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Sample records for testis diagnosis treatment

  1. UNDESCENDED TESTIS, DIAGNOSIS AND TREATMENT

    Directory of Open Access Journals (Sweden)

    Winarta Lesmana Handrea

    2013-05-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Undescended testis (UDT or cryptorchidism is one of the commonest abnormalities in male infants. In this anomaly, testes are not located normally in the scrotum. The incidence of UDT is 4-5% of term male infants, and 20-33% of premature male infants. The occurrence of abnormalities of hormones control or anatomy process that is required in the normal process of lowering the testes can cause UDT. UDT can be differentiated into palpable and nonpalpable. The diagnosis of UDT can be known through physical examination. However, if the testes are impalpable, laparoscopy can be done to determine the position of the testis. Hormonal therapy to overcome UDT is still under controversy. The action that often done is surgery, called orchidopexy. The most serious complication of orchidopexy is testicular atrophy. It occurs in a small percentage, which is about 5-10%. Infertility may occur in 1 to 3 of 4 adult males and the risk of occurrence of malignancies is increased by as much as 5-10 times higher in men with a history of UDT. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  2. Laparoscopic diagnosis and treatment of nonpalpable testis

    Directory of Open Access Journals (Sweden)

    Francisco T. Denes

    2008-06-01

    Full Text Available INTRODUCTION: Treatment of the cryptorchid testicle is justified due to the increased risk of infertility and malignancy as well as the risk of testicular trauma and psychological stigma on patients and their parents. Approximately 20% of cryptorchid testicles are nonpalpable. In these cases, the videolaparoscopic technique is a useful alternative method for diagnosis and treatment. MATERIALS AND METHODS: We present data concerning 90 patients submitted to diagnostic laparoscopy for impalpable testicles. Forty-six patients (51.1% had intra-abdominal gonads. In 25 testicles of 19 patients, we performed a two stage laparoscopic Fowler-Stephens orchiopexy. The other 27 patients underwent primary laparoscopic orchiopexy, in a total of 29 testicles. RESULTS: We obtained an overall 88% success rate with the 2 stage Fowler-Stephens approach and only 33% rate success using one stage Fowler-Stephens surgery with primary vascular ligature. There was no intraoperative complication in our group of patients. In the laparoscopic procedures, the cosmetic aspect is remarkably more favorable as compared to open surgeries. Hospital stay and convalescence were brief. CONCLUSIONS: In pediatric age group, the laparoscopic approach is safe and feasible. Furthermore, the laparoscopic orchiopexy presents excellent results in terms of diagnosis and therapy of the impalpable testis, which is why this technique has been routinely incorporated in our Department.

  3. Treatment options for carcinoma in situ testis

    DEFF Research Database (Denmark)

    Mortensen, M S; Gundgaard, M.G.; Daugaard, G

    2011-01-01

    Carcinoma in situ testis (CIS) is known as the precursor of germ cell cancer of the testis. International guidelines on diagnosis and treatment are inconsistent. Some countries offer routine biopsies of the contralateral testicle in relation to orchidectomy for testicular cancer, whereas other...... their androgen status measured on a regular basis to find those cases where hormone substitution is needed....

  4. [Undescended testis: current treatment guidelines].

    Science.gov (United States)

    Haid, B

    2016-01-01

    Cryptorchidism is the most common genital malformation in male newborns. In recent years, guidelines concerning diagnosis and therapy have undergone considerable evolution with the implementation of recent knowledge in pathophysiology, diagnosis, and therapy. The aim of this publication is to provide an overview of the current national and international guideline recommendations concerning diagnosis and treatment of cryptorchidism. Critical points are discussed in light of current scientific literature. The current guidelines of the European Association of Urology (EAU)/European Society for Pediatric Urology (ESPU), the American Association of Urology (AUA), the pediatric urologic task force of the Austrian Society of Urology (ÖGU), the international consultation on urological disease (ICUD) and the German Society of Urology (DGU)/German Association of Pediatric Surgery (DGKCh) have been analyzed concerning the most important aspects of treatment and diagnosis. There is broad consensus concerning most steps and decisions for the treatment of cryptorchidism. However, some aspects of diagnostic imaging, the use of hormonal therapy, and surgical access in nonpalpable testis warrant further discussion and are the fields of considerable changes.

  5. Cancer testis antigen SPAG9 is a promising marker for the diagnosis and treatment of lung cancer.

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    Ren, Biqiong; Wei, Xiaobin; Zou, Guoying; He, Junyu; Xu, Guofeng; Xu, Fei; Huang, Yiran; Zhu, Haowen; Li, Yong; Ma, Guoan; Yu, Ping

    2016-05-01

    Cancer testis antigen sperm-associated antigen 9 (SPAG9) is highly expressed in many types of cancers. In the present study, to obtain a better understanding of the relevance of SPAG9 in cancer diagnosis and treatment, the expression of SPAG9 mRNA and protein in lung cancer specimens was evaluated by RT-PCR, western blotting and immunohistochemistry. ELISA was used to quantify the SPAG9 autoantibody in the peripheral blood of lung cancer patients. The results showed that the expression of SPAG9 mRNA and protein in the lung cancer tissues was significantly higher than that in the adjacent non-cancerous tissues (Plung cancer patients was significantly higher than the level in the healthy controls (Plung cancer patients than these levels in the untreated patients (P=0.006, P=0.026, respectively), while no statistical difference was found between treated and untreated squamous cell carcinoma patients. Our results suggest that the SPAG9 antibody in serum is a promising marker for the diagnosis of lung cancer, and the level of the humoral immune response to this antigen appears to be related to the type of lung cancer.

  6. Surgical treatment and follow up on undescended testis

    DEFF Research Database (Denmark)

    Thorup, Jorgen; Cortes, Dina

    2009-01-01

    number at birth in some cryptorchid testes and Intratubular Germ Cell Neoplasia seen in early childhood. The hypothesis that the abnormal location of the testis exposes the testis to infertility and malignant transformation is supported by the findings of early treatment lowering the risk of both...... a common etiologic antenatal factor is associated with infertility and/or testicular malignancy is supported by the finding of the influence of maternal lifestyle factors on fertility, a relative cancer risk of OR: 2.0 in contralateral descended testis of unilateral cryptorchidism, impaired germ cell...... infertility and testicular cancer. Disrupted endocrine regulation may be combined with both hypotheses....

  7. Prenatal diagnosis of juvenile granulosa cell tumor of the testis.

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    Peterson, Chad; Skoog, Steven

    2008-12-01

    Juvenile granulosa cell tumor is a rare benign neoplasm of the testicular stroma that accounts for 1-5% of all prepubertal testis tumors [Metcalfe PD, Farivar-Mohseni H, Farhat W, McLorie G, Khoury A, Bagli DJ. Pediatric testicular tumors: contemporary incidence and efficacy of testicular preserving surgery. J Urol 2003;170:2412-2416; Ross JH, Rybicki L, Kay R. Clinical behavior and a contemporary management algorithm for prepubertal testis tumors: a summary of the prepubertal testis tumor registry. J Urol 2002;168:1675-1679]. A prior case series retrospectively identified a cystic testis tumor on prenatal ultrasound images which was subsequently diagnosed as a juvenile granulosa cell tumor [Bryan DE, Cain MP, Casale AJ. Juvenile granulosa-theca cell (sex cord-stromal) tumor of the infant testis. J Urol 2003;169:1497-1498]. We report a case of a prenatally diagnosed testis tumor which was subsequently diagnosed as a juvenile granulosa cell tumor.

  8. Necrotic seminoma of the testis: establishing the diagnosis with Masson trichrome stain and immunostains.

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    Florentine, Barbara D; Roscher, Arno A; Garrett, Jerry; Warner, Nancy E

    2002-02-01

    We describe an infarcted mass in the testis containing "ghost" cells suspicious for neoplasm. The entire lesion was necrotic. A Masson trichrome stain greatly improved nuclear and cytologic detail, confirming the suspicion of neoplasm. Placental alkaline phosphatase revealed specific membrane staining of the neoplastic cells and established a diagnosis of seminoma. Masson trichrome plus selected immunostains offer a promising approach to the diagnosis of certain necrotic neoplasms.

  9. [Treatment of an undescended testis with human chorionic gonadotropin (HCG)].

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    Orkiszewski, M; Wieckowski, J; Zieliński, W

    1989-01-01

    Seventy one patients with ectopic testis of age between 2 and 11.5 years were treated with human chorionic gonadotropin (HCG) at doses recommended by the International Health Foundation. The descent of testis to the scrotum was achieved in almost half of the treated boys (49.3%). The descent was successful mainly in cases of lower inguinal position of the undescended testicle, and only rarely when the testicle was situated higher. The descent was never successful in cases when the scrotum was small and underdeveloped.

  10. Protective effect of Zingiber officinale extract on rat testis after cyclophosphamide treatment.

    Science.gov (United States)

    Mohammadi, F; Nikzad, H; Taghizadeh, M; Taherian, A; Azami-Tameh, A; Hosseini, S M; Moravveji, A

    2014-08-01

    Decreasing the side effects of chemotherapy in testis has been the subjects of many studies. In this study, the protective effects of Zingiber officinale extract on rat testis were investigated after chemotherapy with cyclophosphamide. Histological and biochemical parameters were compared in cyclophosphamide-treated rats with or without ginger extract intake. Wistar male rats were randomly divided into four groups each 10. The control group received a single injection of 1 ml isotonic saline intraperitoneally. The Cyclophosphamide (CP) group received a single dose of cyclophosphamide (100 mg kg(-1) BW) intraperitoneally. CP + 300 and CP + 600 groups received orally 300 or 600 mg of ginger extract, respectively, for a period of 6 weeks after cyclophosphamide injection. The morphologic and histological structure of the testis was compared in different groups of the rats. Also, factors like malondialdehyde, reactive oxygen species, total antioxidant capacity and testosterone level were assessed in blood serum as well. Our results showed that although ginger extract could not change testis weight, malondialdehyde (MDA) and ROS, but antioxidant and testosterone levels in serum were increased significantly. Also, an obvious improved histological change was seen in CP + 300 and CP + 600 groups in comparison with CP group. These protective effects of ginger on rat testis after cyclophosphamide treatment could be attributed to the higher serum level of antioxidants. © 2013 Blackwell Verlag GmbH.

  11. Plague Diagnosis and Treatment

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    ... Search Form Controls Cancel Submit Search the CDC Plague Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . Plague Home Ecology & Transmission Symptoms Diagnosis & Treatment Maps & Statistics ...

  12. Salmonella Diagnosis and Treatment

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    ... FDA) USDA Food Safety and Inspection Service Follow Salmonella RSS Diagnosis and Treatment Recommend on Facebook Tweet Share Compartir How Can Salmonella Infections Be Diagnosed? Diagnosing salmonellosis requires testing a ...

  13. Somnambulism: Diagnosis and treatment

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    Bharadwaj, Rahul; Kumar, Suresh

    2007-01-01

    Somnambulism is an arousal disorder that is usually benign, self-limited and only infrequently requires treatment. Chronic sleepwalking in children has been shown to be associated with behavioral problems and poor emotional regulation. Most cases can be diagnosed with careful noting of case history and epilepsy is an important differential diagnosis. Management with pharmacological and behavioural measures is usually safe and effective. We present two cases of somnambulism that highlight the importance of the diagnosis and treatment of this condition. PMID:20711396

  14. [Urticaria: diagnosis and treatment].

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    Soria, A; Francès, C

    2014-09-01

    Urticaria is a common inflammatory skin disease. It is clinically defined as the occurrence of transient papular skin and/or mucosal lesions or subcutaneous lesions called angioedema. Chronic urticaria is defined as a clinical course over more than 6weeks. Different clinical forms of urticaria can coexist in the same patient. Urticaria results of mast cell activation. The diagnosis of urticaria is based on clinical examination. An allergic etiology for acute urticaria, although rare, is always to find and remove. Chronic urticaria is not allergic. Diagnosis is based on questioning and a careful clinical examination to rule out differential diagnoses. Few diagnostic tests are necessary for diagnosis and management, and are especially useful in case of doubtful diagnosis. The treatment of urticaria is symptomatic and based on anti-H1 second generation antihistamines as first-line therapy. In some chronic urticarial, antihistamines up dosing may be necessary. In the majority of patients, this treatment is sufficient to control chronic urticaria. In case of antihistamines failure, other treatment particularly immunomodulatory treatments can be offered in specialized departments. Copyright © 2014 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  15. Effects of chronic amiodarone treatment on rat testis.

    Science.gov (United States)

    Özkaya, Ahmet Kağan; Dilber, Embiya; Gürgen, Seren Gülşen; Kutlu, Ömer; Cansu, Ali; Gedik, Yusuf

    2016-04-01

    Amiodarone is a potent agent used to treat tachyarrhythmias, which are especially refractory to other medications, in both adults and children. Although widely used as an antiarrhythmic drug, amiodarone causes many serious adverse effects that limit its use. This study investigated the possible morphological and apoptotic effects of amiodarone on rat testes. Amiodarone was administered to male Sprague-Dawley rats at doses of 20 or 200mg/kg/day for 14 days. A histopathological examination of testicular tissue revealed the presence of inflammatory cells in the seminiferous tubule lumen together with swelling and vacuolization in the cytoplasm of some spermatogonia; these effects occured in a dose-dependent manner. Immunohistochemical staining showed evidence of apoptosis, including caspase-3, caspase-9, Bax and increased DNA fragmentation was detected via a terminal deoxynucleotidyl transferase dUTP nick-end labeling assay. In conclusion, the results show that chronic amiodarone treatment causes dose-dependent degenerative and apoptotic effects on rat testes. Copyright © 2016 Elsevier GmbH. All rights reserved.

  16. Narcolepsy. Diagnosis and treatment.

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    Dement, W C; Carskadon, M A; Guilleminault, C; Zarcone, V P

    1976-12-01

    Narcolepsy may affect as many as 200,000 Americans. The illness involves a neurologic defect in the regulation of sleep and wakefulness. The chief symptoms are sleepiness, inappropriate sleep episodes, and cataplexy. A characteristic history of cataplexy establishes the diagnosis. Narcoleptic patients also frequently complain of hypnagogic hallucinations, sleep paralysis, blackouts (or automatic behavior), and disturbed nocturnal sleep. Narcolepsy usually develops in adolescence and is a life-long illness. Symptoms may also appear in young children who may be misdiagnosed as hyperactive or psychotic. No completely satisfactory treatment is available at the present time. The current treatments of choice are methylphenidate (for sleepiness and sleep episodes) and imipramine (for cataplexy). Medication dosages must be adjusted for individual patients. A careful history of the illness can rule out hypothyroidism, hypoglycemia, and epilepsy. Sleep apnea is a serious complication of narcolepsy and may be life threatening.

  17. Arsenicosis: Diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Das Nilay

    2008-01-01

    Full Text Available Diagnosis of arsenicosis relies on both clinical and laboratory criteria, but principally it can be diagnosed on the basis of its cutaneous manifestations. Cutaneous manifestations (melanosis, keratosis, and cutaneous cancers are essential clues in the diagnosis, and trained dermatologists or arsenic experts are able to clinically confirm a case even without laboratory backup. Although systemic manifestations are not considered as diagnostic hallmarks, yet their presence serves as important telltale signs in arriving at the diagnosis. In countries where laboratory facilities are available, measuring the level of arsenic in drinking water (consumed in the last 6 months, urine, hair, and nails is of immense value. Newer biomarkers of arsenic exposure are being explored to provide early information about arsenic intoxication, of which urinary porphyrin level, blood metallothionein have shown promising results. Controlling the problem of arsenicosis depends on various factors, of which the most important is cessation of intake of arsenic-contaminated water. Deep wells, traditional dug wells, treatment of surface water, rainwater harvesting, and removing arsenic from the contaminated water by arsenic removal plant or arsenic treatment unit are the available options for providing arsenic-free drinking water. The role of nutrition and antioxidants in preventing the onset of symptoms of arsenicosis is also of importance. Nonspecific therapies (e.g., keratolytics for hyperkeratosis cannot also be ignored and serve as palliative measures. The persons affected need to be followed up at regular intervals to detect the onset of cancers (if any at the earliest. Role of counseling and education should never be underestimated since absence of public awareness can undermine all efforts of mitigation measures.

  18. Celiac Disease: Symptoms, Diagnosis & Treatment

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    ... of this page please turn JavaScript on. Feature: Celiac Disease Symptoms, Diagnosis & Treatment Past Issues / Spring 2015 Table ... Contents What are some of the symptoms of celiac disease? Some people with celiac disease may not feel ...

  19. Pediatric Hypothyroidism: Diagnosis and Treatment.

    Science.gov (United States)

    Wassner, Ari J

    2017-08-01

    Thyroid hormone has important physiologic functions in nearly every organ system. The critical role of thyroid hormone in growth and in physical and neurologic development lends particular importance to the prompt diagnosis and appropriate treatment of hypothyroidism in infants and children. Congenital hypothyroidism is common and has potentially devastating neurologic consequences. While the approach to diagnosis and treatment of severe congenital hypothyroidism is well established, data continue to emerge about the genetic causes, clinical significance, and prognosis of the milder forms of congenital hypothyroidism that are increasingly being diagnosed by newborn screening. Similarly, the diagnosis and treatment of severe acquired hypothyroidism is straightforward and clearly of clinical benefit, but uncertainty remains about the optimal management of mild subclinical hypothyroidism. This review summarizes current knowledge of the causes, clinical manifestations, diagnosis, treatment, and prognosis of hypothyroidism in infants and children, with a focus on recent developments and areas of uncertainty in this field.

  20. Glaucoma: Symptoms, Diagnosis & Treatment

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    ... of this page please turn JavaScript on. Feature: Glaucoma Symptoms, Treatment and Research Past Issues / Spring 2015 ... vision, without any pain. Photo courtesy of NEI Glaucoma Symptoms At first, open-angle glaucoma has no ...

  1. Diagnosis and treatment of haemorrhoids

    DEFF Research Database (Denmark)

    Buntzen, Steen; Christensen, Peter Quist; Khalid, Ali

    2013-01-01

    These guidelines provide a review of diagnosis, conservative and surgical treatment of haemorrhoids with primary focus on the surgical treatment. In symptomatic hemorrhoids it is recommended, that conservative treatment is used as basic treatment regardless of grading. The vast majority of grade II...... haemorrhoids are treated conservatively, but surgery may be considered in a few cases with pronounced symptoms. In these cases chirurgia minor, Doppler guided dearterilization procedures or stapled haemorrhoidopexy are recommended. In grade III and IV Doppler guided dearterilization procedures, stapled...

  2. Impetigo: diagnosis and treatment.

    Science.gov (United States)

    Hartman-Adams, Holly; Banvard, Christine; Juckett, Gregory

    2014-08-15

    Impetigo is the most common bacterial skin infection in children two to five years of age. There are two principal types: nonbullous (70% of cases) and bullous (30% of cases). Nonbullous impetigo, or impetigo contagiosa, is caused by Staphylococcus aureus or Streptococcus pyogenes, and is characterized by honey-colored crusts on the face and extremities. Impetigo primarily affects the skin or secondarily infects insect bites, eczema, or herpetic lesions. Bullous impetigo, which is caused exclusively by S. aureus, results in large, flaccid bullae and is more likely to affect intertriginous areas. Both types usually resolve within two to three weeks without scarring, and complications are rare, with the most serious being poststreptococcal glomerulonephritis. Treatment includes topical antibiotics such as mupirocin, retapamulin, and fusidic acid. Oral antibiotic therapy can be used for impetigo with large bullae or when topical therapy is impractical. Amoxicillin/clavulanate, dicloxacillin, cephalexin, clindamycin, doxycycline, minocycline, trimethoprim/sulfamethoxazole, and macrolides are options, but penicillin is not. Natural therapies such as tea tree oil; olive, garlic, and coconut oils; and Manuka honey have been anecdotally successful, but lack sufficient evidence to recommend or dismiss them as treatment options. Treatments under development include minocycline foam and Ozenoxacin, a topical quinolone. Topical disinfectants are inferior to antibiotics and should not be used. Empiric treatment considerations have changed with the increasing prevalence of antibiotic-resistant bacteria, with methicillin-resistant S. aureus, macrolide-resistant streptococcus, and mupirocin-resistant streptococcus all documented. Fusidic acid, mupirocin, and retapamulin cover methicillin-susceptible S. aureus and streptococcal infections. Clindamycin proves helpful in suspected methicillin-resistant S. aureus infections. Trimethoprim/sulfamethoxazole covers methicillin-resistant S

  3. Rosacea: Diagnosis and Treatment.

    Science.gov (United States)

    Oge', Linda K; Muncie, Herbert L; Phillips-Savoy, Amanda R

    2015-08-01

    Rosacea is a chronic facial skin condition of unknown cause. It is characterized by marked involvement of the central face with transient or persistent erythema, telangiectasia, inflammatory papules and pustules, or hyperplasia of the connective tissue. Transient erythema, or flushing, is often accompanied by a feeling of warmth. It usually lasts for less than five minutes and may spread to the neck and chest. Less common findings include erythematous plaques, scaling, edema, phymatous changes (thickening of skin due to hyperplasia of sebaceous glands), and ocular symptoms. The National Rosacea Society Expert Committee defines four subtypes of rosacea (erythematotelangiectatic, papulopustular, phymatous, and ocular) and one variant (granulomatous). Treatment starts with avoidance of triggers and use of mild cleansing agents and moisturizing regimens, as well as photoprotection with wide-brimmed hats and broad-spectrum sunscreens (minimum sun protection factor of 30). For inflammatory lesions and erythema, the recommended initial treatments are topical metronidazole or azelaic acid. Once-daily brimonidine, a topical alpha-adrenergic receptor agonist, is effective in reducing erythema. Papulopustular rosacea can be treated with systemic therapy including tetracyclines, most commonly subantimicrobial-dose doxycycline. Phymatous rosacea is treated primarily with laser or light-based therapies. Ocular rosacea is managed with lid hygiene, topical cyclosporine, and topical or systemic antibiotics.

  4. Plague: Clinics, Diagnosis and Treatment.

    Science.gov (United States)

    Nikiforov, Vladimir V; Gao, He; Zhou, Lei; Anisimov, Andrey

    2016-01-01

    Plague still poses a significant threat to human health and as a reemerging infection is unfamiliar to the majority of the modern medical doctors. In this chapter, the plague is described according to Dr. Nikiforov's experiences in the diagnosis and treatment of patients, and also a review of the relevant literature on this subject is provided. The main modern methods and criteria for laboratory diagnosis of plague are briefly described. The clinical presentations include the bubonic and pneumonic form, septicemia, rarely pharyngitis, and meningitis. Early diagnosis and the prompt initiation of treatment reduce the mortality rate associated with bubonic plague and septicemic plague to 5-50 %; although a delay of more than 24 h in the administration of antibiotics and antishock treatment can be fatal for plague patients. Most human cases can successfully be treated with antibiotics.

  5. Pneumococcal Disease: Diagnosis and Treatment

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    ... Diseases Sepsis Diagnosis and Treatment Recommend on Facebook Tweet Share Compartir Doctors use a lumbar puncture to collect a sample of cerebrospinal fluid. Larger image . Doctors consider some pneumococcal infections “invasive.” Invasive disease means that germs invade parts of the body that ...

  6. Cardiorenal Syndrome: Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    O.O. Melnyk

    2017-03-01

    Full Text Available In the diagnosis of cardiorenal syndrome (CRS, the biological markers are widely used, they can be applied to identify the pathophysiological stages of CRS, to assess the amount of risk, prognosis and outcome, as well as to monitor the effectiveness of treatment. CRS therapy includes diuretics, vasodilators, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, nitrates and cardiac glycosides. One of the most effective methods of CRS treatment is the use of renal replacement therapy.

  7. De niet-scrotale testis: huidige standpunten van de Werkgroep Kinderurologie van de Nederlandse Vereniging voor Urologie [Undescended testis: Current views and advice for treatment

    NARCIS (Netherlands)

    Hack, W.W.M.; Sijstermans, K.; Voort-Doedens, L.M. van der; Meijer, R.W.; Heij, H.A.; Delemarre-van de Waal, H.A.; Pierik, F.H.

    2008-01-01

    Eerder dit jaar verschenen in dit tijdschrift drie artikelen gewijd aan de niet-scrotale testis (NST).1-3 Ze hebben tot veel discussie geleid binnen de Werkgroep Kinderurologie (WGKU) van de Nederlandse Vereniging voor Urologie (NVU), hetgeen resulteerde in dit commentaar. Vooral de artikelen van

  8. Porphyria: Pathophysiology, diagnosis, and treatment.

    Science.gov (United States)

    Gasson, Tracy; Klein, Kathleen

    2015-08-15

    Porphyrias are inherited metabolic disorders that involve alterations in enzymes utilized in the heme biosynthetic pathway. Most of these conditions are inherited; however, some are believed to be acquired through environmental exposures. Patients with porhyrias often present with a wide range of clinical symptoms, making it difficult to diagnose. Treatments vary depending on clinical presentation. A thorough and detailed history is essential and key to discovering a porphyria diagnosis.

  9. Diagnosis and Treatment of Neurocysticercosis

    Directory of Open Access Journals (Sweden)

    Christina M. Coyle

    2009-01-01

    Full Text Available Neurocysticercosis, the infection caused by the larval form of the tapeworm Taenia solium, is the most common parasitic disease of the central nervous system and the most common cause of acquired epilepsy worldwide. This has primarily been a disease that remains endemic in low-socioeconomic countries, but because of increased migration neurocysticercosis is being diagnosed more frequently in high-income countries. During the past three decades improved diagnostics, imaging, and treatment have led to more accurate diagnosis and improved prognosis for patients. This article reviews the current literature on neurocysticercosis, including newer diagnostics and treatment developments.

  10. Diagnosis and treatment of impetigo.

    Science.gov (United States)

    Cole, Charles; Gazewood, John

    2007-03-15

    Impetigo is a highly contagious, superficial skin infection that most commonly affects children two to five years of age. The two types of impetigo are nonbullous impetigo (i.e., impetigo contagiosa) and bullous impetigo. The diagnosis usually is made clinically, but rarely a culture may be useful. Although impetigo usually heals spontaneously within two weeks without scarring, treatment helps relieve the discomfort, improve cosmetic appearance, and prevent the spread of an organism that may cause other illnesses (e.g., glomerulonephritis). There is no standard treatment for impetigo, and many options are available. The topical antibiotics mupirocin and fusidic acid are effective and may be superior to oral antibiotics. Oral antibiotics should be considered for patients with extensive disease. Oral penicillin V is seldom effective; otherwise there is no clear preference among antistaphylococcal penicillins, amoxicillin/clavulanate, cephalosporins, and macrolides, although resistance rates to erythromycin are rising. Topical disinfectants are not useful in the treatment of impetigo.

  11. Hanging drop cultures of human testis and testis cancer samples

    DEFF Research Database (Denmark)

    Jørgensen, Anne; Young, J; Nielsen, J E

    2014-01-01

    limited by the lack of experimental models. The aim of this study was to establish an experimental tissue culture model to maintain normal and malignant germ cells within their niche and allow investigation of treatment effects. METHODS: Human testis and testis cancer specimens from orchidectomies were...... cultured in 'hanging drops' and effects of activin A and follistatin treatment were investigated in seminoma cultures. RESULTS: Testis fragments with normal spermatogenesis or CIS cells were cultured for 14 days with sustained proliferation of germ cells and CIS cells and without increased apoptosis....... Seminoma cultures survived 7 days, with proliferating cells detectable during the first 5 days. Activin A treatment significantly reduced KIT transcript and protein levels in seminoma cultures, thereby demonstrating a specific treatment response. CONCLUSIONS: Hanging drop cultures of human testis...

  12. Osteogenesis imperfecta: diagnosis and treatment.

    Science.gov (United States)

    Palomo, Telma; Vilaça, Tatiane; Lazaretti-Castro, Marise

    2017-12-01

    Here we summarize the diagnosis of osteogenesis imperfecta, discuss newly discovered genes involved in osteogenesis imperfecta, and review the management of this disease in children and adults. Mutations in the two genes coding for collagen type I, COL1A1 and COL1A2, are the most common cause of osteogenesis imperfecta. In the past 10 years, defects in at least 17 other genes have been identified as responsible for osteogenesis imperfecta phenotypes, with either dominant or recessive transmission. Intravenous bisphosphonate infusions are the most widely used medical treatment. This has a marked effect on vertebra in growing children and can lead to vertebral reshaping after compression fractures. However, bisphosphonates are less effective for preventing long-bone fractures. At the moment, new therapies are under investigation. Despite advances in the diagnosis and treatment of osteogenesis imperfecta, more research is needed. Bisphosphonate treatment decreases long-bone fracture rates, but such fractures are still frequent. New antiresorptive and anabolic agents are being investigated but efficacy and safety of these drugs, especially in children, need to be better established before they can be used in clinical practice.

  13. Glaucoma: Symptoms, Diagnosis, Treatment and Latest Research

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    ... please turn Javascript on. Feature: Glaucoma Glaucoma: Symptoms, Diagnosis, Treatment and Latest Research Past Issues / Fall 2009 Table ... of glaucoma, looking for ways to improve its diagnosis and treatment. For instance, the National Eye Institute is funding ...

  14. SARCOPENIA: DIAGNOSIS, STAGES AND TREATMENT

    Directory of Open Access Journals (Sweden)

    Pasca Luminita Aurelia

    2015-02-01

    Full Text Available Sarcopenia is defined as the age-related loss of skeletal muscle mass and decline of function. The causes of sarcopenia are multi-factorial. The diagnosis of sarcopenia should be considered in all older patients who present with declines in physical function, because of potential consequences for the development of frailty and disability. There are numerous techniques to assess muscle mass, muscle strength and physical performance. Treatment consists of nutritional (macro- and micronutrients and physical activity (resistance exercise regimens adapted to person. There is an emerging role for testosterone and anabolic steroids in severe sarcopenia.

  15. [Lymphedema: From diagnosis to treatment].

    Science.gov (United States)

    Vignes, S

    2017-02-01

    Lymphedema results from impaired lymphatic transport with increased limb volume. Lymphedema are divided in primary and secondary forms. Upper-limb lymphedema secondary to breast cancer treatment is the most frequent in France. Primary lymphedema is sporadic, rarely familial or associated with complex malformative or genetic disorders. Diagnosis of lymphedema is mainly clinical and lymphoscintigraphy is useful in primary form to assess precisely the lymphatic function of the two limbs. Erysipelas (cellulitis) is the main complication, but psychological or functional discomfort may occur throughout the course of lymphedema. Lipedema is the main differential diagnosis, defined as an abnormal accumulation of fat from hip to ankle. Lymphedema management is based on complete decongestive physiotherapy (multilayer low-stretch bandage, manual lymph drainage, skin care, exercises). The first phase of treatment leads to a reduction of lymphedema volume and the second phase stabilizes the volume. Multilayer low-stretch bandage and elastic compression is the cornerstone of the complete decongestive physiotherapy. Patient-education programs, including self-management, aim to improve patient autonomy. Copyright © 2016 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  16. Feature Hepatitis: Hepatitis Symptoms, Diagnosis, Treatment & Prevention

    Science.gov (United States)

    ... Navigation Bar Home Current Issue Past Issues Feature Hepatitis Hepatitis: Symptoms, Diagnosis, Treatment & Prevention Past Issues / Spring 2009 ... No appetite Fever Headaches Diagnosis To check for hepatitis viruses, your doctor will test your blood. You ...

  17. [Halitosis--diagnosis and treatment].

    Science.gov (United States)

    Chomyszyn-Gajewska, Maria; Skrzypek, Agata

    2013-01-01

    Halitosis (bad breath) applies to according to various authors--even 25-50% of the population. Volatile sulfur compounds are frequently encountered in the exhaled air. The article presents the most common causes of halitosis. It is believed that approximately 80-90% of the causes of halitosis are located in the head area (mouth, ear, nose, throat), whereas the remaining cases correspond to systemic illness, such as of the stomach and lung, certain medications or food. This paper describes different means to assess halitosis, which can be helpful in determining the diagnosis. The article describes ways to treat the symptoms and causes of halitosis associated with oral cavity. In patients who have had another source of halitosis, additional diagnostic procedures and appropriate treatment must be performed. Given the prevalence of the problem of the malodour and its impact on the quality of everyday life, halitosis is a phenomenon that should not be underestimated. The causes need to be detected and an appropriate therapy must be performed. Patients with diagnosed halitophobia should be directed to appropriate specialists.

  18. Infectious endocarditis: diagnosis and treatment.

    Science.gov (United States)

    Pierce, Deborah; Calkins, Bethany C; Thornton, Kristen

    2012-05-15

    Infectious endocarditis results from bacterial or fungal infection of the endocardial surface of the heart and is associated with significant morbidity and mortality. Risk factors include the presence of a prosthetic heart valve, structural or congenital heart disease, intravenous drug use, and a recent history of invasive procedures. Endocarditis should be suspected in patients with unexplained fevers, night sweats, or signs of systemic illness. Diagnosis is made using the Duke criteria, which include clinical, laboratory, and echocardiographic findings. Antibiotic treatment of infectious endocarditis depends on whether the involved valve is native or prosthetic, as well as the causative microorganism and its antibiotic susceptibilities. Common blood culture isolates include Staphylococcus aureus, viridans Streptococcus, enterococci, and coagulase-negative staphylococci. Valvular structural and functional integrity may be adversely affected in infectious endocarditis, and surgical consultation is warranted in patients with aggressive or persistent infections, emboli, and valvular compromise or rupture. After completion of antibiotic therapy, patients should be educated about the importance of daily dental hygiene, regular visits to the dentist, and the need for antibiotic prophylaxis before certain procedures.

  19. [Fascioliasis: diagnosis, epidemiology and treatment].

    Science.gov (United States)

    Carrada-Bravo, Teodoro

    2003-01-01

    Fascioliasis is a trematode, disease of liver and bile ducts of sheep, cattle, and other ruminants throughout the world that is caused by the fluke, Fasciola hepatica. Human infection has been reported in Mexico, Cuba, Puerto Rico, Chile, Peru, Uruguay, Brazil, Argentina, the US, Europe, eastern Africa, Japan and Australia. The parasite's miracidium invades one of the various Lymnaea water snail hosts. Infection results from ingestion of encysted metacercariae attached to raw watercress (Nasturtium officinale). Symptoms recorded from human cases included irregular fever, epigastric pain and abdominal tenderness, obstructive jaundice and leucocytosis with eosinophilea up to 60%. Specific diagnosis is based on recovery of the eggs in the patient's stool or from biliary tract drainage. Treatment is with emetine hydrochloride given intramusculary. Bithionol is given orally at a dosage of 30-50 mg/kg but on alternate days from 10 to 15 doses. Praziquantel is probably effective. Preventive measures include education of the public on mode of transmission of life cycle of the parasite, and dipping fresh watercress into boiling water for a few sec, or drying suspected watercress.

  20. [Diagnosis and treatment of cervicothoracic injuries].

    Science.gov (United States)

    Tatarinova, E V; Pogodina, A N; Abakumov, M M

    2014-01-01

    It analyzed the diagnosis and treatment results of 123 patients with cervicothoracic injuries for 21 years. The frequency of cervicothoracic injuries among all patients with cervical injuries was 5.7%. Preoperative and postoperative diagnosis included radial and endoscopic methods. The complications rate was 43.6%. The most severe complications were observed in patients with delayed diagnosis of trachea and esophagus injuries.

  1. Diagnosis and treatment of hepatic alveolar echinococcosis

    Directory of Open Access Journals (Sweden)

    FANG Dan

    2017-05-01

    Full Text Available Alveolar echinococcus can be found in various organs of the body, with the liver as the most common organ. This article briefly elaborates on the diagnosis and treatment of hepatic alveolar echinococcosis. The diagnosis of this disease includes epidemic areas, serology, ultrasound, imaging examination, and pathological diagnosis, and its treatment includes radical hepatectomy, palliative hepatectomy, liver transplantation, high-intensity focused ultrasound, radiofrequency ablation, ultrasound- or CT-guided percutaneous biliary drainage, and pharmacotherapy. Regular screening, early diagnosis, and a combination of prevention and treatment should be performed for the high-risk population in epidemic areas to improve prognosis and prolong survival time.

  2. Diagnosis and Treatment of Syncope

    Directory of Open Access Journals (Sweden)

    Youichi Kobayashi, MD

    2006-01-01

    Full Text Available Accurate diagnosis of syncope is essential because it ranges from cardiac syncope with a very poor prognosis to neurally-mediated syncope (NMS with a relatively favorable prognosis. Diagnosis of syncope, however, is difficult in many patients even by HUT, so a new loading method for HUT or implanted Holter ECG monitoring will be required in the future. The prognosis of NMS itself may be favorable, but it may cause the aggravation of complications.

  3. Alterations of gene profiles in Leydig-cell-regenerating adult rat testis after ethane dimethane sulfonate-treatment

    Directory of Open Access Journals (Sweden)

    Yu-Fei Zhang

    2015-04-01

    Full Text Available Only occupying about 1%-5% of total testicular cells, the adult Leydig cell (ALC is a unique endocrine cell that produces androgens. Rat Leydig cells regenerate after these cells in the testis are eliminated with ethane dimethane sulfonate (EDS. In this study, we have characterized Leydig cell regeneration and messenger ribonucleic acids (mRNA profiles of EDS treated rat testes. Serum testosterone, testicular gene profiling and some steroidogenesis-related proteins were analyzed at 7, 21, 35 and 90 days after EDS treatment. Testicular testosterone levels declined to undetectable levels until 7 days after treatment and then started to recover. Seven days after treatment, 81 mRNAs were down-regulated greater than or equal to two-fold, with 48 becoming undetectable. These genes increased their expression 21 days and completely returned to normal levels 90 days after treatment. The undetectable genes include steroidogenic pathway proteins: steroidogenic acute regulatory protein, Scarb1, Cyp11a1, Cyp17a1, Hsd3b1, Cyp1b1 and Cyp2a1. Seven days after treatment, there were 89 mRNAs up-regulated two-fold or more including Pkib. These up-regulated mRNAs returned to normal 90 days after treatment. Cyp2a1 did not start to recover until 35 days after treatment, indicating that this gene is only expressed in ALCs not in the precursor cells. Quantitative polymerase chain reaction, western blotting and semi-quantitative immunohistochemical staining using tissue array confirmed the changes of several randomly picked genes and their proteins.

  4. Adult asthma: Diagnosis and treatment.

    Science.gov (United States)

    Durham, Catherine O; Fowler, Terri; Smith, Whitney; Sterrett, James

    2017-11-16

    Adult asthma is a prevalent chronic medical condition that is associated with high morbidity, mortality, and cost. Early identification, evidence-based diagnosis, and step-wise management can lead to improvements in patient outcomes, decrease exacerbations, and eliminate respiratory function decline as the patient ages.

  5. Diagnosis and treatment of ampullary tumors

    Directory of Open Access Journals (Sweden)

    YIN Tao

    2017-02-01

    Full Text Available Ampullary tumors mainly manifest as obstructive jaundice and ampullary mass in clinical practice and are difficult to be identified in early stage due to a complex structure of the anatomical site, a deep location, and hidden symptoms. Sometimes a qualitative diagnosis cannot be made. Based on the experience in the treatment of ampullary tumors for many years in our center, this article summarizes the features of ampullary tumors from the aspects of clinical manifestations, diagnosis, treatment, and prognosis, especially the issues regarding imaging evaluation of ampullary tumors, selection of surgical procedure, and prognosis. An early diagnosis is the key to the treatment of ampullary tumors, and early identification and treatment of lesions have great impacts on patients′ prognosis. Accurate preoperative imaging evaluation, a professional diagnosis and treatment team, accurate preoperative and intraoperative pathological analysis, and implementation of reasonable therapeutic strategy are the key to patients′ recovery.

  6. [Integrated diagnosis and treatment of scar].

    Science.gov (United States)

    Cen, Y; Chen, J J

    2016-11-20

    Scar is the common disease in the field of burn and plastic surgery, and its diagnosis and treatment should be involved in overwhelming majority hospitals. There are many substandard methods and medical hidden dangers in diagnosis and treatment of scar, due to the unevenness of doctors' clinical experience. According to the classification of integral scar and diabrotic scar, the problems related to diagnosis and treatment of scar are systemically summarized and normalized in this article for decrease in the incidence of adverse events and medical hidden dangers.

  7. [Lymphoedema--diagnosis and treatment].

    Science.gov (United States)

    Cisek, Paweł; Starosławska, Elzbieta; Kieszko, Dariusz; Patyra, Krzysztof; Surdyka, Dariusz; Kolak, Agnieszka; Kordzińska-Cisek, Izabela; Czubacka-Szewczyk, Magdalena; Mocarska, Agnieszka; Burdan, Franciszek

    2013-12-01

    Lymphoedema is a common complication of oncological treatment. Various methods of imaging are used in its diagnosing and monitoring. However, presently lymphoscintigraphy has become the golden standard. A physical examination and detailed medical history also play a very important role. There are still no effective methods of prevention and treatment of lymphoedema in spite of medical progress. The treatment requires a multidisciplinary approach with the use of various methods of physiotherapy (pressure therapy, pneumatic pumps and electric high-voltage treatment), pharmacology and surgery. Patient's education and suitable physical exercises are also significant.

  8. HIV / AIDS: Symptoms, Diagnosis, Prevention and Treatment

    Science.gov (United States)

    Skip Navigation Bar Home Current Issue Past Issues HIV / AIDS HIV / AIDS: Symptoms , Diagnosis, Prevention and Treatment Past Issues / ... Most people who have become recently infected with HIV will not have any symptoms. They may, however, ...

  9. Heart Health - Heart Disease: Symptoms, Diagnosis, Treatment

    Science.gov (United States)

    ... Bar Home Current Issue Past Issues Cover Story Heart Health Heart Disease: Symptoms, Diagnosis, Treatment Past Issues / Winter 2009 ... of this page please turn Javascript on. Most heart attacks happen when a clot in the coronary ...

  10. Reflex syncope: Diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Richard Sutton

    2017-12-01

    Full Text Available For the diagnosis of reflex syncope, diligent history-building with the patient and a witness is required. In the Emergency Department (ED, the assessment of syncope is a challenge which may be addressed by an ED Observation Unit or by a referral to a Syncope Unit. Hospital admission is necessary for those with life-threatening cardiac conditions although risk stratification remains an unsolved problem. Other patients may be investigated with less urgency by carotid sinus massage (>40 years, tilt testing, and electrocardiogram loop recorder insertion resulting in a clear cause for syncope. Management includes, in general terms, patient education, avoidance of circumstances in which syncope is likely, increase in fluid and salt consumption, and physical counter-pressure maneuvers. In older patients, those that will benefit from cardiac pacing are now well defined. In all patients, the benefit of drug therapy is often disappointing and there remains no ideal drug. A role for catheter ablation may emerge for the highly symptomatic reflex syncope patient. Keywords: Cardiac pacing, Catheter ablation, Diagnosis, Drugs, Management, Reflex syncope

  11. Feline otitis: diagnosis and treatment.

    Science.gov (United States)

    Kennis, Robert A

    2013-01-01

    Feline otitis is reviewed by evaluating the predisposing, primary, and secondary causes. Diagnostic and treatment options are summarized. Emphasis is placed on comparing feline and canine otitis. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Alleviation of lindane induced toxicity in testis of Swiss mice (Mus musculus) by combined treatment with vitamin C, vitamin E and alpha-lipoic acid.

    Science.gov (United States)

    Nagda, Girima; Bhatt, Devendra Kumar

    2011-03-01

    Mitigation of lindane induced toxicity in testis of Swiss mice by combined treatment with vitamin C, vitamin E and alpha-lipoic acid has been evaluated. Male healthy mice (40), 8-10 weeks old were randomly selected and divided into 4 groups, control (C); lindane (L); antioxidant (A) and antioxidant plus lindane (A+L). Group C animals were administered only the vehicle (olive oil); in group L lindane was administered orally at a dose of 40 mg/kg body wt.; in group A combination of antioxidants at a dose of 125 mg/kg body wt.(vitamin C: 50 mg/kg body wt., vitamin E: 50 mg/kg body wt. and alpha-lipoic acid: 25 mg/kg body wt.) was administered orally; in group A+L both antioxidants (125 mg/kg body wt.) and lindane (40 mg/kg body wt.) were administered at their respective doses. In group A+L antioxidants were administered 1 h prior to lindane administration. All treatments were continuously given for 60 days. Histopathological changes due to lindane intoxication indicated shrunken and distorted seminiferous tubules, sparse Leydig cells and blood vessels and atrophy in the tissue. The testis weight also decreased significantly. Lindane treated group showed increased lipid peroxidation, whereas glutathione, glutathione peroxidase, superoxide dismutase, catalase and protein were significantly decreased compared to control. Lindane induced damage was minimized by administration of antioxidants. Results suggest that combined pretreatment with antioxidants can alleviate the damage caused to testis by lindane.

  13. [New diagnosis without new treatments].

    Science.gov (United States)

    Bobbio, Marco; Galvagno, Giovanni

    2014-05-01

    The improvement of our investigative and diagnostic capability allows us to recognize early stage or mostly stable diseases in asymptomatic individuals and to treat those patients based on research conducted on more severe and acute conditions. Our main concern is avoiding not to treat a patient because of a missed diagnosis, so that we can avoid regrets and legal troubles. Usually, we do not take into account the opposite risk: overtreatment induced by overdiagnosis. For example, the increased number of diagnoses of pulmonary embolism did not reduce the incidence of death, but increased the number of bleeding from subsequent anticoagulation therapy. Similarly, the widespread detection of troponin increased the number of diagnoses of myocardial infarction solely on the basis of Lab values. In both cases we apply therapeutic strategies that have been proven effective in patients with more advanced and unstable clinical presentations with the risk of doing more harm than benefit. To be reassured by doing more, we risk to do worse.

  14. Diagnosis and treatment of hypernatremia.

    Science.gov (United States)

    Muhsin, Saif A; Mount, David B

    2016-03-01

    Hypernatremia is defined as a serum sodium level above 145 mmol/L. It is a frequently encountered electrolyte disturbance in the hospital setting, with an unappreciated high mortality. Understanding hypernatremia requires a comprehension of body fluid compartments, as well as concepts of the preservation of normal body water balance. The human body maintains a normal osmolality between 280 and 295 mOsm/kg via Arginine Vasopressin (AVP), thirst, and the renal response to AVP; dysfunction of all three of these factors can cause hypernatremia. We review new developments in the pathophysiology of hypernatremia, in addition to the differential diagnosis and management of this important electrolyte disorder. Copyright © 2016. Published by Elsevier Ltd.

  15. Multiple myeloma: diagnosis and treatment.

    Science.gov (United States)

    Nau, Konrad C; Lewis, William D

    2008-10-01

    Multiple myeloma, the most common bone malignancy, is occurring with increasing frequency in older persons. Typical symptoms are bone pain, malaise, anemia, renal insufficiency, and hypercalcemia. Incidental discovery on comprehensive laboratory panels is common. The disease is diagnosed with serum or urine protein electrophoresis or immunofixation and bone marrow aspirate analysis. Skeletal radiographs are important in staging multiple myeloma and revealing lytic lesions, vertebral compression fractures, and osteoporosis. Magnetic resonance imaging and positron emission tomography or computed tomography are emerging as useful tools in the evaluation of patients with myeloma; magnetic resonance imaging is preferred for evaluating acute spinal compression. Nuclear bone scans and dual energy x-ray absorptiometry have no role in the diagnosis and staging of myeloma. The differential diagnosis of monoclonal gammopathies includes monoclonal gammopathy of uncertain significance, smoldering (asymptomatic) and symptomatic multiple myeloma, amyloidosis, B-cell non-Hodgkin lymphoma, Waldenström macroglobulinemia, and rare plasma cell leukemia and heavy chain diseases. Patients with monoclonal gammopathy of uncertain significance or smoldering multiple myeloma should be followed closely, but not treated. Symptomatic multiple myeloma is treated with chemotherapy followed by autologous stem cell transplantation, if possible. Melphalan, prednisolone, dexamethasone, vincristine, doxorubicin, bortezomib, and thalidomide and its analogue lenalidomide have been used successfully. It is important that family physicians recognize and appropriately treat multiple myeloma complications. Bone pain is treated with opiates, bisphosphonates, radiotherapy, vertebroplasty, or kyphoplasty; nephrotoxic nonsteroidal anti-inflammatory drugs should be avoided. Hypercalcemia is treated with isotonic saline infusions, steroids, furosemide, or bisphosphonates. Because of susceptibility to infections

  16. Diagnosis and treatment of neurocysticercosis.

    Science.gov (United States)

    Nash, Theodore E; Garcia, Hector H

    2011-09-13

    Neurocysticercosis is a parasitic disease caused by the larval (cystic) form of the pork cestode tapeworm, Taenia solium, and is a major cause of acquired seizures and epilepsy worldwide. Development of sensitive and specific diagnostic methods, particularly CT and MRI, has revolutionized our knowledge of the burden of cysticercosis infection and disease, and has led to the development of effective antihelminthic treatments for neurocysticercosis. The importance of calcified granulomas with perilesional edema as foci of seizures and epilepsy in populations where neurocysticercosis is endemic is newly recognized, and indicates that treatment with anti-inflammatory agents could have a role in controlling or preventing epilepsy in these patients. Importantly, neurocysticercosis is one of the few diseases that could potentially be controlled or eliminated-an accomplishment that would prevent millions of cases of epilepsy. This Review examines the rationale for treatment of neurocysticercosis and highlights the essential role of inflammation in the pathogenesis of disease, the exacerbation of symptoms that occurs as a result of antihelminthic treatment, and the limitations of current antihelminthic and anti-inflammatory treatments.

  17. Patellar Tendinopathy: Diagnosis and Treatment.

    Science.gov (United States)

    Figueroa, David; Figueroa, Francisco; Calvo, Rafael

    2016-12-01

    Patellar tendinopathy is a common cause of pain in athletes' knees. Historically, it has been related to jumping sports, such as volleyball and basketball. Repetitive jumping generates a considerable load of energy in the extensor mechanism, leading to symptoms. The main pathophysiologic phenomenon in patellar tendinopathy is tendinosis, which is a degenerative disorder rather than an inflammatory disorder; therefore, the other popular term for this disease, tendinitis, is not appropriate. The nonsurgical treatment of patellar tendinopathy is focused on eccentric exercises and often has good results. Other experimental options, with variable levels of evidence, are available for recalcitrant cases. Surgical treatment is indicated for cases that are refractory to nonsurgical treatment. Open or arthroscopic surgery can be performed; the two methods are comparable, but arthroscopic surgery results in a faster recovery time.

  18. [Coma: etiology, diagnosis, and treatment].

    Science.gov (United States)

    Adukauskiene, Dalia; Budryte, Brigita; Karpec, Diana

    2008-01-01

    Coma is the disorder of consciousness because of the damage to diffused bilateral cerebral hemisphere cortex or reticular activating system. Coma can be caused by neurogenic (head brain injury), metabolic (endogenic), and toxic (exogenic) factors. To determine the cause of metabolic and toxic coma, laboratory tests are performed; in case of neurogenic coma, the neurologic examination is essential, when five systems are evaluated: the level of consciousness (according to Glasgow Coma Scale or Full Outline of Unresponsiveness Scale), photoreaction of pupils and ophthalmoscopic examination, oculomotoric, motoric, and cardiopulmonary systems. For the treatment of coma, adequate oxygenation and correction of blood circulation disorders are important. The treatment of metabolic coma is guided by special schemes; antidotes often are needed in the treatment of toxic coma, and surgery helps if traumatic brain injury is present. The prognosis and outcomes of the comatose patient depend on the age and comorbid diseases of the patient, the underlying cause of coma, timely medical help and its quality, and intensive treatment and care of the patient in coma.

  19. Childhood Asthma: Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Wim M. van Aalderen

    2012-01-01

    Full Text Available Many children suffer from recurrent coughing, wheezing and chest tightness. In preschool children one third of all children have these symptoms before the age of six, but only 40% of these wheezing preschoolers will continue to have asthma. In older school-aged children the majority of the children have asthma. Quality of life is affected by asthma control. Sleep disruption and exercised induced airflow limitation have a negative impact on participation in sports and social activities, and may influence family life. The goal of asthma therapy is to achieve asthma control, but only a limited number of patients are able to reach total control. This may be due to an incorrect diagnosis, co-morbidities or poor inhalation technique, but in the majority of cases non-adherence is the main reason for therapy failures. However, partnership with the parents and the child is important in order to set individually chosen goals of therapy and may be of help to improve control. Non-pharmacological measures aim at avoiding tobacco smoke, and when a child is sensitised, to avoid allergens. In pharmacological management international guidelines such as the GINA guideline and the British Guideline on the Management of Asthma are leading.

  20. Ex vivo culture of human fetal gonads: manipulation of meiosis signalling by retinoic acid treatment disrupts testis development.

    Science.gov (United States)

    Jørgensen, A; Nielsen, J E; Perlman, S; Lundvall, L; Mitchell, R T; Juul, A; Rajpert-De Meyts, E

    2015-10-01

    What are the effects of experimentally manipulating meiosis signalling by addition of retinoic acid (RA) in cultured human fetal gonads? RA-treatment accelerated meiotic entry in cultured fetal ovary samples, while addition of RA resulted in a dysgenetic gonadal phenotype in fetal testis cultures. One of the first manifestations of sex differentiation is the initiation of meiosis in fetal ovaries. In contrast, meiotic entry is actively prevented in the fetal testis at this developmental time-point. It has previously been shown that RA-treatment mediates initiation of meiosis in human fetal ovary ex vivo. This was a controlled ex vivo study of human fetal gonads treated with RA in 'hanging-drop' tissue cultures. The applied experimental set-up preserves germ cell-somatic niche interactions and the investigated outcomes included tissue integrity and morphology, cell proliferation and survival and the expression of markers of meiosis and sex differentiation. Tissue from 24 first trimester human fetuses was included in this study, all from elective terminations at gestational week (GW) 7-12. Gonads were cultured for 2 weeks with and without addition of 1 µM RA. Samples were subsequently formalin-fixed and investigated by immunohistochemistry and cell counting. Proteins investigated and quantified included; octamer-binding transcription factor 4 (OCT4), transcription factor AP-2 gamma (AP2γ) (embryonic germ cell markers), SRY (sex determining region Y)-box 9 (SOX9), anti-Müllerian hormone (AMH) (immature Sertoli cell markers), COUP transcription factor 2 (COUP-TFII) (marker of interstitial cells), forkhead box L2 (FOXL2) (granulosa cell marker), H2A histone family, member X (γH2AX) (meiosis marker), doublesex and mab-3 related transcription factor 1 (DMRT1) (meiosis regulator), cleaved poly ADP ribose polymerase (PARP), cleaved Caspase 3 (apoptosis markers) and Ki-67 antigen (Ki-67) (proliferation marker). Also, proliferation was determined using a 5'-bromo-2

  1. Effects of bleomycin, etoposide and cisplatin treatment on Leydig cell structure and transcription of steroidogenic enzymes in rat testis.

    Science.gov (United States)

    Al-Bader, Maie; Kilarkaje, Narayana

    2015-01-15

    Cytotoxic anticancer chemotherapy affects pituitary-testicular hormonal axis in humans and in animals. This study investigated the effects on Leydig cells of three cycles of bleomycin, etoposide and cisplatin (0.75, 7.5, and 1.5mg/kg, respectively; BEP) chemotherapy in rat testis. The chemotherapy has induced hyperplasia of and degenerative changes in Leydig cells at the end of BEP exposure, which remained so even after a recovery time of 63 days. The increased testicular oxidative stress at the end of the chemotherapy returned to normal level after the recovery time. The chemotherapy has stimulated the transcription of scavenger receptor class type-B1 (SCARB1), steroidogenic acute-regulatory protein (StAR), cytochrome P450 cholesterol side-chain cleavage (CYP11A1), CYP17A1, and inhibited that of 17β-hydroxysteroid dehydrogenase (HSD17B6) and CYP19A1 in association with increased cholesterol and decreased testosterone levels. Even after the recovery time, the chemotherapy still had inhibitory effects on the transcription of all of the above genes in addition to luteinizing hormone receptor and HSD3B1, but not on the StAR gene. The cholesterol and testosterone levels also did not show any significant differences with the control group. The decreased testosterone level at the end of chemotherapy was probably due to inhibition of HSD3B1 and HSD17B6 genes. In conclusion, clinically relevant dose-levels and treatment protocols of BEP chemotherapy adversely affect Leydig cell function. The BEP chemotherapy inhibits the transcription of steroidogenic enzymes and that these effects sustain over an extended period of time without returning to normal levels. Copyright © 2014 Elsevier B.V. All rights reserved.

  2. Hodgkin Lymphoma: Diagnosis and Treatment.

    Science.gov (United States)

    Ansell, Stephen M

    2015-11-01

    Hodgkin lymphoma is a rare B-cell malignant neoplasm affecting approximately 9000 new patients annually. This disease represents approximately 11% of all lymphomas seen in the United States and comprises 2 discrete disease entities--classical Hodgkin lymphoma and nodular lymphocyte-predominant Hodgkin lymphoma. Within the subcategorization of classical Hodgkin lymphoma are defined subgroups: nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte-rich Hodgkin lymphoma. Staging of this disease is essential for the choice of optimal therapy. Prognostic models to identify patients at high or low risk for recurrence have been developed, and these models, along with positron emission tomography, are used to provide optimal therapy. The initial treatment for patients with Hodgkin lymphoma is based on the histologic characteristics of the disease, the stage at presentation, and the presence or absence of prognostic factors associated with poor outcome. Patients with early-stage Hodgkin lymphoma commonly receive combined-modality therapies that include abbreviated courses of chemotherapy followed by involved-field radiation treatment. In contrast, patients with advanced-stage Hodgkin lymphoma commonly receive a more prolonged course of combination chemotherapy, with radiation therapy used only in selected cases. For patients with relapse or refractory disease, salvage chemotherapy followed by high-dose treatment and an autologous stem cell transplant is the standard of care. For patients who are ineligible for this therapy or those in whom high-dose therapy and autologous stem cell transplant have failed, treatment with brentuximab vedotin is a standard approach. Additional options include palliative chemotherapy, immune checkpoint inhibitors, nonmyeloablative allogeneic stem cell transplant, or participation in a clinical trial testing novel agents. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All

  3. Metabolic syndrome-associated sperm alterations in an experimental rabbit model: relation with metabolic profile, testis and epididymis gene expression and effect of tamoxifen treatment.

    Science.gov (United States)

    Marchiani, Sara; Vignozzi, Linda; Filippi, Sandra; Gurrieri, Bruna; Comeglio, Paolo; Morelli, Annamaria; Danza, Giovanna; Bartolucci, Gianluca; Maggi, Mario; Baldi, Elisabetta

    2015-02-05

    The influence of metabolic syndrome (MetS) on sperm quality and function is debated. Using a well-established high fat diet (HFD) rabbit model resembling human MetS, including development of hypogonadism, we demonstrate that HFD decreased sperm motility, morphology and acrosome reaction in response to progesterone and increased sperm cholesterol content. All the above parameters were associated with most MetS features, its severity and plasma testosterone (T) at univariate analysis. After T adjustment, sperm morphology and motility retained a significant association, respectively, with mean arterial pressure and circulating cholesterol levels. MetS modified the expression of inflammatory and tissue remodelling genes in the testis and of aquaporins in the epididymis. In a multivariate analysis, sperm morphology resulted associated with testis expression of fibronectin and collagen type 1 genes, whereas motility with epididymis aquaporin 1 gene. Administration of tamoxifen, used in the treatment of idiopathic male infertility, to HFD rabbits partially restored motility, but further decreased morphology and increased spontaneous acrosome reaction, without restoring responsiveness to progesterone. Overall our results indicate that development of MetS produces detrimental effects on sperm quality and functionality by inducing metabolic disorders leading to alterations in testis and epididymis functions and evidence a role of hypertension as a new determinant of abnormal sperm morphology, in line with a previous human study from our group. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Acute withdrawal: diagnosis and treatment.

    Science.gov (United States)

    Brust, John C M

    2014-01-01

    Symptoms of alcohol withdrawal range in severity from mild "hangover" to fatal delirium tremens (DTs). Tremor, hallucinosis, and seizures usually occur within 48 hours of abstinence. Seizures tend to be generalized without focality, occurring singly or in a brief cluster, but status epilepticus is not unusual. DTs usually appears after 48 hours of abstinence and consists of marked inattentiveness, agitation, hallucinations, fluctuating level of alertness, marked tremulousness, and sympathetic overactivity. The mainstay of treatment for alcohol withdrawal is benzodiazepine pharmacotherapy, which can be used to control mild early symptoms, to prevent progression to DTs, or to treat DTs itself. Alternative less evidence-based pharmacotherapies include phenobarbital, anticonvulsants, baclofen, gamma-hydroxybutyric acid, beta-blockers, alpha-2-agonists, and N-methyl-d-aspartate receptor blockers. Treatment of DTs is a medical emergency requiring heavy sedation in an intensive care unit, with close attention to autonomic instability, fever, fluid loss, and electrolyte imbalance. Frequent comorbid disorders include hypoglycemia, liver failure, pancreatitis, sepsis, meningitis, intracranial hemorrhage, and Wernicke-Korsakoff syndrome. © 2014 Elsevier B.V. All rights reserved.

  5. Diagnosis and treatment of abnormal dental pain

    OpenAIRE

    Fukuda, Ken-ichi

    2016-01-01

    Most dental pain is caused by an organic problem such as dental caries, periodontitis, pulpitis, or trauma. Diagnosis and treatment of these symptoms are relatively straightforward. However, patients often also complain of abnormal dental pain that has a non-dental origin, whose diagnosis is challenging. Such abnormal dental pain can be categorized on the basis of its cause as referred pain, neuromodulatory pain, and neuropathic pain. When it is difficult to diagnose a patient's dental pain, ...

  6. Diagnosis and treatment of obturator hernia

    Energy Technology Data Exchange (ETDEWEB)

    Nakayama, Takamori; Kobayashi, Seiji; Shiraishi, Kou; Nishiumi, Takao; Mori, Syunji; Isobe, Kiyoshi; Furuta, Yoshiaki [Shizuoka Red Cross Hospital (Japan)

    2002-09-01

    Obturator hernia is a rare type of hernia, but it is a significant cause of intestinal obstruction due to the associated anatomy. Correct diagnosis and treatment of obturator hernia is important, because delay can lead to high mortality. Twelve patients with obturator hernia were managed during a 11-year period, including 11 women and 1 man with a mean age of 82 years. We compared our experience with the previously published data to establish standards for the diagnosis and treatment of this hernia. All 12 patients presented with intestinal obstruction. The median interval from admission to operation was 2 days. The Howship-Romberg sign was positive in 5 patients. A correct diagnosis was made in all 8 patients who underwent pelvic CT scanning. Surgery was performed via an abdominal approach (n=7) or an inguinal approach (n=5). The hernial orifice was closed using the uterine fundus (n=6), a patch (n=5), and direct suture (n=1). Mean follow-up time was 33 months, and no recurrence has been detected. The poor physical condition of patients might have led to a delay in diagnosis and treatment. In troubled patients with nonspecific intestinal obstruction, CT scanning is useful for the early diagnosis of obturator hernia. Correct CT diagnosis of obturator hernia allows us to select the inguinal approach combined with patch repair, which is minimally invasive surgery. (author)

  7. Nummular headache: diagnosis and treatment.

    Science.gov (United States)

    Pareja, Juan A; Pareja, Julia

    2003-05-01

    Nummular headache (coin-shaped cephalgia) has an unusual distinct feature: it is characterized by mild-to-moderate pressure-like pain exclusively felt in a rounded or elliptical area typically 2-6 cm in diameter. Although any region of the head may be affected, the parietal area is the common localization of nummular headache. The pain remains confined to the same symptomatic area which does not change in shape or size with time. The pain is continuous but lancinating exacerbations lasting for several seconds or gradually increasing from 10 mins to 2 h may superimpose the baseline pain. The temporal pattern is either chronic or remitting. Pseudoremissions may be observed when the pain reaches a very low grade or only discomfort (not pain) in the affected area is reported. At times, discomfort may prevail. Either during symptomatic periods or interictally, the affected area may show a variable combination of hypoethesia, dysesthesia, paresthesia or tenderness. Physical and supplementary examinations are normal. Nummular headache emerges as a primary clear-cut clinical picture. The particular topography and signs of sensory dysfunction make it reasonable to vent the idea that nummular headache is an extracranial headache, probably stemming from epicranial tissues such as terminal branches of sensitive nerves. Nummular headache may seem to be the paradigm of epicranias (group of headaches and pericranial neuralgias stemming from epicranial tissues). Nummular headache must be distinguished from head pain secondary to local processes and from tender points of more extensive headaches. Although nummular headache may frequently coexist with other primary headaches, it has an independent course. Treatment is seldom necessary and in most cases simple reassurance is sufficient.

  8. Diagnosis and treatment of central diabetes insipidus

    Directory of Open Access Journals (Sweden)

    Ekaterina Aleksandrovna Pigarova

    2014-11-01

    Full Text Available Diabetes insipidus represents a serious disease that dramatically interferes with the everyday life of patients due to the need to constantly replenish of fluid lost in the urine, which comes amid shortage of synthesis, secretion or action of pituitary hormone vasopressin. The main difficulty is the differential diagnosis of types of diabetes insipidus in patients with the syndrome of polydipsia-polyuria as the correct differential diagnosis of these forms predetermine the safety and efficacy of further treatment. This lecture presents the current concepts of etiology, diagnosis and treatment of central diabetes insipidus (CDI. We give the comparative characteristics of various preparations of desmopressin for the treatment of the central form of the disease. We also consider the features of the management of selected patient populations with CDI: during pregnancy and lactation, pathology of the thirst sensation, after traumatic brain injury and neurosurgery.

  9. Early breast cancer: diagnosis, treatment and survivorship.

    LENUS (Irish Health Repository)

    Meade, Elizabeth

    2013-01-11

    Breast cancer is the most common female cancer and globally remains a major public health concern. The diagnosis and treatment of breast cancer continues to develop. Diagnosis is now more precise, surgery is less mutilating and women now have the option of breast conserving therapy with better cosmesis, and without sacrificing survival. Radiotherapy is more targeted and the selection of patients for adjuvant chemotherapy is based not only on prognostic and predictive factors, but also on newer molecular profiling that will ensure that chemotherapy is given to the patients who need and respond to it. These developments all provide a more tailored approach to the treatment of breast cancer. Management now involves a multidisciplinary team approach in order to provide the highest standard of care for patients throughout their cancer journey from diagnosis through treatment and into follow-up care.

  10. [Cervical lymph node tuberculosis: diagnosis and treatment].

    Science.gov (United States)

    Zaatar, R; Biet, A; Smail, A; Strunski, V; Page, C

    2009-01-01

    The purpose of this study was to evaluate the advantages of surgery for diagnosis and treatment of cervical lymph node tuberculosis. This was a retrospective study from 1st January 1998 to 31st December 2007 including 30 patients with cervical lymph node tuberculosis. The population included 60% autochthones with a mean age of 47.1 years and a female predominance (73.33%). The lymph nodes were most often supraclavicular, unilateral, firm, and a mean 3 cm at its largest span. Lymph nodes were excised for diagnosis in 22 patients, which demonstrated specific granulomatous and giant cell lesions with caseous necrosis in 21 patients out of 22. Five abscessed adenopathies required surgical drainage, and three cases required repeated lymph node cleaning after well-conducted medical treatment. Surgery retains an important place in the diagnosis and treatment of cervical lymph node tuberculosis.

  11. [Symptoms diagnosis and treatment of dyscalulia].

    Science.gov (United States)

    Ise, Elena; Schulte-Körne, Gerd

    2013-07-01

    Children with dyscalculia show deficits in basic numerical processing which cause difficulties in the acquisition of mathematical skills. This article provides an overview of current research findings regarding the symptoms, cause, and prognosis of dyscalculia, and it summarizes recent developments in the diagnosis, early intervention, and treatment thereof. Diagnosis has improved recently because newly developed tests focus not only on the math curriculum, but also on basic skills found to be impaired in dyscalculia. A controversial debate continues with regard to IQ achievement discrepancy. International studies have demonstrated the effectiveness of specialized interventions. This article summarizes the research findings from intervention studies, describes different treatment approaches, and discusses implications for clinical practice.

  12. [Diagnosis and treatment of tarsometatarsal joint injury].

    Science.gov (United States)

    Gu, Wenqi; Shi, Zhongmin; Chai, Yimin

    2009-12-01

    To review the diagnosis, treatment method, and surgical technique of tarsometatarsal joint injury. Recent literature concerning tarsometatarsal joint injury was reviewed and analyzed in terms of anatomy, injury mechanism, classification, diagnosis, management principle and methods, and surgical techniques. It could be difficult to diagnose tarsometatarsal joint injury, and subtle injury was more difficult to diagnose with a high rate of missed diagnosis. Fairly accurate diagnosis of tarsometatarsal joint injury could be made based on medical history, symptoms and signs, and necessary imaging examinations. For the patient of partial ligament rupture caused by subtle or non-displacement injury, a cast for immobilization could be adopted; the patients of instable injury should be treated with open reduction and internal fixation. For the patients of complete dislocation and severe comminuted fractures, arthrodesis should be suggested. The diagnosis and management of tarsometatarsal joint injury is complicated. The treatment method of tarsometatarsal joint injury has evoked controversy. Surgeons should choose the optimal treatment method and surgical technique according to the injury type, radiological manifestation, and classification so as to obtain the best clinical outcome.

  13. Degenerative cervical radiculopathy: diagnosis and conservative treatment. A review

    NARCIS (Netherlands)

    Kuijper, B.; Tans, J. Th J.; Schimsheimer, R. J.; van der Kallen, B. F. W.; Beelen, A.; Nollet, F.; de Visser, M.

    2009-01-01

    Degenerative cervical radiculopathy: clinical diagnosis and conservative treatment. A review. To provide a state-of-the-art assessment of diagnosis and non-surgical treatment of degenerative cervical radiculopathy a literature search for studies on epidemiology, diagnosis including

  14. Cervical cancer: Biomarkers for diagnosis and treatment.

    Science.gov (United States)

    Dasari, Subramanyam; Wudayagiri, Rajendra; Valluru, Lokanatha

    2015-05-20

    Cervical cancer is a major gynecological cancer which involves uncontrolled cell division and tissue invasiveness of the female uterine cervix. With the availability of new technologies researchers have increased their efforts to develop novel biomarkers for early diagnosis, and evaluation and monitoring of therapeutic treatments. This approach will help in the development of early diagnosis and in increasing treatment efficacy with decreased recurrence. The present review explains the currently available biomarkers for cervical cancer diagnosis and prognosis. Apart from the currently available biomarkers the review also explains strategies for the development of biomarkers based on cellular and molecular approaches such as DNA, protein and other metabolic markers with suitable clinical examples. The investigations of specific proteins, enzymes and metabolites will establish more useful biomarkers for accurate detection and management of gynecological cancers especially cervical cancer. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. Primary melanoma of testis

    Directory of Open Access Journals (Sweden)

    Katiyar R

    2008-01-01

    Full Text Available Primary melanoma of testis is extremely rare and even the existence of such an entity is questioned. We present the case of a 60-year-old man with primary malignant melanoma in the testis. We report this case to emphasize the need for awareness of the possibility of the testis being the primary site in the patient with a melanoma and to underline the necessity of meticulous investigation of suspicious lesions of the testis in patients with or without a past history of malignant melanoma.

  16. CLINIC, DIFFERENTIAL DIAGNOSIS AND TREATMENT OF GALACTOSEMIA

    Directory of Open Access Journals (Sweden)

    N.V. Zhurkova

    2008-01-01

    Full Text Available The data of different firms of hereditary galactosemia was analyzed in this article. Clinical and biochemical characteristics and molecular and genetic features of diagnostics of this disease were described. The information about differential diagnosis and problems, related with hereditary galactozemia screening in Russia was given.Key words: children, galactosemia, treatment, screening.

  17. [Rational diagnosis and treatment of male infertility].

    Science.gov (United States)

    Kliesch, S

    2017-07-19

    Male infertility can be diagnosed by evaluation of the (female and) male history with respect to risk factors, and includes scrotal sonography, hormone and semen measurements. In severe male factor infertility, genetic testing is indicated. Treatment options vary between preventive, medical or surgical strategies depending on the underlying diagnosis. Assisted reproductive techniques may be applied as a consequence of the couple's infertility profile.

  18. Giant cell arteritis: diagnosis and treatment.

    Science.gov (United States)

    Calvo Romero, J M

    2015-01-01

    Giant cell arteritis is the most common primary systemic vasculitis in adults. The condition is granulomatous arteritis of large and medium vessels, which occurs almost exclusively in patients aged 50 years or more. This article reviews the diagnosis and treatment of the disease. Copyright © 2015. Published by Elsevier España, S.L.U.

  19. Ambiguous diagnosis, futile treatments and temporary recovery ...

    African Journals Online (AJOL)

    Unavailability of medicines that control pain and symptoms effectively continues to be a prominent feature of HIV and AIDS home-based caregiving in Lesotho. It is recommended that health professionals should facilitate disclosure of HIV diagnosis to family caregivers to assist them to understand unstable treatment ...

  20. Cervicogenic vertigo: etiology, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Elham Tavanai

    2013-07-01

    Full Text Available Background and Aim: Cervicogenic dizziness is induced by a specific neck position and the earth’s gravity has no effect on provoking of it. The precise incidence of cervicogenic dizziness is not certain but, 20-58% of patients following sudden head injuries experience its symptoms . In this article, the etiology, diagnosis and treatment of cervicogenic vertigo is discussed. Methods: At first, articles of cervicogenic dizziness from electronic databases of Google scholar , PubMed, Scopus, Ovid and CINAHL were searched from 1987 up to 2012. Then, the articles in them vertigo, disequilibrium or nystagmus were consistent with neck disorders were searched. Conclusion: Articles with title of cervicogenic vertigo (cervical vertigo were limited. Clinical researches about cervicogenic vertigo up to now implicate on several points; all signify that we cannot diagnose it certainly and there is not any specific single test for that. Recently, smooth pursuit neck torsion test (SPNTT has introduced for diagnosis of cervicogenic vertigo that is not valid yet. There is no protocol for diagnosis of cervicogenic vertigo and diagnosis is often based on limited clinical experiences of clinicians. Physiotherapy, medication and manual therapies are options for treatment but there is no distinct and effective treatment for it and in just one article, a combination of treatments for cervicogenic vertigo as a protocol has recommended.

  1. Diagnosis and treatment of myopic traction maculopathy

    Directory of Open Access Journals (Sweden)

    Ping-Bo Ouyang

    2012-12-01

    Full Text Available In recent years, the broad application of optical coherence tomography and vitrectomy, combined with research efforts in maculopathy in high myopia have provided many achievements, such as the new classification of myopic traction maculopathy (MTM. Here, we review the latest developments in the diagnosis and treatment of MTM, including its conception, clinical characteristics, pathogenesis, clinical stages, and the options for surgical treatment.

  2. Problems of diagnosis and treatment of echinococcosis

    Directory of Open Access Journals (Sweden)

    Тунзала Али кызы Велиева

    2015-05-01

    Full Text Available The lack of specificity of clinical and laboratory manifestations of echinococcosis allocates to the fore diagnostic tool methods of research, which are at present leading in identifying the disease.The widespread introduction into clinical practice of modern highly informative instrumental methods such as ultrasonography (US and computed tomography (CT, significantly improved the early detection of liver echinococcosis. In conjunction with the serological reactions to echinococcosis they allow in most cases the diagnosis of the disease. However, false-negative results of serological tests in more than 10–20 % of the patients and the difficulty of differential diagnosis with small brush size and "pseudotumoral" forms of ultrasound often lead to delayed diagnosis, and thus to a deterioration of treatment results. Moreover, failure to identify at an early stage of echinococcosis virtually eliminates the possibility of conservative treatment of echinococcosis without performing surgery.It is given the profound immune disorders in patients with echinococcosis, treatment should be complex and along with the surgical removal of hydatid cyst should be included in it and biostimulating. Immunocorrecting lechebnye event. Recent require further development.Methods. The work is based on an analysis of 25 cases operated on echinococcosis in the period from January 2013 to December 2014. To confirm the diagnosis using tools (ultrasound, computed tomography, X-ray, serology (detection of antibodies to echinococcus ELISA, histological (after removal of cysts methods. The data are processed by the method of variation statistics.Results. An analysis of 25 cases of echinococcosis showed that among the 15 cases dominated by women (60 % versus 10 (40 % men. Treatment – removal of cysts of 25 patients with echinococcosis is made surgically. Among the analyzed cases in 6 (20.4 % patients had the relapsing form of the disease. The factors leading to relapse of the

  3. [Tendinitis in athletes: etiology, diagnosis and treatment].

    Science.gov (United States)

    Gremion, G; Zufferey, P

    2015-03-11

    Tendinopathy is one of the most common diagnosis in sports. Knowledges about their etiology, the repair process to their diagnosis and their treatment have improved thanks to the development of imaging, especially ultra- sound. The disorder whose etiology could be mechanical or degenerative can cause long- term disability and sometimes the end of the sport carreer. The risk of reccurence is com- mon; this may lead to tendon rupture whose functional effects can be significative. The management should be early: it must respect the deadlines for tendon healing and pro- pose a gradual recovery efforts after elimina tion of the contributing factors involved.

  4. Diagnosis and treatment of Lyme arthritis.

    Science.gov (United States)

    Arvikar, Sheila L; Steere, Allen C

    2015-06-01

    In the United States, Lyme arthritis is the most common feature of late-stage Borrelia burgdorferi infection, usually beginning months after the initial bite. In some, earlier phases are asymptomatic and arthritis is the presenting manifestation. Patients with Lyme arthritis have intermittent or persistent attacks of joint swelling and pain in 1 or a few large joints. Serologic testing is the mainstay of diagnosis. Synovial fluid polymerase chain reaction for B burgdorferi DNA is often positive before treatment, but is not a reliable marker of spirochetal eradication after therapy. This article reviews the clinical manifestations, diagnosis, and management of Lyme arthritis. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment

    Directory of Open Access Journals (Sweden)

    Enrico Bellato

    2012-01-01

    Full Text Available Fibromyalgia syndrome is mainly characterized by pain, fatigue, and sleep disruption. The etiology of fibromyalgia is still unclear: if central sensitization is considered to be the main mechanism involved, then many other factors, genetic, immunological, and hormonal, may play an important role. The diagnosis is typically clinical (there are no laboratory abnormalities and the physician must concentrate on pain and on its features. Additional symptoms (e.g., Raynaud’s phenomenon, irritable bowel disease, and heat and cold intolerance can be associated with this condition. A careful differential diagnosis is mandatory: fibromyalgia is not a diagnosis of exclusion. Since 1990, diagnosis has been principally based on the two major diagnostic criteria defined by the ACR. Recently, new criteria have been proposed. The main goals of the treatment are to alleviate pain, increase restorative sleep, and improve physical function. A multidisciplinary approach is optimal. While most nonsteroidal anti-inflammatory drugs and opioids have limited benefit, an important role is played by antidepressants and neuromodulating antiepileptics: currently duloxetine (NNT for a 30% pain reduction 7.2, milnacipran (NNT 19, and pregabalin (NNT 8.6 are the only drugs approved by the US Food and Drug Administration for the treatment of fibromyalgia. In addition, nonpharmacological treatments should be associated with drug therapy.

  6. Fibromyalgia Syndrome: Etiology, Pathogenesis, Diagnosis, and Treatment

    Science.gov (United States)

    Bellato, Enrico; Marini, Eleonora; Castoldi, Filippo; Barbasetti, Nicola; Mattei, Lorenzo; Bonasia, Davide Edoardo; Blonna, Davide

    2012-01-01

    Fibromyalgia syndrome is mainly characterized by pain, fatigue, and sleep disruption. The etiology of fibromyalgia is still unclear: if central sensitization is considered to be the main mechanism involved, then many other factors, genetic, immunological, and hormonal, may play an important role. The diagnosis is typically clinical (there are no laboratory abnormalities) and the physician must concentrate on pain and on its features. Additional symptoms (e.g., Raynaud's phenomenon, irritable bowel disease, and heat and cold intolerance) can be associated with this condition. A careful differential diagnosis is mandatory: fibromyalgia is not a diagnosis of exclusion. Since 1990, diagnosis has been principally based on the two major diagnostic criteria defined by the ACR. Recently, new criteria have been proposed. The main goals of the treatment are to alleviate pain, increase restorative sleep, and improve physical function. A multidisciplinary approach is optimal. While most nonsteroidal anti-inflammatory drugs and opioids have limited benefit, an important role is played by antidepressants and neuromodulating antiepileptics: currently duloxetine (NNT for a 30% pain reduction 7.2), milnacipran (NNT 19), and pregabalin (NNT 8.6) are the only drugs approved by the US Food and Drug Administration for the treatment of fibromyalgia. In addition, nonpharmacological treatments should be associated with drug therapy. PMID:23213512

  7. Diagnosis, staging and treatment of hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    A.V.C. França

    2004-11-01

    Full Text Available Hepatocellular carcinomas are aggressive tumors with a high dissemination power. An early diagnosis of these tumors is of great importance in order to offer the possibility of curative treatment. For an early diagnosis, abdominal ultrasound and serum alpha-fetoprotein determinations at 6-month intervals are suggested for all patients with cirrhosis of the liver, since this disease is considered to be the main risk factor for the development of the neoplasia. Helicoidal computed tomography, magnetic resonance and/or hepatic arteriography are suggested for diagnostic confirmation and tumor staging. The need to obtain a fragment of the focal lesion for cytology and/or histology for a diagnosis of hepatocellular carcinoma depends on the inability of imaging methods to diagnose the lesion. Several classifications are currently available for tumor staging in order to determine patient prognosis. All take into consideration not only the stage of the tumor but also the degree of hepatocellular dysfunction, which is known to be the main factor related to patient survival. Classifications, however, fail to correlate treatment with prognosis and cannot suggest the ideal treatment for each tumor stage. The Barcelona Classification (BCLC attempts to correlate tumor stage with treatment but requires prospective studies for validation. For single tumors smaller than 5 cm or up to three nodules smaller than 3 cm, surgical resection, liver transplantation and percutaneous treatment may offer good anti-tumoral results, as well as improved patient survival. Embolization or chemoembolization are therapeutic alternatives for patients who do not benefit from curative therapies.

  8. Diagnosis and treatment of transverse maxillary deficiency.

    Science.gov (United States)

    Betts, N J; Vanarsdall, R L; Barber, H D; Higgins-Barber, K; Fonseca, R J

    1995-01-01

    Treatment of skeletally mature patients is often complicated by inadequately treated or undiagnosed transverse skeletal discrepancy. This report emphasizes diagnosis of transverse maxillo-mandibular discrepancy and describes recommendations for treatment. Proper treatment strategy must consider the type and magnitude of transverse deficiency, patient's growth status, dentofacial esthetics, stability factors, and periodontal tissue health. Indications for surgically assisted maxillary expansion are listed, and the recommended surgical technique to improve frontal dentofacial esthetics, provide better stability, and enhance long-term periodontal health is described. Specific modifications in surgical technique to help prevent postoperative complications are included. New recommendations for sequencing, timing, and correction of transverse deficiency are presented.

  9. Tuberculous meningitis: advances in diagnosis and treatment.

    Science.gov (United States)

    Török, M E

    2015-03-01

    Tuberculous meningitis (TBM) is the most severe form of infection caused by Mycobacterium tuberculosis, causing death or disability in more than half of those affected. The aim of this review is to examine recent advances in our understanding of TBM, focussing on the diagnosis and treatment of this devastating condition. Papers on TBM published between 1891 and 2014 and indexed in the NCBI Pubmed. The following search terms were used: TBM, diagnosis, treatment and outcome. The diagnosis of TBM remains difficult as its presentation is non-specific and may mimic other causes of chronic meningoencephalitis. Rapid recognition of TBM is crucial, however, as delays in initiating treatment are associated with poor outcome. The laboratory diagnosis of TBM is hampered by the low sensitivity of cerebrospinal fluid microscopy and the slow growth of M. tuberculosis in conventional culture systems. The current therapy of TBM is based on the treatment of pulmonary tuberculosis, which may not be ideal. The combination of TBM and HIV infection poses additional management challenges because of the need to treat both infections and the complications associated with them. The pathogenesis of TBM remains incompletely understood limiting the development of interventions to improve outcome. The optimal therapy of TBM has not been established in clinical trials, and increasing antimicrobial resistance threatens successful treatment of this condition. The use of adjunctive anti-inflammatory agents remains controversial, and their mechanism of action remains incompletely understood. The role of surgical intervention is uncertain and may not be available in areas where TBM is common. Laboratory methods to improve the rapid diagnosis of TBM are urgently required. Clinical trials of examining the use of high-dose rifampicin and/or fluoroquinolones are likely to report in the near future. The use of biomarkers to improve the rapid diagnosis of TBM warrants further investigation. The role of

  10. Diagnosis and Treatment Algorythm in Lyme Neuroborreliosis

    Directory of Open Access Journals (Sweden)

    Țilea Brîndușa

    2016-03-01

    Full Text Available Lyme neuroborreliosis is an infection of the nervous system caused by spirochetes of the Borrelia burgdorferi sensulato group. Neurological clinical manifestations usually present a steady evolution and are different in patients from Europe compared to those from America, possibly due to vector agents and different bacterial species. Various diagnostic markers were studied in consideration of a clear or possible diagnosis of the disease, because evolution and complications depend on early diagnosis and initiation of therapy. The isolation of the bacterium is difficult, microscopic examination and the bacterial dezoxiribonucleic acid amplification shows low sensitivity. However, the diagnosis of Lyme neuroborreliosis is mainly based on serological methods that have a satisfactory sensitivity and specificity. A correct diagnosis can be performed by strictly respecting clinical guidelines and protocols and carefully interpreting the serological tests. The presence of anti-borrelia burgdorferi antibodies in the cerebrospinal fluid with evidence of intrathecal antibody production is the gold standard diagnosis of Lyme neuroborreliosis. Early administration of antibiotic treatment (third generation cephalosporins, cyclins, aminopenicillins can produce the remission of neurological symptoms, the eradication of spirochetes in acute phase of the disease, thus avoiding the development of the chronic disease.

  11. Laryngopharyngeal Reflux: Diagnosis, Treatment, and Latest Research

    Directory of Open Access Journals (Sweden)

    Campagnolo, Andrea Maria

    2014-01-01

    Full Text Available Introduction Laryngopharyngeal reflux (LPR is a highly prevalent disease and commonly encountered in the otolaryngologist's office. Objective To review the literature on the diagnosis and treatment of LPR. Data Synthesis LPR is associated with symptoms of laryngeal irritation such as throat clearing, coughing, and hoarseness. The main diagnostic methods currently used are laryngoscopy and pH monitoring. The most common laryngoscopic signs are redness and swelling of the throat. However, these findings are not specific of LPR and may be related to other causes or can even be found in healthy individuals. Furthermore, the role of pH monitoring in the diagnosis of LPR is controversial. A therapeutic trial with proton pump inhibitors (PPIs has been suggested to be cost-effective and useful for the diagnosis of LPR. However, the recommendations of PPI therapy for patients with a suspicion of LPR are based on the results of uncontrolled studies, and high placebo response rates suggest a much more complex and multifactorial pathophysiology of LPR than simple acid reflux. Molecular studies have tried to identify biomarkers of reflux such as interleukins, carbonic anhydrase, E-cadherin, and mucin. Conclusion Laryngoscopy and pH monitoring have failed as reliable tests for the diagnosis of LPR. Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR. However, further research is needed to develop a definitive diagnostic test for LPR.

  12. Diagnosis and treatment of microscopic colitis.

    Science.gov (United States)

    Okamoto, Ryuichi; Negi, Mariko; Tomii, Syohei; Eishi, Yoshinobu; Watanabe, Mamoru

    2016-08-01

    Microscopic colitis (MC) designates two types of chronic diarrhea diseases, which are lymphocytic colitis and collagenous colitis. The prevalence of microscopic colitis is increasing in both Western and Eastern countries, possibly due to the high incidence of colonoscopic survey in chronic diarrhea patients. Although the overall prognosis of MC patients is mostly good, it should be noted that appropriate diagnosis and choice of treatment is required to assure a good clinical outcome for MC patients. Also, a certain population of MC patients may take a severe and refractory clinical course, and thus require advanced clinical care using medications supported by less evidence. In this review, we would like to feature the essential points regarding the diagnosis of MC, and also describe the current standard of treatments for MC patients. In addition, we would like to add some findings from the national survey and research carried out in Japan, to compare those data with the western countries.

  13. Actinomycetoma: an update on diagnosis and treatment.

    Science.gov (United States)

    Arenas, Roberto; Fernandez Martinez, Ramón F; Torres-Guerrero, Edoardo; Garcia, Carlos

    2017-02-01

    Mycetoma is a chronic infection that develops after traumatic inoculation of the skin with either true fungi or aerobic actinomycetes. The resultant infections are known as eumycetoma or actinomycetoma, respectively. Although actinomycetoma is rare in developed countries, migration of patients from endemic areas makes knowledge of this condition crucial for dermatologists worldwide. We present a review of the current concepts in the epidemiology, clinical presentation, diagnosis, and treatment of actinomycetoma.

  14. Diagnosis and Treatment of Heterotopic Ossification

    Science.gov (United States)

    2015-10-01

    1 Award Number: W81XWH-12-1-0274 TITLE: Diagnosis and Treatment of Heterotopic Ossification PRINCIPAL INVESTIGATOR: Dr. Alan R. Davis...STATEMENT 13. SUPPLEMENTARY NOTES 14. ABSTRACT We recently developed a model of heterotopic ossification (HO) that suggests blocking the initial...progenitors. We are currently following up on these and other experiments proposed in the application. 15. SUBJECT TERMS BMP2, Heterotopic ossification

  15. Deep vein thrombosis: diagnosis, treatment, and prevention

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, W.P.; Youngswick, F.D.

    Deep vein thrombosis (DVT) is a dangerous complication that may present after elective foot surgery. Because of the frequency with which DVT occurs in the elderly patient, as well as in the podiatric surgical population, the podiatrist should be acquainted with this entity. A review of the diagnosis, treatment, prevention, and the role of podiatry in the management of DVT is discussed in this paper.

  16. ACTUAL METHODS’ OF DIAGNOSIS AND TREATMENT ARVI

    Directory of Open Access Journals (Sweden)

    A. N. Kupchenko

    2016-01-01

    Full Text Available The classification of respiratory viruses and etiological structure in coldly epidemiological period of year 2014 in article, clinical features and differential — diagnostics simptoms of influenza and other acute respiratory infections are presented in detail, modern methods of diagnosis and treatment of influenza and ARVI described, therapeutic and prophylactic doses of drugs for etiological and pathogenesis therapy, the basic directions of specific and nonspecific immunization and preventive vaccination presented in article. 

  17. Diagnosis and Treatment of Pityriasis Rubra Pilaris

    Directory of Open Access Journals (Sweden)

    Kubanov Alexey

    2014-12-01

    Full Text Available The article deals with clinical diagnosis and treatment of pityriasis rubra pilaris (PRP. The authors analyze the diagnostic errors, present literature review, and their own observations. The clinical study included 23 patients with pityriasis rubra pilaris: 18 women and 5 men, average age of 54 ± 7.2. The clinical diagnosis of all examined patients was subsequently confirmed by histological analysis of the skin. The primary clinical diagnosis was psoriasis in 15 (65.2% patients, 6 (26% patients received treatment for toxic exanthema, and only 2 (8.8% patients were presumptively diagnosed with pityriasis rubra pilaris. In conclusion, pityriasis rubra pilaris was initially misdiagnosed in 91.2% of patients. Considering the great number of diagnostic errors, we analyzed the main diagnostic and differential diagnostic features of PRP. The most effective of all synthetic retinoids in PRP treatment is acitretin. Although symptomatic improvement in PRP occurs within a month, substantial improvement, even clearing is possible within 4 - 6 months.

  18. Diagnosis and treatment of plantar fasciitis.

    Science.gov (United States)

    Goff, James D; Crawford, Robert

    2011-09-15

    Plantar fasciitis, a self-limiting condition, is a common cause of heel pain in adults. It affects more than 1 million persons per year, and two-thirds of patients with plantar fasciitis will seek care from their family physician. Plantar fasciitis affects sedentary and athletic populations. Obesity, excessive foot pronation, excessive running, and prolonged standing are risk factors for developing plantar fasciitis. Diagnosis is primarily based on history and physical examination. Patients may present with heel pain with their first steps in the morning or after prolonged sitting, and sharp pain with palpation of the medial plantar calcaneal region. Discomfort in the proximal plantar fascia can be elicited by passive ankle/first toe dorsiflexion. Diagnostic imaging is rarely needed for the initial diagnosis of plantar fasciitis. Use of ultrasonography and magnetic resonance imaging is reserved for recalcitrant cases or to rule out other heel pathology; findings of increased plantar fascia thickness and abnormal tissue signal the diagnosis of plantar fasciitis. Conservative treatments help with the disabling pain. Initially, patient-directed treatments consisting of rest, activity modification, ice massage, oral analgesics, and stretching techniques can be tried for several weeks. If heel pain persists, then physician-prescribed treatments such as physical therapy modalities, foot orthotics, night splinting, and corticosteroid injections should be considered. Ninety percent of patients will improve with these conservative techniques. Patients with chronic recalcitrant plantar fasciitis lasting six months or longer can consider extracorporeal shock wave therapy or plantar fasciotomy.

  19. Cardiac Arrhythmias: Diagnosis, Symptoms, and Treatments.

    Science.gov (United States)

    Fu, Du-Guan

    2015-11-01

    The cardiac arrhythmia is characterized by irregular rhythm of heartbeat which could be either too slow (100 beats/min) and can happen at any age. The use of pacemaker and defibrillators devices has been suggested for heart arrhythmias patients. The antiarrhythmic medications have been reported for the treatment of cardiac arrhythmias or irregular heartbeats. The diagnosis, symptoms, and treatments of cardiac arrhythmias as well as the radiofrequency ablation, tachycardia, Brugada syndrome, arterial fibrillation, and recent research on the genetics of cardiac arrhythmias have been described here.

  20. The marijuana withdrawal syndrome: diagnosis and treatment.

    Science.gov (United States)

    Haney, Margaret

    2005-10-01

    A subset of marijuana smokers develop a cannabis use disorder and seek treatment for their marijuana use on their own initiative. A less well-known consequence of daily, repeated marijuana use is a withdrawal syndrome, characterized by a time-dependent constellation of symptoms: irritability, anxiety, marijuana craving, decreased quality and quantity of sleep, and decreased food intake. Treatment studies show that rates of continuous abstinence are low (comparable to relapse rates for other abused drugs), and more treatment options are needed. The objective of this review is to update clinicians on the current state of marijuana research and to describe features of marijuana withdrawal to facilitate the diagnosis and treatment of cannabis use disorders.

  1. Testis evaluation of adult Wistar rats after neonatal treatment with fluoxetine - doi: 10.4025/actascibiolsci.v35i1.10946

    Directory of Open Access Journals (Sweden)

    Bruno Mendes Tenorio

    2012-12-01

    Full Text Available In current assay the serotoninergic system in newly-born Wistar rats underwent pharmacological modification by fluoxetine, a selective serotonin reuptake inhibitor (SSRI, to investigate its repercussion on testicular parameters in adult animals. Thirty animals were distributed according to treatment: control animals (n = 6, animals treated with 1 mg kg-1 (n = 6, 5 mg kg-1 (n = 6, 10 mg kg-1 (n = 6 and 20 mg kg-1 (n = 6 of fluoxetine (IP. When 150 days old, the animals were anesthetized and perfused intra-cardiacally with fixative solution. Testes were routinely processed for inclusion in plastic resin (methacrylate glycol. Further, 4 µm-thick histological sections were stained with toluidine blue/sodium borate 1% and analyzed histometrically. Pharmacological intervention on the serotoninergic system during the postnatal period of the testes development in Wistar rats with fluoxetine chlorohydrate reduced parameters, such as testicular weight, testis liquid weight and seminiferous tubules diameter. However, testicular parameters, such as daily sperm production (DSP, spermatogenesis efficiency (DSP/g/testis and cell population in stage VII of adult animals, were not influenced by fluoxetine chlorohydrate usage during neonatal period. Results show that administration of fluoxetine during 21 days after birth may induce adverse changes in the spermatogenesis of adult rats.  

  2. The diagnosis and treatment of dermatitis herpetiformis

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    Antiga E

    2015-05-01

    Full Text Available Emiliano Antiga, Marzia Caproni Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy Abstract: Dermatitis herpetiformis (DH is an inflammatory cutaneous disease with a chronic relapsing course, pruritic polymorphic lesions, and typical histopathological and immunopathological findings. According to several evidences, DH is considered the specific cutaneous manifestation of celiac disease, and the most recent guidelines of celiac disease have stated that, in celiac patients with a proven DH, a duodenal biopsy is unnecessary for the diagnosis. In this review, the most recent data about the diagnosis and the management of DH have been reported and discussed. In particular, in patients with clinical and/or histopathological findings suggestive for DH, the finding of granular IgA deposits along the dermal–epidermal junction or at the papillary tips by direct immunofluorescence (DIF assay, together with positive results for anti-tissue transglutaminase antibody testing, allows the diagnosis. Thereafter, a gluten-free diet should be started in association with drugs, such as dapsone, that are able to control the skin manifestations during the first phases of the diet. In conclusion, although DH is a rare autoimmune disease with specific immunopathological alterations at the skin level, its importance goes beyond the skin itself and may have a big impact on the general health status and the quality of life of the patients. Keywords: dermatitis herpetiformis, celiac disease, diagnosis, treatment, autoimmune disease, inflammatory cutaneous disease 

  3. Rare presentation of a testicular angiofibroma treated with testis sparing surgery

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    Luca Leone

    2016-12-01

    Full Text Available Introduction: Testicular benign tumors are very rare (< 5%. Testicular Angiofibroma (AF is one of those, however the gold standard of treatment and follow-up is still unclear. Case report: A 47 years-old man with only one functioning testis was referred to our clinic for a palpable right testicular mass and atrophic contralateral testis. Patient underwent testis-sparing surgery with inguinal approach and intraoperative frozen sections examination with diagnosis of AF. Final histology confirmed AF. Post-operative follow-up was uneventful. Clinical and ultrasonographic follow-up was negative after 8 months. Conclusion: We report a conservative surgery in a patient with AF of the solitary testis. AF is a benign para-testicular fibrous neoplasm that could be misinterpreted as malignant tumor and treated with orchiectomy. Testis-sparing surgery is recommended in this case with intraoperative pathological examination. The excision of the mass is enough but in front of a possible recurrence a long follow-up is advisable.

  4. Quadrilateral space syndrome: diagnosis, pathology, and treatment.

    Science.gov (United States)

    Lester, B; Jeong, G K; Weiland, A J; Wickiewicz, T L

    1999-12-01

    Quadrilateral space syndrome is an infrequent, recently established neurovascular compression syndrome affecting young active adults. With this syndrome, the neurovascular bundle, consisting of the posterior humeral circumflex artery (PHCA) and the axillary nerve, is compressed by fibrotic bands as it traverses the quadrilateral space. Symptoms result from compression of the axillary nerve, not from PHCA occlusion. Because of the vague, often nonspecific, clinical presentation of patients with quadrilateral space syndrome, diagnosis is challenging and requires a high index of suspicion from the orthopedist. Subclavian arteriography confirms the diagnosis. Treatment is usually conservative; operative management is reserved for selected patients. A posterior approach with detachment of the deltoid and teres minor muscles is recommended for surgical decompression and for lysis of fibrous tissue. We report two cases of persistent quadrilateral space syndrome in young adults, treated surgically, with 2-year follow-up. In the present report, diagnostic criteria, pathology, management, operative technique, and recent literature are also reviewed.

  5. AD/HD: POSSIBLE DIAGNOSIS AND TREATMENT

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    Karl REICHELT

    2008-12-01

    Full Text Available The purpose of this paper is to show that a more exact diagnosis and dietary intervention in AD/HD (Attention Deficit/Hyperactivity Di­sor­der is possible and probable. The clinical symptom based diagnosis we suggest may be supplemented with physiological tests. A ge­netic and environmental inter-action is clearly involved and explainable using phenyl­ke­tonuria as a model.Method: Examining peer reviewed published papers on gut to blood, blood to brain inter­action and effect of interventions in AD/HD and our own studies in the field. The various treatment options are discussed.Results: It can be shown that a gut to brain activity is possible and probable, and dietary intervention is useful and probably safer than drugs. Preliminary data on a small five year follow up of dietary intervention is shown.

  6. Resurgence of congenital syphilis: diagnosis and treatment.

    Science.gov (United States)

    Follett, Tara; Clarke, Denise F

    2011-01-01

    Despite comprehensive antenatal screening recommendations and inexpensive treatment, congenital syphilis has long been and continues to be a public health concern, causing substantial morbidity and adverse outcomes. The following article reviews syphilis etiology and presentation, clinical disease, laboratory diagnosis, and treatment of congenital syphilis. A case will be presented describing a 31-week male infant exposed to infectious syphilis in utero. The neonate presented with classic signs of infection at birth. After initial serology testing of the infant, appropriate treatment was commenced. The infant received crystalline penicillin G for a period of ten days in consultation with pediatric infectious disease specialists. As expected, the infant's rapid plasma reagin (RPR) titers declined by three and six months of age. An interdisciplinary approach provided safe and optimal care for this infant. He was discharged, stable, and thriving at 38 weeks corrected age. Long-term multidisciplinary management and follow-up were arranged.

  7. DIAGNOSIS AND TREATMENT OF WATERING EYE

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    Brigita Drnovšek Olup

    2016-07-01

    Full Text Available Background: Watering eye is in the population a very common eye phenomenon. Watering eye is presented with excessive amount of tears on the surface of the eye that are spilled over the edge of the eyelid on the skin of the eyelids and face. Basically, watering eye is divided into excessive tearing or lacrimation and on the lack of drainage of tears or epiphora. Only correct identification of both phenomena can lead to successful treatment of several patients.Methods: The article presents the anatomy and physiology of lacrimal system causes for lacrimation and epiphora, diagnostic tests and types of treatment. Laser treatment method for epiphora which is performed at the Eye Hospital in Ljubljana is presented.Results: The most common cause for epiphora is nasolacrimal duct occlusion, which is treated by dacryocystorhinostomy. With the minimally invasive version of this treatment method, transcanalicular laser dacryocystorhinostomy, we are able to treat epiphora in 85% of cases.Conclusions: Proper diagnosis and treatment of watering eye is important because of the impact of tearing on a number of eye processes. Incorrectly identified causes and treatment deteriorate patients' quality of life with decreased visual acuity and disrupted social contacts. In the article we show the contribution of the Eye Hospital in Ljubljana to the successful treatment of epiphora with transcanalicular diode laser-assisted dacryocystorhinostomy.

  8. Diagnosis and treatment of prostatic abscess

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    Paulo Oliveira

    2003-02-01

    Full Text Available OBJECTIVES: Present and discuss the pathogenesis, diagnostic methods and treatment of the prostatic abscess. MATERIALS AND METHODS: We have retrospectively studied the medical records of 9 patients diagnosed and treated for prostatic abscess, between March 1998 and December 2000, assessing age, context, associated diseases, and diagnostic and therapeutic methods. We have compared the data found with those described in literature, based on Medline data. RESULTS: Mean age was 52.6 years. Three patients had previous diabetes mellitus diagnosis, and one was infected by HIV virus. Transrectal ultrasound of the prostate confirmed the diagnosis of prostatic abscess in all 7 cases in which it was performed. All cases received antibiotic treatment, and 77.8% needed concomitant surgical treatment. Two cases of microabscess were treated only with antibiotics. Four patients were submitted to perineal catheter drainage, 2 were submitted to transurethral resection of the prostate (TURP, and one patient required both procedures. Mean hospitalization time was 11.2 days, and most frequent bacterial agent was S. aureus. All patients were discharged from the hospital, and there was no death in this series. CONCLUSIONS: Prostatic abscess should be treated with broad-spectrum antibiotics and surgical drainage (perineal puncture or TURP. Microabscess may heal without surgery.

  9. Diagnosis and treatment of malignant pleural mesothelioma.

    Science.gov (United States)

    Rodríguez Panadero, Francisco

    2015-04-01

    There are three major challenges in the diagnosis of malignant pleural mesothelioma: mesothelioma must be distinguished from benign mesothelial hyperplasia; malignant mesothelioma (and its subtypes) must be distinguished from metastatic carcinoma; and invasion of structures adjacent to the pleura must be demonstrated. The basis for clarifying the first two aspects is determination of a panel of monoclonal antibodies with appropriate immunohistochemical evaluation performed by highly qualified experts. Clarification of the third aspect requires sufficiently abundant, deep biopsy material, for which thoracoscopy is the technique of choice. Video-assisted needle biopsy with real-time imaging can be of great assistance when there is diffuse nodal thickening and scant or absent effusion. Given the difficulties of reaching an early diagnosis, cure is not generally achieved with radical surgery (pleuropneumonectomy), so liberation of the tumor mass with pleurectomy/decortication combined with chemo- or radiation therapy (multimodal treatment) has been gaining followers in recent years. In cases in which surgery is not feasible, chemotherapy (a combination of pemetrexed and platinum-derived compounds, in most cases) with pleurodesis or a tunneled pleural drainage catheter, if control of pleural effusion is required, can be considered. Radiation therapy is reserved for treatment of pain associated with infiltration of the chest wall or any other neighboring structure. In any case, comprehensive support treatment for pain control in specialist units is essential: this acquires particular significance in this type of malignancy. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  10. Headaches and Migraines: Headache Symptoms, Diagnosis, and Treatment

    Science.gov (United States)

    ... Issue Past Issues Headaches and Migraines Headache Symptoms, Diagnosis, and Treatment Past Issues / Spring 2009 Table of Contents For ... types of headache. Each has distinct symptoms and treatments. Migraine ... and Diagnosis Migraine: The most common of vascular headaches, migraines ...

  11. Orthopedic Health: Joint Health and Care: Prevention, Symptoms, Diagnosis & Treatment

    Science.gov (United States)

    ... Orthopedic Health Joint Health and Care: Prevention, Symptoms, Diagnosis & Treatment Past Issues / Spring 2009 Table of Contents For ... may be used to help achieve an accurate diagnosis, including: ... joint for examination Treatment The only type of arthritis that can be ...

  12. Tinea Unguium: Diagnosis and Treatment in Practice.

    Science.gov (United States)

    Asz-Sigall, Daniel; Tosti, Antonella; Arenas, Roberto

    2017-02-01

    Onychomycosis is caused by dermatophytes, yeasts or non-dermatophyte molds; when caused by dermatophytes, it is called tinea unguium. The main etiological agents are Trichophyton rubrum and Trichophyton interdigitale. The most frequent types are distal and lateral subungual onychomycosis. Diagnosis usually requires mycological laboratory confirmation. Dermoscopy can be helpful and also biopsy is an excellent diagnostic method in uncommon cases or when mycological test is negative. Treatment must be chosen according to clinical type, number of affected nails and severity. The goal for antifungal therapy is the clearing of clinical signs or mycological cure.

  13. Diagnosis and treatment of portal biliopathy.

    Science.gov (United States)

    He, Zhen-Ping; Fan, Lin-Jun

    2002-11-01

    Portal biliopathy producing intrahepatic and extrahepatic biliary ductal abnormalities from portal hypertension, particularly with extrahepatic portal vein obstruction (EHPVO) is common. A majority of these patients are asymptomatic, but occasionally there is symptomatic biliary obstruction, and cholangitis and choledocholithiasis. To explore the principles of diagnosis and treatment of portal biliopathy. To review the literature of portal biliopathy. Endoscopic sphincterotomy, stone extraction and supportive drainage could effectively relieve cholangitis when jaundice is associated with common bile duct stones. Definitive decompressive portal-system vein shunting operation and choledocho-jejunostomy are sometimes required when biliary obstruction is recurrent and progressive.

  14. PSEUDOMEMBRANOUS COLITIS: DIAGNOSIS, TREATMENT AND PREVENTION

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    T. V. Chyornenkaya

    2016-01-01

    Full Text Available In recent years, Clostridium difficile has become one of the most common and aggressive nosocomial pathogens. The toxigenic strain of C. difficile is the etiological agent of pseudomembranous colitis. This disease leads to the development of dangerous complications without proper therapy. To prevent the C. difficile infection, optimization of in-hospital antibiotics usage and strict compliance with principles of infection control are required. The review of literature presents modern approaches to diagnosis, treatment and prevention of infections, caused by C. difficile.

  15. Porphyrias at a glance: diagnosis and treatment.

    Science.gov (United States)

    Cappellini, Maria Domenica; Brancaleoni, Valentina; Graziadei, Giovanna; Tavazzi, Dario; Di Pierro, Elena

    2010-10-01

    Porphyrias are a group of eight rare inherited metabolic disorders of heme biosynthesis pathway. Porphyrias are still underdiagnosed, although examinations of urine and plasma are first-line tests for detecting excess of porphyrins or heme precursors in suspected patients. Diagnosis, particularly for the acute forms, is essential to avoid precipitating factors and the use of triggering drugs. Mutation screening of family members is recommended to identify presymptomatic carriers and to prevent acute attacks. The therapeutic approach should be appropriate regarding specific forms of porphyria and treatment should be started promptly.

  16. [Vasocardiogenic syncope: pathogenesis, diagnosis and treatment].

    Science.gov (United States)

    Przewłocka-Kosmala, M

    1999-10-01

    Syncope is important clinical problem which is a cause of 1-2% cases of hospitalization. Annual mortality in patients with vaso-cardiogenic syncope is 30%. Vaso-cardiogenic syncope can be related to reduced cardiac output, reduced venous return or disturbations of blood flow in vessels supplying central nervous system. The basis of diagnosing of syncope is precise physical examination and anamnesis. In further diagnosis one can use: echocardiography, ecg Holter monitoring, exercise test, transesophageal atrial stimulation, tilt-up test, electrophysiologic examination. Treatment of syncope consists in elimination of causes or factors inducing syncope.

  17. MODERN ASPECTS OF GIARDIASIS DIAGNOSIS AND TREATMENT

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    D. V. Usenko

    2015-01-01

    Full Text Available Giardiasis is one of the most common parasitic invasions. Parasitizing the intestine, Giardia disrupt the structure and function of the small intestine, leading to recurrent or persistent clinical manifestations, as a rule, combining pain, dyspeptic and asthenoneurotic symptoms. Signs are similar to those of other variants of the pathology of gastroduodenal zone, intestine, biliary passages that makes clinical diagnosis almost impossible. A rational use of available diagnostic tests, as well as a strict adherence to the approved recommendations for giardiasis treatment in children allows to avoid the disease overdiagnosis and to increase therapy efficiency. 

  18. Mialgias: Approaches to differential diagnosis, treatment

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    Nadezhda Aleksandrovna Shostak

    2013-01-01

    Full Text Available Differential diagnosis in muscle pains often presents great difficulties so all existing signs of the disease should be carefully considered to make its diagnosis and to prescribe adequate therapy. The paper considers the causes of muscle pains, laboratory and instrumental studies (immunological tests, determination of the level of specific muscular enzymes, primarily creatine phosphokinase – CPK, etc., and the main reasons for enhanced plasma CPK activity. It also describes acute and chronic mialgias associated with enhanced plasma CPK activity, as well as diseases in which mialgias are related to the normal level of CPK, myofascial syndrome (MFS and fibromyalgia (FM in particular. The characteristic features of MFS are given in its diagnostic criteria. It is stated that a differential diagnosis should be made between MFS and major muscle pain-associated abnormalities, such as polymyalgia rheumatica, FM, etc. Diagnosticcriteria for polymyalgia rheumatica are given. A MFS treatment algorithm is presented. Local exposure methods applied to altered musculoligamentous structures in combination with myorelaxants and non-steroidal anti-inflammatory drugs assume paramount importance in MFS.

  19. Old World cutaneous leishmaniasis: diagnosis and treatment.

    Science.gov (United States)

    Masmoudi, Abderrahmen; Hariz, Wala; Marrekchi, Slaheddine; Amouri, Mariem; Turki, Hamida

    2013-06-30

    Cutaneous leishmaniasis is a major world health problem. Diagnosis is suspected on evocative clinical presentation in patients living in or coming from endemic areas. Several methods have been used. The smear is a simple investigation used in endemic regions. The culture enables to identify the specimen. PCR has a high sensitivity. Montenegro's reaction is used in the epidemiological study. Pentavalent antimony derivatives remain the mainstay of systemic treatment. Their efficiency is well established. Their toxicity should be researched. Other treatments can be utilized, such as miltefosine. Local therapy is used in uncomplicated lesions. Injections of the pentavalent antimony derivate, cryotherapy and paromomycin ointmentsis are important options and should be used more frequently in Old World leishmaniasis.

  20. Diagnosis and treatment of Wilson's disease.

    Science.gov (United States)

    Schilsky, Michael L

    2002-02-01

    Wilson's disease (WD) has moved on from being a recognized syndrome that was uniformly fatal to a curative disease for which the genetic basis has been discovered. Most pediatric patients present with hepatic manifestations, but some may have neurologic or psychiatric features. Clinical and biochemical screening, including liver biopsy for hepatic copper analysis, remain the standard for diagnosis, but haplotype analysis for siblings is now available and should be considered for family screening when possible. Lifelong medical therapy remains the mainstay of treatment, but treatment preferences are changing from penicillamine to alternative agents such as trientine and zinc. OLT remains lifesaving for those with fulminant WD and those in whom initial medical therapy fails. The future will probably see the application of rapid and accurate molecular diagnostic testing for this disorder and new therapeutic modalities such as hepatocyte transplantation, gene replacement therapy, and gene modification.

  1. Diagnosis, phenomenology and treatment of poststroke depression

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    Starkstein Sergio E

    2002-01-01

    Full Text Available Diagnosing depression in stroke patients is a challenge in neuropsychiatry since depression symptoms may overlap neurological deficit signs. The best approach is to assess the presence of depressive symptoms using semi-structured or structured psychiatric interviews, such as the Present State Exam, the Structured Clinical Interview for DSM-IV or the Schedules for Clinical Assessment in Neuropsychiatry. The diagnosis of a depressive syndrome should be made according to standardized diagnostic criteria for mood disorders due to neurological disease such as in the DSM-IV or ICD-10. Depression rating scales such as the Hamilton Depression Scale and the Center for Epidemiologic Scales for Depression may be used to rate the depression severity and monitor the progression of antidepressant treatment. Most studies have reported the effectiveness of pharmacological treatment in patients with post-stroke depression, and there is preliminary evidence that the degree of impairment in activities of daily living (ADL may improve as well.

  2. Diagnosis and treatment of Helicobacter pylori infection

    DEFF Research Database (Denmark)

    Bytzer, Peter; Dahlerup, Jens Frederik; Eriksen, Jens Ravn

    2011-01-01

    National Danish guidelines for the diagnosis and treatment of Helicobacter pylori (Hp) infection have been approved by the Danish Society for Gastroenterology. All patients with peptic ulcer disease, gastric cancer, and MALT lymphoma should be tested for Hp. We also recommend testing in first...... degree relatives to patients with gastric cancer, in NSAID-naive patients, who need long-term NSAID therapy, and in patients presenting with dyspepsia and no alarm symptoms. Non-endoscoped patients can be tested with a urea-breath test or a faecal antigen test. Endoscoped patients can be tested...... with a rapid urease test. Proton pump inhibitor therapy should be stopped at least 1 week prior to Hp testing. All infected patients should be offered Hp eradication therapy. First-line treatment is 7-day triple therapy with a proton pump inhibitor and clarithromycine in combination with metronidazole...

  3. Meniscal root tears: significance, diagnosis, and treatment.

    Science.gov (United States)

    Bhatia, Sanjeev; LaPrade, Christopher M; Ellman, Michael B; LaPrade, Robert F

    2014-12-01

    Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that often result in significant knee joint disorders. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbing function in the knee. With root tears, meniscal extrusion often occurs, and the transmission of circumferential hoop stresses is impaired. This alters knee biomechanics and kinematics and significantly increases tibiofemoral contact pressure. In recent years, meniscal root tears, which by definition include direct avulsions off the tibial plateau or radial tears adjacent to the root itself, have attracted attention because of concerns that significant meniscal extrusion dramatically inhibits normal meniscal function, leading to a condition biomechanically similar to a total meniscectomy. Recent literature has highlighted the importance of early diagnosis and treatment; fortunately, these processes have been vastly improved by advances in magnetic resonance imaging and arthroscopy. This article presents a review of the clinically relevant anatomic, biomechanical, and functional descriptions of the meniscus root attachments, as well as current strategies for accurate diagnosis and treatment of common injuries to these meniscus root attachments. © 2014 The Author(s).

  4. Diagnosis and treatment of hyperfiltering blebs

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    Sebastião Cronemberger

    2011-08-01

    Full Text Available PURPOSE: To report on a new treatment for hyperfiltering bleb as well as its diagnostic criteria. METHODS: Twenty eyes with hypotony due to hyperfiltering bleb caused by trabeculectomy with mitomicin C were treated with bleb resection. The diagnosis of hyperfiltering bleb followed these criteria: intraocular pressure lower than six mmHg (Goldmann tonometer; no inflammation in the anterior segment; presence of an elevated and/or diffuse and avascular bleb with or without microcysts; negative Seidel test; no ciliochoroidal detachment found with ultrasound biomicroscopy. We registered the following data pre and post operatively: type of glaucoma, visual acuity, bleb aspect and fundoscopic findings. A successful resolution of hypotony was achieved when intraocular pressure ranged from six to 14 mmHg with or without antiglaucomatous medication. RESULTS: At a minimum follow-up of 19 months ocular hypotony had been reversed in all eyes. At the last exam, intraocular pressure varied from eight to 14 mmHg in 18 (90% eyes; 12 (66.7% eyes had no medication and six (33.3% used antiglaucomatous medication. In two (10% eyes, another trabeculectomy was necessary to control intraocular pressure. Hypotonic maculopathy developed preoperatively in seven eyes and was reversed after bleb resection. Visual acuity improved in 15 (75% eyes but did not change in five (25%. CONCLUSION: Bleb resection is a safe and adequate treatment for ocular hypotony due to hyperfiltering bleb. It also restores vision in a considerable number of patients. The diagnosis of hyperfiltering bleb must follow rigorous criteria.

  5. DIAGNOSIS AND TREATMENT OF CHILDREN ECHINOCOCCOSIS

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    Veliyeva T.A.

    2015-05-01

    Full Text Available The problem of echinococcosis, despite the progress made in its diagnosis and treatment, currently remains poorly understood and highly relevant in pediatric Parasitology. Studies of many authors show that in recent years the number of patients with echinococcosis not only universally recognized endemic foci, but also among people in the European region, including in countries such as Romania, Germany, Austria. However, studies on the prevalence and structure of echinococcosis among children in Ukraine, are not held. Despite the large number of papers devoted to the treatment of echinococcosis, the problem of the treatment of this disease in children is still far from its final decision. Usually offered surgical treatment, which is not possible with multiple lesions of the liver or other organs. All this shows the relevance and importance for practical public health issues for further study of diagnosis and treatment of echinococcosis in children. The purpose of the study. A comparative analysis of the diagnostic efficacy of X-ray and ultrasound method in the diagnosis of echinococcosis in children. Material & methods. This work is based on a survey of 39 children with hepatic echinococcosis, were examined at the Department of Medical Parasitology and Tropical Diseases Kharkiv Medical Academy of Postgraduate Education from 2005 to 2015. Boys was 1.5 times greater (59.5% than girls - 40.5%. Children under five years of age accounted for only 4.0% of all patients, due to their limited contact with the environment when compared with older age. The greatest risk of disease was in the 10- 13 years of age, the number of children in the group reached 40.3% of the patients. The vast majority of patients (89.6% lived in rural areas. In this case, the parents of sick children from the village were engaged in farming, were in personal use livestock, dogs, which probably contributed to the invasion. Very often ill children pas¬tuhov, shepherds. 78% of

  6. [Diagnosis and treatment of Chagas disease].

    Science.gov (United States)

    Murcia, Laura; Carrilero, Bartolomé; Saura, Daniel; Iborra, M Asunción; Segovia, Manuel

    2013-02-01

    Trypanosoma cruzi infection, or Chagas disease, was discovered more than 100 years ago by Carlos Chagas. Although the infection kills more than 15,000 people each year, it is still classified as a neglected tropical disease. Today, this disease affects eight million people in 21 Latin American countries and, due to immigration, is also present in non-endemic countries. In recent years, the size of the immigrant population with chronic imported forms of Chagas disease has increased in Spain. In addition, several cases of congenital transmission have been reported. Some patients have severe infection and require specialized treatment such as pacemaker implantation or even heart transplantation, representing a considerable clinical, social and economic burden, particularly in areas with a large immigrant population. Since the 1960s, the only drugs available for the etiological treatment of this infection have been benznidazole and nifurtimox. Although new, more effective and better tolerated compounds are urgently needed, treatment with these trypanocidal drugs is recommended in both the acute and chronic stages of Chagas disease. New strategies for diagnosis and infection control in chronically infected patients have recently been reported, allowing the effectiveness of treatments to be assessed. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  7. Tuberculous Meningitis: Diagnosis and Treatment Overview

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    Grace E. Marx

    2011-01-01

    Full Text Available Tuberculous meningitis (TBM is the most common form of central nervous system tuberculosis (TB and has very high morbidity and mortality. TBM is typically a subacute disease with symptoms that may persist for weeks before diagnosis. Characteristic cerebrospinal fluid (CSF findings of TBM include a lymphocytic-predominant pleiocytosis, elevated protein, and low glucose. CSF acid-fast smear and culture have relatively low sensitivity but yield is increased with multiple, large volume samples. Nucleic acid amplification of the CSF by PCR is highly specific but suboptimal sensitivity precludes ruling out TBM with a negative test. Treatment for TBM should be initiated as soon as clinical suspicion is supported by initial CSF studies. Empiric treatment should include at least four first-line drugs, preferably isoniazid, rifampin, pyrazinamide, and streptomycin or ethambutol; the role of fluoroquinolones remains to be determined. Adjunctive treatment with corticosteroids has been shown to improve mortality with TBM. In HIV-positive individuals with TBM, important treatment considerations include drug interactions, development of immune reconstitution inflammatory syndrome, unclear benefit of adjunctive corticosteroids, and higher rates of drug-resistant TB. Testing the efficacy of second-line and new anti-TB drugs in animal models of experimental TBM is needed to help determine the optimal regimen for drug-resistant TB.

  8. VON WILLEBRAND DISEASE: DIAGNOSIS AND TREATMENT

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    Majda Benedik Dolničar

    2004-12-01

    Full Text Available Background. Von Willebrand disease (VWD is a most frequently inborn bleeding disorder caused by quantitative or qualitative defects of von Willebrand factor (VWF. VWF promotes platelet-vessel wall (adhesion and plateletplatelet interaction (aggregation. It is also the carrier for factor VIII (F VIII in plasma. A deficiency of VWF may results in impairment of both, primary and secondary haemostasis. Therefore, patients with VWD can have bleeding symptoms typical fot the defect in primary haemostasis (mucocutaneous haemorrhages. In severe deficiency of VWF there are also haemarthroses and haematomas typical for patients with coagulation defects. Several types and subtypes of VWD have been described. The diagnosis is based on measurements of VWF concentration and activity and F VIII activity in plasma. The tests identifying VWD subtypes are ristocetin induced platelet agglutination (RIPA, multimeric analysis of VWF and measurement of the binding of VWF to F VIII.Conclusions. Due to heterogeneity of VWF defects, the correct diagnosis of types and subtypes is sometimes difficult but is important for appropriate treatment. There are two main therapeutic options for patients with VWD: desmopressin and blood derived concentrates of F VIII/VWF. In certain cases antifibrinolytics and hormones can be suitable treatment. Desmopressin is the treatment of choice in patients with type 1 VWD. It raises endogenous F VIII and VWF and thereby corrects the intrinsic coagulation defect as well as the prolonged bleeding time (BT or closure time (CT-PFA100 in most type 1 VWD patients. In type 3 and in the majority of type 2 patients desmopressin is not effective and it is necessary to use concentrates containing F VIII and VWF. These are always effective in raising of F VIII activity, whereas the BT/CT may not be completely corrected, but the normalisation of the BT/CT is not always necessary.

  9. DIAGNOSIS AND TREATMENT OF METACHRONOUS TESTICULAR CANCER: A CLINICAL CASE

    Directory of Open Access Journals (Sweden)

    A. S. Kalpinsky

    2013-01-01

    Full Text Available The incidence of bilateral testicular cancer is 5% in the total cohort of patients. Synchronous and metachronous testicular cancers are detected in 1-2 and 3% of cases, respectively. The standard treatment for testicular cancer is orchifuniculectomy and that for synchronous or metachronous cancer is organ-saving treatment, testectomy.The paper describes a clinical case of multiple primary metachronous testicular cancer. A 24-year-old patient underwent surgery (orchifuniculectomy and received 4 courses of BEP polychemotherapy for embryonal carcinoma of the left testicle at the P.A. Herzen Moscow Oncology Research Institute. After 55 months, a dynamic control examination diagnosed a 9-mm tumor in his single right testis that was thereafter resected. Its histological examination revealed embryonal carcinoma with solitary structures in the immature teratoma. Following 22 months, a control examination showed a recurrence of the disease, for which orchifuniculectomy of the single right testis, followed by hormone replacement therapy, was performed. The follow-up period was 80 months; no recurrence is now observed.

  10. Adrenal Insufficiency - Aetiology, Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Nazma Akter

    2015-03-01

    Full Text Available Adrenal insufficiency is caused by either primary adrenal failure or by hypothalamic-pituitary impairment of the corticotropic axis. Adrenal insufficiency, first codified in 1855 by Thomas Addison, remains relevant in 2014 because of its lethal nature. Though, it is a rare disease but is life threatening when overlooked. Main presenting symptoms such as fatigue, anorexia and weight loss are nonspecific, thus diagnosis is often delayed. The diagnostic work-up is well established but some pitfalls remain. The diagnosis is adequately established by the 250 μg ACTH (adrenocorticotropic hormone stimulation test in most cases. Glucocorticoids provide life saving treatment but long-term quality of life is impaired, perhaps because therapy is not given in a physiologic way. Dehydroepiandrosterone-replacement therapy has been introduced that could help to restore quality of life. It may be useful in pubertal girls, but not in adults. Monitoring of glucocorticoid-replacement is difficult due to lack of objective methods of assessment and is therefore largely based on clinical grounds. Thus, long-term management of patients with adrenal insufficiency remains a challenge, requiring an experienced specialist.

  11. [Diagnosis and treatment of Pompe disease].

    Science.gov (United States)

    Bravo-Oro, Antonio; de la Fuente-Cortez, Beatriz; Molina-García, Avril; Romero-Díaz, Víktor; Rodríguez-Leyva, Ildefonso; Esmer-Sánchez, María del Carmen

    2013-01-01

    Pompe disease is a rare, progressive and often fatal neuromuscular disorder. It is caused by a deficiency of the lysosomal alpha-glucosidase. Among glycogen storage disorders, it is one of the most common. Its clinical manifestations can start at any moment of life, with a very variable symptomatology. In this article, we show an extended revision of the literature in regards to the main medical aspects of Pompe disease: etiology, psychopathology, epidemiology, clinical variants, pathological diagnosis, and enzyme replacement therapy. With this information, we created a diagnostic and therapeutic guide, which is addressed to specialists and to first-level physicians, in order to let them identify both the classic and the late forms of this disease. We describe as well the best, timely, multidisciplinary treatment in use. Also, we show some suggestions to the proper functioning of health institutions, and routes to diagnosis. We conclude that Pompe disease may be properly diagnosed and treated if health care professionals follow the internationally approved recommendations.

  12. [Intracranial plasmocytomas: biology, diagnosis, and treatment].

    Science.gov (United States)

    Belov, A I; Gol'bin, D A

    2006-01-01

    Intracranial plasmocytomas are a rare abnormality in a neurosurgeon's practice. The plasmocytomas may originate from the skull bones or soft tissue intracranial structures; they may be solitary or occur as a manifestation of multiple myeloma, this type being typical of most intracranial plasmocytomas. Progression of solitary plasmocytoma to multiple myeloma is observed in a number of cases. Preoperative diagnosis involves computed tomography or magnetic resonance imaging; angiography is desirable. The final diagnosis of plasmocytoma is chiefly based on a morphological study. Special immunohistochemical studies yield very promising results; these are likely to be of high prognostic value. Intracranial plasmocytomas require a differential approach and a meticulous examination since the presence or absence of multiple myeloma radically affects prognosis. There are well-defined predictors; however, it is appropriate that craniobasal plasmocytomas show a worse prognosis than plasmocytomas of the skull vault and more commonly progress to multiple myeloma. Plasmocytomas respond to radiotherapy very well. The gold standard of treatment for plasmocytoma is its total removal and adjuvant radiation therapy; however, there is evidence for good results when it is partially removed and undergoes radiotherapy or after radical surgery without subsequent radiation. The role of chemotherapy has not been defined today.

  13. Stress fractures: diagnosis, treatment, and prevention.

    Science.gov (United States)

    Patel, Deepak S; Roth, Matt; Kapil, Neha

    2011-01-01

    Stress fractures are common injuries in athletes and military recruits. These injuries occur more commonly in lower extremities than in upper extremities. Stress fractures should be considered in patients who present with tenderness or edema after a recent increase in activity or repeated activity with limited rest. The differential diagnosis varies based on location, but commonly includes tendinopathy, compartment syndrome, and nerve or artery entrapment syndrome. Medial tibial stress syndrome (shin splints) can be distinguished from tibial stress fractures by diffuse tenderness along the length of the posteromedial tibial shaft and a lack of edema. When stress fracture is suspected, plain radiography should be obtained initially and, if negative, may be repeated after two to three weeks for greater accuracy. If an urgent diagnosis is needed, triple-phase bone scintigraphy or magnetic resonance imaging should be considered. Both modalities have a similar sensitivity, but magnetic resonance imaging has greater specificity. Treatment of stress fractures consists of activity modification, including the use of nonweight-bearing crutches if needed for pain relief. Analgesics are appropriate to relieve pain, and pneumatic bracing can be used to facilitate healing. After the pain is resolved and the examination shows improvement, patients may gradually increase their level of activity. Surgical consultation may be appropriate for patients with stress fractures in high-risk locations, nonunion, or recurrent stress fractures. Prevention of stress fractures has been studied in military personnel, but more research is needed in other populations.

  14. Nanotechnologies in cancer treatment and diagnosis.

    Science.gov (United States)

    Morris, Stephanie A; Farrell, Dorothy; Grodzinski, Piotr

    2014-12-01

    Despite significant efforts toward research and treatment development, cancer continues to be a major health problem in the United States that is only further enhanced by the heterogeneous nature of the disease. Nanotechnology has evolved as a technology with applications to medicine and the potential to improve clinical outcomes, with its application to cancer garnering much attention recently. In particular, through the generation of novel nanoscale devices and therapeutic platforms, nanotechnologies have emerged as innovative approaches that enable the detection and diagnosis of cancer at its earliest stages, and the delivery of anticancer drugs directly to tumors. This article highlights recent advances in the development of nanotechnologies for cancer therapeutics and diagnostics, and focuses on the potential future of cancer nanotechnology and the challenges this young field faces as it continues to move toward clinical translation. Copyright © 2014 by the National Comprehensive Cancer Network.

  15. Childhood Tuberculosis: Epidemiology, Diagnosis, Treatment, and Vaccination

    Directory of Open Access Journals (Sweden)

    Kuo-Sheng Tsai

    2013-10-01

    Full Text Available Despite the existence of a government-run tuberculosis (TB control program, the current nationwide burden of TB continues to be a public health problem in Taiwan. Intense current and previous efforts into diagnostic, therapeutic, and preventive interventions have focused on TB in adults, but childhood TB has been relatively neglected. Children are particularly vulnerable to severe disease and death following infection, and children with latent infections become reservoirs for future transmission following disease reactivation in adulthood, thus fueling future epidemics. Additional research, understanding, and prevention of childhood TB are urgently needed. This review assesses the epidemiology, diagnosis, treatment, and relevant principles of TB vaccine development and presents efficacy data for the currently licensed vaccines.

  16. [Burnout syndrome: diagnosis, principles of treatment, prophylaxis].

    Science.gov (United States)

    Ovchinnikov, Yu V; Palchenkova, M V; Kalachev, O V

    2015-07-01

    Burnout syndrome is a socio-psychological phenomenon of emotional, motivational, and physical exhaustion as a result of chronic occupational stress. It is manifested as long-term emotional exhaustion, depersonalization and diminished personal and professional achievements. Burnout syndrome is common among health care workers, 'due to their high dedication, empathy for suffering patients, and decision-making related to life and health of patients. Personal, role and organizational factors influence on development of burnout. The clinical picture of burnout is multifactorial and can be described as a set of psychosomatic and somatic disorders, symptoms of social dysfunction. Diversity and non-specific symptoms of burnout syndrome determine the need for an interdisciplinary approach to its diagnosis. The leading role in solving problems related to stress and emotional burnout plays psychotherapy. The paper presents diagnostic criteria, risk factors, and methods of prevention and treatment of emotional burnout.

  17. Fetal alcohol exposure: consequences, diagnosis, and treatment.

    Science.gov (United States)

    Pruett, Dawn; Waterman, Emily Hubbard; Caughey, Aaron B

    2013-01-01

    Maternal alcohol use during pregnancy is prevalent, with as many as 12% of pregnant women consuming alcohol. Alcohol intake may vary from an occasional drink, to weekly binge drinking, to chronic alcohol use throughout pregnancy. Whereas there are certain known consequences from fetal alcohol exposure, such as fetal alcohol syndrome, other effects are less well defined. Craniofacial dysmorphologies, abnormalities of organ systems, behavioral and intellectual deficits, and fetal death have all been attributed to maternal alcohol consumption. This review article considers the theoretical mechanisms of how alcohol affects the fetus, including the variable susceptibility to fetal alcohol exposure and the implications of ethanol dose and timing of exposure. Criteria for diagnosis of fetal alcohol syndrome are discussed, as well as new methods for early detection of maternal alcohol use and fetal alcohol exposure, such as the use of fatty acid ethyl esters. Finally, current and novel treatment strategies, both in utero and post utero, are reviewed.

  18. Dysmenorrhea in adolescents: diagnosis and treatment.

    Science.gov (United States)

    French, Linda

    2008-01-01

    Dysmenorrhea occurs in the majority of adolescent girls and is the leading cause of recurrent short-term school absence in this group. In the vast majority of cases, a presumptive diagnosis of primary dysmenorrhea can be made based on a typical history of low anterior pelvic pain coinciding with the onset of menses and lasting 1-3 days with a negative physical examination. Risk factors for primary dysmenorrhea include nulliparity, heavy menstrual flow, and smoking. Poor mental health and social supports are other associations. Empiric therapy for primary dysmenorrhea can be initiated without diagnostic testing. Effective therapies include NSAIDs, oral contraceptives, and pharmacologic suppression of menstrual cycles. In atypical, severe, or refractory cases, imaging and/or laparoscopy should be performed to investigate secondary causes of dysmenorrhea. The most common cause of secondary dysmenorrhea is endometriosis, the treatment of which may include medical and surgical approaches. Pharmacologic treatment of young women with pain related to endometriosis is similar to treatment of primary dysmenorrhea but may infrequently include gonadotropin-releasing hormone agonists in severe refractory cases.

  19. Anterior canal lithiasis: diagnosis and treatment.

    Science.gov (United States)

    Casani, Augusto Pietro; Cerchiai, Niccolò; Dallan, Iacopo; Sellari-Franceschini, Stefano

    2011-03-01

    To describe the clinical and oculographic features in patients with anterior semicircular canal benign paroxysmal positional vertigo and to determine the efficacy of a canalith repositioning procedure for its management. Case series with chart review of patients presenting positional vertigo and positional downbeating nystagmus during a 2-year period. Outpatients' tertiary referral center for balance disorders. Eighteen patients suffering from positional vertigo and presenting positional downbeating nystagmus were treated with a maneuver based on a modification of the procedure proposed by Crevits. disappearance of positional downbeating nystagmus. Positional downbeating nystagmus was elicited unilaterally with the Dix-Hallpike maneuver in 6 cases. In 4 patients, it was triggered by both left and right Dix-Hallpike tests. In 8 patients, the positional nystagmus was elicited by a straight head-hanging maneuver. The positional nystagmus was purely downbeating in 12 patients. In the remaining, a torsional component was detected. After the treatment, only 1 patient showed positional nystagmus at 30 days. In anterior canal benign paroxysmal positional vertigo, the presence of a positional downbeating nystagmus in response to positional tests is key for diagnosis. In a significant number of patients, the affected side may not be detected because of the inconstant presence of a torsional component. Treatment with a simplified maneuver based on Crevits's technique can be considered an effective method for the treatment of anterior canal lithiasis, especially when the affected side cannot be detected clearly.

  20. Food addiction-diagnosis and treatment.

    Science.gov (United States)

    Dimitrijević, Ivan; Popović, Nada; Sabljak, Vera; Škodrić-Trifunović, Vesna; Dimitrijević, Nina

    2015-03-01

    In this article we summarized the recent research of the food addiction, diagnosis, treatment and prevention, which is carried out in this area. The concept of food addiction is new and complex, but proven to be very important for understanding and solving the problem of obesity. First part of this paper emphasizes the neurological studies, whose results indicate the similarity of brain processes that are being activated during drug abuse and during eating certain types of food. In this context, different authors speak of "hyper-palatable", industrial food, saturated with salt, fat and sugar, which favor an addiction. In the section on diagnostic and instruments constructed for assessing the degree of dependence, main diagnostic tool is standardized Yale Food Addiction Scale constructed by Ashley Gearhardt, and her associates. Since 2009, when it was first published, this scale is used in almost all researches in this area and has been translated into several languages. Finally, distinguish between prevention and treatment of food addiction was made. Given that there were similarities with other forms of addictive behavior, the researchers recommend the application of traditional addiction treatment.

  1. [Diagnosis and treatment of pelvic girdle pain].

    Science.gov (United States)

    Stuge, Britt

    2010-11-04

    Pelvic girdle pain (PGP) usually presents during pregnancy. About 25% of all pregnant women and 5% of all women suffer from postpartum lumbopelvic pain causing them to seek medical help. This article discusses possible causes, diagnostic aspects and treatment of PGP. The paper is based on literature identified through non-systematic searches in PubMed, Medline, Embase, Cinahl and Cochrane. Only randomized controlled trials were considered for effect of treatment. Possible underlying mechanisms are hormonal, biomechanical, inadequate motor control and stress of ligament structures. The diagnosis should be based on pain location and several clinical tests. Characteristic signs are problems with walking, standing and sitting. There is evidence for the existence of PGP subgroups that require different treatment. It is well documented that individualized physiotherapy focused on body awareness and specific functional training, has a good and long-lasting effect. Patients with PGP may benefit from reassuring information based on medical history and clinical examination. When needed, patients may be referred to targeted individualized physiotherapy which is continuously evaluated. Few seem to have effect of general or stabilizing exercises. General or stabilizing exercises seem to have miner effect in a number of women.

  2. Torsion of an undescended testis located in the inguinal canal.

    Science.gov (United States)

    Weiss, Andrew P; Van Heukelom, Jon

    2012-05-01

    Torsion of undescended testis located within the inguinal canal is a rare finding in the emergency department (ED). This diagnosis can present as undifferentiated abdominal or groin pain, and a full genitourinary examination is essential to making this diagnosis. We present this case to increase awareness among emergency physicians regarding torsion of undescended testis. A 5-year-old boy presented to the ED with abdominal pain and a mass in his right groin. Physical examination and Doppler ultrasound were used to diagnose torsion of undescended testis. In a patient with undescended testis, torsion must be considered as a cause of abdominal or groin pain. Full genitourinary examination is essential to making this diagnosis. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Current Diagnosis and Treatment of Halitosis

    Directory of Open Access Journals (Sweden)

    Mehmet Mustafa Kılıçkaya

    2015-11-01

    Full Text Available Halitosis or oral malodor is not a diagnosis, but is symptom. Halitosis, that we frequently encounter in ear, nose and throat practice can be the harbinger of some serious underlying disease. Therefore, diagnosis and to find the cause of the halitosis are important. Also halitosis treatment is necessary due to the social and psychological effects. Breath contains hundreds of volatile organic compounds that are by-products of our metabolism. Certain diseases such as nasopharynx cancer, larynx cancer ve lung cancer alter the mix of gases. Thus, the analysis of exhaled air has gained importance. New technologies lead to the development of new devices. And with these called electronic noses the analysis of exhaled air has becomes an important non-invasive diagnostic method. In the literature, halitosis and bad breath which is used as synonymus with oral malodor is the emission of unpleasant odor from mouth and nasal passage. It occurs in 25% of the population, approximately and it has a significant social and economic impact. Halitosis is classified as true halitosis (physiologic halitosis and pathologic halitosis, pseudohalitosis and halitophobia. The most common cause is intra-oral diseases. Among all these factors, the most important etiologic factor are the coating tongue. Other ear, nose and throat diseases such as rhinitis and sinusitis are seen among the most common extraoral causes. Treponema denticola, Porphyromonas gingivalis, Tanneralla forsythia, Fusobacterium nucleatum, Prevotella intermedia, Prevotella nigrescens, Actinobacilli and Solobacterium moorei are the bacteria which are commonly isolated from patients with halitosis and they are volatile sulfur compounds (VSCs producing ones as well. The treatment of halitosis should be carried out according to the etiology. In the physiologic halitosis tooth brushing, use of dental floss, tongue cleaning and chlorhexidine, cetylpyridinium chloride and zinc containing antimicrobial mouthwashes

  4. Comments to Recent Guidelines on Undescended Testis

    DEFF Research Database (Denmark)

    Kutasy, Balazs; Thorup, Joergen M; Wester, Tomas

    2016-01-01

    During the past couple of decades, our understanding of the treatment of undescended testis (UDT) has hugely expanded and it is still dynamically changing: new diagnostic tools are available, and experimental procedures are becoming a real-life treatment options. Our community needs to continuous...

  5. Allergy Diagnosis and Treatment | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... this page please turn Javascript on. Feature: Managing Allergies Allergy Diagnosis and Treatment Past Issues / Spring 2013 Table of Contents Diagnosis Testing for Allergies Knowing exactly what you are allergic to can ...

  6. Adult Patients Presenting with Undescended Testis in Awareness ...

    African Journals Online (AJOL)

    Conclusion: Management of adults with undescended testis was challenging due to irreversible complications, psychological effects and poor outcome of treatment which shows the importance of awareness programs that will result in childhood presentation. Key Words: Undescended testis, cryptorchidism, infertility, adults, ...

  7. Utilization Of Crude Testis Extract To Enhance Broiler Production In ...

    African Journals Online (AJOL)

    Two experiments were conducted to investigate the possibility of using aqueous testis extracts as growth promoters. In the first experiments, 100 Abore Acre chicks were assigned to four treatments in which the birds were given 0, 10,15 and 20% of a 3.3 % aqueous bull testis extract in drinking water ad libitum from week ...

  8. Worm Infestation: Diagnosis, Treatment and Prevention.

    Science.gov (United States)

    Bharti, Bhavneet; Bharti, Sahul; Khurana, Sumeeta

    2017-11-11

    Worm infections continue to be among the most common diseases affecting children from low and middle income countries. Major worm infections of public health importance include Ascariasis, Trichuriasis, Hookworm, and Enterobiasis, which are transmitted through contaminated soil. In India, combined prevalence rates of worm infestation as per pooled data of 127 surveys is over 20%. Although most helminthic infections are mild and are often asymptomatic, but moderate to heavy worm infestations are generally associated with growth faltering, nutritional compromise, anemia and suboptimal academic performance among children from endemic regions. Migration of larval or adult worms also underpins pulmonary and gastrointestinal morbidity in affected children. Some of the distinctive life cycle and clinical features of various worms are discussed in the review. The gold standard diagnostic technique for evaluation of worm infestation includes stool microscopy for direct egg detection and species identification. Most of the community based surveys for detecting soil transmitted helminths (STH) use Kato-Katz technique. The drug armamentarium against worm infestation has evolved tremendously in last three to four decades with the availability of more efficacious and broad spectrum anthelminthics. The key strategies of a multi-component integrated management of worm infestation include individualized treatment, community management (mass drug administration) as well as preventive measures. Finally, barriers to diagnosis, treatment and prevention of worm infestations need to be identified and aggressively managed at individual, family and societal levels so that WHO's 75% coverage target can be achieved to eliminate soil transmitted helminthiasis in children by 2020.

  9. Diagnosis and Treatment of Extrapulmonary Tuberculosis

    Science.gov (United States)

    2015-01-01

    Extrapulmonary tuberculosis (EPTB) constitutes about 20% of all cases of tuberculosis (TB) in Korea. Diagnosing EPTB remains challenging because clinical samples obtained from relatively inaccessible sites may be paucibacillary, thus decreasing the sensitivity of diagnostic tests. Whenever practical, every effort should be made to obtain appropriate specimens for both mycobacteriologic and histopathologic examinations. The measurement of biochemical markers in TB-affected serosal fluids (adenosine deaminase or gamma interferon) and molecular biology techniques such as polymerase chain reaction may be useful adjuncts in the diagnosis of EPTB. Although the disease usually responds to standard anti-TB drug therapy, the ideal regimen and duration of treatment have not yet been established. A paradoxical response frequently occurs during anti-TB therapy. It should be distinguished from other causes of clinical deterioration. Surgery is required mainly to obtain valid diagnostic specimens and to manage complications. Because smear microscopy or culture is not available to monitor patients with EPTB, clinical monitoring is the usual way to assess the response to treatment. PMID:25861336

  10. Myofascial pain and fibromyalgia: Diagnosis and treatment.

    Science.gov (United States)

    Gerwin, R D

    1998-01-01

    Myofascial pain syndrome (MPS) and fibromyalgia (FM) are common muscular pain syndromes. They are both characterized by tenderness, but MPS is further characterized by the myofascial trigger point that has a taut band and causes referred pain. FM can be either primary (idiopathic) or secondary. MPS is always secondary to some muscle stressor. The diagnosis of these conditions is generally made by physical examination. Algometry can quantify the tenderness. EMG of the trigger point and diagnostic ultrasound can provide objective evidence of the trigger point. Biochemical markers and other phenomena associated with FM have not yet been shown to be either specific or sensitive enough to use as clinical indicators of the condition. Tryptophane is low in the serum and spinal fluid of FM patients, whereas substance P is elevated in the spinal fluid. Treatment of MPS is effective when the trigger point is inactivated and underlying mechanical or medical perpetuating factors are corrected. Treatment of fibromyalgia is more difficult as the drugs commonly used, such as the tricyclic antidepressants, which have uncertain benefits; and exercise, which clearly shows a short-term benefit, fail to provide long-lasting relief at 4 years.

  11. The porphyrias: advances in diagnosis and treatment

    Science.gov (United States)

    Balwani, Manisha

    2012-01-01

    The inborn errors of heme biosynthesis, the porphyrias, are 8 genetically distinct metabolic disorders that can be classified as “acute hepatic,” “hepatic cutaneous,” and “erythropoietic cutaneous” diseases. Recent advances in understanding their pathogenesis and molecular genetic heterogeneity have led to improved diagnosis and treatment. These advances include DNA-based diagnoses for all the porphyrias, new understanding of the pathogenesis of the acute hepatic porphyrias, identification of the iron overload-induced inhibitor of hepatic uroporphyrin decarboxylase activity that causes the most common porphyria, porphyria cutanea tarda, the identification of an X-linked form of erythropoietic protoporphyria due to gain-of-function mutations in erythroid-specific 5-aminolevulinate synthase (ALAS2), and new and experimental treatments for the erythropoietic prophyrias. Knowledge of these advances is relevant for hematologists because they administer the hematin infusions to treat the acute attacks in patients with the acute hepatic porphyrias, perform the chronic phlebotomies to reduce the iron overload and clear the dermatologic lesions in porphyria cutanea tarda, and diagnose and treat the erythropoietic porphyrias, including chronic erythrocyte transfusions, bone marrow or hematopoietic stem cell transplants, and experimental pharmacologic chaperone and stem cell gene therapies for congenital erythropoietic protoporphyria. These developments are reviewed to update hematologists on the latest advances in these diverse disorders. PMID:22791288

  12. The porphyrias: advances in diagnosis and treatment.

    Science.gov (United States)

    Balwani, Manisha; Desnick, Robert J

    2012-01-01

    The inborn errors of heme biosynthesis, the porphyrias, are 8 genetically distinct metabolic disorders that can be classified as "acute hepatic," "hepatic cutaneous," and "erythropoietic cutaneous" diseases. Recent advances in understanding their pathogenesis and molecular genetic heterogeneity have led to improved diagnosis and treatment. These advances include DNA-based diagnoses for all the porphyrias, new understanding of the pathogenesis of the acute hepatic porphyrias, identification of the iron overload-induced inhibitor of hepatic uroporphyrin decarboxylase activity that causes the most common porphyria, porphyria cutanea tarda, the identification of an X-linked form of erythropoietic protoporphyria due to gain-of-function mutations in erythroid-specific 5-aminolevulinate synthase (ALAS2), and new and experimental treatments for the erythropoietic prophyrias. Knowledge of these advances is relevant for hematologists because they administer the hematin infusions to treat the acute attacks in patients with the acute hepatic porphyrias, perform the chronic phlebotomies to reduce the iron overload and clear the dermatologic lesions in porphyria cutanea tarda, and diagnose and treat the erythropoietic porphyrias, including chronic erythrocyte transfusions, bone marrow or hematopoietic stem cell transplants, and experimental pharmacologic chaperone and stem cell gene therapies for congenital erythropoietic protoporphyria. These developments are reviewed to update hematologists on the latest advances in these diverse disorders.

  13. Food Allergy: Common Causes, Diagnosis, and Treatment.

    Science.gov (United States)

    Patel, Bhavisha Y; Volcheck, Gerald W

    2015-10-01

    Food allergy is a growing concern, and recognition of symptoms, knowledge of common food allergens, and management of reactions are important for patients and practitioners. Symptoms of a classic IgE-mediated food allergy vary in severity and can include any combination of laryngeal edema, wheezing, nausea, vomiting, diarrhea, urticaria, angioedema, and hypotension. Many foods can induce an allergic reaction, but the most commonly implicated foods include cow's milk, egg, peanut, tree nut, soy, wheat, fish, and shellfish. Milk and egg allergy generally develop and are outgrown in childhood. Peanut and tree nut allergy can occur during childhood or adulthood, are less likely to be outgrown, and tend to cause more fatal reactions. Given the possibility of life-threatening reactions, it is important to recognize the potential for cross-reactivity among food groups. Diagnosis of food allergy includes skin prick testing, specific serum IgE testing, and oral food challenges. Management is centered on avoidance of allergenic and cross-reacting foods and early recognition and immediate treatment of reactions. Treatment protocols to desensitize patients to food are currently under investigation. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  14. Oncogenic cancer/testis antigens

    DEFF Research Database (Denmark)

    Gjerstorff, Morten F; Andersen, Mads H; Ditzel, Henrik J

    2015-01-01

    Recent developments have set the stage for immunotherapy as a supplement to conventional cancer treatment. Consequently, a significant effort is required to further improve efficacy and specificity, particularly the identification of optimal therapeutic targets for clinical testing. Cancer....../testis antigens are immunogenic, highly cancer-specific, and frequently expressed in various types of cancer, which make them promising candidate targets for cancer immunotherapy, including cancer vaccination and adoptive T-cell transfer with chimeric T-cell receptors. Our current understanding of tumor...... or novel immunotherapies such as checkpoint blockade or adoptive transfer, represents a highly synergistic approach with the potential to improve patient survival....

  15. School Refusal: Clinical Features, Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Kayhan Bahali

    2010-12-01

    Full Text Available Children regularly and voluntarily go to school in order to fulfill the expectations of society from them to continue their education or schooling. School continuation has been made compulsory by laws. Nonetheless, contrary to popular belief, for some children it is distressing to go to school. These children have difficulty continuing school and/or refuse to go to school. Today school refusal is defined as a child’s inability to continue school for reasons, such as anxiety and depression. The prevalence of school refusal has been reported to be approximately 1% in school-age children and 5% in child psychiatry samples. The prevalence of school refusal is similar among boys and girls. School refusal can occur at any time throughout the child’s academic life and at all socio-economic levels. School refusal is considered a symptom rather than a clinical diagnosis and can manifest itself as a sign of many psychiatric disorders, with anxiety disorders predominant. Separation anxiety disorder, generalized anxiety disorder, social phobia, specific phobia, and adjustment disorder with anxiety symptoms are the most common disorders co-occurring with school refusal. While separation anxiety disorder is associated with school refusal in younger children, other anxiety disorders, especially phobias, are associated with school refusal in adolescents. Children who have parents with psychiatric disorders have a higher incidence of school refusal, and psychiatric disorders are more frequently seen in adult relatives of children with school refusal, which supports a significant role of genetic and environmental factors in th etiology of school refusal. School refusal is a emergency state for child mental health. As it leads to detrimental effects in the short term and the long term, it should be regarded as a serious problem. The long-lasting follow-up studies of school refusing children have revealed that these children have a higher incidence of

  16. Aortic stenosis: From diagnosis to optimal treatment

    Directory of Open Access Journals (Sweden)

    Tavčiovski Dragan

    2008-01-01

    Full Text Available Aortic stenosis is the most frequent valvular heart disease. Aortic sclerosis is the first characteristic lesion of the cusps, which is considered today as the process similar to atherosclerosis. Progression of the disease is an active process leading to forming of bone matrix and heavily calcified stiff cusps by inflammatory cells and osteopontin. It is a chronic, progressive disease which can remain asymptomatic for a long time even in the presence of severe aortic stenosis. Proper physical examination remains an essential diagnostic tool in aortic stenosis. Recognition of characteristic systolic murmur draws attention and guides further diagnosis in the right direction. Doppler echocardiography is an ideal tool to confirm diagnosis. It is well known that exercise tests help in stratification risk of asymptomatic aortic stenosis. Serial measurements of brain natriuretic peptide during a follow-up period may help to identify the optimal time for surgery. Heart catheterization is mostly restricted to preoperative evaluation of coronary arteries rather than to evaluation of the valve lesion itself. Currently, there is no ideal medical treatment for slowing down the disease progression. The first results about the effect of ACE inhibitors and statins in aortic sclerosis and stenosis are encouraging, but there is still not enough evidence. Onset symptoms based on current ACC/AHA/ESC recommendations are I class indication for aortic valve replacement. Aortic valve can be replaced with a biological or prosthetic valve. There is a possibility of percutaneous aortic valve implantation and transapical operation for patients that are contraindicated for standard cardiac surgery.

  17. The undescended testis

    DEFF Research Database (Denmark)

    Vikraman, Jaya; Hutson, John M; Li, Ruili

    2016-01-01

    Undescended testes (UDT), where one or both testes fail to migrate to the base of the scrotum, can be congenital (2-5% of newborn males) or acquired (1-2% of males). The testis may be found in any position along its usual line of descent. Cryptorchidism affects the developing testicular germ cell...

  18. Uterine arteriovenous malformations: from diagnosis to treatment.

    Science.gov (United States)

    O'Brien, Padraig; Neyastani, Amir; Buckley, Anne R; Chang, Silvia D; Legiehn, Gerald M

    2006-11-01

    The purpose of this study was to describe the sonographic features of uterine arteriovenous malformations (AVMs) and to describe the role and clinical outcome after transcatheter arterial embolization of symptomatic uterine AVMs. In our institution, over a 4-year period, symptomatic uterine AVMs were diagnosed in 21 women. Endovaginal sonography with gray scale, color, and spectral Doppler imaging was performed on all patients. Fourteen patients required therapeutic angiography/embolization to control bleeding. These 14 patients had follow-up endovaginal sonography 24 hours after the procedure. The sonographic gray scale findings of uterine AVMs were nonspecific. The most common finding was subtle myometrial heterogeneity (n = 14), whereas other patients had small anechoic spaces in the myometrium (n = 7). Color Doppler sonography showed a tangle of vessels with multidirectional high-velocity flow that produced a "color mosaic" pattern. Spectral Doppler analysis showed arteriovenous shunting with high-velocity, low-resistance flow. Fourteen patients required transcatheter arterial embolization to control bleeding. Thirteen of 14 patients had no sonographic evidence of a residual AVM 24 hours after the procedure. One of 14 patients had a residual AVM requiring additional embolization. One patient had recurrent bleeding at 4 months and required further embolization. The remaining 7 patients were treated conservatively. Endovaginal sonography is the imaging modality of choice in patients with abnormal uterine bleeding. Routine use of color and spectral Doppler sonography allows one to confidently make the correct diagnosis. Transcatheter arterial embolization is an excellent treatment option. Endovaginal sonography should be used to monitor postembolization outcomes.

  19. HIV Diagnosis and Treatment through Advanced Technologies.

    Science.gov (United States)

    Zulfiqar, Hafiza Fizzah; Javed, Aneeqa; Sumbal; Afroze, Bakht; Ali, Qurban; Akbar, Khadija; Nadeem, Tariq; Rana, Muhammad Adeel; Nazar, Zaheer Ahmad; Nasir, Idrees Ahmad; Husnain, Tayyab

    2017-01-01

    Human immunodeficiency virus (HIV) is the chief contributor to global burden of disease. In 2010, HIV was the fifth leading cause of disability-adjusted life years in people of all ages and leading cause for people aged 30-44 years. It is classified as a member of the family Retroviridae and genus Lentivirus based on the biological, morphological, and genetic properties. It infects different cells of the immune system, such as CD4+ T cells (T-helper cells), dendritic cells, and macrophages. HIV has two subtypes: HIV-1 and HIV-2. Among these strains, HIV-1 is the most virulent and pathogenic. Advanced diagnostic methods are exploring new ways of treatment and contributing in the reduction of HIV cases. The diagnostic techniques like PCR, rapid test, EIA, p24 antigen, and western blot have markedly upgraded the diagnosis of HIV. Antiretroviral therapy and vaccines are promising candidates in providing therapeutic and preventive regimes, respectively. Invention of CRISPR/Cas9 is a breakthrough in the field of HIV disease management.

  20. HIV Diagnosis and Treatment through Advanced Technologies

    Directory of Open Access Journals (Sweden)

    Hafiza Fizzah Zulfiqar

    2017-03-01

    Full Text Available Human immunodeficiency virus (HIV is the chief contributor to global burden of disease. In 2010, HIV was the fifth leading cause of disability-adjusted life years in people of all ages and leading cause for people aged 30–44 years. It is classified as a member of the family Retroviridae and genus Lentivirus based on the biological, morphological, and genetic properties. It infects different cells of the immune system, such as CD4+ T cells (T-helper cells, dendritic cells, and macrophages. HIV has two subtypes: HIV-1 and HIV-2. Among these strains, HIV-1 is the most virulent and pathogenic. Advanced diagnostic methods are exploring new ways of treatment and contributing in the reduction of HIV cases. The diagnostic techniques like PCR, rapid test, EIA, p24 antigen, and western blot have markedly upgraded the diagnosis of HIV. Antiretroviral therapy and vaccines are promising candidates in providing therapeutic and preventive regimes, respectively. Invention of CRISPR/Cas9 is a breakthrough in the field of HIV disease management.

  1. Naegleria fowleri: pathogenesis, diagnosis, and treatment options.

    Science.gov (United States)

    Grace, Eddie; Asbill, Scott; Virga, Kris

    2015-11-01

    Naegleria fowleri has generated tremendous media attention over the last 5 years due to several high-profile cases. Several of these cases were followed very closely by the general public. N. fowleri is a eukaryotic, free-living amoeba belonging to the phylum Percolozoa. Naegleria amoebae are ubiquitous in the environment, being found in soil and bodies of freshwater, and feed on bacteria found in those locations. While N. fowleri infection appears to be quite rare compared to other diseases, the clinical manifestations of primary amoebic meningoencephalitis are devastating and nearly always fatal. Due to the rarity of N. fowleri infections in humans, there are no clinical trials to date that assess the efficacy of one treatment regimen over another. Most of the information regarding medication efficacy is based on either case reports or in vitro studies. This review will discuss the pathogenesis, diagnosis, pharmacotherapy, and prevention of N. fowleri infections in humans, including a brief review of all survivor cases in North America. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

  2. [Narcolepsy: etiology, clinical features, diagnosis and treatment].

    Science.gov (United States)

    Zawilska, Jolanta B; Woldan-Tambor, Agata; Płocka, Anna; Kużajska, Katarzyna; Wojcieszak, Jakub

    2012-10-24

     Narcolepsy is a chronic hypersomnia characterized by excessive daytime sleepiness (EDS) and manifestations of disrupted rapid eye movement sleep stage (cataplexy, sleep paralysis, and hypnagogic/hypnopompic hallucinations). Mechanisms underlying narcolepsy are not fully understood. Experimental data indicate that the disease is caused by a loss of hypocretin neurons in the hypothalamus, likely due to an autoimmune process triggered by environmental factors in susceptible individuals. Most patients with narcolepsy and cataplexy have very low hypocretin-1 levels in the cerebrospinal fluid. An appropriate clinical history, polysomnogram, and multiple sleep latency test are necessary for diagnosis of the disease. Additionally, two biological markers, i.e., cerebrospinal fluid hypocretin-1 levels and expression of the DQB1*0602 gene, are used. The treatment of narcolepsy is aimed at the different symptoms that the patient manifests. Excessive daytime sleepiness is treated with psychostimulants (amphetamine-like, modafinil and armodafinil). Cataplexy is treated with sodium oxybate (GHB), tricyclic antidepressants, or selective serotonin and noradrenaline reuptake inhibitors. Sleep paralysis, hallucinations, and fragmented sleep may be treated with sodium oxybate. Patients with narcolepsy should follow proper sleep hygiene and avoid strong emotions.

  3. Chronic fatigue syndrome: diagnosis and treatment.

    Science.gov (United States)

    Yancey, Joseph R; Thomas, Sarah M

    2012-10-15

    Chronic fatigue syndrome is characterized by debilitating fatigue that is not relieved with rest and is associated with physical symptoms. The Centers for Disease Control and Prevention criteria for chronic fatigue syndrome include severe fatigue lasting longer than six months, as well as presence of at least four of the following physical symptoms: postexertional malaise; unrefreshing sleep; impaired memory or concentration; muscle pain; polyarthralgia; sore throat; tender lymph nodes; or new headaches. It is a clinical diagnosis that can be made only when other disease processes are excluded. The etiology of chronic fatigue syndrome is unclear, is likely complex, and may involve dysfunction of the immune or adrenal systems, an association with certain genetic markers, or a history of childhood trauma. Persons with chronic fatigue syndrome should be evaluated for concurrent depression, pain, and sleep disturbances. Treatment options include cognitive behavior therapy and graded exercise therapy, both of which have been shown to moderately improve fatigue levels, work and social adjustment, anxiety, and postexertional malaise. No pharmacologic or alternative medicine therapies have been proven effective.

  4. Narcolepsy: etiology, clinical features, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Jolanta B. Zawilska

    2012-10-01

    Full Text Available [u][/u] Narcolepsy is a chronic hypersomnia characterized by excessive daytime sleepiness (EDS and manifestations of disrupted rapid eye movement sleep stage (cataplexy, sleep paralysis, and hypnagogic/hypnopompic hallucinations. Mechanisms underlying narcolepsy are not fully understood. Experimental data indicate that the disease is caused by a loss of hypocretin neurons in the hypothalamus, likely due to an autoimmune process triggered by environmental factors in susceptible individuals. Most patients with narcolepsy and cataplexy have very low hypocretin-1 levels in the cerebrospinal fluid. An appropriate clinical history, polysomnogram, and multiple sleep latency test are necessary for diagnosis of the disease. Additionally, two biological markers, i.e., cerebrospinal fluid hypocretin-1 levels and expression of the DQB1*0602 gene, are used. The treatment of narcolepsy is aimed at the different symptoms that the patient manifests. Excessive daytime sleepiness is treated with psychostimulants (amphetamine-like, modafinil and armodafinil. Cataplexy is treated with sodium oxybate (GHB, tricyclic antidepressants, or selective serotonin and noradrenaline reuptake inhibitors. Sleep paralysis, hallucinations, and fragmented sleep may be treated with sodium oxybate. Patients with narcolepsy should follow proper sleep hygiene and avoid strong emotions.

  5. [Sarcoidosis : Organ involvement, diagnosis, current treatment].

    Science.gov (United States)

    Weidenthaler-Barth, B; Steinbrink, K; Kümmel, A; von Stebut, E

    2015-07-01

    Sarcoidosis is characterized by the appearance of noncausating, epitheloid cell granulomas, primarily in skin and lung. Hereditary disposition is well known; additional infection-associated triggers play a role for the development of inflammation mediated by T helper (Th)1 cells. Clinically, various disease courses can be observed that are characterized by the formation of skin papules at typical sites of the body which differ in their tendency to be associated with systemic organ involvement. Systemic disease without skin affections is also possible. The diagnosis is based on the typical clinical appearance, biopsy of affected tissue (e.g. skin, lung) and laboratory investigations. Additional systemic involvement needs to be excluded. In most cases, the disease is self-limited, but can also be life threatening due to organ fibrosis. The degree of (extra-)cutaneous involvement and level of discomfort are used to select the type of treatment, which ranges from topical immune suppressive agents to systemic therapy with corticosteroids. In nonresponders, additional modern immunosuppressive/immunomodulating therapeutic options are available.

  6. Undescended testis? How best to teach the physical examination.

    Science.gov (United States)

    Zundel, S; Blumenstock, G; Herrmann-Werner, A; Trueck, M; Schmidt, A; Wiechers, S

    2016-12-01

    Undescended testis in boys is common. Guidelines recommend surgical treatment between the ages of 6 months and 2 years; nevertheless, orchidopexy is frequently performed at later ages. One reason is the belated diagnosis due to a perceived difficulty in the physical examination (PE) and correct localization of the testis. We aimed to find an effective method for teaching the physical examination of the testis in a child. An interdisciplinary team developed teaching sessions, including an educational video and a simulator. Medical students (n = 133) were randomized into three groups: self-study only, video, and video and simulator. The sessions were carried out and quantitative feedback was collected from the teachers and students. The learning achievements of the different groups were assessed with an objective structured clinical examination (OSCE). The differences in mean OSCE results between all three groups were tested using one-way analysis of variance (ANOVA). For multiple pairwise comparisons, a closed testing procedure was performed using unpaired t-tests. The self-study only group acquired the poorest results in the OSCE, with a mean score of 5.1 out of 10. The video-only-group reached a mean of 6.7, and the video-and-simulator group performed best with a mean score of 8.5. The differences between all three groups were found to be statistically significant, with P = 0.007. The attached figure illustrates this data. If analyzed in pairs, this difference was particularly apparent between the groups self-study only vs video and simulator, with P = 0.002. Qualitative feedback revealed doubtful effectiveness for educational videos, but positive reactions to training on a simulator. The poor results of the self-study-only group were in accordance with the literature, where textbook learning was found not to increase OSCE results. The effectiveness of video tutorials remains doubtful; studies focusing on this teaching method are divergent and the present

  7. Abfraction lesions: etiology, diagnosis, and treatment options

    Directory of Open Access Journals (Sweden)

    Nascimento MM

    2016-05-01

    Full Text Available Marcelle M Nascimento,1 Deborah A Dilbone,1 Patricia NR Pereira,1 Wagner R Duarte,2,3 Saulo Geraldeli,1 Alex J Delgado1 1Department of Restorative Dental Sciences, Division of Operative Dentistry, 2Department of Periodontology, College of Dentistry, University of Florida, Gainesville, FL, USA; 3Private Practice, Brasilia, DF, Brazil Abstract: Abfraction is a type of noncarious cervical lesion (NCCL characterized by loss of tooth tissues with different clinical appearances. Evidence supports that abfraction lesions, as any NCCLs, have a multifactorial etiology. Particularly, the cervical wear of abfraction can occur as a result of normal and abnormal tooth function and may also be accompanied by pathological wear, such as abrasion and erosion. The interaction between chemical, biological, and behavioral factors is critical and helps to explain why some individuals exhibit more than one type of cervical wear mechanism than others. In an era of personalized dentistry, patient risk factors for NCCLs must be identified and addressed before any treatment is performed. Marked variations exist in dental practice concerning the diagnosis and management of these lesions. The lack of understanding about the prognosis of these lesions with or without intervention may be a major contributor to variations in dentists’ management decisions. This review focuses on the current knowledge and available treatment strategies for abfraction lesions. By recognizing that progressive changes in the cervical area of the tooth are part of a physiologically dynamic process that occurs with aging, premature and unnecessary intervention can be avoided. In cases of asymptomatic teeth, where tooth vitality and function are not compromised, abfraction lesions should be monitored for at least 6 months before any invasive procedure is planned. In cases of abfraction associated with gingival recession, a combined restorative-surgical approach may be performed. Restorative

  8. Chronic fatigue syndrome: aetiology, diagnosis and treatment

    Science.gov (United States)

    Avellaneda Fernández, Alfredo; Pérez Martín, Álvaro; Izquierdo Martínez, Maravillas; Arruti Bustillo, Mar; Barbado Hernández, Francisco Javier; de la Cruz Labrado, Javier; Díaz-Delgado Peñas, Rafael; Gutiérrez Rivas, Eduardo; Palacín Delgado, Cecilia; Rivera Redondo, Javier; Ramón Giménez, José Ramón

    2009-01-01

    Chronic fatigue syndrome is characterised by intense fatigue, with duration of over six months and associated to other related symptoms. The latter include asthenia and easily induced tiredness that is not recovered after a night's sleep. The fatigue becomes so severe that it forces a 50% reduction in daily activities. Given its unknown aetiology, different hypotheses have been considered to explain the origin of the condition (from immunological disorders to the presence of post-traumatic oxidative stress), although there are no conclusive diagnostic tests. Diagnosis is established through the exclusion of other diseases causing fatigue. This syndrome is rare in childhood and adolescence, although the fatigue symptom per se is quite common in paediatric patients. Currently, no curative treatment exists for patients with chronic fatigue syndrome. The therapeutic approach to this syndrome requires a combination of different therapeutic modalities. The specific characteristics of the symptomatology of patients with chronic fatigue require a rapid adaptation of the educational, healthcare and social systems to prevent the problems derived from current systems. Such patients require multidisciplinary management due to the multiple and different issues affecting them. This document was realized by one of the Interdisciplinary Work Groups from the Institute for Rare Diseases, and its aim is to point out the main social and care needs for people affected with Chronic Fatigue Syndrome. For this, it includes not only the view of representatives for different scientific societies, but also the patient associations view, because they know the true history of their social and sanitary needs. In an interdisciplinary approach, this work also reviews the principal scientific, medical, socio-sanitary and psychological aspects of Chronic Fatigue Syndrome. PMID:19857242

  9. Diagnosis, treatment, and prevention of gout.

    Science.gov (United States)

    Hainer, Barry L; Matheson, Eric; Wilkes, R Travis

    2014-12-15

    Gout is characterized by painful joint inflammation, most commonly in the first metatarsophalangeal joint, resulting from precipitation of monosodium urate crystals in a joint space. Gout is typically diagnosed using clinical criteria from the American College of Rheumatology. Diagnosis may be confirmed by identification of monosodium urate crystals in synovial fluid of the affected joint. Acute gout may be treated with nonsteroidal anti-inflammatory drugs, corticosteroids, or colchicine. To reduce the likelihood of recurrent flares, patients should limit their consumption of certain purine-rich foods (e.g., organ meats, shellfish) and avoid alcoholic drinks (especially beer) and beverages sweetened with high-fructose corn syrup. Consumption of vegetables and low-fat or nonfat dairy products should be encouraged. The use of loop and thiazide diuretics can increase uric acid levels, whereas the use of the angiotensin receptor blocker losartan increases urinary excretion of uric acid. Reduction of uric acid levels is key to avoiding gout flares. Allopurinol and febuxostat are first-line medications for the prevention of recurrent gout, and colchicine and/or probenecid are reserved for patients who cannot tolerate first-line agents or in whom first-line agents are ineffective. Patients receiving urate-lowering medications should be treated concurrently with nonsteroidal anti-inflammatory drugs, colchicine, or low-dose corticosteroids to prevent flares. Treatment should continue for at least three months after uric acid levels fall below the target goal in those without tophi, and for six months in those with a history of tophi.

  10. Chronic fatigue syndrome: aetiology, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Palacín Delgado Cecilia

    2009-10-01

    Full Text Available Abstract Chronic fatigue syndrome is characterised by intense fatigue, with duration of over six months and associated to other related symptoms. The latter include asthenia and easily induced tiredness that is not recovered after a night's sleep. The fatigue becomes so severe that it forces a 50% reduction in daily activities. Given its unknown aetiology, different hypotheses have been considered to explain the origin of the condition (from immunological disorders to the presence of post-traumatic oxidative stress, although there are no conclusive diagnostic tests. Diagnosis is established through the exclusion of other diseases causing fatigue. This syndrome is rare in childhood and adolescence, although the fatigue symptom per se is quite common in paediatric patients. Currently, no curative treatment exists for patients with chronic fatigue syndrome. The therapeutic approach to this syndrome requires a combination of different therapeutic modalities. The specific characteristics of the symptomatology of patients with chronic fatigue require a rapid adaptation of the educational, healthcare and social systems to prevent the problems derived from current systems. Such patients require multidisciplinary management due to the multiple and different issues affecting them. This document was realized by one of the Interdisciplinary Work Groups from the Institute for Rare Diseases, and its aim is to point out the main social and care needs for people affected with Chronic Fatigue Syndrome. For this, it includes not only the view of representatives for different scientific societies, but also the patient associations view, because they know the true history of their social and sanitary needs. In an interdisciplinary approach, this work also reviews the principal scientific, medical, socio-sanitary and psychological aspects of Chronic Fatigue Syndrome.

  11. Chronic fatigue syndrome: aetiology, diagnosis and treatment.

    Science.gov (United States)

    Avellaneda Fernández, Alfredo; Pérez Martín, Alvaro; Izquierdo Martínez, Maravillas; Arruti Bustillo, Mar; Barbado Hernández, Francisco Javier; de la Cruz Labrado, Javier; Díaz-Delgado Peñas, Rafael; Gutiérrez Rivas, Eduardo; Palacín Delgado, Cecilia; Rivera Redondo, Javier; Ramón Giménez, José Ramón

    2009-10-23

    Chronic fatigue syndrome is characterised by intense fatigue, with duration of over six months and associated to other related symptoms. The latter include asthenia and easily induced tiredness that is not recovered after a night's sleep. The fatigue becomes so severe that it forces a 50% reduction in daily activities. Given its unknown aetiology, different hypotheses have been considered to explain the origin of the condition (from immunological disorders to the presence of post-traumatic oxidative stress), although there are no conclusive diagnostic tests. Diagnosis is established through the exclusion of other diseases causing fatigue. This syndrome is rare in childhood and adolescence, although the fatigue symptom per se is quite common in paediatric patients. Currently, no curative treatment exists for patients with chronic fatigue syndrome. The therapeutic approach to this syndrome requires a combination of different therapeutic modalities. The specific characteristics of the symptomatology of patients with chronic fatigue require a rapid adaptation of the educational, healthcare and social systems to prevent the problems derived from current systems. Such patients require multidisciplinary management due to the multiple and different issues affecting them. This document was realized by one of the Interdisciplinary Work Groups from the Institute for Rare Diseases, and its aim is to point out the main social and care needs for people affected with Chronic Fatigue Syndrome. For this, it includes not only the view of representatives for different scientific societies, but also the patient associations view, because they know the true history of their social and sanitary needs. In an interdisciplinary approach, this work also reviews the principal scientific, medical, socio-sanitary and psychological aspects of Chronic Fatigue Syndrome.

  12. [Periodontal abscess: etiology, diagnosis and treatment].

    Science.gov (United States)

    Vályi, Péter; Gorzó, István

    2004-08-01

    The periodontal abscess is an acute destructive process in the periodontium resulting in localized collections of pus communicating with the oral cavity through the gingival sulcus or other periodontal sites and not arising from the tooth pulp. The prevalence of periodontal abscess is relatively high and it affects the prognosis of the tooth. Periodontal abscesses can develop on the base of persisting periodontitis but can also occur in the absence of periodontitis. The cause of the development of periodontal abscess originating from chronic periodontitis is the marginal closure of a periodontal pocket, or the pocket lumen might be too tight to drain the increased suppuration due to changes in the composition of subgingival microflora, alteration of bacterial virulence or host defenses. Diagnosis of a periodontal abscess is based on medical and dental history as well as oral examination (pocket depth, swelling, suppuration, mobility, sensibility of the tooth). The most prevalent group of bacteria: P. gingivalis, P. intermedia, B. forsythus, F. nucleatum and P. micros. Previous studies have suggested that the complete therapy of the periodontitis patients with acute periodontal abscess has to do in two stages: the first stage is the management of acute lesions, then the second stage is the appropriate comprehensive treatment of the original and/or residual lesions. The management of acute lesions includes establishing drainage via pocket lumen, subgingival scaling and root planing, curettage of the lining pocket epithelia and seriously inflamed connective tissue, compressing pocket wall to underlying tooth and periodontal support, and maintaining tissue contact. Some authors recommend the incision or to establish drainage and irrigation, or a flap surgery, or even extraction of hopeless teeth. We recommend the use of systemic antibiotics as a preventive measure of systemic disease or in case of systemic symptoms.

  13. [Diagnosis and treatment of tumor metastases].

    Science.gov (United States)

    Petruzelka, L

    2001-08-01

    More than half the patients with malignat tumours have at the time of diagnosis already remote metastases or they develop remote dissemination after different intervals following termination of local treatment. Organ complications in case of metastatic dissemination are for the majority of patients the most life threatening condition. In therapeutic decisions the approach to some solid tumours is the same as in systemic diseases. The possibility to achieve a long-term therapeutic effect during conventional systemic therapy are limited in metastatizing solid tumours of adult age. Assessment of the extent of the disease incl. detection of metastatic dissemination is of decisive importance for the selection of therapeutic strategy. Imaging methods such as computed tomography, ultrasonography and nuclear magnetic resonance provide basic structural anatomic information. The limitating factor is obtaining functional information on tumor tissues and the possibility to differentiate the residual disease from non-viable or necrotic tumor masses. These data can be provided by radiopharmacological imaging methods such as positron emission tomography. Introduction of new imaging methods is becoming increasingly important when new therapeutic methods are used where the effect of the therapeutic result does not mean necessarily reduction of the tumour volume. Research of the metastatic process involved revolutionary changese lucidating individual stages linked in a cascade pattern. The metastatic potential of human tumours correlates with the expression of a number of genes regulating tumour growth (EGF - epidermal growth factor, IGF - insulin like growth factor) motility of tumour cells (AMF - autocrine motility factor) the process of angiogenesis (VEGF vascular endothelial growth factor, bFGF - basal fibroblastic growth factor, interleukin-8) and the invasiveness (genes for the matrix of metalloproteinase MMP-2/MMP-9). Expression of the surface glycoporotein E-cadherin which

  14. Advances in the diagnosis and treatment of pediatric acute pancreatitis

    Directory of Open Access Journals (Sweden)

    WU Jie

    2017-06-01

    Full Text Available The incidence rate of acute pancreatitis (AP has been gradually increasing in recent years, and pediatric AP is often seen in clinical practice. Pediatric AP has complex causes and diverse clinical manifestations, and infants and children cannot clearly explain their discomforts, which makes it more difficult to make an accurate diagnosis and may easily cause misdiagnosis, missed diagnosis, and delayed treatment. A deep understanding of pediatric AP helps to improve the diagnosis and treatment level of this disease. This article reviews the advances in the diagnosis and treatment of pediatric AP, in order to provide guidance to clinical practice.

  15. Diagnosis and Treatment of Influenza in Children

    Directory of Open Access Journals (Sweden)

    M. S. Savenkova

    2016-01-01

    Full Text Available The article presents data on influenza epidemiology, pathogenesis, classification, clinical variants, diagnosis. Given the variety of antiviral drugs, highlighted the most relevant and used in pediatric patients, depending on age and mixed-flow options viral infections.

  16. [Amanita phalloides poisoning--diagnosis, clinical course, treatment].

    Science.gov (United States)

    Wiernikowski, A; Szczepanek, M

    1999-01-01

    This study presents a general review of current opinion on Amanita phalloides and other toxic Amanita species poisonings, clinical symptoms, elementary principles of mycological, clinical and laboratory diagnostics, and treatment. Early diagnosis, centralization of the treatment have been particularly emphasized.

  17. Idiopathic granulomatous mastitis: dilemmas in diagnosis and treatment

    OpenAIRE

    Mahmodlou, Rahim; Dadkhah, Niloofar; Abbasi, Fariba; Nasiri, Jafar; Valizadeh, Rohollah

    2017-01-01

    Background Idiopathic granulomatous mastitis (IGM) is a benign rare inflammatory disease of the breast. Due to its uncommon etiology, diagnosis and treatment is still unknown. Selection of a standard method for diagnosing idiopathic granulomatous mastitis is sophisticated. In view of non-definitive clinical and imaging finding, histopathology is the cornerstone of definitive diagnosis. Objective To determine and help solve the dilemma of treatment and diagnosis of idiopathic granulomatous mas...

  18. Burned-out testis tumour that metastasized to retroperitoneal lymph nodes: a case report

    Directory of Open Access Journals (Sweden)

    Yucel Mehmet

    2009-05-01

    Full Text Available Abstract Introduction Burned-out testicular tumour is a very rare clinical entity. There is no clinical finding in the testicle, because it regresses spontaneously with no treatment, and generally presents with metastases. Abdominal masses in young male patients may sometimes be caused by a metastatic burned-out testicular tumour. We report a patient with a burned-out testicular tumour that metastasized to retroperitoneal lymph nodes. Case presentation A 28-year-old man complained of an abdominal mass and continuously increasing pain over the previous 2 months. A midabdominal mass, atrophy and minimal induration in the right testis were revealed on physical examination. Ultrasound findings revealed focally increased echogenicity, which is typical of burned-out tumours. Inguinal orchiectomy was performed, and the histological examination of the biopsy specimen revealed a large area of hyalinization, tubular hyalinization, interstitial fibrosis and focal Leydig cell hyperplasia, with no abnormal pathological findings in the epididymis and spermatic cord. The final pathological diagnosis was concluded as "burned-out" testicular tumour. Surgical treatment was followed by appropriate chemotherapy and in the follow-up, the abdominal mass was observed to regress. The patient is currently free of disease 5 years after diagnosis. Conclusion For the detection of intratesticular lesions, especially in patients with extragonadal metastatic involvement and normal palpation findings for the testis, scrotal sonography is very important. A burned-out testicular tumour should be considered and testis biopsies should be performed if there is any risk factor of malignancy.

  19. Nuclear protein in testis carcinoma of the mediastinum: a case report.

    Science.gov (United States)

    Boleto, Gonçalo; Perotin, Jeanne-Marie; Launois, Claire; Uro-Coste, Emmanuelle; Birembaut, Philippe; Dury, Sandra; Vallerand, Hervé; Lebargy, François; Deslée, Gaëtan; Vella-Boucaud, Juliette

    2017-06-09

    Nuclear protein in testis carcinoma is a rare and very aggressive undifferentiated cancer which characteristically arises in the midline of the head, neck, and mediastinum. We describe the case of a 46-year-old white woman admitted for superior vena cava syndrome revealing a mediastinal tumor. Pathological examination of specimens obtained by mediastinoscopy revealed an undifferentiated tumor with solid growth and positive immunoreactivity for p40 and negative immunoreactivity for cytokeratin markers. Immunohistochemical staining was positive for nuclear protein in testis, allowing the diagnosis of nuclear protein in testis midline carcinoma of the mediastinum. We present a rare case of mediastinal nuclear protein in testis carcinoma with diagnosis based on nuclear protein in testis protein positivity and atypical immunohistochemical features including p40 positivity and anti-cytokeratin negativity. Physicians must remain aware of the possibility of nuclear protein in testis carcinoma especially in young patients with thoracic symptoms and suspicion of neoplasm.

  20. Free radicals in adolescent varicocele testis.

    Science.gov (United States)

    Romeo, Carmelo; Santoro, Giuseppe

    2014-01-01

    We examine the relationship between the structure and function of the testis and the oxidative and nitrosative stress, determined by an excessive production of free radicals and/or decreased availability of antioxidant defenses, which occur in the testis of adolescents affected by varicocele. Moreover, the effects of surgical treatment on oxidative stress were provided. We conducted a PubMed and Medline search between 1980 and 2014 using "adolescent," "varicocele," "free radicals," "oxidative and nitrosative stress," "testis," and "seminiferous tubules" as keywords. Cross-references were checked in each of the studies, and relevant articles were retrieved. We conclude that increased concentration of free radicals, generated by conditions of hypoxia, hyperthermia, and hormonal dysfunction observed in adolescent affected by varicocele, can harm germ cells directly or indirectly by influencing nonspermatogenic cells and basal lamina. With regard to few available data in current literature, further clinical trials on the pre- and postoperative ROS and RNS levels together with morphological studies of the cellular component of the testis are fundamental for complete comprehension of the role played by free radicals in the pathogenesis of adolescent varicocele and could justify its pharmacological treatment with antioxidants.

  1. Terminology and details of the diagnostic process for testis cancer.

    LENUS (Irish Health Repository)

    Connolly, Stephen S

    2011-03-01

    We examined the process and causes of diagnostic delay, defined as the interval from symptom onset to diagnosis, for testis (germ cell) cancer and the change with time. Diagnostic delay influences disease burden and may be subdivided into symptomatic interval, defined as symptom onset to first presentation, and diagnostic interval, defined as first presentation to diagnosis.

  2. Autoimmune hepatitis : Pathogenesis, diagnosis and treatment

    NARCIS (Netherlands)

    van den Berg, AP

    Background: Autoimmune hepatitis (AIH) is a chronic necro-inflammatory disease of the liver. Early recognition is important in order to prevent the development of cirrosis. This review discusses recent developments in the fields of diagnosis, pathophysiology and management of AIH. Methods: Relevant

  3. Chronic fatigue syndrome: diagnosis and treatment | Revelas ...

    African Journals Online (AJOL)

    Chronic fatigue syndrome (CFS) refers to marked and prolonged fatigue, for which no indentifiable cause can be found. Despite the presence of extensive symptoms, diagnosis is made when there is profound fatigue, lasting for a duration of six months, or longer. CFS is frequently seen in association with psychiatric ...

  4. Type 4 cardiorenal syndrome: diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Luca Di Lullo

    2015-05-01

    Full Text Available The clinical presentation of, and diagnostic approach taken for, a 63-year-old man with worsening dyspnea, chest heaviness and widespread lower limb edema, leading to a diagnosis of type 4 cardiorenal syndrome, is presented. The most appropriate approach at point of care is thoroughly discussed.

  5. Oncogenic cancer/testis antigens

    DEFF Research Database (Denmark)

    Gjerstorff, Morten F; Andersen, Mads H; Ditzel, Henrik J

    2015-01-01

    immunology and immune escape suggests that targeting oncogenic antigens may be beneficial, meaning that identification of cancer/testis antigens with oncogenic properties is of high priority. Recent work from our lab and others provide evidence that many cancer/testis antigens, in fact, have oncogenic...... functions, including support of growth, survival and metastasis. This novel insight into the function of cancer/testis antigens has the potential to deliver more effective cancer vaccines. Moreover, immune targeting of oncogenic cancer/testis antigens in combination with conventional cytotoxic therapies...

  6. Acute Pancreatitis: Etiology, Pathology, Diagnosis, and Treatment.

    Science.gov (United States)

    Majidi, Shirin; Golembioski, Adam; Wilson, Stephen L; Thompson, Errington C

    2017-11-01

    Acute pancreatitis is a fascinating disease. In the United States, the two most common etiologies of acute pancreatitis are gallstones and excessive alcohol consumption. The diagnosis of acute pancreatitis is made with a combination of history, physical examination, computed tomography scan, and laboratory evaluation. Differentiating patients who will have a benign course of their pancreatitis from patients who will have severe pancreatitis is challenging to the clinician. C-reactive protein, pro-calcitonin, and the Bedside Index for Severity of Acute Pancreatitis appeared to be the best tools for the early and accurate diagnosis of severe pancreatitis. Early laparoscopic cholecystectomy is indicated for patients with mild gallstone pancreatitis. For patients who are going to have a prolonged hospitalization, enteral nutrition is preferred. Total parenteral nutrition should be reserved for patients who cannot tolerate enteral nutrition. Prophylactic antibiotics are not indicated for patients with pancreatic necrosis. Surgical intervention for infected pancreatic necrosis should be delayed as long as possible to improve patient outcomes.

  7. Diagnosis and treatment of diabetic foot infections.

    Science.gov (United States)

    Lipsky, Benjamin A; Berendt, Anthony R; Deery, H Gunner; Embil, John M; Joseph, Warren S; Karchmer, Adolf W; LeFrock, Jack L; Lew, Daniel P; Mader, Jon T; Norden, Carl; Tan, James S

    2006-06-01

    -stimulating factors and systemic hyperbaric oxygen therapy may help prevent amputations (B-I). These treatments may be useful for severe infections or for those that have not adequately responded to therapy, despite correcting for all amenable local and systemic adverse factors. 18. Spread of infection to bone (osteitis or osteomyelitis) may be difficult to distinguish from noninfectious osteoarthropathy. Clinical examination and imaging tests may suffice, but bone biopsy is valuable for establishing the diagnosis of osteomyelitis, for defining the pathogenic organism(s), and for determining the antibiotic susceptibilities of such organisms (B-II). 19. Although this field has matured, further research is much needed. The committee especially recommends that adequately powered prospective studies be undertaken to elucidate and validate systems for classifying infection, diagnosing osteomyelitis, defining optimal antibiotic regimens in various situations, and clarifying the role of surgery in treating osteomyelitis (A-III).

  8. Aggressive surgical management of adenocarcinoma of the rete testis

    Directory of Open Access Journals (Sweden)

    Avinash Maganty

    2018-01-01

    Full Text Available Adenocarcinoma of the rete testis is a rare and aggressive malignancy arising from the epididymal epithelium. We present a case of a 66-year-old male who presented with left testis mass. Histopathological analysis of orchiectomy specimen was consistent with adenocarcinoma of the rete testis. Subsequent retroperitoneal lymph node dissection revealed metastatic disease not detected on preoperative PET-CT. Prior reports have suggested poor response rates to both systemic chemotherapy and radiation therapy. Aggressive surgical management of the retroperitoneum should be considered even in clinically node-negative patients given the paucity of other effective treatment regimens.

  9. Depression diagnosis and treatment amongst multimorbid patients: a thematic analysis

    OpenAIRE

    Stanners, Melinda N; Barton, Christopher A; Shakib, Sepehr; Winefield, Helen R.

    2014-01-01

    Background We explored experiences of depression diagnosis and treatment amongst multimorbid patients referred to a metropolitan multidisciplinary outpatient clinic to identify commonalities across this patient group. Methods Patients with two or more chronic conditions and a diagnosis of depression participated in semi-structured interviews that were digitally recorded and transcribed. Thematic analysis was performed on the transcriptions. Results Multimorbid patients attributed depressive s...

  10. Feature: Post Traumatic Stres Disorder PTSD: Symptoms, Diagnosis, Treatment

    Science.gov (United States)

    ... Home Current Issue Past Issues Feature PTSD Symptoms, Diagnosis , Treatment Past Issues / Winter 2009 Table of Contents For ... that can help rule out similar conditions. PTSD diagnosis is made based on a certain set of symptoms that begin or ... is yielding new, improved therapies that can ...

  11. Diagnosis and Treatment of Hypophyseal Cushing’s Syndrome

    Directory of Open Access Journals (Sweden)

    M.L. Kirilyuk

    2014-09-01

    Full Text Available The paper deals with the questions on etiology, pathogenesis and diagnosis of hypophyseal Cushing’s syndrome. There are described the clinical picture of Cushing’s syndrome as well as the conditions associated with hypercorticoidism in the absence of Cushing’s syndrome. There are dwelt the principles of laboratory and instrumental diagnosis and treatment of this syndrome.

  12. Diagnosis and treatment of xerostomia (dry mouth).

    Science.gov (United States)

    Napeñas, Joel J; Brennan, Michael T; Fox, Philip C

    2009-07-01

    Xerostomia (dry mouth) is a common complaint with widespread implications such as impaired quality of life, oral pain, and numerous oral complications. There are a variety of salivary and nonsalivary causes of xerostomia, the most frequent being medication side effects and systemic disorders. A systematic approach should be employed to determine the etiology of this condition, with distinctions made between patients with subjective complaints of xerostomia alone and those with measurable salivary gland dysfunction. Management is multidisciplinary and multimodal. This review summarizes the current literature on the etiology, diagnosis, and complications of xerostomia, and on the management of patients with xerostomia.

  13. Nursing diagnosis Noncompliance to treatment in men with hypertension

    Directory of Open Access Journals (Sweden)

    Talliton Uchôa de Araújo

    2016-01-01

    Full Text Available Objective : to identify the frequency of occurrence of nursing diagnosis Noncompliance of treatment in men with high blood pressure, its defining characteristics, and related factors. Methods : a Cross-sectional study involving 44 men with hypertension by applying a validated instrument for identification of nursing diagnosis. Results : the diagnosis frequency of occurrence was 56.8%, the most present defining characteristics were the inadequate management of nonpharmacological treatment (p=0.000 and adherence failure of indicative behavior (p=0.000. The most common related factors were deficient knowledge for the monitor of the non- drug treatment regimen (p=0.000 and insufficient teaching ability of health staff (p=0.002. Conclusion : it was found a high frequency of diagnosis in men and the data point to the need for training of health professionals for the development of skills in promoting adherence of men to the treatment of hypertension.

  14. New developments in the diagnosis and treatment of thyroid cancer.

    Science.gov (United States)

    Schneider, David F; Chen, Herbert

    2013-01-01

    Thyroid cancer exists in several forms. Differentiated thyroid cancers include those with papillary and follicular histologies. These tumors exist along a spectrum of differentiation, and their incidence continues to climb. A number of advances in the diagnosis and treatment of differentiated thyroid cancers now exist. These include molecular diagnostics and more advanced strategies for risk stratification. Medullary cancer arises from the parafollicular cells and not the follicular cells. Therefore, diagnosis and treatment differs from those of differentiated thyroid tumors. Genetic testing and newer adjuvant therapies have changed the diagnosis and treatment of medullary thyroid cancer. This review will focus on the epidemiology, diagnosis, workup, and treatment of both differentiated and medullary thyroid cancers, focusing specifically on newer developments in the field. © 2013 American Cancer Society, Inc.

  15. Osteoarthritis: Symptoms, Diagnosis & Treatment | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Osteoarthritis Osteoarthritis: Symptoms, Diagnosis & Treatment Past Issues / Winter 2013 Table of Contents Warning Signs of Osteoarthritis Pain and stiffness in a joint after getting ...

  16. Hypothyroidism:Symptoms,Diagnosis and Treatment | NIH Medlineplus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Hypothyroidism Hypothyroidism: Symptoms, Diagnosis & Treatment Past Issues / Spring 2012 Table ... of its symptoms are seen in other diseases, hypothyroidism usually cannot be diagnosed based on symptoms alone. ...

  17. diagnosis and treatment of heart failure in the community

    African Journals Online (AJOL)

    Enrique

    hydralazine if tolerated. ACE inhibitor. + temporary inotropic beta-blockade or ACE inhibitor + ARB if beta- support spironolactone blocker intolerant. Adapted from the Task force report: ESC: Guidelines for the diagnosis and treatment of heart failure.

  18. Current Thoughts in Fungal Keratitis: Diagnosis and Treatment

    Science.gov (United States)

    Ansari, Zubair; Miller, Darlene; Galor, Anat

    2013-01-01

    Fungal keratitis remains a challenging and often elusive diagnosis in geographic regions where it is endemic. Marred by delays in diagnosis, the sequelae of corneal fungal infections, though preventable, can be irreversible. Recent studies and advances in the arena have broadened the approach and treatment to mycotic keratitis. This review will discuss current diagnostic modalities of fungal keratitis and will particularly focus on treatment regimens. It will also explore future therapeutic models and critique the potential benefit of each. PMID:24040467

  19. Undescended testis in Spigelian hernia

    Directory of Open Access Journals (Sweden)

    Ravi Kumar V

    2007-01-01

    Full Text Available Spigelian hernias are uncommon in children. We report a 3-year-old boy with right spigelian hernia and right undescended testis. The hernial sac contained the testis, which is a rare presentation. The repair of the large defect with a prosthetic mesh and a concomitant orchidopexy were performed uneventfully.

  20. Early and Periodic Screening, Diagnosis and Treatment

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who...

  1. Oral leukoplakia:Diagnosis and treatment

    OpenAIRE

    Kjærgaard Larsen, Marie; Sorensen, J.A.; Godballe, C.; Thygesen, T. H.

    2016-01-01

    BACKGROUND AND AIM: Oral leukoplakia (OL) is a common premalignant lesion. The possible benefits of specific interventions in preventing a malignant transformation of OL are not well understood. This review assesses different invasive treatment techniques for OL and evaluate the optimal treatment possibilities. METHODS: A Medline (PubMed) search was conducted and heterogeneity between the studies was found, e.g., with regard to the OL lesions, patient groups, follow-up time, and definition of...

  2. Diagnosis and treatment of temporomandibular disorders.

    Science.gov (United States)

    Gauer, Robert L; Semidey, Michael J

    2015-03-15

    Temporomandibular disorders (TMD) are a heterogeneous group of musculoskeletal and neuromuscular conditions involving the temporomandibular joint complex, and surrounding musculature and osseous components. TMD affects up to 15% of adults, with a peak incidence at 20 to 40 years of age. TMD is classified as intra-articular or extra-articular. Common symptoms include jaw pain or dysfunction, earache, headache, and facial pain. The etiology of TMD is multifactorial and includes biologic, environmental, social, emotional, and cognitive triggers. Diagnosis is most often based on history and physical examination. Diagnostic imaging may be beneficial when malocclusion or intra-articular abnormalities are suspected. Most patients improve with a combination of noninvasive therapies, including patient education, self-care, cognitive behavior therapy, pharmacotherapy, physical therapy, and occlusal devices. Nonsteroidal anti-inflammatory drugs and muscle relaxants are recommended initially, and benzodiazepines or antidepressants may be added for chronic cases. Referral to an oral and maxillofacial surgeon is indicated for refractory cases.

  3. Hyperthyroidism in pregnancy: diagnosis and treatment.

    Science.gov (United States)

    Masiukiewicz, U S; Burrow, G N

    1999-07-01

    Hyperthyroidism due to autoimmune Graves' disease is the leading cause of thyrotoxicosis in pregnant women. The peak incidence of the disease is in the second through the fourth decade of life, which encompasses the reproductive years for women. Although menstrual irregularity is frequent in women with mild to moderate hyperthyroidism, convincing evidence that fertility is impaired is lacking. In general, 2 of every 1000 pregnancies have been reported to be complicated by hyperthyroidism. Hyperthyroidism associated with pregnancy may pose a challenging diagnostic and therapeutic dilemma. The current review focuses on the discussion of symptomatology and diagnosis of the disease, on therapeutic options available to women presenting with hyperthyroidism during gestation, and on the controversy surrounding maternal and fetal outcome in pregnancies complicated by thyrotoxicosis.

  4. Clinical manifestations, diagnosis, and treatment of neurocysticercosis.

    Science.gov (United States)

    Sotelo, Julio

    2011-12-01

    Neurocysticercosis (NCC) is the most frequent parasitic disease of the human brain. Modern imaging studies, CT and MRI, have defined the diagnosis and characterization of the disease. Through these studies the therapeutic approach for each case may be individualized with the aid of antihelmintics, steroids, symptomatic medicines, or surgery. The use of one or various therapeutic measures largely depends on the peculiar combination of number, location, and biological stage of lesions as well as the degree of inflammatory response to the parasites. Although there is not a typical clinical picture of NCC, epilepsy is the most frequent manifestation of parenchymal NCC, whereas hydrocephalus is the most frequent manifestation of meningeal NCC. Eradication of cysticercosis is an attainable goal by public education and sanitary improvement in endemic areas.

  5. Canine hypoadrenocorticism: pathogenesis, diagnosis, and treatment.

    Science.gov (United States)

    Van Lanen, Kathleen; Sande, Allison

    2014-12-01

    Hypoadrenocorticism (Addison disease) is an uncommon condition in dogs and even more rare in cats. Hypoadrenocorticism is most often caused by immune-mediated destruction of the adrenal glands resulting in decreased mineralocorticoid and glucocorticoid production. Although less common, some dogs with hypoadrenocorticism have normal serum electrolytes. Hypoadrenocorticism causes a wide variety of clinical symptoms including gastrointestinal upset, weakness, weight loss, and hypovolemia. Laboratory and diagnostic findings vary, but classic abnormalities include hyperkalemia, hyponatremia, azotemia, anemia, and lack of a stress leukogram. However, many other diseases present with similar symptoms and diagnostic findings. Definitive diagnosis requires adrenocorticotropic hormone (ACTH) stimulation testing to demonstrate low basal and post-ACTH cortisol levels. In some cases, ACTH level or basal- and ACTH-stimulated aldosterone levels must also be measured. The prognosis for hypoadrenocorticism is good with appropriate mineralocorticoid and glucocorticoid supplementation. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. LOW BACK PAIN: CAUSES, DIAGNOSIS, AND TREATMENT

    Directory of Open Access Journals (Sweden)

    V A Parfenov

    2009-01-01

    Full Text Available Low back pain is stated to be of muscular origin, it is somewhat less frequently associated with osteochondrosis or/and spondyloarthrosis. While examining a patient with back pain, it is necessary to exclude rare causes (fractures, neoplasms, etc. that require special management. The diagnosis is established on the basis of physical, neurological, manual, and orthopedic studies. The presence of herniated disks, particularly those of small sizes detectable by computed tomography or magnetic resonance imaging, does not rule out any other cause of back pain. Musculoskeletal pain management is noted to relieve the pain, by returning the patient to an active life as soon as possible. Nonsteroidal anti-inflammatory drugs and myorelaxants are beneficial for pain relief. In chronic back pain, antidepressants are effective in case of depression; the occupational, social, and everyday rehabilitations are of great value.

  7. [Diagnosis and treatment of fungal ball rhino-sinusitis].

    Science.gov (United States)

    Nie, Jun; Liu, Fenfang; Zhang, Hanwu; Li, Li

    2013-07-01

    To explore the diagnosis and treatment of the fungal ball rhino-sinusitis. The clinical data of 128 cases with the fungal ball rhino-sinusitis in our hospital between September 2005 and January 2012 were retrospectively analyzed. All patients were accepted nasal endoscopic surgery and followed up after surgery. The diagnosis were confirmed by postoperative pathological examination. The sinus of all patients epithelialized after the surgery from fourth to ninth weeks, one case recurred eight months later. Sinus CT scan and nasal endoscopy were very important to the diagnosis of the fungal ball rhino-sinusitis, and nasal endoscopic surgery is the most important treatment method to fungal ball rhino-sinusitis.

  8. Cancer Cachexia: Cause, Diagnosis, and Treatment.

    Science.gov (United States)

    Mattox, Todd W

    2017-10-01

    Patients with cancer frequently experience unintended weight loss due to gastrointestinal (GI) dysfunction caused by the malignancy or treatment of the malignancy. However, others may present with weight loss related to other symptoms not clearly associated with identifiable GI dysfunction such as anorexia and early satiety. Cancer cachexia (CC) is a multifactorial syndrome that is generally characterized by ongoing loss of skeletal muscle mass with or without fat loss, often accompanied by anorexia, weakness, and fatigue. CC is associated with poor tolerance of antitumor treatments, reduced quality of life (QOL), and negative impact on survival. Symptoms associated with CC are thought to be caused in part by tumor-induced changes in host metabolism that result in systemic inflammation and abnormal neurohormonal responses. Unfortunately, there is no single standard treatment for CC. Nutrition consequences of oncologic treatments should be identified early with nutrition screening and assessment. Pharmacologic agents directed at improving appetite and countering metabolic abnormalities that cause inefficient nutrient utilization are currently the foundation for treating CC. Multiple agents have been investigated for their effects on weight, muscle wasting, and QOL. However, few are commercially available for use. Considerations for choosing the most appropriate treatment include effect on appetite, weight, QOL, risk of adverse effects, and cost and availability of the agent.

  9. Clinical symptoms, diagnosis, and treatment of neurocysticercosis.

    Science.gov (United States)

    Garcia, Hector H; Nash, Theodore E; Del Brutto, Oscar H

    2014-12-01

    The infection of the nervous system by the cystic larvae of Taenia solium (neurocysticercosis) is a frequent cause of seizure disorders. Neurocysticercosis is endemic or presumed to be endemic in many low-income countries. The lifecycle of the worm and the clinical manifestations of neurocysticercosis are well established, and CT and MRI have substantially improved knowledge of the disease course. Improvements in immunodiagnosis have further advanced comprehension of the pathophysiology of this disease. This knowledge has led to individualised treatment approaches that account for the involvement of parenchymal or extraparenchymal spaces, the number and form of parasites, and the extent of degeneration and associated inflammation. Clinical investigations are focused on development of effective treatments and reduction of side-effects induced by treatment, such as seizures, hydrocephalus, infarcts, and neuroinjury. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Dual diagnosis in Depression: treatment recommendations.

    Science.gov (United States)

    Tirado Muñoz, Judit; Farré, Adriana; Mestre-Pintó, Joan; Szerman, Nestor; Torrens, Marta

    2018-01-01

    Comorbidity between substance use disorders (SUD) and major depression (MD) is the most common dual pathology in the field of addiction to substances and has prevalence rates ranging between 12% and 80%, which complicates the response to treatment and worsens the prognosis of patients. Differentiating between diagnoses of induced depressive episodes and primary depressive episodes concurrent to substance use is especially relevant for therapeutic management. This article presents the state of the art of the currently available pharmacologic treatments of comorbid depression in patients with SUD, taking into account the safety and risk of abuse of antidepressant drugs. Due to the fact that comorbidity of MD and SUD is frequent and presents greater psychopathological and medical severity, as well as worse social functioning, it is crucial to treat MD and SUD simultaneously using the integrated treatment model and not to treat both conditions separately.

  11. Mozart ear: diagnosis, treatment, and literature review.

    Science.gov (United States)

    Yamashita, Ken; Yotsuyanagi, Takatoshi; Saito, Tamotsu; Isogai, Noritaka; Mori, Hiromasa; Itani, Yoshihito

    2011-11-01

    Mozart ear is a congenital auricular deformity, which is mainly characterized by a bulging appearance of the anterosuperior portion of the auricle, a convexly protruded cavum conchae, and a slit-like narrowing of the orifice of the external auditory meatus. It is said to be uncommon, and because no one has yet fully described neither the disease nor the treatment, the concept of Mozart ear has not been unified. This report describes a case of a 13-year-old girl presented with an unusual congenital deformity which showed the features of Mozart ear. It is an extremely rare deformity that only about 4 clinical cases have been reported in medical literature thereby a treatment method has not been fully discussed. For surgical correction of our cases, we excised deformed conchal cartilage, turned it over, regrafted, and maintained a cosmetically positive result. We also reviewed and described the origin, current concept, and treatment method of Mozart ear.

  12. Diagnosis and treatment of Helicobacter pylori infection

    DEFF Research Database (Denmark)

    Bytzer, Peter; Dahlerup, Jens Frederik; Eriksen, Jens Ravn

    2011-01-01

    with a rapid urease test. Proton pump inhibitor therapy should be stopped at least 1 week prior to Hp testing. All infected patients should be offered Hp eradication therapy. First-line treatment is 7-day triple therapy with a proton pump inhibitor and clarithromycine in combination with metronidazole...... or amoxicilline. Quadruple therapy for 2 weeks with bismuthsubsalicylate, tetracycline, metronidazole and a proton pump inhibitor is recommended in case of treatment failure. Hp testing should be offered to all patients after eradication therapy but is mandatory in patients with ulcer disease, noninvasive gastric...

  13. Diagnosis and Treatment of Thrombotic Thrombocytopenic Purpura

    African Journals Online (AJOL)

    Abe Olugbenga

    une des rares cliniques d'urgence qui se caractérise par des fonctionnalités d' .... A new drug,. Eculizumab an anti-C5 complement monoclonal antibody has been approved for treatment of a HUS (24). DEAP–HUS (deficiency of CFHR1 and.

  14. Crohn disease: pathophysiology, diagnosis, and treatment.

    Science.gov (United States)

    Mazal, Jonathan

    2014-01-01

    Crohn disease (often seen in the literature as "Crohn's disease"), an autoimmune disease with debilitating gastrointestinal and extragastrointestinal manifestations, is on the rise in the United States and Europe. This article discusses the disease process, clinical presentation, diagnostic tools, and treatment options for Crohn disease. Statistics regarding disease prevalence and epidemiology also are reported.

  15. Lyme Borreliosis: Diagnosis and Treatment Issues

    Directory of Open Access Journals (Sweden)

    L.R. Shostakovych-Koretska

    2014-04-01

    Full Text Available Lyme borreliosis (LB — the most common natural focal transmissible infection which occur in the USA, Europe, including Ukraine. It is a multisystem disease affecting the skin, heart, nervous system, joints that are prone to prolonged course. Official registration of the disease in Ukraine is being carried out since 2000. Level of epidemiological registration increases every year: LB incidence in Ukraine since 2000 for 10 years has increased 29 times, in the Dnipropetrovsk region — 12 times. The disease goes through several stages: from the appearance of the primary form — erythema migrans to the formation of chronic forms, which can lead to disability. In 25–50 % of patients, in the absence of adequate antibiotic therapy, in the early LB period we defined chronic form of the disease, especially heart failure. In this paper we present an algorithm for early diagnosis of «minor», clinically silent forms of heart disorders in LB at the early stages of the disease with the aim of rational choice of antibiotic therapy. It is shown that serological markers of LB (antibodies to IgM and IgG Borrelias can not be used to monitor the effectiveness of therapy.

  16. Septic Shock: Advances in Diagnosis and Treatment.

    Science.gov (United States)

    Seymour, Christopher W; Rosengart, Matthew R

    2015-08-18

    Septic shock is a clinical emergency that occurs in more than 230,000 US patients each year. OBSERVATIONS AND ADVANCES: In the setting of suspected or documented infection, septic shock is typically defined in a clinical setting by low systolic (≤90 mm Hg) or mean arterial blood pressure (≤65 mm Hg) accompanied by signs of hypoperfusion (eg, oliguria, hyperlactemia, poor peripheral perfusion, or altered mental status). Focused ultrasonography is recommended for the prompt recognition of complicating physiology (eg, hypovolemia or cardiogenic shock), while invasive hemodynamic monitoring is recommended only for select patients. In septic shock, 3 randomized clinical trials demonstrate that protocolized care offers little advantage compared with management without a protocol. Hydroxyethyl starch is no longer recommended, and debate continues about the role of various crystalloid solutions and albumin. The prompt diagnosis of septic shock begins with obtainment of medical history and performance of a physical examination for signs and symptoms of infection and may require focused ultrasonography to recognize more complex physiologic manifestations of shock. Clinicians should understand the importance of prompt administration of intravenous fluids and vasoactive medications aimed at restoring adequate circulation, and the limitations of protocol-based therapy, as guided by recent evidence.

  17. Diagnosis and treatment of acute bronchitis.

    Science.gov (United States)

    Albert, Ross H

    2010-12-01

    Cough is the most common symptom bringing patients to the primary care physician's office, and acute bronchitis is usually the diagnosis in these patients. Acute bronchitis should be differentiated from other common diagnoses, such as pneumonia and asthma, because these conditions may need specific therapies not indicated for bronchitis. Symptoms of bronchitis typically last about three weeks. The presence or absence of colored (e.g., green) sputum does not reliably differentiate between bacterial and viral lower respiratory tract infections. Viruses are responsible for more than 90 percent of acute bronchitis infections. Antibiotics are generally not indicated for bronchitis, and should be used only if pertussis is suspected to reduce transmission or if the patient is at increased risk of developing pneumonia (e.g., patients 65 years or older). The typical therapies for managing acute bronchitis symptoms have been shown to be ineffective, and the U.S. Food and Drug Administration recommends against using cough and cold preparations in children younger than six years. The supplement pelargonium may help reduce symptom severity in adults. As patient expectations for antibiotics and therapies for symptom management differ from evidence-based recommendations, effective communication strategies are necessary to provide the safest therapies available while maintaining patient satisfaction.

  18. Treatments for patients with dual diagnosis: a review.

    Science.gov (United States)

    Tiet, Quyen Q; Mausbach, Brent

    2007-04-01

    Comorbid substance use and mental illness is prevalent and often results in serious consequences. However, little is known about the efficacy of treatments for patients with dual diagnosis. This paper reviews both the psychosocial and medication treatments for those diagnosed with a substance-related disorder and one of the following disorders: (a) depression, (b) anxiety disorder, (c) schizophrenia, (d) bipolar disorder, (e) severe mental illness, and (f) nonspecific mental illness. We made no restriction of study design to include all published studies, due to the dearth of studies on treatments of patients with dual diagnosis. Fifty-nine studies were identified (36 randomized-controlled trials; RCT). Limited number of studies, especially RCTs, have been conducted within each comorbid category. This review did not find treatments that had been replicated and consistently showed clear advantages over comparison condition for both substance-related and other psychiatric outcomes. Although no treatment was identified as efficacious for both psychiatric disorders and substance-related disorder, this review finds: (1) existing efficacious treatments for reducing psychiatric symptoms also tend to work in dual-diagnosis patients, (2) existing efficacious treatments for reducing substance use also decrease substance use in dually diagnosed patients, and (3) the efficacy of integrated treatment is still unclear. This review provides a critique of the current state of the literature, identifies the directions for future research on treatment of dual-diagnosis individuals, and calls for urgent attention by researchers and funding agencies to conduct more and more methodologically rigorous research in this area.

  19. Medial Patella Subluxation: Diagnosis and Treatment

    Science.gov (United States)

    McCarthy, Mark A.; Bollier, Mathew J.

    2015-01-01

    Medial patella subluxation is a disabling condition typically associated with previous patellofemoral instability surgery. Patients often describe achy pain with painful popping episodes. They often report that the patella shifts laterally, which occurs as the medial subluxed patella dramatically shifts into the trochlear groove during early knee flexion. Physical examination is diagnostic with a positive medial subluxation test. Nonoperative treatment, such as focused physical therapy and patellofemoral stabilizing brace, is often unsuccessful. Primary surgical options include lateral retinacular repair/imbrication or lateral reconstruction. Prevention is key to avoid medial patella subluxation. When considering patellofemoral surgery, important factors include appropriate lateral release indications, consideration of lateral retinacular lengthening vs release, correct MPFL graft placement and tension, and avoiding excessive medialization during tubercle transfer. This review article will analyze patient symptoms, diagnostic exam findings and appropriate treatment options, as well as pearls to avoid this painful clinical entity. PMID:26361441

  20. Medial Patella Subluxation: Diagnosis and Treatment.

    Science.gov (United States)

    McCarthy, Mark A; Bollier, Mathew J

    2015-01-01

    Medial patella subluxation is a disabling condition typically associated with previous patellofemoral instability surgery. Patients often describe achy pain with painful popping episodes. They often report that the patella shifts laterally, which occurs as the medial subluxed patella dramatically shifts into the trochlear groove during early knee flexion. Physical examination is diagnostic with a positive medial subluxation test. Nonoperative treatment, such as focused physical therapy and patellofemoral stabilizing brace, is often unsuccessful. Primary surgical options include lateral retinacular repair/imbrication or lateral reconstruction. Prevention is key to avoid medial patella subluxation. When considering patellofemoral surgery, important factors include appropriate lateral release indications, consideration of lateral retinacular lengthening vs release, correct MPFL graft placement and tension, and avoiding excessive medialization during tubercle transfer. This review article will analyze patient symptoms, diagnostic exam findings and appropriate treatment options, as well as pearls to avoid this painful clinical entity.

  1. Diagnosis and treatment of fistulising Crohn's disease

    DEFF Research Database (Denmark)

    Hvas, Christian Lodberg; Dahlerup, Jens Frederik; Jacobsen, Bent Ascanius

    2011-01-01

    A fistula is defined as a pathological connection between the intestine and an inner (bladder or other intestine) or outer (vagina or skin) epithelial surface. Fistulas are discovered in up to 25% of all Crohn's disease patients during long-term follow-up examinations. Most are perianal fistulas....../MRI for complete anatomical definition. Any abscess should be drained, and the disease extent throughout the entire gastrointestinal tract should be evaluated. Treatment goals for perianal fistulas include reduced fistula secretion or none, evaluated by clinical examination; the absence of abscesses; and patient....... Definitive surgical closure of perianal fistulas using an advancement flap may be attempted, but this procedure is associated with a high risk of relapse. Colostomy and proctectomy are the ultimate surgical treatment options for fistulas. Intestinal resection is almost always needed for the closure...

  2. MALFUNCTIONING POSTGASTRECTOMY STOMA—Diagnosis and Treatment

    Science.gov (United States)

    Smith, Gordon K.; Overman, William E.

    1956-01-01

    Individualization in the treatment of patients with malfunctioning gastrojejunostomy stomas is paramount. Prompt surgical intervention in critically ill patients is necessary to save life. In the early postoperative phase, the use of barium studies is disappointing and very seldom gives information as to the actual site of the obstruction. In surgical treatment, operation directly upon the stoma should be avoided as much as possible. The release of small bowel obstruction, the reduction of intussusception or the correction of retraction of the jejunum through the mesocolon can be accomplished readily. Double or single jejunostomy for feeding and decompression are all that is necessary in cases in which no cause can be found for obstruction at or below the stoma. In a patient with peptic ulcer, the use of enteroenterostomy below the stoma is unphysiological and will predispose to gastrojejunal ulcer at a later date. PMID:13276832

  3. Orthopaedic Surgeon Burnout: Diagnosis, Treatment, and Prevention.

    Science.gov (United States)

    Daniels, Alan H; DePasse, J Mason; Kamal, Robin N

    2016-04-01

    Burnout is a syndrome marked by emotional exhaustion, depersonalization, and low job satisfaction. Rates of burnout in orthopaedic surgeons are higher than those in the general population and many other medical subspecialties. Half of all orthopaedic surgeons show symptoms of burnout, with the highest rates reported in residents and orthopaedic department chairpersons. This syndrome is associated with poor outcomes for surgeons, institutions, and patients. Validated instruments exist to objectively diagnose burnout, although family members and colleagues should be aware of early warning signs and risk factors, such as irritability, withdrawal, and failing relationships at work and home. Emerging evidence indicates that mindfulness-based interventions or educational programs combined with meditation may be effective treatment options. Orthopaedic residency programs, departments, and practices should focus on identifying the signs of burnout and implementing prevention and treatment programs that have been shown to mitigate symptoms.

  4. Medial Patella Subluxation: Diagnosis and Treatment

    OpenAIRE

    McCarthy, Mark A.; Bollier, Mathew J.

    2015-01-01

    Medial patella subluxation is a disabling condition typically associated with previous patellofemoral instability surgery. Patients often describe achy pain with painful popping episodes. They often report that the patella shifts laterally, which occurs as the medial subluxed patella dramatically shifts into the trochlear groove during early knee flexion. Physical examination is diagnostic with a positive medial subluxation test. Nonoperative treatment, such as focused physical therapy and pa...

  5. Alcohol withdrawal delirium - diagnosis, course and treatment.

    Science.gov (United States)

    Mainerova, Barbora; Prasko, Jan; Latalova, Klara; Axmann, Karel; Cerna, Monika; Horacek, Rostislav; Bradacova, Romana

    2015-03-01

    Delirium tremens represents the most severe complication of alcohol withdrawal syndrome and, in its complications, significantly increases the morbidity and mortality of patients. Alcohol withdrawal delirium is characterized by features of alcohol withdrawal itself (tremor, sweating, hypertension, tachycardia etc.) together with general delirious symptoms such as clouded consciousness, disorientation, disturbed circadian rhythms, thought processe and sensory disturbances, all of them fluctuating in time. The treatment combines a supportive and symptomatic approach. Benzodiazepines in supramaximal doses are usually used as drugs of choice but in some countries such as the Czech Republic or Germany, clomethiazole is frequently used as well. A computer search of the all the literature published between 1966 and December 2012 was accomplished on MEDLINE and Web of Science with the key words "delirium tremens", "alcohol withdrawal", "treatment" and "pharmacotherapy". There were no language or time limits applied. When not early recognized and treated adequately, delirium tremens may result in death due to malignant arrhythmia, respiratory arrest, sepsis, severe electrolyte disturbance or prolonged seizures and subsequent trauma. Owing to these possible fatalities and other severe unexpected complications, delirium tremens should be managed at an ICU or wards ensuring vital signs monitoring. In symptomatic treatment, high doses of benzodiazepines, especially lorazepam, diazepam and oxazepam are considered the gold standard drugs. Supportive therapy is also of great importance.

  6. Pancreas Bone Testis Axis

    Directory of Open Access Journals (Sweden)

    Gulfidan Coskun

    2015-09-01

    Full Text Available Bone which has movement and support functions, is the largest organ of the body. Bone is regulated by hormonal signal but it also acts as an endocrine organ. Many peptide hormones such as osteocalcin are secreted from bone. Osteocalcin which is an osteoblast derived hormone, has two forms: and ldquo;carboxylated (inactive osteocalcin and decarboxylated (active osteocalcin and rdquo;. While inactive osteocalcin is found in bone matrix, active osteocalcin is given to blood circulation and acts as a multifunctional hormone. In the past ten years, numerous epidemiological, genetic and biochemical studies have revealed hormonal links between bone and pancreas, adipose tissue, gonads via active osteocalcin. In this review, a newly defined pathway called pancreas-bone-testis axis which stimulates testosterone synthesis independent of hypothalamic hypophyseal testicular axis, is discussed. [Archives Medical Review Journal 2015; 24(3.000: 355-367

  7. Acute recurrent pancreatitis: Etiopathogenesis, diagnosis and treatment.

    Science.gov (United States)

    Testoni, Pier Alberto

    2014-12-07

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

  8. [Diagnosis and treatment of bladder cancer].

    Science.gov (United States)

    Lopatkin, N A; Darenkov, S P; Chernyshev, I V; Martov, A G; Stupak, N V

    2004-01-01

    The authors present a retrospective analysis of the results of transurethral conservative and radical operations in 125 patients with invasive cancer of the urinary bladder (UB) treated in the Research Institute of Urology throughout 1992-2002. Transurethral resection (TUR) of the UB was made in 72 patients. Stages pT2a, pT2b, T3 and T4 were diagnosed in 23 (31.9%), 18 (25%), 14 (19.5%) and 17 (23.6%) cases, respectively. 53 patients with advanced invasive UB cancer have undergone radical cystectomy varying by the method of urine derivation. Stages pT2N0M0, pT3aN0M0, pT3bN0M0, pT4aN0M0 and N1-2 were registered in 4 (7.5%), 13 (25%), 21 (40%), 7 (12.5%) and 8 (15%) patients, respectively. UB cancer recurrences after TUR occurred in 12 (16.7%) patients with stage pT2a, in 8 (11.1%) patients with stage pT2b. Three-year overall and recurrence-free survival after TUR at stage T2 reached 97.5 +/- 3.2 and 47.4 +/- 2.8, respectively, at stage T3 and T4--57.1 +/- 4.3 and 26.6 +/- 3.4%, respectively. Postcystectomy distant metastases to the lungs, bones and iliac lymph nodes after treatment were detected in 3, 2 and 3 patients, respectively. One patient had a local pelvic recurrence. For all 53 patients a 2-year corrected survival made up 68 +/- 12.0%. Thus, transurethral electrosurgery is an effective treatment of invasive UB cancer; the only radical surgical treatment for invasive UB cancer is cystectomy.

  9. Acute recurrent pancreatitis: Etiopathogenesis, diagnosis and treatment

    Science.gov (United States)

    Testoni, Pier Alberto

    2014-01-01

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

  10. Prenatal Depression: Best Practice Guidelines for Diagnosis and Treatment

    Science.gov (United States)

    Choate, Laura H.; Gintner, Gary G.

    2011-01-01

    The purpose of this article is to provide counselors with an overview of best practices for the treatment of women who experience prenatal depression (PND). The authors first discuss issues in the screening and diagnosis of PND. Next, the 2 most common treatments, antidepressants and psychotherapy, are reviewed and discussed in relation to current…

  11. [Device diagnosis and combined treatment of hyperventilation syndrome].

    Science.gov (United States)

    2012-01-01

    Hyperventilation syndrome is a separate disease and a symptom of other psychosomatic diseases. A variant of device diagnosis of the disease is proposed--integral rheoplethysmography by M. I. Tischenko and cardiointervalography by R. M. Baevsky. Hyper- and asthenic courses of the disease are described, the pathological psychoemotional pattern is recognized. The proposed treatment combines physiohemotherapy (laser treatment) and pharmacotherapy.

  12. Illicit Opioid Intoxication: Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    A. Fareed

    2011-01-01

    Full Text Available Opioid intoxications and overdose are associated with high rates of morbidity and mortality. Opioid overdose may occur in the setting of intravenous or intranasal heroin use, illicit use of diverted opioid medications, intentional or accidental misuse of prescription pain medications, or iatrogenic overdose. In this review, we focused on the epidemiology of illict opioid use in the United States and on the mechanism of action of opioid drugs. We also described the signs and symptoms, and diagnoses of intoxication and overdose. Lastly, we updated the reader about the most recent recommendations for treatment and prevention of opioid intoxications and overdose.

  13. Cheating and sports: history, diagnosis and treatment.

    Science.gov (United States)

    Kamis, Danielle; Newmark, Thomas; Begel, Daniel; Glick, Ira D

    2016-12-01

    This paper focuses on "cheating" in modern day athletics from youth through professional sports. We briefly summarize a history of cheating in the sports world. We examine the current role cheating plays in sports as well as its causes including, psychodynamic issues, the development of personality disorders and how personality traits become pathological resulting in deception, dishonesty, and underhandedness. We describe management and treatment including psychotherapeutic intervention as well as medication. Finally we discuss a systems approach involving outreach to coaches, families, and related sports organizations (like FIFA, WADA, etc) or the professional leagues which have institutional control and partial influence on the athlete.

  14. Inhalation Injury: Pathophysiology, Diagnosis, and Treatment.

    Science.gov (United States)

    Jones, Samuel W; Williams, Felicia N; Cairns, Bruce A; Cartotto, Robert

    2017-07-01

    The classic determinants of mortality from severe burn injury are age, size of injury, delays of resuscitation, and the presence of inhalation injury. Of the major determinants of mortality, inhalation injury remains one of the most challenging injuries for burn care providers. Patients with inhalation injury are at increased risk for pneumonia (the leading cause of death) and multisystem organ failure. There is no consensus among leading burn care centers in the management of inhalation injury. This article outlines the current treatment algorithms and the evidence of their efficacy. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Diagnosis and Treatment of Clinical Rumen Acidosis.

    Science.gov (United States)

    Snyder, Emily; Credille, Brent

    2017-11-01

    Clinical rumen acidosis is an important cause of morbidity and mortality in both large and small ruminants. Feeding and management practices that lead to the consumption of large amounts of readily fermentable carbohydrates precipitate clinical disease. The fermentation of carbohydrates into volatile fatty acids and lactate causes acidosis (local and systemic), rumen ulceration, cardiovascular compromise, and organ dysfunction. Animals affected with acidosis can suffer from numerous sequelae. Treatment of animals with clinical rumen acidosis is focused on addressing plasma volume deficits, correcting acid-base disturbances, and restoring a normal rumen microenvironment. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Plantar fasciitis: what is the diagnosis and treatment?

    Science.gov (United States)

    Johnson, Rachel E; Haas, Kim; Lindow, Kyle; Shields, Robert

    2014-01-01

    Foot pain, specifically plantar heel pain, is a common complaint among patients in a podiatric or orthopaedic office setting but may be seen in primary care offices, urgent care centers, or emergency departments as well. There are numerous causes for heel pain, but plantar fasciitis is the most frequent cause. The diagnosis of plantar fasciitis is generally made clinically, but there are many diagnostic modalities that may be used to confirm the diagnosis. Treatment of plantar fasciitis ranges from conservative measures to surgical interventions, but most cases of plantar fasciitis can be managed conservatively. There is no definitive treatment proven to be the best option for plantar fasciitis. Treatment is patient dependent and commonly requires a combination of different modalities to successfully alleviate the symptoms. In this article, plantar fasciitis from defining the disorder, diagnosis, and treatment are discussed.

  17. Correction of posterior crossbites: diagnosis and treatment.

    Science.gov (United States)

    Binder, Robert E

    2004-01-01

    The correction of posterior crossbites is more complex than it appears. To develop an appropriate treatment plan, it is first necessary to determine if: (1) there is a functional jaw shift on closing; (2) the crossbite is unilateral or bilateral; (3) it is dental, skeletal, or a combination of both; and (4) it is related only to the maxilla or both jaws. Once the problem's apparent cause has been defined, it is then necessary to select the appropriate modality of treatment, which, in the maxilla, is: (1) usually a removable acrylic-based appliance with 1 or more transverse screws; or (2) a fixed Hyrax-type or Hass-type appliance. In the mandible, if dental expansion is required, the appliances most frequently used are the lip bumper or a removable acrylic-based appliance with a single screw lingual to the incisors. Once the appliance has been placed, it must be determined when adequate expansion has been achieved and how best to retain it.

  18. Hemoglobinopathies: clinical manifestations, diagnosis, and treatment.

    Science.gov (United States)

    Kohne, Elisabeth

    2011-08-01

    Hemoglobinopathies are among the most common inherited diseases around the world. They have become much more common recently in northern and central Europe, including Germany, due to immigration. Selective review of the literature with consideration of national guidelines. The hemoglobinopathies encompass all genetic diseases of hemoglobin. They fall into two main groups: thalassemia syndromes and structural hemoglobin variants (abnormal hemoglobins). α- and β-thalassemia are the main types of thalassemia; the main structural hemoglobin variants are HbS, HbE and HbC. There are many subtypes and combined types in each group. The highly variable clinical manifestations of the hemoglobinopathies range from mild hypochromic anemia to moderate hematological disease to severe, lifelong, transfusion-dependent anemia with multiorgan involvement. Stem-cell transplantation is the preferred treatment for the severe forms of thalassemia. Supportive, rather than curative, treatment consists of periodic blood transfusions for life, combined with iron chelation. Drugs to treat the symptoms of sickle-cell disease include analgesics, antibiotics, ACE inhibitors and hydroxyurea. Blood transfusions should be given only when strictly indicated. More than 90% of patients currently survive into adulthood. Optimally treated patients have a projected life span of 50 to 60 years. Hemoglobinopathies are a public health issue in today's multiethnic German population. Adequate care of the affected patients requires a wide variety of diagnostic and therapeutic measures.

  19. Axillary nerve injury: diagnosis and treatment.

    Science.gov (United States)

    Steinmann, S P; Moran, E A

    2001-01-01

    Axillary nerve injury is infrequently diagnosed but is not a rare occurrence. Injury to the nerve may result from a traction force or blunt trauma applied to the shoulder. The most common zone of injury is just proximal to the quadrilateral space. Atraumatic causes of neuropathy include brachial neuritis and quadrilateral space syndrome. The vast majority of patients recover with non-operative treatment. Baseline electromyographic and nerve conduction studies should be obtained within 4 weeks after injury, with a follow-up evaluation at 12 weeks. If no clinical or electromyographic improvement is noted, surgery may be appropriate. The results of operative repair are best if surgery is performed within 3 to 6 months from the injury. Surgical options include neurolysis, nerve grafting, and neurotization. The results of repair of axillary nerve injuries have been good compared with treatment of other peripheral nerve lesions, due to the monofascicular composition of the nerve and the relatively short distance between the zone of injury and the motor end-plate.

  20. [Diagnosis and treatment for complicated atlantoaxial dislocation].

    Science.gov (United States)

    Yin, Qing-shui; Xia, Hong; Wu, Zeng-hui; Ai, Fu-zhi; Ma, Xiang-yang; Zhang, Kai; Wang, Jian-hua; Mai, Xiao-hong; Wan, Lei; Chen, Xu-qiong

    2010-09-01

    To explore the clinical characteristics and treatment methods for complicated atlantoaxial dislocation. A retrospective evaluation was done to summarize and analyze the clinical characteristics and complicated factors of 54 patients with complicated atlantoaxial dislocation who could not to be treated effectively by using conventional therapy in our hospital from February 2005 to October 2008. According to different complicated factors, different treatment methods mainly including transoral atlantoaxial reduction plate-III (TARP-III) operation, decompression procedure with deep grinding guided by computer aided design-rapid prototyping (CAD-RP), screw placement technique with CAD-RP guide plate and extensile approach surgery were performed. The average follow-up period was 24 months. Among 54 cases, 48 cases achieved immediate anatomic reduction completely and 6 cases almost achieved anatomical reduction. All the compressed spinal cords were decompressed sufficiently. The decompression rate was 86.0% and the improvement rate of nerve function was 77.8%. Two cases suffered postoperative intracranial infection. Some cases of complicated atlantoaxial dislocation can be effectively treated by using TARP-III operation, decompression procedure with deep grinding guided by CAD-RP, individualized screw placement technique with CAD-RP guide plate and extensile approach surgery.

  1. Ultrastructural changes in the testis and epididymis of rats following treatment with the benzene chromatographic fraction of the chloroform extract of the seeds of Carica papaya.

    Science.gov (United States)

    Manivannan, B; Mishra, P K; Pathak, N; Sriram, S; Bhande, S S; Panneerdoss, S; Lohiya, N K

    2004-04-01

    The benzene chromatographic fraction of the chloroform extract of the seeds of Carica papaya at a dose of 10 mg/rat/day for 150 days, which has shown a total inhibition of motility, reduced sperm count and infertility, was tested to de fi ne the mode of action at the subcellular level in the testis and epididymis. The ultrastructure of the testis of the treated animals revealed no appreciable changes in the subcellular characteristics. The mechanism of protein synthesis as well as steroidogenesis were evident in the Sertoli cells while the spermatogonia, spermatocytes and spermatids, both round and elongated, depicted a prominent nucleus, distinct nuclear membrane and cytoplasmic characteristics indicating normal germ cell differentiation. The principal cells of the cauda epididymis were characterized by the presence of well-de fi ned rough endoplasmic reticulum, mitochondria, Golgi bodies and secretary granules, suggesting active secretory functions. The absorptive function of the cauda epididymis was evidenced by the presence of numerous vesicles and multivesicular bodies adjacent to stereocilia. It is concluded that the inhibition of sperm motility by the drug could be due to other epididymal factors rather than the subcellular characteristics of testis and epididymis. Copyright 2004 John Wiley & Sons, Ltd.

  2. Diagnosis and Treatment of Intussusception in Children

    Directory of Open Access Journals (Sweden)

    O.V. Spakhi

    2016-08-01

    Full Text Available Intussusception is the most common form of acquired gastrointestinal obstruction in children. The aim is to study the features of clinical course and treatment strategy for intussusception in children and to analyze limitations of diagnostic, clinical and special research methods. Materials and methods of the study. The analysis of treatment outcomes has been carried out in 272 children in pediatric surgery clinic from 2004 to 2015. We have developed the objective criteria for evaluation of intussusception stages that correlate with the degree of endotoxemia, changes in respiratory function and circulation, the disorders of gut motility, as well as ultrasound of the abdominal organs. Results and discussion. Patients with intussusception stage I (233 children had no signs of endotoxemia or they were non-significant. In 10 children we performed surgery, in 4 cases — laporoscopically. Of the 32 patients with stage II, in 8 cases the intussusception was straightened conservatively on the first try. We don’t make a second attempt in children with intussusception stage II. Surgical straightening was perfomed in 24 patients. Intussusception stage III in children (7 patients had signs of third degree endotoxemia. All patients of the third stage of intussusception underwent median laparotomy. In 5 cases we have detected intussusceptum necrosis, and these children were made bowel resection followed by the imposition of final ileostomy and intubation of the small intestine. In the rest (2 of patients, we managed to straighten the intussusceptum, and the gut was recognized as vital. Imposing primary anastomosis after the bowel resection in peritonitis we consider unacceptable. Conclusions. 1. Comprehensive survey of children using laboratory and instrumental methods became the basis for the allocation of 3 stages of intussusception, which correlated with the degree of endotoxemia and impaired bowel functions: stage I — compensated; stage II

  3. Alcohol: intoxication and poisoning - diagnosis and treatment.

    Science.gov (United States)

    Jung, Young-Chul; Namkoong, Kee

    2014-01-01

    Alcohol intoxication refers to a clinically harmful condition induced by recent ingestion of alcohol, when alcohol and its metabolites accumulate in the blood stream faster than it can be metabolized by the liver. The major adverse effects of alcohol that gain clinical attention are the neurologic, gastrointestinal, and cardiovascular problems, which are usually related to blood alcohol concentration; however, the extent of acute alcohol intoxication also depends on several factors. Individuals who seek medical treatment for acute alcohol intoxication likely have additional medical problems related to chronic alcohol consumption or alcohol dependence. For this reason, additional investigations to identify potential problems needing particular attention should be considered, depending on the clinical features of the patient. © 2014 Elsevier B.V. All rights reserved.

  4. Diagnosis and treatment of viral myocarditis.

    Science.gov (United States)

    Schultz, Jason C; Hilliard, Anthony A; Cooper, Leslie T; Rihal, Charanjit S

    2009-11-01

    Myocarditis, an inflammatory disease of heart muscle, is an important cause of dilated cardiomyopathy worldwide. Viral infection is also an important cause of myocarditis, and the spectrum of viruses known to cause myocarditis has changed in the past 2 decades. Several new diagnostic methods, such as cardiac magnetic resonance imaging, are useful for diagnosing myocarditis. Endomyocardial biopsy may be used for patients with acute dilated cardiomyopathy associated with hemodynamic compromise, those with life-threatening arrhythmia, and those whose condition does not respond to conventional supportive therapy. Important prognostic variables include the degree of left and right ventricular dysfunction, heart block, and specific histopathological forms of myocarditis. We review diagnostic and therapeutic strategies for the treatment of viral myocarditis. English-language publications in PubMed and references from relevant articles published between January 1, 1985, and August 5, 2008, were analyzed. Main keywords searched were myocarditis, dilated cardiomyopathy, endomyocardial biopsy, cardiac magnetic resonance imaging, and immunotherapy.

  5. Herpes Genitalis: Diagnosis, Treatment and Prevention

    Science.gov (United States)

    Sauerbrei, A.

    2016-01-01

    Herpes genitalis is caused by the herpes simplex virus type 1 or type 2 and can manifest as primary or recurrent infection. It is one of the most common sexually transmitted infections and due to associated physical and psychological morbidity it constitutes a considerable, often underestimated medical problem. In addition to providing the reader with basic knowledge of the pathogen and clinical presentation of herpes genitalis, this review article discusses important aspects of the laboratory diagnostics, antiviral therapy and prophylaxis. The article is aimed at all health-care workers managing patients with herpes genitalis and attempts to improve the often suboptimal counselling, targeted use of laboratory diagnostics, treatment and preventive measures provided to patients. PMID:28017972

  6. Research advance on diagnosis and treatment for atypical optic neuritis

    Directory of Open Access Journals (Sweden)

    Guo-Yan Zeng

    2016-06-01

    Full Text Available Optic neuritis(ONis one of the most common causes of vision loss by neural eye diseases in youth and middle-aged. In the past, the diagnosis simply according to the risk position, which did not distinguish from the pathogenesis and clinical characteristics, can not meet the current clinical diagnosis and treatment needs. Combining with the etiology, clinical characteristics and prognosis, the latest classification of the current international diagnosis of ON are typical and atypical ON. Typical ON relates to multiple sclerosis(MSor demyelinating disease of the central nervous system, it has a relatively good therapeutic effect and prognosis. Rather than, atypical ON has complex etiology, clinical manifestation, and the treatment and prognosis are also different. At present there are many international ON treatment guidelines with level I evidence-based medical evidence, but with different genetic background, geographical environment and ethnic groups, they are not been determined. China lacks of such a multicenter large sample, a wide range of research evidence. In this paper, we will summarize the progress of the diagnosis and treatment about ON, especially about the atypical ON, in order to provide some suggestions to further improve the standardization and individualization for clinical diagnosis and treatment on ON.

  7. [Infective endocarditis : Update on prophylaxis, diagnosis, and treatment].

    Science.gov (United States)

    Dietz, S; Lemm, H; Janusch, M; Buerke, M

    2016-05-01

    The diagnosis of infective endocarditis is often delayed in clinical practice. Timely diagnosis and rapid antibiotic treatment is important. Higher age of patients, new risk factors, and increasing use of intravascular prosthetic materials resulted in changes in microbial spectrum. Nowadays, nonspecific symptoms, critically ill patients, and immunocompromised patients require a high level of diagnostic expertise.The new guidelines from the European Society of Cardiology provide various diagnostic algorithms and recommendations for antibiotic treatment. The new guidelines also recommend the formation of an endocarditis team with various medical disciplines, including a cardiac surgeon, to improve treatment because in half of all endocarditis patients, antibiotic therapy alone does not result in successful management of the infection. If complications occur, early surgical treatment should be performed.In this overview, diagnostic strategies and therapeutic approaches for the treatment of infectious endocarditis according to the current guidelines and aspects of surgical treatment are provided.

  8. [Diagnosis, pathogenesis and treatment of panic attacks].

    Science.gov (United States)

    Turczyński, J

    Panic accompanies several diseases both psychological and somatic. It may be secondary, i.e. produced by other symptoms and morbid processes. It may also be primary--"neurotic". In such cases there are two forms of panic: generalized and paroxysmal. Attacks of panic are seen in 1.6-2.9% of women and in 0.4-1.7% of men. Main pathogenetic role is played by the psychologic factors (psychical trauma precedes the onset of diseases). The role of biological factors is also important. It is believed that disorders of the noradrenergic, serotonin-ergic, and GABA-ergic transmission may produce the attacks of panic. Psychotherapy is a treatment of choice. Pharmacotherapy plays only an adjuvant role. Antidepressants (tricyclic of II generation) are most frequently used for this purpose and--exceptionally due to possible addiction--benzodiazepines. The highest impact on the development of disease has first contact physician attitude. Patient and thoughtful listening to the patient, explanation of the complaints and their source often produce and improvement, and even complete recovery.

  9. The diagnosis and treatment of pediatric narcolepsy.

    Science.gov (United States)

    Nevsimalova, Sona

    2014-08-01

    Narcolepsy in children is a serious disorder marked by a chronic course and lifelong handicap in school performance and choice of employment, by free time activity limitation, and by behavior and personality changes, all of which constitute a major influence on the quality of life. Increased daytime sleepiness may be the only sign at the disease onset, with attacks of sleep becoming longer and lasting up to hours. Also present may be confusional arousals with features of sleep drunkenness. Paradoxically, preschool and young children may show inattentiveness, emotional lability, and hyperactive behavior. Cataplexy may develop after onset of sleepiness and affect mainly muscles of the face. Hypnagogic hallucinations and sleep paralysis are seldom present. Multiple Sleep Latency Test criteria are not available for children younger than 6 years. The haplotype (HLA-DQB1:0602) can be associated with the disorder; however, the best predictor of narcolepsy-cataplexy is hypocretin deficiency. The treatment generally used in adults is regarded as off-label in childhood, which is why the management of pediatric narcolepsy is difficult.

  10. Dysthymia and Apathy: Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Junko Ishizaki

    2011-01-01

    Full Text Available Dysthymia is a depressive mood disorder characterized by chronic and persistent but mild depression. It is often difficult to be distinguished from major depression, specifically in its partially remitted state because “loss of interest” or “apathy” tends to prevail both in dysthymia, and remitted depression. Apathy may also occur in various psychiatric and neurological disorders, including schizophrenia, stroke, Parkinson's disease, progressive supranuclear palsy, Huntington's disease, and dementias such as Alzheimer's disease, vascular dementia, and frontotemporal dementia. It is symptomatologically important that apathy is related to, but different from, major depression from the viewpoint of its causes and treatment. Antidepressants, especially noradrenergic agents, are useful for depression-related apathy. However, selective serotonin reuptake inhibitors (SSRIs may be less effective for apathy in depressed elderly patients and have even been reported to worsen apathy. Dopaminergic agonists seem to be effective for apathy. Acetylcholine esterase inhibitors, methylphenidate, atypical antipsychotics, nicergoline, and cilostazol are another choice. Medication choice should be determined according to the background and underlying etiology of the targeting disease.

  11. Diagnosis and treatment of chronic insomnia.

    Science.gov (United States)

    Saddichha, Sahoo

    2010-04-01

    Insomnia is a disorder characterized by inability to sleep or a total lack of sleep, prevalence of which ranges from 10 to 15% among the general population with increased rates seen among older ages, female gender, White population and presence of medical or psychiatric illness. Yet this condition is still under-recognized, under-diagnosed, and under-treated. This article aims to review the operational definitions and management of chronic insomnia. A computerized search on PubMed carried from 1980 to January 2009 led to the summarization of the results. There are several strategies to manage chronic insomnia. To initiate treatment, it is necessary to define it and differentiate it from other co-morbid psychiatric disorders. Non-pharmacologic strategies such as stimulus control therapy and relaxation and cognitive therapies have the best effect sizes followed by sleep restriction, paradoxical intention and sleep hygiene education which have modest to less than modest effect sizes. Among pharmacotherapeutic agents, non-benzodiazepine hypnotics are the first line of management followed by benzodiazepines, amitryptiline and antihistaminics. However, adequate trials of combined behavior therapy and pharmacotherapy are the best course of management.

  12. Diagnosis and treatment of chronic insomnia

    Directory of Open Access Journals (Sweden)

    Saddichha Sahoo

    2010-01-01

    Full Text Available Insomnia is a disorder characterized by inability to sleep or a total lack of sleep, prevalence of which ranges from 10 to 15% among the general population with increased rates seen among older ages, female gender, White population and presence of medical or psychiatric illness. Yet this condition is still under-recognized, under-diagnosed, and under-treated. This article aims to review the operational definitions and management of chronic insomnia. A computerized search on PubMed carried from 1980 to January 2009 led to the summarization of the results. There are several strategies to manage chronic insomnia. To initiate treatment, it is necessary to define it and differentiate it from other co-morbid psychiatric disorders. Non-pharmacologic strategies such as stimulus control therapy and relaxation and cognitive therapies have the best effect sizes followed by sleep restriction, paradoxical intention and sleep hygiene education which have modest to less than modest effect sizes. Among pharmacotherapeutic agents, non-benzodiazepine hypnotics are the first line of management followed by benzodiazepines, amitryptiline and antihistaminics. However, adequate trials of combined behavior therapy and pharmacotherapy are the best course of management.

  13. An unexpected finding of a rare intrascrotal lesion: the sertoliform cystadenoma of the rete testis.

    Science.gov (United States)

    Sahnan, Kapil; Manjunath, Aditya; Vaughan-Shaw, Peter G; Mitsopoulos, Grigorios

    2013-02-20

    A 19-year-old man presented with a right testicular swelling. Testicular ultrasound demonstrated areas suspicious for malignancy and so it was decided to proceed for a right radical inguinal orchiectomy. Initial histological examination revealed a multiloculated cystic lesion at the area of the rete testis yet normal testicular parenchyma elsewhere. Specialist histological opinion was sought from the regional teratoma multi-disciplinary team which confirmed the diagnosis of a sertoliform cystadenoma, an extremely rare benign testicular neoplasm. The recognition of the benign nature of the mass enabled complete reassurance to be offered to the patient and avoided further oncological treatment.

  14. Diagnosis and treatment of superficial vein thrombosis.

    Science.gov (United States)

    Bauersachs, R M

    2013-08-01

    Superficial vein thrombosis (SVT) is a common disease, characterized by an inflammatory-thrombotic process in a superficial vein. Typical clinical findings are pain and a warm, tender, reddish cord along the vein. Until recently, no reliable epidemiological data were available. The incidence is estimated to be higher than that of deep-vein thrombosis (DVT) (1/1000). SVT shares many risk factors with DVT, but affects twice as many women than men and frequently occurs in varicose veins. Clinically, SVT extension is commonly underestimated, and patients may have asymptomatic DVT. Therefore, ultrasound assessment and exclusion of DVT is essential. Risk factors for concomitant DVT are recent hospitalization, immobilization, autoimmune disorders, age > 75 years, prior VTE, cancer and SVT in non-varicose veins. Even though most patients with isolated SVT (without concomitant DVT or PE) are commonly treated with anticoagulation for a median of 15 days, about 8% experience symptomatic thromboembolic complications within three months. Risk factors for occurrence of complications are male gender, history of VTE, cancer, SVT in a non-varicose vein or SVT involving the sapheno-femoral junction (SFJ). As evidence supporting treatment of isolated SVT was sparse and of poor quality, the large, randomized, double-blind, placebo-controlled CALISTO trial was initiated assessing the effect of fondaparinux on symptomatic outcomes in isolated SVT. This study showed that, compared with placebo, 2.5 mg fondaparinux given for 45 days reduced the risk of symptomatic thromboembolic complications by 85% without increasing bleeding. Based on CALISTO and other observational studies, evidence-based recommendations can be made for the majority of SVT patients. Further studies can now be performed in higher risk patients to address unresolved issues.

  15. Synchronous rhabdomyosarcoma of the testis and kidney: A case ...

    African Journals Online (AJOL)

    ... obstructed left inguinoscrotal hernia and a right renal mass. The patient had surgery, and a diagnosis of synchronous rhabdomyosarcoma of the left testis, paratesticular tissue and right kidney was made by histology and immunohistochemistry. Keywords: Rhabdomyosarcoma; Synchronous tumour; Immunohistochemistry ...

  16. Synchronous rhabdomyosarcoma of the testis and kidney: A case ...

    African Journals Online (AJOL)

    Babatunde M. Duduyemi

    2015-04-15

    Apr 15, 2015 ... b Department of Paediatric Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana c Department of Medicine, Kwame Nkrumah ... The patient had surgery, and a diagnosis of synchronous rhabdomyosar- coma of the left testis, paratesticular ..... Children's cancer study group. Pediatric oncology group.

  17. Ruptured Seminoma of Undescended Testis Presenting as Acute ...

    African Journals Online (AJOL)

    Radiological and pre‑operative diagnosis of complications such as torsion or rupture is often difficult because, generally, the history of cryptorchidism is not provided and imaging findings can be non‑specific. In a male patient with undescended testis, and presence of a retroperitoneal mass on imaging, testicular malignancy.

  18. Experiences of cancer patients in Poland throughout diagnosis and treatment.

    Science.gov (United States)

    Godlewski, D; Adamczak, M; Wojtyś, P

    2017-03-01

    Previous studies have failed to explain why the mortality rate of cancer patients is higher in Poland than other countries in the European Union. We aimed to evaluate the health care system in Poland during the diagnosis and treatment of cancer. In this multicentre study, 125 cancer patients treated at 15 centres across Poland participated in focus group interviews in 2014. We identified and assessed crucial elements that affect a patients' experience from the early onset of symptoms, through to diagnosis and treatment. We found that the majority of patients were dissatisfied with the length of time taken to diagnose cancer. Throughout diagnosis, treatment and follow-up, patients reported a lack of communication from health care professionals. While dealings with oncologists and medical staff were viewed favourably, patients felt the cancer centres were not well organised. Patients recommended that having one doctor in charge of an individual's treatment and follow-up would improve patient care and well-being. A late cancer diagnosis may be contributing to the high mortality rate observed in Poland. In the future, new policies should be developed to reduce the time to cancer diagnosis, increase communication with health care professionals and improve the organisation of cancer care for patients. © 2016 John Wiley & Sons Ltd.

  19. Psychiatric conditions in sports: diagnosis, treatment, and quality of life.

    Science.gov (United States)

    Glick, Ira D; Horsfall, Jessica L

    2009-10-01

    The social stigma surrounding psychiatric illness may prevent athletes from seeking counseling, psychotherapy, medication, or other treatment when needed. Few controlled studies on athletes exist to guide the team physician, clinician, or psychiatrist who must deal with diagnostic issues. Management involves setting realistic goals, educating as well as inducing the patient into treatment, soliciting support from family or significant others, and delivering appropriate treatment (the most difficult task). The objective is to improve performance and quality of life. Confidentiality issues are paramount during diagnosis and treatment. Physicians who understand sports and team dynamics may have more success in helping patients follow through with treatment.

  20. Research Progress of Exosomes in Lung Cancer Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Hongbo ZOU

    2016-11-01

    Full Text Available As the leading cause of morbidity and cancer related-death worldwide, lung cancer has a serious threat to human health. Exosomes are nanoscale lipid membrane vesicles derived from multivesicles, which containing active biomolecules including proteins, lipids, nucleic acids and etc. Exosomes play important roles in lung cancer initiation and progression by promoting the formation of tumor microenvironment, enhancing tumor invasive and metastasis capability, leading to immunosuppression and resistance to chemoradiotherapy, and also have the application value in early diagnosis and treatment. This review summarizes the research progress of exosomes in tumor initiation and progression, and its roles in diagnosis and treatment of lung cancer.

  1. [Meningocele, glioma and optic nerve meningioma: differential diagnosis and treatment].

    Science.gov (United States)

    Genol, I; Troyano, J; Ariño, M; Iglesias, I; Arriola, P; García-Sánchez, J

    2009-11-01

    After studying 3 clinical cases, we have reviewed the clinical and radiological characteristics of meningocele, meningioma and optic nerve glioma. The differential diagnosis and therapeutic management are also discussed. Review of three clinical reports of three patients seen in our unit and a bibliographic search concerning the diagnosis and therapeutic management of these three entities at the present time. Differential diagnosis has to be based on a wide range of parameters: epidemiologic (age, race, sex, prevalence of the tumors), clinical (visual acuity, perimetry, Hertel exophthalmometry and funduscopy) and radiologic (computed tomography and magnetic resonance). Anatomopathologic study is required only rarely. The therapeutic options are: observation, surgery and radiotherapy. A correct differential diagnosis is mandatory to be able to individualize the treatment for each entity (Arch Soc Esp Oftalmol 2009; 84: 563-568).

  2. Depression diagnosis and treatment amongst multimorbid patients: a thematic analysis.

    Science.gov (United States)

    Stanners, Melinda N; Barton, Christopher A; Shakib, Sepehr; Winefield, Helen R

    2014-06-19

    We explored experiences of depression diagnosis and treatment amongst multimorbid patients referred to a metropolitan multidisciplinary outpatient clinic to identify commonalities across this patient group. Patients with two or more chronic conditions and a diagnosis of depression participated in semi-structured interviews that were digitally recorded and transcribed. Thematic analysis was performed on the transcriptions. Multimorbid patients attributed depressive symptoms to the loss of 'normal' roles and functionality and struggled to reconcile the depression diagnosis with their sense of identity. Beliefs about themselves and depression affected their receptivity to diagnosis and intervention strategies. These included prescribed interventions, such as psychotherapy or pharmacotherapy, and patient-developed strategies. Functional and social role losses present a clear context in which GPs should raise the subject of mood, with the situational attribution of depression suggesting that psychotherapy, which is rarely offered, should be prioritised in these circumstances.

  3. Update on the diagnosis and treatment of autoimmune pancreatitis.

    Science.gov (United States)

    Ghazale, Amaar H; Chari, Suresh T; Vege, Santhi Swaroop

    2008-04-01

    Autoimmune pancreatitis (AIP) is the pancreatic manifestation of a systemic fibroinflammatory disease (IgG4-related systemic disease) in which affected organs demonstrate dense lymphoplasmacytic infiltration with abundant IgG4-positive cells. The diagnosis of AIP and its differentiation from pancreatic cancer, its main differential diagnosis, remains a clinical challenge. The five cardinal features of AIP are characteristic histology, imaging, and serology; other organ involvement; and response to steroid therapy. Recent advances in our understanding of these features have resulted in enhanced recognition and diagnosis of this benign disease. This in turn has resulted in the avoidance of unnecessary surgical procedures for suspected malignancy. This article reviews recent updates in the diagnosis and treatment of autoimmune pancreatitis.

  4. Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis.

    Science.gov (United States)

    Goto, Hiro; Lindoso, José Angelo Lauletta

    2010-04-01

    Tegumentary leishmaniasis, comprising the cutaneous and mucocutaneous forms, is caused by at least 13 dermotropic species of protozoa of the genus Leishmania, most of which are prevalent in the New World. Although diseases in the Old and New Worlds share similar characteristics, the ultimate manifestations and severity are quite different, with more severe forms associated with mucosal lesions observed in the New World. For the diagnosis and treatment of leishmaniasis, differences based on clinical features, usefulness/sensitivity of diagnostic methods and therapeutic responses are mainly emphasized. We present a critical review of the diagnostic methods, their contribution and the necessity for their improvement/development, particularly in molecular diagnosis aimed at detection and species identification, as well as serodiagnosis. In addition to a review of the drugs currently utilized, we describe differences in their effectiveness in Old and New World leishmaniasis. HIV/Leishmania coinfection is also presented in the context of diagnosis and treatment.

  5. REM sleep behavior disorder (RBD): Update on diagnosis and treatment.

    Science.gov (United States)

    Högl, Birgit; Stefani, Ambra

    2017-01-01

    REM sleep behavior disorder (RBD) is parasomnia characterized by dream enactment and enabled by disruption of physiological muscle atonia during REM sleep. Over the past few years, diagnostic criteria and the methods used to confirm diagnosis have been updated. In this review article, the current knowledge regarding RBD diagnosis and treatment is presented. A selective literature search was carried out. Although several RBD screening questionnaires have been developed, diagnosis can only be definitely confirmed on the basis of polysomnography. New methods for scoring electromyography (EMG) activity during REM sleep have been proposed during recent years and cutoff values have been established. The latest cutoff values for scoring EMG activity during REM sleep are included in the International Classification of Sleep Disorders (ICSD). The cutoff of 27 % muscle activity during REM sleep suggested by the Sleep Innsbruck Barcelona (SINBAR) group was also included in the third edition of the ICSD. The best-researched treatments for RBD are clonazepam and melatonin.

  6. Toward personalizing treatment for depression: predicting diagnosis and severity.

    Science.gov (United States)

    Huang, Sandy H; LePendu, Paea; Iyer, Srinivasan V; Tai-Seale, Ming; Carrell, David; Shah, Nigam H

    2014-01-01

    Depression is a prevalent disorder difficult to diagnose and treat. In particular, depressed patients exhibit largely unpredictable responses to treatment. Toward the goal of personalizing treatment for depression, we develop and evaluate computational models that use electronic health record (EHR) data for predicting the diagnosis and severity of depression, and response to treatment. We develop regression-based models for predicting depression, its severity, and response to treatment from EHR data, using structured diagnosis and medication codes as well as free-text clinical reports. We used two datasets: 35,000 patients (5000 depressed) from the Palo Alto Medical Foundation and 5651 patients treated for depression from the Group Health Research Institute. Our models are able to predict a future diagnosis of depression up to 12 months in advance (area under the receiver operating characteristic curve (AUC) 0.70-0.80). We can differentiate patients with severe baseline depression from those with minimal or mild baseline depression (AUC 0.72). Baseline depression severity was the strongest predictor of treatment response for medication and psychotherapy. It is possible to use EHR data to predict a diagnosis of depression up to 12 months in advance and to differentiate between extreme baseline levels of depression. The models use commonly available data on diagnosis, medication, and clinical progress notes, making them easily portable. The ability to automatically determine severity can facilitate assembly of large patient cohorts with similar severity from multiple sites, which may enable elucidation of the moderators of treatment response in the future. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  7. Sportsman hernia; the review of current diagnosis and treatment modalities.

    Science.gov (United States)

    Paksoy, Melih; Sekmen, Ümit

    2016-01-01

    Groin pain is an important clinical entity that may affect a sportsman's active sports life. Sportsman's hernia is a chronic low abdominal and groin pain syndrome. Open and laparoscopic surgical treatment may be chosen in case of conservative treatment failure. Studies on sportsman's hernia, which is a challenging situation in both diagnosis and treatment, are ongoing in many centers. We reviewed the treatment results of 37 patients diagnosed and treated as sportsman's hernia at our hospital between 2011-2014, in light of current literature.

  8. Association of Human Development Index with global bladder, kidney, prostate and testis cancer incidence and mortality.

    Science.gov (United States)

    Greiman, Alyssa K; Rosoff, James S; Prasad, Sandip M

    2017-12-01

    To describe contemporary worldwide age-standardized incidence and mortality rates for bladder, kidney, prostate and testis cancer and their association with development. We obtained gender-specific, age-standardized incidence and mortality rates for 184 countries and 16 major world regions from the GLOBOCAN 2012 database. We compared the mortality-to-incidence ratios (MIRs) at national and regional levels in males and females, and assessed the association with socio-economic development using the 2014 United Nations Human Development Index (HDI). Age-standardized incidence rates were 2.9 (bladder) to 7.4 (testis) times higher for genitourinary malignancies in more developed countries compared with less developed countries. Age-standardized mortality rates were 1.5-2.2 times higher in more vs less developed countries for prostate, bladder and kidney cancer, with no variation in mortality rates observed in testis cancer. There was a strong inverse relationship between HDI and MIR in testis (regression coefficient 1.65, R2 = 0.78), prostate (regression coefficient -1.56, R2 = 0.85), kidney (regression coefficient -1.34, R2 = 0.74), and bladder cancer (regression coefficient -1.01, R2 = 0.80). While incidence and mortality rates for genitourinary cancers vary widely throughout the world, the MIR is highest in less developed countries for all four major genitourinary malignancies. Further research is needed to understand whether differences in comorbidities, exposures, time to diagnosis, access to healthcare, diagnostic techniques or treatment options explain the observed inequalities in genitourinary cancer outcomes. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

  9. Imaging of mesothelioma of tunica vaginalis testis

    Energy Technology Data Exchange (ETDEWEB)

    Bertolotto, M. [University of Trieste, Department of Radiology, Trieste (Italy); Boulay-Coletta, I. [Fondation Hopital Saint Joseph, Service d' Imagerie Medical, Paris (France); Butini, R. [Ospedale S. Giacomo, Department of Radiology, Castelfranco Veneto, TV (Italy); Dudea, S.M. [Univ. Med. Pharm. ' ' Iuliu Hatieganu' ' , Department of Radiology, Cluj-Napoca (Romania); Grenier, N. [Pellegrin Hospital, Department of Radiology, Bordeaux (France); Oltmanns, G. [University Hospital of North Norway, Department of Radiology, Tromsoe (Norway); Ramchandani, P. [University of Pennsylvania, Department of Radiology, Perelman School of Medicine, Philadelphia, PA (United States); Stein, M.W. [Montefiore Medical Center, Department of Radiology, Albert Einstein College of Medicine, Bronx, NY (United States); Valentino, M. [Sant' Antonio Hospital, Department of Radiology, Tolmezzo, UD (Italy); Derchi, Lorenzo E. [University of Genoa, Department of Health Sciences, Genova (Italy); IRCCS Azienda Ospedaliera Universitaria San Martino IST, Radiologia d' Urgenza, Genova (Italy)

    2016-03-15

    To describe the imaging findings in a series of patients with mesothelioma of the tunica vaginalis testis. We reviewed clinical data, imaging findings and follow-up information in a series of 10 pathology-proven cases of mesothelioma (all had US; 2 had MR) of the tunica vaginalis. A variety of patterns could be observed, the most common (5/10) being a hydrocele with parietal, solid and hypervascular vegetations; one patient had a septated hydrocele with hypervascular walls; one had multiple, solid nodules surrounded by a small, physiological quantity of fluid; one a cystic lesion with thick walls and vegetations compressing the testis; two had a solid paratesticular mass. MR showed multiple small nodules on the surface of the tunica vaginalis in one case and diffuse thickening and vegetations in the other one; lesions had low signal intensity on T2-w images and were hypervascular after contrast injection. A preoperative diagnosis of mesotheliomas presenting as solid paratesticular masses seems very difficult with imaging. On the contrary, the diagnosis must be considered in patients in whom a hydrocele with parietal vegetations is detected, especially if these show high vascularity. (orig.)

  10. Malaria diagnosis and treatment amongst health workers in ...

    African Journals Online (AJOL)

    Folders successfully traced were 1012; in 92 percent investigations for malaria were requested while 32 percent had differential diagnosis. Out of the 931 malaria investigations requested, 30percent did the tests and positive results were 94.9 percent. Presumptive treatment was 98 percent. Majority (83.3%) received ACTs.

  11. Helicobacter pylori in childhood : aspects of prevalence, diagnosis and treatment

    NARCIS (Netherlands)

    Mourad-Baars, Petronella Elisabeth Cornelia

    2012-01-01

    In this dissertation we present the results of our research on Helicobacter pylori infections in childhood, focusing on the prevalence, diagnosis and treatment of the infection. Our studies were conducted in the Netherlands, Europe and Indonesia. We discuss diagnostic tests, therapeutic regimens,

  12. Hip osteoarthrosis: clinical presentation, diagnosis, approaches to treatment

    Directory of Open Access Journals (Sweden)

    Marina Stanislavovna Svetlova

    2013-01-01

    Full Text Available The paper characterizes the specific features of the anatomy and physiology of the hip joint, the clinical presentation of coxarthrosis and presents current methods for the diagnosis and treatment of the disease. It gives the results of a trial evaluating the impact of long-term (one-year theraflex therapy on the symptoms of hip osteoarthrosis.

  13. Interocclusal Registration for Diagnosis and Treatment Planning for ...

    African Journals Online (AJOL)

    2017-09-14

    Sep 14, 2017 ... records. The well-fitting appliance can be used to accurately mount implant cases with inadequate posterior support for diagnosis and treatment planning. This technique of interocclusal registration has the advantages of accurate mounting, preservation of materials and financial expenses, and reduction of ...

  14. Diagnosis and treatment of schizophrenia in a general hospital ...

    African Journals Online (AJOL)

    interviews in order to enhance the quality of the routine process of diagnosis and treatment of patients with ... recommended in compliant users and a change to depot ... organizations, contracted care facilities and old age homes). As an acute ward, a major challenge is the continuous ... The data source for the study was.

  15. Gastric cancer diagnosis and treatment guidelines 2008: Uganda ...

    African Journals Online (AJOL)

    In Uganda most cancers to the exception of bladder and penis are increasing in incidence. The incidence of cancer of stomach is 5.6/100,000 from 0.8/100,000 in the 1960s a seven fold increase.The purpose of this guideline document is to highlight the salient points in gastric cancer diagnosis and treatment in the ...

  16. Stage at diagnosis, clinicopathological and treatment patterns of ...

    African Journals Online (AJOL)

    Breast cancer, although reported to be the commonest female malignancy worldwide has not been extensively studied in north-western Tanzania. The aim of this retrospective review was to describe in our setting, the stage at diagnosis, clinicopathological and treatment patterns among patients with breast cancer.

  17. Diagnosis and Treatment of Three-Rooted Maxillary Premolars

    Science.gov (United States)

    Arisu, Hacer Deniz; Alacam, Tayfun

    2009-01-01

    Anatomical variations must be considered in clinical and radiographical evaluations during endodontic treatment. Access cavity modifications may be required for stress free entry to complex anatomy. Higher magnification and illumination can be useful for access cavity preparation and to recognize and locate additional canals. This article describes the diagnosis and clinical management of two clinical cases of three rooted maxillary premolars. PMID:19262733

  18. Acute bronchitis: general practitioners' views regarding diagnosis and treatment.

    NARCIS (Netherlands)

    Verheij, T.J.M.; Hermans, J.; Kaptein, A.A.; Wijkel, D.; Mulder, J.D.

    1990-01-01

    A survey was conducted among 800 Dutch general practitioners to establish their views on the diagnosis and treatment of bronchitis and related disorders with reference to 12 theoretical patients. The answers of the 467 respondents (response rate 60%) showed no clear relationship between signs and

  19. Diagnosis without treatment: responding to the War on Terror | Cox ...

    African Journals Online (AJOL)

    This is like a doctor diagnosing gout and recommending to the patient that they reduce the level of uric acid in their big toe. We argue that diagnosis without treatment is endemic in literature on the War on Terror and the ills of liberal democracy. We divide this literature into five categories and examine representative works ...

  20. Challenge in diagnosis and treatment of colonic carcinoma ...

    African Journals Online (AJOL)

    Alaa Hussein Abdel-Razek

    2012-01-23

    Jan 23, 2012 ... Abstract Introduction: Despite advances in perioperative care and operative techniques, urgent colorectal operations are still associated with higher mortality and morbidity than elective surgery. Aim: This study was to identify the challenge in diagnosis and treatment of emergencies caused by.

  1. Diagnosis, monitoring and treatment of tuberous sclerosis complex ...

    African Journals Online (AJOL)

    NC 4.0. Diagnosis, monitoring and treatment of tuberous sclerosis complex: A South African consensus response to international guidelines. P J de Vries,1 MB ChB, MRCPsych, PhD; L Leclezio,1 MSc (Med) Neurosci; J M Wilmshurst,2 MB BS, ...

  2. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy Advances in Diagnosis and Treatment : Advances in Diagnosis and Treatment

    NARCIS (Netherlands)

    Novak, Iona; Morgan, Cathy; Adde, Lars; Blackman, James; Boyd, Roslyn N; Brunstrom-Hernandez, Janice; Cioni, Giovanni; Damiano, Diane; Darrah, Johanna; Eliasson, Ann-Christin; de Vries, Linda S; Einspieler, Christa; Fahey, Michael; Fehlings, Darcy; Ferriero, Donna M; Fetters, Linda; Fiori, Simona; Forssberg, Hans; Gordon, Andrew M; Greaves, Susan; Guzzetta, Andrea; Hadders-Algra, Mijna; Harbourne, Regina; Kakooza-Mwesige, Angelina; Karlsson, Petra; Krumlinde-Sundholm, Lena; Latal, Beatrice; Loughran-Fowlds, Alison; Maitre, Nathalie; McIntyre, Sarah; Noritz, Garey; Pennington, Lindsay; Romeo, Domenico M; Shepherd, Roberta; Spittle, Alicia J; Thornton, Marelle; Valentine, Jane; Walker, Karen; White, Robert; Badawi, Nadia

    IMPORTANCE Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months' corrected age. OBJECTIVES To systematically review best available

  3. Assessment, Diagnosis, and Treatment of Binge Eating Disorder.

    Science.gov (United States)

    Ambrogne, Janet A

    2017-08-01

    Binge eating disorder (BED) is the most prevalent eating disorder in the United States, believed to affect an estimated 2.8 million adults. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, BED was recognized as a separate diagnosis. The purpose of the current article is to provide an overview of BED including assessment, diagnosis, and current pharmacological and nonpharmacological treatment options. Implications for nursing are also addressed. [Journal of Psychosocial Nursing and Mental Health Services, 55(8), 32-38.]. Copyright 2017, SLACK Incorporated.

  4. Cracked and broken teeth--definitions, differential diagnosis and treatment.

    Science.gov (United States)

    Paul, R A; Tamse, A; Rosenberg, E

    2007-04-01

    Cracked and broken teeth present a diagnostic dilemma to the dentist and the sooner a correct diagnosis is made the greater are the chances to save the tooth. As the location, direction and size of the crack or fracture dictates the choice of treatment, it is important to first define the types of cracks and fractures in the coronal and radicular tooth structure. Cracks and fractures can be classified as follows: 1. craze lines 2. fractured cusps 3. cracked teeth 4. split teeth 5. vertical root fractures. The vertical root fracture has been described recently in two articles in this publication, and therefore will not be discussed here. Diagnosis of a cracked tooth is not always initially obvious. The patient's response to clinical testing is the primary diagnostic tool along with the dental history provided by the patient. Radiographs are secondary in making a diagnosis. Clinical aids for reproducing the patient's symptoms such as occlusal bite devices, observing occlusal wear facets and the application of cold water to one tooth at a time may isolate the offending tooth. In situations where an irreversible pulpitis is diagnosed, endodontic treatment is indicated. In the case of a questionable diagnosis, or one in which a potential reversible pulpitis is made, a provisional restoration can be placed for an unspecified time as a diagnostic aid. If endodontic therapy were indicated, consultation with the patient as to the compromised prognosis and the alternatives to endodontic treatment is essential.

  5. Rural practitioners' experiences in dementia diagnosis and treatment.

    Science.gov (United States)

    Teel, C S

    2004-09-01

    When diagnosis of dementia occurs earlier in the disease process, more time is available for treatment aimed at maintaining patient function and delaying decline, and for family education about the disease and its management. Primary care providers often, however, face challenges in making timely diagnoses. Nineteen practitioners in mostly rural areas of a mid-western state were interviewed about their experiences in diagnosis and treatment, to develop a more comprehensive understanding of barriers encountered by providers in non-metropolitan areas. Participants estimated that the time from symptom onset to diagnosis ranged from several months to one year, largely dependant upon family recognition. Limitations in access to consultants and limited or non-existent community support and education resources were major impediments to diagnosis and treatment, respectively. Like their colleagues in more urban communities, denial among family members, or families who were absent or uncooperative, created additional challenges for providers in making and communicating diagnoses and in supporting home-based or institutional care. Conversely, supportive and motivated families played a central role in positive patient care experiences. Participants agreed that support and education services were important for family caregivers, but generally had few resources to offer families, which constrained their ability to provide optimal care. Identifying challenges faced by rural practitioners is essential to planning appropriate interventions for consultative support and educational outreach.

  6. WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis.

    Science.gov (United States)

    Di Saverio, Salomone; Birindelli, Arianna; Kelly, Micheal D; Catena, Fausto; Weber, Dieter G; Sartelli, Massimo; Sugrue, Michael; De Moya, Mark; Gomes, Carlos Augusto; Bhangu, Aneel; Agresta, Ferdinando; Moore, Ernest E; Soreide, Kjetil; Griffiths, Ewen; De Castro, Steve; Kashuk, Jeffry; Kluger, Yoram; Leppaniemi, Ari; Ansaloni, Luca; Andersson, Manne; Coccolini, Federico; Coimbra, Raul; Gurusamy, Kurinchi S; Campanile, Fabio Cesare; Biffl, Walter; Chiara, Osvaldo; Moore, Fred; Peitzman, Andrew B; Fraga, Gustavo P; Costa, David; Maier, Ronald V; Rizoli, Sandro; Balogh, Zsolt J; Bendinelli, Cino; Cirocchi, Roberto; Tonini, Valeria; Piccinini, Alice; Tugnoli, Gregorio; Jovine, Elio; Persiani, Roberto; Biondi, Antonio; Scalea, Thomas; Stahel, Philip; Ivatury, Rao; Velmahos, George; Andersson, Roland

    2016-01-01

    Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.

  7. Naegleria fowleri: Diagnosis, Pathophysiology of Brain Inflammation, and Antimicrobial Treatments.

    Science.gov (United States)

    Pugh, J Jeffrey; Levy, Rebecca A

    2016-09-21

    Primary amoebic meningoencephalitis (PAM) is a very rare disease with a high mortality rate. PAM is caused by Naegleria fowleri, an amoeba which resides in freshwater lakes and ponds and can survive in inadequately chlorinated pools ( Lopez, C.; Budge, P.; Chen, J., et al. Primary amebic meningoencephalitis: a case report and literature review . Pediatr. Emerg. Care 2012 , 28 , 272 - 276 ). In the past 50 years, there have been over 130 cases of Naegleria induced PAM in the United States with only three known survivors; one survivor was diagnosed and treated at Arkansas Children's Hospital. Successful treatment of PAM started with a rapid diagnosis, extensive antimicrobial therapy including an investigational medication miltefosine, supportive care, an intraventricular shunt, and hypothermia. These treatments address different aspects of the disease process. Increased understanding of the diagnosis and treatment of PAM is important especially for patients who present with meningitis-like findings during the summer months.

  8. Advances in diagnosis and treatment of cerebral venous system diseases

    Directory of Open Access Journals (Sweden)

    Xiao-yun LIU

    2016-11-01

    Full Text Available Cerebral venous system diseases include cerebral venous thrombosis (CVT, venous sinus stenosis, carotid cavernous fistula (CCF, intracranial arteriovenous malformation (AVM and so on. In recent years, due to the rapid development of neuroimaging and interventional technology, more and more cerebral venous system diseases have been timely diagnosed and treated, such as magnetic resonance black-blood thrombus imaging (MRBTI in the diagnosis of CVT, stenting in the treatment of venous sinus stenosis, micro coil plus Onyx glue or covered stents in the treatment of CCF, which allow us to make a deeper recognition of cerebral venous system diseases. Therefore, this paper will introduce the latest diagnosis and treatment of cerebral venous system diseases. DOI: 10.3969/j.issn.1672-6731.2016.11.006

  9. Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo

    Directory of Open Access Journals (Sweden)

    Muhammed Dagkiran

    2015-12-01

    Full Text Available Benign paroxysmal positional vertigo is the cause of peripheral vertigo, which only takes seconds posed by certain head and body position and led to severe attacks of vertigo. Therefore, it is a disturbance that causes a continuous fear of fall and anxiety in some patients. Although benign paroxysmal positional vertigo is the most common cause of peripheral vertigo, it may cause unnecessary tests, treatment costs and the loss of labor due to the result of the delay in the diagnosis and treatment stages. Diagnosis and treatment of this disease is easy. High success rates can be achieved with appropriate repositioning maneuvers after taking a detailed medical history and accurate assessment of accompanying nystagmus. The aim of this paper was to review the updated information about benign paroxysmal positional vertigo. [Archives Medical Review Journal 2015; 24(4.000: 555-564

  10. [Current situation of courses on diagnosis and treatment with acupuncture].

    Science.gov (United States)

    Gu, Jie; Zhong, Lan

    2011-04-01

    The current situation of courses on diagnosis and treatment with acupuncture both domestically and internationally were analyzed in this article. It explored the methods of enhancing the dialectical thinking method in clinic through specific cases, and proposed suggestions for editions of the textbooks and examination papers on acupuncture education. It is held that the effect of courses on acupuncture diagnosis and treatment may directly influence the ability of student on application of acupuncture in disease prevention and treatment. Acupuncture education abroad is featured with flexibility and practicability. However, attention attached on theory is not enough. Oppositely, domestic courses focus more on theoretical study, but neglect the hands-on ability. Although certain result has been achieved by various forms of the domestic education reform, it still needs to be further perfected.

  11. Asthma in elite athletes: pathogenesis, diagnosis, differential diagnoses, and treatment

    DEFF Research Database (Denmark)

    Pedersen, Lars; Elers, Jimmi; Backer, Vibeke

    2011-01-01

    is essential when treating elite athletes. This article is aimed at physicians who diagnose and treat athletes with respiratory symptoms. It focuses on the pathogenesis of asthma and exercise-induced bronchoconstriction in elite athletes and how the diagnosis can be made. Furthermore, treatment of elite......Elite athletes have a high prevalence of asthma and exercise-induced bronchoconstriction. Although respiratory symptoms can be suggestive of asthma, the diagnosis of asthma in elite athletes cannot be based solely on the presence or absence of symptoms; diagnosis should be based on objective...... measurements, such as the eucapnic voluntary hyperpnea test or exercise test. When considering that not all respiratory symptoms are due to asthma, other diagnoses should be considered. Certain regulations apply to elite athletes who require asthma medication for asthma. Knowledge of these regulations...

  12. Dilemmas in the diagnosis and treatment of intracranial tuberculomas.

    Science.gov (United States)

    Ramachandran, Rajeswari; Muniyandi, M; Iyer, Vijay; Sripriya, T; Priya, B; Govindarajan, T G

    2017-10-15

    Tuberculosis (TB) remains a major public health problem across the globe. A common form of extrapulmonary TB (EPTB) with high mortality and morbidity is neuro TB or tuberculosis of the nervous system. The management of brain TB remains a big challenge due to the lack of specific diagnostic tools and appropriate treatment guidelines. In this context, this manuscript discusses clinical, diagnostic and treatment dilemmas in the management of intracranial tuberculomas. Brain tuberculoma may occur at any site within the cranium, no part of the brain substance or ventricular surface being exempt. The diagnosis of tuberculoma is often based on imaging techniques such as CT brain and MRI/MRS, even though, no radiological feature is confirmative or specific for tuberculoma. In this regard, a promising development is a new MRS marker that is currently being assessed. Based on a single peak at 3.8ppm, it may differentiate tuberculoma from tumors. This lack of diagnostic tools results in an increased cost to patient on average three times that for pulmonary TB. The increase in cost stems from multiple laboratory tests with diagnosis often achieved only after biopsy. As for treatment, the choice of drugs for treatment and the duration for treatment is also not clearly understood. The recent increase in drug resistant TB adds to the problem. The possible pitfalls during treatment include paradoxical response, hyponatremia, and development of hydrocephalus. These and other treatment related complications require follow-up and monitoring. A fraction of patients may even require emergency surgery due to increased intracranial tension. This can further increase cost to the patient and family. Overall, there is a need for continued efforts to develop new diagnostic tools for brain TB. Until such tools are available, high degree of awareness among treatment providers is necessary to avoid delays in diagnosis and increased costs. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Prostate Cancer: Symptoms, Diagnosis and Treatment | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... this page please turn Javascript on. Feature: Prostate Cancer Prostate Cancer: Symptoms, Diagnosis and Treatment Past Issues / Winter 2010 ... only way to confirm a diagnosis of prostate cancer. Treatment Prostate cancer treatment depends on how serious the cancer ...

  14. Osteoporosis: Symptoms, Diagnosis, Treatment and Prevention | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... please turn Javascript on. Feature: Osteoporosis Osteoporosis: Symptoms, Diagnosis, Treatment and Prevention Past Issues / Winter 2011 Table of ... bump, or fall causes a bone to break. Diagnosis A bone mineral density test ... are making the bones stronger Treatment Treatment includes: ...

  15. Psychological effects of diagnosis and treatment of cervical intraepithelial neoplasia

    DEFF Research Database (Denmark)

    Frederiksen, Maria Eiholm; Njor, Sisse; Lynge, Elsebeth

    2015-01-01

    test results, but the impact decreased over time. In several but not all studies, CIN appeared to have similar psychological consequences to abnormal smears. No study showed a difference in psychological outcomes between CIN and cervical cancer diagnosis when these were measured some years after......BACKGROUND: Treatment of cervical intraepithelial neoplasia (CIN) is a common minor surgical procedure to prevent uterine cervical cancer. However, news of an abnormality detected at screening for cancer might cause the woman to worry. OBJECTIVES: To investigate the psychological consequences...... statistical testing, we estimated the statistical significance of the differences between the compared groups using unpaired t tests. MAIN RESULTS: From 5099 retrieved abstracts, 16 studies were included. Diagnosis and treatment of CIN were associated with worse psychological outcomes than normal cytology...

  16. Diagnosis and Treatment of Drug-Resistant Tuberculosis.

    Science.gov (United States)

    Caminero, José A; Cayla, Joan A; García-García, José-María; García-Pérez, Francisco J; Palacios, Juan J; Ruiz-Manzano, Juan

    2017-09-01

    In the last 2 decades, drug-resistant tuberculosis has become a threat and a challenge to worldwide public health. The diagnosis and treatment of these forms of tuberculosis are much more complex and prognosis clearly worsens as the resistance pattern intensifies. Nevertheless, it is important to remember that with the appropriatesystematic clinical management, most of these patients can be cured. These guidelines itemize the basis for the diagnosis and treatment of all tuberculosis patients, from those infected by strains that are sensitive to all drugs, to those who are extensively drug-resistant. Specific recommendations are given forall cases. The current and future role of new molecular methods for detecting resistance, shorter multi-drug-resistant tuberculosis regimens, and new drugs with activity against Mycobacterium tuberculosis are also addressed. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Lameness diagnosis and treatment in the quarter horse racehorse.

    Science.gov (United States)

    Goodman, N L; Baker, B K

    1990-04-01

    Lameness problems constitute a major part of racing Quarter Horse practice. This article considers the diagnosis, prognosis, and treatment of the frequently encountered lamenesses. The main conditions included are synovitis, intra-articular fractures, osteochondritis dissecans, and degenerative joint disease as they relate to the coffin, fetlock, carpal, and tarsal joints. Intra-articular injection techniques and medications are discussed because of the frequency of joint disease. Bucked shins and stress fractures are also reviewed.

  18. Prevalence, etiology, diagnosis, treatment and complications of supernumerary teeth

    OpenAIRE

    Ata-Ali Mahmud, Fadi; Ata-Ali Mahmud, Francisco Javier; Peñarrocha Oltra, David; Peñarrocha Diago, Miguel

    2014-01-01

    The aim of this article was to review the literature on supernumerary teeth, analyzing their prevalence, etiology, diagnosis, treatment and possible complications. An electronic search was made in the Pubmed-Medline database up to January 2014 using the key search terms ?multiple supernumerary teeth? (n=279), ?prevalence supernumerary teeth? (n=361), and ?supernumerary teeth? (n=2412). In addition to the articles initially identified, others were included in the review proceeding from a manua...

  19. Diagnosis and Treatment of Pseudo-Class III Malocclusion

    OpenAIRE

    Ariel Reyes; Luis Serret; Marcos Peguero; Orlando Tanaka

    2014-01-01

    Pseudo-Class III malocclusion is characterized by the presence of an anterior crossbite due to a forward functional displacement of the mandible; in most cases, the maxillary incisors present some degree of retroclination, and the mandibular incisors are proclined. Various types of appliances have been described in the literature for the early treatment of pseudo-Class III malocclusion. The objectives of this paper are to demonstrate the importance of making the differential diagnosis between...

  20. NEW DEVELOPMENTS IN THE DIAGNOSIS AND TREATMENT OF THYROID CANCER

    OpenAIRE

    Schneider, David F.; Chen, Herbert

    2013-01-01

    Thyroid cancer exists in several forms. Differentiated thyroid cancers include papillary and follicular histologies. These tumors exist along a spectrum of differentiation, and their incidence continues to climb. A number of advances in the diagnosis and treatment of differentiated thyroid cancers now exist. These include molecular diagnostics and more advanced strategies for risk stratification. Medullary cancer arises from the parafollicular cells and not the follicular cells. Therefore, di...

  1. [Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome].

    Science.gov (United States)

    Kuratsune, Hirohiko

    2018-01-01

    We present here the Japanese clinical diagnostic criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) that were proposed in 2016 by the Japanese Ministry of Health, Labour and Welfare study group. The clinical diagnosis criteria of ME/CFS were created to be used by healthcare agencies in charge of primary care practice. We also explain the current prognosis in ME/CFS and medical treatments used in major medical institutions in Japan.

  2. [Diagnosis, treatment, and follow-up of cesarean scar pregnancy].

    Science.gov (United States)

    Nguyen-Xuan, H-T; Lousquy, R; Barranger, E

    2014-01-01

    Cesarean scar pregnancy is a rare entity. This situation may induce uterine rupture and/or a massive life-threatening hemorrhage. The standard treatment is laparotomy surgery, but in situ injections to replace invasive surgery. The objective of this study was to focus on the diagnosis, optimal management and long-term follow-up of the patients. Data from 6 patients with diagnosis of cesarean scar pregnancy between 2007 and 2013 at Lariboisière hospital were retrospectively collected. Endovaginal ultrasound succeeded to diagnose all cases. Four patients were treated with in situ injection of methotrexate performing a vaginal way (n=2) or laparoscopy (n=2) and two others using systemic injection. One patient was complicated by hemorrhagic shock requiring iterative embolizations. Three patients achieved a new pregnancy, with one recurrent scar pregnancy complicated by massive hemorrhage. Diagnosis and treatment of cesarean scar pregnancies must be done precociously because of high hemorrhage risks. Endovaginal ultrasound is the gold standard exam. Treatment is non-consensual, but methotrexate in situ injection is effective and safer. Monitoring the decrease of HCG levels and ultrasonography supervision of gestational sac size and its vascularization must be performed. Due to the risk of recurrence, any subsequent pregnancy shows a high risk of complications. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  3. [Diagnosis and treatment of epilepsy and narcolepsy comorbid].

    Science.gov (United States)

    Yang, Zhi-xian; Han, Fang; Qin, Jiong; Liu, Xiao-yan

    2013-09-01

    To analyze the clinical diagnosis and treatment process of narcolepsy and epilepsy co-existence, and thereby to improve awareness of such cases. The clinical manifestations of 2 cases were observed, and video-electroencephalogram (VEEG), multiple sleep latency tests (MSLT) were performed. Hypocretin 1 level in cerebrospinal fluid was examined in one case. The onset of disease of case one was started with epilepsy with myoclonic seizure. After half a year, catalepsy induced by emotion especially laughing and excessive daytime sleepiness appeared. MSLT was positive and hypocretin 1 level decreased. Narcolepsy-cataplexy was definitely diagnosed in this case. Valproate was given and seizure was controlled completely, but the excessive daytime sleepiness was aggravated. Combination of valproate, methylphenidate and clomipramine treatment improved the symptoms of narcolepsy and the patient was still free of epileptic seizures. The onset symptoms of case 2 were catalepsy and excessive daytime sleepiness. MSLT was positive. The treatment was ineffective because of bad compliance. After 2 years, episodes of impairment of consciousness with automatism occurred. VEEG showed slow waves and spikes in right temporal area. Complex partial seizure was determined. Oxcarbazepine was used and then the patients became seizures free, but the symptoms of narcolepsy were still obvious. Comorbidity of narcolepsy and epilepsy is a rare phenomenon. Clinical symptoms, predisposing factor, VEEG and MSLT can help diagnosis and differential diagnosis. The antiepileptic drugs might aggravate drowsiness. Based on therapy of epilepsy by using antiepileptic drugs, low dosage of central nervous system stimulants might improve the drowsiness and catalepsy symptoms of narcolepsy.

  4. Diagnosis and treatment of chronic acquired demyelinating polyneuropathies.

    Science.gov (United States)

    Latov, Norman

    2014-08-01

    Chronic neuropathies are operationally classified as primarily demyelinating or axonal, on the basis of electrodiagnostic or pathological criteria. Demyelinating neuropathies are further classified as hereditary or acquired-this distinction is important, because the acquired neuropathies are immune-mediated and, thus, amenable to treatment. The acquired chronic demyelinating neuropathies include chronic inflammatory demyelinating polyneuropathy (CIDP), neuropathy associated with monoclonal IgM antibodies to myelin-associated glycoprotein (MAG; anti-MAG neuropathy), multifocal motor neuropathy (MMN), and POEMS syndrome. They have characteristic--though overlapping--clinical presentations, are mediated by distinct immune mechanisms, and respond to different therapies. CIDP is the default diagnosis if the neuropathy is demyelinating and no other cause is found. Anti-MAG neuropathy is diagnosed on the basis of the presence of anti-MAG antibodies, MMN is characterized by multifocal weakness and motor conduction blocks, and POEMS syndrome is associated with IgG or IgA λ-type monoclonal gammopathy and osteosclerotic myeloma. The correct diagnosis, however, can be difficult to make in patients with atypical or overlapping presentations, or nondefinitive laboratory studies. First-line treatments include intravenous immunoglobulin (IVIg), corticosteroids or plasmapheresis for CIDP; IVIg for MMN; rituximab for anti-MAG neuropathy; and irradiation or chemotherapy for POEMS syndrome. A correct diagnosis is required for choosing the appropriate treatment, with the aim of preventing progressive neuropathy.

  5. Diagnosis and results of treatment of heart myxoma

    Directory of Open Access Journals (Sweden)

    Rafajlovski Sašo

    2011-01-01

    Full Text Available Background/Aim. Myxoma is the most common benign primary cardiac neoplasm, and usually originates from the left atrial septum. Early diagnosis of cardiac myxomas depends on a high index of a clinical suspicion. Surgical management must be done as soon as possible after diagnosis. The aim of this retrospective study was to present diagnostics and treatment outcome data of 61 patients with cardiac myxoma treated in the Military Medical Academy, Belgrade during a 49-years period. Methods. Intrahospital diagnosis was established in all the patients by the cardiologist. Diagnostic methods were various, in dependence on the examination period and suspected diagnosis. Results. Within a 49-years period (1961-2009 heart myxoma was diagnozed and treated in 61 patients in the Military Medical Academy, Belgrade. Most of the operated patients were females (38 or 62.3%. The operated patients were 19-68 years old. Average age of all the patients was 47.9%. The great majority of them (98.4% had atrial, and only one operated patient had ventricular myxoma. In 13 (21.3% of the patients heart myxoma was found out accidentally due to no previous cardiologic symptomatology. In most patients (27.44% symptomatology was presented as thromboembolic disease. Because of the suspected ventricular myxoma in one patient, the patient was operated on, but Hodgkin's lymphoma was found out which, according to the subsequent course of the disease, could be justifiably recognized as primary heart lymphoma. This study presented brief descriptions of the course of the disease in 4 patients with myxomas in each of the cardiac cavities. Conclusion. The only diagnostic difficulty in cardiac myxoma is due to its asymptomatic and oligosymptomatic presence within the longer period of time, namely, its growth period. Echocardiography should be the standard method of cardiologic examination of these patients, which could considerably contribute to early diagnosis and treatment of heart

  6. Diagnosis and treatment of pulmonary mucormycosis: A case report.

    Science.gov (United States)

    Luo, Zhiming; Zhang, Lin

    2017-10-01

    Pulmonary mucormycosis, a relatively rare pulmonary fungal disease, is difficult to diagnose and lacks effective treatment. The present study reports the case of a 64-year-old patient who was treated successfully for pulmonary mucormycosis in Xuan Wu Hospital. The patient presented with low-grade fever and a productive cough that persisted for 1 month with no evident cause, and also suffered from diabetes mellitus. Prior antibiotic treatment with levofloxacin had been ineffective. Culture of mucus obtained by bronchoscopy resulted in a diagnosis of pulmonary mucormycosis. The patient received a cumulative dose of 1,355 mg amphotericin B over 2 months and presented a full recovery.

  7. Update on diagnosis and treatment of idiopathic pulmonary fibrosis

    Science.gov (United States)

    Baddini-Martinez, José; Baldi, Bruno Guedes; da Costa, Cláudia Henrique; Jezler, Sérgio; Lima, Mariana Silva; Rufino, Rogério

    2015-01-01

    Idiopathic pulmonary fibrosis is a type of chronic fibrosing interstitial pneumonia, of unknown etiology, which is associated with a progressive decrease in pulmonary function and with high mortality rates. Interest in and knowledge of this disorder have grown substantially in recent years. In this review article, we broadly discuss distinct aspects related to the diagnosis and treatment of idiopathic pulmonary fibrosis. We list the current diagnostic criteria and describe the therapeutic approaches currently available, symptomatic treatments, the action of new drugs that are effective in slowing the decline in pulmonary function, and indications for lung transplantation. PMID:26578138

  8. Early Gastric Cancer: Current Advances of Endoscopic Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Linlin Zhu

    2016-01-01

    Full Text Available Endoscopy is a major method for early gastric cancer screening because of its high detection rate, but its diagnostic accuracy depends heavily on the availability of endoscopic instruments. Many novel endoscopic techniques have been shown to increase the diagnostic yield of early gastric cancer. With the improved detection rate of EGC, the endoscopic treatment has become widespread due to advances in the instruments available and endoscopist’s experience. The aim of this review is to summarize frequently-used endoscopic diagnosis and treatment in early gastric cancer (EGC.

  9. Challenges With the Diagnosis and Treatment of Cerebral Radiation Necrosis

    Energy Technology Data Exchange (ETDEWEB)

    Chao, Samuel T., E-mail: chaos@ccf.org [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Ahluwalia, Manmeet S. [Department of Medical Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Barnett, Gene H. [Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Stevens, Glen H.J. [Department of Neurology, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Murphy, Erin S. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio (United States); Stockham, Abigail L. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Shiue, Kevin [Case Western Reserve University School of Medicine, Cleveland, Ohio (United States); Suh, John H. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Cleveland Clinic, Cleveland, Ohio (United States)

    2013-11-01

    The incidence of radiation necrosis has increased secondary to greater use of combined modality therapy for brain tumors and stereotactic radiosurgery. Given that its characteristics on standard imaging are no different that tumor recurrence, it is difficult to diagnose without use of more sophisticated imaging and nuclear medicine scans, although the accuracy of such scans is controversial. Historically, treatment had been limited to steroids, hyperbaric oxygen, anticoagulants, and surgical resection. A recent prospective randomized study has confirmed the efficacy of bevacizumab in treating radiation necrosis. Novel therapies include using focused interstitial laser thermal therapy. This article will review the diagnosis and treatment of radiation necrosis.

  10. Odontogenic sinusitis: developments in diagnosis, microbiology, and treatment.

    Science.gov (United States)

    Workman, Alan D; Granquist, Eric J; Adappa, Nithin D

    2017-10-27

    Odontogenic causes of sinusitis are frequently missed; clinicians often overlook odontogenic disease whenever examining individuals with symptomatic rhinosinusitis. Conventional treatments for chronic rhinosinusitis (CRS) will often fail in odontogenic sinusitis. There have been several recent developments in the understanding of mechanisms, diagnosis, and treatment of odontogenic sinusitis, and clinicians should be aware of these advances to best treat this patient population. The majority of odontogenic disease is caused by periodontitis and iatrogenesis. Notably, dental pain or dental hypersensitivity is very commonly absent in odontogenic sinusitis, and symptoms are very similar to those seen in CRS overall. Unilaterality of nasal obstruction and foul nasal drainage are most suggestive of odontogenic sinusitis, but computed tomography is the gold standard for diagnosis. Conventional panoramic radiographs are very poorly suited to rule out odontogenic sinusitis, and cannot be relied on to identify disease. There does not appear to be an optimal sequence of treatment for odontogenic sinusitis; the dental source should be addressed and ESS is frequently also necessary to alleviate symptoms. Odontogenic sinusitis has distinct pathophysiology, diagnostic considerations, microbiology, and treatment strategies whenever compared with chronic rhinosinusitis. Clinicians who can accurately identify odontogenic sources can increase efficacy of medical and surgical treatments and improve patient outcomes.

  11. [Diagnosis and treatment of arrhythmogenic right ventricular cardiomyopathy in children].

    Science.gov (United States)

    Wang, Shu-Shui; Zhang, Zhi-Wei; Xu, Yan-Mei; Jiang, Qiu-Ping; Li, Hong; Qian, Ming-Yang; Li, Yu-Fen

    2010-03-01

    To summarize the experience in diagnosis and treatment of arrhythmogenic right ventricular cardiomyopathy (ARVC) in children. A total of 14 children (7 females and 7 males) with ARVC were involved. The cases underwent electrocardiography, echocardiography, cardiac CT or MRI examinations. All cases were treated with sotalol or amiodarone in combination with propranolol. In 2 cases with drug-refractory ventricular extrasystoles, catheter ablation treatment was performed. In 6 cases with obvious impaired ventricular function, additional pharmacological therapy including vasodilators, diuretics, and digitalis were given. Ventricular extrasystoles occurred in all 14 cases and ventricular tachycardia in 8 cases. Ten cases showed Epsilon wave on electrocardiography. All 14 cases had enlarged right ventricle and reduced right ventricular ejection fraction. CT or MRI examination showed right ventricular dilatation and a thinned wall of right ventricle in 10 cases. Ventricular extrasystoles or tachycardia disappeared in 7 cases and was reduced in 4 cases after treatment. The two children receiving catheter ablation treatment did not present ventricular extrasystoles or tachycardia in a 3-month follow-up. The heart function was improved in the 6 children with obvious impaired ventricular function after pharmacological therapy. The clinical manifestations are diverse in children with ARVC. A definite diagnosis of ARVC should be based on a combination of electrocardiography and echocardiography examinations. Pharmacological therapy is effective partially. Catheter ablation treatment appears to be a promising option in patients with drug-refractory ventricular extrasystoles.

  12. Developments and challenges in the diagnosis and treatment of ADHD

    Directory of Open Access Journals (Sweden)

    Taciana G. Costa Dias

    2013-01-01

    Full Text Available Attention-deficit/hyperactivity disorder (ADHD is a prevalent neurodevelopmental disorder, often associated with other psychiatric comorbidities, functional impairments, and poor long-term outcomes. The objective of this selected review is to describe current advances and challenges in the diagnosis and treatment of ADHD. The disorder is associated with neurobiological underpinnings and is highly heterogeneous in various aspects, such as symptom profiles, cognitive impairments, and neurobiological and genetic features. The efficacy and safety of short-term pharmacological treatments across the life cycle is well studied, but further research investigating long-term treatment, impact of treatment in preschoolers, and non-pharmacological interventions is needed. Future research is also needed to better characterize the neurodevelopmental pathways of the disorder, linking clinical and neurobiological information, less investigated populations, and new interventions.

  13. Binge-eating disorder: emerging treatments for a new diagnosis.

    Science.gov (United States)

    Tsappis, Michael; Freizinger, Melissa; Forman, Sara F

    2016-08-01

    This review provides an update on the new Diagnostic and Statistical Manual (DSM) diagnosis of binge-eating disorder (BED) by presenting diagnostic criteria, associated risk factors and co-morbidities, and tools for assessment. An update on the currently available evidence-based treatments for adolescent BED is provided to help with the coordination of treatment planning for identified patients with this condition. BED is now officially included in the DSM. Research with youth has begun to show improvement from treatments such as cognitive behavioral therapy, previously shown to be useful in adults. BED is common and often begins during youth. The availability of diagnostic criteria, along with increasing knowledge about the condition and available treatments, is expected to result in improved identification and management in younger patients.

  14. Idiopathic granulomatous mastitis: dilemmas in diagnosis and treatment.

    Science.gov (United States)

    Mahmodlou, Rahim; Dadkhah, Niloofar; Abbasi, Fariba; Nasiri, Jafar; Valizadeh, Rohollah

    2017-09-01

    Idiopathic granulomatous mastitis (IGM) is a benign rare inflammatory disease of the breast. Due to its uncommon etiology, diagnosis and treatment is still unknown. Selection of a standard method for diagnosing idiopathic granulomatous mastitis is sophisticated. In view of non-definitive clinical and imaging finding, histopathology is the cornerstone of definitive diagnosis. To determine and help solve the dilemma of treatment and diagnosis of idiopathic granulomatous mastitis. This historical cohort study was conducted on 48 patients who referred to the general surgery clinic of Imam Khomeini Hospital of Urmia, were diagnosed with IGM and were histopathologically selected by census using the registry system, in Urmia city, Iran, during 2010-2015 so that medical reports, ultrasonography (US) and mammography (MMG) findings, follow-up information and recurrence rate were obtained from records. The data were analyzed using SPSS software version 18 and descriptive statistics were used. According to records, 68.75% of patients (n=33) had palpable mass, 45.83% of patients (n=22) had breast pain and swelling, erythema and 20.83% of patients (n=10) had purulent drainage. Of the 48 patients 12 (25%) had mammography, which revealed the following findings: mass with irregular border in 6 patients, skin thickness in 2 cases (4.16%), and parenchymal asymmetry in 4 cases (8.33%). Minimum follow-up was 24 (range 24-56) months. According to our findings, histopathology of the disease is fundamental for correct diagnosis. Steroid therapy as a therapeutic method such as prednisolone was an effective and applicable choice in the treatment of idiopathic granulomatous mastitis by decreasing in inflammation.

  15. Recent advances in the diagnosis and treatment of childhood tuberculosis.

    Science.gov (United States)

    Kumar, Mani Kant; Kumar, Prashant; Singh, Anjali

    2015-01-01

    Despite over 2.3 million (26% of global burden) cases of tuberculosis (TB) in India the accurate diagnosis of childhood TB remains a major challenge. Children with TB usually have paucibacillary disease and contribute little to disease transmission within the community. Consequently the treatment of children with TB is often not considered a priority by TB control programmes. Adequate and timely assessment of TB infection in childhood could diminish epidemiological burden as underdiagnosed pediatric patients can eventually evolve in to an active state and have the potential to disseminate the etiological agent Mycobacterium tuberculosis, notably increasing this worldwide public health problem. In this review we discuss the most important recent advances in the diagnosis of childhood TB: (1) Symptom-based approaches, (2) novel immune-based approaches, including in vitro interferon-γ IGRA release assays IGRA tests; and (3) bacteriological and molecular methods that are more rapid and/or less expensive than conventional culture techniques for TB diagnosis and/or drug-resistance testing. Recent advances have improved our ability to diagnose latent infection and active TB in children, nevertheless establishing a diagnosis of either latent infection or active disease in HIV-infected children remains a major challenge.

  16. Epithelial borderline ovarian tumor: Diagnosis and treatment strategy.

    Science.gov (United States)

    Ushijima, Kimio; Kawano, Kouichiro; Tsuda, Naotake; Nishio, Shin; Terada, Atsumu; Kato, Hiroyuki; Tasaki, Kazuto; Matsukuma, Ken

    2015-05-01

    Epithelial borderline ovarian tumors (BOT) are distinctive from benign tumors and carcinoma. They occur in younger women more often than carcinoma, and there is some difficulty making correct diagnosis of BOT. Two subtypes of BOT, serous and mucinous borderline tumor have different characteristics and very different clinical behavior. Serous borderline tumor (SBT) with micropapillary pattern shows more incidence of extra ovarian disease and often coexists with invasive implant. SBT with micropapillary pattern in advanced stage has showed a worse prognosis than typical SBT. Huge mucinous borderline tumors have histologic heterogeneity, and the accuracy of frozen section diagnosis is relatively low. Extensive sampling is required to reach a correct pathological diagnosis. Mucinous adenoma (intestinal type) also runs the risk of recurrence after cystectomy, or intraoperative rupture of cyst. Laparoscopic procedure for BOT has not increased the risk of recurrence. Fertility preserving procedures are generally accepted, except in advanced stage SBT with invasive implants. Only cystectomy shows a significant risk of recurrence. Re-staging surgery and full staging surgery is not necessary for all BOT. We should not attempt to treat them uniformly, by the single diagnosis of "borderline tumor". It depends on histologic type. Close communication with the pathologist is necessary to gain more detail and ask more pathological samples in order to make the optimal treatment strategy for each individual patients.

  17. SEMINOMA COMPLICATING ECTOPIC ABDOMINAL TESTIS

    African Journals Online (AJOL)

    Departments of Surgery and Pathology, Aminu Kano Teaching Hospital, Kano, Nigeria. INTRODUCTION. Germ cell tumors of the testis are the most common solid tumors in men ... weight loss were also noticed, but he had no cough, bone pains, jaundice or urinary symp- toms. The past medical history revealed a his-.

  18. Risk factors for undescended testis.

    NARCIS (Netherlands)

    Brouwers, M.M.; Bruijne, L.M. de; Gier, R.P.E. de; Zielhuis, G.A.; Feitz, W.F.J.; Roeleveld, N.

    2012-01-01

    OBJECTIVE: To contribute to the understanding of the etiology of undescended testis (UDT), by exploring a wide range of potential risk factors in a case-referent study. PATIENTS AND METHODS: Cases and referents were recruited at five hospitals and included 200 boys with surgically corrected UDT and

  19. Advanced Nanobiomaterials: Vaccines, Diagnosis and Treatment of Infectious Diseases

    Directory of Open Access Journals (Sweden)

    Eva Torres-Sangiao

    2016-07-01

    Full Text Available The use of nanoparticles has contributed to many advances due to their important properties such as, size, shape or biocompatibility. The use of nanotechnology in medicine has great potential, especially in medical microbiology. Promising data show the possibility of shaping immune responses and fighting severe infections using synthetic materials. Different studies have suggested that the addition of synthetic nanoparticles in vaccines and immunotherapy will have a great impact on public health. On the other hand, antibiotic resistance is one of the major concerns worldwide; a recent report of the World Health Organization (WHO states that antibiotic resistance could cause 300 million deaths by 2050. Nanomedicine offers an innovative tool for combating the high rates of resistance that we are fighting nowadays, by the development of both alternative therapeutic and prophylaxis approaches and also novel diagnosis methods. Early detection of infectious diseases is the key to a successful treatment and the new developed applications based on nanotechnology offer an increased sensibility and efficiency of the diagnosis. The aim of this review is to reveal and discuss the main advances made on the science of nanomaterials for the prevention, diagnosis and treatment of infectious diseases. Highlighting innovative approaches utilized to: (i increasing the efficiency of vaccines; (ii obtaining shuttle systems that require lower antibiotic concentrations; (iii developing coating devices that inhibit microbial colonization and biofilm formation.

  20. Leishmaniasis revisited: Current aspects on epidemiology, diagnosis and treatment.

    Science.gov (United States)

    Georgiadou, Sarah P; Makaritsis, Konstantinos P; Dalekos, George N

    2015-01-01

    Leishmaniasis is a vector-borne disease caused by protozoan parasites of the genus Leishmania. It is transmitted by phlebotomine female sand flies of the genera Phlebotomus and Lutzomyia in the old and new world, respectively. More than 20 well-recognized Leishmania species are known to infect humans and cause visceral (VL), cutaneous (CL) and mucocutaneous (ML) forms of the disease. Approximately 350 million people are at risk of contracting the disease and an estimated 1.6 million new cases occur annually. The disease mainly affects poor people in Africa, Asia and Latin America, and is associated with malnutrition, population migration, poor residency conditions, frail immune system and lack of resources. Previously, diagnosis of leishmaniasis relied mainly on invasive techniques of detecting parasites in splenic and bone marrow aspirates. Nevertheless, serological tests using the recombinant kinesin antigen (rK39) and molecular methods (polymerase chain reaction) are considered the best options for diagnosis today, despite problems related to varying sensitivities and specificities and field adaptability. Therapy of leishmaniasis ranges from local treatment of cutaneous lesions to systemic often toxic, therapy for disseminated CL, ML and VL. Agents with efficacy against leishmaniasis include amphotericin B, pentavalent antimonial drugs, paromomycin and miltefosine. No single therapy of VL currently offers satisfactory efficacy along with safety. This article provides a brief and updated systematic review on the epidemiology, diagnosis and treatment of this neglected disease.

  1. Diagnosis and treatment of hepatocellular carcinoma: An update

    Science.gov (United States)

    Tejeda-Maldonado, Javier; García-Juárez, Ignacio; Aguirre-Valadez, Jonathan; González-Aguirre, Adrián; Vilatobá-Chapa, Mario; Armengol-Alonso, Alejandra; Escobar-Penagos, Francisco; Torre, Aldo; Sánchez-Ávila, Juan Francisco; Carrillo-Pérez, Diego Luis

    2015-01-01

    Hepatocellular carcinoma (HCC) is one of the most common malignancies leading to high mortality rates in the general population; in cirrhotic patients, it is the primary cause of death. The diagnosis is usually delayed in spite of at-risk population screening recommendations, i.e., patients infected with hepatitis B or C virus. Hepatocarcinogenesis hinges on a great number of genetic and molecular abnormalities that lead to tumor angiogenesis and foster their dissemination potential. The diagnosis is mainly based on imaging studies such as computed tomography and magnetic resonance, in which lesions present a characteristic classical pattern of early arterial enhancement followed by contrast medium “washout” in late venous phase. On occasion, when imaging studies are not conclusive, biopsy of the lesion must be performed to establish the diagnosis. The Barcelona Clinic Liver Cancer staging method is the most frequently used worldwide and recommended by the international guidelines of HCC management. Currently available treatments include tumor resection, liver transplant, sorafenib and loco-regional therapies (alcoholization, radiofrequency ablation, chemoembolization). The prognosis of hepatocarcinoma is determined according to the lesion’s stage and in cirrhotic patients, on residual liver function. Curative treatments, such as liver transplant, are sought in patients diagnosed in early stages; patients in more advanced stages, were not greatly benefitted by chemotherapy in terms of survival until the advent of target molecules such as sorafenib. PMID:25848464

  2. [Recent progress on diagnosis and treatment of benign symmetric lipomatosis].

    Science.gov (United States)

    Kan, Yingnan; Yao, Ping; Xin, Weihong; Chen, Qianqian; Wang, Jun; Yue, Jian; Zhu, Jiajing

    2010-02-01

    To introduce recent progress on diagnosis and treatment of benign symmetric lipomatosis (BSL). Detailed clinical data of 6 patients with BSL were reviewed and analyzed. We present a summary of the clinical symptoms, physical sign, diagnosis and therapeutic methods of BSL. And related literatures were discussed together. All of 6 patients have excessive subcutaneous fat deposit predominantly around neck. One patients had upper extremity localizations. Six patients had the complication of left ventricular diastolic function changes, glucose intolerance or diabetes mellitus, chronic hepatopathy, hyperuricemia and sleep apnea syndrome in one or more. One patients with several symptoms occur simultaneously, another one female patient was accompanied by all symptoms but chronic hepatopathy. Five male patient were alcohol abusers. Total neck lipectomy and abstinence from alcohol were performed on 5 patients. One patient refused treatment. During a follow-up of 3 months to 4 years, one patients was relapsed again, and no recurrence was seen in another 4 patients. All patho logical results were nonencapsulated fat. BSL is a lipodystrophy caused by diffuse fatty tissue, symmetry deposition in the neck and shoulder subcutaneous fascia space or deep fascial space. The highest incidence favors to middle-aged man who is alcoholic. Chronic alcohol addiction and typical clinical symptoms help to diagnosis BSL. Lipectomy represents a successful procedure in treating BSL.

  3. Challenges in the diagnosis and treatment of pulmonary arterial hypertension.

    LENUS (Irish Health Repository)

    2012-12-01

    Advances in the diagnosis and management of pulmonary arterial hypertension (PAH) have resulted in significant improvements in outcomes for patients with this devastating and progressive disease. However, because of the non-specific nature of its symptoms, and the low level of suspicion among clinicians, prompt and accurate diagnosis of PAH as a rare disease remains a challenge. This article explains some of the issues that need to be addressed when faced with a patient with suspected PAH and describes how noninvasive and invasive techniques can be used effectively to ensure an accurate diagnosis. The availability of PAH-specific therapy means that once diagnosed, patients have a much greater chance of survival than they would have had in the past. However, despite improved survival, mortality is still high and, therefore, there is still room for improvement. It is currently recommended that patients with an inadequate clinical response to treatment receive sequential combination therapy; however, supportive data are still scarce. Although there is no clear explanation, these findings may be explained by the design and end-points chosen in clinical trials, the changing population of PAH and a need to improve the management strategy in this disease. Indeed, there is a clear need for randomised controlled studies that investigate whether adopting individualised treatment strategies, including upfront combination therapy, could help to optimise long-term management of patients with PAH.

  4. [Diagnosis and treatment of familial hypercholesterolemia in Spain: consensus document].

    Science.gov (United States)

    Mata, Pedro; Alonso, Rodrigo; Ruiz, Antonio; Gonzalez-Juanatey, Jose R; Badimón, Lina; Díaz-Díaz, Jose L; Muñoz, María Teresa; Muñiz, Ovidio; Galve, Enrique; Irigoyen, Luis; Fuentes-Jiménez, Francisco; Dalmau, Jaime; Pérez-Jiménez, Francisco

    2015-01-01

    Familial hypercholesterolemia (FH) is a common genetic disorder, clinically manifested since birth, and associated with very high levels of plasma LDL-cholesterol (LDL-c), xanthomas, and premature coronary heart disease. Its early detection and treatment reduces coronary morbidity and mortality. Despite effective treatment being available, FH is under-diagnosed and under-treated. Identification of index cases and cascade screening using LDL-c levels and genetic testing are the most cost-effective strategies for detecting new cases and starting early treatment. Long-term treatment with statins has decreased the vascular risk to the levels of the general population. LDL-c targets are diabetes. Most patients do not to reach these goals, and combined treatments with ezetimibe or other drugs may be necessary. When the goals are not achieved with the maximum tolerated drug treatment, a reduction ≥ 50% in LDL-c levels can be acceptable. Lipoprotein apheresis can be useful in homozygous, and in treatment-resistant severe heterozygous, cases. This Consensus Paper gives recommendations on the diagnosis, screening, and treatment of FH in children and adults, and specific advice to specialists and general practitioners with the objective of improving the clinical management of these patients, in order to reduce the high burden of coronary heart disease. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  5. Elderly patients with schizophrenia and depression: diagnosis and treatment.

    Science.gov (United States)

    Felmet, Kandi; Zisook, Sidney; Kasckow, John W

    2011-01-01

    The treatment of older patients with schizophrenia and depressive symptoms poses many challenges for clinicians. Current classifications of depressive symptoms in patients with schizophrenia include: Major Depressive Episodes that occur in patients with schizophrenia and are not classified as schizoaffective disorder, Schizoaffective Disorder, and Schizophrenia with subsyndromal depression in which depressive symptoms do not meet criteria for Major Depression. Research indicates that the presence of any of these depressive symptoms negatively impacts the lives of patients suffering from schizophrenia-spectrum disorders. The purpose of this paper is to review the literature related to older patients with schizophrenia-spectrum disorders and co-occurring depressive symptoms, and to guide mental health professionals to better understand the diagnosis and treatment of depressive symptoms in patients with schizophrenia. The treatment of elderly patients with schizophrenia and depressive symptoms includes first reassessing the diagnosis to make sure symptoms are not due to a comorbid condition, metabolic problems or medications. If these are ruled out, pharmacological agents in combination with psychosocial interventions are important treatments for older patients with schizophrenia and depressive symptoms. A careful assessment of each patient is needed in order to determine which antipsychotic would be optimal for their care; second-generation antipsychotics are the most commonly used antipsychotics. Augmentation with an antidepressant medication can be helpful for the elderly patient with schizophrenia and depressive symptoms. More research with pharmacologic and psychosocial interventions is needed, however, to better understand how to treat this population of elderly patients.

  6. Elderly Patients with Schizophrenia and Depression: Diagnosis and Treatment

    Science.gov (United States)

    Felmet, Kandi; Zisook, Sidney; Kasckow, John W.

    2011-01-01

    Background The treatment of older patients with schizophrenia and depressive symptoms poses many challenges for clinicians. Current classifications of depressive symptoms in patients with schizophrenia include: Major Depressive Episodes that occur in patients with schizophrenia and are not classified as schizoaffective disorder, Schizoaffective Disorder, and Schizophrenia with subsyndromal depression in which depressive symptoms do not meet criteria for Major Depression. Research indicates that the presence of any of these depressive symptoms negatively impacts the lives of patients suffering from schizophrenia-spectrum disorders. Purpose The purpose of this paper is to review the literature related to older patients with schizophrenia-spectrum disorders and co-occurring depressive symptoms, and to guide mental health professionals to better understand the diagnosis and treatment of depressive symptoms in patients with schizophrenia. Conclusions The treatment of elderly patients with schizophrenia and depressive symptoms includes first reassessing the diagnosis to make sure symptoms are not due to a comorbid condition, metabolic problems or medications. If these are ruled out, pharmacological agents in combination with psychosocial interventions are important treatments for older patients with schizophrenia and depressive symptoms. A careful assessment of each patient is needed in order to determine which antipsychotic would be optimal for their care; second-generation antipsychotics are the most commonly used antipsychotics. Augmentation with an antidepressant medication can be helpful for the elderly patient with schizophrenia and depressive symptoms. More research with pharmacologic and psychosocial interventions is needed, however, to better understand how to treat this population of elderly patients. PMID:21177241

  7. Oral lichen planus: A look from diagnosis to treatment.

    Directory of Open Access Journals (Sweden)

    Pablo Córdova

    2014-03-01

    Full Text Available Oral lichen planus (OLP is a chronic mucocutaneous disease of unknown etiology. Its pathogenesis is multifactorial and it may affect the oral mucosa, skin and other mucous membranes. Diagnosis is based on clinic and histopathology; direct immunofluorescence techniques can also be of use. It affects about one to two percent of the population, mainly women between the fifth and sixth decades of life. In the mouth, the most affected area is the buccal mucosa, followed by the gums, tongue and/or palate. Its three most representative clinical forms are reticular, erythematous and erosive; evolution depends on the type it is. Lesion treatment is determined by the clinical form and, since no fully effective treatment has been found yet, it is directed towards controlling the disease. The treatment of choice involves topical or systemic corticosteroids, but other drugs may also be used.The aim of this paper is to gather current and relevant information about oral lichen planus: its pathogenesis, diagnosis, treatment and management.

  8. Diagnosis and treatment of autoimmune pancreatitis: experience with 100 patients.

    Science.gov (United States)

    Xin, Lei; He, Yuan-Xiang; Zhu, Xiao-Fei; Zhang, Qun-Hua; Hu, Liang-Hao; Zou, Duo-Wu; Jin, Zhen-Dong; Chang, Xue-Jiao; Zheng, Jian-Ming; Zuo, Chang-Jing; Shao, Cheng-Wei; Jin, Gang; Liao, Zhuan; Li, Zhao-Shen

    2014-12-01

    Autoimmune pancreatitis (AIP) is increasingly recognized as a unique subtype of pancreatitis. This study aimed to analyze the diagnosis and treatment of AIP patients from a tertiary care center in China. One hundred patients with AIP who had been treated from January 2005 to December 2012 in our hospital were enrolled in this study. We retrospectively reviewed the data of clinical manifestations, laboratory tests, imaging examinations, pathological examinations, treatment and outcomes of the patients. The median age of the patients at onset was 57 years (range 23-82) with a male to female ratio of 8.1:1. The common manifestations of the patients included obstructive jaundice (49 patients, 49.0%), abdominal pain (30, 30.0%), and acute pancreatitis (11, 11.0%). Biliary involvement was one of the most extrapancreatic manifestations (64, 64.0%). Fifty-six (56.0%) and 43 (43.0%) patients were classified into focal-type and diffuse-type respectively according to the imaging examinations. The levels of serum IgG and IgG4 were elevated in 69.4% (43/62) and 92.0% (69/75) patients. Pathological analysis of specimens from 27 patients supported the diagnosis of lymphoplasmacytic sclerosing pancreatitis, and marked (>10 cells/HPF) IgG4 positive cells were found in 20 (74.1%) patients. Steroid treatment and surgery as the main initial treatments were given to 41 (41.0%) and 28 (28.0%) patients, respectively. The remission rate after the initial treatment was 85.0%. Steroid was given as the treatment after relapse in most of the patients and the total remission rate at the end of follow-up was 96.0%. Clinical manifestations, laboratory tests, imaging and pathology examinations in combination could increase the diagnostic accuracy of AIP. Steroid treatment with an initial dose of 30 or 40 mg prednisone is effective and safe in most patients with AIP.

  9. Diagnosis and Treatment of Refractory Gastroesophageal Reflux Disease (GERD

    Directory of Open Access Journals (Sweden)

    Selfie

    2015-12-01

    Full Text Available Gastroesophageal reflux disease (GERD was a damage in mucosal layer caused by gastric acid reflux. GERD was found about 10-20% in Western Countries and less in Asia, about 2,6-6,7%. Among different type of GERD, refractory GERD was a problem found in daily clinical practice. This terminology was used in patients with regurgitation and heartburn symptoms which is not responsive to 8 weeks proton pump inhibitor (PPI therapy. There were several mechanisms underlying the etiology and pathophysiology of refractory GERD. In general, refractory GERD diagnosis was based on clinical findings, objective endoscopic examination, ambulatory reflux monitoring, and response to antiacid-secretion therapy. Reevaluation of patients compliance should be the first step in refractory GERD management. A further treatment strategies could be started, consist of medical and surgical therapies. A basic clinical knowledge of refractory GERD would help clinician in deciding the best approach for diagnosis and therapy.

  10. Antenatal Hydronephrosis: Differential Diagnosis, Evaluation, and Treatment Options

    Directory of Open Access Journals (Sweden)

    C.D. Anthony Herndon

    2006-01-01

    Full Text Available The diagnosis, evaluation and management of antenatal hydronephrosis has undergone a two stage paradigm shift since the advent of prenatal ultrasonography in the early 1980s. Initially the identification of a large number of asymptomatic infants appeared to afford the surgeon the opportunity for preemptive intervention. However, it has now become apparent that antenatal hydronephrosis (AH is far more difficult to interpret thanoriginally perceived. The initial enthusiasm for surgery has now been replaced by a much more conservative approach to ureteropelvic junction(UPJ obstruction, multi-cystic dysplastic kidney(MCDK, vesicoureteral reflux and the non-refluxing megaureter. This review will highlight the postnatal evaluation of AH and include an overview of the Society for Fetal Urology grading system for hydronephrosis. The differential diagnosis and treatment options for UPJ obstruction, vesicoureteral reflux, MCDK, duplication anomalies, megaureter, and posterior urethral valves will be discussed.

  11. Advances in the Diagnosis and Treatment of Acute Pulmonary Embolism

    Science.gov (United States)

    2012-01-01

    Over the past two decades, considerable progress in technology and clinical research methods have led to advances in the diagnosis, treatment and prevention of acute venous thromboembolism. Despite this, however, the diagnosis is still often missed and preventive methods are often ignored. Published guidelines are useful, but are limited by the existing evidence base so that controversies remain with regard to topics such as duration of anticoagulation, indications for placement and removal of inferior vena caval filters, and when and how to administer thrombolytic therapy. The morbidity and mortality of this disease remain high, particularly when undiagnosed. While preventive approaches remain crucial, the focus of this review is on the diagnostic and therapeutic approach to acute venous thromboembolism, with an emphasis on acute pulmonary embolism. PMID:22619694

  12. Dysfunction of the hypothalamus: etiology, clinical picture, diagnosis, treatment (guidelines

    Directory of Open Access Journals (Sweden)

    V.I. Botsyurko

    2017-05-01

    Full Text Available In the hypothalamus, there are nuclei of autonomic nervous system, as well endocrine system, and vitally important centers — of hunger, saturation, thermoregulation, sleep and wakefulness. Under the influence of traumatic brain injuries, neuroinfections and poisons, this complex integral system is often disturbed causing dysfunction of the hypothalamus. The prepared guidelines observe questions of the etiology, pathogenesis, clinical picture, diagnosis and treatment of hypothalamic dysfunction. In terms of therapy, a main emphasis is put on physiological approaches to the normalization of hypothalamic disorders. Particular attention is paid to the formulation of diagnosis according to the 10th revision of the International Statistical Classification of Diseases and Related Health Problems that has a significant importance for the regulation of statistical statements. Guidelines are intended for endocrinologists, neuropathologists, cardiologists, general practitioners and family doctors.

  13. Guidelines for the diagnosis, prevention and treatment of osteoporosis

    Directory of Open Access Journals (Sweden)

    M. Rossini

    2011-06-01

    Full Text Available The guidelines for the osteoporosis management were first drafted by a working group and then critically evaluated by the board of SIOMMMS. The most relevant points are: Definition: Osteoporosis is defined as a quantitative and qualitative deterioration of bone tissue leading to increased risk of fracture. Postmenopausal and senile osteoporosis are defined as primitive. Diagnosis: The cornerstone for the diagnosis of osteoporosis is the measurement of bone mineral density (BMD by DXA (dual-energy X-ray absortiometry at the femoral neck with T-score values -2.5 is usually not justified. Pharmacological intervention: The use of drugs registered for the treatment of osteoporosis are recommended when the benefits overcome the risk. This is the case only when the risk of fracture is rather high. FRAX™ is recognized as a useful tool for easily estimate the long-term fracture risk. SIOMMMS with these guidelines is committed to validate and further develop this diagnostic tool.

  14. Angiogenic factors in preeclampsia: potential for diagnosis and treatment.

    Science.gov (United States)

    Goel, Arvind; Rana, Sarosh

    2013-11-01

    The review summarizes new observations of key roles for circulating angiogenic factors in diagnosing, managing, and treating preeclampsia. Alterations in circulating angiogenic factors (soluble fms-like tyrosine kinase-1 and placental growth factor) in preeclampsia correlate with the diagnosis and adverse outcomes, particularly when the disease presents prematurely (preeclampsia and its complications from other disorders that present with similar clinical profiles. A ratio of soluble fms-like tyrosine kinase-1/placental growth factor greater than 85 appears ideal as the cut-off for both diagnosis and prognosis. There is also evidence that modulating these factors has therapeutic effects, suggesting a future role for angiogenic factors in treatment and prevention of preeclampsia. Circulating angiogenic biomarkers help in diagnostic and prognostic profiling of preeclampsia and may facilitate better management of these patients.

  15. Advances in diagnosis and treatment of portal hypertensive biliopathy

    Directory of Open Access Journals (Sweden)

    WENG Ningna

    2014-08-01

    Full Text Available With the progress in research on portal hypertension in recent years, portal hypertensive biliopathy (PHB has attracted more and more attention. The pathophysiology and clinical manifestations of PHB, as well as the main methods for the diagnosis and treatment of this disease, are briefly described. The pathogenesis of PHB remains unclear, and it has been postulated that the external pressure of portal cavernoma and the ischemic stricture of the bile duct may play a role. Magnetic resonance cholangiopancreatography is the primary diagnostic tool for PHB. Currently, it is thought that asymptomatic PHB patients do not require any treatment, and symptomatic PHB patients should receive individualized treatment, which mainly included reducing portal pressure and relieving biliary obstruction. Transjugular intrahepatic portosystemic shunt has become the first-line therapy for symptomatic PHB. More research and practice are needed for further understanding of PHB.

  16. Update on the diagnosis and treatment of pulmonary tuberculosis.

    Science.gov (United States)

    Caminero Luna, J A

    2016-03-01

    Tuberculosis (TB) remains the most important human infectious disease. Currently, the TB diagnosis is still based on the clinical presentation, radiographic findings and microbiological results; all of which have sensitivity or specificity issues. For that reason, the immediate future involves rapid molecular microbiological techniques, in particular GeneXpert (which is more sensitive than bacilloscopy and is able to detect rifampicin resistance) and GenoType. The current six-month treatment for TB has remained unchanged for decades. Attempts to shorten this treatment have failed. In recent years, new drugs have been reported that could contribute to TB treatment in the near future, and are already being used in multi-drug-resistance TB. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  17. Management of cerebral cavernous malformations: from diagnosis to treatment.

    Science.gov (United States)

    Mouchtouris, Nikolaos; Chalouhi, Nohra; Chitale, Ameet; Starke, Robert M; Tjoumakaris, Stavropoula I; Rosenwasser, Robert H; Jabbour, Pascal M

    2015-01-01

    Cerebral cavernous malformations are the most common vascular malformations and can be found in many locations in the brain. If left untreated, cavernomas may lead to intracerebral hemorrhage, seizures, focal neurological deficits, or headaches. As they are angiographically occult, their diagnosis relies on various MR imaging techniques, which detect different characteristics of the lesions as well as aiding in planning the surgical treatment. The clinical presentation and the location of the lesion are the most important factors involved in determining the optimal course of treatment of cavernomas. We concisely review the literature and discuss the advantages and limitations of each of the three available methods of treatment--microsurgical resection, stereotactic radiosurgery, and conservative management--depending on the lesion characteristics.

  18. [The diagnosis and treatment of quadrilateral space syndrome].

    Science.gov (United States)

    Kuang, Y; Hou, C L

    2001-07-01

    To investigate the compression feature, clinical manifestation and the results of treatment of quadrilateral space syndrome. Four patients with axillary nerve entrapment at quadrilateral space had been treated and followed up for 5 to 12 months from May 1999 to June 2000. The causes, symptoms, signs and the treatment management of those cases were analyzed. Among the 3 cases which received operation, sensation and motor function completely recovered in 2 cases and partially recovered in 1 case. No obvious recovery of sensation and motor function in the case which received local nerve blocking treatment. The main diagnostic evidence for axillary nerve entrapment is the deltoid muscle paralysis and paresthesia in the lateral side of shoulder, and early neurolysis is recommended as soon as the diagnosis is clarified.

  19. New Insights in the Diagnosis and Treatment of Heart Failure

    Science.gov (United States)

    Agnetti, Giulio; Piepoli, Massimo F.; Siniscalchi, Giuseppe

    2015-01-01

    Cardiovascular disease is the leading cause of mortality in the US and in westernized countries with ischemic heart disease accounting for the majority of these deaths. Paradoxically, the improvements in the medical and surgical treatments of acute coronary syndrome are leading to an increasing number of “survivors” who are then developing heart failure. Despite considerable advances in its management, the gold standard for the treatment of end-stage heart failure patients remains heart transplantation. Nevertheless, this procedure can be offered only to a small percentage of patients who could benefit from a new heart due to the limited availability of donor organs. The aim of this review is to evaluate the safety and efficacy of innovative approaches in the diagnosis and treatment of patients refractory to standard medical therapy and excluded from cardiac transplantation lists. PMID:26634204

  20. New Insights in the Diagnosis and Treatment of Heart Failure

    Directory of Open Access Journals (Sweden)

    Giulio Agnetti

    2015-01-01

    Full Text Available Cardiovascular disease is the leading cause of mortality in the US and in westernized countries with ischemic heart disease accounting for the majority of these deaths. Paradoxically, the improvements in the medical and surgical treatments of acute coronary syndrome are leading to an increasing number of “survivors” who are then developing heart failure. Despite considerable advances in its management, the gold standard for the treatment of end-stage heart failure patients remains heart transplantation. Nevertheless, this procedure can be offered only to a small percentage of patients who could benefit from a new heart due to the limited availability of donor organs. The aim of this review is to evaluate the safety and efficacy of innovative approaches in the diagnosis and treatment of patients refractory to standard medical therapy and excluded from cardiac transplantation lists.

  1. Gorlin-Goltz Syndrome: Diagnosis and Treatment Options

    Directory of Open Access Journals (Sweden)

    João Mendes-Abreu

    2017-05-01

    Full Text Available The Gorlin-Goltz syndrome is a rare autosomal dominant hereditary condition, with complete penetrance and variable expressivity. Characterized by the appearance of multiple basaliomas, and often the development of keratocyst, it can also express itself by the presence of palmar/plantar depressions, calcification of brain sickle, and skeletal birth defects, although less frequently. This article presents two cases involving direct relatives, referred after the identification of several basaliomas and jaw cysts. After establishing the diagnosis, given the identification of three major criteria, the treatment consisted in the excision of the lesions followed, in one case, with vismodegib treatment resulting in complete remission. Gorlin-Goltz syndrome is therefore a multidisciplinary challenge, whose variable morbidity and high risk of recurrence make treatment and surveillance critical. However, new molecular targeted therapies have brought a new hope in treating these patients.

  2. Malignant mesothelioma of the tunica vaginalis testis: a malignancy associated with recurrent epididymitis?

    Directory of Open Access Journals (Sweden)

    Yen Ching-Heng

    2012-11-01

    Full Text Available Abstract A 53-year-old Taiwanese male had several episodes of left epididymitis with hydrocele refractory to antibiotic treatment. Partial epididymectomy plus preventive vasectomy were planned, and, incidentally, an ill-defined nodule was found lying on the tunica vaginalis near the epididymal head. The pathological diagnosis was malignant mesothelioma of the tunica vaginalis testis. Radical orchiectomy with wide excision of the hemi-scrotal wall was performed. So far, there is no evidence of recurrence after more than 3 years of follow-up. Malignant tumor should be considered in the case of recurrent epididymitis refractory to empirically effective antibiotic treatment. Although the nature of this tumor is highly fatal, the malignancy can possibly be cured by early and aggressive surgical treatment.

  3. Delirium in Older Persons: Advances in Diagnosis and Treatment.

    Science.gov (United States)

    Oh, Esther S; Fong, Tamara G; Hshieh, Tammy T; Inouye, Sharon K

    2017-09-26

    Delirium is defined as an acute disorder of attention and cognition. It is a common, serious, and often fatal condition among older patients. Although often underrecognized, delirium has serious adverse effects on the individual's function and quality of life, as well as broad societal effects with substantial health care costs. To summarize the current state of the art in diagnosis and treatment of delirium and to highlight critical areas for future research to advance the field. Search of Ovid MEDLINE, Embase, and the Cochrane Library for the past 6 years, from January 1, 2011, until March 16, 2017, using a combination of controlled vocabulary and keyword terms. Since delirium is more prevalent in older adults, the focus was on studies in elderly populations; studies based solely in the intensive care unit (ICU) and non-English-language articles were excluded. Of 127 articles included, 25 were clinical trials, 42 cohort studies, 5 systematic reviews and meta-analyses, and 55 were other categories. A total of 11 616 patients were represented in the treatment studies. Advances in diagnosis have included the development of brief screening tools with high sensitivity and specificity, such as the 3-Minute Diagnostic Assessment; 4 A's Test; and proxy-based measures such as the Family Confusion Assessment Method. Measures of severity, such as the Confusion Assessment Method-Severity Score, can aid in monitoring response to treatment, risk stratification, and assessing prognosis. Nonpharmacologic approaches focused on risk factors such as immobility, functional decline, visual or hearing impairment, dehydration, and sleep deprivation are effective for delirium prevention and also are recommended for delirium treatment. Current recommendations for pharmacologic treatment of delirium, based on recent reviews of the evidence, recommend reserving use of antipsychotics and other sedating medications for treatment of severe agitation that poses risk to patient or staff

  4. Advances in diagnosis and treatment of metastatic cervical cancer.

    Science.gov (United States)

    Li, Haoran; Wu, Xiaohua; Cheng, Xi

    2016-07-01

    Cervical cancer is one of the most common cancers in women worldwide. The outcome of patients with metastatic cervical cancer is poor. We reviewed the relevant literature concerning the treatment and diagnosis of metastatic cervical cancer. There are two types of metastasis related to different treatments and survival rates: hematogenous metastasis and lymphatic metastasis. Patients with hematogenous metastasis have a higher risk of death than those with lymphatic metastasis. In terms of diagnosis, fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) and PET-computed tomography are effective tools for the evaluation of distant metastasis. Concurrent chemoradiotherapy and subsequent chemotherapy are well-tolerated and efficient for lymphatic metastasis. As for lung metastasis, chemotherapy and/or surgery are valuable treatments for resistant, recurrent metastatic cervical cancer and chemoradiotherapy may be the optimal choice for stage IVB cervical cancer. Chemotherapy and bone irradiation are promising for bone metastasis. A better survival is achieved with multimodal therapy. Craniotomy or stereotactic radiosurgery is an optimal choice combined with radiotherapy for solitary brain metastases. Chemotherapy and palliative brain radiation may be considered for multiple brain metastases and other organ metastases.

  5. Diagnosis and Treatment of Cyclothymia: The "Primacy" of Temperament.

    Science.gov (United States)

    Perugi, Giulio; Hantouche, Elie; Vannucchi, Giulia

    2017-04-01

    Contrary to DSM-5 definition based on recurrence of low grade hypomanic and depressive symptoms, cyclothymia is better defined in a neurodevelopmental perspective as an exaggeration of cyclothymic temperament. Emotional dysregulation with extreme mood instability and reactivity is the core features of the complex symptomatology. In the present article, we critically reviewed the literature on the diagnosis and treatment of cyclothymia, focusing on the temperamental and neurodevelopmental perspectives. Current epidemiological and clinical research showed the high prevalence and the validity of cyclothymia as a distinct form of bipolarity, frequently associated with multiple comorbidities with anxiety, impulse control, substance use, and so called "personality" disorders. Many patients receive correct diagnosis and treatments after many years of illness, when the superposition of complications reduces the possibility of complete remission. A therapeutic model combining the focus on symptomatic presentations with a temperamental perspective seems to represent an effective approach for cyclothymic patients with complex clinical presentations. Cyclothymic mood instability is an understudied issue despite the evidence of its clinical relevance. Unresolved issues concern its diagnostic delimitation and the possible relationships with emotional dysregulation observed in other neurodevelopmental disorders. We need to confirm the specificity of the disorder and to improve its recognition in early phase of the life, especially in youth. Early recognition means avoiding unnecessary complications and establishing specific treatments and clinical management since the beginning.

  6. Candidiasis: predisposing factors, prevention, diagnosis and alternative treatment.

    Science.gov (United States)

    Martins, Natália; Ferreira, Isabel C F R; Barros, Lillian; Silva, Sónia; Henriques, Mariana

    2014-06-01

    Candidiasis is the most common opportunistic yeast infection. Candida species and other microorganisms are involved in this complicated fungal infection, but Candida albicans continues to be the most prevalent. In the past two decades, it has been observed an abnormal overgrowth in the gastrointestinal, urinary and respiratory tracts, not only in immunocompromised patients, but also related to nosocomial infections and even in healthy individuals. There is a widely variety of causal factors that contribute to yeast infection which means that candidiasis is a good example of a multifactorial syndrome. Due to rapid increase in the incidence in these infections, this is the subject of numerous studies. Recently, the focus of attention is the treatment and, above all, the prevention of those complications. The diagnosis of candidiasis could become quite complicated. Prevention is the most effective "treatment," much more than eradication of the yeast with antifungal agents. There are several aspects to consider in the daily routine that can provide a strength protection. However, a therapeutic approach is necessary when the infection is established, and therefore, other alternatives should be explored. This review provides an overview on predisposition factors, prevention and diagnosis of candidiasis, highlighting alternative approaches for candidiasis treatment.

  7. Advances in Diagnosis and Treatment of Fetal Alcohol Spectrum Disorders

    Science.gov (United States)

    Murawski, Nathen J.; Moore, Eileen M.; Thomas, Jennifer D.; Riley, Edward P.

    2015-01-01

    Prenatal alcohol exposure can cause a number of physical, behavioral, cognitive, and neural impairments, collectively known as fetal alcohol spectrum disorders (FASD). This article examines basic research that has been or could be translated into practical applications for the diagnosis or treatment of FASD. Diagnosing FASD continues to be a challenge, but advances are being made at both basic science and clinical levels. These include identification of biomarkers, recognition of subtle facial characteristics of exposure, and examination of the relation between face, brain, and behavior. Basic research also is pointing toward potential new interventions for FASD involving pharmacotherapies, nutritional therapies, and exercise interventions. Although researchers have assessed the majority of these treatments in animal models of FASD, a limited number of recent clinical studies exist. An assessment of this literature suggests that targeted interventions can improve some impairments resulting from developmental alcohol exposure. However, combining interventions may prove more efficacious. Ultimately, advances in basic and clinical sciences may translate to clinical care, improving both diagnosis and treatment. PMID:26259091

  8. [Diagnosis and treatment of occult breast cancer in 44 cases].

    Science.gov (United States)

    Lu, Su; Liu, Hong

    2011-07-01

    To summarize the experience of diagnosis and treatment of occult breast cancer in 44 cases. Clinicopathological data of 44 cases of occult breast cancer initially presenting axillary mass alone treated in our department during Jan 1997 to Dec 2008 were retrospectively analyzed. The 44 patients with occult breast cancer accounted for 0.42% of all breast cancer patients admitted to our hospital and institute in the same period. The surgery included radical mastectomy in 16 cases, modified radical mastectomy in 19 cases, axillary clearance in 1 case, and simple axillary node excision in 8 cases. Follow-up, ranging from 12-132 months, was available in 38 cases. Among 32 cases who underwent mastectomy or axillary clearance, 2 cases died of distant metastases and 3 cases were still alive with local recurrence at the time of analysis. In two out of six cases who refused further surgical treatment received mastectomy 16 months and 41 months after the primary diagnosis of occult breast cancer, respectively. Others were alive without evidence of recurrence or metastases at the time of analysis. Occult breast cancer should be taken into consideration in cases presenting with axillary metastasis of unknown primary origin. The treatment of occult breast cancer should include modified radical mastectomy/radical mastectomy or breast conserving surgery combined with breast irradiation.

  9. Heterotopic cesarean scar pregnancy: diagnosis, treatment, and prognosis.

    Science.gov (United States)

    OuYang, Zhenbo; Yin, Qian; Xu, Yujing; Ma, Yunyan; Zhang, Qiushi; Yu, Yanhong

    2014-09-01

    Heterotopic cesarean scar pregnancy is a rare, life-threatening form of ectopic pregnancy. To provide information regarding the clinical manifestations, diagnosis, management, and prognosis of this condition, we reviewed all cases reported in the English literature. All literature on heterotopic cesarean scar pregnancy was retrieved by searching the PubMed database and tracking references of the relevant literature. Full texts were reviewed, and clinical manifestations, diagnostic methods, and the relationship between the treatment and prognosis were summarized. A total of 14 patients with heterotopic cesarean scar pregnancies were identified, including 6 spontaneous pregnancies and 8 following in vitro fertilization-embryo transfer. Gestational ages at diagnosis ranged from 5 weeks to 8 weeks 4 days. Only 5 cases presented with vaginal bleeding, and the others were asymptomatic. All 14 cases were diagnosed by transvaginal sonography. One patient with no future fertility requirements underwent pregnancy termination by methotrexate. Of the remaining 13 patients who desired to preserve their intrauterine gestations, 10 were treated by sonographically guided selective embryo reduction in situ (by embryo aspiration, drug injection, or both); 2 underwent laparoscopic and hysteroscopic excision of the ectopic pregnancy masses; and 1 was treated by expectant management. All operations were successful and maintained a living intrauterine gestation. Twelve cases resulted in live births by cesarean delivery (3 at term and 9 preterm). One patient underwent pregnancy termination at 12 weeks because of a fetal malformation confirmed by sonography. The possibility of heterotopic cesarean scar pregnancy after cesarean delivery should be considered, especially when pregnancy follows assisted reproductive technology. Transvaginal sonography is an important tool for diagnosis and management. Despite the many options, the best treatment for this condition remains unclear. Selective

  10. Chronic Pain: Symptoms, Diagnosis, & Treatment | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... Javascript on. Feature: Chronic Pain Chronic Pain: Symptoms, Diagnosis, & Treatment Past Issues / Spring 2011 Table of Contents Symptoms ... Although technology can help health professionals form a diagnosis, the best treatment plans are tailored to the person, with input ...

  11. Sickle Cell Research: Symptoms, Diagnosis, Treatment and Recent Developments | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... Section: Sickle Cell Disease Sickle Cell Disease: Symptoms, Diagnosis, Treatment and Recent Developments Past Issues / Winter 2011 Table ... because many complications can be prevented with early diagnosis and treatment. Sickle cell disease and sickle cell trait can ...

  12. Diagnosis and Treatment of Latent Tuberculosis Infection in Healthcare Workers.

    Science.gov (United States)

    Mok, Jeong Ha

    2016-07-01

    Tuberculosis (TB) is one of the most important occupational risks for healthcare workers (HCWs) in South Korea. Many policies regarding the control and prevention of TB in healthcare settings recommend that HCWs are tested for latent tuberculosis infection (LTBI) in addition to active TB. Moreover, the Korean Tuberculosis Prevention Act also recommends that HCWs receive regular testing for LTBI. However, there are no specific or detailed guidelines for dealing with LTBI in HCWs. Herein, we discuss the diagnosis and treatment of LTBI in HCWs and focus particularly on the baseline screening of hired HCWs, routine follow-up, and contact investigation.

  13. Arthroscopy in diagnosis and treatment of hip disorders

    DEFF Research Database (Denmark)

    Frich, Lars Henrik; Lauritzen, J.; Juhl, M.

    1989-01-01

    Fourteen hip arthroscopies between January 1985 and May 1988 were reviewed. Included were ten women and four men with an age ranging from 12 to 76 years. Indications were avascular necrosis; loose bodies; osteoarthrosis, arthritis, or pain; and snapping hip. The diagnosis was verified in five cas...... field of vision in a dysplastic hip. No serious complications occurred. Hip arthroscopy is useful in diagnostics and surgical treatment of selected hip disorders. The rehabilitation time is short. Hip arthroscopy is, however, a technically demanding procedure....

  14. Thoracic intramedullary epidermoid cyst-timely fashion diagnosis and treatment.

    Science.gov (United States)

    Babayev, Rasim; Abbasov, Bahadur; Ekşi, Murat Şakir

    2015-05-01

    Epidermoid cysts are composed of stratified squamous epithelium, which develop from inclusion of ectodermal tissue remnants entrapped during primitive neural tube closure period between the 3rd and 5th weeks of gestation. Intramedullary epidermoid cysts (IEC) are very rare in childhood. Eleven cases have been reported previously. Even though it is a rare entity, early diagnosis with timely fashioned surgical treatment has a great influence on patients' symptoms, especially if there are myelopathic findings. In this case report, we demonstrate this fact with a demonstrative clinical case and review radiological, pathological, and surgical perspectives with literature review.

  15. Advances in the Diagnosis and Treatment of PCOS.

    Science.gov (United States)

    Carmina, Enrico; Guastella, Ettore; Longo, Rosa Alba

    2016-01-01

    While the Rotterdam criteria look simple and easy to follow, in clinical practice diagnosis of PCOS may be problematic because of the use of inaccurate commercial androgen assays. Progresses in ovarian ultrasound and in AMH measurement have modified the way to make the diagnosis of PCOS and an update of Rotterdam criteria may be necessary. In classic severe form of PCOS, ovarian follicle count is a very reliable diagnostic criterion but AMH measurement may also present high diagnostic specificity and sensitivity. This finding is particularly important when no clinical signs of androgen excess are present and only commercial assays for androgen measurement are available. At the contrary, in mild PCOS phenotypes, sensitivity of AMH measurement is too low whileFNPO count maintains a high diagnostic sensitivity. However, at least in ovulatory hyperandrogenic PCOS phenotype, increased AMH values in association with enlarged ovarian size permit the diagnosis of ovulatory PCOS in 85% of these patients. Treatment of PCOS women has to be directed to get fertility or in patients not seeking fertility to solve or attenuate the psychological implications of androgen excess and of irregular menses and the risk of endometrial hyperplasia. The therapeutic protocols that are used in our department are presented.

  16. [Diagnosis and treatment of atlanto-occipital ruptures].

    Science.gov (United States)

    Hummel, A; Plaue, R

    1988-12-01

    Atlantooccipital rupture is a rare ligamentous injury, which is usually accompanied by multiple trauma. Literature and personal communications report of 30 patients with such an injury. Long term survival is known in 18 cases, but there were severe neurological deficits in two cases. Reports of five of our own patients are presented. Death occurred after a few hours in three cases. One patient survived for four weeks, and one girl fully recovered after timely atlantooccipital fusion. In seven of 18 cases who have survived for a long time, the diagnosis was made only at a late stage. This underscores the necessity of including the occipitocervical transition in the diagnosis of the cervical spine. This applies in particular to unconscious accident casualties. Standard X-rays of the upper cervical spine (supplemented if necessary by cautious radiographic control under mild head extension) verify the diagnosis. In treatment, an early fusion of the cervicooccipital transition is to be given preference. Only in this way can stable healing and thus the most important precondition for neurological restitution be fulfilled.

  17. [Clinical Pathological Diagnosis, and Treatment for Pleural Mesothelioma].

    Science.gov (United States)

    Kishimoto, Takumi; Fujimoto, Nobukazu; Nishi, Hideyuki

    2016-05-01

    For the differential diagnosis between fibrous pleuritis and other malignancies such as lung cancer, multiple immunostaining is essential to diagnose pleural mesothelioma. For cytological diagnosis of pleural effusions, differentiation between mesothelioma cells and reactive mesothelial cells is very difficult. Therefore, histological diagnoses of tumor tissues obtained via biopsy are essential. To diagnose epthelioid mesothelioma, more than 2 positive and negative markers must be consistent with those known for mesothelioma. To diagnose sarcomatoid mesothelioma, keratin is usually positive, differentiating the diagnosis from that for real sarcoma. For surgical treatment for pleural mesothelioma, extrapleural pneumonectomy (EPP) and pleurectomy/decortication (P/D) are usually performed. The proportion of P/D increases because of the low death rates with surgery and similar survivals. However, a trimodal approach, such as EPP with chemotherapy and radiotherapy, is best for longer survival and expected to be curative. For chemotherapy, only cisplatin (CDDP) combined with pemetrexed (PEM) is effective, and no other agents have been identified for this disease. Nowadays, clinical immunotherapy trials start with phase II study.

  18. Pathophysiology, Diagnosis and Treatment of Somatosensory Tinnitus: A Scoping Review

    Directory of Open Access Journals (Sweden)

    Haúla F. Haider

    2017-04-01

    Full Text Available Somatosensory tinnitus is a generally agreed subtype of tinnitus that is associated with activation of the somatosensory, somatomotor, and visual-motor systems. A key characteristic of somatosensory tinnitus is that is modulated by physical contact or movement. Although it seems common, its pathophysiology, assessment and treatment are not well defined. We present a scoping review on the pathophysiology, diagnosis, and treatment of somatosensory tinnitus, and identify priority directions for further research.Methods: Literature searches were conducted in Google Scholar, PubMed, and EMBASE databases. Additional broad hand searches were conducted with the additional terms etiology, diagnose, treatment.Results: Most evidence on the pathophysiology of somatosensory tinnitus suggests that somatic modulations are the result of altered or cross-modal synaptic activity within the dorsal cochlear nucleus or between the auditory nervous system and other sensory subsystems of central nervous system (e.g., visual or tactile. Presentations of somatosensory tinnitus are varied and evidence for the various approaches to treatment promising but limited.Discussion and Conclusions: Despite the apparent prevalence of somatosensory tinnitus its underlying neural processes are still not well understood. Necessary involvement of multidisciplinary teams in its diagnosis and treatment has led to a large heterogeneity of approaches whereby tinnitus improvement is often only a secondary effect. Hence there are no evidence-based clinical guidelines, and patient care is empirical rather than research-evidence-based. Somatic testing should receive further attention considering the breath of evidence on the ability of patients to modulate their tinnitus through manouvers. Specific questions for further research and review are indicated.

  19. Diagnosis and treatment of obstructive megaureter in young children

    Directory of Open Access Journals (Sweden)

    Kokorin A.D.

    2016-03-01

    Full Text Available Congenital megaureter is one of the most severe urological diseases of childhood. The frequency of this disease in recent years has a tendency to decrease. Objective: To evaluate the effectiveness of early diagnosis and treatment megaureter young children. Materials and Methods: The study of materials examination and surgical treatment of 34 children with obstructive megaureter. The children were divided into two comparable age and sex groups: primary (n=16 and control (n=18. In the main group of staged diagnosis is confirmed by the results of prenatal ultrasound and fetal MRI. Children in the control group was established at the time of defect treatment in the clinic with symptoms of pyelonephritis. During treatment groups compared the dynamics of the US of kidneys and bladder, the results of preoperative voiding cystography, excretory urography, and Doppler sonography. Results and discussion for the correction of the defect in the main group, 50% of children used the methods of intravesical endoscopic correction of the defect using a technique stenting, which was effective in 75% of cases. In 31.3% of cases in children with moderate defect used conservative therapy. The open method of defect correction used only in 18.7% of cases. In the control group the use of endoscopic correction of the defect was effective only in 16.1% of patients. In other cases, we use multi-stage «open» technique. The choice of the defect correction affected the long-term results of surgical treatment. In children with primary use of endoscopic correction of the defect number of pyelonephritis was observed in 18% of patients. In the control group, with primary use of open methods of operating pyelonephritis were observed in 77.7% of cases (p <0,05. Conclusion: Early diagnosis megaureter using staged ultrasound and MR imaging allows you to expand the indications for the use of endoscopic correction of the defect, effectively use methods of conservative therapy and

  20. Patient misconceptions concerning lumbar spondylosis diagnosis and treatment.

    Science.gov (United States)

    Franz, Eric W; Bentley, J Nicole; Yee, Patricia P S; Chang, Kate W C; Kendall-Thomas, Jennifer; Park, Paul; Yang, Lynda J S

    2015-05-01

    OBJECT Patient outcome measures are becoming increasingly important in the evaluation of health care quality and physician performance. Of the many novel measures currently being explored, patient satisfaction and other subjective measures of patient experience are among the most heavily weighted. However, these subjective measures are strongly influenced by a number of factors, including patient demographics, level of understanding of the disorder and its treatment, and patient expectations. In the present study, patients referred to a neurosurgery clinic for degenerative spinal disorders were surveyed to determine their understanding of lumbar spondylosis diagnosis and treatment. METHODS A multiple-choice, 6-question survey was distributed to all patients referred to a general neurosurgical spine clinic at a tertiary care center over a period of 11 months as a quality improvement initiative to assist the provider with individualized patient counseling. The survey consisted of questions designed to assess patient understanding of the role of radiological imaging in the diagnosis and treatment of low-back and leg pain, and patient perception of the indications for surgical compared with conservative management. Demographic data were also collected. RESULTS A total of 121 surveys were included in the analysis. More than 50% of the patients indicated that they would undergo spine surgery based on abnormalities found on MRI, even without symptoms; more than 40% of patients indicated the same for plain radiographs. Similarly, a large proportion of patients (33%) believed that back surgery was more effective than physical therapy in the treatment of back pain without leg pain. Nearly one-fifth of the survey group (17%) also believed that back injections were riskier than back surgery. There were no significant differences in survey responses among patients with a previous history of spine surgery compared with those without previous spine surgery. CONCLUSIONS These

  1. Diagnosis and treatment of chronic cerebrovascular disease, use of pentoxifylline

    Directory of Open Access Journals (Sweden)

    V. A. Parfenov

    2016-01-01

    Full Text Available Chronic cerebrovascular disease (CCVD is one of the most common  iagnoses in Russian neurology, by which is meant vascular cognitive impairment (VCI in modern foreign literature. There are data available in the literature on the diagnosis and treatment of CCVD (VCI. Theresults of the author’s studies show that CCVD often masks other diseases (anxiety and depressive disorders, primary headache, peripheral vestibulopathy, and Alzheimer's disease that are unfortunately poorly diagnosed in our country, so patients do not receive effective treatment. To modify risk factors for stroke (smoking and alcohol cessation, sufficient exercise, to normalize blood pressure (the use of antihypertensivemedications, to reduce blood cholesterol levels (statins, to perform antithrombotic therapy (antiplatelet agents and anticoagulants, and to use cognitive enhancers are of key importance when treating patients with CCVD (VCI. There are data on the use of pentoxifylline in patients with CCVD, vascular dementia.

  2. Management of Cerebral Cavernous Malformations: From Diagnosis to Treatment

    Directory of Open Access Journals (Sweden)

    Nikolaos Mouchtouris

    2015-01-01

    Full Text Available Cerebral cavernous malformations are the most common vascular malformations and can be found in many locations in the brain. If left untreated, cavernomas may lead to intracerebral hemorrhage, seizures, focal neurological deficits, or headaches. As they are angiographically occult, their diagnosis relies on various MR imaging techniques, which detect different characteristics of the lesions as well as aiding in planning the surgical treatment. The clinical presentation and the location of the lesion are the most important factors involved in determining the optimal course of treatment of cavernomas. We concisely review the literature and discuss the advantages and limitations of each of the three available methods of treatment—microsurgical resection, stereotactic radiosurgery, and conservative management—depending on the lesion characteristics.

  3. Infection after total knee replacement: diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Lucio Honorio de Carvalho Junior

    2013-09-01

    Full Text Available Infection after total knee replacement (IATJ is a rare complication. It is associated with increased morbidity and mortality increasing the final costs. Gram positive coccus and Staphylococcus coagulase-negative and Staphylococcus aureus are the most common isolated germs (>50% of the cases. Conditions related to the patient, to the surgical procedure and even to the post op have been identified as risk factors to IATJ. Many complementary methods together with clinical symptoms are useful to a proper diagnosis. Treatment for IATJ must be individualized but generally is a combination of systemic antibiotic therapy and surgical treatment. Prosthesis exchange in one or two stages is the first choice procedure. Debridement with prosthesis retention is an option in acute cases with stable implants and antibiotic sensible germs.

  4. Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis

    Science.gov (United States)

    Brouwer, Matthijs C.; Tunkel, Allan R.; van de Beek, Diederik

    2010-01-01

    Summary: The epidemiology of bacterial meningitis has changed as a result of the widespread use of conjugate vaccines and preventive antimicrobial treatment of pregnant women. Given the significant morbidity and mortality associated with bacterial meningitis, accurate information is necessary regarding the important etiological agents and populations at risk to ascertain public health measures and ensure appropriate management. In this review, we describe the changing epidemiology of bacterial meningitis in the United States and throughout the world by reviewing the global changes in etiological agents followed by specific microorganism data on the impact of the development and widespread use of conjugate vaccines. We provide recommendations for empirical antimicrobial and adjunctive treatments for clinical subgroups and review available laboratory methods in making the etiological diagnosis of bacterial meningitis. Finally, we summarize risk factors, clinical features, and microbiological diagnostics for the specific bacteria causing this disease. PMID:20610819

  5. Black Hairy Tongue: Predisposing Factors, Diagnosis, and Treatment.

    Science.gov (United States)

    Schlager, Emma; St Claire, Chelsea; Ashack, Kurt; Khachemoune, Amor

    2017-08-01

    Black hairy tongue (BHT) is a benign condition commonly found among people who smoke, have poor oral hygiene, are immunocompromised, or have a medical condition limiting their ability to practice good oral hygiene. Though this condition is harmless, patients need to be educated on etiology as many common medications are associated with this condition. Patients being placed on certain antibiotics or antipsychotics should be educated on the importance of good oral hygiene or cessation of habits that promote BHT. Similarly, those with medical conditions increasing the risk for the development of BHT should schedule routine visits with their dentist or dental hygienist. Prognosis is good, and treatment consists of gentle brushing of the tongue, but many anecdotal reports exist demonstrating the use of medications or other products to treat this condition. This review addresses the epidemiology, clinical presentation, pathophysiology, etiology, histology, differential diagnosis, and treatment of BHT and lists all of the medications reported to cause this condition.

  6. [Clinical practice guideline. Diagnosis and treatment of dyslipidemia.

    Science.gov (United States)

    Canalizo-Miranda, Elvia; Favela-Pérez, Eddie Alberto; Salas-Anaya, Javier Alejandro; Gómez-Díaz, Rita; Jara-Espino, Ricardo; Del Pilar Torres-Arreola, Laura; Viniegra-Osorio, Arturo

    2013-01-01

    Non-communicable diseases are a public health problem in México. Coronary heart disease and diabetes mellitus are the first and second cause of death in the country, followed by thrombotic cerebrovascular events. Cardiovascular diseases are the leading cause of death; one primary risk factor is hypercholesterolemia. The detection and treatment of lipid abnormalities is the key to the prevention and management of chronic non-communicable diseases. Two nationally representative surveys have shown that lipid abnormalities are the most common risk factors in Mexican adults. The purpose of this guide is to provide a basis for identifying dyslipidemia in a timely manner, and to systematize the criteria for diagnosis and treatment in the first and second level of care.

  7. Management of Cerebral Cavernous Malformations: From Diagnosis to Treatment

    Science.gov (United States)

    Mouchtouris, Nikolaos; Chitale, Ameet; Starke, Robert M.; Tjoumakaris, Stavropoula I.; Rosenwasser, Robert H.; Jabbour, Pascal M.

    2015-01-01

    Cerebral cavernous malformations are the most common vascular malformations and can be found in many locations in the brain. If left untreated, cavernomas may lead to intracerebral hemorrhage, seizures, focal neurological deficits, or headaches. As they are angiographically occult, their diagnosis relies on various MR imaging techniques, which detect different characteristics of the lesions as well as aiding in planning the surgical treatment. The clinical presentation and the location of the lesion are the most important factors involved in determining the optimal course of treatment of cavernomas. We concisely review the literature and discuss the advantages and limitations of each of the three available methods of treatment—microsurgical resection, stereotactic radiosurgery, and conservative management—depending on the lesion characteristics. PMID:25629087

  8. [Diagnosis and treatment of trauma-induced coagulopathy].

    Science.gov (United States)

    David, J-S; Roumagnac, A; Rulliat, É; Bernet, C; Rugeri, L; Marcotte, G; Levrat, A

    2012-11-01

    Trauma-induced coagulopathy is frequent and complex, and is responsible for an impairment of trauma outcome. Diagnosis of trauma coagulopathy is usually done with standard biology but recently new technics arose and gave us the opportunity to have faster information on coagulopathy with quick INR measure or clot formation study with thrombelastometry. Treatment of the coagulopathy should be done earlier in the course of trauma. Two strategies are possible that include either the association of RBC, platelet and FFP in a predefined ratio, or the use of factor concentrates guided with thrombelastometry. Treatment of favouring factors such as hypothermia, acidosis and hypocalcemia is also mandatory. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  9. Еctopic ACTH syndrome: clinical picture, diagnosis, treatment

    Directory of Open Access Journals (Sweden)

    N S Kuznetsov

    2012-03-01

    Full Text Available Diagnosis and treatment of ectopic ACTH-syndrome currently is one of the most challenging problems among other forms of endogenous hypercorticism. This syndrome is associated with presence of extrapituitary tumors characterized with different histogenesis and localization, which produce adrenocorticotropic hormone (ACTH, or – rarely – corticotrophin-releasing hormone. In most cases the ectopic synthesis of ACTH is performed in bronchial carcinoid tumors (36–46%, oat cell cancer (18–20%, medullary thyroid cancer (3–7%, pheochromocytoma (9–23%, other sites are infrequent (pancreas, thymus, parotid gland, ovaries, uterus, prostate, colon, stomach, esophagus, etc.. Much of these tumors are aggressive and are characterized with propensity to metastasize and relapse. Currently there are few contradictory data on the comparative evaluation of the effectiveness of methods of topical diagnosis of the source of ectopic ACTH-secretion, and therefore there is an urgent need to develop an optimal and most efficient algorithm for diagnostic procedures to determine the extent of the tumor in patients with ectopic ACTH-syndrome. Indications for surgery, timing and extent of surgical intervention, the effectiveness of the operation, the causes and frequency of relapses are still discussed.The present difficulties of diagnosis, as well as the lack of a unified approach to the treatment of this disease in the complex, often lead to the progression and development of a large number of serious complications functions of up to disability, which in turn does not lead to significant improvement of quality of life. Thus further research is necessary to study of this disease

  10. Malignant pleural mesothelioma: incidence, etiology, diagnosis, treatment, and occupational health.

    Science.gov (United States)

    Neumann, Volker; Löseke, Stefan; Nowak, Dennis; Herth, Felix J F; Tannapfel, Andrea

    2013-05-01

    The incidence of malignant mesothelioma in Germany is about 20 cases per million persons per year. Its association with asbestos exposure, usually occupational, has been unequivocally demonstrated. Even though the industrial use of asbestos was forbidden many years ago, new cases of mesothelioma continue to appear because of the long latency of the disease (median, 50 years). Its diagnosis and treatment still present a major challenge for ambulatory and in-hospital care and will do so for years to come. This article is based on a selective review of the literature, along with data from the German Mesothelioma Register. 1397 people died of mesothelioma in Germany in 2010. A plateau in the incidence of the disease is predicted between 2015 and 2030. Most mesotheliomas arise from the pleura. The histological subtype and the Karnofsky score are the main prognostic factors. Only limited data are now available to guide treatment with a combination of the available methods (chemotherapy, surgery, radiotherapy). The prognosis is still poor, with a median survival time of only 12 months. Symptom control and the preservation of the patient's quality of life are the main aspects of care for patients with mesothelioma. The incidence of mesothelioma is not expected to drop in the next few years. The available treatments are chemotherapy, surgery, and radiotherapy. Specialized treatment centers now increasingly provide multimodal therapy for treatment of mesothelioma.

  11. [Diagnosis and treatment of familial hypercholesterolemia in Spain: Consensus document].

    Science.gov (United States)

    Mata, Pedro; Alonso, Rodrigo; Ruiz, Antonio; Gonzalez-Juanatey, Jose R; Badimón, Lina; Díaz-Díaz, Jose L; Muñoz, María Teresa; Muñiz, Ovidio; Galve, Enrique; Irigoyen, Luis; Fuentes-Jiménez, Francisco; Dalmau, Jaime; Pérez-Jiménez, Francisco

    2015-01-01

    Familial hypercholesterolemia (FH) is a common genetic disorder, clinically manifested since birth, and associated with very high levels of plasma LDL-cholesterol (LDL-c), xanthomas, and premature coronary heart disease. Its early detection and treatment reduces coronary morbidity and mortality. Despite effective treatment being available, FH is under-diagnosed and under-treated. Identification of index cases and cascade screening using LDL-c levels and genetic testing are the most cost-effective strategies for detecting new cases and starting early treatment. Long-term treatment with statins has decreased the vascular risk to the levels of the general population. LDL-c targets are <130mg/dL for children and young adults, <100mg/dL for adults, and <70mg/dL for adults with known coronary heart disease or diabetes. Most patients do not to reach these goals, and combined treatments with ezetimibe or other drugs may be necessary. When the goals are not achieved with the maximum tolerated drug treatment, a reduction ≥50% in LDL-c levels can be acceptable. Lipoprotein apheresis can be useful in homozygous, and in treatment-resistant severe heterozygous, cases. This Consensus Paper gives recommendations on the diagnosis, screening, and treatment of FH in children and adults, and specific advice to specialists and general practitioners with the objective of improving the clinical management of these patients, in order to reduce the high burden of coronary heart disease. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  12. Diagnosis and treatment of cervical cancer during pregnancy

    Directory of Open Access Journals (Sweden)

    Carla Vitola Gonçalves

    Full Text Available CONTEXT AND OBJECTIVE: One third of all cervical carcinomas occur during the reproductive period. Cervical carcinoma is the second greatest cause of death due to cancer during this phase. The estimated frequency of cervical cancer during pregnancy is one case for every 1,000 to 5,000 pregnancies. The aim here was to provide information about the difficulties in diagnosing and managing cervical neoplasia during pregnancy. MATERIALS: A systematic review of the literature was undertaken through the PubMed, Cochrane, Excerpta Medica (Embase, Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs and Scientific Electronic Library Online (SciELO databases, using the following words: pregnancy, cervical cancer, diagnosis and management. RESULTS: There was a consensus in the literature regarding diagnosis of cervical carcinoma and management of preneoplastic lesions during pregnancy. However, for management of invasive carcinoma, there was great divergence regarding the gestational age taken as the limit for observation rather than immediate treatment. CONCLUSION: All patients with cytological abnormalities should undergo colposcopy, which will indicate and guide biopsy. Conization is reserved for patients with suspected invasion. High-grade lesions should be monitored during pregnancy and reevaluated after delivery. In cases of invasive carcinoma detected up to the 12th week of pregnancy, patient treatment is prioritized. Regarding diagnoses made during the second trimester, fetal pulmonary maturity can be awaited, and the use of chemotherapy to stabilize the disease until the time of delivery appears to be viable.

  13. Pediculosis capitis: new insights into epidemiology, diagnosis and treatment.

    Science.gov (United States)

    Feldmeier, H

    2012-09-01

    Pediculosis capitis is a ubiquitous parasitic skin disease caused by Pediculus humanus capitis. Head lice are highly specialised parasites which can propagate only on human scalp and hair. Transmission occurs by direct head-to-head contact. Head lice are vectors of important bacterial pathogens. Pediculosis capitis usually occurs in small epidemics in play groups, kindergartens and schools. Population-based studies in European countries show highly diverging prevalences, ranging from 1% to 20%. The diagnosis of head lice infestation is made through the visual inspection of hair and scalp or dry/wet combing. The optimal method for the diagnosis of active head lice infestation is dry/wet combing. Topical application of a pediculicide is the most common treatment. Compounds with a neurotoxic mode of action are widely used but are becoming less effective due to resistant parasite populations. Besides, their use is restricted by safety concerns. Dimeticones, silicone oils with a low surface tension and the propensity to perfectly coat surfaces, have a purely physical mode of action. This group of compounds is highly effective and safe, and there is no risk that head lice become resistant. The control of epidemics requires active contact tracing and synchronised treatment with an effective and safe pediculicide.

  14. [Guidelines for diagnosis and treatment of mucocutaneous candidiasis].

    Science.gov (United States)

    Katoh, Takuro

    2009-01-01

    This document summarizes current knowledge about diagnosis and treatment of candidiasis affecting the skin and oral mucosa. Several clinical forms of mucocutaneous candidiasis are distinguished depending on a patient's age and infected site, e.g. Candida intertrigo, erythema mycoticum infantile, erosio interdigitalis blastomycetica, candidal paronychia and onychia, Candida onychomycosis, and oral candidiasis. The diagnosis of candidiasis is confirmed by observation of mycelial forms on microscopic examination. Since Candida yeasts (especially C. albicans) are normal inhabitants of the skin and oral mucosa, it must always be noted that positive culture does not always indicate the presence of candidal infection. The pathogenicity of Candida species is relatively low, and some special conditions are required for tissue invasion by the fungus. Predisposing factors, such as disturbances of the cutaneous and mucosal microenvironment and systemic or local immunosuppression, should be checked in patients with recurrent infection. Therapy for cutaneous candidiasis is dominated by topical antifungal agents. Azole antifungal cream (e.g., bifonazole, ketoconazole, neticonazole hydrochloride, lanoconazole and luliconazole) is most effective. Terbinafine hydrochloride and amorolfine hydrochloride are also useful. Cutaneous candidiasis usually requires a shorter duration of topical treatment (1-2 weeks) than superficial dermatophyte infections. For candidal paronychia and onychomycosis, oral therapy with itraconazole is recommended. The daily dose of itraconazole should be taken for several months, while its pulse therapy for candidiasis is not approved in Japan. Itraconazole oral solution is commonly used for oral candidiasis, and miconazole gel is also effective.

  15. Vaginohysteroscopy for the diagnosis and treatment of vaginal lesions.

    Science.gov (United States)

    Di Spiezio Sardo, Attilio; Zizolfi, Brunella; Calagna, Gloria; Florio, Pasquale; Nappi, Carmine; Di Carlo, Costantino

    2016-05-01

    The vaginoscopic approach for hysteroscopy allows detailed endoscopic evaluation of the vaginal walls, fornices, and exocervix. To review the feasibility and efficacy of vaginohysteroscopy in the diagnosis and treatment of vaginal lesions. A systematic review was performed of PubMed/Medline, Embase, Google Scholar, and the Cochrane Database to identify papers published in English. The search terms were "hysteroscopy," "vaginoscopy," "vagino-hysteroscopy," and "vaginal lesion." The last review was performed on January 31, 2015. Studies in which the diagnosis and treatment of vaginal lesions used the vaginoscopic approach and hysteroscopic instrumentation were reviewed. Data were extracted from the identified studies and then analyzed. Thirteen studies were reviewed. Eleven described one case; one reported observations from two patients, and one study reported a case series. All vaginohysteroscopies reported were performed successfully and without significant complications. Vaginohysteroscopy is an easy way to gain access to the cervical canal and an important tool with which to diagnose and treat vaginal lesions. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  16. Bipolar disorder with comorbid substance abuse: diagnosis, prognosis, and treatment.

    Science.gov (United States)

    Goldberg, J F

    2001-03-01

    Alcohol and drug abuse occur frequently in individuals with bipolar disorder, but clinicians may often feel ill-prepared to identify such multi-diagnosis syndromes, to contextualize drug abuse alongside affective symptoms, and to formulate appropriate treatment strategies. Plausible explanations for high comorbidity rates between bipolar illness and substance use disorders are complex and likely embrace numerous factors that extend beyond simple, older theories about drug use as sheer "self-medication." Evidence from epidemiologic, family-genetic, pharmacologic, psychosocial, and clinical psychopathology studies suggest that a majority of bipolar patients are at risk for developing lifetime drug or alcohol-related problems, which may in turn contribute to more varied and complex clinical presentations, accelerated relapses, worsening of depressive features, poorer lithium response, functional disability, and elevated suicide risk. In this article, the author reviews essential concepts about the phenomenology and treatment outcome of bipolar illness with substance use comorbidities and offers a systematic approach to the diagnosis and management of patients with such dual diagnoses.

  17. Brazilian guidelines for the diagnosis and treatment of cystic fibrosis

    Science.gov (United States)

    Athanazio, Rodrigo Abensur; da Silva, Luiz Vicente Ribeiro Ferreira; Vergara, Alberto Andrade; Ribeiro, Antônio Fernando; Riedi, Carlos Antônio; Procianoy, Elenara da Fonseca Andrade; Adde, Fabíola Villac; Reis, Francisco José Caldeira; Ribeiro, José Dirceu; Torres, Lídia Alice; de Fuccio, Marcelo Bicalho; Epifanio, Matias; Firmida, Mônica de Cássia; Damaceno, Neiva; Ludwig-Neto, Norberto; Maróstica, Paulo José Cauduro; Rached, Samia Zahi; Melo, Suzana Fonseca de Oliveira

    2017-01-01

    ABSTRACT Cystic fibrosis (CF) is an autosomal recessive genetic disorder characterized by dysfunction of the CFTR gene. It is a multisystem disease that most often affects White individuals. In recent decades, various advances in the diagnosis and treatment of CF have drastically changed the scenario, resulting in a significant increase in survival and quality of life. In Brazil, the current neonatal screening program for CF has broad coverage, and most of the Brazilian states have referral centers for the follow-up of individuals with the disease. Previously, CF was limited to the pediatric age group. However, an increase in the number of adult CF patients has been observed, because of the greater number of individuals being diagnosed with atypical forms (with milder phenotypic expression) and because of the increase in life expectancy provided by the new treatments. However, there is still great heterogeneity among the different regions of Brazil in terms of the access of CF patients to diagnostic and therapeutic methods. The objective of these guidelines was to aggregate the main scientific evidence to guide the management of these patients. A group of 18 CF specialists devised 82 relevant clinical questions, divided into five categories: characteristics of a referral center; diagnosis; treatment of respiratory disease; gastrointestinal and nutritional treatment; and other aspects. Various professionals working in the area of CF in Brazil were invited to answer the questions devised by the coordinators. We used the PubMed database to search the available literature based on keywords, in order to find the best answers to these questions. PMID:28746534

  18. Diagnosis and treatment of dizziness in outpatient practice

    Directory of Open Access Journals (Sweden)

    L. M. Antonenko

    2015-01-01

    Full Text Available Objective: to study the causes of dizziness and instability in patients during an outpatient specialized appointment and to analyze and improve typical management tactics for these patients. Patients and methods. In 2009 to 2014, neurologists, dizziness specialists, examined 300 patients (122 men and 178 women aged 18 to 85 years, who complained of dizziness and instability. Prior to the examination, the patients had been diagnosed as having dyscirculatory encephalopathy (46%, vertebrobasilar insufficiency (30%, cervical osteochondrosis (12%, and vegetative dystonia (7%. Results and discussion. The examination established the causes of dizziness: benign paroxysmal positional vertigo (BPPV (34%, phobic postural instability (22%, multiple sensory insufficiency (15%, Meniere's disease (7%, migraine-associated vertigo (5%, vestibular neuronitis (4%, acute cerebrovascular accident (4%, and other diseases (9%. In accordance with the established diagnosis, adequate treatment which could completely eliminate or substantially reduce the magnitude of dizziness in the majority of cases was performed. The paper describes two clinical cases (BPPV and Meniere's disease. Betahistine dihydrochloride (vesticap, betaserc were most commonly used in a dose of 48 mg/day to treat vestibular vertigo. It gives the results of comparative treatment (with vesticap or betaserc for vestibular vertigo in 62 patients. The authors note the low level of diagnosis and effective treatment in patients with dizziness in outpatient practice. They show the expediency of a specialized examination, the efficiency and safety of current treatments, including medication therapy with betahistine dihydrochloride (betaserc and vesticap and rehabilitation on a stabiligraphic platform with biofeedback, for vestibular vertigo. 

  19. Benign paroxysmal positional vertigo in outpatient practice: Diagnosis and treatment

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    N. V. Bestuzheva

    2014-01-01

    Full Text Available Dizziness is one of the common reasons for visits to physicians of various specialties; the data of foreign investigations show that benign paroxysmal positional vertigo (BPPV is most frequently encountered.Objective: to study the causes of dizziness, to analyze the frequency of BPPV and the efficiency of its treatment in outpatient practice.Patients and methods. The investigation enrolled 80 patients, including 55 (68.7% women and 25 (31.3% men, aged 18 to 75 years (mean age 53.8±12.8 years, who complained of dizziness and sought for medical advice in the Therapeutic-and-Diagnostic Unit, A.Ya. Kozhevnikov Clinic of Nervous System Diseases, I.M. Sechenov First Moscow State Medical University.Results. The most common causes of dizziness in outpatient practice were BPPV (46.2% and postural phobic vertigo (35%. The diagnosis of VPPV, if special positional testing (Dix-Hallpike and McClure-Pagnini tests was carried out, was shown to create no significant difficulties. The diagnosis was not established in the majority (97.5% of the patients; effective treatment was performed in one of the patients. Combined treatment, by performing the positional tests and using betaserc for 2 months, led to complete resolution of positional vertigo in most (97.3% patients.Discussion. The findings indicate the efficiency of examining patients with complaints of dizziness, by using the special otoneurological tests to detect BPPV. The purposeful questioning of patients with BPPV can suspect this disease in the majority of cases. Our investigation shows the high efficiency of rehabilitation maneuvers for BPPV, which agrees well with the data of other authors. Physicians’ poor awareness of BPPV among physicians and the high efficiency of its treatment in outpatient practice are noted.

  20. SLEEP APNEA/HIPOPNEA SYNDROME (SAHS: HOME DIAGNOSIS AND TREATMENT

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    Coma del Corral MJ

    2006-02-01

    Full Text Available SUMMARYRecent studies associate SAHS with higher cardiovascular morbidity-mortality and we know that even today SAHS continues to be under-diagnosed. This under-diagnosis, signifies, on the one hand, a lowering or loss of health, and on the other, an increase in costs, since it has been demonstrated that patients with undiagnosed or untreated SAHS are higher consumers of health service resources and have higher work absenteeism, while these costs are reduced in SAHS patients treated with CPAP. Therefore, we find ourselves faced with the need to diagnose and suitably treat the largest possible number of patients who suffer from SAHS.The diagnostic method of choice continues to be supervised nocturnal PSG in the sleep laboratory, however, the future of SAHS diagnosis is inevitably moving towards the use of simplified systems with a high sensitivity and specificity. In this sense, the Respiratory Polygraphy represents an alternative tool for the diagnosis of SAHS, being able to be carried out in the home of the patient, just like the Auto-CPAP systems. Thus, the current approach to SAHS has changed and therefore, a patient with a high probability of suffering from SAHS, is able to have a RP carried out at home which might diagnose SAHS and later to have the CPAP adjusted to the optimum pressure level, as a recording using Auto-CPAP, could be carried out at home.With this new approach to SAHS, waiting lists could be reduced and thus reduce the under-diagnosis. All this brings about an implicit saving of resources. The place of diagnosis will basically be the home, and in this sense, the development of telematic applications will contribute significantly to the modification of diagnostic strategies.The success of this form of approach to SAHS, will be established with a suitable selection of subsidiary diagnosed patients and adjustment of home treatment, therefore, each sleep unit must set up its own diagnostic-therapeutic strategy which may be more

  1. Multifocal motor neuropathy: a review of pathogenesis, diagnosis, and treatment

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    Lawson VH

    2014-04-01

    Full Text Available Victoria H Lawson,1 W David Arnold1,2 1Division of Neuromuscular Disorders, Department of Neurology, 2Department of Physical Medicine and Rehabilitation, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA Abstract: Multifocal motor neuropathy (MMN is an uncommon, purely motor neuropathy associated with asymmetric deficits with predilection for upper limb involvement. Even in the early descriptions of MMN, the associations of anti-GM1 antibodies and robust response to immunomodulatory treatment were recognized. These features highlight the likelihood of an underlying autoimmune etiology of MMN. The clinical presentation of MMN can closely mimic several neurological conditions including those with more malignant prognoses such as motor neuron disease. Therefore early and rapid recognition of MMN is critical. Serological evidence of anti GM-1 antibodies and electrodiagnostic findings of conduction block are helpful diagnostic clues for MMN. Importantly, these diagnostic features are not universally present, and patients lacking these characteristic findings can demonstrate similar robust response to immunodulatory treatment. In the current review, recent research in the areas of diagnosis, pathogenesis, and treatment of MMN and needs for the future are discussed. The characteristic findings of MMN and treatment implications are reviewed and contrasted with other mimicking disorders. Keywords: autoimmune, conduction block, electrodiagnosis, motor neuron, nerve, inflammatory

  2. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment

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    Napolitano M

    2017-04-01

    Full Text Available Maddalena Napolitano,1 Matteo Megna,2 Elena A Timoshchuk,3 Cataldo Patruno,2 Nicola Balato,2 Gabriella Fabbrocini,2 Giuseppe Monfrecola2 1Dipartimento di Medicina e Scienze della Salute “Vincenzo Tiberio”, Università degli Studi del Molise, Campobasso, 2Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy; 3Department of Dermatovenereology, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia Abstract: Hidradenitis suppurativa (HS is a chronic inflammatory skin disease primarily affecting apocrine gland-rich areas of the body and presenting with painful nodules, abscesses, sinus tracts, and scarring. HS is a multifactorial disease in which genetic and environmental factors play a key role. The primary defect in HS pathophysiology involves follicular occlusion of the folliculopilosebaceous unit, followed by follicular rupture, and immune responses (perifollicular lympho-histiocytic inflammation, finally leading to the development of clinical HS lesions. HS has a destructive impact on the patient’s quality of life, being a very challenging disease. Available treatments are limited, mostly off-label and with high variability in the reported efficacy. Fortunately, a monoclonal antibody against tumor necrosis factor alpha has been recently approved for treatment of moderate to severe HS, offering patients a promising new option. This review focuses on the main features of HS, including epidemiology, clinical aspects, pathogenesis, severity classifications, comorbidities, and currently available treatments. Keywords: hidradenitis suppurativa, pathogenesis, diagnosis, treatment

  3. Diagnosis and treatment of vascular damage in dementia.

    Science.gov (United States)

    Biessels, Geert Jan

    2016-05-01

    This paper provides an overview of cognitive impairment due to vascular brain damage, which is referred to as vascular cognitive impairment (VCI). Over the past decades, we have seen marked progress in detecting VCI, both through maturation of diagnostic concepts and through advances in brain imaging, especially MRI. Yet in daily practice, it is often challenging to establish the diagnosis, particularly in patients where there is no evident temporal relation between a cerebrovascular event and cognitive dysfunction. Because vascular damage is such a common cause of cognitive dysfunction, it provides an obvious target for treatment. In patients whose cognitive dysfunction follows directly after a stroke, the etiological classification of this stroke will direct treatment. In many patients however, VCI develops due to so-called "silent vascular damage," without evident cerebrovascular events. In these patients, small vessel diseases (SVDs) are the most common cause. Yet no SVD-specific treatments currently exist, which is due to incomplete understanding of the pathophysiology. This review addresses developments in this field. It offers a framework to translate diagnostic criteria to daily practice, addresses treatment, and highlights some future perspectives. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia, edited by M. Paul Murphy, Roderick A. Corriveau, and Donna M. Wilcock. Copyright © 2015 Elsevier B.V. All rights reserved.

  4. Chiropractic diagnosis and treatment of closed head trauma.

    Science.gov (United States)

    Dalby, B J

    1993-01-01

    The objective of this article is to review the current literature relating to the chiropractic diagnosis and treatment of closed head trauma. It outlines the clinical exam, offers a diagnostic protocol and describes current chiropractic management and treatment of acute and chronic closed head trauma. Particular importance is placed on the need to differentiate between mild, moderate and severe head injury. Treatment protocols are elucidated for cerebral concussion and a rationale proposed for the management and treatment of posttraumatic concussion syndrome. Information was obtained from English language chiropractic, medical and scientific journals as well as chiropractic and medical textbooks. The CHIROLARS data retrieval system was used (year 0-1992) as was the MEDLINE data base (1988-1992). Head trauma, head injury, headache, concussion, vertigo, posttraumatic syndrome and whiplash injury were the indexing terms used. The doctor of chiropractic is often the first practitioner a patient will see following a motor vehicle accident, sports injury or other acute trauma. The chiropractor is also the practitioner a patient seeks for help after suffering for months with chronic posttraumatic concussion syndrome. It is important that we have a protocol for effectively managing both acute and chronic closed head injury.

  5. Unruptured tubal pregnancy: different treatments for early and late diagnosis.

    Science.gov (United States)

    Elito Junior, Julio; Camano, Luiz

    2006-11-07

    There is evidence that ectopic pregnancies present different behavioral patterns. These distinct evolutions of ectopic pregnancies represent two different natural histories. To evaluate these evolution patterns, we compared patients undergoing medical treatment and expectant management according to their gestational age and initial beta-hCG levels. Prospective study at the Department of Obstetrics of Universidade Federal de São Paulo, a tertiary center. Among 119 cases of unruptured ectopic pregnancies diagnosed from April 1999 to February 2004, 57 received systemic treatment with methotrexate 50 mg/m(2) (body surface area) intramuscularly and 62 were managed expectantly. In this study we evaluated the beta-hCG levels at presentation and amenorrhea duration. There was a significant difference between the two groups regarding amenorrhea duration and initial beta-hCG levels (p < 0.001). The group with decreasing beta-hCG levels (managed expectantly) had longer amenorrhea (mean: 8.87 +/- 1.71 weeks) and lower initial beta-hCG levels (mean: 648.8 +/- 754.7 mIU/ml). On the other hand, the group treated with methotrexate had shorter amenorrhea (mean: 6.81 +/- 1.88 weeks) and higher beta-hCG levels at presentation (2642.7 +/- 2315.1 mIU/ml). The data suggest that ectopic pregnancies can be categorized into two groups: those with early diagnosis and shorter amenorrhea, increasing or maintained beta-hCG levels over 24 and 48-hour intervals and higher beta-hCG levels requiring medical treatment; and those with late diagnosis and longer amenorrhea, decreased beta-hCG levels over 24 and 48-hour intervals and lower beta-hCG levels requiring expectant management.

  6. Unruptured tubal pregnancy: different treatments for early and late diagnosis

    Directory of Open Access Journals (Sweden)

    Julio Elito Junior

    Full Text Available CONTEXT AND OBJECTIVE: There is evidence that ectopic pregnancies present different behavioral patterns. These distinct evolutions of ectopic pregnancies represent two different natural histories. To evaluate these evolution patterns, we compared patients undergoing medical treatment and expectant management according to their gestational age and initial beta-hCG levels. DESIGN AND SETTING: Prospective study at the Department of Obstetrics of Universidade Federal de São Paulo, a tertiary center. METHODS: Among 119 cases of unruptured ectopic pregnancies diagnosed from April 1999 to February 2004, 57 received systemic treatment with methotrexate 50 mg/m² (body surface area intramuscularly and 62 were managed expectantly. In this study we evaluated the beta-hCG levels at presentation and amenorrhea duration. RESULTS: There was a significant difference between the two groups regarding amenorrhea duration and initial beta-hCG levels (p < 0.001. The group with decreasing beta-hCG levels (managed expectantly had longer amenorrhea (mean: 8.87 ± 1.71 weeks and lower initial beta-hCG levels (mean: 648.8 ± 754.7 mIU/ml. On the other hand, the group treated with methotrexate had shorter amenorrhea (mean: 6.81 ± 1.88 weeks and higher beta-hCG levels at presentation (2642.7 ± 2315.1 mIU/ml. CONCLUSIONS: The data suggest that ectopic pregnancies can be categorized into two groups: those with early diagnosis and shorter amenorrhea, increasing or maintained beta-hCG levels over 24 and 48-hour intervals and higher beta-hCG levels requiring medical treatment; and those with late diagnosis and longer amenorrhea, decreased beta-hCG levels over 24 and 48-hour intervals and lower beta-hCG levels requiring expectant management.

  7. Neonatal Respiratory Distress Syndrome: Early Diagnosis, Prevention, and Treatment

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    S. A. Perepelitsa

    2012-01-01

    Full Text Available to improve treatment results in premature infants with neonatal respiratory distress syndrome (NRDS, by establishing developmental mechanisms and elaborating methods for its early diagnosis, treatment, and prevention. Material and methods. The paper analyzes the results of a clinical observation and laboratory, instrumental, immunological, morphological, and radiological studies of 320 premature neonates at 26—35 weeks gestational age. The following groups of neonates were identified: 1 40 premature neonatal infants without NRDS and with the physiological course of an early neonatal period (a comparison group; 2 190 premature neonates with severe NRDS in whom the efficiency of therapy with exogenous surfactants, such as surfactant BL versus curosurf, was evaluated; 3 90 premature newborn infants who had died from NRDS at its different stages. Results. The poor maternal somatic, obstetric, and gynecological histories in the early periods of the current pregnancy create prerequisites for its termination, favor the development of severe acute gestosis, and cause abnormal placental changes. Each gestational age is marked by certain placental changes that promote impaired uterineplacentalfetal blood flow and premature birth. Alveolar and bronchial epithelial damages, including those ante and intranatally, microcircula tory disorders play a leading role in the tanatogenesis of NRDS. Intranatal hypoxia and amniotic fluid aspiration are one of the important factors contributing to alveolar epithelial damage and NRDS in premature neonates. Exogenous surfactants prevent the development of hyaline membranes and are useful in the normalization of ventilation-perfusion relationships and lung biomechanical properties. Conclusion. This study could improve the diagnosis and treatment of NRDS, which assisted in reducing the duration of mechanical ventilation from 130±7.6 to 65±11.6 hours, the number of complications (the incidence of intragastric

  8. Delayed Diagnosis of Vesicouterine Fistula After Treatment for Mixed Urinary Incontinence: Menstrual Cup Management and Diagnosis.

    Science.gov (United States)

    Goldberg, Leah; Elsamra, Sammy; Hutchinson-Colas, Juana; Segal, Saya

    2016-01-01

    A vesicouterine fistula is a rare form of urogenital fistula, yet there is increasing prevalence in the United States because of the rising rate of cesarean deliveries. Vesicouterine fistulas have various presentations including menouria, hematuria, or urinary incontinence. A 39-year-old multiparous woman presented with urine leakage after her third cesarean delivery. She had been treated for mixed urinary incontinence with overactive bladder medications and a midurethral sling with continued complaints of urine leakage. The patient noticed her symptoms of urine leakage improved during menses when she used a menstrual cup. After confirmation of vesicouterine fistula, the patient underwent robotic-assisted surgery and her symptoms of insensible urine leakage resolved. When evaluating women with urinary incontinence and a history of cesarean deliveries, use of menstrual cup may aid in the diagnosis of vesicouterine fistula. Robotic-assisted laparoscopic repair with tissue interposition flap is an efficacious minimally invasive method for treatment of vesicouterine fistula.

  9. Diagnosis and office-based treatment of urinary incontinence in adults. Part one: diagnosis and testing.

    Science.gov (United States)

    Cameron, Anne P; Heidelbaugh, Joel J; Jimbo, Masahito

    2013-08-01

    Urinary incontinence is a common problem in both men and women. This review article addresses its prevalence, risk factors, cost, the various types of incontinence, as well as how to diagnose them. The US Preventive Services Task Force, the Cochrane Database of Systematic Reviews, and PubMed were reviewed for articles focusing on urinary incontinence. Incontinence is a common problem with a high societal cost. It is frequently underreported by patients so it is appropriate for primary-care providers to screen all women and older men during visits. A thorough history and physical examination combined with easy office-based tests can often yield a clear diagnosis and rule out other transient illnesses contributing to the incontinence. Specialist referral is occasionally needed in specific situations before embarking on a treatment plan.

  10. [Unruptured ectopic pregnancy: diagnosis and treatment. State of art].

    Science.gov (United States)

    Elito Junior, Julio; Montenegro, Nuno Aires Mota de Mendonça; Soares, Roberto da Costa; Camano, Luiz

    2008-03-01

    It is advisable to do the non-invasive diagnosis of ectopic pregnancy precociously, before there is the tube rupture, combining for that the transvaginal ultrasonography with the dosage of the b-fraction of the chorionic gonadotrophin. A range of treatment options may be used. Either a surgical intervention or a clinical treatment may be taken into consideration. Laparotomy is indicated in cases of hemodynamic instability. Laparoscopy is the preferential route for the treatment of tube pregnancy. Salpingectomy should be performed in patients having the desired number of children, while salpingostomy should be indicated in patients willing to have more children, when the b-hCG titers are under 5,000 mUI/mL and the surgical conditions are favorable. The use of methotrexate (MTX) is a consecrated clinical procedure and should be indicated as the first option of treatment. The main criteria for MTX indication are hemodynamic stability, b-hCG 5,000 mUI/mL and no alive embryo. Indication for local treatment with an injection of MTX (1 mg/kg) guided by transvaginal ultrasonography should occur in cases of alive embryos, but with an atypical localization. An expectant conduct should be indicated in cases of decrease in the b-hCG titers within 48 hours before the treatment, and when the initial titers are under 1,500 mUI/mL. There are controversies between salpingectomy and salpingostomy, concerning the reproductive future. Till we reach an agreement in the literature, the advice to patients who are looking forward to a future gestation, is to choose either surgical or clinical conservative conducts.

  11. Difficulties in diagnosis and treatment of Paget’s disease

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    Aleksandra Kawalec

    2016-12-01

    Full Text Available Paget’s disease is a rare finding in Poland. It is a disorder of the osteoarticular system, which, in adults, mostly affects people over 55 years of age. The clinical picture varies, depending on the location of the lesions, making the diagnosis difficult, sometimes taking many years for a correct diagnosis to be made. In etiopathogenesis, genetic predispositions as well as viral infections play an important role. From the genetic point of view, Paget’s disease is heterogeneous, as numerous mutations are known, and the genotype to phenotype relationship is unclear. The first phase of the disease is characterized by an increased osteocytes activity, due to morphologically changed and RANKL overstimulated osteocytes. This leads to an intensification of ossification processes that occur in a chaotic manner. Therefore, the resulting bone is weak, extensively vascularized and there is an increased risk of fracture or deformity. Clinical manifestations of Paget’s disease might include pain, excessive warmth, bone deformations, degenerative lesions in the adjacent joints, compression of the neural structures, hearing loss, and dilated cardiomiopathy. Other possible complications include the development of benign and malignant bone tumors and hypercalcaemia in the case of immobilization. An elevated level of serum alkaline phosphatase, bone x-ray and bone scintigraphy are crucial in making the diagnosis. The disease should be distinguished from osteomalacia, osteoporosis, hyperparathyroidism and multiple myeloma. Bisphosphonates at doses higher than those applied for osteoporosis are an effective treatment. The occurrence of orthopedic, neurological and laryngological complications is often a reason for surgical intervention.

  12. Type 4 capitellum fractures: Diagnosis and treatment strategies

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    Suresh S

    2009-01-01

    Full Text Available Background: Fractures of the capitellum are rare injuries of the elbow usually seen in the adolescents. This fracture is often missed in the emergency room if a proper radiograph is not available. Recent reports have described many modalities of treatment favoring headless screw for fixation. The facility for headless screw fixation, however, is not available in most centers. This paper presents the diagnosis and management of type 4 capituller fractures (Mckee with gadgets available in a district hospital. Materials and Methods: Between 2004 and 2007 three patients with right sided type IV capetullar fracture were treated in a district hospital. There were two boys aged 15 and 17 and one 33 years old lady. In one case, the fracture was missed in the emergency room. A double arc sign in the lateral views of the X-rays of the elbow was seen in all the cases. In each case a preoperative CT scan was done and a diagnosis of Mckee type IV fracture of the capitellum was made. Under tourniquet, using extended lateral approach, open reduction and internal fixation was done using 4mm partially threaded AO cancellous screws (n=2 and 2.7 mm AO screws (n=1, under vision from posterior to anterior direction from the posterior aspect of lateral condyle of humerus avoiding articular penetration. Results: All the fractures united uneventfully. At the end of one year follow-up, two cases had excellent elbow function; implants were removed and there were no signs of AVN or arthritis. The third case had good elbow ROM at 11 months without AVN. Conclusion: Double arc sign on lateral X-rays of the elbow along with pre-operative CT scan evaluation is important to avoid a missed diagnosis and analysis of type IV capitellur fracture. Fixation with non-cannulated ordinary AO screws using extended Kocher′s lateral approach has given good results.

  13. Diagnosis and Treatment of Urticaria and Angioedema: A Worldwide Perspective

    Science.gov (United States)

    2012-01-01

    Urticaria and angioedema are common clinical conditions representing a major concern for physicians and patients alike. The World Allergy Organization (WAO), recognizing the importance of these diseases, has contributed to previous guidelines for the diagnosis and management of urticaria. The Scientific and Clinical Issues Council of WAO proposed the development of this global Position Paper to further enhance the clinical management of these disorders through the participation of renowned experts from all WAO regions of the world. Sections on definition and classification, prevalence, etiology and pathogenesis, diagnosis, treatment, and prognosis are based on the best scientific evidence presently available. Additional sections devoted to urticaria and angioedema in children and pregnant women, quality of life and patient-reported outcomes, and physical urticarias have been incorporated into this document. It is expected that this article will supplement recent international guidelines with the contribution of an expert panel designated by the WAO, increasing awareness of the importance of urticaria and angioedema in medical practice and will become a useful source of information for optimum patient management worldwide. PMID:23282382

  14. Traumatic brain injury: the lag between diagnosis and treatment.

    Science.gov (United States)

    Retsinas, J

    1993-01-01

    Ogburn described the "culture lag" between technology and attitudes, as people take time to assimilate new technologies, and new facts, into their worldviews. Traumatic brain injury is now a common diagnosis, thanks to neurosurgical expertise. Where thirty years ago mortality from head injuries was high, today mortality rates have improved dramatically; yet even while neurosurgeons spare thousands of people each year, our society struggles to develop appropriate rehabilitation protocols. To date, we are in the lag phase, between diagnosis and treatment. This paper discusses that lag, including reasons for the lack of an effective rehabilitation protocol (the paucity of funds for research, the nature of brain injuries per se), the reluctance of insurers to cover brain injury rehabilitation (the lengthy time involved in rehabilitation, the blurring between rehabilitation and long term care, the nature of experience-rated contracting to businesses for health care insurance, the burgeoning of proprietary brain injury rehabilitation centers), and the prospects for closing the gap in the near future. The paper concludes that preventive measures (seat belt laws, motorcycle helmet laws, laws for helmets in contact sports) allow policy-makers to confront the growing societal problem of the mounting census of head-injured, by avoiding that census and focusing instead on the prevention, or diminution, of future head injuries.

  15. Spinal dural arteriovenous fistulas: Pathogenesis, clinical manifestations, diagnosis, treatment

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    G. Yu. Evzikov

    2015-01-01

    Full Text Available The paper describes spinal dural arteriovenous fistulas (SDAVF, the most common type of spinal cord vascular anomalies. SDAVFs account for 60–80% of the spinal cord vascular anomalies. The causes of SDAVFs, the specific features of their hemodynamics, and their classification remain the subject matter of disputes.SDAVFs form in dura mater tissue, on the dorsal surface of radicular cuffs. The pathogenesis of neurological disorders in SDAVF has determined the name «venous hypertensive myelopathy», a spinal cord injury occurring in their presence. Pain and paresthesias, cacesthesia (more commonly in their distal parts, and motor disorders as flail legs are observed at the onset of SDAVF in typical cases. On average, 12 to 44 months elapse to establish its diagnosis. In addition of motor and sensory disorders, sphincter impairments and sexual dysfunction are detected in the patients at the time of diagnosis. By this time, most patients have already neurological disability.The paper presents the history of studying SDAVF, the existing classifications of arteriovenous malformations and fistulas, the clinical manifestations of venous hypertensive myelopathy in SDAVF, neuroimaging findings, and treatment options.

  16. Constipation in Duchenne Muscular Dystrophy: Prevalence, Diagnosis, and Treatment.

    Science.gov (United States)

    Kraus, Dror; Wong, Brenda L; Horn, Paul S; Kaul, Ajay

    2016-04-01

    To determine the prevalence and clinical characteristics of constipation among patients with Duchenne muscular dystrophy (DMD). This cross-sectional prospective study included 120 patients (age range 5-30 years old) with an established diagnosis of DMD. Participants filled out the constipation section of a validated Questionnaire on Pediatric Gastrointestinal Symptoms based on Rome-III Criteria (QPGS-RIII) for the diagnosis of functional constipation as part of a routine clinic visit. We evaluated several potential screening methods for constipation: the Bristol stool form scale, routine physical examination, and fecal load on abdominal radiograph. These methods were compared with the QPGS-RIII in diagnosing functional constipation. Risk factors for the development of functional constipation were determined. Based on the QPGS-RIII, 46.7% of patients with DMD in this cohort were diagnosed with functional constipation. Prevalence was not affected by age or functional status. None of the screening methods tested were sensitive enough to diagnose functional constipation. Among patients with constipation, only 43.6% received specific treatment for constipation and only one-half of these treated patients reported resolution of constipation. This study systematically examined constipation among patients with DMD and provides evidence that constipation among patients with DMD is highly prevalent, underdiagnosed, and undertreated. QPGS-RIII is easy to administer and is an efficient tool to diagnose functional constipation in patients with DMD in a clinic setting. Copyright © 2016. Published by Elsevier Inc.

  17. [Diagnosis and treatment of hemophilia A acquired during postpartum ].

    Science.gov (United States)

    Castillo-Cañadas, Ana María; Serrano-Diana, Carolina; López-Del Cerro, Esther; Gómez-García, María Teresa; González De Merlo, Gaspar

    2014-10-01

    Acquired hemophilia A is a truly exceptional hemorrhagic diathesis, that consists of the emergence of polyclonal autoantibodies (inhibitor) IgG-type (subclasses 1 and 4, in most cases) against the coagulant function of the circulating factor VIII, which acts in the domains C2, A2 and A3 of the molecule, thus interfering their interaction with the factor IXa, the phospholipids and the Von Willebrand factor. Its morbidity and mortality are high, but nevertheless its low incidence (1-1.5 cases per million population per year) is the most frequent autoimmune disorder. This paper reports the clinical case of two patients; the first one, 36 years old, who the tenth day of postpartum required re-entry due to a diagnosis of hematoma of the abdominal wall that was surgically drained twice. The patient of case 2 was 39 years old and at six days of postpartum went to the emergency room due to bleeding, she was underwent to curettage and therapeutic transfusion of 3 UCH. Because of the persistence of bleeding, which was not possible to control with medical treatment and conservative measures, therapeutic hysterectomy was performed, with blood transfusion later. Due to the hemorrhagic complications of this condition and the serious clinical consequences derived from them, it is important to establish an early diagnosis; it is therefore critical to know the existence of this very rare disease to be able to avoid its consequences.

  18. A Review Article: Diagnosis and Treatment of Radial Tunnel Syndrome

    Directory of Open Access Journals (Sweden)

    Ebrahimzadeh Mohammad Hosein

    2015-04-01

    Full Text Available  Radial tunnel syndrome is a disease which we should consider it in elbow and forearm pains. It is diagnosed with lateral elbow and dorsal forearm pain may radiate to the wrist and dorsum of fingers. The disease is more prevalent in women with the age of 30 to 50 years old. It occurs by intermittent compression on the radial nerve from the radial head to the inferior border of the supinator muscle, without obvious extensor muscle weakness. Compression could happen in five different sites but the arcade of Frose is the most common area that radial nerve is compressed. To diagnosis radial tunnel syndrome, clinical examination is more important than paraclinic tests such as electrodiagnsic test and imaging studies. The exact site of the pain which can more specified by rule of nine test and weakness of the third finger and wrist extension are valuable physical exams to diagnosis. MRI studies my show u muscle edema or atrophy along the distribution of the posterior interosseous nerve. Although non-surgical treatments such as rest, NSAIDs, injections and physiotherapy do not believe to have permanent relief, but it is justify undergoing them before surgery. Surgery could diminish pain and symptoms in 67 to 93 percents of patients completely.

  19. [Neurologopedic treatment in dysarthria cases. Diagnosis and therapy].

    Science.gov (United States)

    Bytnar-Hys, Radosława; Mirecka, Urszula

    The article is devoted to the problems of diagnosis and neurologopedic therapy of hospitalized persons suffering from dysarthria. The research presented in the article was conducted on a group of 49 patients (people aged 18-95, including 26 men and 23 women) who were diagnosed and underwent logopedic therapy in the department of Neurological Rehabilitation in the Independent Public Teaching Hospital no 4 in lublin in 2014. In the neurologopedic diagnostics the following methods were used: the analysis of the medical record (information cards containing medical diagnosis, mriri, ct head scanning, eeg ), clinical interview and clinical observations, The Robertson Dysarthria Profile, Dysarthria Scale by mirecka and gustaw, scale of deficiency depth, w. Łucki's package of tests to examine cognitive processes in the patients with brain damages, tests to examine aphasia by j. Szumska, tests to examine aphasia by m. Szepietowska and h. Misztal, author's questionnaire to examine dysarthria and aphasia, experimental tests to examine pragnosia and dysphagia. In the group of 49 patients dysarthria was diagnosed among 22 persons as the only speech disorder and in the group of 27 patients other speech disorders (aphasia, pragnosia, interpersonal communication disorders) co-occurred with dysarthria. Dysphagia was diagnosed among 21 patients. Neurologopedic diagnostics and therapy of the dysarthric patients should constitute an integral part of the complex improving treatment (in addition to medical, rehabilitation and psychological procedures).

  20. Infantile Pompe disease: Clinical picture, diagnosis, and treatment

    Directory of Open Access Journals (Sweden)

    N. P. Kotlukova

    2012-01-01

    Full Text Available Pompe disease is a rare inherited disease that belongs to lysosomal accumulation diseases and can be considered as cardiac glycogenosistype II, as well as a severe neuromuscular disease or metabolic myopathy. Physicians of different specialties very rarely identify this pathology, which is due to both its rarity and clinical and genetic polymorphism. Infantile Pompe disease is the severest form. It is characterized by a progressive pattern and a fatal outcome during the first year of life. The possibility of performing enzyme replacement therapy for this disease, which can improve the prognosis and quality of life of patients, makes the early diagnosis of Pompe disease urgent. The paper describes the clinical presentation of infantile Pompe disease and current methods for its diagnosis and treatment. The authors give their experience in diagnosing and treating infantile Pompe disease, by demonstrating 3 cases of the disease. The characteristics of each infant, which confirm the clinical and genetic variety of this pathology, are discussed.

  1. Diagnosis and Treatment of Pseudo-Class III Malocclusion

    Science.gov (United States)

    Reyes, Ariel; Serret, Luis; Peguero, Marcos; Tanaka, Orlando

    2014-01-01

    Pseudo-Class III malocclusion is characterized by the presence of an anterior crossbite due to a forward functional displacement of the mandible; in most cases, the maxillary incisors present some degree of retroclination, and the mandibular incisors are proclined. Various types of appliances have been described in the literature for the early treatment of pseudo-Class III malocclusion. The objectives of this paper are to demonstrate the importance of making the differential diagnosis between a skeletal and a pseudo-Class III malocclusion and to describe the correction of an anterior crossbite. The association of maxillary expansion and a 2 × 4 appliance can successfully be used to correct anterior crossbites. PMID:25525526

  2. Diagnosis and Treatment of Pseudo-Class III Malocclusion

    Directory of Open Access Journals (Sweden)

    Ariel Reyes

    2014-01-01

    Full Text Available Pseudo-Class III malocclusion is characterized by the presence of an anterior crossbite due to a forward functional displacement of the mandible; in most cases, the maxillary incisors present some degree of retroclination, and the mandibular incisors are proclined. Various types of appliances have been described in the literature for the early treatment of pseudo-Class III malocclusion. The objectives of this paper are to demonstrate the importance of making the differential diagnosis between a skeletal and a pseudo-Class III malocclusion and to describe the correction of an anterior crossbite. The association of maxillary expansion and a 2 × 4 appliance can successfully be used to correct anterior crossbites.

  3. Typical and atypical shoulder impingement syndrome: diagnosis, treatment, and pitfalls.

    Science.gov (United States)

    Buss, Daniel D; Freehill, Michael Q; Marra, Guido

    2009-01-01

    The cause of shoulder impingement syndrome usually is considered to be compression of the rotator cuff and subacromial bursa against the anterolateral aspect of the acromion. The typical symptom is anterolateral shoulder pain that worsens at night and with overhead activity. However, the pain may be caused by factors other than a hooked acromion. Atypical impingement syndrome most commonly results from an os acromiale, a subcoracoid disorder, acromioclavicular joint undersurface hypertrophy, a deconditioned rotator cuff, or scapular dyskinesis. The correct diagnosis is made through the patient history and physical examination, with appropriate diagnostic imaging. Nonsurgical treatment is successful for most types of impingement syndrome; if it is not successful, all structural causes of mechanical impingement must be corrected.

  4. Diagnosis and treatment of polycystic ovarian syndrome and insulin resistance.

    Science.gov (United States)

    Fleischman, Amy; Mansfield, Joan

    2005-09-01

    PCOS is a complex syndrome that includes clinical and biochemical evidence of hyperandrogenism and hyperinsulinism. Adolescents with PCOS are affected by the diagnosis with both short-term and long-term consequences. Adolescents with PCOS report lower self-esteem and quality of life, based on standard assessments, when compared with age matched peers. These young women also are concerned about future fertility, which may affect psychological well being and health behaviors. In addition, patients with PCOS are at an increased risk for development of insulin resistance, type 2 diabetes, metabolic syndrome, and cardiovascular disease. Therefore, this identified at-risk group requires rigorous evaluation, treatment and long-term counseling and management by healthcare providers.

  5. Current Concepts in the Diagnosis and Treatment of Shoulder Impingement

    Science.gov (United States)

    Singh, Bijayendra; Bakti, Nik; Gulihar, Abhinav

    2017-01-01

    Subacromial impingement syndrome (SIS) is a very common cause of shoulder pain in the young adults. It can cause debilitating pain, dysfunction, and affects the activities of daily living. It represents a spectrum of pathology ranging from bursitis to rotator cuff tendinopathy which can ultimately lead to degenerative tear of the rotator cuff. Various theories and concepts have been described and it is still a matter of debate. However, most published studies suggest that both extrinsic and intrinsic factors have a role in the development of SIS. The management is controversial as both nonoperative and operative treatments have shown to provide good results. This article aims to provide a comprehensive current concepts review of the pathogenesis, etiologies, clinical diagnosis, appropriate use of investigations, and discussion on the management of SIS. PMID:28966374

  6. Canine angiostrongylosis: recent advances in diagnosis, prevention, and treatment

    Directory of Open Access Journals (Sweden)

    Di Cesare A

    2014-12-01

    Full Text Available Angela Di Cesare, Donato Traversa Faculty of Veterinary Medicine, University of Teramo, Teramo, Italy Abstract: Angiostrongylus vasorum is a parasitic nematode affecting the heart and pulmonary arteries of wild (eg, foxes and domestic canids. The parasite has an indirect life cycle in which slugs and snails act as intermediate hosts. In the last few years the parasite has spread outside the traditional endemic foci, and there is a rise of documented cases of canine angiostrongylosis across Europe. Angiostrongylus vasorum causes cardiopulmonary disorders and coagulopathies, along with different nonspecific clinical signs. Fatal infections are frequently reported. Given the severity of the infection and the recent geographic spreading of the parasite, this article reviews and discusses the current knowledge of A. vasorum, with a special focus on recent insights on diagnosis, prevention, and treatment of dog angiostrongylosis. Keywords: Angiostrongylus vasorum, dog, epidemiology, diagnostic approaches, control, therapy

  7. Pathophysiology, Diagnosis, and Treatment of Radiation Necrosis in the Brain

    Science.gov (United States)

    MIYATAKE, Shin-Ichi; NONOGUCHI, Noasuke; FURUSE, Motomasa; YORITSUNE, Erina; MIYATA, Tomo; KAWABATA, Shinji; KUROIWA, Toshihiko

    2015-01-01

    New radiation modalities have made it possible to prolong the survival of individuals with malignant brain tumors, but symptomatic radiation necrosis becomes a serious problem that can negatively affect a patient’s quality of life through severe and lifelong effects. Here we review the relevant literature and introduce our original concept of the pathophysiology of brain radiation necrosis following the treatment of brain, head, and neck tumors. Regarding the pathophysiology of radiation necrosis, we introduce two major hypotheses: glial cell damage or vascular damage. For the differential diagnosis of radiation necrosis and tumor recurrence, we focus on the role of positron emission tomography. Finally, in accord with our hypothesis regarding the pathophysiology, we describe the promising effects of the anti-vascular endothelial growth factor antibody bevacizumab on symptomatic radiation necrosis in the brain. PMID:25744350

  8. European guideline for the diagnosis and treatment of insomnia

    DEFF Research Database (Denmark)

    Riemann, Dieter; Baglioni, Chiara; Bassetti, Claudio

    2017-01-01

    diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate- to high-quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected......This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant...... meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation...

  9. [Guidelines for the diagnosis, prevention and treatment of osteoporosis].

    Science.gov (United States)

    Adami, S; Bertoldo, F; Brandi, M L; Cepollaro, C; Filipponi, P; Fiore, E; Frediani, B; Giannini, S; Gonnelli, S; Isaia, G C; Luisetto, G; Mannarino, E; Marcocci, C; Masi, L; Mereu, C; Migliaccio, S; Minisola, S; Nuti, R; Rini, G; Rossini, M; Varenna, M; Ventura, L; Bianchi, G

    2009-01-01

    The guidelines for the osteoporosis management were first drafted by a working group and then critically evaluated by the board of SIOMMMS. The most relevant points are: Osteoporosis is defined as a quantitative and qualitative deterioration of bone tissue leading to increased risk of fracture. Postmenopausal and senile osteoporosis are defined as primitive. The cornerstone for the diagnosis of osteoporosis is the measurement of bone mineral density (BMD) by DXA (dual-energy X-ray absortiometry) at the femoral neck with T-score values -2.5 is usually not justified. Pharmacological intervention: The use of drugs registered for the treatment of osteoporosis are recommended when the benefits overcome the risk. This is the case only when the risk of fracture is rather high. FRAX is recognized as a useful tool for easily estimate the long-term fracture risk. SIOMMMS with these guidelines is committed to validate and further develop this diagnostic tool.

  10. Contemporary methods for the diagnosis and treatment of microscopic colitis.

    Science.gov (United States)

    Jauregui-Amezaga, Aranzazu; Vermeire, Séverine; Geboes, Karel

    2016-01-01

    Microscopic colitis is a common cause of chronic diarrhea. It is characterized by non-bloody watery diarrhea with macroscopically normal colonic mucosa. Its specific histological characteristics confirm the diagnosis. Two distinct histological forms can be identified, namely, collagenous colitis and lymphocytic colitis. In collagenous colitis, a thick colonic subepithelial collagenous deposit can be observed, whereas in lymphocytic colitis, a pronounced intraepithelial lymphocytic inflammation in the absence of a thickened collagen band can be identified. Microscopic colitis occurs more frequently in elderly females and its etiology is believed to be multifactorial, although smoking and consumption of several drugs have been identified as risks factors for the development of the disease. The treatment is based on avoiding the risks factors and administration of oral budesonide.

  11. Dementia with Parkinson's disease: Clinical diagnosis, neuropsychological aspects and treatment

    Directory of Open Access Journals (Sweden)

    Jorge Lorenzo Otero

    Full Text Available Abstract Dementia with Parkinson's disease represents a controversial issue in the complex group of alpha-synucleinopathies. The author acknowledges the concept of a "continuum" between Parkinson disease's (PD, Lewy body dementia (LBD, and dementia in Parkinson's disease (PDD. However, the practicing neurologist needs to identify the phenotypic signs of each dementia. The treatment and prognosis are different in spite of the overlaps between them. The main aim of this review was to characterize the clinical diagnoses of dementia associated with Parkinson's disease (PDD. Secondarily, the review discussed some epidemiological and neuropsychological issues. Selection of articles was not systematic and reflects the author's opinion, where the main text selected was the recommendations from the Movement Disorder Society Task Force for PDD diagnosis. The Pub Med, OVID, and Proquest data bases were used for the search.

  12. Current concepts in the diagnosis and treatment of shoulder impingement

    Directory of Open Access Journals (Sweden)

    Bijayendra Singh

    2017-01-01

    Full Text Available Subacromial impingement syndrome (SIS is a very common cause of shoulder pain in the young adults. It can cause debilitating pain, dysfunction, and affects the activities of daily living. It represents a spectrum of pathology ranging from bursitis to rotator cuff tendinopathy which can ultimately lead to degenerative tear of the rotator cuff. Various theories and concepts have been described and it is still a matter of debate. However, most published studies suggest that both extrinsic and intrinsic factors have a role in the development of SIS. The management is controversial as both nonoperative and operative treatments have shown to provide good results. This article aims to provide a comprehensive current concepts review of the pathogenesis, etiologies, clinical diagnosis, appropriate use of investigations, and discussion on the management of SIS.

  13. Recent trends in the diagnosis and treatment of sinusitis

    Energy Technology Data Exchange (ETDEWEB)

    Jorissen, M. [Dept. of E.N.T., Head and Neck Surgery, Univ. Hospital Sint-Rafaeel, Leuven (Belgium)

    1996-04-01

    The almost simultaneous introduction of nasal endoscopy and CT imaging led to better understanding of normal and pathologic function of the paranasal sinuses. Diagnosis and treatment of many paranasal sius diseases improved considerably. Endoscopy and CT are not concurrential; they are complementary, but they have specific strengths and weaknesses, as well as specific indicatons and consideratons. Staging systems for chronic sinusitis are currently used based on CT findings and response to medical therapy. Functional endoscopic sinus surgery (FESS) has become the standard procedure for most surgical cases of chronic sinusitis. Indications for FESS have enlarged beyond chronic sinus problems and even beyond the borders of the sinuses. Functional endoscopic sinus surgery aims to gain maximal result (restoring normal function) with minimal trauma and morbidity. (orig.)

  14. Malignant pleural mesothelioma: an update on diagnosis and treatment options.

    Science.gov (United States)

    Kondola, Sanjana; Manners, David; Nowak, Anna K

    2016-06-01

    Malignant pleural mesothelioma (MPM) represents a significant diagnostic and therapeutic challenge and is almost always a fatal disease. Imaging abnormalities are common, but have a limited role in distinguishing mesothelioma from metastatic pleural disease. Similarly, minimally invasive biomarkers have shown promise but also have limitations in the diagnosis of mesothelioma. In experienced centers, cytology and immunohistochemistry are now sufficient to diagnose the epithelioid subtype of mesothelioma, which can reduce the need for more invasive diagnostic investigations. Prognosis of MPM is modestly impacted by oncological treatments. Chemotherapy with cisplatin and pemetrexed is considered the standard of care, though the addition of bevacizumab to the platinum doublet may be the new standard of care. New targeted therapies have demonstrated some promise and are being addressed in clinical trials. This review focuses on the current data on the diagnostic and therapeutic issues of MPM. © The Author(s), 2016.

  15. [Laryngeal paraganglioma: diagnosis and treatment. A propos of a case].

    Science.gov (United States)

    Rubio, Vladimir; Tamarit, José Manuel; Baviera, Nuria; Estrems, Paloma; López, Celia; Estellés, Enrique; Dalmau, José

    2007-01-01

    Paragangliomas of the larynx (LPG) are unusual neuroendocrine tumors that are seen as a vascular submucosal mass, with a female predilection. We add another case of LPG to the 77 previously reported in the literature. We present the clinical, radiologic, and surgical features of a supraglottic LPG seen in a 40-year-old woman with a 8-month history of slowly progressive hoarseness. The tumor was removed approaching a lateral thyrotomy. The patient remains disease free 18 months after surgery. Preoperative CT, angiography, and embolization are useful in making the diagnosis and reducing perisurgical bleeding of LPG before surgical intervention. Complete excision through an external mucosa-sparing approach is the treatment of choice.

  16. Portal vein thrombosis: Insight into physiopathology, diagnosis, and treatment

    Science.gov (United States)

    Ponziani, Francesca R; Zocco, Maria A; Campanale, Chiara; Rinninella, Emanuele; Tortora, Annalisa; Maurizio, Luca Di; Bombardieri, Giuseppe; Cristofaro, Raimondo De; Gaetano, Anna M De; Landolfi, Raffaele; Gasbarrini, Antonio

    2010-01-01

    Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but might also occur in absence of an overt liver disease. Several causes, either local or systemic, might play an important role in PVT pathogenesis. Frequently, more than one risk factor could be identified; however, occasionally no single factor is discernable. Clinical examination, laboratory investigations, and imaging are helpful to provide a quick diagnosis, as prompt treatment might greatly affect a patient’s outcome. In this review, we analyze the physiopathological mechanisms of PVT development, together with the hemodynamic and functional alterations related to this condition. Moreover, we describe the principal factors most frequently involved in PVT development and the recent knowledge concerning diagnostic and therapeutic procedures. Finally, we analyze the implications of PVT in the setting of liver transplantation and its possible influence on patients’ future prognoses. PMID:20066733

  17. Application of aptamers in treatment and diagnosis of leukemia.

    Science.gov (United States)

    Yazdian-Robati, Rezvan; Arab, Atefeh; Ramezani, Mohammad; Abnous, Khalil; Taghdisi, Seyed Mohammad

    2017-08-30

    Leukemia is a cancer of blood cells and bone marrow, leading to death in many patients mainly in children. Over the last several years, aptamers generated by SELEX (Systematic evolution of ligands by exponential enrichment) method, have quickly become a new class of targeting ligands for drug delivery applications and recently have been widely exploited in different biomedical applications, due to several potent properties such as high binding affinity and selectivity, low or no immunogenicity and toxicity, low cost and thermal stability. In this review, we presented in details about aptamers involved in targeting, and treatment of leukemia. Moreover, some analytical approaches such as electrochemical and optical aptasensors were introduced for detection and diagnosis of leukemia. Finally, we discussed about the directions and challenges of aptamer application in this field. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Prevalence, etiology, diagnosis, treatment and complications of supernumerary teeth.

    Science.gov (United States)

    Ata-Ali, Fadi; Ata-Ali, Javier; Peñarrocha-Oltra, David; Peñarrocha-Diago, Miguel

    2014-10-01

    The aim of this article was to review the literature on supernumerary teeth, analyzing their prevalence, etiology, diagnosis, treatment and possible complications. An electronic search was made in the Pubmed-Medline database up to January 2014 using the key search terms "multiple supernumerary teeth" (n=279), "prevalence supernumerary teeth" (n=361), and "supernumerary teeth" (n=2412). In addition to the articles initially identified, others were included in the review proceeding from a manual search and from any references considered of relevance. Supernumerary teeth are those that exceed the normal dental formula. They are more common in men, more common in the upper maxilla, and more prevalent in permanent dentition. Complications associated with supernumerary teeth include dental impaction, delayed eruption, ectopic eruption, overcrowding, spacing anomalies and the formation of follicular cysts. The treatment of supernumerary teeth depends on their type, position, and possible complications, detected clinically and radiographically. No clear consensus exists as to the best time to extract unerupted supernumerary teeth. Key words:Hyperdoncia, supernumerary teeth, impacted teeth, treatment, permanent teeth, deciduous teeth.

  19. Particularities in diagnosis and treatment for infectious endocarditis in children.

    Science.gov (United States)

    Luca, Alina Costina; Begezsan, Isabela Ioana; Iordache, C

    2012-01-01

    Infectious endocarditis (IE) represents a rare pathology in children, but with lethal potential. The goal of the therapy is fast and total eradication of the infection. To study particularities in diagnosis and treatment for infectious endocarditis in children. Children with infectious endocarditis hospitalized between January 2007 - February 2012 in the Cardiology Department of the ,,Sfânta Maria" Children Emergency Hospital of lasi have been included in the study. The patients are aged between 23 days and 16 years, the average age being 4 years old. At approximately 88% of the patients (14 cases), the endocardial damage appeared in the pre-existent valvular lesions, specially mitral and aortal. As associated congenital malformations, the patients prevailingly presented ventricular septal defect, mitral valve prolapse, arterial canal persistence, aortic stenosis, coarctation of the aorta. Blood cultures were collected and the most frequent identified etiological agents were: Staphylococcus coagulase-positive, Streptococcus mitis, Staphylococcus speciae coagulase-negative, Staphylococcus haemolyticus, Streptococcus bovis, Escherichia coli, for which the antibiogram showed sensitivity for beta-lactam, cephalosporins, glycopeptides, trimethoprim-sulfamethoxazole, rifampicin, quinolone, lincosamides, oxazolidinones, and thus specific treatment was set up according to the antibiogram. The infectious endocarditis is a serious disease that affects young age too, leading towards exitus in some cases. Diagnostic imaging and early blood cultures are of relevance in order to intervene promptly. The treatment must be targeted and applied as fast as possible.

  20. Prostate Cancer in Renal Transplant Recipients: Diagnosis and Treatment.

    Science.gov (United States)

    Carvalho, J A; Nunes, P; Dinis, P J; Antunes, H; Parada, B; Marconi, L; Moreira, P; Roseiro, A; Bastos, C; Rolo, F; Dias, V; Figueiredo, A

    2017-05-01

    We currently know that prostate cancer (Pca) risk is reduced in patients undergoing kidney transplantation. However, its impact and treatment are not widely studied. This was a retrospective study of male patients submitted to kidney transplantation in our center from 1980 to 2016 evaluating incidence, treatment, and follow-up of Pca in our population. In 1805 patients undergoing kidney transplantation, 20 men were diagnosed with Pca, leading to an incidence of 1.1%. Median age at renal transplantation was 53.4 years with a median age at diagnosis of Pca of 61.2 years. Initial median prostate-specific antigen (PSA) was 6 ng/mL and Gleason score was 7 (3 + 4) in about 50% of cases. Bone metastasis developed in 10% and no visceral metastases were diagnosed. The majority of patients were submitted to radical prostatectomy and bilateral pelvic lymph node dissection. Some other cancers occurred in these patients such as skin and pulmonary cancers. In 35% of the cases, the graft was lost. The main cause of patient death was cardiovascular. The mean graft survival was about 14 years. The majority of patients are alive with functioning grafts (65%). In our center the clinical incidence of Pca in patients undergoing kidney transplantation is 1.1% and surgical treatment seems to be a good initial option. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Clinical management guidelines for subarachnoid haemorrhage. Diagnosis and treatment.

    Science.gov (United States)

    Vivancos, J; Gilo, F; Frutos, R; Maestre, J; García-Pastor, A; Quintana, F; Roda, J M; Ximénez-Carrillo, A; Díez Tejedor, E; Fuentes, B; Alonso de Leciñana, M; Alvarez-Sabin, J; Arenillas, J; Calleja, S; Casado, I; Castellanos, M; Castillo, J; Dávalos, A; Díaz-Otero, F; Egido, J A; Fernández, J C; Freijo, M; Gállego, J; Gil-Núñez, A; Irimia, P; Lago, A; Masjuan, J; Martí-Fábregas, J; Martínez-Sánchez, P; Martínez-Vila, E; Molina, C; Morales, A; Nombela, F; Purroy, F; Ribó, M; Rodríguez-Yañez, M; Roquer, J; Rubio, F; Segura, T; Serena, J; Simal, P; Tejada, J

    2014-01-01

    To update the Spanish Society of Neurology's guidelines for subarachnoid haemorrhage diagnosis and treatment. A review and analysis of the existing literature. Recommendations are given based on the level of evidence for each study reviewed. The most common cause of spontaneous subarachnoid haemorrhage (SAH) is cerebral aneurysm rupture. Its estimated incidence in Spain is 9/100 000 inhabitants/year with a relative frequency of approximately 5% of all strokes. Hypertension and smoking are the main risk factors. Stroke patients require treatment in a specialised centre. Admission to a stroke unit should be considered for SAH patients whose initial clinical condition is good (Grades I or II on the Hunt and Hess scale). We recommend early exclusion of aneurysms from the circulation. The diagnostic study of choice for SAH is brain CT (computed tomography) without contrast. If the test is negative and SAH is still suspected, a lumbar puncture should then be performed. The diagnostic tests recommended in order to determine the source of the haemorrhage are MRI (magnetic resonance imaging) and angiography. Doppler ultrasonography studies are very useful for diagnosing and monitoring vasospasm. Nimodipine is recommended for preventing delayed cerebral ischaemia. Blood pressure treatment and neurovascular intervention may be considered in treating refractory vasospasm. SAH is a severe and complex disease which must be managed in specialised centres by professionals with ample experience in relevant diagnostic and therapeutic processes. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  2. Lyme disease – principles of diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Sławomir A. Pancewicz

    2014-06-01

    Full Text Available The paper discusses epidemiological and clinical data as well as therapeutic and diagnostic methods with regard to Lyme disease. Main manifestations of early (erythema migrans, borrelial lymphoma, Lyme carditis, neuroborreliosis and Lyme arthritis and late (neuroborreliosis, Lyme arthritis, acrodermatitis chronica atrophicans Lyme borreliosis are described and their treatment is discussed. The most useful antibiotics are doxycycline and ceftriaxone. It was noted that in most cases of Lyme disease the prognosis is good, and antibiotic treatment is very effective regardless of the stage of infection. Detection of specific anti-Borrelia burgdorferi antibodies in a patient with a history of a tick bite and clinical symptoms suggesting Lyme disease is necessary for diagnosis. The results of serological tests must be interpreted carefully and always in connection with the clinical picture. A seropositivity without clinical symptoms of the disease does not necessarily prove an active infection. Antibody serum titres should not be used to assess therapeutic efficacy or be regarded as an indication for a re-treatment. Current recommendations stress that detection of chemokine CXCL13, searching for B. burgdorferi antigens in the cerebrospinal fluid and urine, searching for B. Burgdorferi spheroplasts or L-forms as well as CD57+/CD3 subpopulation assessment as well as lymphocyte transformation test have no confirmed diagnostic significance in Lyme disease diagnostics.

  3. Translation research: from accurate diagnosis to appropriate treatment

    Directory of Open Access Journals (Sweden)

    Pass Harvey I

    2004-10-01

    Full Text Available Abstract This review article focuses on the various aspects of translational research, where research on human subjects can ultimately enhance the diagnosis and treatment of future patients. While we will use specific examples relating to the asbestos related cancer mesothelioma, it should be stressed that the general approach outlined throughout this review is readily applicable to other diseases with an underlying molecular basis. Through the integration of molecular-based technologies, systematic tissue procurement and medical informatics, we now have the ability to identify clinically applicable "genotype"-"phenotype" associations across cohorts of patients that can rapidly be translated into useful diagnostic and treatment strategies. This review will touch on the various steps in the translational pipeline, and highlight some of the most essential elements as well as possible roadblocks that can impact success of the program. Critical issues with regard to Institutional Review Board (IRB and Health Insurance Portability and Accountability Act (HIPAA compliance, data standardization, sample procurement, quality control (QC, quality assurance (QA, data analysis, preclinical models and clinical trials are addressed. The various facets of the translational pipeline have been incorporated into a fully integrated computational system, appropriately named Dx2Tx. This system readily allows for the identification of new diagnostic tests, the discovery of biomarkers and drugable targets, and prediction of optimal treatments based upon the underlying molecular basis of the disease.

  4. Pompe Disease: Early Diagnosis and Early Treatment Make a Difference

    Directory of Open Access Journals (Sweden)

    Yin-Hsiu Chien

    2013-08-01

    Full Text Available Pompe disease (glycogen storage disease type II or acid maltase deficiency is a lysosomal disorder in which acid α-glucosidase (GAA deficiencies lead to intralysosomal accumulation of glycogen in all tissues; most notably in skeletal muscles. Both the patient's age at the onset of Pompe disease symptoms and the rate of deterioration caused by the disease can vary considerably. In classical infant-onset Pompe disease (IOPD, symptoms start very early in life, and death occurs soon afterward if the disease remains untreated. In later-onset Pompe disease, symptoms are slower to appear, and patients often progress to wheelchair confinement and eventual respiratory failure. A diagnosis can be made by screening for GAA in dried blood samples, followed either by GAA assessment in lymphocytes or in fibroblasts or by the genetic analysis of mutations. Treatment by enzyme replacement therapy (ERT with alglucosidase alfa was approved for human use in 2006. In classical IOPD, treatment significantly lengthens survival and improves motor development and cardiac function. The sooner ERT begins, the better are the results. Newborn screening aims to take advantage of different technologies for diagnosing and treating newborns early on and it yields better outcomes. However, newborns diagnosed early and other long-term survivors may encounter fresh problems, making up a new phenotype of IOPD patients. Further modifications of the treatment, such as a decrease in immune responses to ERT, a higher dosage, a better uptake formulation, and gene therapy delivered locally or systemically are being explored.

  5. Recent advances in diagnosis and treatment of microscopic colitis

    Science.gov (United States)

    Tysk, Curt; Wickbom, Anna; Nyhlin, Nils; Eriksson, Sune; Bohr, Johan

    2011-01-01

    Microscopic colitis, comprising collagenous colitis and lymphocytic colitis, is a common cause of chronic diarrhea. It is characterized clinically by chronic watery diarrhea and a macroscopically normal colonic mucosa where diagnostic histopathological features are seen on microscopic examination. The annual incidence of each disorder is 4-6/100,000 inhabitants, with a peak incidence in individuals 60-70 years old and a noticeable female predominance in collagenous colitis. The etiology is unknown. Chronic diarrhea, abdominal pain, weight loss, fatigue, and fecal incontinence are common symptoms that impair the health-related quality of life of the patient. There is an association with other autoimmune disorders, such as celiac disease, thyroid disorders, diabetes mellitus, and arthritis. Budesonide is the best-documented treatment, both short-term and long-term. Recurrence of symptoms is common after withdrawal of successful budesonide therapy, and the optimal long-term treatment strategy needs further study. The long-term prognosis is good, and the risk of complications including colon cancer is low. We review the epidemiology, clinical features, diagnosis and treatment of microscopic colitis. PMID:24713787

  6. Diagnosis and treatment of HIV-associated manifestations in otolaryngology.

    Science.gov (United States)

    Iacovou, Emily; Vlastarakos, Petros V; Papacharalampous, George; Kampessis, George; Nikolopoulos, Thomas P

    2012-01-02

    Almost 30 years after its first description, HIV still remains a global pandemic. The present paper aims to review the current knowledge on the ear, nose and throat (ENT) manifestations of HIV infection, and present the available diagnostic and treatment options. A literature review was conducted in Medline and other available database sources. Information from related books was also included in the data analysis. It is well acknowledged that up to 80% of HIV-infected patients eventually develop ENT manifestations; among which, oral disease appears to be the most common. Oro-pharyngeal manifestations include candidiasis, periodontal and gingival disease, HSV and HPV infection, oral hairy leucoplakia, Kaposi's sarcoma, and non-Hodgkin's lymphoma. ENT manifestations in the neck can present as cervical lymphadenopathy or parotid gland enlargement. Respective nasal manifestations include sinusitis (often due to atypical bacteria), and allergic rhinitis. Finally, otological manifestations include otitis (externa, or media), inner ear involvement (sensorineural hearing loss, disequilibrium), and facial nerve palsy (up to 100 times more frequently compared to the general population). Although ENT symptoms are not diagnostic of the disease, they might be suggestive of HIV infection, or related to its progression and the respective treatment failure. ENT doctors should be aware of the ENT manifestations associated with HIV disease, and the respective diagnosis and treatment. A multi-disciplinary approach may be required to provide the appropriate level of care to HIV patients.

  7. Diagnosis and treatment of HIV-associated manifestations in otolaryngology

    Directory of Open Access Journals (Sweden)

    Emily Iacovou

    2012-01-01

    Full Text Available Almost 30 years after its first description, HIV still remains a global pandemic. The present paper aims to review the current knowledge on the ear, nose and throat (ENT manifestations of HIV infection, and present the available diagnostic and treatment options. A literature review was conducted in Medline and other available database sources. Information from related books was also included in the data analysis. It is well acknowledged that up to 80% of HIV-infected patients eventually develop ENT manifestations; among which, oral disease appears to be the most common. Oro-pharyngeal manifestations include candidiasis, periodontal and gingival disease, HSV and HPV infection, oral hairy leucoplakia, Kaposi’s sarcoma, and non- Hodgkin’s lymphoma. ENT manifestations in the neck can present as cervical lymphadenopathy or parotid gland enlargement. Respective nasal manifestations include sinusitis (often due to atypical bacteria, and allergic rhinitis. Finally, otological manifestations include otitis (externa, or media, inner ear involvement (sensorineural hearing loss, disequilibrium, and facial nerve palsy (up to 100 times more frequently compared to the general population. Although ENT symptoms are not diagnostic of the disease, they might be suggestive of HIV infection, or related to its progression and the respective treatment failure. ENT doctors should be aware of the ENT manifestations associated with HIV disease, and the respective diagnosis and treatment. A multi-disciplinary approach may be required to provide the appropriate level of care to HIV patients.

  8. The Diagnosis and Treatment of Behavioral Disorders in Dementia.

    Science.gov (United States)

    Kratz, Torsten

    2017-06-30

    Behavioral disorders such as aggressiveness, agitation, delusions, disinhibition, affect lability, and apathy arise in more than 90% of patients with dementia. Behavioral disorders are a major challenge and the greatest stress factor in everyday life for nursing personnel and for family members caring for the patient. This review is based on relevant publications retrieved by a selective literature search in the PubMed, Cochrane Library, and German S3 guideline databases with the search terms "behavioral disorders," "non-cognitive disorders," and "challenging behavior," in conjunction with "dementia" and "behavioral and psychological symptoms of dementia." Behavioral disorders regularly accompany dementing illness and have identifiable and treatable somatic and environment-related causes. They should be treated symptomatically, both with non-pharmacological measures and with drugs. Memory therapy (d = 0.47), ergotherapy (d = 0.72), music therapy (d = 0.62), and physical exercise (d = 0.68) are effective, as are antidementia drugs (galantamine: p = 0.04, donepezil: p = 0.01, rivastigmine: p = 0.02, memantine: p = 0.004). Risperidone is the drug of choice to combat agitation and aggressiveness (d = 0.33) as well as dementia and hallucinations (d = 0.5). Citalopram can be recommended for the treatment of depression in patients with dementia (p = 0.05). Because of an improved evidence base, the latest version of the German S3 guideline on the diagnosis and treatment of dementia places greater emphasis on non-pharmacological treatments for behavioral disorders in dementia than it did in the past. The global efficacy of such treatments against behavioral disorders is well documented. Nonetheless, because of the heterogeneity of interventions and varying standards of assessment, the evidence for the utility of certain specific methods in the treatment of specific behavioral disorders is still limited. More research is needed in this area.

  9. Cardiac Involvement in Sarcoidosis: Evolving Concepts in Diagnosis and Treatment

    Science.gov (United States)

    Lynch, Joseph P.; Hwang, Jennifer; Bradfield, Jason; Fishbein, Michael; Shivkumar, Kalyanam; Tung, Roderick

    2014-01-01

    Clinically evident sarcoidosis involving the heart has been noted in at least 2 to 7% of patients with sarcoidosis, but occult involvement is much higher (> 20%). Cardiac sarcoidosis is often not recognized antemortem, as sudden death may be the presenting feature. Cardiac involvement may occur at any point during the course of sarcoidosis and may occur in the absence of pulmonary or systemic involvement. Sarcoidosis can involve any part of the heart, with protean manifestations. Prognosis of cardiac sarcoidosis is related to extent and site(s) of involvement. Most deaths due to cardiac sarcoidosis are due to arrhythmias or conduction defects, but granulomatous infiltration of the myocardium may be lethal. The definitive diagnosis of isolated cardiac sarcoidosis is difficult. The yield of endomyocardial biopsies is low; treatment of cardiac sarcoidosis is often warranted even in the absence of histologic proof. Radionuclide scans are integral to the diagnosis. Currently, 18F-fluorodeoxyglucose positron emission tomography/computed tomography and gadolinium-enhanced magnetic resonance imaging scans are the key imaging modalities to diagnose cardiac sarcoidosis. The prognosis of cardiac sarcoidosis is variable, but mortality rates of untreated cardiac sarcoidosis are high. Although randomized therapeutic trials have not been done, corticosteroids (alone or combined with additional immunosuppressive medications) remain the mainstay of treatment. Because of the potential for sudden cardiac death, implantable cardioverter-defibrillators should be placed in any patient with cardiac sarcoidosis and serious ventricular arrhythmias or heart block, and should be considered for cardiomyopathy. Cardiac transplantation is a viable option for patients with end-stage cardiac sarcoidosis refractory to medical therapy. PMID:25007089

  10. Pre-symptomatic diagnosis and treatment of filovirus diseases

    Directory of Open Access Journals (Sweden)

    Amy C Shurtleff

    2015-02-01

    Full Text Available Filoviruses are virulent human pathogens which cause severe illness with high case fatality rates and for which there are no available FDA-approved vaccines or therapeutics. Diagnostic tools including antibody- and molecular-based assays, mass spectrometry, and next-generation sequencing are continually under development. Assays using the polymerase chain reaction (PCR have become the mainstay for the detection of filoviruses in outbreak settings. In many cases, real-time reverse transcriptase-PCR allows for the detection of filoviruses to be carried out with minimal manipulation and equipment and can provide results in less than two hours. In cases of novel, highly diverse filoviruses, random-primed pyrosequencing approaches have proved useful. Ideally, diagnostic tests would allow for diagnosis of filovirus infection as early as possible after infection, either before symptoms begin, in the event of a known exposure or epidemiologic outbreak, or post-symptomatically. If tests could provide an early definitive diagnosis, then this information may be used to inform the choice of possible therapeutics. Several exciting new candidate therapeutics have been described recently; molecules that have therapeutic activity when administered to animal models of infection several days post-exposure, once signs of disease have begun. The latest data for candidate nucleoside analogs, small interfering RNA molecules, phosphorodiamidate molecules, as well as antibody and blood-product therapeutics and therapeutic vaccines are discussed. For filovirus researchers and government agencies interested in making treatments available for a nation’s defense as well as its general public, having the right diagnostic tools to identify filovirus infections, as well as a panel of available therapeutics for treatment when needed, is a high priority. Additional research in both areas is required for ultimate success, but significant progress is being made to reach these

  11. Diagnosis and Surgical Treatment of Intrahepatic Hepatolithiasis Associated Cholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Shao-Liang Han

    2009-01-01

    Full Text Available Liver malignancy is known to be associated with hepatolithiasis. The present report summarises the results and our experience for management of 23 patients with intrahepatic hepatolithiasis associated cholangiocarcinoma (IHHCC. The correct diagnosis rates of US (ultrasonography, CT (computed tomography, and MRCP (magnetic resonance cholangiopancreatography were 82.6% (19/23, 95.7% (22/23, and 91.7% (11/12, respectively. Carbohydrate antigen 19-9 (CA 19-9 was helpful in the diagnosis of IHHCC. All 23 patients with IHHCC underwent laparotomy. The surgical procedure consisted hepatectomy with a bile duct exploration in 16 patients (69.6%, a hepatectomy and drainage procedure such as sphincteroplasty and choledo-jejunostomy in three patients (13.0%, a bile duct exploration with biopsy in two patients (8.7%, and simple laparotomy and biopsy in two patients (8.7%. All the IHHCC patients who underwent a palliative procedure or laparotomy died within 1 year, and the overall cumulative survival rates at 1, 3, and 5 years were 43.8% (10/23, 13.0% (3/23, and 4.3% (1/23, respectively, and those patients who underwent curative resection were 88.9% (8/9, 33.3% (3/9, and 11.1% (1/9, respectively, which significantly longer than those (20.0%, 2/10; 0.0%, 0/10; and 0.0%, 0/10 patients who underwent palliative resection, respectively (p < 0.05. A suspicion of malignancy is necessary when managing patients with long-term hepatolithiasis. Hepatic resection with postoperative treatment is the treatment of choice for cholangiocarcinoma when it is resectable.

  12. Diagnosis, follow-up and treatment of cystic fibrosis-related liver disease

    NARCIS (Netherlands)

    van de Peppel, Ivo P; Bertolini, Anna; Jonker, Johan W; Bodewes, Frank A J A; Verkade, Henkjan J

    2017-01-01

    Purpose of review To provide an insight and overview of the challenges in the diagnosis, follow-up and treatment of cystic fibrosis-related liver disease (CFLD). Recent findings The variable pathophysiology of CFLD complicates its diagnosis and treatment. A 'gold standard' for CFLD diagnosis is

  13. Initial diagnosis and treatment in first-episode psychosis: can an operationalized diagnostic classification system enhance treating clinicians' diagnosis and the treatment chosen?

    LENUS (Irish Health Repository)

    Coentre, Ricardo

    2011-05-01

    Diagnosis during the initial stages of first-episode psychosis is particularly challenging but crucial in deciding on treatment. This is compounded by important differences in the two major classification systems, International Classification of Diseases, 10th revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). We aimed to compare the concordance between an operationalized diagnosis using Operational Criteria Checklist (OPCRIT) and treating clinician-generated diagnosis in first episode psychosis diagnosis and its correlation with treatment prescribed.

  14. Diagnosis & Treatment | Coronary Artery Disease | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Coronary Artery Disease Diagnosis & Treatment Past Issues / Fall 2010 Table of Contents Diagnosis Your healthcare provider diagnoses coronary artery disease (atherosclerosis) based on your medical and family histories, ...

  15. Diagnosis and treatment of attention deficit hyperactivity disorder (ADHD).

    Science.gov (United States)

    The objective of this NIH Consensus Statement is to inform the biomedical research and clinical practice communities of the results of the NIH Consensus Development Conference on Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder (ADHD). The statement provides state-of-the-art information regarding effective treatments for ADHD and presents the conclusions and recommendations of the consensus panel regarding these issues. In addition, the statement identifies those areas of study that deserve further investigation. Upon completion of this educational activity, the reader should possess a clear working clinical knowledge of the state of the art regarding this topic. The target audience of clinicians for this statement includes, but is not limited to, psychiatrists, family practitioners, pediatricians, internists, neurologists psychologists, and behavioral medicine specialists. Participants were a non-Federal, nonadvocate, 13-member panel representing the fields of psychology, psychiatry, neurology, pediatrics, epidemiology, biostatistics, education and the public. In addition, 31 experts from these same fields presented data to the panel and a conference audience of 1215. The literature was searched through Medline and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft

  16. Espondilodiscitis por Candida albicans Candida albicans spondylodiscitis: Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Silvina De Luca

    2008-03-01

    Full Text Available Propósito: Describir los hallazgos radiológicos distintivos en resonancia magnética de las espondilodiscitis fúngicas (Candida albicans y su importancia en el diagnóstico temprano de estas entidades. Se reporta el caso de un paciente masculino de 51 años de edad, inmunocomprometido, que consulta por fiebre y dolor lumbar. La RM con gadolinio demostró en secuencias T2 hipointensidad de la médula ósea en los cuerpos vertebrales afectados, asociados a cambios en la señal discal y realce intenso discovertebral. Ante un paciente inmunocomprometido con dolor lumbar que presenta modificaciones disco vertebrales atípicas en la resonancia magnética, debe considerarse la infección micótica dentro de las posibilidades diagnósticas. El diagnóstico de certeza requiere la toma de biopsia del tejido afectado mediante punción aspiración y posterior análisis microbiológico. El tratamiento médico es el de elección, aunque en algunos casos se plantea el drenaje quirúrgico. El reconocimiento de las características radiológicas distintivas evita retardos en el diagnóstico y el tratamiento.Purpose: To describe Candida albicans spondylodiscitis distinctive imaging findings and treatment. The authors reported a 51 years old, male inmunocompromised patient with fever and lumbar pain. MR findings include bone marrow hypointense signal intensity in T2 weighted of affected vertebral bodies and intense discovertebral enhancement. Candida albicans spondylodiscitis should be considered as one of the differential diagnosis of an inmunocompromised patient with lumbar pain and lumbar atypical findings at MR. Biopsy sample is required in order to reach final diagnosis. The first choice treatment is antyfungal drugs although in certain cases surgery is required. Rapid recognition of distinctive imaging findings avoid missdiagnosis and treatment delays.

  17. The diagnosis and treatment of dyskeratosis congenita: a review

    Directory of Open Access Journals (Sweden)

    Fernández García MS

    2014-08-01

    Full Text Available M Soledad Fernández García,1,2 Julie Teruya-Feldstein1 1Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; 2Department of Pathology, Hospital Universitario Central de Asturias, Oviedo, Spain Abstract: Dyskeratosis congenita (DC is an inherited bone marrow failure (BMF syndrome characterized by the classic triad of abnormal skin pigmentation, nail dystrophy, and oral leukoplakia. However, patients usually develop BMF and are predisposed to cancer, with increased risk for squamous cell carcinoma and hematolymphoid neoplasms. DC is a disease of defective telomere maintenance and is heterogeneous at the genetic level. It can be inherited in X-linked, autosomal dominant, or autosomal recessive patterns. Mutations in at least ten telomere- and telomerase-associated genes have been described in DC. There are no targeted therapies for DC and patients usually die of BMF due to a deficient renewing capability of hematopoietic stem cells. Allogeneic hematopoietic stem cell transplantation is the only curative treatment for BMF. Keywords: dyskeratosis congenita, diagnosis, genetics, clinical, treatment

  18. Lactose malabsorption and intolerance: pathogenesis, diagnosis and treatment

    Science.gov (United States)

    Pohl, Daniel; Frühauf, Heiko; Fried, Michael; Vavricka, Stephan R; Fox, Mark

    2013-01-01

    Lactose malabsorption is a common condition caused by reduced expression or activity of lactase in the small intestine. In such patients, lactose intolerance is characterized by abdominal symptoms (e.g. nausea, bloating, and pain) after ingestion of dairy products. The genetic basis of lactose malabsorption is established and several tests for this condition are available, including genetic, endoscopic, and H2-breath tests. In contrast, lactose intolerance is less well understood. Recent studies show that the risk of symptoms after lactose ingestion depends on the dose of lactose, lactase expression, intestinal flora, and sensitivity of the gastrointestinal tract. Lactose intolerance has recently been defined as symptoms developing after ingestion of lactose which do not develop after placebo challenge in a person with lactose maldigestion. Such blinded testing might be especially important in those with functional gastrointestinal diseases in whom self-reported lactose intolerance is common. However, placebo-controlled testing is not part of current clinical practice. Updated protocols and high-quality outcome studies are needed. Treatment options of lactose intolerance include lactose-reduced diet and enzyme replacement. Documenting the response to multiple doses can guide rational dietary management; however, the clinical utility of this strategy has not been tested. This review summarizes the genetic basis, diagnosis, and treatment of lactose malabsorption and intolerance. PMID:24917953

  19. Canine mast cell tumors: diagnosis, treatment, and prognosis

    Directory of Open Access Journals (Sweden)

    Garrett LD

    2014-08-01

    Full Text Available Laura D Garrett Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, Urbana, IL, USA Abstract: Mast cell tumors (MCTs are the most common malignant skin cancer in dogs, and significant variability exists in their biological behavior. Most MCTs are cured with appropriate local therapy, but a subset shows malignant behavior with the potential to spread to lymph nodes, liver, spleen, and other areas and to thus become a systemic cancer. Because of this variable behavior, it is difficult to predict how any individual tumor is going to behave. The variability thus creates uncertainty in deciding what a particular dog's prognosis is, whether staging tests to assess for metastasis are needed, and even what treatments will be necessary for best outcome. In addition to controversies over the potential for development of systemic disease, or diffuse metastasis, controversies also exist over what treatment is needed to best attain local control of these tumors. This article will briefly discuss the diagnosis of MCTs in dogs and will summarize the literature in regards to the controversial topics surrounding the more aggressive form of this disease, with recommendations made based on published studies. Keywords: mitotic index, mastocytosis, tyrosine kinase inhibitor, histologic grade

  20. [Cherubism: diagnosis and treatment in the pediatric age].

    Science.gov (United States)

    Sánchez Burgos, R; Martín Pérez, M; Ramírez Piqueras, M; Gómez García, E; Burgueño García, M

    2012-01-01

    Cherubism is a benign bone dysplasia of childhood, exclusively involving maxillary bones and spontaneous resolving after puberty in different grades. Approximately, 280 cases have been reviewed in the literature. It is an autosomal dominant disorder in which the normal bone is replaced by cellular fibrous and immature bone, resulting in painless symmetrical enlargement of the jaws. Diagnosis is based in clinical and radiological findings, confirmed by histology. Treatment is a controversial issue, and it is recommended surgical management as conservative as possible during the rapid growth phases. An aggressive case of cherubism is reported, diagnosed and followed since early childhood until puberty, with progressive involvement of facial bones developing in a disruption of facial contours and occlusion. The patient is treated by several surgical interventions oriented to minimize the aesthetic impact of the disease being as conservative as possible. The highlights of this case are the great proportion of the lesions, the functional and emotional disturbances brought out by these lesions and the difficulty to choose the most appropriate age and form of treatment.

  1. Autism spectrum disorders: an overview on diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Helena Brentani

    2013-01-01

    Full Text Available Pervasive developmental disorders are now commonly referred to as autism spectrum disorders (ASDs. ASDs present with a range of severity and impairments, and often are a cause of severe disability, representing a major public health concern. The diagnostic criteria require delays or abnormal functioning in social interaction, language, and/or imaginative play within the first 3 years of life, resulting in a deviation from the developmental pattern expected for the age. Because establishing a diagnosis of ASD is possible as early as 18-24 months of age, clinicians should strive to identify and begin intervention in children with ASD as soon as signs are manifest. Increasing efforts are underway to make ASD screening universal in pediatric healthcare. Given the crucial importance of early identification and multiple modalities of treatment for ASD, this review will summarize the diagnostic criteria, key areas for assessment by clinicians, specific scales and instruments for assessment, and discussion of evidence-based treatment programs and the role of specific drug therapies for symptom management.

  2. [Sleep apnea-hypopnea syndrome. Concept, diagnosis and medical treatment].

    Science.gov (United States)

    Eguía, V M; Cascante, J A

    2007-01-01

    The sleep apnea-hypopnea syndrome (SAHS) is characterised by daytime sleepiness, cardiorespiratory and cognitive disorders, secondary to repeated episodes of obstruction of the upper airway during sleep. This disease is highly prevalent in the general population and has damaging effects on the cardiovascular system; it increases the incidence of traffic accidents due to excessive somnolence, reduces the quality of life and is associated with an excess of mortality. It usually affects obese patients and the most important symptoms are snoring and repeated respiratory pauses. With each apnea and/or hypopnea there is a fall in saturation that alters the nocturnal average and ends up causing serious cardiovascular problems in the medium to long term. The destructuring of the architecture of sleep leads to daytime sleepiness that can interfere in social and working life. Diagnosis is carried out by means of polysomnography or respiratory poligraphy, an abbreviated method that is valid for 75% of cases. The most efficient medical treatment is the application of positive pressure to the airway (Continuous positive airway pressure - CPAP) that has scarce and light secondary effects and is in general well-tolerated. Once adapted, the patient must carry out an adjustment of the pressure through polysomnography and with the autoCPAP, which can vary pressure until the respiratory events are corrected. Primary care has an essential role to play in suspicion of the clinical symptoms, the correct utilisation of the referral criteria and the control of patients receiving treatment once adapted.

  3. Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era

    Directory of Open Access Journals (Sweden)

    M. Crespi

    2016-01-01

    Full Text Available Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results.

  4. Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era.

    Science.gov (United States)

    Crespi, M; Montecamozzo, G; Foschi, D

    2016-01-01

    Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results.

  5. Diagnosis and Treatment of Common Forms of Tremor

    Science.gov (United States)

    Puschmann, Andreas; Wszolek, Zbigniew K.

    2014-01-01

    Tremor is the most common movement disorder presenting to an outpatient neurology practice and is defined as a rhythmical, involuntary oscillatory movement of a body part. The authors review the clinical examination, classification, and diagnosis of tremor. The pathophysiology of the more common forms of tremor is outlined, and treatment options are discussed. Essential tremor is characterized primarily by postural and action tremors, may be a neurodegenerative disorder with pathologic changes in the cerebellum, and can be treated with a wide range of pharmacologic and nonpharmacologic methods. Tremor at rest is typical for Parkinson’s disease, but may arise independently of a dopaminergic deficit. Enhanced physiologic tremor, intention tremor, and dystonic tremor are discussed. Further differential diagnoses described in this review include drug- or toxin-induced tremor, neuropathic tremor, psychogenic tremor, orthostatic tremor, palatal tremor, tremor in Wilson’s disease, and tremor secondary to cerebral lesions, such as Holmes’ tremor (midbrain tremor). An individualized approach to treatment of tremor patients is important, taking into account the degree of disability, including social embarrassment, which the tremor causes in the patient’s life. PMID:21321834

  6. Epigenetics application in the diagnosis and treatment of bladder cancer.

    Science.gov (United States)

    Harb-de la Rosa, Alfredo; Acker, Matthew; Kumar, Raj A; Manoharan, Murugesan

    2015-10-01

    Bladder cancer is the sixth most common cancer in the Western world. Patients with bladder cancer require close monitoring, which may include frequent cystoscopy and urine cytology. Such monitoring results in significant health care cost. The application of epigenetics may allow for a risk adapted approach and more cost-effective method of monitoring. A number of epigenetic changes have been described for many cancer sites, including the urinary bladder. In this review, we discuss the use of epigenetics in bladder cancer and the potential diagnostic and therapeutic applications. A comprehensive search of the English medical literature was conducted in PubMed using the terms microRNA regulation, DNA methylation, histone modification and bladder cancer. The most important epigenetic changes include DNA methylation, histone modification and microRNA regulation. Both DNA hypomethylation and hypermethylation have been associated with higher rate of cancer. The association of epigenetic changes with bladder cancer has led to the research of its diagnostic and prognostic implications as well as to the development of novel drugs to target these changes with the aim of achieving a survival benefit. Recently, epigenetics has been shown to play a much greater role than previously anticipated in the initiation and propagation of many tumors. The use of epigenetics for the diagnosis and treatment of bladder cancer is an evolving and promising field. The possibility of reversing epigenetic changes may facilitate additional cancer treatment options in the future.

  7. Diagnosis and treatment of pulmonary tuberculosis in pediatric population

    Directory of Open Access Journals (Sweden)

    Rosalba Díaz-Castro

    2014-04-01

    Full Text Available Pulmonary Tuberculosis (TB is a serious disease and the second cause of death from an infectious agent after the Acquired Immunodeficiency Syndrome according to the World Health Organization. Incidence in Colombia for 2008 was 5.47 cases per 100,000 in children under 15 years. However, global statistics suggests that the TB affects 10% of the pediatric population worldwide; in 2010 Cauca’s government reported a total of 298 new cases. The prevention of TB in children has not been a priority talking about governmental policies and pediatric cases help to perpetuate the chain of transmission. Hence, is necessary to increase the research of active cases and latent TB infection by the identification of risky factors and high degree of suspicion of the disease in order to establish chemoprophylaxis or potential curable treatment, and thus, to achieve control and the reduction of morbidity, and mortality. Bearing in mind that the disease has a major negative impact on the population this review is conducted to gather updated information related to the diagnosis and treatment of pulmonary TB in children.

  8. Radiologic diagnosis and treatment of iatrogenic acquired uterine arteriovenous malformation

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Jung Hyeok [College of Medicine, Keimyung Univ., Taegu (Korea, Republic of)

    2002-05-01

    To analyze gray-scale US, color and duplex Doppler US, and angiographic findings in patients with acquired uterine arteriovenous malformations (AVMs), and to evaluate the usefulness of these modalities in the diagnosis of this disease and the effect of transcatheter arterial embolization in its treatment. During a recent seven-year period, we diagnosed 21 cases of acquired uterine AVM. Nineteen of these patients had a history of causative D and C (between one and seven D and C procedures per patient), one had a history of causative cesarean section, and one had cervical conization. All patients underwent transabdominal and endovaginal gray-scale, color Doppler, and duplex Doppler US and angiography, with therapeutic embolization of bilateral uterine arteries. The majority underwent follow-up Doppler US after embolization. The gray-scale US morphology of uterine AVMs included subtle myometrial inhomogeneity and multiple distinct, small anechoic spaces in the thickened myometrium or endometrium. Color Doppler US showed a tangle of tortuous vessels with multidirectional, high-velocity arterial flow, which was focally or asymmetrically distributed. Duplex Doppler US depicted a waveform of fast arterial flow with low resistance, while angiography demonstrated a complex tangle of vessels supplied by enlarged uterine arteries, in association with early venous drainage during the arterial phase, and staiss of contrast medium within abnormal vasculature. Where AVMs were combined with a pseudoaneurysm, this finding was observed. Transcatheter arterial embolization provided a complete cure, without recurrence. Color and duplex Doppler US in an appropriate modality for the detection and diagnosis of uterine AVMs and for follow-up after embolization. Transcatheter arterial embolization is a safe and effective method of treating this disease.

  9. Food Allergies: Symptoms, Diagnosis, Prevention and Treatment | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. Feature: Food Allergies Food Allergies: Symptoms, Diagnosis, Prevention and Treatment Past Issues / ... available treatments only ease the symptoms. Preventing a food allergy reaction There are no drugs or treatments ...

  10. DIAGNOSIS AND TREATMENT OF COMBAT INJURIES OF THE EAR

    Directory of Open Access Journals (Sweden)

    V. I. Egorov

    2016-01-01

    Full Text Available The authors  discuss specifics of the  wound  process in modern  combat  injury of the  ear, significance  and  specifics of diagnosis  of gunshot ear injury related to individual characteristics of gunshot  wounds  with consideration of the  accepted anatomical classification of the injured zones. Typical complications of ear injuries are described that  can result in death. The authors  analyze an approach  to  surgical treatment of traumatic  ear injuries based on their own experience, including non-conventional choice  of the  type  of surgery. They proposed an algorithm to assess the auditory and  vestibular  analyzers in the  injured based  on their analysis of date obtained from 772 patients, determine types of pure-tone audiograms  typical for acoustic  and  barotrauma,  and  underline  the informative  value  of optokinetic  nystagmus   assessment. Various types of conservative  management of the sequelae of the mine-blast ear trauma are discussed  aimed at potential  minimization of the  post-traumatic reactions  of the  auditory  and vestibular  analyzers.  The  authors  draw attention to the importance of early treatment, the highest effectiveness of combination therapy and plasmapheresis. They propose  their  experience  of care for the above mentioned traumatic injuries to improve treatment efficacy.

  11. Acquired hemophilia a: diagnosis, aetiology, clinical spectrum and treatment options.

    Science.gov (United States)

    Shetty, Shrimati; Bhave, Manali; Ghosh, Kanjaksha

    2011-04-01

    Acquired hemophilia A (AHA) is a rare disorder with an incidence of approximately 1 per million/year with a high mortality rate of more than 20%. The disease occurs due to autoantibodies against coagulation factor VIII (FVIII) which neutralize its procoagulant function and result in severe, often life-threatening bleeding. The antibodies arise in individuals with no prior history of hemophilia A. AHA may be associated with pregnancy, autoimmune diseases, malignancy, infections or medication and occurs most commonly in the elderly. Approximately 50% of the patients remain idiopathic with no known underlying pathological condition. Clinical manifestations include spontaneous hemorrhages into the skin, muscles or soft tissues or excessive bleeding during surgery. Hemarthrosis which is the hallmark of congenital severe hemophilia A seldom occurs in AHA. The diagnosis of AHA is based on the isolated prolongation of activated partial thromboplastin time (APTT) which does not normalize after the addition of normal plasma along with reduced FVIII levels. The treatment involves two aspects-eradication of antibodies and maintaining effective hemostasis during a bleeding episode. The protocols for eradication of antibodies include immunoadsorption, immunosuppression or immune tolerance induction (ITI). The treatment of acute bleeding episodes involves use of different bypassing agents like recombinant activated factor VIIa (rFVIIa, NovoSeven®) and activated prothrombin complex concentrate (aPCC, (FEIBA®) in case of patients with high titer inhibitors or with antifibrinolytics,1-deamino-8-D-arginine vasopressin (DDAVP) or FVIII concentrates in low titer inhibitor patients. The anti CD20 monoclonal antibody, rituximab, has shown very good results either singly or in combination with immunosuppressive regimens in patients who do not respond to standard immunosuppressors. The present review summarizes the diagnostic, aetiological, clinical and treatment aspects of AHA focusing

  12. Exercise addiction- diagnosis, bio-psychological mechanisms and treatment issues.

    Science.gov (United States)

    Weinstein, Aviv; Weinstein, Yitzhak

    2014-01-01

    Exercise and sports activity are beneficial both physically and psychologically but excessive exercise may have adverse physiological and psychological effects. There are methodological issues in the definition, diagnosis and etiology of exercise addiction. Several questionnaires and diagnostic tools have been developed and validated and they show high validity and reliability. Exercise addiction has been suggested as having an obsessive-compulsive dimension as well as rewarding aspects that may include it among the behavioral addictions. Biological studies show that in rodents, exercise such as wheel running activates the dopamine reward system and thus contributing to stress reduction. Further evidence suggests that running is associated with endorphins and cannabinoids thus explaining the "runners high" or euphoric feelings that may lead to exercise addiction. Genetic studies suggest that genes which control preference for drugs also control the preference for naturally rewarding behaviors such as exercise. Psychological studies also explain exercise addiction in terms of reward, habituation, social support, stress-relief, avoidance of withdrawal and reduction of anxiety. It has been suggested that exercise addiction is a part of a continuum of sportive activity that develops in stages from the recreational exercise to at-risk exercise, problematic exercise and finally into exercise addiction. Assessment and treatment should take into account the various stages of exercise addiction development, its comorbidity with other psychiatric disorders such as eating disorders or substance use and alcohol disorders. Treatment approaches for exercise addiction are based on the cognitive-behavioral approach but little is known about their effectiveness. A single-case study shows promise of pharmacological treatment for exercise addiction and further studies are required. This review summarizes diagnostic and phenomenology of exercise addiction with emphasis on

  13. Detection in testis, epididymis and ovary

    Indian Academy of Sciences (India)

    2017-01-11

    Jan 11, 2017 ... in normal reproductive tissues of male and female mice. For the first time, we demonstrate that beyond the oviduct,. Ovgp1 mRNA is expressed in the testis, epididymis and ovary, but not in the uterus, cervix, vagina, breast, seminal vesicles and prostate gland. In the testis, Ovgp1 mRNA was localized in the ...

  14. Stralenbehandeling van 'germinal tumors' van de testis

    NARCIS (Netherlands)

    Keijser, Sijbrand Pieter

    1957-01-01

    Na een kotte inleiding wordt in het eerste hoofdstuk een beknopt overzicht gegeven van de ontwikkeling van de testis bij het embryo. In het tweede hoofdstuk wordt de anatomie van de testis en zijn afvoersvsteem besproken, waarbij speciale aandacht wordt geschonken aan de afvoerende lymphvaten van de

  15. [Application of three-dimensional digital technology in the diagnosis and treatment planning in orthodontics].

    Science.gov (United States)

    Bai, Y X

    2016-06-01

    Three-dimensional(3D)digital technology has been widely used in the field of orthodontics in clinical examination, diagnosis, treatment and curative effect evaluation. 3D digital technology greatly improves the accuracy of diagnosis and treatment, and provides effective means for personalized orthodontic treatment. This review focuses on the application of 3D digital technology in the field of orthodontics.

  16. Early diagnosis and treatment of uncomplicated malaria and patterns of health seeking in Vietnam

    NARCIS (Netherlands)

    Giao, Phan T.; Vries, Peter J.; Binh, Tran Q.; Nam, Nguyen V.; Kager, Piet A.

    2005-01-01

    Early diagnosis and treatment of malaria (EDTM) is a key component of malaria control. The success of EDTM depends on health seeking behaviour and the quality of the health service. This study assessed self-diagnosis, treatment and treatment delay after the introduction of EDTM in 1993. In southern

  17. Brazilian guidelines for the diagnosis and treatment of cystic fibrosis.

    Science.gov (United States)

    Athanazio, Rodrigo Abensur; Silva Filho, Luiz Vicente Ribeiro Ferreira da; Vergara, Alberto Andrade; Ribeiro, Antônio Fernando; Riedi, Carlos Antônio; Procianoy, Elenara da Fonseca Andrade; Adde, Fabíola Villac; Reis, Francisco José Caldeira; Ribeiro, José Dirceu; Torres, Lídia Alice; Fuccio, Marcelo Bicalho de; Epifanio, Matias; Firmida, Mônica de Cássia; Damaceno, Neiva; Ludwig-Neto, Norberto; Maróstica, Paulo José Cauduro; Rached, Samia Zahi; Melo, Suzana Fonseca de Oliveira

    2017-01-01

    Cystic fibrosis (CF) is an autosomal recessive genetic disorder characterized by dysfunction of the CFTR gene. It is a multisystem disease that most often affects White individuals. In recent decades, various advances in the diagnosis and treatment of CF have drastically changed the scenario, resulting in a significant increase in survival and quality of life. In Brazil, the current neonatal screening program for CF has broad coverage, and most of the Brazilian states have referral centers for the follow-up of individuals with the disease. Previously, CF was limited to the pediatric age group. However, an increase in the number of adult CF patients has been observed, because of the greater number of individuals being diagnosed with atypical forms (with milder phenotypic expression) and because of the increase in life expectancy provided by the new treatments. However, there is still great heterogeneity among the different regions of Brazil in terms of the access of CF patients to diagnostic and therapeutic methods. The objective of these guidelines was to aggregate the main scientific evidence to guide the management of these patients. A group of 18 CF specialists devised 82 relevant clinical questions, divided into five categories: characteristics of a referral center; diagnosis; treatment of respiratory disease; gastrointestinal and nutritional treatment; and other aspects. Various professionals working in the area of CF in Brazil were invited to answer the questions devised by the coordinators. We used the PubMed database to search the available literature based on keywords, in order to find the best answers to these questions. RESUMO A fibrose cística (FC) é uma doença genética autossômica recessiva caracterizada pela disfunção do gene CFTR. Trata-se de uma doença multissistêmica que ocorre mais frequentemente em populações descendentes de caucasianos. Nas últimas décadas, diversos avanços no diagnóstico e tratamento da FC mudaram drasticamente o

  18. Advances in diagnosis and treatment of trigeminal neuralgia

    Directory of Open Access Journals (Sweden)

    Montano N

    2015-02-01

    neurostimulation might represent an opportunity in TN refractory to other surgical treatments. The aim of this work was to review the recent literature about the pathogenesis, diagnosis, and medical and surgical treatments, and discuss the significant advances in all these fields. Keywords: microvascular decompression, percutaneous balloon compression, gamma knife radiosurgery, surgical treatment, magnetic resonance imaging, therapy

  19. Current Practice in Diagnosis and Treatment of Growth Hormone Deficiency in Childhood: A Survey from Turkey

    OpenAIRE

    Poyrazo?lu, ??kran; Ak?ay, Teoman; Arslano?lu, ?lknur; Atabek, Mehmet Emre; Atay, Zeynep; Berbero?lu, Merih; Bereket, Abdullah; Bideci, Aysun; Bircan, ?ffet; B?ber, Ece; Can, ?ule; Cesur, Ya?ar; Darcan, ??kran; Demir, Korcan; D?ndar, Bumin

    2015-01-01

    Objective: Approaches to diagnosis and treatment of growth hormone deficiency (GHD) in children vary among countries and even among centers in the same country. This survey, aiming to facilitate the process of preparing the new consensus on GHD by the Turkish Pediatric Endocrinology and Diabetes Society, was designed to evaluate the current practices in diagnosis and treatment of GHD in different centers in Turkey. Methods: A questionnaire covering relevant items for diagnosis and treatment o...

  20. [Mistakes and countermeasures in diagnosis and treatment of prolapse of lumbar intervertebral disc].

    Science.gov (United States)

    Xu, Lin-bo

    2007-06-01

    The mistakes in clinical diagnosis and treatment due to dealing with symptoms, signs and imaging data in isolation, and unclear differentiation of relative diseases are found by reviewing definition and cause of disease and pathogenesis of prolapse of lumbar intervertebral disc, so as to probe into mistakes and countermeasures in diagnosis and treatment of prolapse of lumbar intervertebral disc. Only combined analysis of clinical symptoms, signs and imaging data, can correct diagnosis and treatment be made.

  1. Internet gaming disorder treatment: a review of definitions of diagnosis and treatment outcome.

    Science.gov (United States)

    King, Daniel L; Delfabbro, Paul H

    2014-10-01

    Internet gaming disorder (IGD) is a new disorder currently positioned in the appendix of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Few clinical studies report that psychological and pharmacological interventions can significantly reduce the severity of IGD symptomatology. The aim of this review was to assess current knowledge of the short- and long-term benefits of IGD interventions. This review presents a systematic evaluation of definitions of diagnosis and treatment outcomes employed in IGD treatment studies, including an assessment of goodness of fit with the DSM-5 classification. A computer database search of Academic Search Premier, PubMed, PsychINFO, ScienceDirect, Web of Science, and Google Scholar was conducted to identify all available research evidence on Internet gaming disorder treatment (N = 8 studies). Diagnostic and treatment outcome parameters were systematically evaluated. Several weaknesses of IGD treatment literature were identified. Only 2 treatment studies have employed an equivalent method of diagnosis for IGD. Studies have not assessed formative change in diagnostic status at posttreatment or follow-up. Duration of follow-up has been inadequate to assess relapse and remission. Posttreatment assessment has been predominantly limited to IGD symptomatology, comorbidity, and frequency of gaming behavior. Currently, there is insufficient evidence to warrant suggestion that trialled IGD interventions confer a long-term therapeutic benefit. Several improvements to study design and reporting are proposed to guide future studies of IGD. © 2014 Wiley Periodicals, Inc.

  2. An update on Acanthamoeba keratitis: diagnosis, pathogenesis and treatment

    Science.gov (United States)

    Lorenzo-Morales, Jacob; Khan, Naveed A.; Walochnik, Julia

    2015-01-01

    Free-living amoebae of the genus Acanthamoeba are causal agents of a severe sight-threatening infection of the cornea known as Acanthamoeba keratitis. Moreover, the number of reported cases worldwide is increasing year after year, mostly in contact lens wearers, although cases have also been reported in non-contact lens wearers. Interestingly, Acanthamoeba keratitis has remained significant, despite our advances in antimicrobial chemotherapy and supportive care. In part, this is due to an incomplete understanding of the pathogenesis and pathophysiology of the disease, diagnostic delays and problems associated with chemotherapeutic interventions. In view of the devastating nature of this disease, here we present our current understanding of Acanthamoeba keratitis and molecular mechanisms associated with the disease, as well as virulence traits of Acanthamoeba that may be potential targets for improved diagnosis, therapeutic interventions and/or for the development of preventative measures. Novel molecular approaches such as proteomics, RNAi and a consensus in the diagnostic approaches for a suspected case of Acanthamoeba keratitis are proposed and reviewed based on data which have been compiled after years of working on this amoebic organism using many different techniques and listening to many experts in this field at conferences, workshops and international meetings. Altogether, this review may serve as the milestone for developing an effective solution for the prevention, control and treatment of Acanthamoeba infections. PMID:25687209

  3. Use of Telomerase Enzyme in Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Figen Guzelgul,Kiymet Aksoy

    2011-04-01

    Full Text Available There are structures on the tip of eukaryotic chromosomes known as telomer. These non-translated repeat sequences participate in the stabilization of chromosomes. These structures shorten 10-12 bp in each replication. However, there is an enzyme which takes effect to prevent the shortening of chromosomes. This enzyme is found in germ cells, embriyonic stem cells, single celled eukaryotes and cancerous cells. Telomer has important roles on aging and cancer. In the last decade, medical sciences focus on the probability of use of telomerase enzyme retarding the aging course and inerease life expectancy. In addition, the presence of the enzyme in cancerous cells suggests the use of this enzyme for cancer diagnosis as a biomarker. The telomerase enzymes may also be used in cancer treatment. Studies on the prevention of ability of finite division of the cancer cells by the inactivation of the telomerase enzyme are promising. [Archives Medical Review Journal 2011; 20(2.000: 69-88

  4. Diagnosis directs treatment in fungal infections of the skin.

    Science.gov (United States)

    Panthagani, Anusha P; Tidman, Michael J

    2015-10-01

    Dermatophyte fungi are confined to the keratin layer of the epidermis and include three genera: Microsporum, Epidermophyton and Trichophyton. These infections can be transmitted by human contact (anthropophilic), from the soil (geophilic) and by animal (zoophilic) spread. Dermatophyte infections usually present as an erythematous, scaly eruption, which may or may not be itchy. Asymmetry is an important clinical clue to fungal infection, as is annular morphology. Examination under ultraviolet (Wood's light) can be helpful. The gold standard for diagnosing cutaneous fungal infections is microscopy and culture of scale, hair or nail, and a definite diagnosis is desirable before commencing treatment, especially with oral therapy. Any dermatophyte species affecting the body can affect the hands. The most common organism is T. rubrum. Tinea corporis infection affects the trunk mainly in children and adolescents, and all genera of dermatophyte can cause it. Tinea cruris infection involves the groin region and is more common in men than women. T. rubrum is the most common causative dermatophyte. The clinical features of tinea capitis include patchy hair loss with varying degrees of scale, erythema and pustules. Infected hairs tend to break at the base, leaving stubble. Occasionally, there is invasion of the visible epidermis, resulting in a boggy, painful swelling with associated alopecia and regional lymphadenopathy known as a kerion.

  5. The diagnosis and nonoperative treatment of shoulder injuries in athletes.

    Science.gov (United States)

    Jobe, F W; Bradley, J P

    1989-07-01

    The specific emphasis in this article has been directed toward the diagnosis of prevalent shoulder pathology in a young athletic population; however, as the interest in sports has blossomed in recent years now encompassing a larger age range, the physician must not neglect common pathologic conditions of the older athletes. Fastidious adherence to complete history, physical examination, and a high level of suspicion for uncommon disorders is paramount. Arthritides such as osteo, rheumatoid, septic, and lyme as well as the hematologic disorders of multiple myeloma, lymphomas, leukemia, hemophilia, and Gaucher's disease can all present with shoulder pain. Thoracic outlet syndrome, scalene syndrome, supra-scapular nerve syndrome, and quadrilateral space syndrome comprise a group of nerve compression syndromes that are becoming more apparent as our diagnostic skills improve. Yet, the most pervasive disorders in the young athlete are due to lack of shoulder stability. By understanding the delicate balance in normal shoulder between mobility and stability, the clinician is better able to conceptualize the etiology and progression of the problem, and design the optimal treatment program.

  6. Narcolepsy: clinical approach to etiology, diagnosis, and treatment.

    Science.gov (United States)

    Koziorynska, Ewa I; Rodriguez, Alcibiades J

    2011-01-01

    Narcolepsy is a neurologic disorder characterized by excessive daytime sleepiness and manifestations of disrupted rapid eye movement sleep stage. The pathologic hallmark is loss of hypocretin neurons in the hypothalamus likely triggered by environmental factors in a susceptible individual. Patients with narcolepsy, in addition to excessive daytime sleepiness, can present with cataplexy, sleep paralysis, sleep fragmentation, and hypnagogic/hypnopompic hallucinations. Approximately 60% to 90% of patients with narcolepsy have cataplexy, characterized by sudden loss of muscle tone. Only 15% of patients manifest all of these symptoms together. Narcolepsy can be misdiagnosed as a psychiatric disorder or even epilepsy. An appropriate clinical history, polysomnogram, Multiple Sleep Latency Test, and, at times, cerebrospinal fluid hypocretin levels are necessary for diagnosis. The treatment of narcolepsy is aimed toward the different symptoms that the patient manifests. Excessive daytime sleepiness is treated with amphetamine-like or non-amphetamine-like stimulants. Cataplexy is treated with sodium oxybate, tricyclic antidepressants, or selective serotonin and norepinephrine reuptake inhibitors. Sleep paralysis, hallucinations, and fragmented sleep may be treated with benzodiazepine hypnotics or sodium oxybate. Patients with narcolepsy should avoid sleep deprivation, sleep at regular hours, and, if possible, schedule routine napping.

  7. [Safety in the diagnosis and treatment of inflammatory bowel disease].

    Science.gov (United States)

    Gomollón, Fernando

    2013-10-01

    The presentations at Digestive Disease Week 2013 emphasized treatment safety. Anti-tumor necrosis factor (TNF) agents and thiopurines are reasonably safe in breastfeeding and pregnancy. Several studies indicate that controlling the risk of tuberculosis when anti-TNF agents are planned presents several problems, both in the initial diagnosis of latent tuberculosis and in subsequent patient follow-up, given that cases of tuberculosis continue to occur, despite recommendations. Thiopurines increase the risk of lymphoma, but there is no residual risk when these drugs are withdrawn. Despite increasing knowledge of the risks and recommendations on how to avoid them, there remain considerable shortfalls in the application of preventive measures and, more specifically, in vaccinations. Infliximab and cyclosporin produce similar results when used to treat severe outbreaks of ulcerative colitis. Thromboembolism prevention continues to be deficient, and the barriers to effective prevention concern not only physicians but can also involve nursing staff, for example. There is still a wide margin for improvement in safety. New drugs under study (vedolizumab, golimumab) have not shown any hitherto unknown signs of significant toxicity. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  8. Chronic urticaria in children: Etiologies, Clinical Manifestations, Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Javad Ghaffari

    2013-06-01

    Full Text Available Chronic urticaria is defined as a skin disease with central induration (wheal and erythema formation around it (flare that appears at least twice a week and remains at least for 6 weeks continually. The incidence of urticaria in children is about 0.1-3%. Most cases of chronic urticaria occur in children between 6-11 years. Autoimmune and allergy immaturity is one of the reasons of lower incidence of chronic urticaria in younger children. Quality of life impairment in children with urticaria has been known to be similar to diseases with severe atopic dermatitis, epilepsy, diabetes mellitus and asthma. There are several causes for chronic urticaria in children in different reports. In most of cases the known etiologic agents are varies from 21 to 83%. Overall, infectious causes of chronic urticaria in children are more common and obvious than other in adults .In most cases, the cause of chronic urticaria are idiopathic or autoimmune. Urticaria severity divided to mild, moderate and severe was based on the number of wheals and severity of pruritus. Diagnosis of chronic urticaria is based on a good history and physical examination. The treatment of chronic urticaria is a patient education that is to remove the triggering and aggravating agents, resolving and treating of the known disease and the use of various medicines based on the history and clinical findings. The first medical therapeutics lines in children are anti-histamines, beta-blocker H1 and new generation of non-sedating agents.

  9. State Medicaid Early and Periodic Screening, Diagnosis and Treatment guidelines

    Science.gov (United States)

    Hom, Jacqueline M.; Lee, Jessica Y.; Silverman, Janice; Casamassimo, Paul S.

    2015-01-01

    Background The authors evaluated adherence of state Medicaid Early and Periodic Screening, Diagnosis and Treatment (EPSDT) guidelines to recommended best oral health practices for infants and toddlers. Methods The authors obtained state EPSDT guidelines via the Internet or from the Medicaid-CHIP State Dental Association in Washington. The authors identified best oral health practices through the American Academy of Pediatric Dentistry (AAPD), Chicago. They evaluated each EPSDT dental periodicity schedule with regard to the timing and content of seven key oral health domains for infants and toddlers. Results Thirty-two states and the District of Columbia (D.C.) had EPSDT dental periodicity schedules. With the exception of the dentist referral domain, 29 states (88 percent) adhered to the content and timing of best oral health practices, as established by the AAPD guideline. For the dentist referral domain, 31 of the 32 states and D.C. (94 percent) required referral of children to a dentist, but only 11 states (33 percent adhered to best oral health practices by requiring referral by age 1 year. Conclusions With the exception of the timing of the first dentist referral, there was high adherence to best oral health practices for infants and toddlers among states with separate EPSDT dental periodicity schedules. Practical Implications States with low adherence to best oral health practices, especially regarding the dental visit by age 1 year can strengthen the oral health content of their EPSDT schedules by complying with the AAPD recommendations. PMID:23449906

  10. [Diagnosis and treatment of Kawasaki disease in burn children].

    Science.gov (United States)

    Feng, Jie; Li, Wei-ren; Wang, Wei

    2011-08-01

    We try to discuss the relationship between burn and Kawasaki disease (KD), and to study the diagnosis and treatment of KD in burn children. The medical records of one burn child with KD from our pediatric ward together with those of 5 burn children with KD retrieved from foreign literature were analyzed. The clinical features of KD, including bilateral nonexudative conjunctivitis, erythema of the lips and oral mucosa, skin rash, cervical lymphadenopathy, changes in the distal part of extremities, were enrolled in the study. Six patients were male and younger than 5 years old, with 2 suffering from mild burn, 2 with moderate burn, and 2 with severe burn. Two days after second degree burn, all burn children had fever and skin rash with 4 or 5 clinical symptoms and signs of KD. Among them, coronary artery dilatation was found in 1 case as detected by echocardiography, positive wound culture was found in 2 cases, negative blood culture was found in 6 cases. All patients were given high-dose gamma globulin or (and) aspirin within 10 days after the first fever, followed by control and amelioration of the disease. We conclude that the pathogenesis of KD may be related with burn wound and reabsorption of edema. KD may be suspected in burn children younger than 5 years when they had fever and skin rash at the same time.

  11. Update on the epidemiology, diagnosis, and treatment of leprosy.

    Science.gov (United States)

    Reibel, F; Cambau, E; Aubry, A

    2015-09-01

    Leprosy is an infectious disease that has now been reported for more than 2000 years. The leprosy elimination goal set by the World Health Organization (WHO), i.e. a global prevalence rate Leprosy is a specific infection: (i) it is a chronic infection primarily affecting the skin and peripheral nerves, (ii) Mycobacterium leprae is one of the last bacterial species of medical interest that cannot be cultured in vitro (mainly because of its reductive genome evolution), and (iii) transmission and pathophysiological data is still limited. The various presentations of the disease (Ridley-Jopling and WHO classifications) are correlated with the patient's immune response, bacillary load, and by the delay before diagnosis. Multidrug therapy (dapsone, rifampicin, with or without clofazimine) has been recommended since 1982 as the standard treatment of leprosy; 6 months for patients presenting with paucibacillary leprosy and 12 months for patients presenting with multibacillary leprosy. The worldwide use of leprosy drugs started in the 1980s and their free access since 1995 contributed to the drastic decline in the number of new case patients. Resistant strains are however emerging despite the use of multidrug therapy; identifying and monitoring resistance is still necessary. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  12. [Pathology in the diagnosis and treatment of palpebral tumors].

    Science.gov (United States)

    Pluot, M; Ducasse, A

    2003-01-01

    The authors stress the role and place of pathology in the diagnosis and treatment of eyelid tumors. After a brief report on the main histological characteristics of eyelid tumors and their classification, the pathological methods are described, with particular attention paid to the technical aspects of frozen sections in palpebral surgery. This study reports the main pathological techniques available for use in eyelid tumor surgery. The advantages of frozen sections are reported from a retrospective study of basal-cell carcinomas of the eyelid. All basal-cell carcinomas treated at the Reims Hospital from 1985 to 1999 were retrospectively studied. The pathological aspects are reported. Most of the tumors (155/193) were examined with frozen sections. Recurrences are considered. Pathology in eyelid tumor surgery must be taken into consideration. Frozen section examination may eliminate recurrences and limit healthy tissue taken at resection. This method is a very useful tool in this type of surgery. The benefits of the classic Mohs technique can be completed by a technique that is more precisely adapted to the control of the lateral limits of the excision in reconstructions which are often complex.

  13. An update on the diagnosis and treatment of vestibular schwannoma.

    Science.gov (United States)

    Halliday, Jane; Rutherford, Scott A; McCabe, Martin G; Evans, Dafydd G

    2018-01-01

    Vestibular schwannomas (VS) account for approximately 85% of tumors in the cerebello-pontine angle, with a lifetime incidence of approximately 1 in 1000. Most are sporadic, with approximately 5% related to the tumor predisposition syndrome Neurofibromatosis Type 2 (NF2). The mainstays of management strategies are: observation, surgery, radiosurgery/radiotherapy and, for patients with NF2 and rapidly growing tumors or deteriorating neurologic function the targeted therapy bevacizumab. While morbidity and mortality rates related to treatment of VS have improved dramatically over the last decades, there are still significant improvements that could be made, in particular with regards to long-term facial nerve and hearing outcomes. Areas covered: The epidemiology and diagnosis of VS are discussed, followed by the different management strategies and outcomes of those for both sporadic and NF2 related tumors. An extensive literature review has been performed to inform this review article using PubMed and Google Scholar. Expert commentary: The future direction of VS management lies in obtaining longer-term follow-up data for patients with treated VS, and in improved understanding of cellular pathways and targeted therapies.

  14. Small Intestinal Tumours: An Overview on Classification, Diagnosis, and Treatment

    Directory of Open Access Journals (Sweden)

    Chiara Notaristefano

    2014-12-01

    Full Text Available The small intestinal neoplasia group includes different types of lesions and are a relatively rare event, accounting for only 3-6% of all gastrointestinal (GI neoplasms and 1-3% of all GI malignancies. These lesions can be classified as epithelial and mesenchymal, either benign or malignant. Mesenchymal tumours include stromal tumours (GIST and other neoplasms that might arise from soft tissue throughout the rest of the body (lipomas, leiomyomas and leiomyosarcomas, fibromas, desmoid tumours, and schwannomas. Other lesions occurring in the small bowel are carcinoids, lymphomas, and melanomas. To date, carcinoids and GIST are reported as the most frequent malignant lesions occurring in the small bowel. Factors that predispose to the development of malignant lesions are different, and they may be hereditary (Peutz-Jeghers syndrome, familial adenomatous polyposis, hereditary non-polyposis colorectal cancer, neuroendocrine neoplasia Type 1, von Hippel-Lindau disease, and neurofibromatosis Type 1, acquired (sporadic colorectal cancer and small intestine adenomas, coeliac disease, Crohn’s disease, or environmental (diet, tobacco, and obesity. Small bowel tumours present with different and sometimes nonspecific symptoms, and a prompt diagnosis is not always so easily performed. Diagnostic tools, that may be both radiological and endoscopic, possess specificity and sensitivity, as well as different roles depending on the type of lesion. Treatment of these lesions may be different and, in recent years, new therapies have enabled an improvement in life expectancy.

  15. Challenge in Clinical Diagnosis and Treatment of Leptospirosis

    Directory of Open Access Journals (Sweden)

    Dora I. Ríos

    2015-01-01

    Full Text Available Abstract: Introduction: Leptospirosis is an acute febrile disease caused by the leptospira. It is considered a zoonosis that affects a variety of animals, both wild and domestic (mainly rodents. Humans become infected accidentally by contact with urine or tissues from infected animals. This pathology has variable clinical manifestations, ranging from inapparent infections and aseptic meningitis, to severe forms such as the Weil syndrome. Development: We present the case of a young patient of 22 years old with fever quantified peaks of 40° C, chills, profuse sweating, headache, muscle and joint pain in knees and malleoli, retroorbital and retrosternal pain; and appetite loss. The symptoms occurred after 20 days of having practiced extreme water sports. Conclusion: The late diagnosis of the patient and hospital readmission are the result of several factors; First, the homology with other infectious diseases that present acute febrile illness with similar symptoms as dengue , malaria, influenza , yellow fever , brucellosis; and secondly the lack of expertise and poor contact with patients who present this disease by the medical staff. Correct antibiotic treatment and proper support reduce morbidity and mortality. The objective of this article is to describe a case of human leptospirosis and make a review of the literature in order to analyze the epidemiological characteristics and relevant clinical manifestations.

  16. Diagnosis, Treatment and Management of Haemonchus contortus in Small Ruminants.

    Science.gov (United States)

    Besier, R B; Kahn, L P; Sargison, N D; Van Wyk, J A

    2016-01-01

    Haemonchus contortus is a highly pathogenic, blood-feeding nematode of small ruminants, and a significant cause of mortalities worldwide. Haemonchosis is a particularly significant threat in tropical, subtropical and warm temperate regions, where warm and moist conditions favour the free-living stages, but periodic outbreaks occur more widely during periods of transient environmental favourability. The clinical diagnosis of haemonchosis is based mostly on the detection of anaemia in association with a characteristic epidemiological picture, and confirmed at postmortem by the finding of large numbers of H. contortus in the abomasum. The detection of impending haemonchosis relies chiefly on periodic monitoring for anaemia, including through the 'FAMACHA' conjunctival-colour index, or through faecal worm egg counts and other laboratory procedures. A range of anthelmintics for use against H. contortus is available, but in most endemic situations anthelmintic resistance significantly limits the available treatment options. Effective preventative programmes vary depending on environments and enterprise types, and according to the scale of the haemonchosis risk and the local epidemiology of infections, but should aim to prevent disease outbreaks while maintaining anthelmintic efficacy. Appropriate strategies include animal management programmes to avoid excessive H. contortus challenge, genetic and nutritional approaches to enhance resistance and resilience to infection, and the monitoring of H. contortus infection on an individual animal or flock basis. Specific strategies to manage anthelmintic resistance centre on the appropriate use of effective anthelmintics, and refugia-based treatment schedules. Alternative approaches, such as biological control, may also prove useful, and vaccination against H. contortus appears to have significant potential in control programmes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Diagnosis and medical treatment of neuropathic pain in leprosy

    Directory of Open Access Journals (Sweden)

    Rogerio Del Arco

    Full Text Available ABSTRACT Objective: to identify the difficulties in diagnosing and treating neuropathic pain caused by leprosy and to understand the main characteristics of this situation. Methods: 85 patients were treated in outpatient units with reference to leprosy and the accompanying pain. We used a questionnaire known as the Douleur Neuropathic 4 test and we conducted detailed neurological exams. As a result, 42 patients were excluded from the study for not having proved their pain. Results: Out of the 37 patients that experienced pain, 22 (59.5% had neuropathic pain (or a mixture of this pain and their existing pain and of these 90.8% considered this pain to be moderate or severe. 81.8% of the sample suffered with this pain for more than 6 months. Only 12 (54.5% of the patients had been diagnosed with neuropathic pain and in almost half of these cases, this pain had not been diagnosed. With reference to medical treatment (n=12 for neuropathic pain, 5 (41.6% responded that they became better. For the other 7 (58.4% there were no changes in relation to the pain or in some cases the pain worsened in comparison to their previous state. Statistical analysis comparing improvements in relation to the pain amongst the patients that were treated (n=12 and those that were not, showed significant differences (value p=0.020. Conclusion: we noted difficulties in diagnosing neuropathic pain for leprosy in that almost half of the patients that were studied had not had their pain diagnosed. We attributed this to some factors such as the non-adoption of the appropriate protocols which led to inadequate diagnosis and treatment that overlooked the true picture.

  18. Transnodal Lymphangiography in the Diagnosis and Treatment of Genital Lymphedema

    Energy Technology Data Exchange (ETDEWEB)

    Gomez, F. M., E-mail: gomez_fermun@gva.es; Martinez-Rodrigo, J.; Marti-Bonmati, L. [Hospital Universitario y Politecnico La Fe, Servicio de Radiologia (Spain); Santos, E. [University of Pittsburgh, Department of Radiology (United States); Forner, I. [Hospital Universitario y Politecnico La Fe, Servicio de Medicina Fisica y Rehabilitacion (Spain); Lloret, M.; Perez-Enguix, D.; Garcia-Marcos, R. [Hospital Universitario y Politecnico La Fe, Servicio de Radiologia (Spain)

    2012-12-15

    Purpose: To report the success of groin nodal lymphography in the diagnosis and treatment of genital lymphedema. Methods and Materials: We present one female (8 years old [patient no. 1]) and two male (69 and [patient no. 2] 31 years old [patient no. 3], respectively) patients with genital lymphedema in whom conservative treatment failed. The girl also had lymphorrhagia. Genital lymphedema was caused by radical cystectomy (patient no. 2), lymphatic hyperplasia (patient no. 1), and idiopathic lymphangitis (patient no. 3). All of them underwent ultrasound-guided bilateral groin lymph node puncture. Afterward, 4-8 ml Lipiodol Ultra-Fluide (Guerbet) were injected at a rate of 0.2 ml/s. Lipiodol progression was assessed by fluoroscopy. Computed tomography scan of the abdomen and pelvis was performed immediately after and again at 24 h after the procedure to confirm the leak. The follow-up period was 15, 13, and 9 months, respectively. Technical success was considered as bilateral pelvic and abdominal filling of lymphatic vessels. Therapeutic success was considered as improvement or disappearance of genital lymphedema and/or lymphorrhagia. Results: Lipiodol leak to the scrotum was observed in patients no. 2 and 3. Lymphaticopelvic fistula and genital lymphatic hyperplasia were seen in patient no. 1. Genital lymphedema diminished within 1 week and almost disappeared in two cases (patients no. 1 and 3) or significantly improved (patient no. 2). lymphorrhagia also resolved in patient no. 1. No recurrence or worsening was detected during follow-up. Conclusion: Therapeutic lymphangiography by lymph node injection seems to be effective to treat genital lymphedema. Lymph node puncture lymphangiography is feasible and less cumbersome than pedal lymphangiography.

  19. Importance of MRI in the diagnosis and treatment of rhabdomyolysis

    Energy Technology Data Exchange (ETDEWEB)

    Moratalla, Monica Ballesta [Department of Radiology, La Fe Hospital, Avenida Campanar, 21, 46009 Valencia (Spain)], E-mail: monica_ballesta@hotmail.com; Braun, Petra; Fornas, Guillermina Montoliu [Department of Radiology, La Fe Hospital, Avenida Campanar, 21, 46009 Valencia (Spain)

    2008-02-15

    Background: Rhabdomyolysis is a common disorder resulting from a large variety of causes. We describe the MRI features and their importance for diagnosis and treatment. Patients and methods: Between 2003 and 2006, four male patients (age range: 25-33 years) with rhabdomyolysis were studied via 1.5 T MRI (GE, Siemens). In all the patients, T1- and T2-weighted sequences with and without fat suppression, short tau inversion recovery (STIR) and gradient-echo sequences were obtained in axial, coronal and sagittal planes. In one patient, contrast material was given. Results: Two patients presented rhabdomyolysis due to drug abuse, one due to intense exercise and the last one due to long unconsciousness with compression of the paravertebral musculature. Two patients had acute kidney failure. The affected muscles showed an increased signal intensity on T2-weighted and STIR sequences and decreased on T1-weighted sequences. In one patient, intramuscular hemorrhage was observed on T1-weighted and gradient-echo sequences. In the patient with kidney failure, a globular swelling of the kidney with alteration of the corticomedullary differentiation on T2-weighted sequences with fat saturation and hypointensity of the renal medulla on T1-weighted contrast enhanced images was found. Discussion: Immediate recognition of rhabdomyolysis is important to prevent late complications. MRI is the method of choice to evaluate the distribution and extension of the affected muscles, especially when fasciotomy is considered for treatment. Even though the MRI findings are non-specific, the sensitivity in the detection of muscle involvement is higher than CT or US.

  20. Diagnosis and treatment of Basal cell and squamous cell carcinoma.

    Science.gov (United States)

    Firnhaber, Jonathon M

    2012-07-15

    Family physicians are regularly faced with identifying, treating, and counseling patients with skin cancers. Nonmelanoma skin cancer, which encompasses basal cell and squamous cell carcinoma, is the most common cancer in the United States. Ultraviolet B exposure is a significant factor in the development of basal cell and squamous cell carcinoma. The use of tanning beds is associated with a 1.5-fold increase in the risk of basal cell carcinoma and a 2.5-fold increase in the risk of squamous cell carcinoma. Routine screening for skin cancer is controversial. The U.S. Preventive Services Task Force cites insufficient evidence to recommend for or against routine whole-body skin examination to screen for skin cancer. Basal cell carcinoma most commonly appears as a pearly white, dome-shaped papule with prominent telangiectatic surface vessels. Squamous cell carcinoma most commonly appears as a firm, smooth, or hyperkeratotic papule or plaque, often with central ulceration. Initial tissue sampling for diagnosis involves a shave technique if the lesion is raised, or a 2- to 4-mm punch biopsy of the most abnormal-appearing area of skin. Mohs micrographic surgery has the lowest recurrence rate among treatments, but is best considered for large, high-risk tumors. Smaller, lower-risk tumors may be treated with surgical excision, electrodesiccation and curettage, or cryotherapy. Topical imiquimod and fluorouracil are also potential, but less supported, treatments. Although there are no clear guidelines for follow-up after an index nonmelanoma skin cancer, monitoring for recurrence is prudent because the risk of subsequent skin cancer is 35 percent at three years and 50 percent at five years.

  1. Diagnosis as the First Critical Point in the Treatment Trajectory

    DEFF Research Database (Denmark)

    Missel, Malene; Pedersen, Jesper H; Hendriksen, Carsten

    2015-01-01

    the patient to face a new life situation, and demands one-on-one supportive care. CONCLUSIONS: Diagnosis is the first critical point for patients with operable lung cancer and disrupts their daily life. Patients need psychosocial support during the period from diagnosis to surgical intervention and patient...

  2. Sociodemographic differences in diagnosis and treatment of pediatric headache.

    Science.gov (United States)

    Stevens, Jack; Harman, Jeffrey; Pakalnis, Ann; Lo, Warren; Prescod, Jessica

    2010-04-01

    The authors investigated the sociodemographic differences in receiving a headache diagnosis for pediatric health care visits using 2 nationally representative databases--the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. For those visits involving a headache diagnosis, the authors explored 2 possible disparities in care--being diagnosed by a neurologist and being prescribed an evidence-based medication. A headache diagnosis was less common during visits for private insurance patients versus Medicaid patients. In addition, while a headache diagnosis was equally likely for visits by Caucasian American children versus African American children and children of other races, visits for the latter 2 groups were less likely to involve a headache diagnosis from a neurologist. Finally, only 37% of the headache visits involved a prescription of an evidence-based medication. The authors conclude that some sociodemographic disparities exist in pediatric headache care across the United States.

  3. HGF and postnatal testis development.

    Science.gov (United States)

    Catizone, A; Ricci, G; Galdieri, M

    2005-09-28

    Hepatocyte growth factor regulates many cellular functions acting through c-met, its specific receptor with tyrosine kinase activity. We have previously reported that in prepubertal rats HGF is secreted in the seminiferous tubules by purified peritubular myoid cells whereas Sertoli cells do not express HGF mRNA. In the present paper we report that HGF is expressed by the myoid cells during the entire postnatal testicular development studied and secreted in the culture medium. On the contrary, in Sertoli cells HGF starts to be clearly detectable by northern blot at 25 days of age. HGF is expressed and secreted by Sertoli cells isolated from 35-day-old rats and is able to increase the levels of c-met expression of the Sertoli cells. Although the role of HGF during the development of the postnatal testis need further research to be clarified, the data here presented indicate that HGF is one of the growth factors regulating mammalian testicular function.

  4. Congenital Heart Disease: Causes, Diagnosis, Symptoms, and Treatments.

    Science.gov (United States)

    Sun, RongRong; Liu, Min; Lu, Lei; Zheng, Yi; Zhang, Peiying

    2015-07-01

    The congenital heart disease includes abnormalities in heart structure that occur before birth. Such defects occur in the fetus while it is developing in the uterus during pregnancy. About 500,000 adults have congenital heart disease in USA (WebMD, Congenital heart defects medications, www.WebMD.com/heart-disease/tc/congenital-heart-defects-medications , 2014). 1 in every 100 children has defects in their heart due to genetic or chromosomal abnormalities, such as Down syndrome. The excessive alcohol consumption during pregnancy and use of medications, maternal viral infection, such as Rubella virus, measles (German), in the first trimester of pregnancy, all these are risk factors for congenital heart disease in children, and the risk increases if parent or sibling has a congenital heart defect. These are heart valves defects, atrial and ventricular septa defects, stenosis, the heart muscle abnormalities, and a hole inside wall of the heart which causes defect in blood circulation, heart failure, and eventual death. There are no particular symptoms of congenital heart disease, but shortness of breath and limited ability to do exercise, fatigue, abnormal sound of heart as heart murmur, which is diagnosed by a physician while listening to the heart beats. The echocardiogram or transesophageal echocardiogram, electrocardiogram, chest X-ray, cardiac catheterization, and MRI methods are used to detect congenital heart disease. Several medications are given depending on the severity of this disease, and catheter method and surgery are required for serious cases to repair heart valves or heart transplantation as in endocarditis. For genetic study, first DNA is extracted from blood followed by DNA sequence analysis and any defect in nucleotide sequence of DNA is determined. For congenital heart disease, genes in chromosome 1 show some defects in nucleotide sequence. In this review the causes, diagnosis, symptoms, and treatments of congenital heart disease are described.

  5. Symptoms, Diagnosis, and Treatment of Cow's Milk Allergy.

    Science.gov (United States)

    Vandenplas, Yvan; Marchand, Johan; Meyns, Lien

    2015-01-01

    The diagnosis and management of cow's milk allergy (CMA) is a topic of debate because there are no specific symptoms and reliable diagnostic tests. Literature was searched using databases to find original papers and reviews on this topic. A "challenge test" is still recommended as the most specific and sensitive diagnostic test, although a positive challenge test does not proof the involvement of the immune system. Only in the rare case of anaphylaxis, the challenge tests is not recommended. The Cow's Milk Symptom Score (CoMiSS) is an awareness tool for health care professionals to better recognize symptoms caused by the ingestion of cow's milk, but still needs validation. Today, the recommended diagnostic approach consists of an elimination diet with an extensive cow's milk based hydrolysate, followed by a challenge test. Amino acid based formula is reserved for the severe cases. Rice hydrolysates are gaining popularity, because they have been shown to be effective, have a better acceptability, and to be cheaper than the extensive cow's milk based hydrolysates. Soy infant formula may offer an additional alternative option as reviews concluded that about 10-15% of infants allergic to cow's milk will also react to soy. Gastro-intestinal microbiota manipulation may be of additional benefit in the treatment of CMA. The development of rice hydrolysates challenge the use of Today, extensive cow's milk based extensive hydrolysates remain the first option for the majority of patients and amino acid formula for the most severe cases. Rice hydrolysates and soy infant formula are considered as second choice options.

  6. Diagnosis and treatment of pediatric vallecular cysts and pseudocysts.

    Science.gov (United States)

    Leibowitz, Jason M; Smith, Lee P; Cohen, Marc A; Dunham, Brian P; Guttenberg, Marta; Elden, Lisa M

    2011-07-01

    To review the experience at a children's hospital diagnosing and treating vallecular cysts. To determine if cyst type, operative mode, or ages are risk factor(s) for recurrence. Chart review of eleven children with vallecular cysts and pseudocysts from 1997 to 2009. The most common presenting symptoms were stridor (8/12, 67%), respiratory distress (7/12, 58%), and feeding difficulties (4/12, 33%). Symptoms of gastroesophageal reflux disease were present in 67% of patients and 17% carried a concurrent diagnosis of laryngomalacia. Eleven of twelve patients required operative intervention, the majority of which were transoral endoscopic procedures. Three patients (3/11, 27%) had recurrences. Two of these patients required only a second procedure, but one patient required multiple procedures. Fifty percent (2/4) of the patients 2 years or older experienced a recurrence, whereas only 14% (1/7) of the patients less than 2 years old had a recurrence, a difference which was not statistically significant (p=0.49). Pseudocysts tended to recur more frequently than vallecular cysts. (p=0.13). Surgical approach (marsupialization versus total excision) did not affect recurrence rate. One patient with a small, asymptomatic cyst was observed and continues to be symptom-free. There were no surgical complications. Vallecular cysts and pseudocysts are rare congenital lesions of the upper aerodigestive tract. Vallecular pseudocysts tended to recur more than vallecular cysts in our series. Surgery is the treatment of choice for symptomatic patients; smaller cysts may be followed closely. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  7. Stress Fractures: Etiology, Epidemiology, Diagnosis, Treatment, and Prevention.

    Science.gov (United States)

    Knapik, Joseph J; Reynolds, Katy; Hoedebecke, Kyle L

    Stress fractures are part of a continuum of changes in healthy bones in response to repeated mechanical deformation from physical activity. If the activity produces excessive repetitive stress, osteoclastic processes in the bone may proceed at a faster pace than osteoblastic processes, thus weakening the bone and augmenting susceptibility to stress fractures. Overall stress fracture incidence is about three cases per 1,000 in active duty Servicemembers, but it is much higher among Army basic trainees: 19 per 1,000 for men and 80 per 1,000 for women. Well-documented risk factors include female sex, white ethnicity, older age, taller stature, lower aerobic fitness, prior physical inactivity, greater amounts of current physical training, thinner bones, cigarette smoking, and inadequate intake of vitamin D and/or calcium. Individuals with stress fractures present with focal tenderness and local pain that is aggravated by physical activity and reduced by rest. A sudden increase in the volume of physical activity along with other risk factors is often reported. Simple clinical tests can assist in diagnosis, but more definitive imaging tests will eventually need to be conducted if a stress fracture is suspected. Plain radiographs are recommended as the initial imaging test, but magnetic resonance imaging has higher sensitivity and is more likely to detect the injury sooner. Treatment involves first determining if the stress fracture is of higher or lower risk; these are distinguished by anatomical location and whether the bone is loaded in tension (high risk) or compression (lower risk). Lowerrisk stress fractures can be initially treated by reducing loading on the injured bone through a reduction in activity or by substituting other activities. Higher-risk stress fractures should be referred to an orthopedist. Investigated prevention strategies include modifications to physical training programs, use of shock absorbing insoles, vitamin D and calcium supplementation

  8. Corneal allograft rejection: Risk factors, diagnosis, prevention, and treatment

    Directory of Open Access Journals (Sweden)

    Dua Harminder

    1999-01-01

    Full Text Available Recent advances in corneal graft technology, including donor tissue retrieval, storage and surgical techniques, have greatly improved the clinical outcome of corneal grafts. Despite these advances, immune mediated corneal graft rejection remains the single most important cause of corneal graft failure. Several host factors have been identified as conferring a "high risk" status to the host. These include: more than two quadrant vascularisation, with associated lymphatics, which augment the afferent and efferent arc of the immune response; herpes simplex keratitis; uveitis; silicone oil keratopathy; previous failed (rejected grafts; "hot eyes"; young recipient age; and multiple surgical procedures at the time of grafting. Large grafts, by virtue of being closer to the host limbus, with its complement of vessels and antigen-presenting Langerhans cells, also are more susceptible to rejection. The diagnosis of graft rejection is entirely clinical and in its early stages the clinical signs could be subtle. Graft rejection is largely mediated by the major histocompatibility antigens, minor antigens and perhaps blood group ABO antigens and some cornea-specific antigens. Just as rejection is mediated by active immune mediated events, the lack of rejection (tolerance is also sustained by active immune regulatory mechanisms. The anterior chamber associated immune deviation (ACAID and probably, conjunctiva associated lymphoid tissue (CALT induced mucosal tolerance, besides others, play an important role. Although graft rejection can lead to graft failure, most rejections can be readily controlled if appropriate management is commenced at the proper time. Topical steroids are the mainstay of graft rejection management. In the high-risk situations however, systemic steroids, and other immunosuppressive drugs such as cyclosporin and tacrolimus (FK506 are of proven benefit, both for treatment and prevention of rejection.

  9. DIAGNOSIS AND TREATMENT OF DEPRESSION IN PERSONS WITH INTELLECTUAL DISABILITY

    Directory of Open Access Journals (Sweden)

    Katarina Tomić1,

    2011-09-01

    Full Text Available This paper considers, from the theoretical point of view, the problem of diagnosing and treatment of depressive disorders in people with intellectual disability (ID, relying primarily on the results of previous researches, which stress the etiological, symptomatic, diagnostic and therapeutic specifics when it comes to depression and its correlates in this population. The interest in mental health and psychopathology of people with ID intensified during the seventh decade of the previous century, when it became clear that some cognitive and behavioral symptoms are not, as hitherto thought, only a part or a consequence of the syndrome of intellectual disability, but a sign of ongoing mental disorder. So, the idea of ''dual diagnosis'' was born, and now it provides guidelines for the growing number of studies which theoretically and empirically review different issues of mental health problems in people with ID. Likewise, the observation of syndrome groups of genetic disorders resulting in intellectual disability has led to the narrowing of the circle of genetic syndromes that carry increased risk for the onset of depression and its correlates, such as: Down syndrome, Fragile X syndrome and Prader-Willi syndrome. Potential diagnostic problem in people with ID, when it comes to depression, may arise from ''diagnostic overshadowing’’ of depression symptoms, which often remain hidden under abnormal behavior and adjustment disorders, especially in patients with severe forms of ID. As a possible way to overcome these problems some authors have proposed the concept of ''behavioral equivalents of depression'' or behavioral disorders that evidently can be associated with depression, such as social withdrawal, aggression, hostility, irritability, psychomotor agitation or retardation. Intensification of these forms of behavior may be a sign of developing depression, and in that sense, this view represents a useful starting point. When it comes to

  10. Salivary testing for periodontal disease diagnosis and treatment.

    Science.gov (United States)

    Nabors, Thomas W; McGlennen, Ronald C; Thompson, Doug

    2010-06-01

    For more than 50 years, clinicians have relied primarily on the same visual and mechanical assessment methods to diagnose and classify periodontal disease. Clinical signs are simply a measurement of the past damage of a disease process. While clinical presentation and probing depths are indicators that the disease exists, these alone cannot determine the types and quantities of the responsible pathogens. Likewise, clinical signs alone cannot determine if therapy has achieved the goal of suppression of the etiological agent(s). Genetic presymptomatic testing complements bacterial DNA testing by providing insight into the patient's genetic predisposition to periodontal disease before symptoms appear, or when disease is already present. DNA-PCR testing of saliva can help the clinician provide an earlier and more specific diagnosis of disease based on causation. Treatment planning is also enhanced, as therapy can be appropriately modified based on both clinical and biological inflammatory factors. Finally, patient communication and case acceptance can be more readily achieved because the test reports elicit a persuasive "seeing is believing" attitude when reviewing test results with patients. Through the use of accurate periodontal charting, medical and dental risk assessments, and other diagnostic screening tests such as OralNA's MyPerioPath and MyPerioID PST tests, highly personalized periodontal therapy can be developed and carried out by the general practitioner. There has never been a better time to become more aware, and keep tighter control, of the periodontal status of one's patient base. Many patients are asking dentists about the connection between periodontal health and general health, While it currently would not be appropriate to suggest a causative relationship, there is abundant ongoing research that suggests a correlative relationship between periodontal disease and other whole-body ailments. Many patients have refused periodontal care or denied the

  11. FDG-PET/CT in a patient with poor-risk non-seminoma testis with mature teratoma and secondary gliosarcoma: Multimodality imaging for guiding multimodality treatment

    Energy Technology Data Exchange (ETDEWEB)

    Quak, Elske; Kovacs, Iringo; Oyen, Wim J. G.; Van der Graaf, Winette T. A. [Radboud University Nijmegen Medical Centre, Nijmegen (Nauru)

    2015-09-15

    The value of F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting viable tumours in patients with metastasised non-seminomatous testicular cancer and residual and new masses post chemotherapy remains to be determined. We describe the case of a 41-year-old patient with metastasised non-seminomatous testicular cancer, with both retroperitoneal and extra-retroperitoneal residual masses post chemotherapy, for whom FDG-PET/CT guided major treatment decisions. FDG-PET/CT correctly identified the locations of viable tumour, as was proved by histology, and successfully guided surgery. In conclusion, in selected cases surveillance of patients with non-seminomatous testicular cancer with FDG-PET/CT can guide major treatment decisions when considering surgery for metastatic disease.

  12. The influence of underweight and obesity on the diagnosis and treatment of appendicitis in children

    NARCIS (Netherlands)

    Timmerman, Marjolijn E. W.; Groen, Henk; Heineman, Erik; Broens, Paul M. A.

    The impact of lower body mass index (BMI) on appendicitis has never been addressed. We investigated whether different BMIs affect the diagnosis and treatment of appendicitis in children. The correlation between BMI and diagnosis accuracy and treatment quality was evaluated by retrospective analysis

  13. Optimizing the diagnosis and treatment of bladder cancer using fluorescence cystoscopy and Raman spectroscopy

    NARCIS (Netherlands)

    Draga, R.O.P.

    2013-01-01

    The gold standard for the diagnosis and treatment of bladder cancer is transurethral resection of bladder tumors (TURBT). A relative high recurrence rate and the need for repeated treatments make bladder cancer one the most expensive cancers from diagnosis till death of the patient. The TURBT

  14. Non-seminimatous germ cell tumors of the testis. Staging and threatment (An anlysis of the results of the treatment of 103 patients in the clinical stages I and II during the period 1963-1977).

    NARCIS (Netherlands)

    Wobbes, Theo

    1981-01-01

    This thesis presents and discusses the results of a retrospective study of 103 patients with a non- seminomatous germ cell tumour of the testis in clinical stages I and II, treated in the Division of Surgical Oncology of the Deparrment of Surgery, Universiry Hospital, Groningen, over the period 1963

  15. Predictive models in the diagnosis and treatment of autoimmune epilepsy.

    Science.gov (United States)

    Dubey, Divyanshu; Singh, Jaysingh; Britton, Jeffrey W; Pittock, Sean J; Flanagan, Eoin P; Lennon, Vanda A; Tillema, Jan-Mendelt; Wirrell, Elaine; Shin, Cheolsu; So, Elson; Cascino, Gregory D; Wingerchuk, Dean M; Hoerth, Matthew T; Shih, Jerry J; Nickels, Katherine C; McKeon, Andrew

    2017-07-01

    To validate predictive models for neural antibody positivity and immunotherapy response in epilepsy. We conducted a retrospective study of epilepsy cases at Mayo Clinic (Rochester-MN; Scottsdale-AZ, and Jacksonville-FL) in whom autoimmune encephalopathy/epilepsy/dementia autoantibody testing profiles were requested (06/30/2014-06/30/2016). An Antibody Prevalence in Epilepsy (APE) score, based on clinical characteristics, was assigned to each patient. Among patients who received immunotherapy, a Response to Immunotherapy in Epilepsy (RITE) score was assigned. Favorable seizure outcome was defined as >50% reduction of seizure frequency at the first follow-up. Serum and cerebrospinal fluid (CSF) from 1,736 patients were sent to the Mayo Clinic Neuroimmunology Laboratory for neural autoantibody evaluation. Three hundred eighty-seven of these patients met the diagnostic criteria for epilepsy. Central nervous system (CNS)-specific antibodies were detected in 44 patients. Certain clinical features such as new-onset epilepsy, autonomic dysfunction, viral prodrome, faciobrachial dystonic seizures/oral dyskinesia, inflammatory CSF profile, and mesial temporal magnetic resonance imaging (MRI) abnormalities had a significant association with positive antibody results. A significantly higher proportion of antibody-positive patients had an APE score ≥4 (97.7% vs. 21.6%, p < 0.01). Sensitivity and specificity of an APE score ≥4 to predict presence of specific neural auto-antibody were 97.7% and 77.9%, respectively. In the subset of patients who received immunotherapy (77), autonomic dysfunction, faciobrachial dystonic seizures/oral dyskinesia, early initiation of immunotherapy, and presence of antibodies targeting plasma membrane proteins (cell-surface antigens) were associated with favorable seizure outcome. Sensitivity and specificity of a RITE score ≥7 to predict favorable seizure outcome were 87.5% and 83.8%, respectively. APE and RITE scores can aid diagnosis

  16. Seminoma in the testis presenting as hemospermia

    DEFF Research Database (Denmark)

    Beji, Sami; Hoejgaard, Martin; Lyngdorf, Peter

    2012-01-01

    Hemospermia is often considered idiopathic. We report a case of a patient who presented with hemospermia. Scrotal examination and ultrasonography found a testis tumor. This case underscores the importance of scrotal examination and eventually ultrasound in patients presenting with hemospermia....

  17. Papillary mesothelioma of the albuginea testis

    NARCIS (Netherlands)

    Tjandra, B. S.; Daemen, M. J.; Weil, E. H.

    1994-01-01

    An eleven-year-old boy is presented with symptom of a torsion of the testis. Scrotal exploration revealed a papillary mesothelioma of the tunica albuginea which is extremely rare in childhood. We report 1 case and review the literature

  18. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy : Advances in Diagnosis and Treatment

    NARCIS (Netherlands)

    Novak, Iona; Morgan, Cathy; Adde, Lars; Blackman, James; Boyd, Roslyn N; Brunstrom-Hernandez, Janice; Cioni, Giovanni; Damiano, Diane; Darrah, Johanna; Eliasson, Ann-Christin; de Vries, Linda S; Einspieler, Christa; Fahey, Michael T.; Fehlings, Darcy; Ferriero, Donna M; Fetters, Linda; Fiori, Simona; Forssberg, Hans; Gordon, Andrew M; Greaves, Susan; Guzzetta, Andrea; Hadders-Algra, Mijna; Harbourne, Regina; Kakooza-Mwesige, Angelina; Karlsson, Petra; Krumlinde-Sundholm, Lena; Latal, Beatrice; Loughran-Fowlds, Alison; Maitre, Nathalie; McIntyre, Sarah; Noritz, Garey; Pennington, Lindsay; Romeo, Domenico M; Shepherd, Roberta; Spittle, Alicia J.; Thornton, Marelle; Valentine, Jane; Walker, Karen; White, Robert; Badawi, Nadia

    2017-01-01

    Importance: Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months' corrected age. Objectives: To systematically review best available

  19. Successful diagnosis and treatment 50 years after exposure: is mucocutaneous leishmaniasis still a neglected differential diagnosis?

    Science.gov (United States)

    Schleucher, Regina D; Zanger, Philipp; Gaessler, Michael; Knobloch, Juergen

    2008-01-01

    We present a case of a long-term history of imported mucocutaneous leishmaniasis, illustrating the importance of this differential diagnosis even decades after exposure. Diagnostic pitfalls and the role of primary subspecies differentiation are demonstrated. Chemotherapy avoiding antimonials was successful and remarkably well tolerated by an elderly patient.

  20. Development of Scabies During Treatment for Mycosis Fungoides: Dermatoscopic Diagnosis

    Directory of Open Access Journals (Sweden)

    Caner Aykol

    2012-09-01

    Full Text Available Scabies is a cutaneous infestation caused by Sarcoptes scabiei var. hominis and characterized by severe and generalized pruritus. A clinical diagnosis can be made when a burrow is detected at a typical predilection site and the lesion is severely itching. Scabies which occurs in the elderly and also in patients who are immunosuppressed, the lesions are very variable and clinical diagnosis may be difficult. In such cases, dermatoscopy is a simple and rapid diagnostic tool for the diagnosis of scabies with high sensitivity and specificity. Here, a 61-year-old woman who was diagnosed as scabies with dermatoscopic findings and already had mycosis fungoides is reported. (Turk J Dermatol 2012; 6: 114-6