Access Journals (Sweden)

    Karen L. Koscica

    2009-01-01

    Full Text Available Background. We report a case of familial hyperlipidemia in pregnancy that resulted in hemorrhagic pancreatitis. Case. A patient at 27-week gestation was admitted for recurrent pancreatitis secondary to severe hyperlipidemia. With conservative care, the patient improved but on the fourth day of admission she experienced a sudden onset of hypotension and was diagnosed with hemorrhagic pancreatitis. Conclusion. Pancreatitis caused by hyperlipidemia is an uncommon event during pregnancy. A familiarity with the severe complications associated with this potentially life-threatening condition is important.

  20. Severe hypoglycaemia associated with ingesting counterfeit medication.

    Science.gov (United States)

    Chaubey, Santosh K; Sangla, Kunwarjit S; Suthaharan, Emershia N; Tan, Yong M

    2010-06-21

    Cross-border importation of traditional and prescription medications is common, and many of these drugs are not approved by the Australian Therapeutic Goods Administration. Furthermore, counterfeit versions of prescription medications are also available (eg, weight-loss medications, anabolic steroids, and medications to enhance sexual performance). We describe a 54-year-old man with the first Australian case of severe hypoglycaemia induced by imported, laboratory-confirmed counterfeit Cialis. This serves to remind medical practitioners that counterfeit medication may be the cause of severe hypoglycaemia (or other unexplained illness).

  1. Analytic functions of several complex variables

    CERN Document Server

    Gunning, Robert C

    2009-01-01

    The theory of analytic functions of several complex variables enjoyed a period of remarkable development in the middle part of the twentieth century. After initial successes by Poincaré and others in the late 19th and early 20th centuries, the theory encountered obstacles that prevented it from growing quickly into an analogue of the theory for functions of one complex variable. Beginning in the 1930s, initially through the work of Oka, then H. Cartan, and continuing with the work of Grauert, Remmert, and others, new tools were introduced into the theory of several complex variables that resol

  2. Cylindrical pressure vessel constructed of several layers

    International Nuclear Information System (INIS)

    Yamauchi, Takeshi.

    1976-01-01

    For a cylindrical pressure vessel constructed of several layers whose jacket has at least one circumferential weld joining the individual layers, it is proposed to provide this at least at the first bending line turning point (counting from the weld between the jacket and vessel floor), which the sinusoidally shaped jacket has. The section of the jacket extending in between should be made as a full wall section. The proposal is based on calculations of the bending stiffness of cylindrical jackets, which could not yet be confirmed for jackets having several layers. (UWI) [de

  3. Concrete under severe conditions. Environment and loading

    International Nuclear Information System (INIS)

    2007-01-01

    The objective of the CONSEC Conferences is to focus on concrete infrastructures, either subjected to severe environment or severe loading, or any combination of severe conditions. Experience from the performance of existing concrete structures, and especially under severe environmental conditions, severe accidental loading or extended lifespan, has demonstrated the need for better integration of structural and durability design, new design concepts including reliability-based durability design, performance-based material requirements, structural robustness, and an improved basis for documentation of obtained construction quality and durability properties during concrete construction. An improved basis for operation and preventive maintenance of concrete structures including repairs and retrofitting is also very important. Premature corrosion of reinforcing steel, inadequate structural design for seismic or blast loading, are examples of reduced service life of concrete structures that not only represent technical and economical problems, but also a huge waste of natural resources and hence also, an environmental and ecological problem. Experience of structures effectively submitted to severe conditions represents a unique benchmark for quantifying the actual safety and durability margin of concrete structures. In fact for several reasons, most concrete design codes, job specifications and other requirements for concrete structures have frequently shown to yield insufficient and unsatisfactory results and ability to solve the above problems, as well as issues raised by specific very long-term or very severe requirements for nuclear and industrial waste management, or civil works of strategic relevance. Recently available high to ultra-high performance concrete may find rational and valuable application in such cases. It is very important, therefore, to bring people with different professional backgrounds together to exchange experience and develop multi

  4. Estuary wader capacity following severe weather mortality

    International Nuclear Information System (INIS)

    Clark, J.A.; Baillie, S.R.; Clark, N.A.; Langston, R.H.W.

    1993-01-01

    The building of a tidal power barrage across an estuary may lead to substantial changes in its ecology. Many of Britain's estuaries hold internationally important numbers of waders. Careful consideration, therefore, needs to be given to the likely effects of tidal power barrages on wader populations. The opportunity for increased understanding of the mechanisms which govern wader populations was provided by a period of severe winter weather in 1991, which resulted in a substantial mortality of waders in eastern England. Such conditions are known to be stressful to birds and the study objectives were to investigate both the effects of and recovery from severe weather. (author)

  5. [Severe infections : causes and management of sepsis].

    Science.gov (United States)

    Salzberger, B; Hanses, F; Birkenfeld, G; Langgartner, J

    2013-08-01

    The sepsis syndrome has only recently been defined as a clinical syndrome but despite its unspecific definition it has evolved rapidly into an important concept. Although specific therapeutic interventions targeting the inflammatory pathway have not yet been effective in treating sepsis, a better understanding of mechanisms leading to organ dysfunction has led to better management of patients with sepsis. Clinical signs of systemic inflammatory response syndrome (SIRS) or sepsis are hallmarks for the definition of severe infections. Current guidelines are presented for the management of a number of severe infectious syndromes.

  6. Palmar Eccrine Hidradenitis Secondary to Trauma from Computer Gaming in an Adolescent After Bone Marrow Transplantation.

    Science.gov (United States)

    Lee, Lynette Ying; Koh, Mark Jean-Aan

    2017-09-01

    A 14-year-old boy who had undergone a matched sibling bone marrow transplant for acute lymphoblastic leukemia presented with painful nodules on his palms after prolonged gaming on his computer and mobile phone. Histology showed a neutrophilic inflammatory infiltrate surrounding the acrosyringium and eccrine sweat coils in the deep dermis. The lesions resolved spontaneously with conservative management. © 2017 Wiley Periodicals, Inc.

  7. Therapy of moderate and severe psoriasis

    Directory of Open Access Journals (Sweden)

    Werfel, Thomas

    2006-04-01

    Full Text Available Objective and methods: This health technology assessment (HTA report synthesises systematically randomized controlled studies (RCT on the therapy of moderate and severe psoriasis vulgaris which were published between 1999 and 2004; it includes some important clinical studies which have been published after 2004 and thus updates the English HTA report by Griffiths et al. [1]. The major objective is the evaluation of the medical effectiveness of different therapeutical approaches and the cost effectiveness with relevance for Germany. Results: The major conclusions from the results of medical RCT on moderate and severe psoriasis vulgaris are: Oral fumarates are effective in the treatment of moderate to severe psoriasis vulgaris. However, fumarates quiet frequently cause moderate side effects. Cyclosporine and methotrexate are both effective in the treatment of severe psoriasis vulgaris. Both substances have a different spectrum of side effects which may limit the individual applicability. Acetritin is only moderately effective in the treatment of severe psoriasis of the plaque type. Calcipotriol or UV-radiation used at the same time can increase the clinical effectiveness of acetritin. Systemic PUVA, balneo-PUVA and UVB therapy are all effective for the treatment of severe psoriasis. The combination of UV therapy with vitamin D3 analogues or with topical steroids is more effective than the treatment with UV radiation alone. Saltwater baths increase the effectiveness of UVB therapy. No RCT on the therapeutical effects of topical tar or of dithranol in combination with UV therapy have been published so far. A continuous therapy with PUVA should not be applied due to its proven photocarcinogenicity. Three substances from the group of biologicals (Efalizumab, Etanercept, and Infliximab are now available in Europe and a further substance (Alefacept is available in the USA for the treatment of moderate to severe psoriasis. All biologicals have been

  8. Therapy of moderate and severe psoriasis.

    Science.gov (United States)

    Claes, Christa; Kulp, Werner; Greiner, Wolfgang; von der Schulenburg, Johann-Matthias; Werfel, Thomas

    2006-04-26

    This health technology assessment (HTA) report synthesises systematically randomized controlled studies (RCT) on the therapy of moderate and severe psoriasis vulgaris which were published between 1999 and 2004; it includes some important clinical studies which have been published after 2004 and thus updates the English HTA report by Griffiths et al. [1]. The major objective is the evaluation of the medical effectiveness of different therapeutical approaches and the cost effectiveness with relevance for Germany. The major conclusions from the results of medical RCT on moderate and severe psoriasis vulgaris are: Oral fumarates are effective in the treatment of moderate to severe psoriasis vulgaris. However, fumarates quiet frequently cause moderate side effects. Cyclosporine and methotrexate are both effective in the treatment of severe psoriasis vulgaris. Both substances have a different spectrum of side effects which may limit the individual applicability. Acetritin is only moderately effective in the treatment of severe psoriasis of the plaque type. Calcipotriol or UV-radiation used at the same time can increase the clinical effectiveness of acetritin. Systemic PUVA, balneo-PUVA and UVB therapy are all effective for the treatment of severe psoriasis. The combination of UV therapy with vitamin D3 analogues or with topical steroids is more effective than the treatment with UV radiation alone. Saltwater baths increase the effectiveness of UVB therapy. No RCT on the therapeutical effects of topical tar or of dithranol in combination with UV therapy have been published so far. A continuous therapy with PUVA should not be applied due to its proven photocarcinogenicity. Three substances from the group of biologicals (Efalizumab, Etanercept, and Infliximab) are now available in Europe and a further substance (Alefacept) is available in the USA for the treatment of moderate to severe psoriasis. All biologicals have been effective in placebo controlled studies. The

  9. Establishing and Validating an Ichthyosis Severity Index.

    Science.gov (United States)

    Marukian, Nareh V; Deng, Yanhong; Gan, Geliang; Ren, Ivy; Thermidor, Wisblaude; Craiglow, Brittany G; Milstone, Leonard M; Choate, Keith A

    2017-09-01

    We designed and validated a Visual Index for Ichthyosis Severity for scale and erythema that provides (1) written descriptions of the features characteristic of each level of severity, (2) visual standards for four body sites, and (3) two distinct standards to account for different types of scale. We tested the Visual Index for Ichthyosis Severity for reliability and reproducibility using two different settings: one that utilized scoring of 60 test photographs by 10 dermatologists, and one with in-person evaluations on 85 subjects by 12 dermatologists at the Foundation for Ichthyosis and Related Skin Types conference. The validation process revealed high reliability and reproducibility for both scale and erythema. The interrater and intrarater intraclass correlation coefficients for scale were consistently near or greater than 0.7 in both settings. By contrast, the interrater reliability for erythema was higher during in-person validation compared with validation on test photographs. Our analysis indicates that the Visual Index for Ichthyosis Severity performs better in person than with photographs, an important consideration in the design of clinical trials. Power analysis predicts that a 1-point difference on this 5-step scale would be detectable with 12 subjects in each of two defined groups. This index provides a tool for clinical phenotyping and assessment of therapeutic response for many disorders of keratinization. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  10. Severe Hailstorm in Nepal: A case study

    Science.gov (United States)

    Aryal, D.

    2017-12-01

    During the pre-monsoon months (March-May) in Nepal, severe thunder and hailstorms cause significant property and agricultural damage in addition to loss of life from lightening. Forecasting thunderstorm severity remains a challenge even in wealthy, developed countries that have modern meteorological data gathering infrastructure, such as Doppler Radar. This study attempts to isolate the specific and unique characteristics of a hailstorm that not only might explain its severity, but also suggest forecasting techniquees for future forecasting in Nepal. The primary data sources for this investigation included Infrared Satellite images, which illustrated the sequences of convective activity, and original archived ESRL India and China upper air data, which was used for synoptic and mesoscale analyses. On May 3, 2001 between the hours of 1100pm and midnight, a severe thunderstorm accompanied by hail stones estimated at 1kg, devastated the village of Thori (Southern border to India). 800 thatched houses were destroyed, over 500 farm animals were killed and more than 200 hectares of crops lost. Many inhabitants were injured, but luckily only one death. Thori hailstorm had its origins in a topographically induced lee-side convergence area in the deserts of Pakistan on May 2, 2001, from where it propagated eastwards into India and evolved into an eastward travelling Mesoscale Convective System reaching Thori near midnight on May 3. Atmospheric instability over the Gangetic Plains, fuelled by a very active surface heat low, cold temperatures and dynamic lifting mechanisms aloft, created a synoptic and mesoscale environment capable of generating a dangerous thunderstorm.

  11. Determinants of severe periodontal disease among diabetes ...

    African Journals Online (AJOL)

    Aim: To determine the prevalence and factors associated with severe periodontal disease among diabetic patients. Design: Cross sectional study. Study subjects and methods: Diabetes mellitus patients visiting their regularly scheduled medical review at NCH Diabetic clinic participated in the study. Data collection was ...

  12. Urine methanol concentration and alcohol hangover severity

    NARCIS (Netherlands)

    Mackus, Marlou; Van de Loo, A J A E; Korte-Bouws, G A H; van Neer, Renier H P; Wang, X; Nguyen, T T; Brookhuis, Karel A; Garssen, J; Verster, J C

    BACKGROUND: Congeners are substances, other than ethanol, that are produced during fermentation. Previous research found that the consumption of congener-rich drinks contributes to the severity of alcohol hangover. Methanol is such a congener that has been related to alcohol hangover. Therefore, the

  13. Severe Hypertriglyceridaemia as a result of Familial ...

    African Journals Online (AJOL)

    Lipoprotein lipase deficiency causes severe hypertriglyceridaemia due to chylomicronaemia, and leads to recurrent and potentially life-threatening pancreatitis. This disorder can only be managed by dietary fat restriction as drugs are ineffective. We review the experience with familial chylomicronaemia in patients who ...

  14. Protein metabolism in severe childhood malnutrition

    Science.gov (United States)

    The major clinical syndromes of severe childhood malnutrition (SCM) are marasmus (non-oedematous SCM), kwashiorkor and marasmic-kwashiorkor (oedematous SCM). Whereas treatment of marasmus is straightforward and the associated mortality is low, kwashiorkor and marasmic-kwashiorkor are difficult to tr...

  15. Severe combined immunodeficiency--an update.

    Science.gov (United States)

    Cirillo, Emilia; Giardino, Giuliana; Gallo, Vera; D'Assante, Roberta; Grasso, Fiorentino; Romano, Roberta; Di Lillo, Cristina; Galasso, Giovanni; Pignata, Claudio

    2015-11-01

    Severe combined immunodeficiencies (SCIDs) are a group of inherited disorders responsible for severe dysfunctions of the immune system. These diseases are life-threatening when the diagnosis is made too late; they are the most severe forms of primary immunodeficiency. SCID patients often die during the first two years of life if appropriate treatments to reconstitute their immune system are not undertaken. Conventionally, SCIDs are classified according either to the main pathway affected by the molecular defect or on the basis of the specific immunologic phenotype that reflects the stage where the blockage occurs during the differentiation process. However, during the last few years many new causative gene alterations have been associated with unusual clinical and immunological phenotypes. Many of these novel forms of SCID also show extra-hematopoietic alterations, leading to complex phenotypes characterized by a functional impairment of several organs, which may lead to a considerable delay in the diagnosis. Here we review the biological and clinical features of SCIDs paying particular attention to the most recently identified forms and to their unusual or extra-immunological clinical features. © 2015 New York Academy of Sciences.

  16. Coexisting Problem Behaviour in Severe Dyslexia

    Science.gov (United States)

    Dahle, Anne Elisabeth; Knivsberg, Ann-Mari; Andreassen, Anne Brit

    2011-01-01

    A small group of children and young adolescent with dyslexia has severely impaired reading skills despite prolonged special education. These are the students in focus. In dyslexia, problem behaviour, internalised as well as externalised, has previously been reported, so also for the participants with dyslexia in this study. The aim of the present…

  17. Urine ethanol concentration and alcohol hangover severity

    NARCIS (Netherlands)

    Brookhuis, Karel; Van De Loo, Aurora; Mackus, M.; Verster, Joris

    Background The aim of this study was to examine the relationship between urine ethanol concentration and alcohol hangover severity. Methods N = 36 healthy social drinkers participated in a naturalistic study, comprising a hangover day and a control day. N = 18 of them have regular hangovers (the

  18. Golimumab for moderate to severe ulcerative colitis

    NARCIS (Netherlands)

    Strik, Anne S.; Berends, Sophie E.; Mathôt, Ron A.; D'Haens, Geert R.; Löwenberg, Mark

    2017-01-01

    Golimumab (GLM) is a subcutaneously administered human anti-tumor necrosis factor (TNF) agent that has been approved by the regulatory authorities for the treatment of moderate to severe ulcerative colitis (UC) in 2013. Areas covered: Maintained clinical remission rates up to 50% have been shown in

  19. Convex trace functions of several variables

    DEFF Research Database (Denmark)

    Hansen, Frank

    2002-01-01

    We prove that the function (x1,...,xk)¿Tr(f(x1,...,xk)), defined on k-tuples of symmetric matrices of order (n1,...,nk) in the domain of f, is convex for any convex function f of k variables. The matrix f(x1,...,xk) is defined by the functional calculus for functions of several variables, and it ...

  20. Synthesis of several new carbapenem antibiotics.

    Science.gov (United States)

    Ohtani, M; Watanabe, F; Narisada, M

    1985-05-01

    A synthesis of several carbapenem antibiotics including 9-methoxythienamycin is described. The final deprotection of C-3 esters was accomplished by a novel procedure using aluminum trichloride under a very mild condition. The antibacterial activity against Gram-positive and Gram-negative bacteria is shown.

  1. Genetics of Asthma Susceptibility and Severity

    NARCIS (Netherlands)

    Slager, Rebecca E.; Hawkins, Gregory A.; Li, Xingnan; Postma, Dirkje S.; Meyers, Deborah A.; Bleecker, Eugene R.

    This article summarizes major findings in genome-wide studies of asthma susceptibility and severity. Two large meta-analyses identified four chromosomal regions which were consistently associated with development of asthma. Genes that are associated with asthma subphenotypes such as lung function,

  2. Severe Accident Test Station Activity Report

    Energy Technology Data Exchange (ETDEWEB)

    Pint, Bruce A [ORNL; Terrani, Kurt A [ORNL

    2015-06-01

    Enhancing safety margins in light water reactor (LWR) severe accidents is currently the focus of a number of international R&D programs. The current UO2/Zr-based alloy fuel system is particularly susceptible since the Zr-based cladding experiences rapid oxidation kinetics in steam at elevated temperatures. Therefore, alternative cladding materials that offer slower oxidation kinetics and a smaller enthalpy of oxidation can significantly reduce the rate of heat and hydrogen generation in the core during a coolant-limited severe accident. In the U.S. program, the high temperature steam oxidation performance of accident tolerant fuel (ATF) cladding solutions has been evaluated in the Severe Accident Test Station (SATS) at Oak Ridge National Laboratory (ORNL) since 2012. This report summarizes the capabilities of the SATS and provides an overview of the oxidation kinetics of several candidate cladding materials. A suggested baseline for evaluating ATF candidates is a two order of magnitude reduction in the steam oxidation resistance above 1000ºC compared to Zr-based alloys. The ATF candidates are categorized based on the protective external oxide or scale that forms during exposure to steam at high temperature: chromia, alumina, and silica. Comparisons are made to literature and SATS data for Zr-based alloys and other less-protective materials.

  3. Severe sepsis and septic shock [author's reply

    NARCIS (Netherlands)

    Angus, Derek C.; van der Poll, Tom

    2013-01-01

    To the Editor: We would like to address two potentially confusing issues concerning venous oxygen saturation (Svo(2)) as presented in Table 1 of the review by Angus and van der Poll (Aug. 29 issue).(1) First, Table 1 suggests that Svo(2) is raised in sepsis, severe sepsis, and septic shock.

  4. Caffeinated drinks, alcohol consumption and hangover severity

    NARCIS (Netherlands)

    Penning, R.; de Haan, L.; Verster, J.C.

    2011-01-01

    This study examined the relationship between consumption of caffeinated beverages and alcohol, and effects on next day hangover severity. In 2010, a survey funded by Utrecht University was conducted among N=549 Dutch students. Beverages consumed on their latest drinking session that produced a

  5. Severe aortic valve stenosis and nosebleed

    NARCIS (Netherlands)

    Schoedel, Johannes; Obergfell, Achim; Maass, Alexander H.; Schodel, Johannes

    2007-01-01

    Aortic valve stenosis is known to be associated with loss of high molecular von Willebrand multimers. This can lead to gastrointestinal bleeding in patients with gastrointestinal angiodysplasia, the Heyde syndrome. Here we present a case of anaemia and severe epistaxis associated with acquired von

  6. Severe Organophosphate Poisoning with Delayed Cholinergic ...

    African Journals Online (AJOL)

    Organophosphate compounds are the organic derivatives of Phosphorous containing acids and their effect on neuromuscular junction and Autonomic Synapses is clinically important. After exposure these agents cause acute and sub acute manifestations depending on the type and severity of the agents like Acute ...

  7. Application of FFTBM to severe accidents

    International Nuclear Information System (INIS)

    Prosek, A.; Leskovar, M.

    2005-01-01

    In Europe an initiative for the reduction of uncertainties in severe accident safety issues was initiated. Generally, the error made in predicting plant behaviour is called uncertainty, while the discrepancies between measured and calculated trends related to experimental facilities are called the accuracy of the prediction. The purpose of the work is to assess the accuracy of the calculations of the severe accident International Standard Problem ISP-46 (Phebus FPT1), performed with two versions of MELCOR 1.8.5 for validation purposes. For the quantitative assessment of calculations the improved fast Fourier transform based method (FFTBM) was used with the capability to calculate time dependent code accuracy. In addition, a new measure for the indication of the time shift between the experimental and the calculated signal was proposed. The quantitative results obtained with FFTBM confirm the qualitative conclusions made during the Jozef Stefan Institute participation in ISP-46. In general good agreement of thermal-hydraulic variables and satisfactory agreement of total releases for most radionuclide classes was obtained. The quantitative FFTBM results showed that for the Phebus FPT1 severe accident experiment the accuracy of thermal-hydraulic variables calculated with the MELCOR severe accident code is close to the accuracy of thermal-hydraulic variables for design basis accident experiments calculated with best-estimate system codes. (author)

  8. Therapy for Severe Gestoses in Incomplete Pregnancy

    Directory of Open Access Journals (Sweden)

    T. V. Pavlova

    2010-01-01

    Full Text Available Objective: to improve pregnancy outcomes in severe gestosis. Subjects and methods: Sixty-five women with incomplete pregnancy in presence of severe gestosis were examined and the status of 65 neonatal babies was evaluated in the early neonatal period. The women were allocated into 3 groups: 1 19 pregnant women were urgently operated on for severe admission condition (preeclampsia; 2 22 pregnant women received standard therapy for gestosis; 3 24 had standard therapy for gestosis in combination with 6% solution of the hydroxyethyl starch Stabisol®. Results. During gestosis therapy, pregnancy prolongation was 4.5±1.2 bed/days in Group 2 and averaged 7.6±1.6 bed/days in Group 3. The rate of neonatal referral to an intensive care unit was 63.1, 50.0, and 37.5% in Groups 1, 2, and 3, respectively. Referral to a neonatal pathology unit at the second stage of nursing was required in 100, 77.2, and 62.5% in Groups 1, 2, and 3, respectively. Conclusion. The use of 6% solution of the hydroxyethyl starch Stabisol® in complex therapy for gestosis in incomplete pregnancy prolongs pregnancy, accelerates rehabilitation in puerperas, prevents respiratory distress syndrome in full measure, and improves the neonatal adaptation period and perinatal outcomes as a whole. Key words: severe gestosis, incomplete pregnancy, 6% solution of Stabisol®.

  9. Minimizing the postoperative complications of severe hypospadias ...

    African Journals Online (AJOL)

    Background The aim of this study was to decrease complication rates in proximal hypospadias surgery. Methods A simple method of stenting using a polypropylene stent has been developed for the most severe form of hypospadias during the period from January 2008 to January 2011 in the Department of Pediatric ...

  10. Prevalence, severity and factors associated with peripheral ...

    African Journals Online (AJOL)

    The history of ever having a foot ulcer was significantly associated with peripheral neuropathy (OR 2.59; 95% CI: 1.03 – 6.49, p = 0.042). Conclusion: DPN occurs in 1 in 4 of newly diagnosed diabetic patients in Mulago hospital. Two thirds of these patients had moderate to severe neuropathy. DPN was independently ...

  11. Clinical severity and prognosis of hand eczema

    DEFF Research Database (Denmark)

    Hald, M; Agner, T; Blands, J

    2009-01-01

    ) and by patients using a self-administered photographic guide. Additional information was obtained from a baseline questionnaire. RESULTS: At baseline, 60.3% assessed their HE as moderate to very severe using the self-administered photographic guide compared with 36.1% at follow-up. The mean HECSI value decreased...

  12. Speech Intelligibility in Severe Adductor Spasmodic Dysphonia

    Science.gov (United States)

    Bender, Brenda K.; Cannito, Michael P.; Murry, Thomas; Woodson, Gayle E.

    2004-01-01

    This study compared speech intelligibility in nondisabled speakers and speakers with adductor spasmodic dysphonia (ADSD) before and after botulinum toxin (Botox) injection. Standard speech samples were obtained from 10 speakers diagnosed with severe ADSD prior to and 1 month following Botox injection, as well as from 10 age- and gender-matched…

  13. [Severe cutaneous drug reactions to celecoxib (Celebrex)].

    Science.gov (United States)

    Marquès, S; Milpied, B; Foulc, P; Barbarot, S; Cassagnau, E; Stalder, J-F

    2003-11-01

    Celecoxib (Celebrex) is a Cox 2 selective non steroidal anti-inflammatory agent. Adverse reactions reported are usually benign, such as maculopapular exanthema. However, recently severe toxiderma have started to appear. We report two patients who developed a sever celecoxib drug skin reaction. Case no 1. In a 73 year-old woman, treated with celecoxib for cervical arthralgia, a maculopapular exanthema five days after treatment was started. The exanthema, initially edematous and purpural became bullous with multi-visceral failure (disseminated intravascular coagulation, renal failure, hepatitis and pancreatic). The disease slowly regressed. Case no 2. A 72 year-old man, treated for cervicalgia with celecoxib, presented a pustular exanthema of the face and the trunk, ten days after introduction of the treatment, associated with an inflammatory syndrome and hepatic cytolysis. Within 8 days the disease had regressed. In both these patients, the celecoxib patch tests were positive. Until now, the side effects reported with celecoxib have been generally benign exanthemas. We report two cases of severe celecoxib-induced toxiderma: a hypersensitivity syndrome with multi-organ failure and an acute generalized atypical exanthematous pustulosis. These severe toxidermas have rarely been reported in the literature, but we now need to reassess the risks with these new molecules.

  14. Several applications of Cartwright-Field's inequality

    OpenAIRE

    Minculete, Nicuşor; Furuichi, Shigeru

    2011-01-01

    In this paper we present several applications of Cartwright-Field's inequality. Among these we found Young's inequality, Bernoulli's inequality, the inequality between the weighted power means, H\\"{o}lder's inequality and Cauchy's inequality. We give also two applications related to arithmetic functions and to operator inequalities.

  15. Comparison of Several Methods to Estimate Reference ...

    African Journals Online (AJOL)

    Evapotranspiration is one of the major components of the hydrologic cycle is highly important in studies relevant to design and management of irrigation systems. The knowledge of the evapotranspiration of natural ecosystems and plant populations is of fundamental importance in several branches of science, research and ...

  16. Severe traumatic brain injury managed with decompressive ...

    African Journals Online (AJOL)

    2012-05-29

    May 29, 2012 ... adequate decompression for patients with severe TBI. Studies of potential gains in cranial volume against size of craniectomy have shown that small craniectomies risk brain herniation with venous infarction at the bone margins.[2]. In our patient, a large fronto-temporo-parietal free bone flap was raised.

  17. Severe pentasomide Armillifer armillatus infestation complicated by ...

    African Journals Online (AJOL)

    ... including laboratory results and radiographic /computed tomography images. Conclusion: Parenchymal damage with organ dysfunction can be seen with severe A. armillatus infestation. Thus, there is a need for regular health education regarding the risk of A. armillatus infestation for individuals who consume snake meat ...

  18. Psychosocial Factors Predicting Severity of Depression Among ...

    African Journals Online (AJOL)

    2017-03-06

    Mar 6, 2017 ... and anticipated discrimination are differentially associated with severity of depression. Materials and Methods: The present study using a multivariate design investigated the role of stigma, anticipated discrimination, self-esteem,. HIV-related factors (e.g., drug use combination, knowledge of duration of HIV.

  19. Neurosurgery for management of severe head injury

    International Nuclear Information System (INIS)

    Seitz, K.; Richter, H.P.

    1998-01-01

    Neurosurgery as a treatment of severe head injuries is not restricted to invasive surgery but also includes peri-operative intensive care medicine. Thanks to the technological progress and advanced diagnostic tools, especially drug treatments and their efficiency as well as risks can be far better monitored and analysed today. (orig./CB) [de

  20. Is paediatric trauma severity overestimated at triage?

    DEFF Research Database (Denmark)

    DO, H Q; Hesselfeldt, R; Steinmetz, J

    2014-01-01

    BACKGROUND: Severe paediatric trauma is rare, and pre-hospital and local hospital personnel experience with injured children is often limited. We hypothesised that a higher proportion of paediatric trauma victims were taken to the regional trauma centre (TC). METHODS: This is an observational fol...

  1. Prevalence and Severity of Depression among Undergraduate ...

    African Journals Online (AJOL)

    Purpose: To highlight the prevalence and severity of depression among undergraduate students in public and private ... mental health effect of university education on undergraduate students, especially female students. Keywords: Depression ..... Kim YS, Koh YJ, Leventhal B. School bullying and suicidal risk in Korean ...

  2. A validated photonumeric cellulite severity scale.

    Science.gov (United States)

    Hexsel, D M; Dal'forno, T; Hexsel, C L

    2009-05-01

    With recent advances in the treatment of cellulite and localized fat, a comprehensive objective method of measuring cellulite can be potentially useful, especially since important morphological aspects of cellulite are not part of the current classification. Objective To develop and to validate a new photonumeric cellulite severity. Based on standardized photographs of 55 patients with cellulite, five key morphological aspects of cellulite were identified. A new photonumeric severity scale was developed and validated. The five key morphological features of cellulite were identified and included the number of depressions, depth of depressions, clinical appearance of evident raised lesions, and presence of flaccidity and the grade of cellulite. Each item was graded from 0 to 3, allowing final classification of cellulite as mild, moderate, and severe. Results for validation of the scale are statistically significant (P 0.7; correlation item-total > 0.7, with the exception of the right buttock; intraclass correlation coefficients 0.881-0.922; Cronbach's alpha 0.851-0.989 and factor analysis 68-76%. The proposed photonumeric scale is a consistent, comprehensive, reliable, and reproducible tool for the standardized and objective assessment of the severity of cellulite. Conflicts of interest The authors hereby affirm that neither the manuscript nor any part of it has been published or is being considered for publication elsewhere.

  3. Primary congenital hypothyroidism complicated by persistent severe ...

    African Journals Online (AJOL)

    2013-12-24

    Dec 24, 2013 ... Case Study: Primary congenital hypothyroidism complicated by persistent severe anaemia in early infancy. 85. 2014 Volume 19 No 2. JEMDSA. Introduction. Although anaemia is a common finding in adults with hypothyroidism, there is a general paucity of studies on anaemia in infants with congenital ...

  4. Dronabinol in severe, enduring anorexia nervosa

    DEFF Research Database (Denmark)

    Andries, Alin; Frystyk, Jan; Flyvbjerg, Allan

    2014-01-01

    The evidence for pharmacological treatment of severe, longstanding anorexia nervosa (AN) is sparse and the few controlled pharmacologic studies have focused on a narrow range of drugs. The aim of the present study was to investigate the effects of treatment with a synthetic cannabinoid agonist...

  5. Severe sepsis secondary to emphysematous cystitis

    African Journals Online (AJOL)

    M.M. Gargouri

    Abstract. Emphysematous cystitis (EC) is a rare, rapidly progressive infection characterized by gas formation within the bladder wall. Gas production is mainly due to fermentation of glucose or albumin by the pathogenic organisms. We present the case of a patient with EC who presented with severe sepsis of unknown ...

  6. Severity of Occlusal Disharmonies in Down Syndrome

    Directory of Open Access Journals (Sweden)

    Danielle Bauer

    2012-01-01

    Full Text Available Objective. To quantify the severity of malocclusion and dental esthetic problems in untreated Down syndrome (DS and untreated non-Down syndrome children age 8–14 years old using the PAR and ICON Indices. Materials and Methods. This retrospective study evaluated pretreatment study models, intraoral photographs, and panoramic radiographs of 30 Down syndrome and two groups of 30 non-Down syndrome patients (private practice and university clinic age 8–14 years. The models were scored via PAR and ICON Indices, and descriptive characteristics such as Angle classification, missing or impacted teeth, crossbites, open bites, and other dental anomalies were recorded. Results. The DS group had significantly greater PAR and ICON scores, as well as 10 times more missing teeth than the non-DS group. The DS group possessed predominantly Class III malocclusions, with the presence of both anterior and posterior crossbites in a majority of the patients. The non-DS group had mostly Class I or II malocclusion with markedly fewer missing teeth and crossbites. The DS group also had more severe malocclusions based upon occlusal traits such as open bite and type of malocclusion. Conclusion. The DS group had very severe malocclusions, while the control group from the university clinic had more severe malocclusions than a control group from a private practice.

  7. Psychosocial factors predicting severity of depression among ...

    African Journals Online (AJOL)

    Background and Objectives: Depression as major psychological sequelea of the HIV/AIDS infection has continued to attract investigation. With few studies in Nigeria, it is unclear whether levels of perceived stigma, sexual risk behaviors, and anticipated discrimination are differentially associated with severity of depression.

  8. Implantology and the severely resorbed edentulous mandible

    NARCIS (Netherlands)

    Stellingsma, C.; Vissink, A.; Meijer, H.J.A.; Raghoebar, G.M.

    Patients with a severely resorbed edentulous mandible often suffer from problems with the lower denture. These problems include: insufficient retention of the lower denture, intolerance to loading by the mucosa, pain, difficulties with eating and speech, loss of soft-tissue support, and altered

  9. Imaging in severe acute respiratory syndrome (SARS)

    International Nuclear Information System (INIS)

    Antonio, G.E.; Wong, K.T.; Chu, W.C.W.; Hui, D.S.C.; Cheng, F.W.T.; Yuen, E.H.Y.; Chung, S.S.C.; Fok, T.F.; Sung, J.J.Y.; Ahuja, A.T.

    2003-01-01

    Severe acute respiratory syndrome (SARS) is a highly infectious disease caused by a novel coronavirus, and has become pandemic within a short period of time. Imaging plays an important role in the diagnosis, management and follow-up of patients with SARS. The current status of imaging in SARS is presented in this review

  10. PPO.02 Severe maternal morbidity in Ireland

    NARCIS (Netherlands)

    Manning, E.; Lutomski, J.E.; O'Connor, L.; Corcoran, P.; Greene, R.

    2014-01-01

    OBJECTIVE: To assess the incidence of severe maternal morbidity (SMM) and examine associated factors in Ireland. METHODS: In 2011, 67,806 maternities were reported from 19 maternity units, representing 93% of maternities in Ireland. SMM was classified as the presence of one or more of 15 categories

  11. Personality dimensions and service failure severity

    African Journals Online (AJOL)

    kirstam

    Dr L. Kruger is a senior lecturer in the Department of Marketing Management, University of Pretoria. E-mail: liezlmarie. ... Personality dimensions and service failure severity: A cross-sectional study in the cellular industry. 161 .... may become satisfied with lower quality for engagement in a relationship with their service ...

  12. Hypereosinophilic syndrome with severe hypokalaemia in a ...

    African Journals Online (AJOL)

    Introduction: Hypereosinophilic syndrome (HES) is a rare disorder.It is defined as eosinophilia of greater than1.5x109 /L persisting for at least 6 months or death before 6 months without an identifiable cause and with eosinophil-mediated organ dysfunction.We present a rare case of hypereosinophilic syndrome with severe ...

  13. Pine Tolerance to Several New Herbicides

    Science.gov (United States)

    J.L. Michael

    1983-01-01

    Four new chemicals and Velpar L (R) were applied at several rates to loblolly pine (Pinus taeda L.) seedlings ranging in age from approximately 1 month to 3 years. Of the chemicals applied (Oust(R) to 3 years DPX-6376, and Velpar L from DuPont. Lontrel(R) from Dow; and EL-187 from...

  14. Scapular fracture: lower severity and mortality

    Directory of Open Access Journals (Sweden)

    Javad Salimi

    Full Text Available CONTEXT AND OBJECTIVE: The presence of scapular fracture is believed to be associated with high rates of other injuries and accompanying morbidities. The aim was to study injury patterns and their overall outcomes in patients with scapula fractures. DESIGN AND SETTING: Cross-sectional study of trauma patients treated at six general hospitals in Tehran. METHODS: One-year trauma records were obtained from six general hospitals Among these, forty-one had sustained a scapular fracture and were included in this study. RESULTS: Scapular fracture occurred predominantly among 20 to 50-year-old patients (78%. Road traffic accidents (RTAs were the main cause of injury (73.2%; 30/41. Pedestrians accounted for 46.7% (14/30 of the injuries due to RTAs. Falls were the next most common cause, accounting for seven cases (17.1%. Body fractures were the most common type of scapular fractures (80%. Eighteen patients (43.9% had isolated scapular fractures. Limb fracture was the most common associated injury, detected in 18 cases (43.9%. Three patients (7.3% had severe injuries (injury severity score, ISS > 16 which resulted in one death (2.4%. The majority of the patients were treated conservatively (87.8%. CONCLUSIONS: Patients with scapula fractures have more severe underlying chest injuries and clavicle fractures. However, this did not correlate with higher rates of injury severity score, intensive care unit admission or mortality.

  15. Managing the Student with Severe Food Allergies

    Science.gov (United States)

    Robinson, Joanne M.; Ficca, Michelle

    2012-01-01

    School nurses play a key role in managing students with food allergies. It is becoming more common to encounter students with severe allergies to multiple foods, putting them at risk for anaphylaxis. It is essential that the school nurse have a clear understanding of food allergies and how to effectively manage students in the school setting.…

  16. Core loss during a severe accident (COLOSS)

    International Nuclear Information System (INIS)

    Adroguer, B.; Bertrand, F.; Chatelard, P.; Cocuaud, N.; Van Dorsselaere, J.P.; Bellenfant, L.; Knocke, D.; Bottomley, D.; Vrtilkova, V.; Belovsky, L.; Mueller, K.; Hering, W.; Homann, C.; Krauss, W.; Miassoedov, A.; Schanz, G.; Steinbrueck, M.; Stuckert, J.; Hozer, Z.; Bandini, G.; Birchley, J.; Berlepsch, T. von; Kleinhietpass, I.; Buck, M.; Benitez, J.A.F.; Virtanen, E.; Marguet, S.; Azarian, G.; Caillaux, A.; Plank, H.; Boldyrev, A.; Veshchunov, M.; Kobzar, V.; Zvonarev, Y.; Goryachev, A.

    2005-01-01

    The COLOSS project was a 3-year shared-cost action, which started in February 2000. The work-programme performed by 19 partners was shaped around complementary activities aimed at improving severe accident codes. Unresolved risk-relevant issues regarding H 2 production, melt generation and the source term were studied through a large number of experiments such as (a) dissolution of fresh and high burn-up UO 2 and MOX by molten Zircaloy (b) simultaneous dissolution of UO 2 and ZrO 2 (c) oxidation of U-O-Zr mixtures (d) degradation-oxidation of B 4 C control rods. Corresponding models were developed and implemented in severe accident computer codes. Upgraded codes were then used to apply results in plant calculations and evaluate their consequences on key severe accident sequences in different plants involving B 4 C control rods and in the TMI-2 accident. Significant results have been produced from separate-effects, semi-global and large-scale tests on COLOSS topics enabling the development and validation of models and the improvement of some severe accident codes. Breakthroughs were achieved on some issues for which more data are needed for consolidation of the modelling in particular on burn-up effects on UO 2 and MOX dissolution and oxidation of U-O-Zr and B 4 C-metal mixtures. There was experimental evidence that the oxidation of these mixtures can contribute significantly to the large H 2 production observed during the reflooding of degraded cores under severe accident conditions. The plant calculation activity enabled (a) the assessment of codes to calculate core degradation with the identification of main uncertainties and needs for short-term developments and (b) the identification of safety implications of new results. Main results and recommendations for future R and D activities are summarized in this paper

  17. Metabolic profile of clinically severe obese patients.

    Science.gov (United States)

    Faria, Silvia Leite; Faria, Orlando Pereira; Menezes, Caroline Soares; de Gouvêa, Heloisa Rodrigues; de Almeida Cardeal, Mariane

    2012-08-01

    Since low basal metabolic rate (BMR) is a risk factor for weight regain, it is important to measure BMR before bariatric surgery. We aimed to evaluate the BMR among clinically severe obese patients preoperatively. We compared it with that of the control group, with predictive formulas and correlated it with body composition. We used indirect calorimetry (IC) to collect BMR data and multifrequency bioelectrical impedance to collect body composition data. Our sample population consisted of 193 patients of whom 130 were clinically severe obese and 63 were normal/overweight individuals. BMR results were compared with the following predictive formulas: Harris-Benedict (HBE), Bobbioni-Harsch (BH), Cunningham (CUN), Mifflin-St. Jeor (MSJE), and Horie-Waitzberg & Gonzalez (HW & G). This study was approved by the Ethics Committee for Research of the University of Brasilia. Statistical analysis was used to compare and correlate variables. Clinically severe obese patients had higher absolute BMR values and lower adjusted BMR values (p BMR were found in both groups. Among the clinically severe obese patients, the formulas of HW & G and HBE overestimated BMR values (p = 0.0002 and p = 0.0193, respectively), while the BH and CUN underestimated this value; only the MSJE formulas showed similar results to those of IC. The clinically severe obese patients showed low BMR levels when adjusted per kilogram per body weight. Body composition may influence BMR. The use of the MSJE formula may be helpful in those cases where it is impossible to use IC.

  18. Alexithymia Is Associated with Tinnitus Severity

    Directory of Open Access Journals (Sweden)

    Jan Wielopolski

    2017-11-01

    Full Text Available ObjectiveAlexithymia is considered to be a personality trait with a tendency to express psychological distress in somatic rather than emotional form and, therefore, may play a vital role in somatization. Although, such a propensity can be found in patients suffering from tinnitus, the relationship between alexithymic characteristics and the subjective experience of tinnitus severity remains yet unclear. Our aim was to evaluate which alexithymic characteristics are linked to the subjective experience of tinnitus symptomatology.MethodsWe evaluated tinnitus severity (Tinnitus Handicap Inventory, THI, alexithymia (20-item Toronto Alexithymia Scale, TAS-20, and depression (Beck Depression Inventory, BDI in 207 outpatients with tinnitus. Correlation analyses and multiple regression analyses were calculated in order to investigate the relationship between alexithymic characteristics, tinnitus severity, and depression.ResultsHighly significant positive correlations were found between THI total score and TAS-20 total score as well as BDI score. Regarding the TAS-20 subscales, multiple regression analyses showed that only the TAS-20 subscale “difficulty in identifying feelings” (DIF and the BDI significantly predicted the subjective experience of tinnitus severity. Regarding the THI subscales, only higher scores of the THI subscale “functional” demonstrated an independent moderate association with higher scores for DIF.ConclusionWe found an independent association between the subjective experience of tinnitus severity and alexithymic characteristics, particularly with regard to limitations in the fields of mental, social, and physical functioning because of tinnitus and the difficulty of identifying feelings facet of alexithymia. These findings are conducive to a better understanding of affect regulation that may be important for the psychological adaptation of patients suffering from tinnitus.

  19. Alexithymia Is Associated with Tinnitus Severity.

    Science.gov (United States)

    Wielopolski, Jan; Kleinjung, Tobias; Koch, Melanie; Peter, Nicole; Meyer, Martin; Rufer, Michael; Weidt, Steffi

    2017-01-01

    Alexithymia is considered to be a personality trait with a tendency to express psychological distress in somatic rather than emotional form and, therefore, may play a vital role in somatization. Although, such a propensity can be found in patients suffering from tinnitus, the relationship between alexithymic characteristics and the subjective experience of tinnitus severity remains yet unclear. Our aim was to evaluate which alexithymic characteristics are linked to the subjective experience of tinnitus symptomatology. We evaluated tinnitus severity (Tinnitus Handicap Inventory, THI), alexithymia (20-item Toronto Alexithymia Scale, TAS-20), and depression (Beck Depression Inventory, BDI) in 207 outpatients with tinnitus. Correlation analyses and multiple regression analyses were calculated in order to investigate the relationship between alexithymic characteristics, tinnitus severity, and depression. Highly significant positive correlations were found between THI total score and TAS-20 total score as well as BDI score. Regarding the TAS-20 subscales, multiple regression analyses showed that only the TAS-20 subscale "difficulty in identifying feelings" (DIF) and the BDI significantly predicted the subjective experience of tinnitus severity. Regarding the THI subscales, only higher scores of the THI subscale "functional" demonstrated an independent moderate association with higher scores for DIF. We found an independent association between the subjective experience of tinnitus severity and alexithymic characteristics, particularly with regard to limitations in the fields of mental, social, and physical functioning because of tinnitus and the difficulty of identifying feelings facet of alexithymia. These findings are conducive to a better understanding of affect regulation that may be important for the psychological adaptation of patients suffering from tinnitus.

  20. MODERN PRINCIPLES OF SURGERY SEVERE CRANIOCEREBRAL TRAUMA

    Directory of Open Access Journals (Sweden)

    V. V. Krylov

    2013-01-01

    Full Text Available Nowadays treatment methods of severe traumatic brain injury - state of the problem in the neurosurgery department of the Sklifosovsky Research Institute for Emergency Medicine.Surgery of traumatic brain injury (TBI is the principal direction of research activities in the neurosurgery department of the Sklifosovsky Research Institute for Emergency Medicine.With a view to produce an unified approach in treatment patients with TBI, in the neurosurgery department brain injury practical classifications have been designed. Using neurological examination and CT data they allow to diagnose and determine a severity of TBI.The conducted at the department researches allowed to clarify the indications to surgery and nonoperative treatment in patients with posterior cranial fossa injury and small intracranial hematomas. For the first time in Russia there was organized and carried out the randomized trial which was dedicated to the choice of surgery (decompressive craniectomy or craniotomy in severe TBI. There were identified risk factors of adverse outcomes in patients with severe TBI.There was worked out and embedded in daily practice the new original minimally invasive method of TBI surgery — the puncture aspiration and local fibrinolysis of traumatic intracranial hematomas. In surgery of subacute and chronic hematomas as well as in surgery of traumatic intracranial hematomas which are located in functionally significant regions of the brain, the endoscopy is being used actively. This method allows to reduce damages of surgical approach and keep its radicality. At the present time the researches is being conducted which are dedicated to surgery of acute brain herniation syndrome. Using original tools the minimally traumatic methods of tentorium and falx cerebri incisions were designed as well as the decompressive craniectomy in combination with lower medial temporal resection were developed.Application of new technologies in diagnosis and treatment in

  1. Designing a Pediatric Severe Sepsis Screening Tool

    Directory of Open Access Journals (Sweden)

    Robert eSepanski

    2014-06-01

    Full Text Available We sought to create a screening tool with improved predictive value for pediatric severe sepsis and septic shock that can be incorporated into the electronic medical record and actively screen all patients arriving at a pediatric Emergency Department (ED. Gold standard severe sepsis cases were identified using a combination of coded discharge diagnosis and physician chart review from 7,402 children who visited a pediatric ED over two months. The tool’s identification of severe sepsis was initially based on International Consensus Conference on Pediatric Sepsis (ICCPS parameters that were refined by an iterative, virtual process that allowed us to propose successive changes in sepsis detection parameters in order to optimize the tool’s predictive value based on receiver operating curve (ROC characteristics. Age-specific normal and abnormal values for heart rate (HR and respiratory rate (RR were empirically derived from 143,603 children seen in a second pediatric ED over three years. Univariate analyses were performed for each measure in the tool to assess its association with severe sepsis and to characterize it as an early or late indicator of severe sepsis. A split-sample was used to validate the final, optimized tool. The final tool incorporated age-specific thresholds for abnormal HR and RR and employed a linear temperature correction for each category. The final tool’s positive predictive value was 48.7%, a significant, nearly three-fold improvement over the original ICCPS tool. False positive Systemic Inflammatory Response Syndrome (SIRS identifications were nearly six-fold lower.

  2. Diagnostic Accuracy of Modified CT Severity Index in Assessing Severity of Acute Pancreatitis.

    Science.gov (United States)

    Rehan, Amna; Shabbir, Zonaira; Shaukat, Asim; Riaz, Osman

    2016-12-01

    To determine the diagnostic accuracy of modified CT severity index in assessing the severe acute pancreatitis keeping APACHE II as gold standard. Cross-sectional (validation) study. Department of Radiology, Allied Hospital, Faisalabad, from February to August 2014. A total of 120 patients of either gender aged 20-60 years with epigastric pain radiating to back and having sonographic findings (decreased or heterogeneous pancreatic echogenicity, pancreatic enlargement, peripancreatic fluid collection), supportive of acute pancreatitis were taken. CT with intravenous contrast was performed on 128-slice scanner within 24 hours of presentation. Slice thickness was 3 mm in region of pancreas. Modified CT severity index was calculated. Score above 5 was graded as severe pancreatitis. APACHE II score of >11 considered as gold standard was also calculated within 24 hours of admission. Mean age of the patients was 39.03 ±8.71 years. Most of the patients were females 73 (60.8%). Out of 120 patients, 43 (35.83%) patients had severe acute pancreatitis. Sensitivity, specificity, positive predictive value and negative predictive value of modified CT severity index in assessing the severe acute pancreatitis were 100%, 87%, 81.13% and 100%, respectively. The diagnostic accuracy was yielded as 91.67% considered APACHE II as gold standard. Modified CT severity index had high diagnostic accuracy in assessment of severe acute pancreatitis and can be used reliably in early prediction of complications of severe acute pancreatitis.

  3. Burn severity mapping in Australia 2009

    Science.gov (United States)

    McKinley, Randy; Clark, J.; Lecker, Jennifer

    2012-01-01

    In 2009, the Victoria Department of Sustainability and Environment estimated approximately 430,000 hectares of Victoria Australia were burned by numerous bushfires. Burned Area Emergency Response (BAER) teams from the United States were deployed to Victoria to assist local fire managers. The U.S. Geological Survey Earth Resources Observation and Science Center (USGS/EROS) and U.S. Forest Service Remote Sensing Applications Center (USFS/RSAC) aided the support effort by providing satellite-derived "soil burn severity " maps for over 280,000 burned hectares. In the United States, BAER teams are assembled to make rapid assessments of burned lands to identify potential hazards to public health and property. An early step in the assessment process is the creation of a soil burn severity map used to identify hazard areas and prioritize treatment locations. These maps are developed primarily using Landsat satellite imagery and the differenced Normalized Burn Ratio (dNBR) algorithm.

  4. Estrogen-associated severe hypertriglyceridemia with pancreatitis.

    Science.gov (United States)

    Aljenedil, Sumayah; Hegele, Robert A; Genest, Jacques; Awan, Zuhier

    Estrogen, whether therapeutic or physiologic, can cause hypertriglyceridemia. Hypertriglyceridemia-induced pancreatitis is a rare complication. We report 2 women who developed estrogen-associated severe hypertriglyceridemia with pancreatitis. The first patient developed pancreatitis secondary to hypertriglyceridemia associated with in vitro fertilization cycles. Marked reduction in her triglyceride was achieved with dietary restrictions and fibrate. The second patient developed pancreatitis secondary to hypertriglyceridemia during her pregnancies. She was noncompliant with the treatment; therefore, her triglyceride remained high after delivery. In both patients, no hypertriglyceridemia-associated genes mutations were identified, although the second patient had strong polygenic susceptibility to hypertriglyceridemia. Estrogen-induced severe hypertriglyceridemia with pancreatitis can be a life-threatening condition. Screening in high-risk patients is crucial to prevent subsequent complications. Copyright © 2016 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  5. Four billion people facing severe water scarcity.

    Science.gov (United States)

    Mekonnen, Mesfin M; Hoekstra, Arjen Y

    2016-02-01

    Freshwater scarcity is increasingly perceived as a global systemic risk. Previous global water scarcity assessments, measuring water scarcity annually, have underestimated experienced water scarcity by failing to capture the seasonal fluctuations in water consumption and availability. We assess blue water scarcity globally at a high spatial resolution on a monthly basis. We find that two-thirds of the global population (4.0 billion people) live under conditions of severe water scarcity at least 1 month of the year. Nearly half of those people live in India and China. Half a billion people in the world face severe water scarcity all year round. Putting caps to water consumption by river basin, increasing water-use efficiencies, and better sharing of the limited freshwater resources will be key in reducing the threat posed by water scarcity on biodiversity and human welfare.

  6. [Scales for predicting outcome after severe trauma].

    Science.gov (United States)

    Ali Ali, B; Fortún Moral, M; Belzunegui Otano, T; Reyero Díez, D; Castro Neira, M

    2017-04-30

    In this article we review the development of the most-used scales for severe trauma patients over the past 40 years. It is well known that anatomical scales are effective for measuring the severity of injuries and for predicting results. Physiological scales measure the dynamic component after trauma, with a great influence on the prognosis of injured patients. Metabolic scales, both lactate and base deficit, are reflections of tissue hypoperfusion states and therefore shock. The combined scales are used for prediction and comparative assessment of results. The inclusion of factors that influence the prognosis of trauma patients has led to the development of new scales. However, they lack external validation studies for their widespread use. Until these validation studies are conducted caution should be taken with the use of existing scales.

  7. Imitators of severe pre-eclampsia/eclampsia.

    Science.gov (United States)

    Sibai, Baha M

    2004-12-01

    Several microangiopathic disorders that are encountered during pregnancy provide physicians with a formidable diagnostic challenge. Severe pre-eclampsia with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome and many other obstetric and medical or surgical conditions produce similar clinical presentations and laboratory study results to pre-eclampsia. Pre-eclampsia is frequently superimposed on one of the above disorders, further confounding an already difficult differential diagnosis. Because of the remarkably similar clinical and laboratory findings of these disease processes, even the most experienced physician will face a diagnostic challenge. An effort should be made to make an accurate diagnosis, given the fact that management strategies and outcome may differ among these conditions.

  8. Severe brachial plexus injuries in rugby.

    Science.gov (United States)

    Altaf, F; Mannan, K; Bharania, P; Sewell, M D; Di Mascio, L; Sinisi, M

    2012-03-01

    We describe the mechanisms, pattern of injuries, management and outcomes of severe injuries to the brachial plexus sustained during the play of rugby. Thirteen cases of severe injury to the brachial plexus caused by tackles in rugby had detailed clinical assessment, and operative exploration of the brachial plexus. Seventeen spinal nerves were avulsed, two were ruptured and there were traction lesions in continuity of 24 spinal nerves. The pattern of nerve lesion was related to the posture of the neck and the forequarter at the moment of impact. Early repair by nerve transfer enabled some functional recovery, and decompression of lesions in continuity was followed by recovery of nerve function and relief of pain. Copyright © 2011 Elsevier Ltd. All rights reserved.

  9. Severe gingival enlargement associated with aggressive periodontitis

    Directory of Open Access Journals (Sweden)

    Shyam Padmanabhan

    2013-01-01

    Full Text Available Enlargement of the gingiva can be due to various causes. Most prevalent are the inflammatory type and drug-induced type of gingival hyperplasia. However, sever enlargement associated with an aggressive type of periodontitis is an infrequent finding. Reported here is a case of a female patient aged 18 years who presented with severe enlargement of the maxillary and mandibular gingiva. Examination revealed enlargement extending up to the incisal edge of all the teeth and also an associated generalized loss of attachment with radiographic evidence of reduced bone height resembling an aggressive type of periodontitis. There were no associated systemic signs and symptoms or any family history except that there was generalized vitiligo of the skin and oral mucous membrane. The case was treated by gross electrosection of the gingiva.

  10. Severe Heterotopic Ossification following Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Alexander L. Dodds

    2014-01-01

    Full Text Available Although the incidence of minor heterotopic ossification is probably higher than what is usually expected, severe heterotopic ossification (HO is an extremely rare event following total knee replacement surgery. We present the case of a 66-year-old woman who initially had achieved an excellent range of motion following bilateral uncemented rotating platform total knee replacement, before presenting with pain and loss of range of motion at 2 months after surgery. Severe HO was diagnosed on X-rays. Treatment consisted of nonoperative measures only, including physiotherapy with hydrotherapy and anti-inflammatories. She eventually regained her range of motion when seen at 8 months after operation. This case illustrates that nonoperative treatment without the use of radiotherapy or surgery can be used to safely resolve stiffness caused by HO after total knee replacement.

  11. Relatives of patients with severe brain injury

    DEFF Research Database (Denmark)

    Norup, Anne; Petersen, Janne; Lykke Mortensen, Erik

    2015-01-01

    relatives of patients with severe brain injury. METHODS: The relatives were assessed on the anxiety and depression scales from the Symptom Checklist-90-Revised and latent variable growth curve models were used to model the trajectories. The effects of patient's age, patient's Glasgow Coma Score, level......PRIMARY OBJECTIVE: To investigate trajectories and predictors of trajectories of anxiety and depression in relatives of patients with a severe brain injury during the first year after injury. RESEARCH DESIGN: A prospective longitudinal study with four repeated measurements. SUBJECTS: Ninety...... improvement. Higher initial level of symptoms of depression was seen in female relatives. Higher initial level of anxiety was associated with younger patient age, lower level of function and consciousness in the patient and the relative being female or the spouse. CONCLUSION: Future research and interventions...

  12. Convex trace functions of several variables

    DEFF Research Database (Denmark)

    Hansen, Frank

    2002-01-01

    We prove that the function (x1,...,xk)¿Tr(f(x1,...,xk)), defined on k-tuples of symmetric matrices of order (n1,...,nk) in the domain of f, is convex for any convex function f of k variables. The matrix f(x1,...,xk) is defined by the functional calculus for functions of several variables, and it ......We prove that the function (x1,...,xk)¿Tr(f(x1,...,xk)), defined on k-tuples of symmetric matrices of order (n1,...,nk) in the domain of f, is convex for any convex function f of k variables. The matrix f(x1,...,xk) is defined by the functional calculus for functions of several variables...

  13. Assessment of problematic severe asthma in children

    DEFF Research Database (Denmark)

    Carlsen, K. C. L.; Hedlin, G.; Bush, A.

    2011-01-01

    Assessment of problematic severe asthma in children should be performed in a stepwise manner to ensure an optimal approach. A four-step assessment scheme is proposed. First, a full diagnostic work-up is performed to exclude other diseases which mimic asthma. Secondly, a multi-disciplinary assessm......Assessment of problematic severe asthma in children should be performed in a stepwise manner to ensure an optimal approach. A four-step assessment scheme is proposed. First, a full diagnostic work-up is performed to exclude other diseases which mimic asthma. Secondly, a multi......-disciplinary assessment is performed to identify issues that may need attention, including comorbidities. Thirdly, the pattern of inflammation is assessed, and finally steroid responsiveness is documented. Based upon these four steps an optimal individualised treatment plan is developed. In this article the many gaps...

  14. Can Severe Kyphoscoliosis Lead to Aorta Rupture?

    Science.gov (United States)

    Kotopoulos, Constantinos; Karakasi, Maria Valeria; Kapetanakis, Stylianos; Pavlidis, Pavlos

    2016-09-01

    Neurofibromatosis type 1 is a polysystemic disease presenting with a multifaceted clinical picture. Clinical manifestations may present in the skin, as well as in the skeletal and cardiovascular system. The present study aims to describe and examine the case of a 46-year-old woman, who suffered from neurofibromatosis type 1 and died abruptly in the emergency room. The forensic examination attributed her death to traumatic rupture of the thoracic aorta resulting from an acute angulation that her vertebral column formed in the thoracic region (severe kyphosis). Outspread cutaneous neurofibromas, severe scoliosis, and osteoporosis (brittle bones) were observed during the autopsy. No atherosclerotic lesions were detected in the aortic lumen. To the authors' knowledge, no similar case has been reported throughout relevant literature.

  15. Korean Conference on Several Complex Variables

    CERN Document Server

    Byun, Jisoo; Gaussier, Hervé; Hirachi, Kengo; Kim, Kang-Tae; Shcherbina, Nikolay

    2015-01-01

    This volume includes 28 chapters by authors who are leading researchers of the world describing many of the up-to-date aspects in the field of several complex variables (SCV). These contributions are based upon their presentations at the 10th Korean Conference on Several Complex Variables (KSCV10), held as a satellite conference to the International Congress of Mathematicians (ICM) 2014 in Seoul, Korea. SCV has been the term for multidimensional complex analysis, one of the central research areas in mathematics. Studies over time have revealed a variety of rich, intriguing, new knowledge in complex analysis and geometry of analytic spaces and holomorphic functions which were "hidden" in the case of complex dimension one. These new theories have significant intersections with algebraic geometry, differential geometry, partial differential equations, dynamics, functional analysis and operator theory, and sheaves and cohomology, as well as the traditional analysis of holomorphic functions in all dimensions. This...

  16. Severe periodontitis and higher cirrhosis mortality

    DEFF Research Database (Denmark)

    Ladegaard Grønkjær, Lea; Holmstrup, Palle; Schou, Søren

    2018-01-01

    Background Periodontitis and edentulism are prevalent in patients with cirrhosis, but their clinical significance is largely unknown. Objective The objective of this article is to determine the association of severe periodontitis and edentulism with mortality in patients with cirrhosis. Methods...... A total of 184 cirrhosis patients underwent an oral examination. All-cause and cirrhosis-related mortality was recorded. The associations of periodontitis and edentulism with mortality were explored by Kaplan–Meier survival plots and Cox proportional hazards regression adjusted for age, gender, cirrhosis...... etiology, Child–Pugh score, Model for End-Stage Liver Disease score, smoker status, present alcohol use, comorbidity, and nutritional risk score. Results The total follow-up time was 74,197 days (203.14 years). At entry, 44% of the patients had severe periodontitis and 18% were edentulous. Forty...

  17. Bazex Syndrome with Hypoalbuminemia and Severe Ascites

    OpenAIRE

    Matsui, Hidetoshi; Iwae, Shigemichi; Hirayama, Yuji; Yonezawa, Koichiro; Shigeji, Jun

    2016-01-01

    Bazex syndrome is a rare paraneoplastic dermatosis. The underlying malignancy frequently is squamous cell carcinoma of the upper aerodigestive tract or cervical lymph nodes from an unknown primary site. We report a 63-year-old man with squamous cell carcinoma of cervical lymph nodes from an unknown primary site. He developed a mass on the right side of his neck, cutaneous lesions diagnosed as Bazex syndrome, hypoalbuminemia, and severe ascites. Right neck dissection was performed. After neck ...

  18. Severe Hyperlipidemia Induced Hemorrhagic Pancreatitis during Pregnancy

    OpenAIRE

    Koscica, Karen L.; Nwaubani, Uzoma; Nazir, Munir; Gimovsky, Martin

    2009-01-01

    Background. We report a case of familial hyperlipidemia in pregnancy that resulted in hemorrhagic pancreatitis. Case. A patient at 27-week gestation was admitted for recurrent pancreatitis secondary to severe hyperlipidemia. With conservative care, the patient improved but on the fourth day of admission she experienced a sudden onset of hypotension and was diagnosed with hemorrhagic pancreatitis. Conclusion. Pancreatitis caused by hyperlipidemia is an uncommon event during pregnancy. A famil...

  19. Severe metabolic alkalosis in a hemodialysis patient.

    Science.gov (United States)

    Huber, Lu; Gennari, F John

    2011-07-01

    We present a patient with end-stage kidney disease receiving hemodialysis therapy who developed severe metabolic alkalosis secondary to vomiting. This case illustrates the important differences in pathogenesis, diagnosis, and management of this common acid-base disorder in patients without kidney function. The diagnostic approach and management strategy for metabolic alkalosis are discussed, highlighting the special issues to be considered in dialysis patients. Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  20. Severe hepatic dysfunction after sevoflurane exposure

    International Nuclear Information System (INIS)

    Alotaibi, Wadha M.

    2008-01-01

    Sevoflurane is thought to have a potential for hepatotoxicity. A few cases of hepatotoxicity have been reported since it was introduced in 1999 into clinical practice in Japan. The underlying pathophysiology of hepatotoxicity is non-specific. We report a case of severe hepatic dysfunction after uneventful sevoflurane anesthesia in a child with posterior fossa resection of medulloblastoma. The case of sevoflurane being incriminated is unclear due to various confounding factors that is worthy of discussion. (author)

  1. An Unexpected Cause of Severe Hypokalemia

    Directory of Open Access Journals (Sweden)

    Fernando Caravaca-Fontan

    2015-01-01

    Full Text Available We describe an unusual case of severe hypokalemia with electrocardiographic changes, due to licorice consumption, in a 15-year-old female student with no previous medical history. Prompt replacement of potassium and cessation of licorice ingestion resulted in a favourable outcome. We also discuss the pathophysiology and diagnosis, emphasizing the importance of a detailed anamnesis to rule out an often forgotten cause of hypokalemia as the licorice poisoning.

  2. Artesunate versus quinine for treating severe malaria.

    Science.gov (United States)

    Sinclair, David; Donegan, Sarah; Isba, Rachel; Lalloo, David G

    2012-06-13

    Severe malaria results in over a million deaths every year, most of them in children aged under five years and living in sub-Saharan Africa. This review examines whether treatment with artesunate, instead of the standard treatment quinine, would result in fewer deaths and better treatment outcomes. To compare artesunate with quinine for treating severe malaria. We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, LILACS, ISI Web of Science, the metaRegister of Controlled trials (mRCT), conference proceedings, and reference lists of articles to November 2010. Randomized controlled trials comparing intravenous, intramuscular, or rectal artesunate with intravenous or intramuscular quinine for treating adults and children with severe malaria who are unable to take medication by mouth. Two authors independently assessed the eligibility and risk of bias of trials, and extracted and analysed data. The primary outcome was all-cause death. Dichotomous outcomes were summarized using risk ratios (RR) and continuous outcomes by mean differences (MD). Where appropriate, we combined data in meta-analyses. Eight trials enrolling 1664 adults and 5765 children are included in this review.Treatment with artesunate significantly reduced the risk of death both in adults (RR 0.61, 95% Confidence Interval (CI) 0.50 to 0.75; 1664 participants, five trials) and children (RR 0.76, 95% CI 0.65 to 0.90; 5765 participants, four trials)In children, treatment with artesunate increased the incidence of neurological sequelae at the time of hospital discharge. The majority of these sequelae were transient and no significant difference between treatments was seen at later follow up. The evidence clearly supports the superiority of parenteral artesunate over quinine for the treatment of severe malaria in both adults and children and in different regions of the world.

  3. Severe shoulder tendinopathy associated with levofloxacin.

    Science.gov (United States)

    Eyer-Silva, Walter de Araujo; Netto, Henrique de Barros Pinto; Pinto, Jorge Francisco da Cunha; Ferry, Fernando Raphael de Almeida; Neves-Motta, Rogério

    2012-01-01

    Fluoroquinolone (FQ)-associated tendinopathy and myopathy are uncommon but well recognized complications of the use of this class of antibacterial agents. The case of a 63-year-old previously asymptomatic female patient who developed severe left shoulder tendinopathy after surreptitiously doubling the prescribed dose of levofloxacin for the treatment of community-acquired pneumonia is reported here. Surgical stabilization with suture anchors and subacromial decompression were needed. Copyright © 2012 Elsevier Editora Ltda. All rights reserved.

  4. Severe shoulder tendinopathy associated with levofloxacin

    OpenAIRE

    Eyer-Silva,Walter de Araujo; Pinto Netto,Henrique de Barros; Pinto,Jorge Francisco da Cunha; Ferry,Fernando Raphael de Almeida; Neves-Motta,Rogério

    2012-01-01

    Fluoroquinolone (FQ)-associated tendinopathy and myopathy are uncommon but well recognized complications of the use of this class of antibacterial agents. The case of a 63-year-old previously asymptomatic female patient who developed severe left shoulder tendinopathy after surreptitiously doubling the prescribed dose of levofloxacin for the treatment of community-acquired pneumonia is reported here. Surgical stabilization with suture anchors and subacromial decompression were needed.

  5. Several complex variables and Banach algebras

    International Nuclear Information System (INIS)

    Allan, G.R.

    1976-01-01

    This paper aims to present certain applications of the theory of holomorphic functions of several complex variables to the study of commutative Banach algebras. The material falls into the following sections: (A) Introcution to Banach algebras (this will not presuppose any knowledge of the subject); (B) Groups of differential forms (mainly concerned with setting up a useful language); (C) Polynomially convex domains. (D) Holomorphic functional calculus for Banach algebras; (E) Some applications of the functional calculus. (author)

  6. Severe autoimmune hemolytic anemia with renal neoplasm.

    Science.gov (United States)

    Rhodes, Emily C; Parikh, Sahil P; Bhattacharyya, Nishith

    2014-02-01

    Autoimmune hemolytic anemia is a type of hemolytic anemia characterized by autoantibodies directed against red blood cells shortening their survival. When autoimmune hemolytic anemia is secondary to a paraneoplastic process, severe anemia can occur leading to significant morbidity and even mortality. Here we discuss the literature and present the case of a child with autoimmune hemolytic anemia from a paraneoplastic syndrome secondary to a renal tumor.

  7. Rituximab for severe refractory pediatric Wegener granulomatosis.

    Science.gov (United States)

    Patel, Aarat M; Lehman, Thomas J A

    2008-10-01

    We describe a case of pediatric Wegener granulomatosis initially treated with cyclophosphamide and oral corticosteroids resulting in remission for 5 years. Of note in this case is relapse with severe pulmonary disease treated with multiple regimens, all unsuccessful. Patient achieved remission with rituximab infusion therapy. This demonstrates how rituximab may be beneficial for childhood-onset Wegener granulomatosis unresponsive to conventional therapy. The case is followed by a review of the current treatment options.

  8. Severe Adverse Drug Reaction to Gadobenate Dimeglumine

    Directory of Open Access Journals (Sweden)

    Benjamin D. Singer

    2009-01-01

    Full Text Available A 57-year-old man was admitted to our hospital for evaluation and management of stroke in the setting of an atrial septal defect. Shortly after receiving gadobenate dimeglumine for magnetic resonance imaging of the pelvic vessels, he experienced cardiac arrest from which he was resuscitated. His course was complicated by profound distributive shock. The presumed cause was a severe anaphylactic or anaphylactoid reaction to the gadolinium-based compound that he received.

  9. Overview of severe accident research at JAERI

    International Nuclear Information System (INIS)

    Sugimoto, Jun

    1999-01-01

    Severe accident research at JAERI aims at the confirmation of the safety margin, the quantification of the associated risk, and the evaluation of the effectiveness of the accident management measures of the nuclear power reactors, in accordance with the government five-year nuclear safety research program. JAERI has been conducting a wide range of severe accident research activities both in experiment and analysis, such as melt coolant interactions, fission product behaviors in coolant system, containment integrity and assessment of accident management measures. Molten core/coolant interaction and in-vessel molten coolability have been investigated in ALPHA Program. MUSE experiments in ALPHA Program has been conducted for the precise energy measurement due to steam explosion in melt jet and stratified geometries. In VEGA Program, which aims at FP release from irradiated fuels at high temperature and high pressure under various atmospheric conditions, the facility construction is almost completed. In WIND Program the revaporization of aerosols due to decay heating and also the integrity of the piping from this heat source are being investigated. Code development activities are in progress for an integrated source term analysis with THALES, fission product behaviors with ART, steam explosion with JASMINE, and in-vessel debris behaviors with CAMP. The experimental analyses and reactor application have made progress by participating international standard problem and code comparison exercises, along with the use of introduced codes, such as SCDAP/RELAP5 and MELCOR. The outcome of the severe accident research will be utilized for the evaluation of more reliable severe accident scenarios, detailed implementation of the accident management measures, and also for the future reactor development, basically through the sophisticated use of verified analytical tools. (author)

  10. Severe accident management. Prevention and Mitigation

    International Nuclear Information System (INIS)

    1992-01-01

    Effective planning for the management of severe accidents at nuclear power plants can produce both a reduction in the frequency of such accidents as well as the ability to mitigate their consequences if and when they should occur. This report provides an overview of accident management activities in OECD countries. It also presents the conclusions of a group of international experts regarding the development of accident management methods, the integration of accident management planning into reactor operations, and the benefits of accident management

  11. MODERN PRINCIPLES OF SURGERY SEVERE CRANIOCEREBRAL TRAUMA

    OpenAIRE

    V. V. Krylov; S. S. Petrikov; A. E. Talypov; Yu. V. Puras; A. A. Solodov; O. V. Levchenko; E. V. Grigoryeva; A. Yu. Kordonskiy

    2013-01-01

    Nowadays treatment methods of severe traumatic brain injury - state of the problem in the neurosurgery department of the Sklifosovsky Research Institute for Emergency Medicine.Surgery of traumatic brain injury (TBI) is the principal direction of research activities in the neurosurgery department of the Sklifosovsky Research Institute for Emergency Medicine.With a view to produce an unified approach in treatment patients with TBI, in the neurosurgery department brain injury practical classific...

  12. Flexoelectricity in several thermoplastic and thermosetting polymers

    Science.gov (United States)

    Chu, Baojin; Salem, D. R.

    2012-09-01

    The flexoelectricity of several thermoplastic and thermosetting polymers was investigated by testing the dielectric polarization response under bending deformation of polymer cantilevers. All the polymers studied showed a flexoelectric response with a flexoelectric coefficient of the order of the 10-9-10-8 C/m. Based on a comparison of the flexoelectric response of the different polymers studied, we discuss factors that may influence the generation of flexoelectricity in polymeric materials.

  13. Severe shoulder tendinopathy associated with levofloxacin

    Directory of Open Access Journals (Sweden)

    Walter de Araujo Eyer-Silva

    Full Text Available Fluoroquinolone (FQ-associated tendinopathy and myopathy are uncommon but well recognized complications of the use of this class of antibacterial agents. The case of a 63-year-old previously asymptomatic female patient who developed severe left shoulder tendinopathy after surreptitiously doubling the prescribed dose of levofloxacin for the treatment of community-acquired pneumonia is reported here. Surgical stabilization with suture anchors and subacromial decompression were needed.

  14. Self-esteem in severely burned adults.

    Science.gov (United States)

    Imran Haider Zaidi, Syed Muhammad; Yaqoob, Nazia; Noreen, Sidra

    2017-12-01

    A cross-sectional study was conducted to investigate the level of and gender difference in self-esteem among adult victims of severe burn injuries. Severely burned adults aged 20 to 40 years participated in this investigation from March 2015 to April 2016 in five hospitals of Faisalabad and Lahore. Purposive sampling technique was used and a self-esteem scale was used to assess different dimensions of self-esteem. Out of 40 patients, there were 25 men (62.5%) and 15 women (37.5%) with mean age of 28.28±4.60 years (range: 20-40 years). A significant positive relationship between subscales of self-esteem scale were found: self-acceptance and self-competence r=0.55, pself-acceptance and academic self-competence r=0.47, pself-acceptance and social and physical acceptance r=0.57, pself-competence and academic self-competence r=0.48, pself-competence and social and physical acceptance r=0.50, pself-competence and social and physical acceptance r=0.45, pdifference between self-competence among severely burned men and women (t=2.18; pgender difference indicated higher affected levels specifically in the self-competency component of self-esteem among women victims.

  15. Severe hypertriglyceridemia-induced pancreatitis during pregnancy.

    Science.gov (United States)

    Gürsoy, Alptekin; Kulaksizoglu, Mustafa; Sahin, Mustafa; Ertugrul, Derun Taner; Ozer, Feyza; Tutuncu, Neslihan Bascil; Demirag, Nilgun Guvener

    2006-04-01

    Chylomicronemia syndrome is a rare disorder characterized by the presence of chylomicrons in the fasting state. An acute and potentially life-threatening complication of chyiomicronemia syndrome is severe acute pancreatitis. We report a case of a 24-year-old primigravida with severe hypertriglyceridemia-induced pancreatitis. We reviewed the clinical course and treatment of hypertriglyceridemia-induced pancreatitis. She was admitted in the 37th week of gestation with severe abdominal pain, which was radiating to the back, and having uterine contractions. Cesarean delivery was performed under spinal anesthesia, and a healthy male infant was born. Intraoperative findings included milky peritoneal fluid collection. Elevated pancreatic enzymes with significant hypertriglyceridemia (10,092 mg/dL) suggesting acute pancreatitis were also found on chemical analysis. The diagnosis of acute pancreatitis was confirmed by computed tomography scan. Treatment with continuous intravenous insulin--glucose, cessation of oral intake, and nasogastric decompression--dramatically decreased the triglyceride levels to 608 mg/dL within five days. She was discharged as symptom free with strict dietary intervention after 10 days. Intravenous insulin is a low-cost and effective alternative treatment in hypertriglyceridemia-induced pancreatitis during pregnancy. To our knowledge, such a high triglyceride level has not previously been reported in pregnancy.

  16. ANS severe accident program overview & planning document

    Energy Technology Data Exchange (ETDEWEB)

    Taleyarkhan, R.P.

    1995-09-01

    The Advanced Neutron Source (ANS) severe accident document was developed to provide a concise and coherent mechanism for presenting the ANS SAP goals, a strategy satisfying these goals, a succinct summary of the work done to date, and what needs to be done in the future to ensure timely licensability. Guidance was received from various bodies [viz., panel members of the ANS severe accident workshop and safety review committee, Department of Energy (DOE) orders, Nuclear Regulatory Commission (NRC) requirements for ALWRs and advanced reactors, ACRS comments, world-wide trends] were utilized to set up the ANS-relevant SAS goals and strategy. An in-containment worker protection goal was also set up to account for the routine experimenters and other workers within containment. The strategy for achieving the goals is centered upon closing the severe accident issues that have the potential for becoming certification issues when assessed against realistic bounding events. Realistic bounding events are defined as events with an occurrency frequency greater than 10{sup {minus}6}/y. Currently, based upon the level-1 probabilistic risk assessment studies, the realistic bounding events for application for issue closure are flow blockage of fuel element coolant channels, and rapid depressurization-related accidents.

  17. APR1400 severe accident mitigation design

    Energy Technology Data Exchange (ETDEWEB)

    Jae Young, Lim; Jae Youb, Byun [Shin-Kori 3 and 4 NPP Project, Korea Power Engineering Company, Yongin-si, Gyeonggi-do (Korea, Republic of)

    2007-07-01

    APR1400, a Korean evolutionary advanced LWR, has been developed to meet the quantitative safety goals of mean core damage frequency to be less than one in one hundred thousand reactor years (10{sup -5}/y) and the expected overall mean frequency of occurrence of offsite doses in excess of 0.01 Sv within 24 hours at the site boundary to be less than one per million reactor years (10{sup -6}/y). In order to meet these quantitative goals, defense in depth, a long standing fundamental principle of reactor safety, was applied to ensure plant safety and to provide the balanced design between prevention and mitigation. And various advanced design features were reviewed to improve plant safety in the viewpoint of prevention and mitigation of design basis accident and severe accident. In this paper, 5 issues concerning severe accident mitigation features of the APR1400 are reviewed: 1) hydrogen control, 2) high pressure melt ejection and direct containment heating, 3) steam explosion, 4) molten corium concrete interaction, and 5) equipment survivability. It is shown that the APR1400 has been designed to withstand severe accidents.

  18. Nuclear power plant Severe Accident Research Plan

    International Nuclear Information System (INIS)

    Larkins, J.T.; Cunningham, M.A.

    1983-01-01

    The Severe Accident Research Plan (SARP) will provide technical information necessary to support regulatory decisions in the severe accident area for existing or planned nuclear power plants, and covers research for the time period of January 1982 through January 1986. SARP will develop generic bases to determine how safe the plants are and where and how their level of safety ought to be improved. The analysis to address these issues will be performed using improved probabilistic risk assessment methodology, as benchmarked to more exact data and analysis. There are thirteen program elements in the plan and the work is phased in two parts, with the first phase being completed in early 1984, at which time an assessment will be made whether or not any major changes will be recommended to the Commission for operating plants to handle severe accidents. Additionally at this time, all of the thirteen program elements in Chapter 5 will be reviewed and assessed in terms of how much additional work is necessary and where major impacts in probabilistic risk assessment might be achieved. Confirmatory research will be carried out in phase II to provide additional assurance on the appropriateness of phase I decisions. Most of this work will be concluded by early 1986

  19. Imitators of severe pre-eclampsia.

    Science.gov (United States)

    Sibai, Baha M

    2009-06-01

    There are many obstetric, medial, and surgical disorders that share many of the clinical and laboratory findings of patients with severe pre-eclampsia-eclampsia. Imitators of severe pre-eclampsia-eclampsia are life-threatening emergencies that can develop during pregnancy or in the postpartum period. These conditions are associated with high maternal and perinatal mortalities and morbidities, and survivors may face long-term sequelae. The pathophysiologic abnormalities in many of these disorders include vasospasm, platelet activation or destruction, microvascular thrombosis, endothelial cell dysfunction, and reduced tissue perfusion. Some of these disorders include acute fatty liver of pregnancy, thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, acute exacerbation of systemic lupus erythematosus, and disseminated herpes simplex and sepsis syndromes. Differential diagnosis may be difficult due to the overlap of several clinical and laboratory findings of these syndrome. It is important that the clinician make the accurate diagnosis when possible because the management and complications from these syndromes may be different. Because of the rarity of these conditions during pregnancy and postpartum, the available literature includes only case reports and case series describing these syndromes. This review focuses on diagnosis, management, and counseling of women who develop these syndromes based on results of recent studies and my own clinical experience.

  20. [Eating habits of patients with severe obesity].

    Science.gov (United States)

    Reséndiz Barragán, Aída Monserrat; Hernández Altamirano, Sheila Viridiana; Sierra Murguía, Mariana Alejandra; Torres Tamayo, Margarita

    2014-11-30

    Severe obesity is a health problem that has medical, emotional and economic consequences. The etiology of severe obesity is multifactorial; however, it is known that the eating habits represent a major factor in the development of this disease. This study aimed to identify eating patterns and specific habits that need to be changed to achieve weight loss. An observational, descriptive, retrospective and cross-sectional study with 250 candidates for bariatric surgery, 79.2% women and 20.8% men aged 37.7 ± 10.2 years and 44.3 ± 7.7 kg/m2 BMI patients was performed. It was found that "drinking water", "eat faster than most people", "leave the plate empty", "have long fasts", "sweet cravings", and "drinking soda" were the most common habits in patients with severe obesity. The existence of significant differences between the habits of men and women and between BMI strata or groups are also discussed. "Snacking" and "eat until you feel uncomfortable" were significantly different between men and women and "eat by yourself because you feel ashamed of eating with others" was significant between BMI strata. It was concluded that it is important that the treatment of these patients includes assessment techniques and behavior modification aimed at these habits. It is recommended to include in future studies patients with normal weight and overweight as well as the use of instruments with adequate psychometric properties. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  1. Development of Severe Accident Containment Analysis Package

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chang-Hwan; Kim, Dong-Min; Seo, Jea-Uk; Lee, Dea-Young; Park, Soon-Ho; Lee, Jae-Gwon; Lee, Jin-Yong; Lee, Byung-Chul [FNC Technology Co., Yongin (Korea, Republic of)

    2016-10-15

    In safety viewpoint, the pressure and temperature of the containment is the important parameters, of course, the local hydrogen concentration is also the parameter of the major concern because of its flammability and the risk of the detonation. In addition, there are possibilities of occurrence of other relevant phenomena following the reactor core melting such as DCH(direct containment heating) due to HPME(high pressure melt ejection), steam explosion due to fuel-coolant interaction in the reactor cavity and molten core concrete interaction at the late stage. It is important to predict the containment responses during a severe accident by a reasonable accuracy for establishing of effective mitigation strategies and preparation of the safety features required. In this paper, the overview of the SACAP development status is presented. SACAP is developed so as to be able to analyze, so called, Ex-Vessel severe accident phenomena including thermal-hydraulics, combustible gas burn, direct containment heating, steam explosion and molten core-concrete interaction. At the parallel time, SACAP and In-Vessel analysis module named CSPACE are processed for integration through MPI communication coupling. Development of the integrated severe accident analysis code system will be completed in following one year to make the code revision zero to be released.

  2. Hierarchical feature selection for erythema severity estimation

    Science.gov (United States)

    Wang, Li; Shi, Chenbo; Shu, Chang

    2014-10-01

    At present PASI system of scoring is used for evaluating erythema severity, which can help doctors to diagnose psoriasis [1-3]. The system relies on the subjective judge of doctors, where the accuracy and stability cannot be guaranteed [4]. This paper proposes a stable and precise algorithm for erythema severity estimation. Our contributions are twofold. On one hand, in order to extract the multi-scale redness of erythema, we design the hierarchical feature. Different from traditional methods, we not only utilize the color statistical features, but also divide the detect window into small window and extract hierarchical features. Further, a feature re-ranking step is introduced, which can guarantee that extracted features are irrelevant to each other. On the other hand, an adaptive boosting classifier is applied for further feature selection. During the step of training, the classifier will seek out the most valuable feature for evaluating erythema severity, due to its strong learning ability. Experimental results demonstrate the high precision and robustness of our algorithm. The accuracy is 80.1% on the dataset which comprise 116 patients' images with various kinds of erythema. Now our system has been applied for erythema medical efficacy evaluation in Union Hosp, China.

  3. Severe neurological complication following adjustable gastric banding.

    Science.gov (United States)

    Martines, G; Musa, N; Aquilino, F; Capuano, P

    2018-01-01

    In the last years with the increase of bariatric surgery, first of all as a result of new indications, a rise in the incidence of nutrient-related complications has been observed. Currently little is known about the impact of post-bariatric malnutrition and neurological complications. Wernicke's encephalopathy is a severe neurological syndrome which occurs as a result of thiamine deficiency. Wernicke-Korsakoff syndrome must be considered a serious neurological complication of bariatric surgery with significant morbidity and mortality, with rapidly progressing neurological symptoms, and must be treated immediately. We report the case of a 35 years-old male patient, affected by morbid obesity, anxious-depressive syndrome and alcohol use disorder, who after adjustable gastric banding implanted in another hospital developed a severe malnutrition and neurological syndrome. The patient showed poor adherence to the follow-up and to the dietary indications and after all, we needed to place a PEG for enteral nutrition in order to resolve the malnutrition condition and the neurological syndrome. Our experience emphasizes that preoperative selection and assessment of a patient's nutritional status according to guidelines, is required to identify potential problems, and that bariatric surgeons or physicians caring for patient who have undergone bariatric surgery should be familiar with the constellation of nutritional and neurological disorder that may occur after surgery. We want to remark the importance of preoperative selection of the patients, the follow-up and the cooperation between patient and physician in order to obtain the best result and avoid severe complications.

  4. Severe allergic reactions to guinea pig

    Directory of Open Access Journals (Sweden)

    Shaw Jeffrey L

    2005-10-01

    Full Text Available Abstract Background Allergic sensitization and reactions to guinea pig (Cavia porcellus have been well documented in laboratory animal handlers, primarily manifesting as rhinitis, conjunctivitis, and asthma. Severe allergic reactions, however, are rare. Methods We report two patients with severe allergic reactions following non-occupational exposure to guinea pigs. The first patient, an 11-year-old female, developed ocular, nasal, skin and laryngeal edema symptoms immediately after handling a guinea pig. The second patient, a 24-year-old female, developed symptoms of isolated laryngeal edema after cleaning a guinea pig cage. Percutaneous skin testing, RAST, ELISA and ELISA inhibition testing with guinea pig extract were performed. Results Both patients had IgE-mediated allergy to guinea pig confirmed by ELISA and either RAST or skin testing. ELISA inhibition studies confirmed the specificity of the IgE reactivity to guinea pig. Conclusion Severe IgE-mediated reactions can occur following non-occupational guinea pig exposure. Physicians should be aware of this possibility.

  5. Dysautonomia after severe traumatic brain injury.

    Science.gov (United States)

    Hendricks, H T; Heeren, A H; Vos, P E

    2010-09-01

    Dysautonomia after traumatic brain injury (TBI) is characterized by episodes of increased heart rate, respiratory rate, temperature, blood pressure, muscle tone, decorticate or decerebrate posturing, and profuse sweating. This study addresses the incidence of dysautonomia after severe TBI, the clinical variables that are associated with dysautonomia, and the functional outcome of patients with dysautonomia. A historic cohort study in patients with severe TBI [Glasgow Coma Scale (GCS) dysautonomia was 11.8%. Episodes of dysautonomia were prevalent during a mean period of 20.1 days (range 3-68) and were often initiated by discomfort. Patients with dysautonomia showed significant longer periods of coma (24.78 vs. 7.99 days) and mechanical ventilation (22.67 vs. 7.21 days). Dysautonomia was associated with diffuse axonal injury (DAI) [relative risk (RR) 20.83, CI 4.92-83.33] and the development of spasticity (RR 16.94, CI 3.96-71.42). Patients with dysautonomia experienced more secondary complications. They tended to have poorer outcome. Dysautonomia occurs in approximately 10% of patients surviving severe TBI and is associated with DAI and the development of spasticity at follow-up. The initiation of dysautonomia by discomfort supports the Excitatory: Inhibitory Ratio model as pathophysiological mechanism.

  6. Fomepizole for severe disulfiram-ethanol reactions.

    Science.gov (United States)

    Sande, Margaret; Thompson, David; Monte, Andrew A

    2012-01-01

    Ingestion of ethanol in the presence of disulfiram may cause a histamine-like reaction due to accumulation of acetaldehyde. These disulfiram-ethanol reactions (DERs) are manifested by hypotension, tachycardia, gastritis, and angioedema. Fomepizole, an inhibitor of alcohol dehydrogenase, may halt progression of this reaction by blocking ethanol metabolism to acetaldehyde. We present 2 cases of disulfiram and alcohol overdose leading to severe reactions unresponsive to fluid resuscitation and treated with a single dose of fomepizole. Case 1: A 20-year-old woman presented after ingestion of vodka and disulfiram. After 11 hours of resuscitation, she had skin flushing, lip swelling, tachycardia, and hypotension. Antihistamines, steroids, and an additional 2 L of normal saline were given without improvement. Fomepizole 15 mg/kg was given with improvement within 1.5 hours, and she was ultimately discharged with no clinical sequelae. Case 2: A 47-year-old woman presented after overdose of vodka and disulfiram. She was tachycardic and hypotensive upon presentation. After administration of 3 L of normal saline, she remained hypotensive and tachycardic. One dose of fomepizole 15 mg/kg was given. Within 1 hour following fomepizole infusion, her blood pressure and heart rate normalized, and she had no further sequelae from her ingestion. Fomepizole may be a safe and effective treatment of severe DERs. We suggest that 1 dose of fomepizole for severe DERs with hypotension unresponsive to fluid resuscitation or for angioedema unresponsive to antihistamines be administered.

  7. Emotional intelligence, trauma severity, and emotional expression.

    Science.gov (United States)

    Kao, Min C; Chen, Yung Y

    2016-07-01

    This study investigated Emotional Intelligence (EI) as a moderator for the association between emotional expression and adaptive trauma processing, as measured by depressive symptoms. Using Pennebaker's written emotional expression paradigm, 105 participants were assigned to either a conventional trauma-writing or religious trauma-writing condition. Depressive symptoms were assessed at baseline and again at one-month post writing. No significant association between EI and religiousness was found at baseline. Results indicated a three-way interaction among EI, trauma severity, and writing condition on depressive symptoms at follow-up. For the religious trauma-writing condition only, there was a significant difference between high- versus low-EI participants who experienced more severe trauma in depressive symptoms at follow-up, such that low-EI participants registered less depressive symptoms than high-EI participants; while there was no significant difference between low versus high EI for participants with less severe trauma. These findings encourage further investigation of the conditions under which religion may be a beneficial factor in trauma adaptation.

  8. Aciduric Microbiota and Mutans Streptococci in Severe and Recurrent Severe Early Childhood Caries

    Science.gov (United States)

    Hughes, Christopher V.; Dahlan, Mohammed; Papadopolou, Eleftheria; Kent, Ralph L.; Loo, Cheen Y.; Pradhan, Nooruddin S.; Lu, Shulin C.; Bravoco, Alexandra; Mathney, Jennifer M.J.; Tanner, Anne C.R.

    2011-01-01

    Purpose Severe early childhood caries (ECC) results from bacterial acid production in an acidic environment. The current study determined Streptococcus mutans, Streptococcus sobrinus and acid-tolerant counts in severe-ECC. Methods Children (2–6 years) with severe-ECC (n=77) or who were caries-free (n=40) were examined. Plaque samples from teeth and the tongue were cultured anaerobically on blood, acid and S. mutans selective agars. Severe-ECC children were monitored post-treatment for recurrent caries. Results Severe-ECC and caries-free children were balanced by household income and education level. Carious lesions were observed in 75% maxillary incisors and >80% molars in severe-ECC. At baseline, Streptococcus mutans, and Streptococcus sobrinus counts and proportions of S. mutans were higher in severe-ECC than caries-free children. Acid and blood counts were elevated only in anterior samples of severe-ECC children. Baseline counts of S. sobrinus, but not S. mutans, were higher in children with recurrent compared with no recurrent caries. S. mutans counts were lower post treatment than pre-treatment, particularly for children without caries recurrence. Other counts did not differ between before and after therapy. Conclusions We conclude that severe and recurrent ECC were better explained by mutans streptococci than the aciduric microbiota. S. mutans did not predict children with recurrent caries. PMID:22583872

  9. Operative treatment of severe forms of hypospadias.

    Science.gov (United States)

    Abramovic, V

    1981-10-01

    Hypospadias is a polymorphic congenital malformation. Aside from the main defect-partial hypoplasia of the urethra--there are other associated malformations: meatal stenosis, penile curvature, penoscrotal skin malformations (pterygiae), partial aplasia of the ventral prepuce, and a large dorsal prepuce. Severe forms are accompanied by hypoplasia of the penis. Hypospadias can be divided into simple forms (anterior hypospadias), in which the meatus is located on the distal half of the penis, and severe forms (posterior hypospadias), in which the meatus is located on the proximal half of the penis, the penoscrotal border, scrotal sulcus, or perineum, either primarily or after elongation and chordectomy. The differences are not only morphological but have practical significance. These two types of hypospadias differ as to operative procedure, complications, and operative results, and cannot be compared with each other. Thus hypospadias must not be considered a single entity, as is often done in the literature, as this may lead to misinterpretation of results. Severe forms of hypospadias are a special problem which require more sophisticated corrective procedures; they are associated with a greater incidence of complications and the aesthetic result is not as good as in the other group. After disappointing results using the Denis-Browne, Cecil, and Broadbent methods, we modified Grob's preputial tube-plasty 15 years ago. This technique enables reconstruction of the urethra with a sufficiently large, well-vascularized, non-hair-bearing preputial skin. The new urethra is long and large enough, and grows along with the penis, avoiding secondary curvature. The incidence of postoperative fistulas is low, and secondary closure is simple and safe. The aesthetic result is also satisfactory. The disadvantage of this method, namely the three-stage operative procedure, is compensated for by the low incidence of fistulas, lower operative risk, and shorter duration of each operation

  10. The diverse application of laser hair removal therapy: a tertiary laser unit's experience with less common indications and a literature overview.

    Science.gov (United States)

    Koch, D; Pratsou, P; Szczecinska, W; Lanigan, S; Abdullah, A

    2015-01-01

    We describe the diversity of indications for laser hair removal (LHR) therapy and compare our experience with the literature. Patients' case notes referred to the Birmingham Regional Skin Laser Centre between 2003 and 2011 for laser hair removal, with indications other than hirsutism, were reviewed retrospectively. Thirty-one treated patients with the following indications were identified: hair-bearing skin grafts/flaps, intra-oral hair-bearing flap, Becker's naevus, localised nevoid hypertrichosis, peristomal hair-bearing skin, scrotal skin prior to vaginoplasty in male-to-female (MTF) gender reassignment, pilonidal sinus disease (PSD), pseudofolliculitis barbae (PFB) and hidradenitis suppurativa (HS). Seven patients with the following indications have been reported before: intra-oral hair-bearing graft, naevoid hypertrichosis and peristomal hair-bearing skin. A clinical review of the evidence available for each indication is provided. Our experience and that in the published literature suggest that LHR is a safe, well-tolerated and effective treatment modality for the indications we report, leading to significant symptom and functional improvement with high patient satisfaction. LHR appears effective in the treatment of chronic inflammatory conditions such as PSD, PFB and HS, particularly at an early disease stage. We aim to increase awareness of the diversity of laser hair removal indications and add evidence to the medical literature of the wide range of indications for this useful treatment modality.

  11. A Proposal for a Study on Treatment Selection and Lifestyle Recommendations in Chronic Inflammatory Diseases: A Danish Multidisciplinary Collaboration on Prognostic Factors and Personalised Medicine

    Directory of Open Access Journals (Sweden)

    Vibeke Andersen

    2017-05-01

    Full Text Available Chronic inflammatory diseases (CIDs, including Crohn’s disease and ulcerative colitis (inflammatory bowel diseases, IBD, rheumatoid arthritis, psoriasis, psoriatic arthritis, spondyloarthritides, hidradenitis suppurativa, and immune-mediated uveitis, are treated with biologics targeting the pro-inflammatory molecule tumour necrosis factor-α (TNF (i.e., TNF inhibitors. Approximately one-third of the patients do not respond to the treatment. Genetics and lifestyle may affect the treatment results. The aims of this multidisciplinary collaboration are to identify (1 molecular signatures of prognostic value to help tailor treatment decisions to an individual likely to initiate TNF inhibitor therapy, followed by (2 lifestyle factors that support achievement of optimised treatment outcome. This report describes the establishment of a cohort that aims to obtain this information. Clinical data including lifestyle and treatment response and biological specimens (blood, faeces, urine, and, in IBD patients, intestinal biopsies are sampled prior to and while on TNF inhibitor therapy. Both hypothesis-driven and data-driven analyses will be performed according to pre-specified protocols including pathway analyses resulting from candidate gene expression analyses and global approaches (e.g., metabolomics, metagenomics, proteomics. The final purpose is to improve the lives of patients suffering from CIDs, by providing tools facilitating treatment selection and dietary recommendations likely to improve the clinical outcome.

  12. A Proposal for a Study on Treatment Selection and Lifestyle Recommendations in Chronic Inflammatory Diseases: A Danish Multidisciplinary Collaboration on Prognostic Factors and Personalised Medicine.

    Science.gov (United States)

    Andersen, Vibeke; Holmskov, Uffe; Sørensen, Signe Bek; Jawhara, Mohamad; Andersen, Karina W; Bygum, Anette; Hvid, Lone; Grauslund, Jakob; Wied, Jimmi; Glerup, Henning; Fredberg, Ulrich; Villadsen, Jan Alexander; Kjær, Søren Geill; Fallingborg, Jan; Moghadd, Seyed A G R; Knudsen, Torben; Brodersen, Jacob; Frøjk, Jesper; Dahlerup, Jens F; Nielsen, Ole Haagen; Christensen, Robin; Bojesen, Anders Bo; Sorensen, Grith Lykke; Thiel, Steffen; Færgeman, Nils J; Brandslund, Ivan; Stensballe, Allan; Schmidt, Erik Berg; Franke, Andre; Ellinghaus, David; Rosenstiel, Philip; Raes, Jeroen; Heitmann, Berit; Boye, Mette; Nielsen, Charlotte Lindgaard; Werner, Lars; Kjeldsen, Jens; Ellingsen, Torkell

    2017-05-15

    Chronic inflammatory diseases (CIDs), including Crohn's disease and ulcerative colitis (inflammatory bowel diseases, IBD), rheumatoid arthritis, psoriasis, psoriatic arthritis, spondyloarthritides, hidradenitis suppurativa, and immune-mediated uveitis, are treated with biologics targeting the pro-inflammatory molecule tumour necrosis factor-α (TNF) (i.e., TNF inhibitors). Approximately one-third of the patients do not respond to the treatment. Genetics and lifestyle may affect the treatment results. The aims of this multidisciplinary collaboration are to identify (1) molecular signatures of prognostic value to help tailor treatment decisions to an individual likely to initiate TNF inhibitor therapy, followed by (2) lifestyle factors that support achievement of optimised treatment outcome. This report describes the establishment of a cohort that aims to obtain this information. Clinical data including lifestyle and treatment response and biological specimens (blood, faeces, urine, and, in IBD patients, intestinal biopsies) are sampled prior to and while on TNF inhibitor therapy. Both hypothesis-driven and data-driven analyses will be performed according to pre-specified protocols including pathway analyses resulting from candidate gene expression analyses and global approaches (e.g., metabolomics, metagenomics, proteomics). The final purpose is to improve the lives of patients suffering from CIDs, by providing tools facilitating treatment selection and dietary recommendations likely to improve the clinical outcome.

  13. Severe Sepsis in Severely Malnourished Young Bangladeshi Children with Pneumonia: A Retrospective Case Control Study.

    Directory of Open Access Journals (Sweden)

    Mohammod Jobayer Chisti

    Full Text Available In developing countries, there is no published report on predicting factors of severe sepsis in severely acute malnourished (SAM children having pneumonia and impact of fluid resuscitation in such children. Thus, we aimed to identify predicting factors for severe sepsis and assess the outcome of fluid resuscitation of such children.In this retrospective case-control study SAM children aged 0-59 months, admitted to the Intensive Care Unit (ICU of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh from April 2011 through July 2012 with history of cough or difficult breathing and radiologic pneumonia, who were assessed for severe sepsis at admission constituted the study population. We compared the pneumonic SAM children with severe sepsis (cases = 50 with those without severe sepsis (controls = 354. Severe sepsis was defined with objective clinical criteria and managed with fluid resuscitation, in addition to antibiotic and other supportive therapy, following the standard hospital guideline, which is very similar to the WHO guideline.The case-fatality-rate was significantly higher among the cases than the controls (40% vs. 4%; p<0.001. In logistic regression analysis after adjusting for potential confounders, lack of BCG vaccination, drowsiness, abdominal distension, acute kidney injury, and metabolic acidosis at admission remained as independent predicting factors for severe sepsis in pneumonic SAM children (p<0.05 for all comparisons.We noted a much higher case fatality among under-five SAM children with pneumonia and severe sepsis who required fluid resuscitation in addition to standard antibiotic and other supportive therapy compared to those without severe sepsis. Independent risk factors and outcome of the management of severe sepsis in our study children highlight the importance for defining optimal fluid resuscitation therapy aiming at reducing the case fatality in such children.

  14. Parenting Stress Related to Behavioral Problems and Disease Severity in Children with Problematic Severe Asthma

    NARCIS (Netherlands)

    Verkleij, Marieke; van de Griendt, E-J.; Colland, V.; Van Loey, N.E.E.; Beelen, A.; Geenen, R.

    2015-01-01

    Our study examined parenting stress and its association with behavioral problems and disease severity in children with problematic severe asthma. Research participants were 93 children (mean age 13.4 ± 2.7 years) and their parents (86 mothers, 59 fathers). As compared to reference groups analyzed in

  15. Imaging findings of severe and critical severe pulmonary infections with A H1N1 influenza

    International Nuclear Information System (INIS)

    Chen Feng; Zhao Dawei; Wen Shuo; Li Hongjun; Wang Wei; He Ning; Zhang Ruichi; Song Wenyan

    2010-01-01

    Objective: To evaluate the pulmonary imaging features in patients with severe or critical severe A H1N1 influenza. Methods: Clinical and imaging findings of 18 cases with H1N1 pneumonia were retrospectively analyzed. These patients were divided into 2 groups including severe group (n=11) and critical group (n=7). Results: Among the severe group, bilateral ill-defined nodules and patch shadows were found in 8 cases, local ill-defined patchy was shown in 3 cases, and consolidation of right inferior lung was demonstrated by CT scan in 1 case. Among the critical group, diffuse ground-glass attenuation with partial consolidation were found in bilateral lungs of 4 cases, subcutaneous emphysema was observed in 1 case. CT showed diffuse ground-glass attenuation and nodular like consolidation in bilateral inferior lungs in 1 case, and other 3 cases showed diffuse consolidation of bilateral lungs. Conclusions: The radiologic findings of severe and critical severe pulmonary infections with H1N1 include ill-defined nodules and patch shadows of bilateral lung in sever patients, diffuse peribronchial ground-glass opacity and multifocal consolidation in critical severe patients. The radiologists should learn the features of H1N1 pneumonia on thoracic plain film and CTT to make diagnosis in time. (authors)

  16. Kyphoplasty for severe osteoporotic vertebral compression fractures

    International Nuclear Information System (INIS)

    Bao Zhaohua; Wang Genlin; Yang Huilin; Meng Bin; Chen Kangwu; Jiang Weimin

    2010-01-01

    Objective: To evaluate the clininal efficacy of kyphoplasty for severe osteoporotic vertebral compression fractures. Methods: Forty-five patients with severe osteoporotic compressive fractures were treated by kyphoplasty from Jan 2005 to Jan 2009. The compressive rate of the fractured vertebral bodies was more than 75%. According to the morphology of the vertebral compression fracture bodies the unilateral or bilateral balloon kyphoplasty were selected. The anterior vertebral height was measured on a standing lateral radiograph at pre-operative, post-operative (one day after operation) and final follow-up time. A visual analog scale(VAS) and the Oswestry disability index (ODI) were chosen to evaluate pain status and functional activity. Results: The mean follow-up was for 21.7 months (in range from 18 to 48 months). The anterior vertebral body height of fracture vertebra was restored from preoperative (18.7 ± 3.1)% to postoperative (51.4 ± 2.3)%, the follow-up period (50.2 ± 2.7)%. There was a significant improvement between preoperative and postoperative values (P 0.05). The VAS was 8.1 ± 1.4 at preoperative, 2.6 ± 0.9 at postoperative, 2.1 ± 0.5 at final follow-up time; and the ODI was preoperative 91.1 ± 2.3, postoperative 30.7 ± 7.1, follow-up period 26.1 ± 5.1. There was statistically significant improvement in the VAS and ODI in the post-operative assessment compared with the pre-operative assessment (P 0.05). Asymptomatic cement leakage occurred in three cases. New vertebral fracture occurred in one case. Conclusion: The study suggests that balloon kyphoplasty is a safe and effective procedure in the treatment of severe osteoporotic vertebral compression fractures. (authors)

  17. Night eating syndrome: implications for severe obesity.

    Science.gov (United States)

    Cleator, J; Abbott, J; Judd, P; Sutton, C; Wilding, J P H

    2012-09-10

    Night eating syndrome (NES) was first identified in 1955 by Stunkard, a psychiatrist specialising in eating disorders (ED). Over the last 20 years considerable progress has been made in defining NES as a significant clinical entity in its own right and it has now been accepted for inclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) due for publication in 2013. NES is considered a dysfunction of circadian rhythm with a disassociation between eating and sleeping. Core criteria include a daily pattern of eating with a significantly increased intake in the evening and/or night time, as manifested by one or both of the following: at least 25% of food intake is consumed after the evening meal or at least two episodes of nocturnal eating per week. An important recent addition to core criteria includes the presence of significant distress and/or impairment in functioning. Stunkard's team recommend further investigation on the pathogenesis of NES, in particular its relationship with traumatic life events, psychiatric comorbidity, the age of onset of NES and course of NES over time. The relationship between NES and other ED also requires further clarification as night-eaters exhibit some features of other ED; previous guidance to separate NES from other ED may have hindered earlier characterisation of NES. Evidence from European and American studies suggests NES features strongly in populations with severe obesity. The complex interplay between depression, impaired sleep and obesity-related comorbidity in severely obese individuals makes understanding NES in this context even more difficult. This review examines evidence to date on the characterisation of NES and concludes by examining the applicability of current NES criteria to individuals with severe obesity.

  18. The Hand Burn Severity (HABS) score: A simple tool for stratifying severity of hand burns.

    Science.gov (United States)

    Bache, Sarah E; Fitzgerald O'Connor, Edmund; Theodorakopoulou, Evgenia; Frew, Quentin; Philp, Bruce; Dziewulski, Peter

    2017-02-01

    Hand burns represent a unique challenge to the burns team due to the intricate structure and unrivalled functional importance of the hand. The initial assessment and prognosis relies on consideration of the specific site involved as well as depth of the burn. We created a simple severity score that could be used by referring non-specialists and researchers alike. The Hand Burn Severity (HABS) score stratifies hand burns according to severity with a numerical value of between 0 (no burn) and 18 (most severe) per hand. Three independent assessors scored the photographs of 121 burned hands of 106 adult and paediatric patients, demonstrating excellent inter-rater reliability (r=0.91, pburn depth alone. The HABS score is a simple to use tool to stratify severity at initial presentation of hand burns which will be useful when referring, and when reporting outcomes. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  19. Severe iron intoxication treated with exchange transfusion

    DEFF Research Database (Denmark)

    Carlsson, Marcella; Cortes, Dina; Jepsen, Søren

    2008-01-01

    An 18-month-old previous healthy girl who had ingested 442 mg elemental iron/kg was admitted to a paediatric intensive care unit. The child was treated with gastric lavage, whole bowel irrigation and intravenous deferoxamine. After 2 h of standard therapy serum iron had risen threefold to 1362 mi...... microg/dl (244 micromol/l). The child was treated with exchange transfusion (ET; 52 ml/kg) and serum iron fell to 134 microg/dl (24 micromol/l). The patient made an uncomplicated recovery. ET should be considered in severe iron poisoning when standard therapy is inadequate....

  20. Severe iron intoxication treated with exchange transfusion

    DEFF Research Database (Denmark)

    Carlsson, M; Cortes, D; Jepsen, S

    2009-01-01

    An 18-month-old previous healthy girl who had ingested 442 mg elemental iron/kg was admitted to a paediatric intensive care unit. The child was treated with gastric lavage, whole bowel irrigation and intravenous deferoxamine. After 2 h of standard therapy serum iron had risen threefold to 1362 µg....../dl (244 µmol/l). The child was treated with exchange transfusion (ET; 52 ml/kg) and serum iron fell to 134 µg/dl (24 µmol/l). The patient made an uncomplicated recovery. ET should be considered in severe iron poisoning when standard therapy is inadequate....

  1. Unusually severe food poisoning from vanilla slices.

    Science.gov (United States)

    Fenton, P. A.; Dobson, K. W.; Eyre, A.; McKendrick, M. W.

    1984-01-01

    Thirty six people suffered from severe vomiting and diarrhoea 15 min to 3 h after eating vanilla slices from the same bakery. Five patients were admitted to hospital, and one developed unusual skin lesions after admission. Staphylococcus aureus was isolated in large numbers from vanilla slices of the same batch as those giving rise to symptoms, and from five faecal specimens obtained from affected persons. Bacillus cereus and Bacillus subtilis were also isolated from the slices. Unbaked custard provides an ideal environment for bacterial multiplication, especially when (as on this occasion) the ambient temperature is persistently high. PMID:6438231

  2. A new perspective on severe nuclear accidents

    International Nuclear Information System (INIS)

    Lee, Jaiki

    2012-01-01

    The reactions of the public in Korea to the nuclear accident at the Fukushima Daiichi plants in Japan, particularly over-reactions, are reviewed, with the conclusion that significant radioactive contamination of a small country could lead to a severe national crisis. The most important factor is the socio-economic damage caused by stigma, which in turn is caused by a misunderstanding of the radiation risk. Given that nuclear power is an important choice in the face of the threat of climate change, the public's perceptions need to be changed at any cost, not only in those countries operating nuclear power plants but globally as well. (note)

  3. The Lindelof principle in several complex variables

    Science.gov (United States)

    Krantz, Steven G.

    2007-02-01

    We formulate and prove a new Lindelof principle in the function theory of several complex variables. Inspired by the classical result, as improved later by Lehto and Virtanen, this new result meshes closely with the well-established Fatou theorems of Koranyi and Stein. In particular, this is a Lindelof principle for admissible approach regions. We further adapt the new principle to the Levi geometry of various domains. The results in this paper improve on earlier results of Cirka, Cima/Krantz, Abate, and Abate/Tauraso.

  4. Bronchial thermoplasty in severe asthma in Australia.

    Science.gov (United States)

    Langton, David; Sha, Joy; Ing, Alvin; Fielding, David; Wood, Erica

    2017-05-01

    Bronchial thermoplasty (BT) is an approved bronchoscopic intervention for the treatment of severe asthma. However, limited published experience exists outside of clinical trials regarding patient selection and outcomes achieved. To evaluate the effectiveness and safety of BT in patients with severe asthma encountered in clinical practice. This is a retrospective analysis of the first 'real world' data from Australia. The following outcomes were measured prior to, and 6 months following BT: spirometry, Asthma Control Questionnaire-5 (ACQ-5) score, reliever and preventer medication use and exacerbation history. Twenty patients were treated from June 2014 to December 2015 at three university teaching hospitals. All subjects met the European Respiratory Society/American Thoracic Society definition of severe asthma. Mean pre-bronchodilator forced expiratory volume in 1 s was 62.8 ± 16.6% predicted (range: 33-95%). All patients were being treated with high dose inhaled corticosteroids, long-acting beta 2 agonists and long-acting muscarinic antagonists. Ten patients (50%) were taking maintenance oral prednisolone. Most subjects also required at least one of montelukast (65%), omalizumab (30%) and methotrexate (20%). ACQ-5 improved from 3.6 ± 1.1 at baseline to 1.6 ± 1.2 at 6 months, P < 0.001. Short-acting reliever use decreased from a median of 8.0-0.25 puffs/day, P < 0.001, and exacerbations requiring corticosteroids also significantly reduced. Five of 10 patients completely discontinued maintenance oral corticosteroids. Ten patients with a baseline forced expiratory volume in 1 s of <60% predicted significantly improved from 49.2 ± 9.6% to 61.8 ± 17.6%, P < 0.05. Only two procedures required hospitalisation beyond the planned overnight admission. BT is a safe procedure which can achieve clinical improvement in those with uncontrolled symptoms and severe airflow obstruction. © 2017 Royal Australasian College of Physicians.

  5. Hurricane Isabel gives accelerators a severe test

    International Nuclear Information System (INIS)

    Swapan Chattopadhyay

    2004-01-01

    Hurricane Isabel was at category five--the most violent on the Saffir-Simpson scale of hurricane strength--when it began threatening the central Atlantic seaboard of the US. Over the course of several days, precautions against the extreme weather conditions were taken across the Jefferson Lab site in south-east Virginia. On 18 September 2003, when Isabel struck North Carolina's Outer Banks and moved northward, directly across the region around the laboratory, the storm was still quite destructive, albeit considerably reduced in strength. The flood surge and trees felled by wind substantially damaged or even devastated buildings and homes, including many belonging to Jefferson Lab staff members. For the laboratory itself, Isabel delivered an unplanned and severe challenge in another form: a power outage that lasted nearly three-and-a-half days, and which severely tested the robustness of Jefferson Lab's two superconducting machines, the Continuous Electron Beam Accelerator Facility (CEBAF) and the superconducting radiofrequency ''driver'' accelerator of the laboratory's free-electron laser. Robustness matters greatly for science at a time when microwave superconducting linear accelerators (linacs) are not only being considered, but in some cases already being built for projects such as neutron sources, rare-isotope accelerators, innovative light sources and TeV-scale electron-positron linear colliders. Hurricane Isabel interrupted a several-week-long maintenance shutdown of CEBAF, which serves nuclear and particle physics and represents the world's pioneering large-scale implementation of superconducting radiofrequency (SRF) technology. The racetrack-shaped machine is actually a pair of 500-600 MeV SRF linacs interconnected by recirculation arc beamlines. CEBAF delivers simultaneous beams at up to 6 GeV to three experimental halls. An imminent upgrade will double the energy to 12 GeV and add an extra hall for ''quark confinement'' studies. On a smaller scale

  6. Perceived Severity of Visually Accessible Fires

    OpenAIRE

    Fridolf, Karl

    2010-01-01

    Investigations of past fires suggest that building occupants faced with a fire have problems defining the severity of it, especially in the early stages of the fire. An experiment was therefore carried out to study people’s ability to estimate fire growth, and their perceived ability to extinguish a fire using a portable fire extinguisher. A total of 535 persons, namely 304 men and 231 women, were asked to fill out a questionnaire that was divided into three parts. In the first part the test ...

  7. Global Strain in Severe Aortic Valve Stenosis

    DEFF Research Database (Denmark)

    Dahl, Jordi S; Videbæk, Lars; Poulsen, Mikael K

    2012-01-01

    BACKGROUND: -Global longitudinal systolic strain (GLS) is often reduced in aortic stenosis despite normal ejection fraction. The importance of reduced preoperative GLS on long-term outcome after aortic valve replacement (AVR) is unknown. METHODS AND RESULTS: -A total of 125 patients with severe...... quartile 49% (n=15), p=0.04. Patients with increased age, left ventricular hypertrophy and left atrial dilatation were at increased risk. In Cox regression analysis after correcting for standard risk factors and ejection fraction, GLS was found to be significantly associated with cardiac morbidity...

  8. Severe Hypoglycemia Accompanied with Thyroid Crisis

    Directory of Open Access Journals (Sweden)

    Yuki Nakatani

    2012-01-01

    Full Text Available We report a 32-year-old Japanese women with severe hypoglycemia accompanied with thyroid crisis. She complained of dyspnea, general fatigue, and leg edema. She was diagnosed with hyperthyroidism with congestive heart failure and liver dysfunction. Soon after admission, sudden cardiopulmonary arrest occurred. She was then transferred to the intensive care unit. Her serum glucose level was 7 mg/dl. Intravenous glucose, hydrocortisone, diuretics, and continuous hemodiafiltration (CHDF saved her. We considered that hypoglycemia occurred due to heart failure and liver dysfunction due to thyroid crisis.

  9. Several rotor noise sources and treatments

    Energy Technology Data Exchange (ETDEWEB)

    Tangler, J. [National Renewable Energy Laboratory, Golden, CO (United States)

    1997-12-31

    Noise has been a design consideration in the development of advanced blades and turbines at the National Renewable Energy Laboratory. During atmospheric testing associated with these efforts various types of aeroacoustic noise have been encountered. This presentation discusses several of these noise sources and treatments used to mitigate or eliminate the noise. Tonal noise resulting from tip-vortex/trailing-edge interaction and laminar separation bubbles was found to be easily eliminated. Impulsive noise resulting from blade/vortex interaction for rotors that furl and that due to tower shadow can be mitigated by various means. (au)

  10. Severe calcinosis cutis in an infant

    Energy Technology Data Exchange (ETDEWEB)

    Puvabanditsin, Surasak; Patel, Jigneshkumar B. [University of Medicine and Dentistry of New Jersey, Department of Pediatrics, Newark, NJ (United States); University of Medicine and Dentistry of New Jersey, Department of Surgery, Newark, NJ (United States); Garrow, Eugene; Titapiwatanakun, Ruetima; Getachew, Rahel [University of Medicine and Dentistry of New Jersey, Department of Pediatrics, Newark, NJ (United States)

    2005-05-01

    We report on an infant with severe asphyxia and persistent pulmonary hypertension as a newborn. The baby received prolonged intravenous calcium gluconate therapy for hypocalcemia. At 5 weeks of age, multiple firm, indurated areas (armor-like lesions) were palpable in the subcutaneous tissues of the trunk, arms, legs, and face, particularly in skin folds. Roentgenographic study showed generalized soft-tissue calcifications throughout the body, extremities, and face. Calcinosis cutis occurs through a variety of pathogenetic mechanisms. Case reports on calcinosis cutis in infants are uncommon, and the calcifications are mostly localized. In our patient, they are generalized. (orig.)

  11. Several Key Features of Marriage in Kosovo

    OpenAIRE

    Dr.Sc. Hamdi Podvorica

    2014-01-01

    In this paper titled “Several key features of marriage in Kosovo”, I have made efforts to address the matrimony, as an important societal and legal concept, in the light of positive law in Kosovo. In short terms, I have addressed the historical development of marriage in general, from the period of promiscuity until today, and I have emphasized key features of marriage in various time periods, only to comprehend better the ways of development of marriage in time and space. A special empha...

  12. Severe cholestatic hepatitis caused by azathioprine.

    Science.gov (United States)

    Eisenbach, Christoph; Goeggelmann, Christoph; Flechtenmacher, Christa; Stremmel, Wolfgang; Encke, Jens

    2005-01-01

    A male patient receiving azathioprine treatment for discoid lupus erythematodes developed severe cholestatic hepatitis between 14 and 21 days after initiation of the treatment with peak bilirubin levels of 62.4 mg/dL. Other causes of hepatic dysfunction including viral hepatitis were clinically and serologically excluded. Liver biopsy revealed cholestatic hepatocellular damage. At 14 days after discontinuation of azathioprine the liver function (transaminases and bilirubin) began to improve. Only alcaline phosphatase and gamma-glutamyl transferase remained elevated even after 4 months. This case argues for an idiosyncratic cholestatic hepatocellular damage caused by azathioprine.

  13. Chemical considerations in severe accident analysis

    International Nuclear Information System (INIS)

    Malinauskas, A.P.; Kress, T.S.

    1988-01-01

    The Reactor Safety Study presented the first systematic attempt to include fission product physicochemical effects in the determination of expected consequences of hypothetical nuclear reactor power plant accidents. At the time, however, the data base was sparse, and the treatment of fission product behavior was not entirely consistent or accurate. Considerable research has since been performed to identify and understand chemical phenomena that can occur in the course of a nuclear reactor accident, and how these phenomena affect fission product behavior. In this report, the current status of our understanding of the chemistry of fission products in severe core damage accidents is summarized and contrasted with that of the Reactor Safety Study

  14. [Palliative care of patients with severe dementia].

    Science.gov (United States)

    Slachevsky Ch, Andrea; Abusleme L, M Teresa; Arenas Massa, Ángela

    2016-01-01

    Dementia is an important public health problem due to the complex challenges it poses during the progression of the disease and especially during its end-of-life stage. The aim of this article is to consider the issues that arise from the use of commonly administered therapies in patients with severe dementia. Scenarios where excessive or futile therapeutic interventions might occur are discussed. The article concludes that it is advisable to analyze the clinical criteria and ethical considerations related to the administration of those treatments in order to develop and disseminate better practice guidelines for health professionals.

  15. Severe haemoptysis due to subclavian arteritis.

    Science.gov (United States)

    Lioulias, A; Misthos, P; Kokotsakis, J; Drosos, O; Karagiannidis, N; Pavlopoulos, D; Mitselou, M

    2012-06-12

    Severe haemoptysis due to infective subclavian arteritis has, to our knowledge, never been documented. We report a case of subclavian arterial vasculitis that eroded into the left lung apex, causing a large intraparenchymal mycotic pseudoaneurysm. The patient presented with high fever and blood expectoration. An emergent left lateral thoracotomy was performed. The inflamed segment of the subclavian artery was resected and continuity was restored with a reversed saphenous vein graft. The postoperative course was uneventful and the patient was discharged on the 10th postoperative day.

  16. [Assessment of concomitant floating knees injuries severity].

    Science.gov (United States)

    Eone, Daniel Handy; Lamah, Léopold; Bayiha, Jean Emile; Ondoa, Danielle Larissa Essomba; Nonga, Bernadette Ngo; Ibrahima, Farikou; Bahebeck, Jean

    2016-01-01

    Floating knee is caused by high-energy trauma, whose genesis is suggestive of extensive locoregional and general damages. Referring to multiple trauma. The aim of our study was to collect data on all concomitant floating knee injuries in our practice environment and to evaluate their severity. We conducted a descriptive and retrospective study over a period of 14 years and 9 months. Our sample consisted of 75 floating knees, the average age was 35 years. Sixty six patients had an ISS≥16 (classified as polytrauma). Head traumas, chest and abdominal injuries associated with floating knee injuries require adequate resuscitation.

  17. Occupational Radiation Protection in Severe Accident Management

    International Nuclear Information System (INIS)

    2015-01-01

    As an early response to the Fukushima Daiichi NPP accident, the Information System on Occupational Exposure (ISOE) Bureau decided to focus on the following issues as an initial response of the joint program after having direct communications with the Japanese official participants in April 2011: - Management of high radiation area worker doses: It has been decided to make available the experience and information from the Chernobyl accident in terms of how emergency worker / responder doses were legally and practically managed, - Personal protective equipment for highly-contaminated areas: It was agreed to collect information about the types of personnel protective equipment and other equipment (e.g. air bottles, respirators, air-hoods or plastic suits, etc.), as well as high-radiation area worker dosimetry use (e.g. type, number and placement of dosimetry) for different types of emergency and high-radiation work situations. Detailed information was collected on dose criteria which are used for emergency workers /responders and their basis, dose management criteria for high dose/dose rate areas, protective equipment which is recommended for emergency workers / responders, recommended individual monitoring procedures, and any special requirement for assessment from the ISOE participating nuclear utilities and regulatory authorities and made available for Japanese utilities. With this positive response of the ISOE official participants and interest in the situation in Fukushima, the Expert Group on Occupational Radiation Protection in Severe Accident Management (EG-SAM) was established by the ISOE Management Board in May 2011. The overall objective of the EG-SAM is to contribute to occupational exposure management (providing a view on management of high radiation area worker doses) within the Fukushima plant boundary with the ISOE participants and to develop a state-of-the-art ISOE report on best radiation protection management practices for proper radiation

  18. Severe head injuries in three countries.

    Science.gov (United States)

    Jennett, B; Teasdale, G; Galbraith, S; Pickard, J; Grant, H; Braakman, R; Avezaat, C; Maas, A; Minderhoud, J; Vecht, C J; Heiden, J; Small, R; Caton, W; Kurze, T

    1977-01-01

    Methods for assessing early characteristics and late outcome after severe head injury have been devised and applied to 700 cases in three countries (Scotland, Netherlands, and USA). There was a close similarity between the initial features of patients in the three series; in spite of differences on organisation of care and in details of management , the mortality was exactly the same in each country. This data bank of cases (which is still being enlarged) can be used for predicting outcome in new cases, and for setting up trials of management. PMID:886355

  19. Containment severe accident management - selected strategies

    International Nuclear Information System (INIS)

    Duco, J.; Royen, J.; Rohde, J.; Frid, W.; De Boeck, B.

    1994-01-01

    The OECD Nuclear Energy Agency (NEA) organized in June 1994, in collaboration with the Swedish Nuclear Power Inspectorate (SKI), a Specialist Meeting on Selected Containment Severe Accident Management Strategies, to discuss their feasibility, effectiveness, benefits and drawbacks, and long-term impact. The meeting focused on water reactors, mainly on existing systems. The technical content covered topics such as general aspects of accident management strategies in OECD Member countries, hydrogen management techniques and other containment accident management strategies, surveillance and protection of the containment function. The main conclusions of the meeting are summarized in the paper. (author)

  20. Preventing drug resistance in severe influenza

    Science.gov (United States)

    Dobrovolny, Hana; Deecke, Lucas

    2015-03-01

    Severe, long-lasting influenza infections are often caused by new strains of influenza. The long duration of these infections leads to an increased opportunity for the emergence of drug resistant mutants. This is particularly problematic for new strains of influenza since there is often no vaccine, so drug treatment is the first line of defense. One strategy for trying to minimize drug resistance is to apply periodic treatment. During treatment the wild-type virus decreases, but resistant virus might increase; when there is no treatment, wild-type virus will hopefully out-compete the resistant virus, driving down the number of resistant virus. We combine a mathematical model of severe influenza with a model of drug resistance to study emergence of drug resistance during a long-lasting infection. We apply periodic treatment with two types of antivirals: neuraminidase inhibitors, which block release of virions; and adamantanes, which block replication of virions. We compare the efficacy of the two drugs in reducing emergence of drug resistant mutants and examine the effect of treatment frequency on the emergence of drug resistant mutants.

  1. Severe metabolic alkalosis: a case report.

    Science.gov (United States)

    Javaheri, S; Nardell, E A

    1981-01-01

    A 45-year-old man who was admitted with nausea, vomiting, and abdominal pain was found to have severe metabolic alkalosis, with a PaCO2 of 11.4kPa (85.5 mm Hg), PaO2 of 5.8 kPa (43.5 mm Hg), pH of 7.61, and plasma bicarbonate concentration of 82.0 mmol/l. He was treated with oxygen, intravenous physiological saline, and phenytoin and improved within 48 hours. Radiographs showed gastric outlet obstruction secondary to peptic ulcer, which was treated by surgery. Though sever, the rise in carbon dioxide concentration in this patient was probably lifesaving. The PaCO2 was therefore allowed to fall gradually as the alkalosis was treated. The return of both PaCO2 and plasma bicarbonate values to normal in parallel suggests that hypoventilation compensated for the metabolic alkalosis and emphasises the importance of conservative treatment in cases of metabolic alkalosis. PMID:6794744

  2. Hyponatraemia and dehydration in severe malaria.

    Science.gov (United States)

    English, M C; Waruiru, C; Lightowler, C; Murphy, S A; Kirigha, G; Marsh, K

    1996-01-01

    The prevalence and likely cause of hyponatraemia in severe childhood malaria were investigated. One hundred and thirty two children, 47 of whom had cerebral malaria, were prospectively recruited and serial simple indices of fluid and electrolyte balance and renal function monitored during admission. In 55%, hyponatraemia (sodium < 135 mmol/l) was present on admission. Hyponatraemia was pronounced (sodium < or = 130 mmol/l) in 21%, and these children gained less weight during admission (mean weight gain 2.4% v 4.3%) than children with a normal sodium (135-145 mmol/l). Overall, 31% of survivors were at least moderately dehydrated on admission (5% weight gain by discharge). These children had higher plasma urea concentrations on admission (6.1 v 4.5 mmol/l) and were more acidotic (mean base excess -12.1 v -8.0) than children who were not dehydrated. There were changes in simple indices of renal function between admission and discharge in children who survived (creatinine 65.7 v 37.9 mumol/l and urea 5.5 v 1.9 mmol/l). The results suggest that dehydration is common in severe childhood malaria, that it may contribute to mild impairment in renal function, and that hyponatraemic children are less water depleted, showing appropriate rather than inappropriate secretion of antidiuretic hormone. PMID:8787422

  3. Partial differential equations in several complex variables

    CERN Document Server

    Chen, So-Chin

    2001-01-01

    This book is intended both as an introductory text and as a reference book for those interested in studying several complex variables in the context of partial differential equations. In the last few decades, significant progress has been made in the fields of Cauchy-Riemann and tangential Cauchy-Riemann operators. This book gives an up-to-date account of the theories for these equations and their applications. The background material in several complex variables is developed in the first three chapters, leading to the Levi problem. The next three chapters are devoted to the solvability and regularity of the Cauchy-Riemann equations using Hilbert space techniques. The authors provide a systematic study of the Cauchy-Riemann equations and the \\bar\\partial-Neumann problem, including L^2 existence theorems on pseudoconvex domains, \\frac 12-subelliptic estimates for the \\bar\\partial-Neumann problems on strongly pseudoconvex domains, global regularity of \\bar\\partial on more general pseudoconvex domains, boundary ...

  4. Society. Part II: moderate to severe psoriasis

    Directory of Open Access Journals (Sweden)

    Jacek Szepietowski

    2014-11-01

    Full Text Available Psoriasis is a chronic inflammatory skin disease affecting about 1–3% of the general population. Recent years have seen great development in the treatment of this dermatosis, especially regarding moderate to severe psoriasis. More numerous and more widely available systemic therapies raise new challenges for all physicians treating patients with psoriasis. New questions arise about patients’ follow-up and long-term safety of such therapies. To meet the expectations of Polish dermatologists, we have prepared a second part of guidelines on the treatment of psoriasis, particularly concentrated on the therapy of severe forms of this disease. We hope that our suggestions will be valuable for physicians in their daily clinical practice. However, we would like to underline that every guideline is characterized by some vagueness, and the final decision about diagnosis and therapy should always be made individually for every patient based on the patient’s current clinical status and the most up-to-date scientific literature data.

  5. Severe combined immunodeficiencies and related disorders.

    Science.gov (United States)

    Fischer, Alain; Notarangelo, Luigi D; Neven, Bénédicte; Cavazzana, Marina; Puck, Jennifer M

    2015-10-29

    Severe combined immunodeficiencies (SCIDs) comprise a group of rare, monogenic diseases that are characterized by an early onset and a profound block in the development of T lymphocytes. Given that adaptive immunity is abrogated, patients with SCID are prone to recurrent infections caused by both non-opportunistic and opportunistic pathogens, leading to early death unless immunity can be restored. Several molecular defects causing SCIDs have been identified, along with many other defects causing profound, albeit incomplete, T cell immunodeficiencies; the latter are referred to as atypical SCIDs or combined immunodeficiencies. The pathophysiology of many of these conditions has now been characterized. Early, accurate and precise diagnosis combined with the ongoing implementation of newborn screening have enabled major advances in the care of infants with SCID, including better outcomes of allogeneic haematopoietic stem cell transplantation. Gene therapy is also becoming an effective option. Further advances and a progressive extension of the indications for gene therapy can be expected in the future. The assessment of long-term outcomes of patients with SCID is now a major challenge, with a view to evaluating the quality and sustainability of immune restoration, the risks of sequelae and the ability to relieve the non-haematopoietic syndromic manifestations that accompany some of these conditions.

  6. Fibrinogen function after severe burn injury.

    Science.gov (United States)

    Schaden, Eva; Hoerburger, David; Hacker, Stefan; Kraincuk, Paul; Baron, David M; Kozek-Langenecker, Sibylle

    2012-02-01

    Evidence regarding hypercoagulability in the first week after burn trauma is growing. This hypercoagulable state may partly be caused by increased fibrinogen levels. Rotational thrombelastometry offers a test which measures functional fibrinogen (FIBTEM(®)). To test the hypothesis that in patients with severe burn injury fibrinogen function changes over time, we simultaneously measured FIBTEM(®) and fibrinogen concentration early after burn trauma. After Ethics Committee approval consecutive patients with severe burn trauma admitted to the burn intensive care unit of the General Hospital of Vienna were included in the study. Blood examinations were done immediately and 12, 24 and 48 h after admission. At each time point fibrinogen level (Clauss) and 4 commercially available ROTEM(®) tests were performed. 20 consecutive patients were included in the study. Fibrinogen level and FIBTEM(®) MCF were within the reference range until 24 h after burn trauma but increased significantly 48 h after trauma. There was a significant correlation between FIBTEM(®) MCF and fibrinogen level (R=0.714, p<0.001). The results of this prospective observational clinical study show that fibrinogen function changes early after burn trauma and can be visualized by ROTEM(®) with the fibrinogen-sensitive FIBTEM(®) test. Copyright © 2010 Elsevier Ltd and ISBI. All rights reserved.

  7. Performance of several low-cost accelerometers

    Science.gov (United States)

    Evans, J.R.; Allen, R.M.; Chung, A. I.; Cochran, E.S.; Guy, R.; Hellweg, M.; Lawrence, J. F.

    2014-01-01

    Several groups are implementing low‐cost host‐operated systems of strong‐motion accelerographs to support the somewhat divergent needs of seismologists and earthquake engineers. The Advanced National Seismic System Technical Implementation Committee (ANSS TIC, 2002), managed by the U.S. Geological Survey (USGS) in cooperation with other network operators, is exploring the efficacy of such systems if used in ANSS networks. To this end, ANSS convened a working group to explore available Class C strong‐motion accelerometers (defined later), and to consider operational and quality control issues, and the means of annotating, storing, and using such data in ANSS networks. The working group members are largely coincident with our author list, and this report informs instrument‐performance matters in the working group’s report to ANSS. Present examples of operational networks of such devices are the Community Seismic Network (CSN; csn.caltech.edu), operated by the California Institute of Technology, and Quake‐Catcher Network (QCN; Cochran et al., 2009; qcn.stanford.edu; November 2013), jointly operated by Stanford University and the USGS. Several similar efforts are in development at other institutions. The overarching goals of such efforts are to add spatial density to existing Class‐A and Class‐B (see next paragraph) networks at low cost, and to include many additional people so they become invested in the issues of earthquakes, their measurement, and the damage they cause.

  8. How I treat severe combined immunodeficiency.

    Science.gov (United States)

    Gaspar, H Bobby; Qasim, Waseem; Davies, E Graham; Rao, Kanchan; Amrolia, Persis J; Veys, Paul

    2013-11-28

    Severe combined immunodeficiency (SCID) arises from different genetic defects associated with lymphocyte development and function and presents with severe infections. Allogeneic hematopoietic stem cell transplantation is an extremely effective way of restoring immunity in these individuals. Numerous multicenter studies have identified the factors determining successful outcome, and survival for SCID has shown great improvement. Advances in understanding the genetic basis of disease also mean that we increasingly tailor transplant protocols to the specific SCID form. Wherever possible, we attempt to transplant SCID patients without the use of cytoreductive conditioning, but it is clear that this is only successful for specific SCID forms and, although survival is good, in specific patients there are ongoing humoral defects. We aim to use matched related and unrelated donors (including cord blood) whenever possible and have limited the use of mismatched haploidentical donors. The development of autologous hematopoietic stem cell gene therapy provides another treatment of the X-linked and adenosine deaminase-deficient forms of SCID, and we discuss how we have integrated gene therapy into our treatment strategy. These developments together with the advent of universal newborn screening for SCID should allow for a highly favorable outcome for this otherwise lethal condition.

  9. Lipodystrophy: Syndrome of severe insulin resistance.

    Science.gov (United States)

    Bindlish, Shagun; Presswala, Lubaina S; Schwartz, Frank

    2015-06-01

    Lipodystrophy (LD) is a relatively rare complex collection of diseases that can be congenital or acquired. It is commonly missed in the clinical setting. Thus, the spectrum of disease presentation mandates clinician expertise in the pathophysiology and management of all forms of LD, obesity, and insulin resistance. An extensive literature search of clinical trials, systematic reviews, and narrative reviews was completed in PubMed for the years 1970 to 2013. The search terms were lipodystrophy, congenital LD, acquired LD, HIV-associated LD, severe insulin resistance, adiposity, obesity, and dyslipidemia. Lipodystrophies are a heterogeneous group of disorders with abnormal adipose tissue distribution, utilization, and metabolism. Adipose tissue can undergo significant changes in composition (hypertrophy and atrophy) in response to a nutritional state. Paradoxically, both excess and deficient adipose tissue is associated with insulin resistance and the metabolic syndrome. Bone density scan (DEXA) for body fat composition analysis or magnetic resonance imaging are optimal modalities for the assessment of abnormal adipose tissue distribution. Ongoing clinical studies suggest thiazolidinediones, insulin like growth factor-1, leptin, and growth hormone-releasing hormone as possible treatment for LPD; however, none of them is approved to reverse fat loss or treat severe insulin resistance due to LPD. The underlying mechanisms for LPD causing insulin resistance may be lipotoxicity and derangements in adipose tissue-derived proteins (adipocytokines). However, the lack of evidence to support this model means that clinicians are on their own as they navigate through the phenotypic presentation of lipodystrophies, obesity, insulin resistance, and the metabolic syndrome.

  10. [Insomnia. A severe health care problem].

    Science.gov (United States)

    Sánchez-Cárdenas, Ana Gabriela; Navarro-Gerrard, Christian; Nellen-Hummel, Haiko; Halabe-Cherem, José

    2016-01-01

    The magnitude which sleep has on personal well-being is similar to the effects of diet and exercise. Sleep deprivation has severe negative effects on an individual's overall health, and this is usually overseen. From 30 to 40 % of the population has presented insomnia at a certain moment of life and from 9 to 15 % have evolved into a chronic and severe insomnia. Recent investigations have related sleep deprivation with obesity, metabolic disorders, heart disease, mental health problems and dementia. Recently, more investigations have focused on the multiple alterations suffered by the immune system in cases of sleep deprivation. In order to make an opportune diagnosis of insomnia, it is vital to obtain a detailed history of the patients' sleep habits. In the physical exam one must search for signs and symptoms which might suggest an organic cause that generates the patient's insomnia. One of the pillars in treatment of these patients consists in acquiring an adequate sleep hygiene based on the optimization of the environment and the behavior that are associated with sleep.

  11. Choosing a technique for severe hypospadias

    Directory of Open Access Journals (Sweden)

    Alexis Arnaud

    2011-01-01

    Full Text Available Introduction: We participate in humanitarian missions in Madagascar during which we treat severe hypospadias. We report our experience and results with these patients, in these conditions, and discuss our choice of technique in this particular setting. Materials and Methods: We retrospectively reviewed the data of 27 patients operated for severe hypospadias during our humanitarian missions in Madagascar between November 2006 and September 2009. Twenty one patients underwent a modified Koyanagi procedure, three underwent a Duckett urethroplasty, two an onlay island flap, one an augmented Duckett and one a tubularised plate urethroplasty. Two patients who underwent a modified Koyanagi repair also had a Nesbitt dorsal plication. Results: Patient age at the time of surgery ranged from 22 to 198 months with a median age of 54.1 months. Mean follow-up was 16 months. Of the 21 patients who underwent a modified Koyanagi procedure, 16 presented at least one complication (76%: A fistula developed in 12 patients (57%, meatal regression developed in 7 (33% and 2 showed complete wound dehiscence (9.5%. None developed stenosis or urethrocoele. Conclusion: In this particular setting, the postoperative complication rate is high. Nevertheless, the Koyanagi technique is appropriate, because its complications are easy to treat and there is always sufficient ventral tissue for the secondary operation, if necessary.

  12. [Validation of an acute bronchiolitis severity scale].

    Science.gov (United States)

    Ramos Fernández, J M; Cordón Martínez, A; Galindo Zavala, R; Urda Cardona, A

    2014-07-01

    Acute bronchiolitis (AB) is a very common disease, with a high rate of seasonal hospitalization. Its management requires homogeneous clinical interpretations for which there are different approaches depending on the scales, none of which are properly validated today. To create an AB severity scale (ABSS) and to validate it. The development of a parameterized construct with a gradual cumulative score of respiratory rate, heart rate, respiratory effort, auscultation of wheezing and crackles, and the inspiration/expiration ratio. Also, the validation of the ABSS performed on patients diagnosed with AB, the reliability measured by observing the behavior of internal consistency, test-retest, external validity and inter-observer agreement. From a total of 290 measurements a Cronbach's reliability alpha of 0.83 was obtained; Kappa agreement index of 0.93 in the test-retest agreement, and Kappa index of 0.682 (α<0.05) for inter-observer agreement. The ABSS can be a reliable tool for measuring the severity of AB. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  13. [Partial parenteral nutrition in severe virus hepatitis].

    Science.gov (United States)

    Kleinberger, G; Schneeweiss, B; Druml, W; Laggner, A; Lenz, K

    1984-03-01

    Patients with severe virus hepatitis and a prothrombin concentration below 25% have a bad prognosis. This is due to direct consequences of hepatic failure and to the rather frequent complications of this disease. The clinical course of such patients is essentially dependent upon the degree of liver regeneration, which again is dependent upon the mass of hepatocytes which are able to regenerate and upon the so called hepatotrophic factors. Patients with severe hepatitis suffer during the first weeks rather frequently from nausea and loss of appetite and for that reason their nutrition is insufficient. In the study recorded here 9 cases were investigated (7 patients with hepatitis B, 2 patients with hepatitis non A non B). The question was asked, if partial parenteral nutrition in addition to a liver diet not containing meat would improve liver function. It could be shown that the prothrombin concentration, which could not be improved by vitamine K1 supplements, was increased during a 7 day parenteral nutrition period from 19,3 +/- 2,9% to 41,5 +/- 8,1% (p less than 0,05), serum albumine and cholinesterase activity improved as well. During the first day of treatment there was a significant fall of ammoniac from 115 +/- 10 mumol to 73 +/- 10 mumol/l (p less than 0,05), at the same time production of urea did not increase. All patients survived. The results show, that parenteral nutrition can improve liver function and decrease the catabolic status of metabolism.

  14. Classifying fibromyalgia patients according to severity: the combined index of severity in fibromyalgia.

    Science.gov (United States)

    Rivera, J; Vallejo, M A; Offenbächer, M

    2014-12-01

    The aim of this study was to establish the cutoff points in the Combined Index of Fibromyalgia Severity (ICAF) questionnaire which allow classification of patients by severity and to evaluate its application in the clinical practice. The cutoff points were calculated using the area under the ROC curve in two cohorts of patients. Three visits, basal, fourth month and 15th month, were considered. The external criterion for grading severity was the number of drugs consumed by the patient. Sequential changes were calculated and compared. Correlations with drug consumption and comparisons of severity between patients with different types of coping were also calculated. Correlation between the number of drugs and the ICAF total score was significant. Three cutoff points were established: absence of Fibromyalgia (FM), 50, with the following distribution of severity: absence in 0.4 %, mild in 18.7 %, moderate in 32.5 % and severe in 48.4 % of the patients. There were significant differences between groups. The treatment under daily clinical conditions showed a significant improvement of the patients which was maintained at the end of follow-up. There was a 17 % reduction in the severe category. The patients with more passive coping factor showed highest punctuations in the remaining scores and were more prevalent in the severe category. The patients with a predominance of the emotional factor showed a better response at the end of follow-up. The established cutoff points allow the classification of FM patients by severity, to know the prognostic and to predict the response to the treatment.

  15. SARNET: Severe accident research network of excellence

    International Nuclear Information System (INIS)

    Albiol, T.; Van Dorsselaere, J. P.; Chaumont, B.; Haste, T.; Journeau, Ch.; Meyer, L.; Sehgal, Bal Raj; Schwinges, Bernd; Beraha, D.; Annunziato, A.; Zeyen, R.

    2010-01-01

    Fifty-one organisations network in SARNET (Severe Accident Research Network of Excellence) their research capacities in order to resolve the most important pending issues for enhancing, with regard to Severe Accidents (SA), the safety of existing and future Nuclear Power Plants (NPPs). This project. co-funded by the European Commission (EC) under the 6. Framework Programme, has been defined in order to optimise the use of the available means and to constitute sustainable research groups in the European Union. SARNET tackles the fragmentation that may exist between the different national R and D programmes, in defining common research programmes and developing common computer tools and methodologies for safety assessment. SARNET comprises most of the organisations involved in SA research in Europe, plus Canada. To reach these objectives, all the organisations networked in SARNET contributed to a joint Programme of Activities, which consisted of: Implementation of an advanced communication tool for accessing all project information, fostering exchange of information, and managing documents; Harmonization and re-orientation of the research programmes, and definition of new ones; Analysis of the experimental results provided by research programmes in order to elaborate a common understanding of relevant phenomena; Development of the ASTEC code (integral computer code used to predict the NPP behaviour during a postulated SA), which capitalizes in terms of physical models the knowledge produced within SARNET; Development of Scientific Databases in which all the results of research programmes are stored in a common format (DATANET); Development of a common methodology for Probabilistic Safety Assessment of NPPs; Development of short courses and writing a textbook on Severe Accidents for students and researchers; Promotion of personnel mobility amongst various European organisations. This paper presents the major achievements after four and a half years of operation of the

  16. Severe European winters in a secular perspective

    Science.gov (United States)

    Hoy, Andreas; Hänsel, Stephanie

    2017-04-01

    Temperature conditions during the winter time are substantially shaped by a strong year-to-year variability. European winters since the late 1980s - compared to previous decades and centuries - were mainly characterised by a high temperature level, including recent record-warm winters. Yet, comparably cold winters and severe cold spells still occur nowadays, like recently observed from 2009 to 2013 and in early 2017. Central England experienced its second coldest December since start of observations more than 350 years ago in 2010, and some of the lowest temperatures ever measured in northern Europe (below -50 °C in Lapland) were recorded in January 1999. Analysing thermal characteristics and spatial distribution of severe (historical) winters - using early instrumental data - helps expanding and consolidating our knowledge of past weather extremes. This contribution presents efforts towards this direction. We focus on a) compiling and assessing a very long-term instrumental, spatially widespread and well-distributed, high-quality meteorological data set to b) investigate very cold winter temperatures in Europe from early measurements until today. In a first step, we analyse the longest available time series of monthly temperature averages within Europe. Our dataset extends from the Nordic countries up to the Mediterranean and from the British Isles up to Russia. We utilise as much as possible homogenised times series in order to ensure reliable results. Homogenised data derive from the NORDHOM (Scandinavia) and HISTALP (greater alpine region) datasets or were obtained from national weather services and universities. Other (not specifically homogenised) data were derived from the ECA&D dataset or national institutions. The employed time series often start already during the 18th century, with Paris & Central England being the longest datasets (from 1659). In a second step, daily temperature averages are involved. Only some of those series are homogenised, but

  17. DENGUE VIRUS VIRULENCE AND DISEASES SEVERITY.

    Science.gov (United States)

    Prommalikit, Olarn; Thisyakorn, Usa

    2015-01-01

    The dengue virus is the causative agent of a wide spectrum of clinical manifestations, ranging from mild acute febrile illness to classical dengue fever, dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). DHF and DSS are the potentially fatal forms of dengue virus infection, which has become an intractable public health problem in many countries. The pathogeneses of DHF/ DSS are not clearly understood. One hypothesis concerning virus virulence and the immune enhancement hypothesis has been debated. Although dengue disease severity has been associated with evidence of genetic differences in dengue strains, virus virulence has been difficult to measure because of the lack of in vivo and in vitro models of the disease.

  18. Correction of a severe Class III malocclusion.

    Science.gov (United States)

    Arslan, Seher Gündüz; Kama, Jalan Devecioglu; Baran, Sedat

    2004-08-01

    The success of early orthopedic treatment in patients with Class III anomalies depends on facial skeletal development and type of treatment. This case report describes the treatment of a 12.6-year-old girl who had a severe Class III malocclusion with a 6-mm anterior crossbite, a deep overbite, a narrow maxilla, and unerupted maxillary canines. The treatment plan included rapid palatal expansion to expand the maxilla, reverse headgear to correct the maxillary retrognathia, a removable anterior inclined bite plane to correct the anterior crossbite and the deep overbite, and fixed edgewise appliances to align the teeth. One canine was brought into alignment, but the other was placed in occlusion in its transposed position. Ideal overjet and overbite relationships were established, and the final esthetic result was pleasing.

  19. Xamoterol in severe congestive heart failure

    DEFF Research Database (Denmark)

    Tangø, M; Lyngborg, K; Mehlsen, J

    1992-01-01

    Twelve patients in severe congestive heart failure were given placebo, 100 mg xamoterol (Corwin) twice daily and 200 mg xamoterol twice daily, respectively, in 3 two-week periods in a double-blind randomised study. At the end of each treatment period the patients were evaluated. No differences were...... found between placebo and xamoterol in the following parameters: New York Heart Association function group index, heart volume, body weight, exercise duration on bicycle and treadmill, heart rate and systolic and diastolic blood pressure at rest. However, during exercise we found significantly lower...... heart rate and rate-pressure product during xamoterol treatment. This reduction is probably indicating occupation of beta-adrenoreceptors with concomitant reduced oxygen consumption during exercise....

  20. Multiple insufficiency fractures with severe osteoporosis.

    Science.gov (United States)

    Iba, Kousuke; Wada, Takuro; Takada, Junichi; Yamashita, Toshihiko

    2003-01-01

    Multiple insufficiency fracture is a rare injury. We report a 63-year-old woman who spontaneously developed insufficiency fractures at multiple sites including ribs, sacrum, pubis, ischium, acetabulum, metatarsal bone, and femoral neck. The patient had severe osteoporosis with a bone mineral density of 0.267 g/cm(2), although there was no evidence of bone metabolic disease or metastatic bone tumor. Risk factors for osteoporosis in this case were her postmenopausal state and a history of gastrectomy. Interestingly, the serum level of insulin-like growth factor I, recognized as a growth factor that stimulates bone formation, was markedly decreased, and the patient had had viral hepatitis C. It was speculated that the synergistic effects of these disorders might have produced the osteoporosis, leading ultimately to the multiple insufficiency fractures.

  1. Severe Accidents in the Energy Sector

    International Nuclear Information System (INIS)

    Hirschberg, S.; Spiekerman, G.; Dones, R.

    1998-11-01

    A comprehensive database on severe accidents, with main emphasis on the ones associated with the energy sector, has been established by the Paul Scherrer Institute (PSI). Fossil energy carriers, nuclear power and hydro power are covered in ENSAD (Energy related Severe Accident Database), and the scope of work includes all stages of the analysed energy chains, i.e. exploration, extraction, transports, processing, storage and waste disposal. The database has been developed using a wide variety of sources. As opposed to the previous studies the ambition of the present work has been, whenever feasible, to cover a relatively broad spectrum of damage categories of interest. This includes apart from fatalities also serious injuries, evacuations, land or water contamination, and economic losses. Currently, ENSAD covers 13,914 accidents, of which 4290 are energy related, and 1943 are considered as severe accidents. Significant effort has been directed towards the examination of the relevance of the worldwide accident records to the Swiss specific conditions, particularly in the context of nuclear and hydro power. For example, a detailed investigation of large dam failures and their consequences was carried out. Generally, while Swiss specific aspects are emphasised, the major part of the collected and analysed data, as well as the insights gained, are considered to be of general interest. In particular, three sets of the aggregated results are provided based on world wide occurrence, on OECD countries, and on non OECD countries, respectively. Significant differences exist between the aggregated, normalised damage rates assessed for the various energy carriers: On the world wide basis, the broader picture obtained by coverage of full energy chains leads to aggregated immediate fatality rates being much higher for the fossil fuels than what one would expect if power plants only were considered. The highest rates apply to LPG, followed by hydro, oil, coal, natural gas and

  2. Severe Accidents in the Energy Sector

    Energy Technology Data Exchange (ETDEWEB)

    Hirschberg, S.; Spiekerman, G.; Dones, R

    1998-11-01

    A comprehensive database on severe accidents, with main emphasis on the ones associated with the energy sector, has been established by the Paul Scherrer Institute (PSI). Fossil energy carriers, nuclear power and hydro power are covered in ENSAD (Energy related Severe Accident Database), and the scope of work includes all stages of the analysed energy chains, i.e. exploration, extraction, transports, processing, storage and waste disposal. The database has been developed using a wide variety of sources. As opposed to the previous studies the ambition of the present work has been, whenever feasible, to cover a relatively broad spectrum of damage categories of interest. This includes apart from fatalities also serious injuries, evacuations, land or water contamination, and economic losses. Currently, ENSAD covers 13,914 accidents, of which 4290 are energy related, and 1943 are considered as severe accidents. Significant effort has been directed towards the examination of the relevance of the worldwide accident records to the Swiss specific conditions, particularly in the context of nuclear and hydro power. For example, a detailed investigation of large dam failures and their consequences was carried out. Generally, while Swiss specific aspects are emphasised, the major part of the collected and analysed data, as well as the insights gained, are considered to be of general interest. In particular, three sets of the aggregated results are provided based on world wide occurrence, on OECD countries, and on non OECD countries, respectively. Significant differences exist between the aggregated, normalised damage rates assessed for the various energy carriers: On the world wide basis, the broader picture obtained by coverage of full energy chains leads to aggregated immediate fatality rates being much higher for the fossil fuels than what one would expect if power plants only were considered. The highest rates apply to LPG, followed by hydro, oil, coal, natural gas and

  3. Antiinflammatory Effect of Several Umbelliferae Species

    Directory of Open Access Journals (Sweden)

    SUWIJIYO PRAMONO

    2005-03-01

    Full Text Available A screening for antiinflammatory effects was performed on several Indonesian Umbelliferae plants based on the contents of saponins and flavonoids. They were compared with Bupleurum falcatum L. as an introduced antiinflammatory plant. Roots and grains of each plant were collected, dried, and extracted with ethanol. The ethanolic extracts were then analyzed for their saponin and flavonoid contents by gravimetric and UV-vis spectrophotometric method. Antiinflammatory activity test was conducted on carragenin induced rat paw oedema. The results showed that the highest contents of saponin and flavonoid were found in the grains of Apium graveolens L. and showed antiinflammatory effect that was equivalent to that of the root of B. falcatum.

  4. Treatments for Severe Cutaneous Adverse Reactions

    Science.gov (United States)

    Cho, Yung-Tsu

    2017-01-01

    Severe cutaneous adverse reaction (SCAR) is life-threatening. It consists of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), and generalized bullous fixed drug eruptions (GBFDE). In the past years, emerging studies have provided better understandings regarding the pathogenesis of these diseases. These diseases have unique presentations and distinct pathomechanisms. Therefore, theoretically, the options of treatments might be different among various SCARs. However, due to the rarity of these diseases, sufficient evidence is still lacking to support the best choice of treatment for patients with SCAR. Herein, we will provide a concise review with an emphasis on the characteristics and treatments of each SCAR. It may serve as a guidance based on the current best of knowledge and may shed light on the directions for further investigations. PMID:29445753

  5. Saccadic Alterations in Severe Developmental Dyslexia

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    Stefano Pensiero

    2013-01-01

    Full Text Available It is not sure if persons with dyslexia have ocular motor deficits in addition to their deficits in rapid visual information processing. A 15-year-old boy afflicted by severe dyslexia was submitted to saccadic eye movement recording. Neurological and ophthalmic examinations were normal apart from the presence of an esophoria for near and slightly longer latencies of pattern visual evoked potentials. Subclinical saccadic alterations were present, which could be at the basis of the reading pathology: (1 low velocities (and larger durations of the adducting saccades of the left eye with undershooting and long-lasting postsaccadic onward drift, typical of the internuclear ophthalmoplegia; (2 saccades interrupted in mid-flight and fixation instability, which are present in cases of brainstem premotor disturbances.

  6. Brain SPECT in severs traumatic head injury

    International Nuclear Information System (INIS)

    Beaulieu, F.; Eder, V.; Pottier, J.M.; Baulieu, J.L.; Fournier, P.; Legros, B.; Chiaroni, P.; Dalonneau, M.

    2000-01-01

    The aim of this work was to compare the results of the early brain scintigraphy in traumatic brain injury to the long term neuropsychological behavior. Twenty four patients had an ECD-Tc99m SPECT, within one month after the trauma; scintigraphic abnormalities were evaluated according to a semi-quantitative analysis. The neuropsychological clinical investigation was interpreted by a synthetic approach to evaluate abnormalities related to residual motor deficit, frontal behavior, memory and language disorders. Fourteen patients (58%) had sequela symptoms. SPECT revealed 80 abnormalities and CT scan only 31. Statistical analysis of uptake values showed significantly lower uptake in left basal ganglia and brain stem in patients with sequela memory disorders. We conclude that the brain perfusion scintigraphy is able to detect more lesions than CT and that it could really help to predict the neuropsychological behavior after severe head injury. Traumatology could become in the future a widely accepted indication of perfusion SPECT. (authors)

  7. Treatments for Severe Cutaneous Adverse Reactions

    Directory of Open Access Journals (Sweden)

    Yung-Tsu Cho

    2017-01-01

    Full Text Available Severe cutaneous adverse reaction (SCAR is life-threatening. It consists of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN, drug reaction with eosinophilia and systemic symptoms (DRESS, acute generalized exanthematous pustulosis (AGEP, and generalized bullous fixed drug eruptions (GBFDE. In the past years, emerging studies have provided better understandings regarding the pathogenesis of these diseases. These diseases have unique presentations and distinct pathomechanisms. Therefore, theoretically, the options of treatments might be different among various SCARs. However, due to the rarity of these diseases, sufficient evidence is still lacking to support the best choice of treatment for patients with SCAR. Herein, we will provide a concise review with an emphasis on the characteristics and treatments of each SCAR. It may serve as a guidance based on the current best of knowledge and may shed light on the directions for further investigations.

  8. Therapeutic Challenge in a Severely Atrophic Mandible

    Directory of Open Access Journals (Sweden)

    Edvard Janev

    2018-03-01

    Full Text Available BACKGROUND: After tooth loss, however, severely atrophic residual alveolar ridges are fairly common, especially in patients who have been edentulous for a long period. Anterior area of the mandible is areas where clinicians have greater anatomical limitations. Reduced alveolar bone height very often represents a contraindication to implant therapy, unless a procedure such as a ridge augmentation is performed. CASE REPORT: This study aims to present two separate cases in highly selected edentulous anterior mandibular sites, where one stage, mini implants were used to support total prostheses. Small diameter implants have been used for retention of complete removable mandibular overdentures. This is an excellent option for those who suffer from the inconvenience and embarrassment of loose lower dentures and are tired of having to use sticky pastes and creams to make their dentures stay in place. CONCLUSION: Small diameter implants, when used multiples may offer adequate support for a removable prosthesis and overcome this problem.

  9. Several aspects of solar radiation pressure

    Science.gov (United States)

    Feltens, Joachim

    The disturbing influence of solar radiation pressure must be taken into account in modeling GPS orbits. The mathematical description of this disturbing force is complicated. There exist several models with distinct complexity. In the special case of GPS satellites there arise difficulties because of the irregular shape and surface of the satellites and by accounting for the alignment of the solar panels. These problems will be considered here. In connection with the alignment of the solar panels the orientation of the spacecraft coordinate system during the satellite's revolution will be examined under consideration of different positions of the Sun. In addition, possibilities to represent the irregular shape of the GPS satellites by parameters, which can be determined via orbit improvement, will be discussed.

  10. Aerosol transport in severe reactor accidents

    International Nuclear Information System (INIS)

    Fynbo, P.; Haeggblom, H.; Jokiniemi, J.

    1990-01-01

    Aerosol behaviour in the reactor containment was studied in the case of severe reactor accidents. The study was performed in a Nordic group during the years 1985 to 1988. Computer codes with different aerosol models were used for calculation of fission product transport and the results are compared. Experimental results from LACE, DEMONA and Marviken-V are compared with the calculations. The theory of aerosol nucleation and its influence on the fission product transport is discussed. The behaviour of hygroscopic aerosols is studied. The pool scrubbing models in the codes SPARC and SUPRA are reviewed and some knowledge in this field is assessed on the background of an international rewiew. (author) 60 refs

  11. Severe lamotrigine toxicosis in a dog

    Directory of Open Access Journals (Sweden)

    Sawyer D

    2017-04-01

    Full Text Available Danielle Sawyer, Kathryn Gates Emergency and Critical Care Department, Advanced Critical Care and Emergency Specialty Services, Culver City, CA, USA Objective: The objective of this study was to describe a case of severe lamotrigine toxicosis in a dog, which was successfully treated using minimal medical interventions. Case summary: A 7-month-old male, intact, Labrador mix was evaluated because of acute onset of vomiting, rigidity, and dull mentation after ingesting lamotrigine tablets. The estimated oral dose that had been ingested was 278 mg/kg (611.6 mg/lb. Physical examination was unremarkable other than abnormalities noted in the cardiovascular and neurological systems. Neurological examination revealed dull mentation, vertical nystagmus, four-legged extensor limb rigidity, and alligator rolling. Cardiovascular examination revealed pale pink mucous membranes and multifocal ventricular tachycardia. Intravenous (IV fluids were started at three times maintenance (180 mL/kg/day. Methocarbamol (100 mg/kg [220 mg/lb], rectally and lidocaine (2 mg/kg [4.4 mg/lb, IV] were administered. Twenty-four and seventy-two hours after presentation, the dog was clinically normal with no ventricular tachycardia being noted. Conclusion: Lamotrigine (6-[2,3-dichlorophenyl]-1,2,4-triazine-3,5-diamine is an anticonvulsant medication used in humans, which inhibits voltage-gated sodium channels. The clinical success of this case suggests that administration of only methocarbamol for the neurologic effects and lidocaine for the arrhythmias, as well as supportive IV fluid therapy, could be a successful treatment strategy for dogs, even with severe lamotrigine toxicosis. Keywords: arrhythmia, toxicity, multifocal ventricular tachycardia, poison

  12. Intensive therapy of severe complications of influenza

    Directory of Open Access Journals (Sweden)

    V. I. Kozhokaru

    2012-01-01

    Full Text Available Definition of risk factors and clinical characteristics of heavy complications of influenza for working out of criteria of polymodal intensive therapy and resuscitation was the work purpose. Results of linical supervision by 114 sick heavy form of influenza with pulmonary and extra pulmonary complications are presented. All patients suffered from virus pneumonia and sharp defeat of lungs /sharp respirator distress-syndrome (OPL/ORDS. Pulmonary complications included bacterial (85, 96 % and micotic (2, 63 % pneumonia, thrombosis of legoch arteries (19,29 %, the sharp respiratory insufficiency, caused by the polyneuropathy of a critical condition of the patient (18,42 %, the exssudative pleuritis (9,65 %, spontaneous pheumothorax (4,39 %, spontaneous pheumomediastinum (2,69 %. Extra pulmonary complications concerned the swell of brain at 100 % of patients, including, with development of a brain coma (26,32 %, sepsis (85,96 %, including, with development of septic shock (68,42 %, syndrome of disseminated intravenous coagulation (49,12 %, multyorgan insufficiency (56,14 %, sharp heavy miocarditis (22,81 %, sharp nephritic insufficiency (18,42 %, sharp hepatic insufficiency (10,52 %. Early development of pathophysiological processes (the expressed infringements of a gas exchange and an acid-base condition, a secondary immunodeficiency, heamodynamical insufficiency,m etc. leads to underestimation of severity of the patient’s condition and to failer of algorithm of polymodal intensive therapy. Development of severe complications(sepsis, septic shock, sharp respirator distress-syndrome demands expansion for epidemic of specialized medicalstructures on rendering timely intensive therapy and resuscitation.

  13. Myocardial Autophagy after Severe Burn in Rats

    Science.gov (United States)

    Zhang, Qiong; Shi, Xiao-hua; Huang, Yue-sheng

    2012-01-01

    Background Autophagy plays a major role in myocardial ischemia and hypoxia injury. The present study investigated the effects of autophagy on cardiac dysfunction in rats after severe burn. Methods Protein expression of the autophagy markers LC3 and Beclin 1 were determined at 0, 1, 3, 6, and 12 h post-burn in Sprague Dawley rats subjected to 30% total body surface area 3rd degree burns. Autophagic, apoptotic, and oncotic cell death were evaluated in the myocardium at each time point by immunofluorescence. Changes of cardiac function were measured in a Langendorff model of isolated heart at 6 h post-burn, and the autophagic response was measured following activation by Rapamycin and inhibition by 3-methyladenine (3-MA). The angiotensin converting enzyme inhibitor enalaprilat, the angiotensin receptor I blocker losartan, and the reactive oxygen species inhibitor diphenylene iodonium (DPI) were also applied to the ex vivo heart model to examine the roles of these factors in post-burn cardiac function. Results Autophagic cell death was first observed in the myocardium at 3 h post-burn, occurring in 0.008 ± 0.001% of total cardiomyocytes, and continued to increase to a level of 0.022 ± 0.005% by 12 h post-burn. No autophagic cell death was observed in control hearts. Compared with apoptosis, autophagic cell death occurred earlier and in larger quantities. Rapamycin enhanced autophagy and decreased cardiac function in isolated hearts 6 h post-burn, while 3-MA exerted the opposite response. Enalaprilat, losartan, and DPI all inhibited autophagy and enhanced heart function. Conclusion Myocardial autophagy is enhanced in severe burns and autophagic cell death occurred early at 3 h post-burn, which may contribute to post-burn cardiac dysfunction. Angiotensin II and reactive oxygen species may play important roles in this process by regulating cell signaling transduction. PMID:22768082

  14. Pathophysiologic response to severe burn injury.

    Science.gov (United States)

    Jeschke, Marc G; Chinkes, David L; Finnerty, Celeste C; Kulp, Gabriela; Suman, Oscar E; Norbury, William B; Branski, Ludwik K; Gauglitz, Gerd G; Mlcak, Ronald P; Herndon, David N

    2008-09-01

    To improve clinical outcome and to determine new treatment options, we studied the pathophysiologic response postburn in a large prospective, single center, clinical trial. A severe burn injury leads to marked hypermetabolism and catabolism, which are associated with morbidity and mortality. The underlying pathophysiology and the correlations between humoral changes and organ function have not been well delineated. Two hundred forty-two severely burned pediatric patients [>30% total body surface area (TBSA)], who received no anabolic drugs, were enrolled in this study. Demographics, clinical data, serum hormones, serum cytokine expression profile, organ function, hypermetabolism, muscle protein synthesis, incidence of wound infection sepsis, and body composition were obtained throughout acute hospital course. Average age was 8 +/- 0.2 years, and average burn size was 56 +/- 1% TBSA with 43 +/- 1% third-degree TBSA. All patients were markedly hypermetabolic throughout acute hospital stay and had significant muscle protein loss as demonstrated by a negative muscle protein net balance (-0.05% +/- 0.007 nmol/100 mL leg/min) and loss of lean body mass (LBM) (-4.1% +/- 1.9%); P < 0.05. Patients lost 3% +/- 1% of their bone mineral content (BMC) and 2 +/- 1% of their bone mineral density (BMD). Serum proteome analysis demonstrated profound alterations immediately postburn, which remained abnormal throughout acute hospital stay; P < 0.05. Cardiac function was compromised immediately after burn and remained abnormal up to discharge; P < 0.05. Insulin resistance appeared during the first week postburn and persisted until discharge. Patients were hyperinflammatory with marked changes in IL-8, MCP-1, and IL-6, which were associated with 2.5 +/- 0.2 infections and 17% sepsis. In this large prospective clinical trial, we delineated the complexity of the postburn pathophysiologic response and conclude that the postburn response is profound, occurring in a timely manner, with

  15. Several Key Features of Marriage in Kosovo

    Directory of Open Access Journals (Sweden)

    Dr.Sc. Hamdi Podvorica

    2014-02-01

    Full Text Available In this paper titled “Several key features of marriage in Kosovo”, I have made efforts to address the matrimony, as an important societal and legal concept, in the light of positive law in Kosovo. In short terms, I have addressed the historical development of marriage in general, from the period of promiscuity until today, and I have emphasized key features of marriage in various time periods, only to comprehend better the ways of development of marriage in time and space. A special emphasis is put on the essential (material conditions of marital union. The paper provides sufficient reasons for which the positive law in Kosovo has provided on the free expression of will of spouses; opposite sexes; the age threshold; entry into matrimony before a competent state authority, and under a procedure provided by law, as substantial conditions for entering a valid matrimony. Sufficient room is allowed also for the treatment of consequences and responsibilities of various entities if marriage is developed without obeying substantial conditions as provided by law. Due to the nature of the paper, formal conditions for entering matrimony are not addressed. The right to enter marriage and establish a family under provided legal conditions is guaranteed to every Kosovo citizen, as a substantial right. The marriage is a basic cell of the family, and as such, it is protected by the state and society. Apart from normative and sociological methods, I have also used the historical method in developing this paper. The purpose was to discover several marriage features, which used to exist, and do not anymore, and also underline some new features, which nowadays form the pillars of the marriage.

  16. Severe combined immunodeficiency: a national surveillance study.

    Science.gov (United States)

    Yee, Anthony; De Ravin, Suk See; Elliott, Elizabeth; Ziegler, John B

    2008-06-01

    National immunodeficiency registers in several countries have reported prevalence but not incidence rates for severe combined immunodeficiency (SCID). The objective of this study was to document the incidence and type of SCID in Australia, the age and clinical features at presentation and short-term management. The Australian Paediatric Surveillance Unit conducts active, monthly, national surveillance of rare disorders with reporting by child-health specialists. Between May 1995 and December 2001, clinicians provided clinical and laboratory data on children newly diagnosed with SCID. Thirty-three incident cases of SCID were identified [incidence 1.8/10(5) live births per annum; 95% confidence interval (CI) 1.2-2.5]. Twenty-six children had classical SCID (1.45/10(5) live births; 95% CI, 0.9-2.0) and 20 (77%) of these were boys. Classical SCID was X-linked in 13 children, autosomal recessive (AR), not further classified in four, and attributed to adenosine deaminase deficiency (ADA) in four, interleukin-7 receptor alpha chain deficiency in one, Ommen syndrome in two, and Di George syndrome in two. Twenty-one (81%) received bone marrow/stem cell transplantation, three of whom died between 1 and 4 months after transplantation (two ADA deficient, one AR). Seven children had atypical SCID, five of whom died within 1-4 yr of diagnosis. Most children with SCID presented with failure to thrive and recurrent infections and there was no significant delay between presentation and diagnosis. The reported national incidence of classical SCID in Australia (1.45/10(5) or approximately 4 cases per year or 1/69,000 live births) is consistent with the rate (1.4/10(5)) previously reported in Victoria. Diagnosis is rarely delayed, and transplantation is associated with good short-term survival.

  17. Streptozotocin, Type I Diabetes Severity and Bone

    Directory of Open Access Journals (Sweden)

    Motyl Katherine

    2009-01-01

    Full Text Available Abstract As many as 50% of adults with type I (T1 diabetes exhibit bone loss and are at increased risk for fractures. Therapeutic development to prevent bone loss and/or restore lost bone in T1 diabetic patients requires knowledge of the molecular mechanisms accounting for the bone pathology. Because cell culture models alone cannot fully address the systemic/metabolic complexity of T1 diabetes, animal models are critical. A variety of models exist including spontaneous and pharmacologically induced T1 diabetic rodents. In this paper, we discuss the streptozotocin (STZ-induced T1 diabetic mouse model and examine dose-dependent effects on disease severity and bone. Five daily injections of either 40 or 60 mg/kg STZ induce bone pathologies similar to spontaneously diabetic mouse and rat models and to human T1 diabetic bone pathology. Specifically, bone volume, mineral apposition rate, and osteocalcin serum and tibia messenger RNA levels are decreased. In contrast, bone marrow adiposity and aP2 expression are increased with either dose. However, high-dose STZ caused a more rapid elevation of blood glucose levels and a greater magnitude of change in body mass, fat pad mass, and bone gene expression (osteocalcin, aP2. An increase in cathepsin K and in the ratio of RANKL/OPG was noted in high-dose STZ mice, suggesting the possibility that severe diabetes could increase osteoclast activity, something not seen with lower doses. This may contribute to some of the disparity between existing studies regarding the role of osteoclasts in diabetic bone pathology. Examination of kidney and liver toxicity indicate that the high STZ dose causes some liver inflammation. In summary, the multiple low-dose STZ mouse model exhibits a similar bone phenotype to spontaneous models, has low toxicity, and serves as a useful tool for examining mechanisms of T1 diabetic bone loss.

  18. Streptozotocin, Type I Diabetes Severity and Bone

    Directory of Open Access Journals (Sweden)

    Motyl Katherine

    2009-03-01

    Full Text Available Abstract As many as 50% of adults with type I (T1 diabetes exhibit bone loss and are at increased risk for fractures. Therapeutic development to prevent bone loss and/or restore lost bone in T1 diabetic patients requires knowledge of the molecular mechanisms accounting for the bone pathology. Because cell culture models alone cannot fully address the systemic/metabolic complexity of T1 diabetes, animal models are critical. A variety of models exist including spontaneous and pharmacologically induced T1 diabetic rodents. In this paper, we discuss the streptozotocin (STZ-induced T1 diabetic mouse model and examine dose-dependent effects on disease severity and bone. Five daily injections of either 40 or 60 mg/kg STZ induce bone pathologies similar to spontaneously diabetic mouse and rat models and to human T1 diabetic bone pathology. Specifically, bone volume, mineral apposition rate, and osteocalcin serum and tibia messenger RNA levels are decreased. In contrast, bone marrow adiposity and aP2 expression are increased with either dose. However, high-dose STZ caused a more rapid elevation of blood glucose levels and a greater magnitude of change in body mass, fat pad mass, and bone gene expression (osteocalcin, aP2. An increase in cathepsin K and in the ratio of RANKL/OPG was noted in high-dose STZ mice, suggesting the possibility that severe diabetes could increase osteoclast activity, something not seen with lower doses. This may contribute to some of the disparity between existing studies regarding the role of osteoclasts in diabetic bone pathology. Examination of kidney and liver toxicity indicate that the high STZ dose causes some liver inflammation. In summary, the multiple low-dose STZ mouse model exhibits a similar bone phenotype to spontaneous models, has low toxicity, and serves as a useful tool for examining mechanisms of T1 diabetic bone loss.

  19. A percutaneous drainage protocol for severe and moderately severe acute pancreatitis.

    Science.gov (United States)

    Sugimoto, Motokazu; Sonntag, David P; Flint, Greggory S; Boyce, Cody J; Kirkham, John C; Harris, Tyler J; Carr, Sean M; Nelson, Brent D; Barton, Joshua G; Traverso, L William

    2015-11-01

    According to the revised Atlanta classification, severe and moderately severe acute pancreatitis (AP) includes patients with pancreatic and peripancreatic collections with or without organ failure. These collections suggest the presence of pancreatic juice leakage. The aim of this study was to evaluate the efficacy of a percutaneous catheter drainage (PCD) protocol designed to control leakage and decrease disease severity. Among 663 patients with clinical AP, 122 were classified as moderately severe or severe AP (all had collections). The computed tomography severity index (CTSI) score was calculated. The indication for PCD was based on progressive clinical signs and symptoms. Drain patency, position, and need for additional drainage sites were assessed using CT scans and drain studies initially every 3 days using a proactive protocol. Drain fluid was examined for amylase concentration and microbiological culture. Clinicopathological variables for patients with and without PCD were compared. Since there was no mortality, we used prolonged drainage time to measure the success of PCD. Within the group treated with PCD, variables that resulted in prolonged drainage time were analyzed. PCD was used in 47/122 (39 %) patients of which 33/47 (70 %) had necrosis. PCD cases had a median CTSI of 8 and were classified as moderately severe AP (57 %) and severe AP (43 %). Inhospital mortality was zero. Surgical necrosectomy was not required for patients with necrosis. Independent risk factors for prolonged drainage time were persistent organ failure >48 h (P = 0.001), CTSI 8-10 (P = 0.038), prolonged duration of amylase-rich fluid in drains (P drainage fluid resulting in a mortality rate of zero.

  20. Allergic rhinitis severity can be assessed using a visual analogue scale in mild, moderate and severe.

    Science.gov (United States)

    Del Cuvillo, A; Santos, V; Montoro, J; Bartra, J; Davila, I; Ferrer, M; Jauregui, I; Sastre, J; Mullol, J; Valero, A

    2017-03-01

    Allergic rhinitis is a global healthcare problem due to its high prevalence, impact on individuals and socioeconomic burden for the nations. Allergic rhinitis severity evaluation is the key to a correct treatment, prevention of comorbidities and improving the quality of life of patients. This evaluation should be made with a simple, easy, fast but accurate and reliable methodology, both in a primary care and specialist setting. The visual analogue scale (VAS) meets all requirements to be the ideal tool to assess allergic rhinitis severity and has already been validated by using a single cut-off point, but this classification in two degrees of severity suffer from not allocating the patients uniformly and from giving a blind interval to classify the patients when the score is between 5 to 6 cm. The main objective of our study is to describe the optimal cut-off points by using a VAS to discriminate between three degrees of allergic rhinitis severity (mild, moderate, and severe) following the ARIA modified severity criteria that has been previously validated. Sensitivity, specificity, positive and negative predictive values just like receiver operating characteristic curves were used to select the best cut-off values. In a cross-sectional multicentre study with 3,572 patients included we have found that VAS has a significant correlation with nasal symptom score and quality of life and that the best cut-off points to differentiate between mild, moderate an severe allergic rhinitis are a VAS score of 4 and 7, respectively. Allergic rhinitis severity could be assessed in three degrees by using VAS in a simple, easy, and accurate method.

  1. Predicting severe winter coastal storm damage

    Energy Technology Data Exchange (ETDEWEB)

    Hondula, David M; Dolan, Robert, E-mail: hondula@virginia.edu [Department of Environmental Sciences, University of Virginia, PO Box 400123, Charlottesville, VA 22903 (United States)

    2010-07-15

    Over the past 40 years residents of, and visitors to, the North Carolina coastal barrier islands have experienced the destructive forces of several 'named' extratropical storms. These storms have caused large-scale redistributions of sand and loss of coastal structures and infrastructure. While most of the population living on the islands are familiar with the wintertime storms, the damage and scars of the 'super northeasters'-such as the Ash Wednesday storm of 7 March 1962, and the Halloween storm of 1989-are slipping away from the public's memory. In this research we compared the damage zones of the 1962 Ash Wednesday storm, as depicted on aerial photographs taken after the storm, with photos taken of the same areas in 2003. With these high-resolution aerial photos we were able to estimate the extent of new development which has taken place along the Outer Banks of North Carolina since 1962. Three damage zones were defined that extend across the islands from the ocean landward on the 1962 aerial photos: (1) the zone of almost total destruction on the seaward edge of the islands where the storm waves break; (2) the zone immediately inland where moderate structural damage occurs during severe storms; and (3) the zone of flood damage at the landward margin of the storm surge and overwash. We considered the rate of coastal erosion, the rate of development, and increases in property values as factors which may contribute to changing the financial risk for coastal communities. In comparing the values of these four factors with the 1962 damage data, we produced a predicted dollar value for storm damage should another storm of the magnitude of the 1962 Ash Wednesday storm occur in the present decade. This model also provides an opportunity to estimate the rate of increase in the potential losses through time as shoreline erosion continues to progressively reduce the buffer between the development and the edge of the sea. Our data suggest that the

  2. Surgical approaches to aortopexy for severe tracheomalacia.

    Science.gov (United States)

    Jennings, Russell W; Hamilton, Thomas E; Smithers, C Jason; Ngerncham, Monawat; Feins, Neil; Foker, John E

    2014-01-01

    The purpose of this study was to determine the outcomes among three different surgical approaches for performing an aortopexy to treat severe tracheomalacia (STM). A retrospective review was performed for all patients who underwent an aortopexy by pediatric surgeons at a single institution during 1997-2012. Data collected included details of the operative approaches and clinical results. The data were analyzed using Chi-square and Fisher exact test. Forty-one patients underwent an aortopexy. The operation was chosen by the surgeon and not randomized. Exposure was by partial sternotomy (PS) (20), open thoracotomy (12), or thoracoscopic approach (7). Only the PS approach was done by a single team. All groups showed improvement in work of breathing, prevention of severe respiratory distress, and acute life threatening events. These effects were more dramatic for the PS group, especially regarding oxygen and/or ventilator dependence and the ability to undergo tracheostomy decannulation. Among the sixteen patients with failure-to-thrive before successful aortopexy by any technique, ten demonstrated significant improvement in their growth (p=0.025). The recurrence rate for the thoracoscopic approach was 38%, and there were no recurrences in the partial sternotomy and the thoracotomy groups, 38% vs 0% vs 0%, p=0.005. Simultaneous bronchoscopy was utilized more commonly in the PS group compared to the thoracotomy and thoracoscopic group, 95% vs 62% vs 38%. In this series, the partial sternotomy technique had the most reliable resolution of symptoms and no recurrence requiring reoperation. The PS approach to STM has the technical advantages of an improved exposure with equal access to the vessels over the right and left mainstem bronchi, as well as the trachea and a more specific elevation of the arteries, including suspension of the pulmonary arteries and trachea itself when desirable. Simultaneous bronchoscopy during aortopexy and an experienced team also likely

  3. Predicting severe winter coastal storm damage

    International Nuclear Information System (INIS)

    Hondula, David M; Dolan, Robert

    2010-01-01

    Over the past 40 years residents of, and visitors to, the North Carolina coastal barrier islands have experienced the destructive forces of several 'named' extratropical storms. These storms have caused large-scale redistributions of sand and loss of coastal structures and infrastructure. While most of the population living on the islands are familiar with the wintertime storms, the damage and scars of the 'super northeasters'-such as the Ash Wednesday storm of 7 March 1962, and the Halloween storm of 1989-are slipping away from the public's memory. In this research we compared the damage zones of the 1962 Ash Wednesday storm, as depicted on aerial photographs taken after the storm, with photos taken of the same areas in 2003. With these high-resolution aerial photos we were able to estimate the extent of new development which has taken place along the Outer Banks of North Carolina since 1962. Three damage zones were defined that extend across the islands from the ocean landward on the 1962 aerial photos: (1) the zone of almost total destruction on the seaward edge of the islands where the storm waves break; (2) the zone immediately inland where moderate structural damage occurs during severe storms; and (3) the zone of flood damage at the landward margin of the storm surge and overwash. We considered the rate of coastal erosion, the rate of development, and increases in property values as factors which may contribute to changing the financial risk for coastal communities. In comparing the values of these four factors with the 1962 damage data, we produced a predicted dollar value for storm damage should another storm of the magnitude of the 1962 Ash Wednesday storm occur in the present decade. This model also provides an opportunity to estimate the rate of increase in the potential losses through time as shoreline erosion continues to progressively reduce the buffer between the development and the edge of the sea. Our data suggest that the losses along the North

  4. Predicting severe winter coastal storm damage

    Science.gov (United States)

    Hondula, David M.; Dolan, Robert

    2010-07-01

    Over the past 40 years residents of, and visitors to, the North Carolina coastal barrier islands have experienced the destructive forces of several 'named' extratropical storms. These storms have caused large-scale redistributions of sand and loss of coastal structures and infrastructure. While most of the population living on the islands are familiar with the wintertime storms, the damage and scars of the 'super northeasters'—such as the Ash Wednesday storm of 7 March 1962, and the Halloween storm of 1989—are slipping away from the public's memory. In this research we compared the damage zones of the 1962 Ash Wednesday storm, as depicted on aerial photographs taken after the storm, with photos taken of the same areas in 2003. With these high-resolution aerial photos we were able to estimate the extent of new development which has taken place along the Outer Banks of North Carolina since 1962. Three damage zones were defined that extend across the islands from the ocean landward on the 1962 aerial photos: (1) the zone of almost total destruction on the seaward edge of the islands where the storm waves break; (2) the zone immediately inland where moderate structural damage occurs during severe storms; and (3) the zone of flood damage at the landward margin of the storm surge and overwash. We considered the rate of coastal erosion, the rate of development, and increases in property values as factors which may contribute to changing the financial risk for coastal communities. In comparing the values of these four factors with the 1962 damage data, we produced a predicted dollar value for storm damage should another storm of the magnitude of the 1962 Ash Wednesday storm occur in the present decade. This model also provides an opportunity to estimate the rate of increase in the potential losses through time as shoreline erosion continues to progressively reduce the buffer between the development and the edge of the sea. Our data suggest that the losses along the

  5. Development of Latrodectus Envenomation Severity Score (LESS; a Severity Index for Widow Spider Bite: Initial Step

    Directory of Open Access Journals (Sweden)

    Seyed Monzavi

    2014-03-01

    Full Text Available Background: In order to describe the patients and evaluate the effectiveness of treatments for widow spider envenomation, investigators require a reliable assessment tool. In this paper, the development of a clinical index for measuring the widow spider bite severity, Latrodectus Envenomation Severity Score (LESS, is described. Methods: According to the valid methods for index development, a Delphi group process was applied. A panel of 13 experienced medical toxicologists and physician experts in treatment of black widow spider bites was assembled in December 2013. The participants were asked to score clinical manifestations of Latrodectus envenomation based on their importance on the severity and patients’ prognosis. Hence, an initial draft of the severity index was developed and in the second phase of study, the draft was discussed in a focus group of experts to finally comment on each variable and vote about the final scores. Results: The proposed version of LESS comprises of 34 clinical items categorized in 8 organ systems. The index includes definition of each clinical variable to help users of the index how to ascertain or rule out the clinical finding. The maximum theoretical score according to LESS is 87. Acute renal failure, myocarditis, pulmonary edema and ileus received the highest scores in this index. Conclusion: The LESS is a new assessment tool that is designed to more objectively evaluate the severity and progression of envenomation in victims of widow spider bite. The prognostic-ability, reliability and sensitivity to change of the index should be investigated in future studies.   How to cite this article: Monzavi SM, Afshari R. Development of Latrodectus Envenomation Severity Score (LESS; a Severity Index for Widow Spider Bite: Initial Step. Asia Pac J Med Toxicol 2014;3:18-22.

  6. Congenital Anorectal Malformation Severity Does Not Predict Severity of Congenital Heart Defects.

    Science.gov (United States)

    Jonker, Jara E; Liem, Eryn T; Elzenga, Nynke J; Molenbuur, Bouwe; Trzpis, Monika; Broens, Paul M A

    2016-12-01

    To determine the prevalence of congenital heart defects (CHDs) in patients with mild or severe congenital anorectal malformations (CARMs), and whether all patients with CARM need pediatric cardiology screening. We included 129 patients with CARM born between 2004 and 2013, and referred to University Medical Center Groningen. Recto-perineal and recto-vestibular fistulas were classified as mild CARMs, all others as severe. Significant patent foramen ovale, secundum atrial septal defect, and small ventricular septum defect were classified as minor CHDs, all others as major. Of 129 patients with CARM, 67% had mild CARM, 33% severe CARM, and 17% were additionally diagnosed with CHD. CHDs were distributed equally in patients with mild or severe CARMs. Patients with multiple congenital abnormalities were more frequently diagnosed with CHD (n = 16, 36%) than patients without multiple congenital malformations (n = 5, 9%, P = .001). Patients with CARM diagnosed with CHD using pediatric cardiac echo screening were younger than 3 months of age at diagnosis. Earlier general pediatric examinations missed 7 (50%) children with mild and 4 (50%) with severe CHDs. The severity of CARM could predict neither prevalence nor severity of CHD. More than one-half of CHDs were missed during the first physical examination. No new CHDs were found in patients older than 3 months of age at the time CARMs were diagnosed. We recommend screening all patients with CARM younger than 3 months of age for CHD at the time CARM is diagnosed. Preoperative echocardiography should be the rule in children younger than 3 months of age and with multiple congenital anomalies. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Immunoadsorption for treatment of severe atopic dermatitis.

    Science.gov (United States)

    Wegner, Joanna; Weinmann-Menke, Julia; von Stebut, Esther

    2017-11-01

    Atopic dermatitis (AD) is a common disease affecting up to 10-20% of the population with the largest disease burden in childhood. Treatment options include basic emollient treatment, topical as well as systemic immunosuppressants. The pathogenesis is complex and among various triggers, genetic predisposition and immunological alterations contribute to development of disease. Atopy is common in patients with AD and many patients have high levels of Immunoglobulin E (IgE), some of which recognizes exogenous or auto/self-allergens. Treatment options targeting IgE such as specific immunotherapy against e.g. house dust mites or using anti-IgE antibodies (omalizumab) showed variable results that were not convincing. We now review recent data on the application of unspecific and IgE-selective immunoadsorption (IA) in AD. All in all, 53 patients have been treated with non-specific pan Ig IA and 28 patients with IgE-selective IA. Side effects were rarely seen. The efficacy of IgE depletion was generally high (<∼80%) for each IA cycle, but transient and lasted only a few days/weeks. Of note, disease activity appeared to improve in almost all cases and lasted for several weeks. Although the evidence is still weak, these case studies suggest that IgE depletion in AD is effective and helped control the disease. The mechanism of action is not understood yet. Future controlled trials are needed to validate this observation. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Sarcoidosis: assessment of disease severity using HRCT

    Energy Technology Data Exchange (ETDEWEB)

    Drent, Marjolein [Department of Respiratory Medicine, University Hospital of Maastricht, P.O. Box 5800, 6202, AZ Maastricht (Netherlands); Nutrition and Toxicology Research Institute Maastricht (NUTRIM), P.O. Box 5800, 6202, AZ Maastricht (Netherlands); Sarcoidosis Management Center, University Hospital of Maastricht, P.O. Box 5800, 6202, AZ Maastricht (Netherlands); Vries, Jolanda De [Department of Clinical Health Psychology, Tilburg University, P.O. Box 90153, 5000, LE Tilburg (Netherlands); Lenters, Merinke; Wouters, Emiel F.M. [Department of Respiratory Medicine, University Hospital of Maastricht, P.O. Box 5800, 6202, AZ Maastricht (Netherlands); Nutrition and Toxicology Research Institute Maastricht (NUTRIM), P.O. Box 5800, 6202, AZ Maastricht (Netherlands); Lamers, Rob J.S. [Department of Radiology, University Hospital of Maastricht, P.O. Box 5800, 6202, AZ Maastricht (Netherlands); Rothkranz-Kos, Snjezana; Dieijen-Visser, Marja P. van [Nutrition and Toxicology Research Institute Maastricht (NUTRIM), P.O. Box 5800, 6202, AZ Maastricht (Netherlands); Department of Clinical Chemistry, University Hospital of Maastricht, P.O. Box 5800, 6202, AZ Maastricht (Netherlands); Verschakelen, Johny A. [Department of Radiology, Catholic University, 3000, Leuven (Belgium)

    2003-11-01

    The value of high-resolution computed tomography (HRCT) in diagnosing and assessing inflammatory activity in sarcoidosis is well established. The aim of the present study was to address the intra- and inter-observer agreements of the HRCT score by Oberstein et al. [8], and to evaluate the relationship between HRCT findings and disease severity expressed in respiratory functional impairment in sarcoidosis. The clinical records of 80 known sarcoidosis patients visiting the outpatient clinic between January 2000 and August 2001, who underwent a HRCT as well as lung function tests (including exercise testing), were reviewed. Two readers scored the first 60 HRCT images twice. Weighted kappa and intra-class correlation coefficient were used to assess the reliability of the HRCT scoring system. Spearman's rank correlation coefficients and multiple regression analyses were performed to evaluate the relationship between HRCT findings (first reading, reader A) and respiratory functional impairment. Intra- and inter-reader reliability demonstrated good agreement. All HRCT subscores, except enlargement of lymph nodes, were correlated to the FEV{sub 1}, FVC, DLco, Pao{sub 2}max (all p<0.05) and A-aPo{sub 2}max (p <0.001). Furthermore, HRCT abnormalities, but not the chest radiographic stage, were strongly associated with functional parameters. Abnormal changes of lung parenchyma, established by HRCT features, were associated with respiratory functional impairment in sarcoidosis. Moreover, compared with the radiographic stages, HRCT findings appeared to be much more sensitive in depicting respiratory disability, especially abnormal gas exchange. (orig.)

  9. [Advance care planning and severe chronic diseases].

    Science.gov (United States)

    Diestre Ortín, Germán; González Sequero, Vanessa; Collell Domènech, Núria; Pérez López, Francisca; Hernando Robles, Pablo

    2013-01-01

    Advanced care planning (ACP) helps in make decisions on the health problems of people who have lost the capacity for informed consent. It has proven particularly useful in addressing the end of life. The aim of this study was to determine the prevalence of ACP in patients with severe chronic diseases. Review of medical records of patients with dementia, amyotrophic lateral sclerosis, Parkinson's disease, chronic obstructive pulmonary disease or interstitial lung disease, heart failure, chronic kidney disease on dialysis and cancer, all in advanced stages. We collected data on living wills or registered prior decisions by the physician according to clinical planned. A total of 135 patients were studied. There was a record of ACP in 22 patients (16.3%). In most of them it was planned not to start any vital treatment in the event of high risk of imminent death and lacking the ability to make decisions. Only two patients were had a legal living will. The registration of ACP is relatively low, and this can affect decision-making in accordance with the personal values of patients when they do not have the capacity to exercise informed consent. Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.

  10. Several remarks on the fuel cycle economy

    International Nuclear Information System (INIS)

    Roman Kubin; Rudolf Vespalec

    2007-01-01

    Present paper deals with some aspects influencing significantly cost of nuclear fuel and possibilities of its usage in optimal fuel cycle technology. Our discussion is focused on the phase of fuel procurement that means financial parts of the contract as well as its technical Appendices. Typically the fuel fabrication price is taken as the main economy indicator; nevertheless also many other financial and technical features of the contract must be taken into account in order to reach the best price of electricity sold into public energy grid. Our experience from several international tenders shows that the consistent complex of commercial and technical parameters of the contract is necessary to achieve optimal economic results and prepare proper conditions for advanced fuel cycle technology. Among those essential characteristics are payment conditions and schedule and extent of vendor's services and assistance to the operator. Very important role play also technical parameters, as safety and operational limits, influencing loading pattern quality and operating flexibility. Obviously also a level of operator's fuel cycle technology is a crucial point that is necessary for usage of technical quality of the fuel at the power plant. The final electricity price, produced by the plant, and uranium consumption are the only objective criteria to evaluate economic level of the fuel contract and the fuel cycle at all (Authors)

  11. Anomalous Solubility Behavior of Several Acidic Drugs

    Directory of Open Access Journals (Sweden)

    Alex Avdeef

    2014-04-01

    Full Text Available The “anomalous solubility behavior at higher pH values” of several acidic drugs originally studied by Higuchi et al. in 1953 [1], but hitherto not fully rationalized, has been re-analyzed using a novel solubility-pH analysis computer program, pDISOL-XTM. The program internally derives implicit solubility equations, given a set of proposed equilibria and constants (iteratively refined by weighted nonlinear regression, and does not require explicit Henderson-Hasselbalch equations. The re-analyzed original barbital, phenobarbital, oxytetracycline, and sulfathiazole solubility-pH data of Higuchi et al. is consistent with the presence of dimers in saturated solutions. In the case of barbital, phenobarbital and sulfathiazole, anionic dimers, reaching peak concentrations near pH 8. However, oxytetracycline indicated a pronounced tendency to form a cationic dimer, peaking near pH 2. Under the conditions of the original study, only barbital indicated a slight tendency to form a salt precipitate at pH > 6.8, with a highly unusual stoichiometry (consistent with a slope of 0.55 in the log S – pH plot: K+ + A2H- + 3HA D KA5H4(s. Thus the “anomaly” in the Higuchi data can be rationalized by invoking specific aggregated species.

  12. Pulse radiolysis study on several fluoroquinolones

    Energy Technology Data Exchange (ETDEWEB)

    Zhang Peng [Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800 (China); Graduate University of Chinese Academy of Science, Beijing 100049 (China); Yao Side [Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800 (China); Li Haixia; Song Xiyu; Liu Yancheng [Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800 (China); Graduate University of Chinese Academy of Science, Beijing 100049 (China); Wang Wenfeng, E-mail: wangwenfeng@sinap.ac.c [Shanghai Institute of Applied Physics, Chinese Academy of Sciences, Shanghai 201800 (China)

    2011-04-15

    Reactions of several fluoroquinolones (FQs), including enoxacin, norfloxacin, and ciprofloxacin, with various reactive species such as e{sub aq}{sup -}, N{sup {center_dot}}{sub 3}, and {sup {center_dot}O}H are investigated by pulse radiolysis techniques. The FQ radical anions formed in the reactions of FQs with e{sub aq}{sup -} could either be protonated or deprotonated, and the absorption of FQ radical anions was located around 370 nm. The absorption of the neutral radicals produced in the protonation, and the radical dianions produced in the deprotonation of FQ radical anions were located in the 500-750 nm region. The FQ radical cations formed in the reactions of FQs with N{sub 3}{sup {center_dot}} showed an absorption band around 360 nm. Due to the strong bleaching below 350 nm, the absorption maxima ({lambda}{sub max}) of FQ radical anions, and the {lambda}{sub max} of FQ radical cations were not confirmed. The absorption of the FQ radical anions and cations was clearly pH dependent. Under neutral conditions, the reaction rate constants of FQs with e{sub aq}{sup -} and {sup {center_dot}O}H, which are diffusion controlled, were determined.

  13. Translating the insomnia severity index into Arabic.

    Science.gov (United States)

    Suleiman, Khaled H; Yates, Bernice C

    2011-03-01

    The purpose of this study was to translate the Insomnia Severity Index (ISI) into Arabic (Fusha dialect), and obtain preliminary reliability and validity estimates for the translated version. Arabic populations experience sleep problems that interfere with their vitality and quality of life. The ISI was established to screen for insomnia in both clinical and research situations. This study used a descriptive correlational design. The ISI was translated into Arabic using the back-translation method and compared with three other sleep measures: the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the Vitality Subscale from the Medical Outcomes Study Short Form-36. These measures were administered to 35 healthy Arabic bilingual participants from three community locations. The mean ISI score was 9.2 (SD = 5.8; range 0-20). Internal consistency reliability was 0.84. The correlations between the total ISI score and the single items ranged from 0.49 to 0.92 (p translated ISI demonstrated adequate reliability and validity. The translated ISI needs further testing in a larger sample of both clinical and healthy Arabic populations in their own countries. Preliminary psychometric estimates show that the translated ISI is reliable and valid in this community-dwelling Arabic sample. The translated ISI allows for Arabic researchers to screen for insomnia and plan for future intervention studies. © 2011 Sigma Theta Tau International.

  14. Lacrimal Gland Fistula following Severe Head Trauma

    Directory of Open Access Journals (Sweden)

    Cemil Demir

    2015-01-01

    Full Text Available We aim to present a unique case with discharging lacrimal gland fistula secondary to severe head trauma by an animal. A 9-year-old girl presented with serous fluid discharge from a cutaneous fistula in the left orbital region. The patient had history of surgery for traumatic frontal bone fracture and skin laceration in the superior orbital rim three weeks earlier. She underwent a complete ophthalmological examination and there was no anterior segment or fundus pathology. The orifice of the fistula was detected in mediolateral part of the left superior orbital rim and fluid secretion was increasing with irritation of the left eye. Neurosurgical complications were excluded and radiological assessment was nonremarkable. The patient’s legal representatives were informed and lacrimal gland fistulectomy was planned. However, the fistula was self-closed one week after initial ophthalmological examination, and the patient had no symptoms. In conclusion, traumatic injuries of superior orbital region should be carefully evaluated and wounds should be well closed to prevent consecutive lacrimal gland fistula.

  15. Porosity effects during a severe accident

    International Nuclear Information System (INIS)

    Cazares R, R. I.; Espinosa P, G.; Vazquez R, A.

    2015-09-01

    The aim of this work is to study the behaviour of porosity effects on the temporal evolution of the distributions of hydrogen concentration and temperature profiles in a fuel assembly where a stream of steam is flowing. The analysis considers the fuel element without mitigation effects. The mass transfer phenomenon considers that the hydrogen generated diffuses in the steam by convection and diffusion. Oxidation of the cladding, rods and other components in the core constructed in zirconium base alloy by steam is a critical issue in LWR accident producing severe core damage. The oxygen consumed by the zirconium is supplied by the up flow of steam from the water pool below the uncovered core, supplemented in the case of PWR by gas recirculation from the cooler outer regions of the core to hotter zones. Fuel rod cladding oxidation is then one of the key phenomena influencing the core behavior under high-temperature accident conditions. The chemical reaction of oxidation is highly exothermic, which determines the hydrogen rate generation and the cladding brittleness and degradation. The heat transfer process in the fuel assembly is considered with a reduced order model. The Boussinesq approximation was applied in the momentum equations for multicomponent flow analysis that considers natural convection due to buoyancy forces, which is related with thermal and hydrogen concentration effects. The numerical simulation was carried out in an averaging channel that represents a core reactor with the fuel rod with its gap and cladding and cooling steam of a BWR. (Author)

  16. Behaviour of several fatigue prone bridge details

    Science.gov (United States)

    Kubiš, Petr; Ryjáček, Pavel

    2017-09-01

    Three fatigue welded bridge joints analysed in this work are the alternative details of the bottom flange connection. This construction detail is mainly used for the erection connection for steel and composite bridges. If applied in the place, where live load is significant, the fatigue becomes the main design criterion. The detail category is thus very important factor. The aim of this paper is to analyse the possibilities of the improving the behaviour of this detail, by various methods. First solution is to modify the shape of the cope hole to the elliptic shape. Second option is to use the “Olemutz” fully welded detail. This detail is often used in bridge designing despite there is no exact information about the fatigue category, and doubts of the performance exists. “Olemutz” is a long web plate slit that is filled by the double bevel weld after the execution of the bottom flange weld. The last detail is the elliptic cope hole filled by the plate-cap welded into an empty hole. The geometry is the same, as in the first case. The conclusion of the numerical analysis and the pilot fatigue experiments is discussed with several practical recommendations for designing.

  17. Prostate Cancer Severity Associations with Neighborhood Deprivation

    Directory of Open Access Journals (Sweden)

    Charnita M. Zeigler-Johnson

    2011-01-01

    Full Text Available Background. The goal of this paper was to examine neighborhood deprivation and prostate cancer severity. Methods. We studied African American and Caucasian prostate cancer cases from the Pennsylvania State Cancer Registry. Census tract-level variables and deprivation scores were examined in relation to diagnosis stage, grade, and tumor aggressiveness. Results. We observed associations of low SES with high Gleason score among African Americans residing in neighborhoods with low educational attainment (OR = 1.34, 95% CI = 1.13–1.60, high poverty (OR = 1.39, 95% CI = 1.15–1.67, low car ownership (OR = 1.46, 95% CI = 1.20–1.78, and higher percentage of residents on public assistance (OR = 1.32, 95% = 1.08–1.62. The highest quartile of neighborhood deprivation was also associated with high Gleason score. For both Caucasians and African Americans, the highest quartile of neighborhood deprivation was associated with high Gleason score at diagnosis (OR = 1.34, 95% CI = 1.19–1.52; OR = 1.71, 95% CI = 1.21–2.40, resp.. Conclusion. Using a neighborhood deprivation index, we observed associations between high-grade prostate cancer and neighborhood deprivation in Caucasians and African-Americans.

  18. Family emergency preparedness plans in severe tornadoes.

    Science.gov (United States)

    Cong, Zhen; Liang, Daan; Luo, Jianjun

    2014-01-01

    Tornadoes, with warnings usually issued just minutes before their touchdowns, pose great threats to properties and people's physical and mental health. Few studies have empirically investigated the association of family emergency preparedness planning and observed protective behaviors in the context of tornadoes. The purpose of this study was to examine predictors for the action of taking shelter at the time of tornadoes. Specifically, this study investigated whether having a family emergency preparedness plan was associated with higher likelihood of taking shelter upon receiving tornado warnings. This study also examined the effects of socioeconomic status and functional limitations on taking such actions. A telephone survey based on random sampling was conducted in 2012 with residents in Tuscaloosa AL and Joplin MO. Each city experienced considerable damages, injuries, and casualties after severe tornadoes (EF-4 and EF-5) in 2011. The working sample included 892 respondents. Analysis was conducted in early 2013. Logistic regression identified emergency preparedness planning as the only shared factor that increased the likelihood of taking shelter in both cities and the only significant factor in Joplin. In Tuscaloosa, being female and white also increased the likelihood of taking shelter. Disability was not found to have an effect. This study provided empirical evidence on the importance of having a family emergency preparedness plan in mitigating the risk of tornadoes. The findings could be applied to other rapid-onset disasters. © 2013 American Journal of Preventive Medicine Published by American Journal of Preventive Medicine All rights reserved.

  19. Severe headache following ozone therapy: Pneumocephalus.

    Science.gov (United States)

    Toman, Hüseyin; Özdemir, Uğur; Kiraz, Hasan Ali; Lüleci, Nurettin

    2017-07-01

    Pneumocephalus is defined as air in the cranial cavity. Pneumocephalus can result from inadvertent dural puncture during lumbar epidural anesthesia or epidural steroid injection. Presently described is case of 41-year-old woman who had undergone lumbar disc hernia operation but due to ongoing complaints, was diagnosed as having failed back surgery syndrome. Percutaneous epidural neuroplasty was performed. In the operating room, under sterile conditions and under sedoanalgesia, Racz catheter was inserted in caudal area and guided to epidural area with scope. In accordance with Madrid Declaration, 20 ug/mL concentration and 5 mL volume oxygen-ozone mixture was injected. After waiting 5 minutes, 0.25% bupivacaine + 80 mg triamcinolone + 1500 units hyaluronidase was administered through the catheter. After epidural neuroplasty procedure, when patient was taken to gurney, she complained of severe headache and nausea. Computed tomography scans of head were done immediately, and consistent with pneumocephalus, air was observed in right lateral ventricle frontal horn, interhemispheric fissure, and superior cerebellar cistern. Patient was placed in Trendelenburg position and intravenous fluid was replaced. Analgesics and bed rest were recommended as treatment. Patient was discharged from hospital on the second day. Within a week, headache pain and other complaints had resolved. In this article, the case of a failed back surgery patient who was postoperatively treated with medical ozone and experienced complication of pneumocephalus is discussed in context of literature data.

  20. Autotransplantation for treatment of severe splenic lesions.

    Science.gov (United States)

    Resende, Vivian; Petroianu, Andy; Junior, Wilson C T

    2002-10-01

    The aim of the study was to evaluate clinical and laboratory variables in patients undergoing spleen autotransplantation. We studied 29 patients with severe trauma of the spleen and its pedicle. Of these, 20 underwent autotransplantation (group I) and 9 underwent total splenectomy without preservation of splenic tissue (group II). Twenty-two additional subjects with an intact spleen were used as controls (group III). Immediate and late postoperative complications were investigated. Laboratory counts were performed during the late postoperative period (red blood cells, hemoglobin, white blood cells, platelets, and Howell-Jolly bodies). To investigate the immunological profiles of patients we performed B- and T-lymphocyte counts and determined IgA, IgG, and IgM levels. All patients underwent splenic scintigraphy with technetium 99m sulfur colloid. Groups I and III did not present abnormal blood bodies, and their hematological and immunological patterns were normal. Group II showed increased numbers of Howell-Jolly bodies and low IgM levels. Splenic scintigraphy indicated the viability and filtering function of the splenic remnant in group I. Autotransplantation is a good option to maintain splenic function when total splenectomy is necessary.