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Sample records for true asymptomatic patients

  1. Asymptomatic HIV positive patient presenting with myelopathy

    Directory of Open Access Journals (Sweden)

    Jatin Agrawal

    2016-01-01

    Full Text Available A wide variety of disorders of diverse pathogenic mechanisms can trigger spinal cord dysfunction in HIV-1-infected patients. The most common such condition is HIV-1-associated myelopathy (HAM which characteristically seen during advanced HIV infection in patients with low CD4 cell counts and previous AIDS-defining diagnoses. Histologically seen in approximately 30% of AIDS patients, but only 10% have clinical symptoms related to the disease. We describe an unusual case of HAM in previously asymptomatic patient with relatively low CD4 cell count (78 cells/mm3. The patient unaware of her seropositive status presented with a clinically slowly progressive myelopathy with difficulty in walking without assistance. We discharged a patient on antiretroviral therapy. We also review the disorders reported to derange spinal cord function in previously asymptomatic HIV-1 infected patients with preserved counts.

  2. Recurrent Parotid Carcinosarcoma in an Asymptomatic Patient

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    Joshua Mansour MD

    2016-10-01

    Full Text Available In this article, we present the case of a 52-year-old male with a history of parotid carcinosarcoma with initial diagnosis being 18 months prior. Initial treatment included a combination of gamma knife surgery coupled with high dosage chemotherapy and X-ray radiation therapy. At the time of follow-up, the patient presented with no complaints and had a nearly normal physical exam with the exception of some facial nerve weakness on the same side as the initial surgery. Despite being asymptomatic, the patient had a significant progression of disease that was manifested with intracranial lesions, multiple pathologic fractures, and a dramatic increase in overall tumor burden. Ultimately, the patient decided to pursue comfort measures only and succumbed to the disease peacefully soon thereafter.

  3. Ultrasound study of the asymptomatic shoulder in patients with a ...

    African Journals Online (AJOL)

    Objective. To document the incidence of asymptomatic rotator cuff tears in patients with a confirmed symptomatic tear in the opposite shoulder, and to identify ultrasound findings that may distinguish symptomatic from asymptomatic tears. Design. When patients are referred for an ultrasound examination for the confirmation ...

  4. Asymptomatic Bacteriuria among Patients with Type 2 Diabetes ...

    African Journals Online (AJOL)

    Introduction: The global increase in the prevalence of both type 1 and type 2 diabetes has brought asymptomatic bacteriuria, one of its complications to the fore. This study was designed to determine the prevalence of asymptomatic bacteriuria in patients with type 2 diabetes, identify the bacterial pathogens and their ...

  5. Asymptomatic brain metastases in patients with cutaneous metastatic malignant melanoma

    DEFF Research Database (Denmark)

    Zukauskaite, Ruta; Schmidt, Henrik; Asmussen, Jon Thor

    2013-01-01

    The aim of the study was to identify the frequency of asymptomatic brain metastases detected by computed tomography (CT) scans in patients with metastatic cutaneous melanoma referred to first-line systemic treatment. Between 1995 and 2009, 697 Danish patients were screened with a contrast......-enhanced CT scan of the brain before the start of interleukin-2 (IL-2)-based immunotherapy. Among the 697 patients, 80 had asymptomatic brain metastases (12%). Patients' characteristics did not differ significantly between groups with and without brain metastases. Patients received systemic treatment (IL-2...

  6. Cardiovascular risk factors in patients with asymptomatic primary hyperparathyroidism.

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    García-Martín, Antonia; Reyes-García, Rebeca; García-Castro, José Miguel; Quesada-Charneco, Miguel; Escobar-Jiménez, Fernando; Muñoz-Torres, Manuel

    2014-12-01

    Patients with primary hyperparathyroidism (PHP), even asymptomatic, have an increased cardiovascular risk. However, data on reversibility or improvement of cardiovascular disorders with surgery are controversial. Our aims were to assess the prevalence of classic cardiovascular risk factors in patients with asymptomatic PHP, to explore their relationship with calcium and PTH levels, and analyze the effect of parathyroidectomy on those cardiovascular risk factors. A retrospective, observational study of two groups of patients with asymptomatic PHP: 40 patients on observation and 33 patients who underwent surgery. Clinical and biochemical data related to PHP and various cardiovascular risk factors were collected from all patients at baseline and one year after surgery in the operated patients. A high prevalence of obesity (59.9%), type 2 diabetes mellitus (25%), high blood pressure (47.2%), and dyslipidemia (44.4%) was found in the total sample, with no difference between the study groups. Serum calcium and PTH levels positively correlated with BMI (r=.568, P=.011, and r=.509, P=.026 respectively) in non-operated patients. One year after parathyroidectomy, no improvement occurred in the cardiovascular risk factors considered. Our results confirm the high prevalence of obesity, type 2 diabetes mellitus, high blood pressure, and dyslipidemia in patients with asymptomatic PHP. However, parathyroidectomy did not improve these cardiovascular risk factors. Copyright © 2014 SEEN. Published by Elsevier Espana. All rights reserved.

  7. Prevalence of asymptomatic microbleeds in patients with moyamoya disease

    International Nuclear Information System (INIS)

    Ishikawa, Tatsuya; Kuroda, Satoshi; Terae, Satoshi; Kudou, Kousuke; Iwasaki, Yoshinobu; Nakayama, Naoki

    2005-01-01

    Basal moyamoya vessels are a potential source of hemorrhage in patients with moyamoya disease, but the etiology remains unclear. Symptomatic hemorrhage resulting from long-standing hemodynamic effects on pathologically dilated, fragile moyamoya vessels may be preceded by asymptomatic microbleeding in adult moyamoya disease patients, regardless of hemorrhagic or ischemic onset. T 2 * -weighted magnetic resonance (MR) imaging was used to investigate the presence of microbleeds in 27 adult patients with angiographically confirmed moyamoya disease, 21 females and six males aged 18-70 years (mean 40.8±15.7 years). Clinical diagnosis was intracranial bleeding in six patients, transient ischemic attack or cerebral infarction in 18, and asymptomatic in three. Asymptomatic microbleeds were detected in four of the 27 patients, two of six who initially presented with hemorrhagic events and two of 18 with ischemic onset. These microbleeds were located in the paraventricular white matter, temporal subcortex, and basal ganglia. The presence of microbleeds had no correlation with either patient age or duration from disease onset or diagnosis of disease. A large cohort study is needed to explore the significance of asymptomatic microbleeds in moyamoya disease. (author)

  8. Asymptomatic Effluent Protozoa Colonization in Peritoneal Dialysis Patients.

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    Simões-Silva, Liliana; Correia, Inês; Barbosa, Joana; Santos-Araujo, Carla; Sousa, Maria João; Pestana, Manuel; Soares-Silva, Isabel; Sampaio-Maia, Benedita

    Currently, chronic kidney disease (CKD) is a global health problem. Considering the impaired immunity of CKD patients, the relevance of infection in peritoneal dialysis (PD), and the increased prevalence of parasites in CKD patients, protozoa colonization was evaluated in PD effluent from CKD patients undergoing PD. Overnight PD effluent was obtained from 49 asymptomatic stable PD patients. Protozoa analysis was performed microscopically by searching cysts and trophozoites in direct wet mount of PD effluent and after staining smears. Protozoa were found in PD effluent of 10.2% of evaluated PD patients, namely Blastocystis hominis, in 2 patients, and Entamoeba sp., Giardia sp., and Endolimax nana in the other 3 patients, respectively. None of these patients presented clinical signs or symptoms of peritonitis at the time of protozoa screening. Our results demonstrate that PD effluent may be susceptible to asymptomatic protozoa colonization. The clinical impact of this finding should be further investigated. Copyright © 2016 International Society for Peritoneal Dialysis.

  9. Cardiac structure and functions in patients with asymptomatic primary hyperparathyroidism.

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    Aktas Yılmaz, B; Akyel, A; Kan, E; Ercin, U; Tavil, Y; Bilgihan, A; Cakır, N; Arslan, M; Balos Toruner, F

    2013-11-01

    The data about cardiovascular (CV) changes in patients with asymptomatic primary hyperparathyroidism (PHPT) are scarce. The aim of this study is to compare cardiac structure and functions in patients with asymptomatic PHPT and controls by using tissue Doppler echocardiography. Thirty-eight patients with asymptomatic PHPT and 31 sex- and age-matched controls with similar cardiac risk factors were evaluated. There was no significant difference in ejection fraction (EF) between the patients and the controls [64±5.95 vs 62±3.25% (p=0.094)]. Left ventricular mass index (LVMI) was significantly higher in patients than controls [105.96 (66.45-167.24) vs 93.79 (64.25- 139.25) g/m2, p=0.014]. There was a significant correlation between LVMI and serum calcium (Ca) (r=0.240, p<0.005). Myocardial performance index (MPI) was significantly higher in patients than controls [0.49 (0.35-0.60) vs 0.39 (0.33-0.62), p<0.001]. There was positive correlation between theMPI and serumCa levels (r=0.505, p<0.001), parathyroid hormone (PTH) levels (r=0.464, p<0.001) and LVMI (r=0.270, p<0.005). When the normotensive patients and controls were evaluated, the difference between the groups remained statistically significant considering LVMI and MPI [109 (66.45-167.24) g/m2 vs 94.17 (64.25-75.10) g/m2, p=0.03; and 0.49 (0.35-0.60) vs 0.39 (0.33-0.62), p<0.01, respectively]. There were significant correlations between MPI and Ca (r=0.566, p<0.001), and PTH (r=0.472, p<0.001). Our study results showed that cardiacmorphology and diastolic functions are altered in the patients with asymptomatic PHPT. High serum PTH and Ca levels may have an impact on these CV changes. Whether these subtle CV changes would affect cardiac systolic functions and mortality in patients with asymptomatic PHPT should be investigated in further prospective studies.

  10. Approach to the asymptomatic patients with Brugada syndrome

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    Minoru Yoshiyama

    2007-04-01

    Full Text Available Brugada syndrome is an arrhythmogenic disease characterized by an ECG pattern of coved-type ST segment elevation in the right precordial leads and an increased risk of sudden cardiac death (SCD as a result of polymorphic ventricular tachyarrhythmia or ventricular fibrillation (VF. Data from large patient studies and a meta-analysis of previous reports have shown that patients with a history of syncope or SCD and a spontaneous type 1 Brugada ECG are at high risk for SCD. However, risk stratification of asymptomatic patients with Brugada type ECG is still a challenge. In particular, the use of electrophysiological study (EPS for risk stratification remains controversial. Although some investigators have reported the possibility of use of EPS for distinguishing between high- and low-risk patients with Brugada type ECG, no precise predictor of risk for SCD in asymptomatic patients has yet been determined. The approach to treatment of these patients is thus still unclear. Large clinical prospective studies with uniform diagnostic criteria and protocols for EPS as well as extended follow-up periods of over ten years are required for prediction of SCD.

  11. Asymptomatic Left Atrial Myxoma in Elderly Patient: A Case Report

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    Seyhan Yilmaz

    2013-08-01

    Full Text Available Approximately 75% of cardiac tumors are benign and approximately 50% are constituted of myxomas. Myxomas are more common among women, and generally appear between the third and sixth decade of life. The most common symptom of myxomas is respiratory distress associated with obstruction. The main goal in the surgery of cardiac myxomas is the full excision of the tumor with minimal manipulation and disruption/fragmentation together with the aid of a cardiopulmonary bypass. This case report is reported a seventy years old patient with asymptomatic cardiac myxoma whom undergoing surgery with general anesthesia twice at different times and undiagnosed cardiac myxoma in past seven years.

  12. Role of myocardial perfusion SPECT in asymptomatic diabetic patients

    International Nuclear Information System (INIS)

    Cho, I.; Chun, K.; Won, K.; Lee, H.; Park, J.; Shin, D.; Kim, Y.; Shim, B.; Lee, J.

    2002-01-01

    Purpose: It is important that early diagnosis and treatment of coronary artery disease in diabetic patients, but there are few reports on the prevalence of stress-induced myocardial perfusion abnormalities and the rates of cardiac event in patients with type 2 diabetes. We evaluated the scan findings on gated myocardial perfusion SPECT in asymptomatic diabetic patients. Methods: We performed pharmacological stress test and gated perfusion SPECT in 69 diabetic patients without cardiovascular symptom (mean age: 65 year, male 31 and female 38). Patients underwent two-day imaging protocol and stress study was performed injection of Tc-99m MIBI during adenosine infusion. We followed up these patients by reviewing medical records. Results: Fifty-two of 69 patients (74.5%) showed normal scan findings and 17 patients (24.6%) showed reversible or fixed perfusion defects. Three of 52 patients with normal scan findings showed decreased LV ejection fraction and decreased wall motion. Twenty-three patients with normal scan findings were possible to follow up for more than 1yr (mean time: 18.3±3.3 mo.) and they all had no cardiac event. Three patients with reversible perfusion defects were performed coronary angioplasty. Conclusion: Myocardial perfusion SPECT is a noninvasive method and maybe useful in early diagnosis and predicting prognosis in diabetic patients

  13. Isolated asymptomatic masseter muscle metastasis as first sign of metastatic disease in a patient with known melanoma

    Directory of Open Access Journals (Sweden)

    Caroline Asirvatham Gjorup

    2016-12-01

    Full Text Available A 65-year-old woman diagnosed with a nodular melanoma on the right shoulder had a PET/CT scan 13 months later demonstrating a FDG-avid mass in the left masseter muscle, which was asymptomatic and not clinically evident. Pathologic analysis confirmed metastasis of melanoma. Further subcutaneous, intramuscular and bone metastases developed and the patient was treated with surgery and immunotherapy. The patient is in complete-remission with no evident metastases seen on PET/CT 2.5 years after treatment with adoptive cell therapy using tumor-infiltrating lymphocytes (TIL therapy. Asymptomatic skeletal muscle metastases identified with PET/CT can have therapeutic and prognostic implications and a PET/CT scan should be performed as a true whole-body scan.

  14. Preoperative asymptomatic leukocytosis and postoperative outcome in cardiac surgery patients.

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    Eitezaz Mahmood

    Full Text Available Despite showing a prognostic value in general surgical patients, preoperative asymptomatic elevated white blood cell (WBC count is not considered a risk factor for cardiac surgery. Whereas there is sporadic evidence of its value as a preoperative risk marker, it has not been looked at methodically as a specific index of outcome during cardiac surgery. Using a national database we sought to determine the relationship between preoperative WBC count and postoperative outcome in cardiac surgical patients.Cardiac surgeries were extracted from the 2007-2013 American College of Surgeons National Surgical Quality Improvement Program database. Leukocytosis was defined by a preoperative WBC count greater than 11,000 cells/μL. A univariate analysis compared the incidence of adverse outcomes for patients with and without leukocytosis. A multivariate logistic regression model was constructed in order to test whether leukocytosis was an independent predictor of morbidity and mortality.Out of a total of 10,979 cardiac surgery patients 863 (7.8% had preoperative leukocytosis. On univariate analysis, patients with leukocytosis experienced greater incidences of 30-day mortality, wound complications, and medical complications. Wound complications included surgical site infection as well as wound dehiscence. The medical complications included all other non-surgical causes of increased morbidity and infection leading to urinary tract infection, pneumonia, ventilator dependence, sepsis and septic shock. After stepwise model adjustment, leukocytosis was a strong predictor of medical complications (OR 1.22, 95% CI: 1.09-1.36, p = 0.002 with c-statistic of 0.667. However, after stepwise model adjustment leukocytosis was not a significant predictor of 30-day mortality and wound complications.Preoperative leukocytosis is associated with adverse postoperative outcome after cardiac surgery and is an independent predictor of infection-related postoperative complications.

  15. Mortality in asymptomatic vs. symptomatic patients surgically treated for non-small cell lung cancer (NSCLC)

    DEFF Research Database (Denmark)

    Madsen, Kirsten Riis; Bødtger, Uffe

    , tobacco pack years, or FEV1. Former malignancy was significantly more prevalent among asymptomatic than symptomatic subjects (33 % vs. 11%), with insignificant differences in prevalence of other co-morbidities or in post-surgical TNM (82% vs 85% in stages IA-IIB). 12-months mortality was insignificantly...... higher in asymptomatic than symptomatic subjects (23% vs. 12%), and in patients with former malignancy compared to patients with no former cancer (17% vs. 16%). Discussion: Symptoms at diagnosis per se appear unrelated to mortality in patients with NSCLC referred for surgery. Asymptomatic patients were...

  16. Postoperative lumbar MR imaging with contrast enhancement. Comparison between symptomatic and asymptomatic patients

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    Grane, P. [Dept. of Neuroradiology, Karolinska Hospital, Stockholm (Sweden); Tullberg, T. [Dept. of Orthopaedics, St. Goeran`s Hospital, Stockholm (Sweden); Rydberg, J. [Dept. of Radiology, St. Goeran`s Hospital, Stockholm (Sweden); Lindgren, L. [Dept. of Neurosurgery, Karolinska Hospital, Stockholm (Sweden)

    1995-05-01

    Contrast-enhanced MR imaging of the spine after surgery for lumbar disk herniation almost always shows pathologic changes. To investigate to what extent these changes are correlated to patients` actual clinical symptoms, we compared the postoperative MR findings in 19 asymptomatic patients with 42 symptomatic patients (43 levels). The asymptomatic patients underwent MR examination one year after surgery. Twenty-six of the symptomatic patients underwent MR one year of less after surgery, and in 16 patients (17 levels) MR was performed more than one year after surgery. Sixteen percent of the asymptomatic and 42% of the symptomatic patients had disk herniation at the level of previous surgery. Most of the herniated disks were found in the symptomatic patients less than one year after surgery. The amount of epidural scar tissue, displacement and thickening of nerve roots, and compression of the dural sac were also studied. Disk herniation as a probable cause of recurrent sciatica was a common finding among symptomatic patients examined one year or less after surgery. In comparing asymptomatic patients and symptomatic patients with more than one year between surgery and MR examination, no significant radiologic differences, including disk herniation, were found. (orig.).

  17. Is asymptomatic peripheral arterial disease associated with walking endurance in patients with COPD?

    Science.gov (United States)

    Sun, Kuo-Shao; Lin, Ming-Shian; Chen, Yi-Jen; Chen, Yih-Yuan; Chen, Solomon Chih-Cheng; Chen, Wei

    2015-01-01

    Symptomatic peripheral arterial disease (PAD) is associated with impaired walking endurance in patients with chronic obstructive pulmonary disease (COPD). However, it is unknown whether asymptomatic PAD is associated with impaired walking endurance in patients with COPD. This prospective cross-sectional study enrolled 200 COPD patients (mean age: 70.9 years) who volunteered to perform ankle-brachial index (ABI) and 6-minute walk test (6MWT) consecutively. Demographic data, lung function, dyspnea scales, and cardiovascular risk factors were recorded. The ABI was used to detect PAD (ABI <0.90). All patients were free of PAD symptoms at enrollment. Of the 200 COPD patients, 17 (8.5%) were diagnosed with asymptomatic PAD. The COPD patients without asymptomatic PAD did not walk significantly further on the 6MWT than the COPD patients with asymptomatic PAD (439±86 m vs 408±74 m, P=0.159). The strongest correlation with the distance walked on the 6MWT was Medical Research Council dyspnea scale (r (2)=-0.667, P<0.001), followed by oxygen-cost diagram (r (2)=0.582, P<0.001) and forced expiratory volume in 1 second (r (2)=0.532, P<0.001). In multivariate linear regression analysis, only age, forced expiratory volume in 1 second, and baseline pulse oximetry were independently correlated with the distance covered on the 6MWT (P<0.05). However, body mass index, baseline heart rate, and ABI were not correlated with the distance covered on the 6MWT. Asymptomatic PAD is not associated with walking endurance in patients with COPD. Therefore, it is important to detect and treat asymptomatic PAD early so that COPD patients do not progress to become exercise intolerant. Limited by the small sample size and predominantly male (99%) population in the study, further large-scale prospective studies are needed to verify the results.

  18. Prevalence of Isolated Asymptomatic Deep Vein Thrombosis in Varicose Vein Patients with Superficial Thrombophlebitis: A Single Center Experience in Japan.

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    Shirasugi, Nozomu; Horiguchi, Sadaaki; Shirato, Hiroyuki; Kawakami, Toshimitsu; Ono, Hisako; Yabuki, Shiho; Jojima, Kumiko; Niimi, Masanori

    2016-01-01

    Prevalence of asymptomatic deep vein thrombosis (DVT) in patients with primary varicose veins remains unclear. Here, we conducted a retrospective study to clarify the incidence of asymptomatic DVT in patients with varicose veins, especially focusing on those with superficial thrombophlebitis (STP). Among 431 patients with primary varicose veins with saphenous vein incompetence, 20 (4.64%) had asymptomatic DVT. The presence of STP was a significant risk factor for asymptomatic DVT as 10 of the 24 (41.7%) patients with STP had asymptomatic DVT, and all cases having calf muscle vein thrombosis. In contrast, of the patients with primary varicose veins without STP only 2.46% had asymptomatic DVT. In patients with primary varicose veins with STP, significant risk factors for DVT were being over C3 on the clinical, etiological, anatomical, and pathophysiological (CEAP) classification. (This article is a translation of Jpn J Phlebol 2014; 25: 13-19.).

  19. Assessing Optimal Blood Pressure in Patients With Asymptomatic Aortic Valve Stenosis

    DEFF Research Database (Denmark)

    Nielsen, Olav W; Sajadieh, Ahmad; Sabbah, Muhammad

    2016-01-01

    BACKGROUND: Evidence for treating hypertension in patients with asymptomatic aortic valve stenosis is scarce. We used data from the SEAS trial (Simvastatin Ezetimibe in Aortic Stenosis) to assess what blood pressure (BP) would be optimal. METHODS: A total of 1767 patients with asymptomatic aortic...... stenosis and no manifest atherosclerotic disease were analyzed. Outcomes were all-cause mortality, cardiovascular death, heart failure, stroke, myocardial infarction, and aortic valve replacement. BP was analyzed in Cox models as the cumulative average of serially measured BP and a time-varying covariate.......039). CONCLUSIONS: Optimal BP seems to be systolic BP of 130 to 139 mm Hg and diastolic BP of 70 to 90 mm Hg in these patients with asymptomatic aortic stenosis and no manifest atherosclerotic disease or diabetes mellitus. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT...

  20. Ultrasound of the coracoacromial ligament in asymptomatic volunteers and patients with shoulder impingement.

    Science.gov (United States)

    Dietrich, Tobias J; Jonczy, Maciej; Buck, Florian M; Sutter, Reto; Puskas, Gabor J; Pfirrmann, Christian Wa

    2016-08-01

    The coracoacromial ligament is part of the coracoacromial arch, which is considered to be involved in shoulder impingement. To compare the coracoacromial ligament on ultrasound in asymptomatic volunteers and in patients with subacromial shoulder impingement. Twenty-nine asymptomatic volunteers (mean age, 35.5 years) and 29 patients (mean age, 49.9 years) with shoulder impingement, diagnosed by experienced shoulder surgeons, were prospectively included. Two radiologists obtained and analyzed ultrasound images of the coracoacromial ligament in the longitudinal axis. The ligament thickness was 1.4 ± 0.2 mm at its midportion, 1.8 ± 0.4 mm at the coracoid, and 2.1 ± 0.6 mm at the acromion in asymptomatic volunteers compared with 1.3 ± 0.2 mm, 1.9 ± 0.5 mm, and 1.9 ± 0.5 mm in impingement patients for observer 1. The ligament length was 30.6 ± 2.4 mm in asymptomatic volunteers compared with 30.4 ± 3.6 mm in impingement patients for observer 1. An anteriorly convex shape of the superficial contour of the coracoacromial ligament was significantly more frequent in impingement patients compared with asymptomatic volunteers for both observers (observer 1: 10% (3/29) versus 45% (13/29), P value shoulder impingement, an anteriorly convex shape of the superficial contour of the coracoacromial ligament was significantly more frequent in impingement patients compared with asymptomatic volunteers. © The Foundation Acta Radiologica 2015.

  1. Prognostic Value of Exercise-Stress Echocardiography in Asymptomatic Patients With Aortic Valve Stenosis.

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    Goublaire, Coppelia; Melissopoulou, Maria; Lobo, David; Kubota, Naozumi; Verdonk, Constance; Cimadevilla, Claire; Codogno, Isabelle; Brochet, Eric; Vahanian, Alec; Messika-Zeitoun, David

    2017-07-19

    This study sought to evaluate the prognostic value of mean pressure gradient (MPG) increase and peak systolic pulmonary artery pressure (SPAP) measured during exercise stress echocardiography in asymptomatic patients with aortic stenosis (AS). Exercise testing is recommended in asymptomatic AS patients, but the additional value of exercise-stress echocardiography, especially the prognostic value of MPG increase and peak SPAP, is still debated. We enrolled all consecutive patients with pure, isolated, asymptomatic AS and preserved ejection fraction ≥50% and normal SPAP (20 mm Hg and/or SPAP at peak exercise >60 mm Hg). These 112 patients were managed conservatively. During a mean follow-up of 14 ± 8 months, an AS-related event occurred in 30 patients, and 25 patients underwent surgery. Neither MPG increase >20 mm Hg nor peak SPAP >60 mm Hg was predictive of occurrence of AS-related events or aortic valve replacement (all p > 0.20). In contrast, baseline AS severity was an important prognostic factor (all p < 0.01). In this observational study including 148 patients with asymptomatic AS, we confirmed and extended the importance of exercise testing for unveiling functional limitation. More importantly, neither the increase in MPG nor in SPAP at peak exercise was predictive of outcome. Our results do not support the use of these parameters in risk-stratification and clinical management of asymptomatic AS patients. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  2. The natural history of inflammatory pseudotumors in asymptomatic patients after metal-on-metal hip arthroplasty.

    Science.gov (United States)

    Almousa, Sulaiman A; Greidanus, Nelson V; Masri, Bassam A; Duncan, Clive P; Garbuz, Donald S

    2013-12-01

    Although pseudotumors have been reported in 32% of asymptomatic metal-on-metal hips, the natural history of asymptomatic pseudotumors is unknown. The purpose of this study was to assess changes over time in asymptomatic pseudotumors and the effect of revision on pseudotumor mass. Followup ultrasound was performed a mean of 25.8 months (range, 21-31 months) after the detection of 15 pseudotumors and five isolated fluid collections in a cohort of 20 asymptomatic patients (13 metal-on-metal, three metal-on-polyethylene, and four hip resurfacings) [42]. Changes in pseudotumors and fluid collections size and nature, and serum ion levels were determined. Among the 15 nonrevised patients, pseudotumors increased in size in six (four solid and two cystic) of 10 patients, three of which had clinically important increases (13-148 cm(3); 28-74 cm(3); 47-104 cm(3)). Three pseudotumors (one solid and two cystic) disappeared completely (the largest measured 31 cm(3)). One solid pseudotumor decreased in size (24 to 18 cm(3)). In five revised patients, pseudotumors completely disappeared in four patients. The fifth patient had two masses that decreased from 437 cm(3) to 262 cm(3) and 43 cm(3) to 25 cm(3). All revision patients had a reduction of chromium (40.42 μ/L to 2.69 μ/L) and cobalt ions (54.19 μ/L to 0.64 μ/L). Of five isolated fluid collections, four completely disappeared (two metal-on-metal and two metal-on-polyethylene) and one (metal-on-metal) increased from 26 cm(3) to 136 cm(3). Our observations suggest pseudotumors frequently increase in size in asymptomatic patients with occasional remission of small masses. Revision resulted in remission of pseudotumors.

  3. Association between aortic valve calcification and myocardial ischemia, especially in asymptomatic patients.

    Science.gov (United States)

    Yamazato, Ryo; Yamamoto, Hideya; Tadehara, Futoshi; Teragawa, Hiroki; Kurisu, Satoshi; Dohi, Yoshihiro; Ishibashi, Ken; Kunita, Eiji; Utsunomiya, Hiroto; Oka, Toshiharu; Kihara, Yasuki

    2012-08-01

    Aortic valve calcification (AVC) is recognized as a manifestation of systemic arteriosclerosis. However, it is unclear whether AVC is associated with myocardial ischemia. Stress myocardial perfusion SPECT (MPS) is widely used for the diagnosis of myocardial ischemia. However, routine MPS is not recommended, particularly in asymptomatic patients. Accordingly, we investigated the hypothesis that the presence of AVC is strongly associated with inducible myocardial ischemia, even among asymptomatic patients. We investigated 669 consecutive patients who underwent both adenosine stress (201)Tl MPS and echocardiography. We evaluated the extent and severity of myocardial ischemia by the summed difference score (SDS). We defined the presence of myocardial ischemia as SDS ≥ 3 and moderate to severe ischemia as SDS ≥ 8. We classified the severity of AVC according to the number of affected aortic leaflets. We also compared the mean SDS and the prevalence of SDS ≥ 3 and SDS ≥ 8 among patients stratified by the severity of AVC. The presence of AVC was significantly associated with myocardial ischemia (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.10-2.23; P = 0.013) and moderate to severe ischemia (OR, 2.16; 95% CI, 1.26-3.80; P = 0.0061). In 311 asymptomatic patients, AVC was strongly associated with moderate to severe ischemia (OR, 4.31; 95% CI, 1.67-12.8; P = 0.0043). However, the SDS value and the prevalence of SDS ≥ 3 and SDS ≥ 8 did not increase with increasing number of affected aortic leaflets. The presence of AVC may be associated with the presence of myocardial ischemia, particularly in asymptomatic patients. However, we found no association between the extent of AVC and inducible myocardial ischemia. The presence of AVC may be a useful anatomic marker to help identify patients at high risk of myocardial ischemia, particularly asymptomatic patients.

  4. Clinical Utility of Serologic Testing for Celiac Disease in Asymptomatic Patients

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    2011-01-01

    Executive Summary Objective The objective of this evidence-based analysis was to evaluate the clinical utility of serologic testing for celiac disease in asymptomatic individuals presenting with one of the non-gastrointestinal conditions evaluated in this report. The clinical utility was based on the effects of a gluten-free diet (GFD) on outcomes specific to each of these conditions. The prevalence of celiac disease in asymptomatic individuals and one of these non-gastrointestinal conditions was also evaluated. Clinical Need and Target Population Celiac Disease Celiac disease is an autoimmune disease characterized by a chronic inflammatory state of the proximal small bowel mucosa accompanied by structural and functional changes. Technology Under Evaluation Serologic Tests for Celiac Disease There are a number of serologic tests for celiac disease available. Serologic tests are automated with the exception of the anti-endomysial antibody test, which is more time-consuming and operator-dependent than the other tests. Research Questions What is the prevalence of asymptomatic celiac disease in patients presenting with one of the non-gastrointestinal conditions evaluated? What is the effect of the gluten-free diet on condition-specific outcomes in patients with asymptomatic celiac disease presenting with one of the non-gastrointestinal conditions evaluated? What is the clinical utility of serologic testing for celiac disease in asymptomatic patients presenting with one of the non-gastrointestinal conditions evaluated? The clinical utility was defined as the impact of the GFD on disease specific outcomes. What is the risk of all-cause mortality and lymphoma in individuals with asymptomatic celiac disease? What is the budget impact of serologic testing for celiac disease in asymptomatic subjects presenting with one of the non-gastrointestinal conditions evaluated? Research Methods Study Population The study population consisted of individuals with newly diagnosed celiac

  5. Prevalence and risk factors of asymptomatic peripheral arterial disease in patients with COPD in Taiwan.

    Science.gov (United States)

    Lin, Ming-Shian; Hsu, Kun-Yen; Chen, Yi-Jen; Chen, Cheng-Ren; Chen, Chuan-Mu; Chen, Wei

    2013-01-01

    Chronic obstructive pulmonary disease (COPD) is an independent risk factor for cardiovascular morbidity and mortality. The aim of this study was to determine the prevalence of asymptomatic peripheral arterial disease (PAD) and the associated risk factors for patients with COPD. This prospective cross-sectional study enrolled 427 COPD patients (mean age: 70.0 years) without PAD symptoms consecutively. Demographic data, lung function and cardiovascular risk factors were recorded. The ankle-brachial index (ABI) was used to detect PAD (ABI<0.90). The overall prevalence of asymptomatic PAD in the COPD patients was 8% (2.5% in the younger participants (<65 years of age, n = 118) and 10% in the elderly participants (≥65 years of age, n = 309). The COPD patients with asymptomatic PAD had a significantly higher rate of hyperlipidemia (47.1% vs. 10.4%) and hypertension (79.4% vs. 45.8%) than those without asymptomatic PAD (p<0.05). There was no significant difference in lung function (forced vital capacity and forced expiratory volume in one second) between the two groups. In multivariate logistic regression, hyperlipidemia was the strongest independent factor for PAD (odds ratio (OR): 6.89, p<0.005), followed by old age (OR: 4.80), hypertension (OR: 3.39) and smoking burden (pack-years, OR: 1.02). The prevalence of asymptomatic PAD among COPD patients in Taiwan is lower than in Western countries. Hyperlipidemia, old age, hypertension, and smoking burden were the associated cardiovascular risk factors. However, there was no association between lung function and PAD in the COPD patients.

  6. Identification of bacteriology and risk factor analysis of asymptomatic bacterial colonization in pacemaker replacement patients.

    Directory of Open Access Journals (Sweden)

    Xian-Ming Chu

    Full Text Available Recent researches revealed that asymptomatic bacterial colonization on PMs might be ubiquitous and increase the risk of clinical PM infection. Early diagnosis of patients with asymptomatic bacterial colonization could provide opportunity for targeted preventive measures.The present study explores the incidence of bacterial colonization of generator pockets in pacemaker replacement patients without signs of infection, and to analyze risk factors for asymptomatic bacterial colonization.From June 2011 to December 2013, 118 patients underwent pacemaker replacement or upgrade. Identification of bacteria was carried out by bacterial culture and 16S rRNA sequencing. Clinical risk characteristics were analyzed.The total bacterial positive rate was 37.3% (44 cases, and the coagulase-negative Staphylococcus aureus detection rate was the highest. Twenty two (18.6% patients had positive bacterial culture results, of which 50% had coagulase-negative staphylococcus. The bacterial DNA detection rate was 36.4 % (43 cases. Positive bacterial DNA results from pocket tissues and the surface of the devices were 22.0% and 29.7%, respectively. During follow-up (median, 27.0 months, three patients (6.8%, 3/44 became symptomatic with the same genus of microorganism, S. aureus (n=2 and S. epidermidis (n=1. Multivariable logistic regression analysis showed that history of bacterial infection, use of antibiotics, application of antiplatelet drugs, replacement frequency were independent risk factors for asymptomatic bacterial colonization.There was a high incidence of asymptomatic bacterial colonization in pacemaker patients with independent risk factors. Bacterial culture combined genetic testing could improve the detection rate.

  7. Prevalence and risk factors of asymptomatic peripheral arterial disease in patients with COPD in Taiwan.

    Directory of Open Access Journals (Sweden)

    Ming-Shian Lin

    Full Text Available AIM: Chronic obstructive pulmonary disease (COPD is an independent risk factor for cardiovascular morbidity and mortality. The aim of this study was to determine the prevalence of asymptomatic peripheral arterial disease (PAD and the associated risk factors for patients with COPD. METHODS: This prospective cross-sectional study enrolled 427 COPD patients (mean age: 70.0 years without PAD symptoms consecutively. Demographic data, lung function and cardiovascular risk factors were recorded. The ankle-brachial index (ABI was used to detect PAD (ABI<0.90. RESULTS: The overall prevalence of asymptomatic PAD in the COPD patients was 8% (2.5% in the younger participants (<65 years of age, n = 118 and 10% in the elderly participants (≥65 years of age, n = 309. The COPD patients with asymptomatic PAD had a significantly higher rate of hyperlipidemia (47.1% vs. 10.4% and hypertension (79.4% vs. 45.8% than those without asymptomatic PAD (p<0.05. There was no significant difference in lung function (forced vital capacity and forced expiratory volume in one second between the two groups. In multivariate logistic regression, hyperlipidemia was the strongest independent factor for PAD (odds ratio (OR: 6.89, p<0.005, followed by old age (OR: 4.80, hypertension (OR: 3.39 and smoking burden (pack-years, OR: 1.02. CONCLUSIONS: The prevalence of asymptomatic PAD among COPD patients in Taiwan is lower than in Western countries. Hyperlipidemia, old age, hypertension, and smoking burden were the associated cardiovascular risk factors. However, there was no association between lung function and PAD in the COPD patients.

  8. Myocardial perfusion abnormalities in asymptomatic patients with systemic lupus erythematosus

    Energy Technology Data Exchange (ETDEWEB)

    Hosenpud, J.D.; Montanaro, A.; Hart, M.V.; Haines, J.E.; Specht, H.D.; Bennett, R.M.; Kloster, F.E.

    1984-08-01

    Accelerated coronary artery disease and myocardial infarction in young patients with systemic lupus erythematosus is well documented; however, the prevalence of coronary involvement is unknown. Accordingly, 26 patients with systemic lupus were selected irrespective of previous cardiac history to undergo exercise thallium-201 cardiac scintigraphy. Segmental perfusion abnormalities were present in 10 of the 26 studies (38.5 percent). Five patients had reversible defects suggesting ischemia, four patients had persistent defects consistent with scar, and one patient had both reversible and persistent defects in two areas. There was no correlation between positive thallium results and duration of disease, amount of corticosteroid treatment, major organ system involvement or age. Only a history of pericarditis appeared to be associated with positive thallium-201 results (p less than 0.05). It is concluded that segmental myocardial perfusion abnormalities are common in patients with systemic lupus erythematosus. Whether this reflects large-vessel coronary disease or small-vessel abnormalities remains to be determined.

  9. Impact of QRS duration and morphology on the risk of sudden cardiac death in asymptomatic patients with aortic stenosis

    DEFF Research Database (Denmark)

    Greve, Anders M; Gerdts, Eva; Boman, Kurt

    2012-01-01

    The aim of the study was to examine the predictive value of QRS duration and morphology during watchful waiting in asymptomatic patients with aortic stenosis (AS).......The aim of the study was to examine the predictive value of QRS duration and morphology during watchful waiting in asymptomatic patients with aortic stenosis (AS)....

  10. Experimental low back pain decreased trunk muscle activity in currently asymptomatic recurrent low back pain patients during step tasks

    DEFF Research Database (Denmark)

    Larsen, Lars Henrik; Hirata, Rogerio Pessoto; Graven-Nielsen, Thomas

    2018-01-01

    Low back pain (LBP) patients demonstrate reorganized trunk muscle activity but if similar changes are manifest in recurrent LBP patients (R-LBP) during asymptomatic periods remains unknown. In 26 healthy and 27 currently asymptomatic R-LBP participants electromyographic activity (EMG) was recorde...

  11. Abnormal peri-operative haemorrhage in asymptomatic patients is ...

    African Journals Online (AJOL)

    Accordingly, we undertook two studies to detertnine whether it could be justified in patients without a history of abnormal bleeding. In the first of these, 45 of 159 patients were excluded because of aspirin ingestion and a further 3 because of positive bleeding history so that prothrombin time, activated partial thromboplastin ...

  12. Continuous Trastuzumab Therapy in Breast Cancer Patients With Asymptomatic Left Ventricular Dysfunction

    Science.gov (United States)

    Yadav, Nandini U.; Eaton, Anne A.; Lung, Betty Y.; Thaler, Howard T.; Liu, Jennifer E.; Hudis, Clifford A.; Dang, Chau T.; Steingart, Richard M.

    2015-01-01

    Background. Adjuvant trastuzumab is a highly effective targeted treatment that improves survival for patients with HER2-positive breast cancer. However, trastuzumab interruption is recommended for patients who develop treatment-induced cardiotoxicity (i.e., decline in left ventricular ejection fraction [LVEF], with or without symptoms) and can lead to an incomplete course of treatment. We studied the cardiac safety of continuous trastuzumab therapy among patients with asymptomatic declines in LVEF. Methods. We retrospectively evaluated patients with HER2-positive breast cancer treated with adjuvant trastuzumab at our institution between 2005 and 2010. Treatment-induced cardiotoxicity was defined by an absolute decrease in LVEF of ≥10% to below 55% or an absolute decrease of ≥16%. Logistic regression was used to determine the association between candidate risk factors and treatment-induced cardiotoxicity. Results. Among 573 patients, 92 (16%) developed treatment-induced cardiotoxicity. Trastuzumab was continued without interruption in 31 of 92 patients with treatment-induced cardiotoxicity—all were asymptomatic with LVEF of ≥50% at cardiotoxicity diagnosis with median LVEF of 53% (range, 50%–63%), and none developed heart failure during follow-up. Risk factors associated with treatment-induced cardiotoxicity included age (p = .011), anthracycline chemotherapy (p = .002), and lower pretrastuzumab LVEF (p < .001). Conclusion. Among patients who develop asymptomatic treatment-induced cardiotoxicity with LVEF of ≥50%, continuous trastuzumab therapy appears to be safe. Implications for Practice: Cardiotoxicity is the most common reason for patients with HER2-positive breast cancer to receive an incomplete course of life-saving trastuzumab therapy. Data from this study suggest that continuous trastuzumab may be safe in patients with asymptomatic cardiotoxicity and left ventricular ejection fraction of ≥50%. Given the substantial oncologic benefit of

  13. Asymptomatic carotid stenosis in patients with intermittent claudication: epidemiological study.

    Science.gov (United States)

    Ramos, M J; González-Fajardo, J A; Vaquero-Puerta, C; Vallina-Victorero, M; Vicente-Santiago, M; Vaquero-Lorenzo, F; Alvarez-Salgado, A; Alvarez-Fernandez, J

    2011-12-01

    The aim of this paper was to determine the prevalence of extracraneal carotid artery disease in patients with intermittent claudication, to describe classic cardiovascular risk factors in those with hemodynamically significant stenosis and to try to define subgroups at high risk, improving therefore the performance of non invasive testing. A prospective descriptive study was conducted, with 146 patients reporting an intermittent claudication of the lower limbs and without a previous cerebrovascular event or carotid surgery. An ultrasonography examination was done. Risk factors were registed (smoking, dislipemia, arterial hypertension, diabetes mellitus), also ischemic cardiopathy and myocardial revascularization procedures. Univariate and multivariate analysis was made to define the variables associated with hemodynamically significant stenosis. Prevalence of hemodynamically significant stenosis was 23.2%. Smoking, dislipemia, arterial hypertension and diabetes mellitus were not significantly associated with carotid stenosis; 24.2% of patients affected of ischemic cardiopathy present a severe stenosis, and myocardial revascularization was a risk factor for carotid stenosis. Patients with claudication and ischemic miocardiopathy, especially when myocardial revascularization is needed, must be explored with carotid ultrasonography. In this patients, probably of hemodynamically significant carotid stenosis that requires treatment is more frequent.

  14. Is asymptomatic peripheral arterial disease associated with walking endurance in patients with COPD?

    Directory of Open Access Journals (Sweden)

    Sun KS

    2015-07-01

    Full Text Available Kuo-Shao Sun,1,2* Ming-Shian Lin,1,2* Yi-Jen Chen,1,2 Yih-Yuan Chen,3 Solomon Chih-Cheng Chen,4 Wei Chen1,5,6 1Division of Pulmonary and Critical Care Medicine, 2Department of Respiratory Care, Chang Gung University of Science and Technology, 3Department of Internal Medicine, 4Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, 5College of Nursing, Dayeh University, Changhua, 6Department of Respiratory Therapy, China Medical University, Taichung, Taiwan, Republic of China *These authors contributed equally to this work Objective: Symptomatic peripheral arterial disease (PAD is associated with impaired walking endurance in patients with chronic obstructive pulmonary disease (COPD. However, it is unknown whether asymptomatic PAD is associated with impaired walking endurance in patients with COPD. Methods: This prospective cross-sectional study enrolled 200 COPD patients (mean age: 70.9 years who volunteered to perform ankle-brachial index (ABI and 6-minute walk test (6MWT consecutively. Demographic data, lung function, dyspnea scales, and cardiovascular risk factors were recorded. The ABI was used to detect PAD (ABI <0.90. All patients were free of PAD symptoms at enrollment. Results: Of the 200 COPD patients, 17 (8.5% were diagnosed with asymptomatic PAD. The COPD patients without asymptomatic PAD did not walk significantly further on the 6MWT than the COPD patients with asymptomatic PAD (439±86 m vs 408±74 m, P=0.159. The strongest correlation with the distance walked on the 6MWT was Medical Research Council dyspnea scale (r2=-0.667, P<0.001, followed by oxygen-cost diagram (r2=0.582, P<0.001 and forced expiratory volume in 1 second (r2=0.532, P<0.001. In multivariate linear regression analysis, only age, forced expiratory volume in 1 second, and baseline pulse oximetry were independently correlated with the distance covered on the 6MWT (P<0.05. However, body mass index, baseline heart rate, and

  15. Asymptomatic and Persistent Elevation of Pancreatic Enzymes in an Ulcerative Colitis Patient

    Directory of Open Access Journals (Sweden)

    Elisa Liverani

    2013-01-01

    Full Text Available Azathioprine has been extensively used in the management of inflammatory bowel diseases. It might cause pancreatic damage in the form of either asymptomatic elevation in serum amylase/lipase or overt acute pancreatitis. Here we report the case of a 61-year-old patient with ulcerative colitis who had been treated with azathioprine for three years, achieving clinical remission. During treatment he presented an asymptomatic elevation of serum pancreatic enzymes, without any signs of pancreatitis at imaging. This evidence brought us to reassess the drug dosage, without achieving a normalization of biochemical analysis. Autoimmune pancreatitis was excluded. One year after the suspension of azathioprine, we still face persistent high levels of amylase/lipase. Normalization of enzymatic values in patients who develop intolerance to azathioprine, in the form of either asymptomatic elevation in serum amylase/lipase or overt acute pancreatitis, is usually achieved in about two months after stopping drug intake. Asymptomatic elevation in serum pancreatic enzymes in the absence of pancreatic disease is reported in the literature and defined as “Gullo’s syndrome,” but nobody of the subjects studied had been treated in the past with pancreatotoxic drugs. Might this case be defined as “benign pancreatic hyperenzymemia”?

  16. Asymptomatic and persistent elevation of pancreatic enzymes in an ulcerative colitis patient.

    Science.gov (United States)

    Liverani, Elisa; Leonardi, Filippo; Castellani, Lucia; Cardamone, Carla; Belluzzi, Andrea

    2013-01-01

    Azathioprine has been extensively used in the management of inflammatory bowel diseases. It might cause pancreatic damage in the form of either asymptomatic elevation in serum amylase/lipase or overt acute pancreatitis. Here we report the case of a 61-year-old patient with ulcerative colitis who had been treated with azathioprine for three years, achieving clinical remission. During treatment he presented an asymptomatic elevation of serum pancreatic enzymes, without any signs of pancreatitis at imaging. This evidence brought us to reassess the drug dosage, without achieving a normalization of biochemical analysis. Autoimmune pancreatitis was excluded. One year after the suspension of azathioprine, we still face persistent high levels of amylase/lipase. Normalization of enzymatic values in patients who develop intolerance to azathioprine, in the form of either asymptomatic elevation in serum amylase/lipase or overt acute pancreatitis, is usually achieved in about two months after stopping drug intake. Asymptomatic elevation in serum pancreatic enzymes in the absence of pancreatic disease is reported in the literature and defined as "Gullo's syndrome," but nobody of the subjects studied had been treated in the past with pancreatotoxic drugs. Might this case be defined as "benign pancreatic hyperenzymemia"?

  17. Blood lipid levels and SPECT of myocardium perfusion to type 2 asymptomatic diabetic patients

    International Nuclear Information System (INIS)

    Pena Quian, Yamile; Fernandez-Britto Rodriguez, Jose; Coca Perez, Marco A; Batista Cuellar, Juan F; Rochela Vazquez, Luis Manuel

    2006-01-01

    SPECT, coronary angiography and laboratories test were performed on 31 asymptomatic type 2 diabetes patients, in order to determine the relationship among the lipid levels in blood and the results of the SPECT. Patients were classified in two groups (positive SPECT or negative SPECT). Simple descriptive statistics were calculated for all variables in both groups. Positive SPECT was detected in 35,5% of the patients and negative SPECT in 64,5%.The coronary angiography and SPECT showed good correlation. Low values of HDLc showed significant association with the positive results of the SPECT. The logistical regression showed an increment of the capacity to predict a positive SPECT if the values of HDLc are used. Conclusion: The present investigation demonstrated a significant association among the low levels of HDLc in blood and the positive results of the SPECT. The low values of HDLc could predict the possibility of a positive SPECT in asymptomatic diabetic type 2 patients (au)

  18. Prognostic implications of left ventricular asymmetry in patients with asymptomatic aortic valve stenosis

    DEFF Research Database (Denmark)

    Sigvardsen, Per Ejlstrup; Larsen, Linnea Hornbech; Carstensen, Helle Gervig

    2018-01-01

    by multi-detector computed tomography according to previous definitions. Follow-up was conducted using electronic health records. Event-free survival was assessed using Cox proportional hazards models. Patients were followed for a median of 2.2 years (interquartile range 1.6-3.6). Indication for AVR......Aims: Left ventricular (LV) regional hypertrophy in the form of LV asymmetry is a common finding in patients with aortic valve stenosis. The aim of this study was to test the hypothesis that LV asymmetry predicts future symptomatic status and indication for aortic valve replacement (AVR......) in patients with asymptomatic aortic valve stenosis. Methods and results: In total, 114 patients with asymptomatic aortic valve stenosis (peak velocity > 2.5 m/s assessed by echocardiographic screening and LV ejection fraction > 50%) were enrolled in the study. LV asymmetry and LV geometry was assessed...

  19. Candida colonisation in asymptomatic HIV patients attending a ...

    African Journals Online (AJOL)

    Background: Candidiasis is the commonest opportunistic fungal infection in patients infected with human immunodeficiency virus (HIV). CD4 lymphocyte counts have been found to be a marker of HIV disease progression. Aim: This study focused on determining the spectrum of Candida isolates in urine, stool, and oral ...

  20. Abnormal peri-operative haemorrhage in asymptomatic patients is ...

    African Journals Online (AJOL)

    was found, according to the same battery of tests employed for pre-operative screening, in 49 of 1 872 patients who had undergone major surgical procedures ... which inadvertent contamination of the specimen with heparin is the single most common cause of prolonged activated partial thromboplastin time, with correction ...

  1. High Prevalence of Esophageal Dysmotility in Asymptomatic Obese Patients

    Directory of Open Access Journals (Sweden)

    Justin Côté-Daigneault

    2014-01-01

    Full Text Available BACKGROUND: Obesity is an important health problem affecting >500 million people worldwide. Esophageal dysmotility is a gastrointestinal pathology associated with obesity; however, its prevalence and characteristics remain unclear. Esophageal dysmotilities have a high prevalence among obese patients regardless of gastrointestinal symptoms.

  2. Asymptomatic thyroid tuberculosis in a multinodular goitre patient: a case report.

    Science.gov (United States)

    Girgin, S; Gedik, E; Büyükbayram, H

    2007-01-01

    Thyroid tuberculosis is a very rare disease of the thyroid gland. In recent years, the incidence of extra-pulmonary tuberculosis has been showing a progressive increase. We present the case of a 41-year old female patient, operated for an asymptomatic multinodular goiter, and who had a histopathological diagnosis of thyroid tuberculosis. Thyroid tuberculosis should be kept in mind in the differential diagnosis of thyroid nodules, even in patients with no history and no symptom of tuberculosis disease.

  3. What is the natural history of asymptomatic pseudotumours in metal-on-metal hip resurfacing patients?

    Science.gov (United States)

    Matharu, Gulraj S; Ostlere, Simon J; Pandit, Hemant G; Murray, David W

    2016-11-10

    We assessed the natural history of asymptomatic pseudotumours associated with metal-on-metal hip resurfacings (MoMHRs), and factors associated with future revision. In 2007-2008, we identified 25 MoMHRs (21 patients; mean age 59.9 years; 76% female) with asymptomatic pseudotumours. All patients underwent identical initial assessment (ultrasound, blood metal ions, radiographs, Oxford Hip Score [OHS]) and were considered asymptomatic because they denied experiencing hip symptoms, were satisfied with their MoMHR surgery, and had good or excellent OHSs (≥34). In 2012-2013, repeat assessments were performed in all non-revised patients. Revision for pseudotumour was performed/recommended in 15 MoMHRs (60%) at a mean 2.7 years (range 0.4-6.4 years) from initial assessment, with 14 developing symptoms before revision. Non-revised MoMHRs (n = 10) underwent repeat ultrasound at a mean 5.1 years (range 4.0-6.5 years) later, with no changes in pseudotumour volume (p = 0.956) or OHS (p = 0.065) between assessments. High blood cobalt (p = 0.0048) and chromium (p = 0.0162), large pseudotumours (p = 0.0458), low OHS (p = 0.0183), and bilateral MoMHRs (p = 0.049) predicted future revision. Patients with blood metal ions above established unilateral/bilateral thresholds and/or initial pseudotumours >30 cm3 had an 86.7% sensitivity, 70.0% specificity, 81.2% positive predictive value, and 77.8% negative predictive value for future revision. MoMHR patients with initially asymptomatic pseudotumours often become symptomatic and require revision. Patients with high blood metal ions and/or pseudotumours >30 cm3 should remain under annual surveillance or be considered for revision (especially in patients also having lower initial OHSs, bilateral MoMHRs, and/or those becoming symptomatic). Less regular surveillance of patients outside these parameters appears acceptable.

  4. A STUDY ON ASYMPTOMATIC CARDIAC CHANGES IN TYPE 2 DIABETES PATIENTS

    Directory of Open Access Journals (Sweden)

    Ramchandra Rao

    2015-06-01

    Full Text Available INTRODUCTION: Majority of the time the patient of Diabetes presents with complications like Myocardial infarction, heart failure, being end stages of cardiovascular 2 disease associated with other macro and microvascular complications. If patients are screened at an early stage of Diabetes before the onset of symptoms the cardiovascular complications can be delayed and mortality can be reduced . There are only few studies in India done to screen asymptomatic diabetic individuals for cardiovascular compli cations. This study is done in view of screening the asymptomatic individuals in our area to prevent complications. With the available infrastructure, ECG, 2D ECHO were done in 50 patients who met inclusion, exclusion criterias, the changes were noted and the cardiac status was evaluated. AIM AND OBJECTIVES : “To study the asymptomatic cardiac changes in type2 Diabetes patients”. To observe the ECG changes in patients of type2 Diabetes without any symptoms of cardiac disease. To evaluate the ECG changes along with 2DECHO findings in asymptomatic cardiac patients of type 2 Diabetes. To study the correlation between these two investigations and evaluate the cardiac status of the individual. CONCLUSIONS : M ost of the patients in study group belong to 5 th decade , Males with Diabetes were almost double that of females , Most of the patients had duration of Diabetes as 5yrs , Less than half of patients had family history of Diabetes , Half of the group had alcohol, smoking habits , More than half of patients were overweight , Only 20% had good control of Diabetes , Total cholesterol is above normal in almost all of the patients, LDL is elevated in half of the patients, triglycerides in most of them, there is significant dyslipidemia in patients of Diabetes , Only 6 had normal ECG. Rest of them have LVH, ischemia , 18 patients had changes in echo including LVD, regional and global hypokinesias , t hus the present study shows patients with type 2

  5. High prevalence of esophageal dysmotility in asymptomatic obese patients

    OpenAIRE

    Côté-Daigneault, Justin; Leclerc, Pierre; Joubert, Josette; Bouin, Mickael

    2014-01-01

    Obesity has emerged as a major health problem in the developed world and has been found to be associated with several respiratory, cardiovascular, neurological and digestive diseases. Few studies have investigated esophageal dysmotility in obese populations; however, they have reported conflicting results, primarily due to varying measures and classification systems. This prospective study aimed to determine the prevalence of esophageal motor disorders in a group of obese patients in Montreal...

  6. Left-atrial-appendage occluder migrates in an asymptomatic patient.

    Science.gov (United States)

    Pisani, Paolo; Sandrelli, Luca; Fabbrocini, Mario; Tesler, Ugo Filippo; Medici, Dante

    2014-08-01

    Percutaneous closure of the left atrial appendage (LAA) is a new approach to the prevention of cardioembolic events in patients with atrial fibrillation. We implanted an LAA occlusion device (Amplatzer™ Cardiac Plug) in a 70-year-old woman via a transseptal approach. Upon her discharge from the hospital, a transthoracic echocardiogram showed stable anchoring of the device; 6 months after implantation, a routine transthoracic echocardiogram revealed migration of the occluder into the left ventricular outflow tract, in the absence of symptoms. We surgically removed the device from the mitral subvalvular apparatus and closed the LAA with sutures. This case shows that percutaneous LAA occlusion can result in serious adverse events, including device migration in the absence of signs or symptoms; therefore, careful follow-up monitoring is mandatory.

  7. Myocardial perfusion scintigraphy in the detection of silent ischemia in asymptomatic diabetic patients

    Energy Technology Data Exchange (ETDEWEB)

    Oki, Glaucia Celeste Rossatto [Clinica Diagnoson and Hospital Aristides Maltez, Salvador, BA (Brazil). Servicos de Medicina Nuclear; Pavin, Elizabeth Joao; Parisi, Maria Candida R. [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil). Department of Internal Medicine. Service of Endocrinology; Coelho, Otavio Rizzi; Almeida, Raitany C. [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil). Department of Internal Medicine. Service of Cardiology; Etchebehere, Elba Cristina Sa de Camargo; Ramos, Celso Dario, E-mail: cdramos@unicamp.br [Universidade Estadual de Campinas (Unicamp), Campinas, SP (Brazil). Department of Radiology. Service of Nuclear Medicine; Camargo, Edwaldo Eduardo [Hospital Sirio-Libanes, Campinas, SP (Brazil). Service of Nuclear Medicine

    2013-01-15

    Objective: This study was aimed to evaluate myocardial perfusion in asymptomatic patients with type 1 (DM1) and type 2 diabetes mellitus (DM2) without previous diagnoses of coronary artery disease (CAD) or cerebral infarction. Materials and Methods: Fifty-nine consecutive asymptomatic patients (16 DM1, 43 DM2) underwent myocardial perfusion scintigraphy with {sup 99m}Tc-sestamibi (MPS). They were evaluated for body mass index, metabolic control of DM, type of therapy, systemic arterial hypertension, dyslipidemia, nephropathy, retinopathy, peripheral neuropathy, smoking, and familial history of CAD. Results: MPS was abnormal in 15 patients (25.4%): 12 (20.3%) with perfusion abnormalities, and 3 with isolated left ventricular dysfunction. The strongest predictors for abnormal myocardial perfusion were: age 60 years and above (p = 0.017; odds ratio [OR] = 6.0), peripheral neuropathy (p = 0.028; OR = 6.1), nephropathy (p = 0.031; OR = 5.6), and stress ECG positive for ischemia (p = 0.049; OR = 4.08). Conclusion: Silent myocardial ischemia occurs in more than one in five asymptomatic diabetic patients. The strongest predictors of ischemia in this study were: patient age, peripheral neuropathy, nephropathy, retinopathy and a stress ECG positive for ischemia. (author)

  8. Identification of monosodium urate crystal deposits in patients with asymptomatic hyperuricemia using dual-energy CT

    Science.gov (United States)

    Smith, Stacy E; Garg, Rajesh; Lu, Fengxin; Wohlfahrt, Alyssa; Campos, Anarosa; Vanni, Kathleen; Yu, Zhi; Solomon, Daniel H; Kim, Seoyoung C

    2018-01-01

    Objectives Dual-energy CT (DECT) scan is a sensitive and specific tool used to visualise and quantify monosodium urate (MSU) crystal deposits in the joints. Few studies have examined MSU crystal deposits in patients with asymptomatic hyperuricemia (ie, hyperuricemia in the absence of gout) using DECT. Methods We conducted a prospective, non-interventional cross-sectional study to detect MSU crystal deposits on DECT scans among patients with asymptomatic hyperuricemia. We also examined patient factors associated with subclinical MSU crystal deposits. Out of 130 subjects aged ≥40 years with metabolic syndrome screened for serum uric acid (sUA) levels ≥6.5 mg/dL, 46 underwent a foot/ankle DECT scan. Results The mean age of the study participants was 62 (±8) years, 41% were men and the mean sUA level was 7.8 (±1.0) mg/dL. Seven (15%) of 46 patients had MSU crystal deposits on DECT with a mean total volume of 0.13 (±0.14) cm3. In the univariable logistic regression analysis, older age had a significant association with presence of MSU crystal deposits (OR 1.20, 95% CI 1.03 to 1.39), but sUA did not (OR 1.36, 95% CI 0.63 to 2.95). In the univariable analysis, sUA levels showed a trend towards a modest linear association (β=0.11, P=0.09) with total volume of MSU crystal deposits. Conclusions Fifteen per cent of patients with asymptomatic hyperuricemia had subclinical MSU crystal deposits on foot/ankle DECT scans. Older age, but not sUA, was significantly associated with presence of subclinical MSU crystal deposits among patients with asymptomatic hyperuricemia. Clinical significance of these subclinical MSU crystal deposits needs to be determined. PMID:29556417

  9. Usefulness of true FISP cine MR imaging in patients with poor cardiac function

    Energy Technology Data Exchange (ETDEWEB)

    Sakuma, Toshiharu; Yamada, Naoaki; Motooka, Makoto; Enomoto, Naoyuki; Maeshima, Isamu; Matsuda, Kazuhide; Urayama, Shinichi; Ikeo, Miki [National Cardiovascular Center, Suita, Osaka (Japan)

    2002-01-01

    This study was done to assess the value of True FISP cine in patients with poor cardiac function. True FISP cine and FLASH cine imaging were performed on a 1.5 T machine. Both short axis and horizontal long axis imaging sections were used. The imaging sections used a Matrix (120 x 128), FOV (24 x 32 cm), and had a slice thickness of 8 mm. The imaging time for True FISP cine was 8 heart beats and 17 heart beats for FLASH cine. The contrast-to-noise ratio between the blood and myocardium (CNR) was measured at enddiastole and endsystole. The subjects in the study were 10 healty volunteers (average age 26.5{+-}3.2 years) and 12 patients with hypofunction (average age 53.9{+-}13.2 years). In the volunteers, the CNR of the short axis imaging was similar in both True FISP (24.6{+-}3.7) and FLASH (23.4{+-}5.9). In the patients with poor cardiac function however, the CNR of True FISP was larger than FLASH in both the short and long axis. In the short axis (22.7{+-}6.1 vs. 17.9{+-}5.3, P<0.01) and in the long axis (17.4{+-}4.3 vs. 9.3{+-}4.0, P<0.01). We conclude that True FISP cine has a higher contrast in a shorter imaging time than FLASH cine. True FISP cine is especially useful in patients with poor cardiac function. (author)

  10. Treatment results of endosaccular coil embolization of asymptomatic unruptured intracranial aneurysms in elderly patients.

    Science.gov (United States)

    Oishi, Hidenori; Yamamoto, Munetaka; Nonaka, Senshu; Shimizu, Takashi; Yoshida, Kensaku; Mitsuhashi, Takashi; Arai, Hajime

    2015-09-01

    We report the results of endosaccular coil embolization of asymptomatic unruptured intracranial aneurysms (UIAs) in elderly patients (≥65 years). There were 375 elderly patients with 400 asymptomatic UIAs. Patients were divided into two groups: group A included patients aged 65-74 years and group B patients aged ≥75 years. Endovascular procedures were completed in 97.8% of patients. Immediate anatomical outcomes showed complete occlusion in 53.7%, residual neck in 18.9%, and residual aneurysm in 27.4%. Anatomical follow-ups (mean 36.3±28.1 months) were unchanged in 55.7%, improved in 22.6%, minor recurrence in 11.5%, and major recurrence in 10.2%. Procedure related complications occurred in 31 patients (8.3%). 15 patients had ischemic and 10 hemorrhagic complications. Retreatments were performed in 16 patients (4.3%). Among 366 patients technically completed, 363 (99.2%) showed a favorable clinical outcome (modified Rankin Scale (mRS) score 0 at 30 days. The latest clinical follow-up outcomes showed: mRS score 0 in 362 patients; mRS score 1 in one; mRS score 3 in one; mRS score 4 in one; and mRS score 5 in one patient. Permanent morbidity and mortality rates were 1.1% and 0%, respectively. There were no statistically significant differences in gender, comorbidities, aneurysm size, neck width, dome-to-neck ratio, immediate anatomical outcomes, anatomical follow-up outcomes, or procedure related complications between the groups. Endosaccular coil embolization is safe and feasible for elderly patients with asymptomatic UIAs. Old age itself should not be a contraindication. 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.

  11. MRA of the intracranial circulation in asymptomatic patients with sickle cell disease

    International Nuclear Information System (INIS)

    Gillams, A.R.; McMahon, L.; Weinberg, G.; Carter, A.P.

    1998-01-01

    Background. MR angiography (MRA) provides a mechanism for non-invasively studying blood flow, thus providing a new opportunity to study the intracranial circulation in asymptomatic sickle cell disease (SCD) patients. Although conventional angiography is the gold standard for the depiction of vascular anatomy, this is too invasive for an asymptomatic population. Objective. To establish the range of appearances in asymptomatic SCD patients and to correlate brain MRI results (either sub-clinical abnormalities or normal brain parenchyma) with the MRA findings. Materials and methods. Brain MRI and MRA of the intracranial circulation was performed on 22 patients (13 male and 9 female, median age 7.5 years, range 1.3-20 years). Fourteen were homozygous SS and eight were SC. The median haematocrit at the time of MRI was 25.9 (range 13.8-33.3). Results. On MR imaging, four patients had infarcts in eight vascular territories (six anterior and two posterior). In 3/4 of anterior vascular territories with infarction, long (≥ 6 mm) segments of abnormal signal were seen at the internal carotid artery bifurcation with associated reduced distal flow. Short focal areas of abnormal signal were commonly seen where vessels branched, bifurcated or curved and were not associated with infarcts. These areas probably represent turbulence-related dephasing secondary to high velocity flow found in SCD. Conclusion. Long segments (≥ 6 mm) of abnormal signal with reduced distal flow correlated with sub-clinical infarction. (orig.)

  12. Prevalence and prognosis of asymptomatic coronary artery disease in patients with abdominal aortic aneurysm and minor or no perioperative risks

    International Nuclear Information System (INIS)

    Takigawa, Masateru; Yokoyama, Naoyuki; Yoshimuta, Tsuyoshi; Takeshita, Satoshi

    2009-01-01

    According to the American Heart Association (AHA)/ American College of Cardiology (ACC) guideline 2002, patients with abdominal aortic aneurysm (AAA) with minor or no clinical risk for perioperative cardiovascular events require no preoperative coronary assessment if they have functional capacity greater than 4 METS. Further coronary assessment is not often performed, even after the operation, because of absence of symptoms. The aim of this study was to clarify the prevalence, and prognosis of asymptomatic coronary artery disease (CAD) in such AAA patients. From 2002 to 2006, 201 patients (161 men; mean age 73.1±7.7 years) were classified as minor or no clinical risk for perioperative cardiovascular events. Medical history, and physical, laboratory, plus imaging examinations were evaluated. Prognosis was assessed by telephone canvass. Asymptomatic CAD was found in 59 patients (29.4%). By multivariate analysis, advanced age (≥75 years: odds ratio (OR) 2.43, P=0.018) and family history of CAD (OR 5.27, P=0.001) independently predicted asymptomatic CAD. Asymptomatic CAD did not significantly affect death or cardiac events when treated appropriately. A high prevalence of asymptomatic CAD requiring treatment was shown in these AAA patients. Under appropriate therapies, prognosis was as well preserved as in patients without asymptomatic CAD, which underscored the importance of appropriate assessment and management of asymptomatic CAD. (author)

  13. Asymptomatic neurocognitive disorders in patients infected by HIV: fact or fiction?

    Directory of Open Access Journals (Sweden)

    Torti Carlo

    2011-12-01

    Full Text Available Abstract Neurocognitive disorders are emerging as a possible complication in patients infected with HIV. Even if asymptomatic, neurocognitive abnormalities are frequently detected using a battery of tests. This supported the creation of asymptomatic neurocognitive impairment (ANI as a new entity. In a recent article published in BMC Infectious Diseases, Magnus Gisslén and colleagues applied a statistical approach, concluding that there is an overestimation of the actual problem. In fact, about 20% of patients are classified as neurocognitively impaired without a clear impact on daily activities. In the present commentary, we discuss the clinical implications of their findings. Although a cautious approach would indicate a stricter follow-up of patients affected by this disorder, it is premature to consider it as a proper disease. Based on a review of the data in the current literature we conclude that it is urgent to conduct more studies to estimate the overall risk of progression of the asymptomatic neurocognitive impairment. Moreover, it is important to understand whether new biomarkers or neuroimaging tools can help to identify better the most at risk population. Please see related article: http://www.biomedcentral.com/1471-2334/11/356

  14. A comparative analysis of static balance between patients with lumbar spinal canal stenosis and asymptomatic participants.

    Science.gov (United States)

    Truszczyńska, Aleksandra; Drzał-Grabiec, Justyna; Trzaskoma, Zbigniew; Rąpała, Kazimierz; Tarnowski, Adam; Górniak, Krystyna

    2014-01-01

    The aim of this study was to assess static balance in patients with lumbar spinal canal stenosis who qualified for surgical decompression of associated neural structures and compare them with asymptomatic participants. This case-controlled study evaluated a sample of 50 patients with spinal canal stenosis (stenosis group) and 48 participants with no history of clinical symptoms of back pain. Static balance was assessed by conducting quantitative analysis of balance reaction parameters in quiet standing with the eyes closed. Higher values were observed in total length of center of pressure (COP) path, length of COP path in the anterior-posterior plane, mean amplitude of COP projection in the anterior-posterior plane, maximal amplitude between the 2 most distant points in the anterior-posterior plane, mean COP velocity, and sway area marked by the moving COP in the stenosis group compared with the asymptomatic group. This study showed statistically significant differences in static balance parameters between patients with spinal canal stenosis compared with the asymptomatic group. Copyright © 2014 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

  15. Uncommon Asymptomatic Unilateral Complete Duplicated Collecting System and Giant Ectopic Ureterocele in Middle-Age Patient

    Directory of Open Access Journals (Sweden)

    Halil Serin

    2014-02-01

    Full Text Available Ureterocele is a common pediatric urologic problem, but has been reported seldom in adults. Most duplex system ureteroceles existent as urinary tract infections at an early age, with adult presentation being uncommon. Urinary stasis in the dilated distal ureter often lends to urinary infection and stone formation; precluding the most common offering symptoms of dysuria, urgency, and recurrent urinary tract infections. Ižn duplex system ureteroceles to poorly or non-functioning moieties, heminephroureterectomy is an definite solution. We present a case of rarely middle-age asymptomatic obstructive giant ureterocele. We intended to emphasize that patient with obstructive, giant, ectopic ureterocele and duplicated collecting system may have asymptomatic course.

  16. Anastomotic pseudoaneurysms after surgical reconstruction: Outcomes after endovascular repair of symptomatic versus asymptomatic patients

    International Nuclear Information System (INIS)

    Nolz, Richard; Gschwendtner, Manfred; Jülg, Gregor; Plank, Christina; Beitzke, Dietrich; Teufelsbauer, Harald; Wibmer, Andreas; Kretschmer, Georg; Lammer, Johannes

    2012-01-01

    Purpose: To compare perioperative and follow-up outcomes of symptomatic versus asymptomatic patients following endovascular repair of anastomotic pseudoaneurysms (APAs) of the abdominal aorta and iliac arteries. Methods: We retrospectively evaluated 17 patients (two women), with a mean age of 66.2 years (range 30–83 years). Endovascular treatment was performed in ten symptomatic, and seven asymptomatic patients electively. Data included technical success, perioperative (within 30 days) mortality and morbidity, as well as stent graft-related complications, reinterventions, and survival in follow-up. Results: Bifurcated (n = 13), aortomonoiliac (n = 3) endoprosthesis and one aortic cuff were implanted with a primary technical success rate of 100%. The overall in-hospital mortality and morbidity rate was 11.8% and 35.3%. The mean survival was 36.5 (range 0–111) months. There was a clear trend toward a lower overall survival within hospital and at one and three years for symptomatic patients compared to asymptomatic patients. (47.7 (CI: 0–138.8) versus 52.6 (CI: 28.5–76.8) months (p = 0.274)). During follow-up, late stent graft related complications were observed in six patients (35.3%) necessitating eight endovascular reinterventions. Additional three patients with primary fistulas between the APA and the intestine were treated by late surgical revision. Conclusion: Endovascular therapy of APAs represents a considerable alternative to open surgical repair. Short proximal anchoring zones still pose a risk for endoleaks and unintentional overstenting of side branches with commercially available devices, but this might be overcome by use of fenestrated and branched stent grafts in elective cases.

  17. Immunological differences between insect venom-allergic patients with and without immunotherapy and asymptomatically sensitized subjects.

    Science.gov (United States)

    Arzt, L; Bokanovic, D; Schrautzer, C; Laipold, K; Möbs, C; Pfützner, W; Herzog, S A; Vollmann, J; Reider, N; Bohle, B; Aberer, W; Sturm, G J

    2017-11-23

    Currently available tests are unable to distinguish between asymptomatic sensitization and clinically relevant Hymenoptera venom allergy. A reliable serological marker to monitor venom immunotherapy (VIT) does also not exist. Our aim was to find reliable serological markers to predict tolerance to bee and vespid stings. We included 77 asymptomatically sensitized subjects, 85 allergic patients with acute systemic sting reactions, and 61 allergic patients currently treated with VIT. Levels of sIgE and sIgG 4 to bee and vespid venom, rApi m 1, and rVes v 5 were measured immediately after allergic sting reactions or before sting challenges and 4 weeks later. All sting challenges were tolerated. The inhibitory activity was determined using BAT inhibition and ELIFAB assay. Median sIgG 4 levels were 96-fold higher in VIT patients (P venom, but not in those treated with bee venom. Four weeks after the sting, sIgE and sIgG 4 levels were increased in allergic and asymptomatically sensitized patients, but not in VIT patients. Immunological responses after stings varied in bee and vespid venom-allergic patients. In patients under VIT, sIgE and sIgG 4 remained completely stable after sting challenges. Monitoring VIT efficacy was only possible in vespid venom allergy, and the sIgG 4 threshold for rVes v 5 had the highest sensitivity to confirm tolerance. The BAT inhibition test was the most reliable tool to confirm tolerance on an individual basis. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

  18. Asymptomatic versus symptomatic episodes in patients with paroxysmal atrial fibrillation via long-term monitoring with implantable loop recorders.

    Science.gov (United States)

    Simantirakis, E N; Papakonstantinou, P E; Chlouverakis, G I; Kanoupakis, E M; Mavrakis, H E; Kallergis, E M; Arkolaki, E G; Vardas, P E

    2017-03-15

    The presentation of atrial fibrillation (AF) varies remarkably, from totally asymptomatic to symptomatic patients, while the same individual may present symptomatic and asymptomatic episodes. We aimed to identify electrocardiographic differences between symptomatic and asymptomatic episodes and to find parameters related to the appearance of symptoms. Thirty consecutive patients (age 66.9±10years) with paroxysmal AF received an implantable loop recorder. Three types of episodes were defined: asymptomatic (ASx), symptomatic (Sx), and mixed asymptomatic-symptomatic (AS-Sx). The heart rate (HR) and heart rate variability (HRV) were recorded during the first 2min of each ASx or Sx episode, and during the first 2min of both the symptomatic and asymptomatic periods in AS-Sx. Eighty-two episodes from twenty-five patients were evaluated. Mean HR was 142.48±25.84bpm for Sx and 95.71±19.29bpm for ASx (pASx (pASx were characterized by a lower HR and higher HRV compared to Sx. In As-Sx, the asymptomatic period was characterized by a lower HR and higher HRV compared to the symptomatic. These findings suggest a possible contribution of variations in the autonomic nervous system activity to the perception of the arrhythmia. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. Left atrial size and function as predictors of new-onset of atrial fibrillation in patients with asymptomatic aortic stenosis

    DEFF Research Database (Denmark)

    Bang, Casper Niels Furbo; Dalsgaard, Morten; Greve, Anders

    2013-01-01

    Left atrial (LA) size and function change with chronically increased left ventricular (LV) filling pressures. It remains unclear whether these variations in LA parameters can predict new-onset atrial fibrillation (AF) in asymptomatic patients with aortic stenosis (AS).......Left atrial (LA) size and function change with chronically increased left ventricular (LV) filling pressures. It remains unclear whether these variations in LA parameters can predict new-onset atrial fibrillation (AF) in asymptomatic patients with aortic stenosis (AS)....

  20. Evaluation of cardiovascular anomalies in patients with asymptomatic turner syndrome using multidetector computed tomography.

    Science.gov (United States)

    Lee, Sun Hee; Jung, Ji Mi; Song, Min Seob; Choi, Seok jin; Chung, Woo Yeong

    2013-08-01

    Turner syndrome is well known to be associated with significant cardiovascular abnormalities. This paper studied the incidence of cardiovascular abnormalities in asymptomatic adolescent patients with Turner syndrome using multidetector computed tomography (MDCT) instead of echocardiography. Twenty subjects diagnosed with Turner syndrome who had no cardiac symptoms were included. Blood pressure and electrocardiography (ECG) was checked. Cardiovascular abnormalities were checked by MDCT. According to the ECG results, 11 had a prolonged QTc interval, 5 had a posterior fascicular block, 3 had a ventricular conduction disorder. MDCT revealed vascular abnormalities in 13 patients (65%). Three patients had an aberrant right subclavian artery, 2 had dilatation of left subclavian artery, and others had an aortic root dilatation, aortic diverticulum, and abnormal left vertebral artery. As for venous abnormalities, 3 patients had partial anomalous pulmonary venous return and 2 had a persistent left superior vena cava. This study found cardiovascular abnormalities in 65% of asymptomatic Turner syndrome patients using MDCT. Even though, there are no cardiac symptoms in Turner syndrome patients, a complete evaluation of the heart with echocardiography or MDCT at transition period to adults must be performed.

  1. Frequency of hepatitis B in asymptomatic patients of district Headquarter hospital Kotli, Azad Kashmir

    International Nuclear Information System (INIS)

    Sarwar, J.; Ahmad, W.; Saleem, M.; Jamshed, F.; Gul, N.; Idrees, M.

    2010-01-01

    Background: Hepatitis B is prevalent throughout the world including Pakistan. A large proportion of patients suffering from Hepatitis B may be asymptomatic and can transmit the disease to healthy population. Objectives of this study were to estimate the frequency of Hepatitis B in asymptomatic adult population coming to District Headquarter Hospital Kotli, Azad Kashmir and to determine the risk factors associated with its transmission. Methods: This was a cross-sectional study extending from January to December 2008. Subjects were randomly selected from those who attended the medial OPD of DHQ Hospital Kotli, Azad Kashmir for non-Hepatitis related problems. Both males and females between the ages of 15-80 years were included in the study. Blood samples taken from selected subjects were analysed for Hepatitis B surface antigen (HBsAg) by Immuno chromatographic kit methods (ICT). Hepatitis B positive samples were further confirmed by third generation ELIZA. The patients thus confirmed were interrogated for different risk factors associated with transmission of Hepatitis B. Results: A total of 9,564 patients were analysed. Out of them 4230 (44.22%) were males and 5334 (55.77%) were females. Overall 141 (1.47%) patients were positive for HBSAg, 71 (1.68%) males and 70 (1.31%) females. Patients between 21-30 years of age were most commonly effected (35.46%, n=50). Blood transfusion was the most common risk factor (24.82%, n=35) associated with Hepatitis B transmission followed by dental procedures (14.18%, n=20). Conclusion: Frequency of Hepatitis B in asymptomatic people in this study was quite high. Blood transfusions and dental procedures were the most common risk factors associated with the transmission of Hepatitis B. (author)

  2. Usefulness of true FISP cine MR imaging in patients with poor cardiac function

    International Nuclear Information System (INIS)

    Sakuma, Toshiharu; Yamada, Naoaki; Motooka, Makoto; Enomoto, Naoyuki; Maeshima, Isamu; Matsuda, Kazuhide; Urayama, Shinichi; Ikeo, Miki

    2002-01-01

    This study was done to assess the value of True FISP cine in patients with poor cardiac function. True FISP cine and FLASH cine imaging were performed on a 1.5 T machine. Both short axis and horizontal long axis imaging sections were used. The imaging sections used a Matrix (120 x 128), FOV (24 x 32 cm), and had a slice thickness of 8 mm. The imaging time for True FISP cine was 8 heart beats and 17 heart beats for FLASH cine. The contrast-to-noise ratio between the blood and myocardium (CNR) was measured at enddiastole and endsystole. The subjects in the study were 10 healty volunteers (average age 26.5±3.2 years) and 12 patients with hypofunction (average age 53.9±13.2 years). In the volunteers, the CNR of the short axis imaging was similar in both True FISP (24.6±3.7) and FLASH (23.4±5.9). In the patients with poor cardiac function however, the CNR of True FISP was larger than FLASH in both the short and long axis. In the short axis (22.7±6.1 vs. 17.9±5.3, P<0.01) and in the long axis (17.4±4.3 vs. 9.3±4.0, P<0.01). We conclude that True FISP cine has a higher contrast in a shorter imaging time than FLASH cine. True FISP cine is especially useful in patients with poor cardiac function. (author)

  3. Plasma copeptin as marker of cardiovascular disease in asymptomatic type 2 diabetes patients

    DEFF Research Database (Denmark)

    Bar-Shalom, Dana; Poulsen, Mikael K; Rasmussen, Lars M

    2014-01-01

    Recently, copeptin was found associated with cardiovascular disease (CVD) and all-cause mortality in type 2 diabetes mellitus (T2DM) patients treated in primary care. This study aimed to evaluate whether plasma copeptin correlated to CVD in asymptomatic T2DM patients intensively investigated...... for sub-clinical CVD. A total of 302 T2DM patients referred to the Diabetes Clinic at Odense University Hospital, Denmark, entered the study. None of the patients had known or suspected CVD. As a control group, 30 healthy adults were recruited from the DanRisk study - a random sample of middle-aged Danes...... correlations between creatinine, copeptin levels and PAD in T2DM patients, and if confirmed, plasma copeptin combined with plasma creatinine could be a candidate for PAD screening in T2DM patients....

  4. The Association between Myocardial Iron Load and Ventricular Repolarization Parameters in Asymptomatic Beta-Thalassemia Patients

    Directory of Open Access Journals (Sweden)

    Mehmet Kayrak

    2012-01-01

    Full Text Available Previous studies have demonstrated impaired ventricular repolarization in patients with β-TM. However, the effect of iron overload with cardiac T2* magnetic resonance imaging (MRI on cardiac repolarization remains unclear yet. We aimed to examine relationship between repolarization parameters and iron loading using cardiac T2* MRI in asymptomatic β-TM patients. Twenty-two β-TM patients and 22 age- and gender-matched healthy controls were enrolled to the study. From the 12-lead surface electrocardiography, regional and transmyocardial repolarization parameters were evaluated manually by two experienced cardiologists. All patients were also undergone MRI for cardiac T2* evaluation. Cardiac T2* score <20 msec was considered as iron overload status. Of the QT parameters, QT duration, corrected QT interval, and QT peak duration were significantly longer in the β-TM group compared to the healthy controls. Tp−Te and Tp−Te dispersions were also significantly prolonged in β-TM group compared to healthy controls. (Tp-Te/QT was similar between groups. There was no correlation between repolarization parameters and cardiac T2* MRI values. In conclusion, although repolarization parameters were prolonged in asymptomatic β-TM patients compared with control, we could not find any relation between ECG findings and cardiac iron load.

  5. [Anti-neutrophil cytoplasmic antibodies (ANCA) in patients with symptomatic and asymptomatic HIV infection].

    Science.gov (United States)

    Habegger de Sorrentino, A; Motta, P; Iliovich, E; Sorrentino, A P

    1997-01-01

    The cytopathic effect of HIV on CD4 T cells, as well as the active autoimmune mechanism occurring during infection, have been documented. Of the cytokines involved in the pathogenesis of AIDS, the main one produced by the monocyte-macrophage series is tumor necrosis factor alfa (TNF alpha). This cytokine induces antigens such as proteinase 3 (Pr 3) or mieloperoxidase (MPO). Anti-neutrophil cytoplasmic antibodies (ANCA) are directed against this type of PMN antigens. In the present paper, the role of anti-neutrophil cytoplasmic antibodies (ANCA) in HIV infected patients as responsible for autoimmune phenomena in relation to opportunistic infections, was studied. A total of 88 serum samples belonging to 49 asymptomatic and 39 symptomatic HIV infected patients were tested for ANCA by an indirect immunofluorescence (IIF) test over a neutrophil substrate. ANCA were detected in 53.8% of symptomatic patients as compared to 4.1% in asymptomatic cases (p tuberculosis is a frequent finding in HIV infected patients from Northeastern Argentina. When the presence of ANCA in TB(+) HIV(+) and TB(+) HIV(-) patients was studied, it was seen that positive-ANCA significantly correlated with the first group (p pulmonar TB, could indicate that the virus may not be responsible for the induction of these antibodies.

  6. Bleeding and asymptomatic overdose in patients under Vitamin K antagonist therapy: Frequency and risk factors

    Directory of Open Access Journals (Sweden)

    F. Ben Mbarka

    2018-03-01

    Full Text Available Background: Vitamin K antagonists are widely used in the treatment and prevention of thromboembolic disease. However, these drugs can cause serious side effects, especially bleeding. This study aims to evaluate frequency and risk factors of both bleeding and asymptomatic overdose in North African patients undergoing Vitamin K antagonist therapy. Methods: We performed a cross-sectional study in patients undergoing Vitamin K antagonist therapy. A statistical analysis has been conducted to identify overdose and bleeding risk factors by using chi-square test (p < .05. Results: One hundred and eleven patients were included. We recorded 14 cases of bleeding and 26 cases of asymptomatic overdose. Advanced age, poor adherence, concomitant use of paracetamol and history of previous bleeding are significant risk factors of over-anticoagulation. An INR value over 6 at admission, a high therapeutic target range for INR, concomitant use of acetylsalicylic acid, lack of information on overdose signs and measures to be taken in case of bleeding were identified as risk factors for bleeding. Conclusion: Most of the risk factors identified in our study seem to be related to patients lack of information and education. These results highlight the importance of creating a therapeutic patient education program. Keywords: Vitamin K antagonist, Bleeding, Risk factor, Overdose

  7. Lipoprotein(a) levels are associated with aortic valve calcification in asymptomatic patients with familial hypercholesterolaemia.

    Science.gov (United States)

    Vongpromek, R; Bos, S; Ten Kate, G-J R; Yahya, R; Verhoeven, A J M; de Feyter, P J; Kronenberg, F; Roeters van Lennep, J E; Sijbrands, E J G; Mulder, M T

    2015-08-01

    Lipoprotein(a) [Lp(a)] is an independent risk factor for aortic valve stenosis and aortic valve calcification (AVC) in the general population. In this study, we determined the association between AVC and both plasma Lp(a) levels and apolipoprotein(a) [apo(a)] kringle IV repeat polymorphisms in asymptomatic statin-treated patients with heterozygous familial hypercholesterolaemia (FH). A total of 129 asymptomatic heterozygous FH patients (age 40-69 years) were included in this study. AVC was detected using computed tomography scanning. Lp(a) concentration and apo(a) kringle IV repeat number were measured using immunoturbidimetry and immunoblotting, respectively. Univariate and multivariate logistic regression were used to assess the association between Lp(a) concentration and the presence of AVC. Aortic valve calcification was present in 38.2% of patients, including three with extensive AVC (>400 Agatston units). Lp(a) concentration was significantly correlated with gender, number of apo(a) kringle IV repeats and the presence and severity of AVC, but not with coronary artery calcification (CAC). AVC was significantly associated with plasma Lp(a) level, age, body mass index, blood pressure, duration of statin use, cholesterol-year score and CAC score. After adjustment for all significant covariables, plasma Lp(a) concentration remained a significant predictor of AVC, with an odds ratio per 10-mg dL(-1) increase in Lp(a) concentration of 1.11 (95% confidence interval 1.01-1.20, P = 0.03). In asymptomatic statin-treated FH patients, plasma Lp(a) concentration is an independent risk indicator for AVC. © 2014 The Association for the Publication of the Journal of Internal Medicine.

  8. Cerebral ischemia and asymptomatic coronary artery disease: a prospective study of 83 patients

    International Nuclear Information System (INIS)

    Di Pasquale, G.; Andreoli, A.; Pinelli, G.; Grazi, P.; Manini, G.; Tognetti, F.; Testa, C.

    1986-01-01

    A prospective cardiologic evaluation was performed in 83 consecutive patients with transient cerebral ischemia or mild stroke and without symptoms or electrocardiographic signs of ischemic heart disease. Patients were studied with an electrocardiographic exercise test; a positive test was followed by exercise Thallium-201 myocardial scintigraphy. Results were compared to those obtained in a group of 83 age and sex-matched healthy subjects submitted to the same study protocol. Asymptomatic coronary artery disease was detected in 28% of cerebrovascular patients with adequate electrocardiographic exercise test. A scintigraphic perfusion defect of variable extension was found in 19 of them. In the control group the electrocardiographic exercise test was positive in only 6% (p less than 0.01). Our results support the concept that: asymptomatic ischemic heart disease is often associated with cerebrovascular disease; therefore cerebral ischemic attacks may be a marker of coronary artery disease, an active investigation of the heart should be considered in cerebrovascular patients in order to plan optimal, comprehensive management

  9. Prognostic value of myocardial sympathetic activity in patients with asymptomatic myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Michihiro; Kurihara, Tadashi; Sindoh, Takashi; Sawada, Yoshihiro [Sumitomo Hospital, Osaka (Japan)

    1999-04-01

    To clarify the significance of myocardial sympathetic activity in patients with asymptomatic myocardial infarction (MI), we performed {sup 123}I-metaiodobenzyl-guanidine (MIBG) and {sup 201}Tl imaging at rest. We calculated the ratio of cardiac uptake of the isotope to the total injected dose (%Uptake), percent washout of MIBG over 3 hours and the Uptake Ratio (UR, %Uptake of MIBG divided by %Uptake of {sup 201}Tl). We compared these indices with clinical findings, exercise stress-rest myocardial perfusion imaging with {sup 99}Tc-methoxy-2-isobutyl isonitrile, coronary angiography, echocardiography and neurohumoral findings. During the follow-up period of 19.9{+-}10.3 months in 32 patients, events (heart failure or cardiac death) developed in 10 (31%). In univariate analysis, diabetes mellitus, atrial fibrillation, left ventricular end-diastolic dimension (LVDd) greater than 54 mm, and the %Uptake of MIBG and UR differed significantly between event and event-free groups. Cox proportional hazard model showed that the UR was a predictor of events (p=0.0007). In patients with UR less than 0.58, the relative risk of events was 19.1 times greater than in patients with an UR greater than 0.58. UR was closely correlated to LVDd (r=-0.578, p=0.01) suggesting that myocardial sympathetic activity is related to LV remodeling after MI. MIBG imaging provides important information regarding the prognosis and the pathophysiologic process of asymptomatic MI. (author)

  10. Frequency of hepatitis C in asymptomatic patients in district headquarters hospital Kotli, Azad Kashmir

    International Nuclear Information System (INIS)

    Saleem, M.; Ahmad, W.; Sarwar, J.

    2011-01-01

    Background: Hepatitis C is a common problem in developing world. It can affect a large number of asymptomatic people in whom it may cause serious complications in long run. Moreover, these asymptomatic infected people pose a serious risk for the transmission of infection to healthy population. Objective of this study was to estimate the frequency of Hepatitis C in asymptomatic adult patients attending medical OPD of District Headquarters Hospital Kotli, Azad Kashmir, and to assess the risk factors associated with its transmission. Methods: This was a cross-sectional study that included asymptomatic patients of both genders, aged 15-80 years, attending medical OPD of District Head quarter Hospital Kotli, Azad Kashmir from January to December, 2008. They attended the OPD for problems other than Hepatitis and most of them presented with vague complaints like generalised body aches, tiredness and dyspeptic symptoms. They were randomly tested for Hepatitis C virus (HCV) antibodies by Immuno chromatographic kit method. Positive samples for Hepatitis C antibodies were confirmed by third generation ELISA. Those who were confirmed were assessed for the risk factors associated with HCV transmission. Results: The study included 9,564 patients. Out of them 4,2 (44.22%) were males and 5,334 (55.77%) were females. A total of 611 (6.38%) cases were positive for HCV; 257 (6.08%) were males, and 354 (6.64%) were females. Highest frequency (36%) was found between 21 and 30 years of age, and 60.54% positive patients were 21-40 years old. Blood transfusion was the most common (34.36%) risk factor followed by history of dental procedures (24.54%). In 27.16% no risk factor could be detected. Conclusion: Frequency of Hepatitis C is quite high in our population. Rate is higher in young adults. It is needed to adopt organised preventive strategies to overcome this problem. Blood transfusion is still the most significant risk factor followed by dental and surgical procedures. Health related

  11. Scrub typhus masquerading as HELLP syndrome and puerperal sepsis in an asymptomatic malaria patient.

    Science.gov (United States)

    Karim, Habib Md Reazaul; Bhattacharyya, Prithwis; Kakati, Sonai Datta; Borah, Tridip Jyoti; Yunus, Md

    2016-01-01

    Scrub typhus and malaria can involve multiple organ systems and are notoriously known for varied presentations. However, clinical malaria or scrub typhus is unusual without fever. On the other hand, altered sensorium with or without fever, dehydration, hemorrhage and hemolysis may lead to low blood pressure. Presence of toxic granules and elevated band forms in such patients can even mimic sepsis. When such a patient is in the peripartum period, it creates a strong clinical dilemma for the physician especially in unbooked obstetric cases. We present such a case where a 26-year-old unbooked female presented on second postpartum day with severe anemia, altered sensorium, difficulty in breathing along with jaundice and gum bleeding without history of fever. Rapid diagnostic test for malaria was negative and no eschar was seen. These parameters suggested a diagnosis of HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet) syndrome with or without puerperal sepsis. Subsequently she was diagnosed as having asymptomatic malaria and scrub typhus and responded to the treatment of it. The biochemical changes suggestive of HELLP syndrome also subsided. We present this case to emphasize the fact that mere absence of fever and eschar does not rule out scrub typhus. It should also be considered as a differential diagnosis in patients with symptoms and signs suggesting HELLP syndrome. Asymptomatic malaria can complicate case scenario towards puerperal sepsis by giving false toxic granules and band form in such situations.

  12. Redundant nerve roots of cauda equina in clinically neurologically asymptomatic patients. A clinical and radiographic study

    International Nuclear Information System (INIS)

    Otoshi, Ken-ichi; Kikuchi, Shin-ichi; Konno, Shin-ichi; Arai, Itaru

    2005-01-01

    A radiographic study was conducted to determine the incidence of redundant nerve roots of the cauda equina (RNR) in neurologically asymptomatic patients, and to clarify whether RNR has an impact on the clinical symptom. 50 patients who had spine disease such as spondylosis and compression fracture were examined by MRI. They didn't have neurological symptom such as sciatica, leg numbness, and motor weakness of lower extremities. There were 18 men and 32 women, and their mean age was 72.4 years (range: 32-87 years). RNR was found in 18 of the 50 patients (36.0%) and in a higher percentage of the patients who had lumber spinal canal stenosis. We concluded that RNR was only a morphological change of the cauda equine and had little effect on the neurological symptom. (author)

  13. Should incidental asymptomatic angiographic stenoses and occlusions be treated in patients with peripheral arterial disease?

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2009-09-01

    The clinical importance of angiographically detected asymptomatic lower-limb stenoses and occlusions is unknown. This study aims to (i) assess the clinical outcome of asymptomatic lesions in the lower limb, (ii) identify predictors of clinical deterioration, and (iii) determine which asymptomatic lower-limb lesions should be treated at presentation.

  14. Effect of carotid endarterectomy on retinal function in asymptomatic patients with hemodynamically significant carotid artery stenosis.

    Science.gov (United States)

    Machalińska, Anna; Kowalska-Budek, Aleksandra; Kawa, Miłosz Piotr; Kazimierczak, Arkadiusz; Safranow, Krzysztof; Kirkiewicz, Marta; Rynio, Paweł; Wilk, Grażyna; Lubiński, Wojciech; Gutowski, Piotr; Machaliński, Bogusław

    2017-11-30

    INTRODUCTION    The corrective effect of carotid endarterectomy (CEA) on impaired ophthalmic artery flow in patients with significant internal carotid artery (ICA) stenosis presenting with ocular ischemic syndrome (ie, symptomatic patients) is well established. However, there is no clear evidence regarding the efficacy of CEA for improvement of neuroretinal function in patients without symptoms of ocular ischemic syndrome. OBJECTIVES    We aimed to determine the effects of CEA on retinal function in asymptomatic patients with hemodynamically significant ICA stenosis. PATIENTS AND METHODS    We enrolled 46 patients with ICA stenosis referred for CEA. Full-field electroretinogram (ERG), pattern ERG, and pattern visual evoked potentials, as well as optical coherence tomography and ophthalmologic examination of both eyes were performed 1 day before and 3 months after CEA. We analyzed eyes ipsilateral (EIE) and contralateral (ECE) to CEA. RESULTS    We observed an increase in several ERG wave parameters in both eye groups, compared with baseline values: rod b-wave amplitudes (P <0.00001 for EIE and P = 0.0001 for ECE); rod-cone a-wave (P = 0.02 for EIE) and b-wave (P = 0.001 for EIE and P = 0.01 for ECE) amplitudes; cone single flash a-wave (P = 0.05 for EIE and P = 0.004 for ECE) and b-wave (P <0.0001 for EIE and P <0.0001 for ECE) amplitudes; cone 30-Hz flicker amplitudes (P = 0.0003 for EIE and P <0.0001 for ECE); and oscillatory potential wave index amplitudes (P <0.00001 for EIE). CONCLUSIONS    The amplitudes of the standard full-field ERG were significantly increased following CEA in EIE and, to a lesser extent, in ECE. Multimodality ERG may represent a unique tool for investigating the effects of carotid revascularization on neuroretinal function in asymptomatic patients with ICA stenosis.

  15. Dysregulation of coronary microvascular reactivity in asymptomatic patients with type 2 diabetes mellitus

    Energy Technology Data Exchange (ETDEWEB)

    Momose, Mitsuru; Neverve, Jodi; Nekolla, Stephan G.; Schwaiger, Markus; Bengel, Frank M. [Nuklearmedizinische Klinik und Poliklinik der Technischen Universitaet Muenchen, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675 Munich (Germany); Abletshauser, Claudia [Department of Medicine, Novartis Pharma GmbH, Nuernberg (Germany); Schnell, Oliver; Standl, Eberhard [Institut fuer Diabetesforschung, Munich (Germany)

    2002-12-01

    In diabetic patients, a number of studies have suggested an impairment of vascular reactivity in response to vasodilatory stimuli. The pattern of dysregulation at the coronary microcirculatory level, however, has not been clearly defined. Thus, it was the aim of this study to characterise coronary microvascular function non-invasively in a homogeneous group of asymptomatic type 2 diabetic patients. In 46 patients with type 2 diabetes, myocardial blood flow (MBF) was quantified at baseline, in response to cold pressor test (CPT) and during adenosine-mediated vasodilation using positron emission tomography and nitrogen-13 ammonia. None of the patients had been treated with insulin, and none had symptoms of cardiac disease. Decreased MBF during CPT, indicating microvascular dysregulation, was observed in 16 patients (CPT-), while 30 patients demonstrated increased MBF during CPT (CPT+). Response to CPT was mildly, but significantly correlated with response to adenosine (r=0.44, P=0.0035). There was no difference in HbA1c, serum lipid levels or serum endothelial markers between the groups. Microvascular dysregulation in the CPT- group was associated with elevated baseline MBF (P<0.0001), reduced baseline vascular resistance (P=0.0026) and an abnormal increase in resistance during CPT (P=0.0002). In conclusion, coronary microvascular dysregulation is present in approximately one-third of asymptomatic, non-insulin-treated type 2 diabetic patients. Elevated baseline blood flow and reduced microvascular resistance at rest are characteristics of this dysregulation. These data suggest a state of activation of endothelial-dependent vasodilation at baseline which appears to limit the flow response to stress conditions. (orig.)

  16. Prevalence of colon polyps detected by colonoscopy screening in asymptomatic black and white patients

    Science.gov (United States)

    Lieberman, David; Holub, Jennifer; Moravec, Matthew; Eisen, Glenn; Peters, Dawn; Morris, Cynthia

    2013-01-01

    Context Compared to whites, Black men and women have a higher incidence and mortality from colorectal cancer and may develop cancer at a younger age. Colorectal cancer screening might be less effective in Blacks, if there are racial differences in the age-adjusted prevalence and location of cancer precursor lesions. Objectives To determine and compare the prevalence rates and location of polyp(s) >9mm in asymptomatic Blacks and whites who receive colonoscopy screening. Design, Setting, and Patients Colonoscopy data were prospectively collected from 67 practice sites in the United States using a computerized endoscopic report generator from 2004–2005. Data were transmitted to a central data repository, where all asymptomatic whites (n = 80,061) and Blacks (n = 5464) who received screening colonoscopy were identified. Main outcome measures Prevalence and location of polyp(s) >9mm, adjusted for age, gender, and family history of colorectal cancer in a multivariate analysis. Results Both Black men and women had a higher prevalence of polyp(s) >9mm (7.7 versus 6.2%; p 9mm (OR 1.133; 95% CI 0.93,1.38). However, in a sub-analysis of patients over age 60 years, proximal polyps >9mm were more likely in Black men (p = 0.026) and women (p9mm, and Black over age 60 years are more likely to proximal polyps >9mm. PMID:18812532

  17. A three centre audit of IVU referrals in patients with asymptomatic microscopic haematuria.

    Science.gov (United States)

    Rockall, A G; Wetton, C W; Thomas, K E; Kellett, M J

    1996-04-01

    There is considerable debate concerning the investigation of patients with asymptomatic microscopic haematuria. Urine dipstick testing is a sensitive screening test but may be positive in some normal individuals. The present consensus is that urine microscopy should be performed to confirm haematuria prior to further investigation. We have performed a retrospective study to establish whether urine microscopy was used in addition to dipstick testing before a request for intravenous urography (IVU) in three centres. IVU request forms from a District General, a Teaching Hospital and a Uroradiological Referral Centre were audited over a 9-month-period. Patients referred with asymptomatic microscopic haematuria were selected. The case notes and urine microscopy results were reviewed. The date of microscopy and its result and the interval between the result and the IVU request were established. One hundred and two cases have been examined, 17 (16.7%) of which were under the age of 40. Only 37 in total had significant haematuria on microscopy and of these, 32 results (31.4% of all cases) were available before the IVU request. In eight patients there was no evidence that urine microscopy had been performed. Fourteen patients had a urinary tract infection. Our findings show that IVUs are often requested on the basis of dipstick testing alone. Only one third of patients had confirmed significant haematuria at the time of IVU request and in some patients infection had not yet been excluded. Although prompt investigation of microscopic haematuria is important, it is essential that the diagnosis is established by microscopy before an IVU is requested.

  18. Evaluation of Asymptomatic Peripheral Arterial Disease by Ankle-brachial Index in Patients with Concomitant Coronary Arterial Disease

    Directory of Open Access Journals (Sweden)

    Hosein Vakili

    2012-12-01

    Full Text Available Background: Peripheral arterial disease is associated with adverse cardiovascular outcomes. As such, it is found that screening for peripheral arterial disease (PAD improves risk assessment. Thus, intensive risk factor modification and medical treatment in these patients are necessary. Objectives: The purpose of this study was to determine the prevalence of asymptomatic peripheral arterial disease in patients with concomitant coronary arterial disease. Methods: Asymptomatic peripheral arterial disease was investigated in 400 patients (60% males, 40% females, aged 59.7± 11.3 with a documented coronary arterial disease. Results: Among patients with documented CAD, 12% had asymptomatic PAD with the ABI ratio of less than 0.9. Conclusions: It is advisable to screen for PAD not only as a disease but also as a risk assessment method for atherosclerosis.

  19. Musculoskeletal loading in the symptomatic and asymptomatic knees of middle-aged osteoarthritis patients.

    Science.gov (United States)

    Sritharan, Prasanna; Lin, Yi-Chung; Richardson, Sara E; Crossley, Kay M; Birmingham, Trevor B; Pandy, Marcus G

    2017-02-01

    This study quantified the contributions by muscles, gravity, and inertia to the tibiofemoral compartment forces in the symptomatic (SYM) and asymptomatic (ASYM) limbs of varus mal-aligned medial knee osteoarthritis (OA) patients, and compared the results with healthy controls (CON). Muscle forces and tibiofemoral compartment loads were calculated using gait data from 39 OA patients and 15 controls aged 49 ± 7 years. Patients exhibited lower knee flexion angle, higher hip abduction, and knee adduction angles, lower internal knee flexion torque but higher external knee adduction moment. Muscle forces were highest in CON except hamstrings, which was highest in SYM. ASYM muscle forces were lowest for biceps femoris short head and gastrocnemius but otherwise intermediate between SYM and CON. In all subjects, vasti, hamstrings, gastrocnemius, soleus, gluteus medius, gluteus maximus, and gravity were the largest contributors to medial compartment force (MCF). Inertial contributions were negligible. Highest MCF was found in SYM throughout stance. Small increases in contributions from hamstrings, gluteus maximus, gastrocnemius, and gravity at the first peak; soleus and rectus femoris at the second peak; and soleus, gluteus maximus, gluteus medius, and gravity during mid-stance summed to produce significantly higher total MCF. Compared to CON, the ASYM limb exhibited similar peak MCF but higher mid-stance MCF. In patients, diminished non-knee-spanning muscle forces did not produce correspondingly diminished MCF contributions due to the influence of mal-alignment. Our findings emphasize consideration of muscle function, lower-limb alignment, and mid-stance loads in developing interventions for OA, and inclusion of the asymptomatic limb in clinical assessments. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:321-330, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  20. Pathophysiologic assessment of left ventricular hypertrophy and strain in asymptomatic patients with essential hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Pringle, S.D.; Macfarlane, P.W.; McKillop, J.H.; Lorimer, A.R.; Dunn, F.G.

    1989-05-01

    To investigate the significance of the electrocardiographic (ECG) pattern of left ventricular hypertrophy and strain, two groups of asymptomatic patients with essential hypertension were compared. The patients were similar in terms of age, smoking habit, serum cholesterol and blood pressure levels, but differed in the presence (Group I, n = 23) or absence (Group II, n = 23) of the ECG pattern of left ventricular hypertrophy and strain. Group I patients had significantly more episodes of exercise-induced ST segment depression (14 versus 4, p less than 0.05) and reversible thallium perfusion abnormalities (11 of 23 versus 3 of 23, p less than 0.05) despite similar exercise capacity and absence of chest pain. Nonsustained ventricular tachycardia was detected on 24 h ambulatory ECG monitoring in two patients in Group I, but no patient in Group II. Coronary arteriography performed in 20 Group I patients demonstrated significant coronary artery disease in 8 patients. This study has shown that there is a subgroup of hypertensive patients with ECG left ventricular hypertrophy and strain who have covert coronary artery disease. This can be detected by thallium perfusion scintigraphy, and may contribute to the increased risk known to be associated with this ECG abnormality.

  1. Pathophysiologic assessment of left ventricular hypertrophy and strain in asymptomatic patients with essential hypertension

    International Nuclear Information System (INIS)

    To investigate the significance of the electrocardiographic (ECG) pattern of left ventricular hypertrophy and strain, two groups of asymptomatic patients with essential hypertension were compared. The patients were similar in terms of age, smoking habit, serum cholesterol and blood pressure levels, but differed in the presence (Group I, n = 23) or absence (Group II, n = 23) of the ECG pattern of left ventricular hypertrophy and strain. Group I patients had significantly more episodes of exercise-induced ST segment depression (14 versus 4, p less than 0.05) and reversible thallium perfusion abnormalities (11 of 23 versus 3 of 23, p less than 0.05) despite similar exercise capacity and absence of chest pain. Nonsustained ventricular tachycardia was detected on 24 h ambulatory ECG monitoring in two patients in Group I, but no patient in Group II. Coronary arteriography performed in 20 Group I patients demonstrated significant coronary artery disease in 8 patients. This study has shown that there is a subgroup of hypertensive patients with ECG left ventricular hypertrophy and strain who have covert coronary artery disease. This can be detected by thallium perfusion scintigraphy, and may contribute to the increased risk known to be associated with this ECG abnormality

  2. Clinical and Imaging Features Associated with an Increased Risk of Late Stroke in Patients with Asymptomatic Carotid Disease

    DEFF Research Database (Denmark)

    Naylor, A R; Schroeder, T V; Sillesen, H

    2014-01-01

    /CAS. METHODS: Review of clinical and/or imaging based scoring systems, predictive algorithms and imaging parameters that may be associated with an increased (or decreased) risk of stroke in patients with asymptomatic carotid disease. RESULTS: Parameters associated with an increased risk of late stroke include...... intracranial disease. CONCLUSIONS: A number of imaging parameters have been shown to be predictive of an increased risk of late stroke in previously asymptomatic patients. None have been independently validated, but many could easily be evaluated in natural history studies or randomized trials in order......BACKGROUND: The 2011 American Heart Association Guidelines on the management of asymptomatic carotid disease recommends that carotid endarterectomy (CEA) (with carotid artery stenting (CAS) as an alternative) may be considered in highly selected patients with 70-99% stenoses. However, no guidance...

  3. Risk of thyroid cancer in euthyroid asymptomatic patients with thyroid nodules with an emphasis on family history of thyroid cancer

    International Nuclear Information System (INIS)

    JHwang, Shin Hye; Kim, Eun Kyung; Moon, Hee Jung; Yoon, Jung Hyun; Kwak, Jin Young

    2016-01-01

    To determine the factors associated with thyroid cancer, focusing on first-degree family history and ultrasonography (US) features, in euthyroid asymptomatic patients with thyroid nodules. This retrospective study included 1310 thyroid nodules of 1254 euthyroid asymptomatic patients who underwent US-guided fine-needle aspiration biopsy between November 2012 and August 2013. Nodule size and clinical risk factors- such as patient age, gender, first-degree family history of thyroid cancer, multiplicity on US and serum thyroid stimulating hormone (TSH) levels - were considered together with US features to compare benign and malignant nodules. Multiple logistic regression analysis was performed to assess the risk of thyroid malignancy according to clinical and US characteristics. Although all of the clinical factors and US findings were significantly different between patients with benign and malignant nodules, a solitary lesion on US (p = 0.041–0.043), US features and male gender (p < 0.001) were significant independent risk factors for thyroid malignancy in a multivariate analysis. Patient age, a first-degree family history of thyroid cancer and high normal serum TSH levels did not independently significantly increase the risk of thyroid cancer. However, multicollinearity existed between US assessment and patient age, first-degree family history of thyroid cancer and serum TSH values. Ultrasonography findings should be the primary criterion used to decide the management of euthyroid asymptomatic patients with thyroid nodules. The concept of first-degree family history as a risk factor for thyroid malignancy should be further studied in asymptomatic patients

  4. Risk of thyroid cancer in euthyroid asymptomatic patients with thyroid nodules with an emphasis on family history of thyroid cancer

    Energy Technology Data Exchange (ETDEWEB)

    JHwang, Shin Hye; Kim, Eun Kyung; Moon, Hee Jung; Yoon, Jung Hyun; Kwak, Jin Young [Dept. of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2016-04-15

    To determine the factors associated with thyroid cancer, focusing on first-degree family history and ultrasonography (US) features, in euthyroid asymptomatic patients with thyroid nodules. This retrospective study included 1310 thyroid nodules of 1254 euthyroid asymptomatic patients who underwent US-guided fine-needle aspiration biopsy between November 2012 and August 2013. Nodule size and clinical risk factors- such as patient age, gender, first-degree family history of thyroid cancer, multiplicity on US and serum thyroid stimulating hormone (TSH) levels - were considered together with US features to compare benign and malignant nodules. Multiple logistic regression analysis was performed to assess the risk of thyroid malignancy according to clinical and US characteristics. Although all of the clinical factors and US findings were significantly different between patients with benign and malignant nodules, a solitary lesion on US (p = 0.041–0.043), US features and male gender (p < 0.001) were significant independent risk factors for thyroid malignancy in a multivariate analysis. Patient age, a first-degree family history of thyroid cancer and high normal serum TSH levels did not independently significantly increase the risk of thyroid cancer. However, multicollinearity existed between US assessment and patient age, first-degree family history of thyroid cancer and serum TSH values. Ultrasonography findings should be the primary criterion used to decide the management of euthyroid asymptomatic patients with thyroid nodules. The concept of first-degree family history as a risk factor for thyroid malignancy should be further studied in asymptomatic patients.

  5. Understanding Patients' Preferences for Referrals to Specialists for an Asymptomatic Condition.

    Science.gov (United States)

    Dunlea, Robert; Lenert, Leslie

    2015-01-14

    A specialty referral is a common but complex decision that often requires a primary care provider to balance his or her own interests with those of the patient. To examine the factors that influence a patient's choice of a specialist for consultation for an asymptomatic condition and better understand the tradeoffs that patients are and are not willing to make in this decision. Stratified cross-sectional convenience sample of subjects selected to parallel US population demographics. Members of an Internet survey panel who reported seeing a physician in the past year whose responses met objective quality metrics for attention. Respondents completed an adaptive conjoint analysis survey comparing specialists regarding eight attributes. The reliability of assessments and the predictive validity of models were measured using holdout samples. The relative importance (RI) of different attributes was computed using paired t tests. The implications of utility values were studied using market simulation methods. Five hundred and thirty subjects completed the survey and had responses that met quality criteria. The reliability of responses was high (86% agreement), and models were predictive of patients' preferences (82.6% agreement with holdout choices). The most important attribute for patients was out-of-pocket cost (RI of 19.5%, P communication" with the primary care provider was the most important attribute (RI of 13.1% P importance was whether the specialist practiced shared decision making (RI of 12.2% P well with their primary care provider and practiced shared decision making. Most patients prefer to wait for a doctor who practices shared decision making: Only one-third (32.3%) of patients preferred a paternalistic doctor who was available in 2 weeks over a doctor who practiced decision making but was available in 4 weeks. In the setting of a referral for an asymptomatic but serious condition, out-of-pocket costs are important to patients; however, they also value

  6. Palliative radiotherapy in asymptomatic patients with locally advanced, unresectable, non-small cell lung cancer

    International Nuclear Information System (INIS)

    Reinfuss, M.; Skolyszewski, J.; Kowalska, T.; Rzepecki, W.; Kociolek, D.

    1993-01-01

    Between 1983 and 1990, 332 patients with non-small cell lung cancer (NSCLC) were referred to short-time, split-course palliative thoracic radiotherapy. The group consisted of patients with locally advanced (III o ), unresectable cancer, not suitable for curative radiotherapy, asymptomatic or having only minimal symptoms related to intrathoracic tumor. The therapeutic plan involved two series of irradiation. Tumor dose delivered in each series was 20 Gy given in five daily fractions over five treatment days. There were four weeks interval between series. Of 332 patients initially qualified to thoracic radiotherapy only 170 patients received the treatment; the other 162 patients were not irradiated because of treatment refusal or logistic problems concerning therapy. They made the control group of the study, receiving the best possible symptomatic care. Twelve-month survivals in the radiotherapy and control groups were 32.4% and 9.3%, respectively; 24-month survivals 11.2% and 0%, respectively. Improvement of survival after palliative thoracic radiotherapy was observed only in patients with clinical stage IIIA and Karnofsky's performance status (KPS) ≥ 70. (orig.) [de

  7. Cystatin C and asymptomatic coronary artery disease in patients with metabolic syndrome and normal glomerular filtration rate

    Directory of Open Access Journals (Sweden)

    Qing Xie

    2012-09-01

    Full Text Available Abstract Background All of the components of Metabolic syndrome (MetS have been regarded as risk factors for coronary artery disease (CAD. Early detection of CAD in asymptomatic patients with MetS remains a challenge. Cystatin C,which has been proposed as a novel marker of renal dysfunction,is correlated with mortality in CAD, The purpose of the study was to evaluate whether cystatin C is a potential marker of asymptomatic CAD in MetS patients with normal kidney function. Methods A total of 211asymptomatic MetS patients without prior history of CAD patients were included in a cross-sectional study. Patients were divided into MetS with asymptomatic CAD (n = 136 and MetS without CAD (n = 75 groups according to coronary angiograph results. Serum cystatin C levels were measured using particle enhanced immunonephelometric assays. We first assessed whether there is an independent association of cystatin C with the presence and severity of asymptomatic CAD. Then, we investigated the association between cystatin C and other biochemical risk factors for atherosclerosis. Results Serum cystatin C levels in patients with asymptomatic CAD were significantly higher than those without CAD (P = 0.004. A multiple logistic regression analysis demonstrated cystatin C was independently associated with the presence of asymptomatic CAD (OR = 1.326, 95%CI: 1.086-1.619. On receiver operating characteristics (ROC analysis, the area under the curve (AUC was 0.622 (95 % CI: 0543–0.701, P = 0.003, and cystatin C showed a moderate predictive value. Furthermore, cystatin C was independently correlated with Gensini score (standardized β = 0.183, P = 0.007, and serum cystatin C levels increased with the increasing of number of disease vessels (P = 0.005. In a multiple stepwise regression analysis, uric acid (UA(P P = 0.002, triglyceride(TG(P = 0.03, estimated glomerular filtration rate (eGFR(P (P = 0.001 were independently

  8. Asymptomatic deep vein thrombosis and superficial vein thrombosis in ambulatory cancer patients: impact on short-term survival.

    Science.gov (United States)

    Gary, T; Belaj, K; Steidl, K; Pichler, M; Eisner, F; Stöger, H; Hafner, F; Froehlich, H; Samonigg, H; Pilger, E; Brodmann, M

    2012-10-09

    Asymptomatic venous thrombotic events (VTEs) are possible findings in ambulatory cancer patients. Data regarding the incidence and clinical impact of asymptomatic VTEs are conflicting. We therefore conducted a study to evaluate the occurrence of asymptomatic VTEs of the lower limbs in ambulatory cancer patients to further evaluate the association of these asymptomatic VTEs on survival during a 9-month follow-up period. In our prospective cohort, we included 150 consecutive ambulatory cancer patients who were free of any clinical symptoms for VTEs. Compression ultrasound to detect deep vein thrombosis (DVT) and superficial venous thrombosis (SVT) of the lower limbs was performed by a vascular specialist in all patients at baseline. In case of pathological findings the patients were treated with low molecular weight heparin (LMWH) because of current established guidelines. The occurrence of death was investigated during a 9-month follow-up period. A total of 27 (18%) patients with VTEs were detected, which included 13 patients (8.7%) with a SVT and 16 patients (10.7%) showing a DVT. Two patients had both, a SVT and a DVT as well. During the 9-month follow-up period the occurrence of a VTE at baseline was associated with a 2.4-fold increased risk for death (HR 2.4 (1.2-5.3); P=0.03). Asymptomatic VTEs of the lower limbs in ambulatory cancer patients are frequently occurring concomitant features and are associated with poor survival during a 9-month follow-up period despite anticoagulation with LMWH.

  9. Asymptomatic deep vein thrombosis and superficial vein thrombosis in ambulatory cancer patients: impact on short-term survival

    Science.gov (United States)

    Gary, T; Belaj, K; Steidl, K; Pichler, M; Eisner, F; Stöger, H; Hafner, F; Froehlich, H; Samonigg, H; Pilger, E; Brodmann, M

    2012-01-01

    Background: Asymptomatic venous thrombotic events (VTEs) are possible findings in ambulatory cancer patients. Data regarding the incidence and clinical impact of asymptomatic VTEs are conflicting. We therefore conducted a study to evaluate the occurrence of asymptomatic VTEs of the lower limbs in ambulatory cancer patients to further evaluate the association of these asymptomatic VTEs on survival during a 9-month follow-up period. Methods: In our prospective cohort, we included 150 consecutive ambulatory cancer patients who were free of any clinical symptoms for VTEs. Compression ultrasound to detect deep vein thrombosis (DVT) and superficial venous thrombosis (SVT) of the lower limbs was performed by a vascular specialist in all patients at baseline. In case of pathological findings the patients were treated with low molecular weight heparin (LMWH) because of current established guidelines. The occurrence of death was investigated during a 9-month follow-up period. Results: A total of 27 (18%) patients with VTEs were detected, which included 13 patients (8.7%) with a SVT and 16 patients (10.7%) showing a DVT. Two patients had both, a SVT and a DVT as well. During the 9-month follow-up period the occurrence of a VTE at baseline was associated with a 2.4-fold increased risk for death (HR 2.4 (1.2–5.3); P=0.03). Conclusion: Asymptomatic VTEs of the lower limbs in ambulatory cancer patients are frequently occurring concomitant features and are associated with poor survival during a 9-month follow-up period despite anticoagulation with LMWH. PMID:22968652

  10. Endothelial progenitor cells in long-standing asymptomatic type 1 diabetic patients with or without diabetic nephropathy

    DEFF Research Database (Denmark)

    Reinhard, Henrik; Jacobsen, Peter Karl; Lajer, Maria

    2011-01-01

    with or without DN and to study the effect of CVD and medication on EPC numbers. Methods: We examined EPC numbers in 37 type 1 diabetic patients with DN and 35 type 1 diabetic patients with long-standing normoalbuminuria. Patients were without symptoms of CVD and the prevalence of CVD was previously shown......A decrease in the number and dysfunction of endothelial progenitor cells (EPC) may increase the risk for progression of cardiovascular disease (CVD) in type 1 diabetic patients with diabetic nephropathy (DN). Our aim was to evaluate EPC numbers in asymptomatic CVD type 1 diabetic patients...... with CVD (p > 0.05). Conventional risk factors were significantly higher in patients with DN and they received more CVD-preventive treatment. All patients receiving simvastatin or calcium-channel blockers had higher numbers of EPC compared to patients not treated with these drugs. Conclusions: Asymptomatic...

  11. Radionuclide ventriculographic evaluation of exercised left ventricular performance in asymptomatic diabetic patients

    International Nuclear Information System (INIS)

    Fujii, Yusuke; Hara, Fumio

    1991-01-01

    Radionuclide ventriculography was made in 49 asymptomatic diabetic patients, aged 30∼70 years, to investigate cardiac function. Comparisons were made with 33 age- and sex-matched non-diabetic controls. Radionuclide ventriculography was performed at rest and during dynamic exercise by multigraded, supine bicycle ergometer. The resting left ventricular ejection fractions were similar between the diabetic patients and control subjects. No significant rise in the left ventricular ejection fractions during dynamic exercise was observed in the diabetic patients [58.4±9.8% (mean±SD) to 60.3±9.9]. In the control subjects, the left ventricular ejection fractions increased during dynamic exercise [59.3±8.4 to 63.0±11.4 (p -1 ) vs -2.66±0.52] and during dynamic exercise [-3.25±0.74 vs -3.23±0.90]. Time to end-systole were similar in both groups at rest [315±42 (ms) vs 309±42] and during dynamic exercise [258±37 vs 262±37]. The resting peak filling rates were similar in both groups [2.27±0.62 (s -1 ) vs 2.45±0.58], and the peak filling rates increased (p 1c in the diabetic patients. These results suggest that diabetic patients have less cardiac reserved performance. (author)

  12. Noninvasive Evaluation of Cardiac Function in Non Hypertensive and Asymptomatic Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Behzad Babapour

    2012-11-01

    Full Text Available Background & Objectives: Type 2 diabetes is a major cardiovascular risk factor such as HTN, HLP and smoking. A primary diabetic cardiomyopathy represents a high risk factor for heart failure in the absence of ischemic, valvular and hypertensive heart disease in the diabetic population. CAD is more common in diabetic patients and it is almost asymptomatic.   Unquestionably, an early detection of LV damage and CAD is a major goal for the prevention of cardiac disease in the diabetic population.   Methods: This study was done as Cross-Sectional method. The study sample consisted of 40 patients with type 2 diabetes mellitus without hypertension and cardiac symptoms (mean age 47 years who recourse to diabetes clinic of Ardabil Imam Khomeini Hospital during 2009-2010. Left ventricular (LV function was studied by echocardiography and exercise test using Bruce protocol. Data from the patients were collected and analyzed using SPSS 17 software.   Results: All studied cases had a normal systolic function. 22 cases (55% had diastolic dysfunction and 8 people (20% had a positive stress test, which all had diastolic dysfunction too.   Conclusion: This study showed that an impairment of left ventricular diastolic function occurs early in the natural history of diabetes mellitus and CAD is more common in diabetic patients with diastolic dysfunction.

  13. Routine MRI findings of the asymptomatic foot in diabetic patients with unilateral Charcot foot

    Directory of Open Access Journals (Sweden)

    Poll Ludger W

    2010-04-01

    Full Text Available Abstract Background Imaging studies of bones in patients with sensory deficits are scarce. Aim To investigate bone MR images of the lower limb in diabetic patients with severe sensory polyneuropathy, and in control subjects without sensory deficits. Methods Routine T1 weighted and T2-fat-suppressed-STIR-sequences without contrast media were performed of the asymptomatic foot in 10 diabetic patients with polyneuropathy and unilateral inactive Charcot foot, and in 10 matched and 10 younger, non-obese unmatched control subjects. Simultaneously, a Gadolinium containing phantom was also assessed for reference. T1 weighted signal intensity (SI was recorded at representative regions of interest at the peritendineal soft tissue, the tibia, the calcaneus, and at the phantom. Any abnormal skeletal morphology was also recorded. Results Mean SI at the soft tissue, the calcaneus, and the tibia, respectively, was 105%, 105% and 84% of that at the phantom in the matched and unmatched control subjects, compared to 102% (soft tissue, 112% (calcaneus and 64% (tibia in the patients; differences of tibia vs. calcaneus or soft tissue were highly significant (p Conclusion MR imaging did not reveal grossly abnormal bone marrow signalling in the limbs with severe sensory polyneuropathy, but occult sequelae of previous traumatic injuries.

  14. Incidence of missed inferior alveolar nerve blocks in vital asymptomatic subjects and in patients with symptomatic irreversible pulpitis.

    Science.gov (United States)

    Fowler, Sara; Reader, Al; Beck, Mike

    2015-05-01

    The purpose of this retrospective study was to determine the incidence of missed inferior alveolar nerve (IAN) blocks by using a 1- or 2-cartridge volume of 2% lidocaine with 1:100,000 epinephrine in vital asymptomatic teeth and in emergency patients with symptomatic irreversible pulpitis. As part of 37 studies, 3169 subjects/patients were evaluated for missed IAN blocks. The study included 2450 asymptomatic subjects and 719 emergency patients presenting with symptomatic irreversible pulpitis. Each subject or patient received either a 1- or 2-cartridge volume of 2% lidocaine with 1:100,000 epinephrine. A missed block was defined as no lip numbness at 15-20 minutes after the IAN block. The effect of anesthetic volume on the incidence of missed blocks was assessed by using mixed models logistic regression with individual studies as a random effect. The incidence of missed blocks for asymptomatic subjects was 6.3% for the 1-cartridge volume and 3.8% for the 2-cartridge volume. For patients presenting with irreversible pulpitis, the incidence of missed blocks was 7.7% for the 1-cartridge volume and 2.3% for the 2-cartridge volume. In both asymptomatic subjects and patients with irreversible pulpitis, the 2-cartridge volume was significantly (P = .0395) better than the 1-cartridge volume. There were no significant effects for pulpal diagnosis (P = .7523) or the pulpal diagnosis and anesthetic volume interaction (P = .3973). Concerning missed IAN blocks, we concluded that administration of a 2-cartridge volume was significantly better (P = .0395) than a 1-cartridge volume in both asymptomatic subjects and emergency patients presenting with irreversible pulpitis. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  15. The impact of asymptomatic helminth co-infection in patients with newly diagnosed tuberculosis in north-west Ethiopia

    DEFF Research Database (Denmark)

    Abate, Ebba; Belayneh, Meseret; Gelaw, Aschalew

    2012-01-01

    Areas endemic of helminth infection, tuberculosis (TB) and HIV are to a large extent overlapping. The aim of this study was to assess the impact of asymptomatic helminth infection on the immunological response among TB patients with and without HIV, their house hold contacts and community controls....

  16. Left Atrial Volume as Predictor of Valve Replacement and Cardiovascular Events in Patients with Asymptomatic Mild to Moderate Aortic Stenosis

    DEFF Research Database (Denmark)

    Dalsgaard, Morten; Egstrup, Kenneth; Wachtell, Kristian

    2013-01-01

    Left atrial (LA) size is known to increase with chronically increased left ventricular (LV) filling pressure. We hypothesized that LA volume was predictive of aortic valve replacement (AVR) and cardiovascular events in a large cohort of patients with asymptomatic mild to moderate aortic valve...

  17. The role of embolic protection devices during carotid stenting prior to cardiac surgery in asymptomatic patients: empty filters?

    Science.gov (United States)

    Van der Heyden, Jan; Wolters, Frank J; Garin, Nathalie; Blant, Snezana Andrejevic; Inglin, Marc; Bal, E T; Suttorp, Jan-Maarten

    2012-07-01

    The purpose of this study was to analyze the debris captured in the distal protection filters used during carotid artery stenting (CAS). CAS is an option available to high-risk patients requiring revascularization. Filters are suggested for optimal stroke prevention during CAS. From May 2005 to June 2007, filters from 59 asymptomatic patients who underwent CAS were collected and sent to a specialized laboratory for light-microscope and histological analysis. Peri- and postprocedural outcomes were assessed during 1-year follow-up. On the basis of biomedical imaging of the filter debris, the captured material could not be identified as embolized particles from the carotid plaque. On histological analysis the debris consisted mainly of red blood cell aggregates and/ or platelets, occasionally accompanied by granulocytes. We found no consistent histological evidence of embolized particles originating from atherosclerotic plaques. Post-procedure, three neurological events were reported: two (3.4%) transient ischemic attacks (TIA) and one (1.7%) ipsilateral minor stroke. The filters used during CAS in asymptomatic patients planned for cardiac surgery often remained empty. These findings may be explained by assuming that asymptomatic patients feature a different atherosclerotic plaque composition or stabilization through antiplatelet medication. Larger, randomized trials are clearly warranted, especially in the asymptomatic population. Copyright © 2011 Wiley Periodicals, Inc.

  18. The proportion of asymptomatic recurrence after catheter ablation of atrial fibrillation in patients with a pacemaker for sick sinus syndrome

    Directory of Open Access Journals (Sweden)

    Yuki Osaka

    2017-09-01

    Conclusions: One-third of PAF patients with SSS and pacemakers recurred after multiple CA sessions. However, 65% of them were asymptomatic and difficult to be identified with conventional follow-up. Pacemaker interrogation significantly increased the detection rate of AF-recurrence.

  19. AIDS Cholangiopathy in an Asymptomatic, Previously Undiagnosed Late-Stage HIV-Positive Patient from Kenya

    Directory of Open Access Journals (Sweden)

    Yiming Gao

    2011-01-01

    Full Text Available AIDS-associated cholangiopathy is a form of biliary tract inflammation with stricture formation seen in AIDS patients who are severely immunosuppressed. It is no longer common in countries in which HAART therapy is widely employed but is still seen in underdeveloped countries. The majority of patients are symptomatic at the time of presentation. Herein, we describe a seventy-four-year-old woman who presented with unilateral leg swelling after a prolonged airplane flight. She was otherwise entirely asymptomatic. Routine laboratory testing was notable for a hypochromic microcytic anemia, slight leukopenia, and mild hypoalbuminemia. Liver enzymes were all elevated. Deep venous thrombosis was confirmed, and a CT scan of the chest disclosed no pulmonary emboli. However, the visualized portion of the abdomen showed dilatation of the common bile and pancreatic ducts. This was confirmed on ultrasonography and MRCP, and no obstructive lesions were noted. An ERCP revealed a dilated common bile duct without filling defects or strictures. A balloon occlusion cholangiogram showed strictures and beading of the intrahepatic ducts. Shortly thereafter, serology for HIV returned positive along with a depressed CD4 cell count, and the patient was diagnosed with AIDS-associated cholangiography.

  20. Asymptomatic carotid artery stenosis in patients with severe peripheral vascular diseases

    Directory of Open Access Journals (Sweden)

    Rasoul Mirsharifi

    2009-04-01

    Full Text Available

    • BACKGROUND: The prevalence of carotid artery stenosis (CAS in the  eneral population is not high enough to justify screening programs. This study was done to determine the prevalence of asymptomatic carotid artery stenosis (ACAS among patients with severe peripheral vascular disease (PVD.
    • METHODS: Between March 2005 and February 2006, 54 consecutive  atients with severe PVD admitted at a vascular surgery unit and underwent carotid duplex scanning in a prospective study. A  uestionnaire was used to collect data concerning known risk factors. Significant CAS was defined as a stenosis of 70% or greater.
    • RESULTS: The mean age was 62.5 years (51-72. Out of 54 patients, 2 (3.7% had an occluded internal carotid artery. Significant CAS was found in 9 (16.7% and its presence was correlated with diabetes, hypertension, hypercholesterolemia, hypertriglyceridemia, coronary artery disease, severity of symptoms, ankle-brachial index, and carotid bruit. On multivariate analysis, only hypercholesterolemia and carotid bruit seemed to have independent influence.
    • CONCLUSION: The prevalence of significant ACAS is higher among  atients with severe PVD. This patient population may indicate a  uitable subgroup for screening of ACAS, especially when hypercholesterolemia and carotid bruit are present.
    • KEYWORDS: Carotid artery stenosis, duplex ultrasound scanning, peripheral vascular disease, carotid endarterectomy,
    • cerebrovascular accident.

  1. Clinical value and severity of myocardial perfusion defects in asymptomatic diabetic patients with negative or weakly positive exercise treadmill test

    International Nuclear Information System (INIS)

    Zakavi, Seyed Rasoul; Taherpour, Mehdi; Moossavi, Zohreh; Sadeghi, Ramin; Kakhki, Vahidreza Dabbagh; Rokni, Haleh

    2013-01-01

    Although coronary artery disease (CAD) is the leading cause of death in type 2 diabetic patients, it is frequently asymptomatic. Myocardial perfusion imaging (MPI) is reported to show ischemia in a significant number of asymptomatic diabetic patients. We studied the prevalence and severity of myocardial perfusion defects in asymptomatic diabetic patients and its clinical impact. One hundred thirty consecutive asymptomatic patients, aged 35-65 years with type 2 diabetes mellitus and with no history of CAD and no cardiac symptoms were recruited in the study. Echocardiography, electrocardiography (ECG), routine laboratory tests and exercise treadmill test (ETT) were performed and patients with weakly positive or negative ETT underwent Dipyridamole MPI. Patients with positive ETT were referred to coronary angiography. Patients were followed for at least 17 months (mean 21.7 months) and any cardiac event was recorded. We studied 81 female and 49 male patients with mean age of 51.8 years. Negative, weakly positive and positive ETT result was noted in 74.3%, 15% and 10.7% respectively. 75% of patients with positive ETT had coronary artery disease in angiography. Gated myocardial perfusion SPECT was done in 106 patients. MPI showed reversible defect in 26.9% of the patients with a mean summed stress score of 3.3±1.8. Follow up completed in 112 patients and only one patient with abnormal MPI underwent coronary angiography followed by PTCA. No cardiac death, MI, UA or hospital admission occurred among our patients during follow up (17-26 months). Mean stress end diastolic volume (EDV) was significantly higher in patients with reversible defect compared to patients without reversible defect based on MPI findings (62.0±31.6 Vs 48.5±18.4 ml, P=0.04). Blood glucose and HbA1c were significantly higher in patients with ischemia compared to patients without ischemia (P<0.05). Meanwhile the ratio of TG to HDL was 6.06±3.2 in ischemic patients compared to 4.8±2.3 in normal

  2. Left Ventricular Diastolic Dysfunction in Asymptomatic Type 2 Diabetic Patients: Detection and Evaluation by Tissue Doppler Imaging

    OpenAIRE

    Zahiti, Bedri Faik; Gorani, Daut Rashit; Gashi, Fitim Bejtullah; Gjoka, Sami Bajram; Zahiti, Lorita Bedri; Haxhiu, Bekim Syl?; Kamberi, Lulzim Selim

    2013-01-01

    CONFLICT OF INTEREST: NONE DECLARED The aim of the study was detection of diastolic dysfunction of myocardium with Tissue Doppler Imaging (TDI) in asymptomatic type 2 diabetic patients, in five years duration of disease, and normal cardiac function on conventional echocardiography (CE), according to the performance showed on exercise stress test. Material and Methods We studied 300 patients, of them 150 patients with non-obese, normotensive, uncomplicated type 2 diabetes, in five years durati...

  3. High-sensitivity Troponin T Assay in Asymptomatic High Cardiovascular Risk Patients. The TUSARC Registry.

    Science.gov (United States)

    Álvarez, Isabel; Hernández, Luis; García, Héctor; Villamandos, Vicente; López, María Gracia; Palazuelos Molinero, Jorge; Martín Raymondi, Diego

    2017-04-01

    High-sensitivity troponin T assays (Hs-TnT) have been carried out in selected populations in clinical trials and in registries of the general population with low cardiovascular risk (CVR). The aim of this study was to determine the proportion of individuals with detectable Hs-TnT and the proportion of individuals with elevated Hs-TnT in a Spanish population of asymptomatic individuals with very high CVR, as well as the parameters associated with Hs-TnT elevation. The study included 690 patients. Hs-TnT detection and Hs-TnT elevation (≥99th percentile value), as well the association of elevated Hs-TnT and clinical, analytical, and treatment data were analyzed. Hs-TnT was analyzed in 646 patients and was detected in 645. Elevated TnT was detected in 212 patients (32.9%). On multivariate analysis, elevated TnT was independently associated with male sex (OR, 2.81; 95%CI, 1.67-4.73; P < .001), older age (OR, 1.06; 95%CI, 1.04-1.09; P < .001), a higher body mass index (OR, 1.07; 95%CI, 1.02-1.12; P < .002), insulin therapy (OR, 1.99; 95%CI, 1.15-3.46; P = .01), history of heart failure (OR, 3.92; 95%CI, 1.24-12.39; P = .02), and estimated glomerular filtration rate calculated by CKD-EPI (OR, 0.96; 95%CI, 0.95-0.97; P < .001). In a Spanish population of asymptomatic individuals at very high CVR, Hs-TnT was associated with older age, male sex, higher body mass index, insulin therapy, history of heart failure, and lower glomerular filtration rate. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  4. Enhanced pulmonary leptin expression in patients with severe COPD and asymptomatic smokers.

    Science.gov (United States)

    Vernooy, J H J; Drummen, N E A; van Suylen, R J; Cloots, R H E; Möller, G M; Bracke, K R; Zuyderduyn, S; Dentener, M A; Brusselle, G G; Hiemstra, P S; Wouters, E F M

    2009-01-01

    Chronic obstructive pulmonary disease (COPD) is characterised by an abnormal inflammatory reaction of the lungs involving activation of epithelial cells. Leptin is a pleiotropic cytokine important in the regulation of immune responses via its functional receptor Ob-Rb. This study was undertaken to test the hypothesis that severe COPD is associated with increased leptin expression in epithelial cells. Immunohistochemistry for leptin was performed on peripheral lung specimens from 20 patients with COPD (GOLD stage 4), 14 asymptomatic ex-smokers and 13 never smokers. Leptin and Ob-Rb mRNA expression were determined by rtPCR in cultured primary bronchial epithelial cells and primary type II pneumocytes. NCI-H292 and A549 cell lines were used to study functional activation of leptin signalling. Leptin immunoreactivity in lung tissue was observed in bronchial epithelial cells, type II pneumocytes, macrophages (tissue/alveolar) and interstitial lymphocytic infiltrates. rtPCR analysis confirmed pulmonary leptin and Ob-Rb mRNA expression in primary bronchial epithelial cells and pneumocytes. Leptin-expressing bronchial epithelial cells and alveolar macrophages were markedly higher in patients with severe COPD and ex-smokers than in never smokers (pleptin and Ob-Rb (pLeptin induced phosphorylation of STAT3 in both NCI-H292 and A549 cells. Leptin expression is increased in bronchial epithelial cells and alveolar macrophages of ex-smokers with or without severe COPD compared with never smokers. A functional leptin signalling pathway is present in lung epithelial cells.

  5. The Role of Gratitude in Spiritual Well-being in Asymptomatic Heart Failure Patients.

    Science.gov (United States)

    Mills, Paul J; Redwine, Laura; Wilson, Kathleen; Pung, Meredith A; Chinh, Kelly; Greenberg, Barry H; Lunde, Ottar; Maisel, Alan; Raisinghani, Ajit; Wood, Alex; Chopra, Deepak

    2015-03-01

    Spirituality and gratitude are associated with wellbeing. Few if any studies have examined the role of gratitude in heart failure (HF) patients or whether it is a mechanism through which spirituality may exert its beneficial effects on physical and mental health in this clinical population. This study examined associations bet ween gratitude, spiritual wellbeing, sleep, mood, fatigue, cardiac-specific self-efficacy, and inflammation in 186 men and women with Stage B asymptomatic HF (age 66.5 years ±10). In correlational analysis, gratitude was associated with better sleep (r=-.25, pgratitude also had lower levels of inflammatory biomarkers (r=-.17, pgratitude. We found that gratitude fully mediated the relationship between spiritual wellbeing and sleep quality (z=-2.35, SE=.03, p=.02) and also the relationship between spiritual wellbeing and depressed mood (z=-4.00, SE=.075, pGratitude also partially mediated the relationships between spiritual wellbeing and fatigue (z=-3.85, SE=.18, pgratitude and spiritual wellbeing are related to better mood and sleep, less fatigue, and more self-efficacy, and that gratitude fully or partially mediates the beneficial effects of spiritual wellbeing on these endpoints. Efforts to increase gratitude may be a treatment for improving wellbeing in HF patients' lives and be of potential clinical value.

  6. High frequency of asymptomatic hyperparathyroidism in patients with fibromyalgia: random association or misdiagnosis?

    Science.gov (United States)

    Costa, Juliana Maria de Freitas Trindade; Ranzolin, Aline; da Costa Neto, Cláudio Antônio; Marques, Claudia Diniz Lopes; Duarte, Angela Luzia Branco Pinto

    Fibromyalgia (FM) and hyperparathyroidism may present similar symptoms (musculoskeletal pain, cognitive disorders, insomnia, depression and anxiety), causing diagnostic confusion. To determine the frequency of asymptomatic hyperparathyroidism in a sample of patients with FM and to evaluate the association of laboratory abnormalities to clinical symptoms. Cross-sectional study with 100 women with FM and 57 healthy women (comparison group). Parathyroid hormone (PTH), calcium and albumin levels were accessed, as well as symptoms in the FM group. In FM group, mean serum calcium (9.6±0.98mg/dL) and PTH (57.06±68.98pg/mL) values were considered normal, although PTH levels had been significantly higher than in the comparison group (37.12±19.02pg/mL; p=0.001). Hypercalcemic hyperparathyroidism was diagnosed in 6% of patients with FM, and 17% of these women exhibited only high levels of PTH, featuring a normocalcemic hyperparathyroidism, with higher frequencies than those expected for their age. There was no significant association between hyperparathyroidism and FM symptoms, except for epigastric pain, which was more frequent in the group of patients concomitantly with both diseases (p=0.012). A high frequency of hyperparathyroidism was noted in women with FM versus the general population. Normocalcemic hyperparathyroidism was also more frequent in patients with FM. Longitudinal studies with greater number of patients are needed to assess whether this is an association by chance only, if the increased serum levels of PTH are part of FM pathophysiology, or even if these would not be cases of FM, but of hyperparathyroidism. Copyright © 2016. Published by Elsevier Editora Ltda.

  7. High frequency of asymptomatic hyperparathyroidism in patients with fibromyalgia: random association or misdiagnosis?

    Science.gov (United States)

    Costa, Juliana Maria de Freitas Trindade; Ranzolin, Aline; Neto, Cláudio Antônio da Costa; Marques, Claudia Diniz Lopes; Duarte, Angela Luzia Branco Pinto

    2016-03-22

    Fibromyalgia (FM) and hyperparathyroidism may present similar symptoms (musculoskeletal pain, cognitive disorders, insomnia, depression and anxiety), causing diagnostic confusion. To determine the frequency of asymptomatic hyperparathyroidism in a sample of patients with FM and to evaluate the association of laboratory abnormalities to clinical symptoms. Cross-sectional study with 100 women with FM and 57 healthy women (control group). Parathyroid hormone (PTH), calcium and albumin levels were accessed, as well as symptoms in the FM group. In FM group, mean serum calcium (9.6±0.98mg/dL) and PTH (57.06±68,98 pg/mL) values were considered normal, although PTH levels had been significantly higher than in the control group (37.12±19.02 pg/mL; p=0.001). Hypercalcemic hyperparathyroidism was diagnosed in 6% of patients with FM, and 17% of these women exhibited only high levels of PTH, featuring a normocalcemic hyperparathyroidism, with higher frequencies than those expected for their age. There was no significant association between hyperparathyroidism and FM symptoms, except for epigastric pain, which was more frequent in the group of patients concomitantly with both diseases (p=0.012). A high frequency of hyperparathyroidism was noted in women with FM versus the general population. Normocalcemic hyperparathyroidism was also more frequent in patients with FM. Longitudinal studies with greater number of patients are needed to assess whether this is an association by chance only, if the increased serum levels of PTH are part of FM pathophysiology, or even if these would not be cases of FM, but of hyperparathyroidism. Copyright © 2015. Published by Elsevier Editora Ltda.

  8. High frequency of asymptomatic hyperparathyroidism in patients with fibromyalgia: random association or misdiagnosis?

    Directory of Open Access Journals (Sweden)

    Juliana Maria de Freitas Trindade Costa

    Full Text Available ABSTRACT Fibromyalgia (FM and hyperparathyroidism may present similar symptoms (musculoskeletal pain, cognitive disorders, insomnia, depression and anxiety, causing diagnostic confusion. Objectives: To determine the frequency of asymptomatic hyperparathyroidism in a sample of patients with FM and to evaluate the association of laboratory abnormalities to clinical symptoms. Methods: Cross-sectional study with 100 women with FM and 57 healthy women (comparison group. Parathyroid hormone (PTH, calcium and albumin levels were accessed, as well as symptoms in the FM group. Results: In FM group, mean serum calcium (9.6 ± 0.98 mg/dL and PTH (57.06 ± 68.98 pg/mL values were considered normal, although PTH levels had been significantly higher than in the comparison group (37.12 ± 19.02 pg/mL; p = 0.001. Hypercalcemic hyperparathyroidism was diagnosed in 6% of patients with FM, and 17% of these women exhibited only high levels of PTH, featuring a normocalcemic hyperparathyroidism, with higher frequencies than those expected for their age. There was no significant association between hyperparathyroidism and FM symptoms, except for epigastric pain, which was more frequent in the group of patients concomitantly with both diseases (p = 0.012. Conclusions: A high frequency of hyperparathyroidism was noted in women with FM versus the general population. Normocalcemic hyperparathyroidism was also more frequent in patients with FM. Longitudinal studies with greater number of patients are needed to assess whether this is an association by chance only, if the increased serum levels of PTH are part of FM pathophysiology, or even if these would not be cases of FM, but of hyperparathyroidism.

  9. Has the time to come leave the “watch-and-wait” strategy in newly diagnosed asymptomatic follicular lymphoma patients?

    International Nuclear Information System (INIS)

    Rueda, Antonio; Casanova, María; Redondo, Maximino; Pérez-Ruiz, Elisabeth; Medina-Pérez, Ángeles

    2012-01-01

    Historically, the median overall survival for follicular lymphoma (FL) has been considered to be 9-10 years, and no treatment had ever prolonged this time period. Studies conducted more than 20 years ago demonstrated that treating patients with asymptomatic FL at the onset of the disease did not increase their survival, and that almost 20% of these patients did not need any treatment in the first 10 years of follow-up. Based on these facts, most clinical practice guidelines recommend active surveillance policies for patients with asymptomatic FL. The introduction of antiCD-20 monoclonal antibodies, over the last 15 years, has significantly increased the median survival rate to above 14 years. This improvement was achieved before the combination of rituximab and chemotherapy regimens became extensively used in patients with symptomatic disease. Therefore, this increase in survival may currently be more significant. At present, several clinical trials have evaluated low-toxicity therapies that prolong progression-free periods, among which rituximab monotherapy, radioimmunotherapy or the combination of rituximab with bendamustine are the most relevant. Unfortunately, these clinical trials have included only patients with symptomatic FL. The results of a recently reported clinical trial show that treatment with single-agent rituximab prolongs progression-free survival rates, time to new treatment and the quality of life of asymptomatic patients, as compared with the active surveillance strategy. Longer follow-up of these results and data regarding overall survival are awaited before this treatment can be recommended as the standard initial therapy. There are different therapeutic possibilities for asymptomatic FL patients, but no data are currently available to indicate which option is the best. Patients need to understand the risks and benefits of observation versus treatment before a final decision can be made. For patients who want active treatment the

  10. Has the time to come leave the "watch-and-wait" strategy in newly diagnosed asymptomatic follicular lymphoma patients?

    Science.gov (United States)

    Rueda, Antonio; Casanova, María; Redondo, Maximino; Pérez-Ruiz, Elisabeth; Medina-Pérez, Angeles

    2012-05-31

    Historically, the median overall survival for follicular lymphoma (FL) has been considered to be 9-10 years, and no treatment had ever prolonged this time period. Studies conducted more than 20 years ago demonstrated that treating patients with asymptomatic FL at the onset of the disease did not increase their survival, and that almost 20% of these patients did not need any treatment in the first 10 years of follow-up. Based on these facts, most clinical practice guidelines recommend active surveillance policies for patients with asymptomatic FL. The introduction of antiCD-20 monoclonal antibodies, over the last 15 years, has significantly increased the median survival rate to above 14 years. This improvement was achieved before the combination of rituximab and chemotherapy regimens became extensively used in patients with symptomatic disease. Therefore, this increase in survival may currently be more significant. At present, several clinical trials have evaluated low-toxicity therapies that prolong progression-free periods, among which rituximab monotherapy, radioimmunotherapy or the combination of rituximab with bendamustine are the most relevant. Unfortunately, these clinical trials have included only patients with symptomatic FL. The results of a recently reported clinical trial show that treatment with single-agent rituximab prolongs progression-free survival rates, time to new treatment and the quality of life of asymptomatic patients, as compared with the active surveillance strategy. Longer follow-up of these results and data regarding overall survival are awaited before this treatment can be recommended as the standard initial therapy. There are different therapeutic possibilities for asymptomatic FL patients, but no data are currently available to indicate which option is the best. Patients need to understand the risks and benefits of observation versus treatment before a final decision can be made. For patients who want active treatment the

  11. Has the time to come leave the “watch-and-wait” strategy in newly diagnosed asymptomatic follicular lymphoma patients?

    Directory of Open Access Journals (Sweden)

    Rueda Antonio

    2012-05-01

    Full Text Available Abstract Background Historically, the median overall survival for follicular lymphoma (FL has been considered to be 9-10 years, and no treatment had ever prolonged this time period. Studies conducted more than 20 years ago demonstrated that treating patients with asymptomatic FL at the onset of the disease did not increase their survival, and that almost 20% of these patients did not need any treatment in the first 10 years of follow-up. Based on these facts, most clinical practice guidelines recommend active surveillance policies for patients with asymptomatic FL. Discussion The introduction of antiCD-20 monoclonal antibodies, over the last 15 years, has significantly increased the median survival rate to above 14 years. This improvement was achieved before the combination of rituximab and chemotherapy regimens became extensively used in patients with symptomatic disease. Therefore, this increase in survival may currently be more significant. At present, several clinical trials have evaluated low-toxicity therapies that prolong progression-free periods, among which rituximab monotherapy, radioimmunotherapy or the combination of rituximab with bendamustine are the most relevant. Unfortunately, these clinical trials have included only patients with symptomatic FL. The results of a recently reported clinical trial show that treatment with single-agent rituximab prolongs progression-free survival rates, time to new treatment and the quality of life of asymptomatic patients, as compared with the active surveillance strategy. Longer follow-up of these results and data regarding overall survival are awaited before this treatment can be recommended as the standard initial therapy. Summary There are different therapeutic possibilities for asymptomatic FL patients, but no data are currently available to indicate which option is the best. Patients need to understand the risks and benefits of observation versus treatment before a final decision

  12. 44-h ambulatory blood pressure monitoring: revealing the true burden of hypertension in pediatric hemodialysis patients.

    Science.gov (United States)

    Haskin, Orly; Wong, Cynthia J; McCabe, Lonisa; Begin, Brandy; Sutherland, Scott M; Chaudhuri, Abanti

    2015-04-01

    The blood pressure (BP) burden is high in pediatric hemodialysis (HD) patients and adversely affects prognosis. The aim of this study was to examine whether 44-h ambulatory BP monitoring (ABPM) provides additional relevant BP data compared with 24-h ABPM. ABPM was initiated at the end of the mid-week dialysis run in 13 stable pediatric HD patients and continued until the next run for 44 h. Day 1 was defined as the initial 24-h ABPM and Day 2 as the time period after that until the next dialysis run. All patients had an echocardiogram to calculate the left ventricular mass index (LVMI). A higher percentage of patients were diagnosed with hypertension from the 44-h ABPM than from the 24-h ABPM. All BP indexes and loads (except nighttime diastolic load) were significantly higher on Day 2 than on Day 1. Patients with BP loads of ≥ 25 % on 44-h ABPM had significantly higher LVMI than those patients with normal BP loads. No such association was found with 24-h ABPM and LVMI. Higher interdialytic weight gain was associated with higher Day-2 nighttime systolic BP load. The 44-h ABPM provides more information than the 24-h ABPM in terms of diagnosing and assessing the true burden of hypertension in pediatric HD patients. Elevated BP loads from 44-h ABPM correlate with a higher LVMI on the echocardiogram.

  13. Occurrence of maxillary sinus abnormalities detected by cone beam CT in asymptomatic patients

    Directory of Open Access Journals (Sweden)

    Rege Inara Carneiro

    2012-08-01

    Full Text Available Abstract Background Although cone beam computed tomography (CBCT images of the maxillofacial region allow the inspection of the entire volume of the maxillary sinus (MS, identifying anatomic variations and abnormalities in the image volume, this is frequently neglected by oral radiologists when interpreting images of areas at a distance from the dentoalveolar region, such as the full anatomical aspect of the MS. The aim of this study was to investigate maxillary sinus abnormalities in asymptomatic patients by using CBCT. Methods 1113 CBCT were evaluated by two examiners and identification of abnormalities, the presence of periapical lesions and proximity to the lower sinus wall were recorded. Data were analyzed using descriptive statistics, chi-square tests and Kappa statistics. Results Abnormalities were diagnosed in 68.2% of cases (kappa = 0.83. There was a significant difference between genders (p Conclusions Abnormalities in maxillary sinus emphasizes how important it is for the dentomaxillofacial radiologist to undertake an interpretation of the whole volume of CBCT images.

  14. Diastolic Blood Pressure is a Risk Factor for Peri-procedural Stroke Following Carotid Endarterectomy in Asymptomatic Patients.

    Science.gov (United States)

    de Waard, D D; de Borst, G J; Bulbulia, R; Huibers, A; Halliday, A

    2017-05-01

    Carotid endarterectomy (CEA) prevents future stroke, but this benefit depends on detection and control of high peri-operative risk factors. In symptomatic patients, diastolic hypertension has been causally related to procedural stroke following CEA. The aim was to identify risk factors causing peri-procedural stroke in asymptomatic patients and to relate these to timing of surgery and mechanism of stroke. In the first Asymptomatic Carotid Surgery Trial (ACST-1), 3,120 patients with severe asymptomatic carotid stenosis were randomly assigned to CEA plus medical therapy or to medical therapy alone. In 1,425 patients having their allocated surgery, baseline patient characteristics were analysed to identify factors associated with peri-procedural (procedural period, resulting in a stroke/death rate of 2.9% (42/1,425). Diastolic blood pressure at randomisation was the only significant risk factor in univariate analysis (odds ratio [OR] 1.34 per 10 mmHg, 95% confidence interval [CI] 1.04-1.72; p = .02) and this remained so in multivariate analysis when corrected for sex, age, lipid lowering therapy, and prior infarcts or symptoms (OR 1.34, 95% CI 1.05-1.72; p = .02). In patients with diastolic hypertension (> 90 mmHg) most strokes occurred during the procedure (67% vs. 20%; p = .02). In ACST-1, diastolic blood pressure was the only independent risk factor associated with peri-procedural stroke or death. While the underlying mechanisms of the association between lower diastolic blood pressure and peri-procedural risk remain unclear, good pre-operative control of blood pressure may improve procedural outcome of carotid surgery in asymptomatic patients. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Thallium-201 per rectum for the diagnosis of cirrhosis in patients with asymptomatic chronic hepatitis

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    D' Arienzo, A.; Celentano, L.; Scuotto, A.; Di Siervi, P.; Lombardi, V.; Squame, G.; Mazzacca, G.

    1988-07-01

    In normal subjects, thallium-201, administered per rectum, is taken up mainly by the liver (heart/liver ratio in normal subjects: 0.04 to 0.12). It has been claimed that an increased heart/liver ratio is suggestive of portal-caval shunting and portal hypertension. To evaluate the possibility of using thallium-201 as a test to diagnose cirrhosis, we administered this substance per rectum to 33 patients with biochemical evidence, but no clinical symptoms, of liver disease. Laparoscopy and liver biopsy revealed chronic active hepatitis without cirrhosis in 18 patients, and chronic active hepatitis with cirrhosis in the others. The results of conventional liver function tests were similar in both groups. A significant difference, however, was found between the means of fasting serum bile acid concentrations (9.8 +/- 3.2 and 18.3 +/- 4.2 microM per liter) in chronic active hepatitis without cirrhosis and cirrhotic patients, and between the means of the heart/liver ratios 20 min after thallium-201 administration (heart/liver: 0.09 +/- 0.03 and 0.54 +/- 0.13, respectively). Unlike the serum bile acid concentration which gave some overlapping values, the thallium-201 test clearly distinguished the chronic active hepatitis without cirrhosis group from the cirrhotics. In the cirrhotic group, there was a significant correlation between the heart/liver ratio and signs of portal hypertension such as esophageal varices, increased diameter of the vena porta and hypersplenism. The thallium-201 test is therefore useful in discriminating between chronic active hepatitis with and without cirrhosis in clinically asymptomatic subjects with biochemical evidence of moderate liver function impairment. A heart/liver uptake ratio much higher than normal (above 0.30) strongly suggests the development of hepatic cirrhosis.

  16. When omeprazole met with asymptomatic Clostridium difficile colonization in a postoperative colon cancer patient: A case report.

    Science.gov (United States)

    Li, Boyu; Ma, Huachong; Wang, Zhenjun; Liu, Lihong

    2017-12-01

    Clostridium difficile infection (CDI) is a symptomatic infection due to the spore-forming bacterium, C. difficile. Asymptomatic C. difficile colonization is the stage in absence of symptoms, with a prevalence of 1.4% to 21% on hospital admission. Proton-pump inhibitors (PPIs) was implicated as a novel potential contributor to CDI. PPIs injection could make asymptomatic C. difficile colonization progress to C. difficile associated diarrhea (CDAD). A postoperative colon cancer patient, who had been taking omeprazole for 4 years after operation, got asymptomatic C. difficile colonization. When he developed clinical symptoms of digestive tract, tumor recurrence was first suspected and intravenous omeprazole was prescribed, which ultimately led to progression to symptomatic CDI. In this report, we tell the confusing differential diagnosis of cancer-associated diseases and CDAD, and discuss the possibility of solving the PPIs overuse problem by making clinical pathway of PPIs use in Chinese hospitals. CDAD, incomplete intestinal obstruction, postoperation of colon cancer. Electrolyte replacement and rehydration. Parenteral nutrition support. Omeprazole was prescribed but withdrawn later, and oral vancomycin was given at a dose of 0.25 g 4 times per day for 10 days. Diarrhea was resolved, so long as the acid reflux and vomiting. We have 2 lessons here: Be aware of PPIs induced CDI, especially the asymptomatic C. difficile colonization. Making clinical pathway specified on PPIs use by pharmacists could be a practical way to solve the problem of PPIs overuse.

  17. Diffusion tensor MR imaging (DTI) metrics in the cervical spinal cord in asymptomatic HIV-positive patients

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Mang, Christina; Mang, Thomas; Fruehwald-Pallamar, Julia; Weber, Michael; Thurnher, Majda M. [Medical University of Vienna, Department of Radiology, Vienna (Austria); Law, Meng [University of Southern California, Los Angeles County Hospital and USC Medical Center, Department of Radiology, Keck School of Medicine, Los Angeles, CA (United States)

    2011-08-15

    This study was conducted to compare diffusion tensor MR imaging (DTI) metrics of the cervical spinal cord in asymptomatic human immunodeficiency virus (HIV)-positive patients with those measured in healthy volunteers, and to assess whether DTI is a valuable diagnostic tool in the early detection of HIV-associated myelopathy (HIVM). MR imaging of the cervical spinal cord was performed in 20 asymptomatic HIV-positive patients and in 20 healthy volunteers on a 3-T MR scanner. Average fractional anisotropy (FA), mean diffusivity (MD), and major (E1) and minor (E2, E3) eigenvalues were calculated within regions of interest (ROIs) at the C2/3 level (central and bilateral anterior, lateral and posterior white matter). Statistical analysis showed significant differences with regard to mean E3 values between patients and controls (p = 0.045; mixed-model analysis of variance (ANOVA) test). Mean FA was lower, and mean MD, mean E1, and mean E2 were higher in each measured ROI in patients compared to controls, but these differences were not statistically significant. Asymptomatic HIV-positive patients demonstrate only subtle changes in DTI metrics measured in the cervical spinal cord compared to healthy volunteers that currently do not support using DTI as a diagnostic tool for the early detection of HIVM. (orig.)

  18. Visual Function in Asymptomatic Patients With Homozygous Sickle Cell Disease and Temporal Macular Atrophy.

    Science.gov (United States)

    Martin, Gilles C; Dénier, Charlotte; Zambrowski, Olivia; Grévent, David; Bruère, Lenaïc; Brousse, Valentine; de Montalembert, Mariane; Brémond-Gignac, Dominique; Robert, Matthieu P

    2017-10-01

    findings were normal. Temporal macular atrophy in sickle cell disease may have direct consequences on visual function, including in children, even when visual acuity is preserved. Optical coherence tomographic imaging may be warranted when evaluating patients with sickle cell disease, even if asymptomatic with 20/20 visual acuity.

  19. Abnormal lung gallium-67 uptake preceding pulmonary physiologic impairment in an asymptomatic patient with Pneumocystis carinii pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Reiss, T.F.; Golden, J. (Univ. of California, San Francisco (USA))

    1990-05-01

    Pneumocystis carinii pneumonia was suggested by a diffuse, bilateral pulmonary uptake of gallium-67 in an asymptomatic, homosexual male with the antibody to the immunodeficiency virus (HIV) who was undergoing staging evaluation for lymphoma clinically localized to a left inguinal lymph node. Chest radiograph and pulmonary function evaluation, including lung volumes, diffusing capacity and arterial blood gases, were within normal limits. Bronchoalveolar lavage revealed Pneumocystis carinii organisms. In this asymptomatic, HIV-positive patient, active alveolar infection, evidenced by abnormal gallium-67 scanning, predated pulmonary physiologic abnormalities. This observation raises questions concerning the natural history of this disease process and the specificity of physiologic tests for excluding disease. It also has implications for the treatment of neoplasia in the HIV-positive patient population.

  20. Abnormal lung gallium-67 uptake preceding pulmonary physiologic impairment in an asymptomatic patient with Pneumocystis carinii pneumonia

    International Nuclear Information System (INIS)

    Reiss, T.F.; Golden, J.

    1990-01-01

    Pneumocystis carinii pneumonia was suggested by a diffuse, bilateral pulmonary uptake of gallium-67 in an asymptomatic, homosexual male with the antibody to the immunodeficiency virus (HIV) who was undergoing staging evaluation for lymphoma clinically localized to a left inguinal lymph node. Chest radiograph and pulmonary function evaluation, including lung volumes, diffusing capacity and arterial blood gases, were within normal limits. Bronchoalveolar lavage revealed Pneumocystis carinii organisms. In this asymptomatic, HIV-positive patient, active alveolar infection, evidenced by abnormal gallium-67 scanning, predated pulmonary physiologic abnormalities. This observation raises questions concerning the natural history of this disease process and the specificity of physiologic tests for excluding disease. It also has implications for the treatment of neoplasia in the HIV-positive patient population

  1. Asymptomatic Primary Hyperparathyroidism

    Science.gov (United States)

    Silverberg, Shonni J.; Walker, Marcella D.; Bilezikian, John P.

    2014-01-01

    The clinical profile of primary hyperparathyroidism (PHPT) as it is seen in the United States and most Western countries has evolved significantly over the past half century. The introduction of the multichannel serum autoanalyzer in the 1970s led to the recognition of a cohort of individuals with asymptomatic hypercalcemia, in whom evaluation led to the diagnosis of PHPT. The term “asymptomatic primary hyperparathyroidism” was introduced to describe patients who lack obvious signs and symptoms referable to either excess calcium or parathyroid hormone. Although it was expected that asymptomatic patients would eventually develop classical symptoms of PHPT, observational data suggest that most patients do not evolve over time to become overtly symptomatic. In most parts of the world, the asymptomatic phenotype of PHPT has replaced classical PHPT. This report is a selective review of data on asymptomatic PHPT: its demographic features, presentation and natural history, as well as biochemical, skeletal, neuromuscular, psychological, and cardiovascular manifestations. In addition, we will summarize available information on treatment indications and options for those with asymptomatic disease. PMID:23374736

  2. Positive Predictive Value of True Bacteremia according to the Number of Positive Culture Sets in Adult Patients.

    Science.gov (United States)

    Kitaura, Tsuyoshi; Chikumi, Hiroki; Fujiwara, Hiromitsu; Okada, Kensaku; Hayabuchi, Tatsuya; Nakamoto, Masaki; Takata, Miyako; Yamasaki, Akira; Igishi, Tadashi; Burioka, Naoto; Shimizu, Eiji

    2014-12-01

    Performing multiple blood culture sets simultaneously is a standard blood culture methodology, although it is often difficult to distinguish true bacteremia from contamination when only one of several blood culture sets is positive. This study clarified the relationship between the number of positive blood culture sets and clinical significance in patients with positive blood culture. Patients aged 18 years and over with at least 1 positive blood culture were enrolled. Positive blood culture episodes were categorized from clinical records as true bacteremia, contamination, or unknown clinical significance. The associations among episodes of true bacteremia, isolated bacteria, the number of positive blood culture sets from among the performed sets, and the clinical background of patients were analyzed. Among a total of 407 episodes, 262, 67 and 78 were true bacteremia, contamination and unknown clinical significance, respectively. The positive predictive values (PPVs) of 1 out of 1, 1 out of 2 and 2 out of 2 positive sets in cases of Staphylococcus aureus, were 81.3%, 50% and 100% respectively; those in cases of coagulase-negative Staphylococci were 20.5%, 10.8% and 63.5%, respectively. Almost all cases of Escherichia coli, Pseudomonas aeruginosa, Klebsiella species and Candida species were true bacteremia. The probability of true bacteremia was strongly associated with recent surgery in multivariate analysis (P sets from among the performed sets varies by microorganism. Therefore, PPVs calculated using this method may help physicians distinguish true bacteremia from contamination.

  3. Existential crises in two religious patients: Vicissitudes of faith and the emergence of the true self.

    Science.gov (United States)

    Fattori, Lucia; Secchi, Cesare

    2015-08-01

    The authors present two clinical cases involving an existential crisis which led the patients to lose what had been the foundation in their lives, their faith. Although the therapeutic settings differ--the first patient had a few psychotherapy sessions following a psychotic episode with a mystical background, while the second was in the final stage of analytic treatment - the authors highlight how in both clinical cases a loss of faith becomes a total and urgent crisis of the Self. The fracture which ensues seems to generate an intense engagement of the body which, paradoxically during a loss of faith, induces an experience of ecstasy of the kind that has traditionally been reported. In the first case the experience of ecstasy was lived first-hand by the patient who thereafter redefined the psychotic breakdown as a "moment of truth"; whereas the second patient, through a deep projective identification, induces an eerie countertransferential feeling of 'metaphysical' shortfall in the agnostic psychoanalyst, triggering bewilderment, physical discomfort and awe in him. In both cases the authors believe that the notable somatic involvement may be correlated to a potentially profound and unprecedented contact with the True Self. Copyright © 2015 Institute of Psychoanalysis.

  4. Comparison of erlotinib and pemetrexed as second-/third-line treatment for lung adenocarcinoma patients with asymptomatic brain metastases

    Directory of Open Access Journals (Sweden)

    He YY

    2016-04-01

    Full Text Available Yayi He,1,* Wenwen Sun,2,* Yan Wang,3,* Shengxiang Ren,1 Xuefei Li,3 Jiayu Li,3 Christopher J Rivard,4 Caicun Zhou,1 Fred R Hirsch4 1Department of Oncology, Shanghai Pulmonary Hospital, 2Clinic and Research Center of Tuberculosis, Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, 3Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, People’s Republic of China; 4Division of Medical Oncology, Department of Medicine, University of Colorado, Aurora, CO, USA *These authors contributed equally to this work Objective: Brain metastases occur in one-third of all non-small-cell lung cancer patients. Due to restrictive transport at the blood–brain barrier, many drugs provide poor control of metastases in the brain. The aim of this study was to compare erlotinib with pemetrexed as second-/third-line treatment in patients with lung adenocarcinoma with asymptomatic brain metastases.Methods: From January 2012 to June 2014, all lung adenocarcinoma patients with asymptomatic brain metastases who received treatment with erlotinib or pemetrexed as second-/third-line treatment were retrospectively reviewed. Chi-square and log-rank tests were used to perform statistical analysis.Results: The study enrolled 99 patients, of which 44 were positive for EGFR mutation. Median progression-free survival (PFS in months was not significantly different between the erlotinib- and pemetrexed-treated groups (4.2 vs 3.4 months; 95% confidence interval [CI]: 2.01–6.40 vs 2.80–5.00, respectively; P=0.635. Median PFS was found to be significantly longer in EGFR mutation–positive patients in the erlotinib-treated group (8.0 months; 95% CI 5.85–10.15 compared to the pemetrexed group (3.9 months; 95% CI: 1.25–6.55; P=0.032. The most common treatment-related side effect was mild-to-moderate rash and the most common drug-related side

  5. Fecal occult blood test and flexible rectosigmoidoscopy: tools for the screening of colorectal neoplasms in asymptomatic patients

    OpenAIRE

    Jucá, Mario Jorge; Assunção, Paulo Roberto Torres; Hasten-Reiter Júnior, Hermann Nogueira

    2015-01-01

    PURPOSE: To assess the feasibility and effectiveness of the fecal occult blood test (FOBT) and flexible rectosigmoidoscopy (RSS), as tools used in the CRC screening, in asymptomatic patients, from 50 years of age. METHODS: The study is transversal and presents a sample of 102 individuals. The FOBT used was the guaiaco, FECA-CULT(r) method, held at a single time, in feces collected from a complete evacuation. Individuals, who presented the positive FOBT, were sent to colonoscopy complement, al...

  6. Incidence of true short esophagus among patients submitted to laparoscopic Nissen fundoplication.

    Science.gov (United States)

    Migaczewski, Marcin; Zub-Pokrowiecka, Anna; Grzesiak-Kuik, Agata; Pędziwiatr, Michał; Major, Piotr; Rubinkiewicz, Mateusz; Winiarski, Marek; Natkaniec, Michał; Budzyński, Andrzej

    2015-04-01

    The last two decades have observed development of surgical treatment of benign conditions of the gastroesophageal junction (GEJ), including anti-reflux surgery, due to the growing popularity of the laparoscopic approach. Migration of the fundoplication band and recurrent hiatal hernia are a result of the lack of correct diagnosis and appropriate management of the so-called short esophagus. According to various authors, short esophagus is present in up to 60% of patients qualified for anti-reflux surgery. However, some researchers question the existence of this condition. To analyze the prevalence of short esophagus in patients subjected to laparoscopic Nissen fundoplication. The study included 202 patients who were subjected to laparoscopic Nissen fundoplication. As many as 96% of the patients qualified for the surgical treatment showed supradiaphragmatic location of the high pressure zone. The extent of GEJ protrusion ranged from 0 cm to 3 cm (mean: 2 cm). The extent of dissection within the mediastinum was determined by the level of GEJ protrusion, and ranged from 5 cm to 12 cm (mean: 6 cm). Upon complete mobilization of the esophagus within the mediastinum, no cases of significantly shortened esophagus, precluding downward retraction of at least a 2.5-cm segment below the diaphragmatic crura, were documented. Therefore, none of the patients required Collis gastroplasty. The presence of "true" short esophagus is a sporadic finding among patients qualified for anti-reflux surgery. Mediastinal dissection of the esophagus and its mobilization at an appropriate, individually defined level seems a sufficient treatment in the vast majority of these patients.

  7. Secretin-stimulated MR cholangio-pancreatography in the evaluation of asymptomatic patients with non-specific pancreatic hyperenzymemia

    Energy Technology Data Exchange (ETDEWEB)

    Donati, Francescamaria, E-mail: fra.donati@katamail.co [2nd Department of Radiology, Pisa University-Hospital, Via Paradisa 2, I-56124 Pisa (Italy); Boraschi, Piero; Gigoni, Roberto; Salemi, Simonetta [2nd Department of Radiology, Pisa University-Hospital, Via Paradisa 2, I-56124 Pisa (Italy); Faggioni, Lorenzo; Bertucci, Cristina; Cecchi, Claudia; Bartolozzi, Carlo [Diagnostic and Interventional Radiology, University of Pisa, Via Rome 67, I-56126 Pisa (Italy); Falaschi, Fabio [2nd Department of Radiology, Pisa University-Hospital, Via Paradisa 2, I-56124 Pisa (Italy)

    2010-08-15

    Purpose: To assess the diagnostic value of secretin-stimulated MRCP (SS-MRCP) compared with conventional MRCP in asymptomatic patients with mild elevations of pancreatic enzymes. Materials and methods: Eighty asymptomatic patients with pancreatic hyperenzymemia underwent MR imaging at 1.5 T-device (Signa EXCITE, GE Healthcare). After the acquisition of axial T1w,T2w sequences, and conventional MRCP, SS-MRCP was performed using a single-slice coronal breath-hold, thick-slab, SSFSE T2w sequence, repeated every 30 s up to 15 min following intravenous injection of secretin (Secrelux, Sanochemia). Results: On the basis of the standards of reference, our final diagnoses were: negative findings (n = 23), pancreas divisum (n = 22), mild chronic pancreatitis (n = 14), inflammatory ampullary stenosis (n = 3), juxtapapillary duodenal diverticulum (n = 1), small cystic lesions (<1 cm) (n = 22; 5/22 cases associated with pancreas divisum). The image quality of SS-MRCP was significantly higher than that of conventional MRCP (p < 0.0001). Standards of reference did not differ significantly from of SS-MRCP findings (p = 0.5), while was statistically different from those of conventional MRCP (p < 0.0001). A significant difference was found between conventional MRCP and SS-MRCP findings (p < 0.0001). Conclusion: In asymptomatic patients with non-specific pancreatic hyperenzymemia SS-MRCP may represent the best non-invasive diagnostic technique, since it gives morphological and functional information.

  8. HTLV-1 proviral load in cerebrospinal fluid may not be a good marker to differentiate asymptomatic carriers with high proviral load in blood from HAM/TSP patients.

    Science.gov (United States)

    Martins, Marina Lobato; de Freitas Carneiro-Proietti, Anna Bárbara; Nicolato, Rodrigo; de Miranda, Débora Marques; Romanelli, Luiz Cláudio Ferreira

    2018-03-27

    An elevated human T cell leukemia virus type 1 (HTLV-1) proviral load (PVL) is an important risk factor for HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP), although there is a considerable frequency of asymptomatic carriers (AC) with high PVL in blood. Our objective was to evaluate whether PVL quantified in cerebrospinal fluid (CSF) is helpful to distinguish AC from HAM when AC have high PVL in blood (AC H ). AC H (n = 7) were characterized to have high PVL in blood by quantification of samples collected over time (mean 7 years). HAM patients (n = 14) also had analyzed blood samples collected at different times (mean 9 years). Comparing paired CSF and blood samples of each individual, CSF PVL mean was 4.7-fold higher than blood PVL in the AC H group and 10.8-fold in the HAM group. CSF PVL was significantly greater than blood PVL in the HAM group (p = 0.004), but not in the AC H group. Important to highlight, CSF PVL was not significantly different between the AC H and the HAM groups. These results suggested that significantly higher PVL in CSF than in blood is a hallmark of HAM/TSP patients, but this is also true for asymptomatic carriers with high PVL in blood, thus reducing its usefulness as a marker for HAM/TSP. A greater number of AC H should be analyzed, but whether they will eventually develop HAM/TSP or why they have not developed the disease are still questions to be clarified. Longitudinal studies are necessary to answer these questions.

  9. Occurrence of sleep-related breathing disorders in patients with chronic urticaria at its asymptomatic or oligosymptomatic stages.

    Science.gov (United States)

    Perkowska, Jolanta; Kruszewski, Jerzy; Gutkowski, Piotr; Chciałowski, Andrzej; Kłos, Krzysztof

    2016-02-01

    Chronic urticaria (CU), in view of its manifestations (pruritus, wheals), chronic and recurrent nature is very bothersome for patients and significantly influences their quality of life. To assess the importance of sleep problems and sleep-related breathing disorders (SRBDs) declared by CU patients, for their quality of life. Twenty-eight patients with CU at an asymptomatic stage or with minimal symptoms and signs were qualified for the study. In these patients, assessment of urticaria severity, QoL and SRBDs incidence was carried out. In a questionnaire study (CU-Q2oL), about 54% of the patients with CU complained of sleeping problems, about 80% reported significant fatigue and lack of concentration in the daytime. Respiratory polygraphy, an objective measure of sleep-related breathing disorders (SRBDs) demonstrated their higher incidence in patients with CU than in the general population, but these disorders were mild and had no influence on the reduced quality of life of the study patients, compared with a group of patients without SRBDs. The occurrence of SRBDs was found in 25% of patients with CU at asymptomatic or oligosymptomatic stages. The SRBDs in those patients were mild, required no treatment and their occurrence did not cause any significant reduction in their quality of life.

  10. Occurrence of sleep-related breathing disorders in patients with chronic urticaria at its asymptomatic or oligosymptomatic stages

    Directory of Open Access Journals (Sweden)

    Jolanta Perkowska

    2016-02-01

    Full Text Available Introduction : Chronic urticaria (CU, in view of its manifestations (pruritus, wheals, chronic and recurrent nature is very bothersome for patients and significantly influences their quality of life. Aim : To assess the importance of sleep problems and sleep-related breathing disorders (SRBDs declared by CU patients, for their quality of life. Material and methods : Twenty-eight patients with CU at an asymptomatic stage or with minimal symptoms and signs were qualified for the study. In these patients, assessment of urticaria severity, QoL and SRBDs incidence was carried out. Results : In a questionnaire study (CU-Q2oL, about 54% of the patients with CU complained of sleeping problems, about 80% reported significant fatigue and lack of concentration in the daytime. Respiratory polygraphy, an objective measure of sleep-related breathing disorders (SRBDs demonstrated their higher incidence in patients with CU than in the general population, but these disorders were mild and had no influence on the reduced quality of life of the study patients, compared with a group of patients without SRBDs. Conclusions : The occurrence of SRBDs was found in 25% of patients with CU at asymptomatic or oligosymptomatic stages. The SRBDs in those patients were mild, required no treatment and their occurrence did not cause any significant reduction in their quality of life.

  11. Comparison of allergen responses based on the TRUE Test and IQ Chamber system in Korean patients.

    Science.gov (United States)

    Kwon, Won Joo; Ko, Joo Yeon; Ro, Young Suck; Kim, Myung Hwa; Kim, Byung Soo; Kim, Hye One; Nam, Jae Hui; Lee, Ga-Young; Park, Mi Youn; Son, Sang Wook; Yang, Jun Mo; Lee, Dong Hun; Lee, Ai Young; Lee, Jun Young; Chang, Sung Eun; Choi, Hae Young; Park, Eun Joo

    2017-12-01

    A comparison between responses to allergens based on the TRUE Test ® (TT) and IQ ® Chamber (IQC) in Europeans has been previously reported, however, no such study has been performed in Asians. To compare allergen responses using the TT and IQC (using the Korean standard series) in order to gather more information regarding the positive response rates for each allergen and the clinical value of IQC. Suspected contact dermatitis patients were enrolled and tested with 18 allergens using the TT and IQC. The test was performed in 214 patients. Simultaneous positive results for both tests were recorded in 242 cases (positive concordance rate: 66.7%). IQC yielded more positive results. Allergens with a high positive concordance rate were nickel sulphate (82.1%), thimerosal (78.6%), and p-phenylenediamine (73.3%). IQC mostly showed similar or higher positive rates than TT, with high concordance. We recommend the IQC method as a screening test in patients with suspected contact dermatitis. To compensate for possible false positive results, careful history taking and a different patch test should be performed when appropriate.

  12. The impact of asymptomatic helminth co-infection in patients with newly diagnosed tuberculosis in north-west Ethiopia.

    Directory of Open Access Journals (Sweden)

    Ebba Abate

    Full Text Available BACKGROUND: Areas endemic of helminth infection, tuberculosis (TB and HIV are to a large extent overlapping. The aim of this study was to assess the impact of asymptomatic helminth infection on the immunological response among TB patients with and without HIV, their house hold contacts and community controls. METHODOLOGY: Consecutive smear positive TB patients (n = 112, their household contacts (n = 71 and community controls (n = 112 were recruited in Gondar town, Ethiopia. Stool microscopy, HIV serology, serum IgE level, eosinophil and CD4 counts were performed and tuberculosis patients were followed up for 3 months after initiation of anti-TB treatment. RESULTS: Helminth co-infection rate was 29% in TB patients and 21% in both community control and household contacts (p = 0.3 where Ascaris lumbricoides was the most prevalent parasite. In TB patients the seroprevalence of HIV was 47% (53/112. Eosinophilia and elevated IgE level were significantly associated with asymptomatic helminth infection. During TB treatment, the worm infection rate of HIV+/TB patients declined from 31% (10/32 at week 0 to 9% (3/32 at week 2 of TB treatment, whereas HIV-/TB patients showed no change from baseline to week 2, 29% (13/45 vs. 22.2% (10/45. This trend was stable at week 8 and 12 as well. CONCLUSION: One third of smear positive TB patients were infected with helminths. Eosinophilia and elevated IgE level correlated with asymptomatic worm infection, indicating an effect on host immunity. The rate of worm infection declined during TB treatment in HIV+/TB co-infected patients whereas no decline was seen in HIV-/TB group.

  13. Asymptomatic chronic gastritis decreases metformin tolerance in patients with type 2 diabetes.

    Science.gov (United States)

    Huang, Y; Sun, J; Wang, X; Tao, X; Wang, H; Tan, W

    2015-08-01

    Digestive disorders represent the most common metformin side effects for type 2 diabetes. The mechanism of these metformin side effects is unclear. The aim of this study was to assess whether asymptomatic chronic gastritis could influence metformin tolerance in patients with type 2 diabetes. Demographic, anthropometric, ultrasound and laboratory data were obtained from 144 metformin naïve patients with diabetes. The diagnosis of chronic gastritis was based on endoscopic and histopathological examination, and H. pylori infection was assessed based on (13) C urea breath test (UBT). All subjects started metformin at 500 mg/day and increasing progressively to 1500 mg/day over 4 weeks. A score of gastrointestinal side effects (abdominal pain, diarrhoea, nausea, vomiting, bloating and anorexia) was assessed each week, and metformin dose was adjusted as appropriate. Based on endoscopy, 64 patients were categorized as non-gastritis subjects and 80 as chronic gastritis subjects. At baseline, there is no statistical difference in gastrointestinal symptoms between two groups. With metformin, the mean scores for gastrointestinal symptoms in the non-gastritis and gastritis subjects were 1·02 ± 1·71 vs. 2·18 ± 2·05 (P = 0·001), 0·20 ± 0·65 vs. 0·50 ± 0·89 (P = 0·022), 0 vs. 0·06 ± 0·24 (P = 0·024) and 1·08 ± 1·03 vs. 1·71 ± 1·66 (P = 0·028). The mean final metformin dose used by gastritis subjects was 706·24 ± 568·90 mg, significantly less than the mean dose used by non-gastritis subjects (1101·56 ± 578·58 mg, P = 0·001). After adjustment for age and sex, the odds ratio (OR) for a final metformin dose of less than 1500 mg/day was found to be 2·76 (95% CI 1·38-5·53, P = 0·004) for chronic gastritis subjects. The OR for a final metformin dose of less than 1000 mg/day was found to be 3·98 (95% CI 1·91-8·27, P = 0·001) for chronic gastritis subjects. Our data suggest that pre-existing non-symptomatic gastritis was associated with metformin

  14. Increased plasma levels of tumor necrosis factor-alpha in asymptomatic/"indeterminate" and Chagas disease cardiomyopathy patients

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    Renata Cristina Ferreira

    2003-04-01

    Full Text Available We compared plasma tumor necrosis factor-alpha (TNF-alpha levels among asymptomatic/"indeterminate" Chagas disease patients (ASY and patients across the clinical spectrum of chronic Chagas disease cardiomyopathy (CCC. Idiopathic dilated cardiomyopathy (DCM patients and normal controls (NC were included as controls. ASY Chagas disease patients had significantly higher plasma TNF-alpha levels than NC. TNF-alpha levels among severe CCC patients with significant left ventricular (LV dysfunction were similar to those of DCM patients, showing average 2-fold higher levels than CCC patients without LV dysfunction and ASY patients, and 8-fold higher levels than NC. In Chagas disease, chronic TNF-a production prior to heart failure may play a role in CCC progression.

  15. The Impact of Carotid Artery Stenting on Cerebral Perfusion, Functional Connectivity, and Cognition in Severe Asymptomatic Carotid Stenosis Patients

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    Tao Wang

    2017-08-01

    Full Text Available Background and purposeAsymptomatic carotid artery stenosis can lead to not only stroke but also cognition impairment. Although it has been proven that carotid artery stenting (CAS can reduce the risk of future strokes, the effect of CAS on cognition is conflicting. In recent years, pulsed arterial spin labeling (pASL MRI and resting-state functional MRI (R-fMRI have been employed in cognitive impairment studies. For the present study, cognition is evaluated in severe asymptomatic carotid artery stenosis patients undergoing CAS, and the mechanisms underlying the cognitive change are explored by pASL MRI and R-fMRI.Materials and methodsWe prospectively enrolled 24 asymptomatic, severe (≥70%, unilateral internal carotid artery stenosis patients, who were expecting the intervention of CAS. Cognition assessment (including the Montreal Cognitive Assessment Beijing Version, the Minimum Mental State Examination, the Digit Symbol Test, the Rey Auditory Verbal Learning Test, and the Verbal Memory Test and an integrated MRI program (pASL MRI, and R-fMRI were administered 7 days before and 3 months after CAS.Results16 subjects completed the follow-up study. After stenting, significant improvement in the scores of the MMSE, the Verbal Memory test, and the delayed recall was found. No significant difference was found in the scores of the Montreal Cognitive Assessment Beijing Version, the Digit Symbol Test, and the immediate recall. After CAS treatment, asymptomatic carotid artery stenosis patients showed increased perfusion in the left frontal gyrus, increased amplitude of low-frequency fluctuation (ALFF in the right precentral gyrus, and increased connectivity to the posterior cingulate cortex (PCC in the right supra frontal gyrus. However, no significant correlations were found between these imaging changes and cognition assessments.ConclusionSuccessful CAS can partly improve cognition in asymptomatic carotid artery stenosis patients. The cognition

  16. Asymptomatic bacteriuria

    Science.gov (United States)

    ... symptoms of this problem. If you have these symptoms, you may have a urinary tract infection but you DO NOT have asymptomatic bacteriuria. Burning during urination Increased urgency to urinate Increased frequency of urination ... for a urine culture . Most people with no urinary tract symptoms do not need this test. You may need ...

  17. Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with symptomatic versus asymptomatic irreversible pulpitis.

    Science.gov (United States)

    Argueta-Figueroa, Liliana; Arzate-Sosa, Gabriel; Mendieta-Zeron, Hugo

    2012-01-01

    This study sought to determine the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine in patients with symptomatic and asymptomatic irreversible pulpitis in mandibular posterior teeth and if individual patient factors, pulpal disease characteristics, and previous medication are correlated to local anesthetic success. A second objective was to determine the specificity and sensibility of a cold test for prediction of anesthetic success prior to endodontic treatment. Seventy patients diagnosed with irreversible pulpitis in mandibular posterior teeth received 1.6 mL of 4% articaine with 1:100,000 epinephrine for an inferior alveolar nerve block (IANB) using a metal guide. The anesthetic solution was injected with a computer-preprogrammed delivery system for local anesthesia. Endodontic access was begun 15 minutes after solution deposition; later, patients rated their discomfort using the visual analog scale (VAS). The success rate for the IA NB using articaine was 64.2% in patients with symptomatic irreversible pulpitis and 86.9% in patients with asymptomatic irreversible pulpitis. Cold test prior to root canal treatment had a specificity and sensibility of 12.5% and 87.1%, respectively. The anesthetic efficacy of articaine in irreversible pulpitis is moderately acceptable, and anesthetic success increases when the patient has been premedicated with NSAIDs. The cold test appears to be a favorable indicator for predicting anesthetic success.

  18. Predictive value of coronary calcifications for future cardiac events in asymptomatic patients with diabetes mellitus: A prospective study in 716 patients over 8 years

    Directory of Open Access Journals (Sweden)

    Tittus Janine

    2008-10-01

    Full Text Available Abstract Background To establish an efficient prophylaxis of coronary artery disease reliable risk stratification is crucial, especially in the high risk population of patients suffering from diabetes mellitus. This prospective study determined the predictive value of coronary calcifications for future cardiovascular events in asymptomatic patients with diabetes mellitus. Methods We included 716 patients suffering from diabetes mellitus (430 men, 286 women, age 55.2 ± 15.2 years in this study. On study entry all patients were asymptomatic and had no history of coronary artery disease. In addition, all patients showed no signs of coronary artery disease in ECG, stress ECG or echocardiography. Coronary calcifications were determined with the Imatron C 150 XP electron beam computed tomograph. For quantification of coronary calcifications we calculated the Agatston score. After a mean observation period of 8.1 ± 1.1 years patients were contacted and the event rate of cardiac death (CD and myocardial infarction (MI was determined. Results During the observation period 40 patients suffered from MI, 36 patients died from acute CD. The initial Agatston score in patients that suffered from MI or died from CD (475 ± 208 was significantly higher compared to those without cardiac events (236 ± 199, p Conclusion By determination of coronary calcifications patients at risk for future MI and CD could be identified within an asymptomatic high risk group of patients suffering from diabetes mellitus. On the other hand future events could be excluded in patients without coronary calcifications.

  19. Can fish oil supplementation improve endothelial function in asymptomatic offspring of patients with peripheral arterial disease?

    Directory of Open Access Journals (Sweden)

    Spark JI

    2013-07-01

    maintain a diary of fish oil consumption on a daily basis, and fish oil returned will be measured to confirm adherence. Participants will complete validated surveys to determine background diet and physical activity levels.Discussion: This study will examine the effectiveness of a moderate-dose fish oil intervention in reversing endothelial dysfunction in asymptomatic offspring of patients with peripheral arterial disease. It provides the opportunity to delay the progression of peripheral arterial disease using a cheap and readily available dietary supplement that has minimal side effects compared with synthetic vasoactive pharmacological medications.Keywords: omega 3 fatty acids, endothelial function, peripheral arterial disease

  20. Computed tomography for the measurement of coronary calcification in asymptomatic risk patients

    Directory of Open Access Journals (Sweden)

    Pichlbauer, Ernest

    2006-05-01

    Full Text Available Background: In 2003 nearly 20% of deaths in Germany were caused by coronary heart disease (CHD. Risk models are used to estimate the ten-year-risk of a coronary event. Coronary calcification may be seen as an additional risk factor. The amount of calcium is correlated with atherosclerotic lesions, but there is no direct correlation with the probability of a plaque rupture. Coronary calcification may be measured either by electron beam computed tomography (EBCT or multi-detector computed tomography (MDCT. Objectives: The aim of this HTA report is to investigate the diagnostic validity and cost effectiveness of computed tomography techniques in measuring coronary calcification of asymptomatic risk patients. Ethical aspects are discussed. Methods: A systematic literature research was performed in 35 international databases which yielded 1080 articles. Overall 43 publications were included for assessment, according to predefined selection criteria. Results: Measuring coronary calcification offers additional information compared with traditional risk factors. Yet at present it cannot be said - according to published literature - which population groups gain most. For determining adequate calcium score thresholds standardisation for age and sex is important. When comparing the reference standard EBCT with MDCT results are inconsistent and depend on the calcium-score value as well as on the scoring method. EBCT as a triage instrument in diagnosing CHD appears to be cost-effective. Yet it is rather not cost-effective as a refinement tool for risk stratification. Discussion: Most of the literature was published in the United States and discusses the use of EBCT as well as (traditional risk stratification by the Framingham Score. Regarding coronary calcification measured by MDCT (which is more widespread in Germany than EBCT and a risk model applicable for European populations clear recommendations based on published literature cannot be made at present

  1. Differences in cardiovascular risk profile between electrocardiographic hypertrophy versus strain in asymptomatic patients with aortic stenosis (from SEAS data)

    DEFF Research Database (Denmark)

    Greve, Anders M; Gerdts, Eva; Boman, Kurt

    2011-01-01

    Electrocardiograms are routinely obtained in clinical follow-up of patients with asymptomatic aortic stenosis (AS). The association with aortic valve, left ventricular (LV) response to long-term pressure load, and clinical covariates is unclear and the clinical value is thus uncertain. Data from...... clinical examination, electrocardiogram, and echocardiogram in 1,563 patients in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study were used. Electrocardiograms were Minnesota coded for arrhythmias and atrioventricular and intraventricular blocks; LV hypertrophy was assessed by Sokolow...

  2. A window of opportunity phase II study of enzastaurin in chemonaive patients with asymptomatic metastatic colorectal cancer

    DEFF Research Database (Denmark)

    Glimelius, B; Lahn, M; Gawande, S

    2010-01-01

    BACKGROUND: Preclinically, protein kinase C and AKT activation can be inhibited by enzastaurin and reduce tumor growth of colorectal cancer cells. In asymptomatic patients with metastatic colorectal cancer (mCRC), enzastaurin activity was evaluated by measuring the 6-month progression-free survival...... cycles. Progression was assessed on the basis of radiographic imaging, rise in carcinoembryonic antigen or lactate dehydrogenase (LDH) levels or by appearance of clinical symptoms. RESULTS: Twenty-eight patients received daily enzastaurin. The 6-month PFS rate was 28% [95% confidence interval (CI) 13...

  3. Left atrial volume in patients with asymptomatic aortic valve stenosis (the Simvastatin and Ezetimibe in Aortic Stenosis study)

    DEFF Research Database (Denmark)

    Dalsgaard, Morten; Egstrup, K.; Wachtell, K.

    2008-01-01

    area. Mean values for age and AVA were 67 +/- 10 years and 1.27 +/- 0.5 cm2, respectively, and 574 were women (38%). Mean value for LA volume indexed (LAVI) was 36 +/- 13 ml/m2. Enlargement of LA volume (> or =32 ml/m2) was found in 57% of patients. AVA indexed was significantly correlated to LAVI (r.......0001), presence of LV hypertrophy (beta = 3.4, p Gender and LV ejection fraction were eliminated from the final model. In conclusion, LA volume is often enlarged in asymptomatic patients with AS. Furthermore, LA volume is related to AVA even...

  4. Radionuclide bone scan, radiographic bone survey, and alkaline phosphatase: studies of limited value in asymptomatic patients with ovarian carcinoma

    International Nuclear Information System (INIS)

    Metler, F.A. Jr.; Christie, J.H.; Crow, N.E. Jr.; Garcia, J.F.; Wicks, J.D.; Bartow, S.A.

    1982-01-01

    Bone scans or skeletal surveys were obtained in 104 patients with ovarian carcinoma. No metastases were identified at staging in the 43 patients with Stage I or II disease. Four patients in the entire series had osseous metastases. Three of the 40 patients with Stage III epithelian ovarian carcinoma has osseous metastases at the time of staging. All of these were Grade III lesions. One Stage I, Grade III patient demonstrated osseous metastases two years after initial diagnosis. None of the four patients with osseous metastases had an elevated alkaline phosphatase; three of the four had bone pain. Based on these results, it is suggested that radiographic bone survey and radionuclide bone scans are not indicated as screening procedures in asymptomatic patients with ovarian carcinoma

  5. The prevalence and bacteriology of asymptomatic bacteriuria among antenatal patients in Nnamdi Azikiwe University Teaching Hospital Nnewi; South Eastern Nigeria.

    Science.gov (United States)

    Oli, A N; Okafor, C I; Ibezim, E C; Akujiobi, C N; Onwunzo, M C

    2010-12-01

    Urinary tract infection in pregnancy leads to poor pregnancy outcome. Diagnosis and treatment of asymptomatic bacteriuria markedly improves pregnancy outcome as well as reduce the incidence of acute pyelonephritis. To determine the prevalence and bacteriology of asymptomatic bacteriuria among Antenatal patients in our centre, and to know if routine screening will be justifiable. This was a prospective study carried out between April and August 2008. Sample size was statistically determined. Women who consented were interviewed and mid stream urine samples were collected and processed in the microbiology laboratory, using standard microbiological methods. Out of 357 women studied, 65(18.21%) had significant bacteriuria. Escherichia coli was the commonest isolate (25.6%), while proteus mirabilis was the least frequent isolate (3.66%). Women in third trimester had the highest prevalence (25.68%) while those in the first trimester had the least (15.79%). Women that had only primary education had the highest prevalence (27.50%) while those that had tertiary education had the least prevalence (21.10%). The prevalence of significant asymptomatic bacteriuria among the women studied was high. Screening of all the pregnant women and treatment will reduce the incidence and complications of overt urinary tract infection in pregnancy among these women.

  6. Antiphospholipid antibodies detected by line immunoassay differentiate among patients with antiphospholipid syndrome, with infections and asymptomatic carriers.

    Science.gov (United States)

    Roggenbuck, Dirk; Borghi, Maria Orietta; Somma, Valentina; Büttner, Thomas; Schierack, Peter; Hanack, Katja; Grossi, Claudia; Bodio, Caterina; Macor, Paolo; von Landenberg, Philipp; Boccellato, Francesco; Mahler, Michael; Meroni, Pier Luigi

    2016-05-21

    Antiphospholipid antibodies (aPL) can be detected in asymptomatic carriers and infectious patients. The aim was to investigate whether a novel line immunoassay (LIA) differentiates between antiphospholipid syndrome (APS) and asymptomatic aPL+ carriers or patients with infectious diseases (infectious diseases controls (IDC)). Sixty-one patients with APS (56 primary, 22/56 with obstetric events only, and 5 secondary), 146 controls including 24 aPL+ asymptomatic carriers and 73 IDC were tested on a novel hydrophobic solid phase coated with cardiolipin (CL), phosphatic acid, phosphatidylcholine, phosphatidylethanolamine, phosphatidylglycerol, phosphatidylinositol, phosphatidylserine, beta2-glycoprotein I (β2GPI), prothrombin, and annexin V. Samples were also tested by anti-CL and anti-β2GPI ELISAs and for lupus anticoagulant activity. Human monoclonal antibodies (humoAbs) against human β2GPI or PL alone were tested on the same LIA substrates in the absence or presence of human serum, purified human β2GPI or after CL-micelle absorption. Comparison of LIA with the aPL-classification assays revealed good agreement for IgG/IgM aß2GPI and aCL. Anti-CL and anti-ß2GPI IgG/IgM reactivity assessed by LIA was significantly higher in patients with APS versus healthy controls and IDCs, as detected by ELISA. IgG binding to CL and ß2GPI in the LIA was significantly lower in aPL+ carriers and Venereal Disease Research Laboratory test (VDRL) + samples than in patients with APS. HumoAb against domain 1 recognized β2GPI bound to the LIA-matrix and in anionic phospholipid (PL) complexes. Absorption with CL micelles abolished the reactivity of a PL-specific humoAb but did not affect the binding of anti-β2GPI humoAbs. The LIA and ELISA have good agreement in detecting aPL in APS, but the LIA differentiates patients with APS from infectious patients and asymptomatic carriers, likely through the exposure of domain 1.

  7. Acupuncture for serum uric acid in patients with asymptomatic hyperuricemia: A randomized, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Huang, Yingjuan; Meng, Jun; Sun, Baoguo; Xiang, Ting; Zhou, Xin; Xu, Biyu; Wu, Yingzi; Chen, Zexiong; Zhang, Shijun

    2017-04-01

    Hyperuricemia (HUA) is the most common disease associated with cardiovascular disease, metabolic syndrome, hypertension, and kidney disease. The objective of the current study was to evaluate the preliminary efficacy, mechanism, and safety of acupuncture on serum uric acid in patients with asymptomatic HUA. A randomized, placebo-controlled trial among 123 patients with asymptomatic HUA was conducted. The acupoints used in the acupuncture group were bilateral Five Shu in Spleen Meridian. Each participant received the intervention once daily for 10 consecutive days. The sham group received the same treatment duration on the same acupoints by the Park Sham Device. All patients underwent measurements of serum or urine creatinine, uric acid, serum lipid profiles, fasting plasma glucose, HbA1c, xanthine oxidase (XOD) and urate-anion exchanger (URAT-1). At the end of the intervention, the individuals in the acupuncture group were found to have significantly less levels of serum uric acid than those in the sham group [(453±65 vs. 528±81) μmol/L, puric acid level, urine pH value and 24-hour urine volume than the sham treatment (puric acid in a Chinese HUA patient population. The mechanism might be associated with the decrease level of enzyme URAT-1. ChiCTR-TRC-13004122. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Perfusion MR imaging with FAIR true FISP spin labeling in patients with and without renal artery stenosis: initial experience.

    Science.gov (United States)

    Fenchel, Michael; Martirosian, Petros; Langanke, Juergen; Giersch, Jenny; Miller, Stephan; Stauder, Norbert I; Kramer, Ulrich; Claussen, Claus D; Schick, Fritz

    2006-03-01

    The purpose of this study was to prospectively evaluate an arterial spin-labeling technique, flow-sensitive alternating inversion-recovery (FAIR) true fast imaging with steady-state precession (FISP), for noninvasive quantification of renal perfusion in patients without a history of renal artery stenosis (RAS) and in patients with proved RAS. The study was approved by the local ethics committee, and all participants provided written informed consent. Six patients with hypertension but no history of renal artery disease and 12 patients with RAS underwent FAIR true FISP magnetic resonance (MR) imaging in a whole-body 1.5-T unit. RAS grade and scintigraphic perfusion data served as the reference standards. On the FAIR true FISP perfusion images, severe RAS (>70% luminal narrowing) could be clearly distinguished from no or mild RAS and moderate RAS (FAIR perfusion data and stenosis grade (r = -0.76) and between FAIR and single photon emission computed tomographic perfusion values (r = 0.83) were observed. FAIR true FISP was found to be suitable for quantitative perfusion imaging of the kidneys in patients with RAS. Copyright RSNA, 2006.

  9. Prevalence and risk factors of asymptomatic bronchiectasis in patients with rheumatoid arthritis at a tertiary care center in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Suzan Mansour Attar

    2015-01-01

    Full Text Available Introduction and Objectives: Bronchiectasis is a pulmonary manifestation that often occurs in individuals with rheumatoid arthritis (RA. Nevertheless, the prevalence of bronchiectasis in RA patients and predictors of its development/progression remain ill-defined. Our objective was to investigate the prevalence of bronchiectasis in a group of RA patients and examine possible clinical or biochemical risk factors that might contribute to its development. Methods: This was an observational study analyzing 100 RA patients with no pulmonary symptoms selected from King Abdulaziz University Hospital in the Western region of Saudi Arabia from October 2013 to 2014. Demographic, clinical and laboratory information were collected for all patients. Diagnosis was based on the 2010 American College of Rheumatology (ACR/European League Against Rheumatism (EULAR classification system, and disease activity was assessed using the 28-Joint Disease Activity Score Index with C-reactive protein; high-resolution computed tomography chest scans were performed. The prevalence of bronchiectasis was recorded and its association with different risk factors was examined using standard statistical methods. Results: All 100 patients fulfilled the ACR and EULAR classification criteria for RA diagnosis. Their mean age was 51.05 ± 13.5 years, disease duration was 6.19 ± 6.4 years and disease activity index was 4 ± 1.3 (moderate activity. A total of 35 (35% patients developed bronchiectasis. Notably, we observed significant positive associations of bronchiectasis with age, disease duration and male gender (P < 0.001, P = 0.006, P = 0.028, respectively. Conclusions: Asymptomatic bronchiectasis represents a common complication in moderately active RA patients within the Western Region of Saudi Arabia. Furthermore, several predictors of bronchiectasis development were identified, which can contribute to effective risk stratification in RA patients. Further prospective studies are

  10. Detection of lower limb deep venous thrombosis in asymptomatic high risk patients using a new radiolabelled thrombus specific agent

    Energy Technology Data Exchange (ETDEWEB)

    Butler, S.P.; Rahman, T.; Boyd S.J. [George Hospital, Sydney (Australia)] [and others

    1995-05-01

    Deep venous thrombosis is a serious consequence of major orthopaedic surgery and non invasive screening with either venous ultrasound or impedance plethysmography is unreliable for detecting or excluding DVT in this group. A new method of thrombus detection has been devised using Tc-99m labelled inhibited recombinant tissue plasminogen activator. The accuracy of scanning with this new radiopharmaceutical in asymptomatic high risk patients was evaluated using venography as the gold standard. 36 consecutive asymptomatic high risk patients (17 total hip, 19 total knee replacements) underwent both a contrast venogram on the operated leg and scintigraphic scan 7 days following operation. Scintigraphic imaging was performed at 4 hours post injection. For the purpose of this analysis, each venogram was divided into a proximal and a distal segment. Venograms were interpreted as being positive, negative or uninterpretable in each segment. Similar analysis of the scintigraphic scans was performed except that all segments were considered to be of diagnostic quality. 57 segments were able to be analysed. Of the 13 thrombosed segments (1 proximal, 12 calf), 12 had positive scans; in the 44 non thrombosed segments, 40 had negative scans. Thus in detecting lower limb thrombosis, scanning had a sensitivity of 92% and a specificity of 91%. Scintigraphic scanning with this new radiopharmaceutical permits accurate detection of thrombus in high risk patients.

  11. Hepatic and pancreatic involvement in hereditary hemorrhagic telangiectasia: quantitative and qualitative evaluation with 64-section CT in asymptomatic adult patients

    Energy Technology Data Exchange (ETDEWEB)

    Barral, Matthias; Sirol, Marc; Hamzi, Lounis; Gayat, Etienne; Boudiaf, Mourad [Hopital Lariboisiere-APHP, Department of Abdominal Imaging, Paris (France); Place, Vinciane [Hopital Lariboisiere-APHP, Department of Abdominal Imaging, Paris (France); Universite Diderot-Paris 7, UFR de Medecine, Paris (France); Borsik, Michel [Hopital Lariboisiere-APHP, Deparment of Ear, Nose and Throat, Paris (France); Soyer, Philippe [Hopital Lariboisiere-APHP, Department of Abdominal Imaging, Paris (France); Universite Diderot-Paris 7, UFR de Medecine, Paris (France); Unite 965 INSERM/Paris7, Hopital Lariboisiere-APHP, Paris (France)

    2012-01-15

    To analyse quantitatively and qualitatively asymptomatic hepatic and pancreatic involvement in hereditary haemorrhagic telangiectasia (HHT) using 64-section helical CT. The 64-section helical CT examinations of 19 patients with HHT (8 men, 11 women; mean age, 58.6 years) were quantitatively and qualitatively analysed and compared to those of 19 control subjects who were matched for age and sex. Comparisons were made using univariate analysis. Dilated and tortuous intrahepatic arterial branches was the most discriminating independent variable (P < 0.0001) and had the highest specificity (100%; 19/19; 95%CI: 82%-100%) and accuracy (97%; 37/38; 95%CI: 86%-100%) for the diagnosis of HHT. Heterogeneous enhancement of hepatic parenchyma, intrahepatic telangiectases, hepatic artery to hepatic vein shunting, hepatic artery enlargement (i.e. diameter > 6.5 mm) and portal vein enlargement (i.e. diameter > 13 mm) were other variables that strongly correlated with the presence of HHT. Intrapancreatic telangiectases and arteriovenous malformations were found in 42% and 16% of patients with HHT, respectively. Liver and pancreatic involvement in asymptomatic HHT patients is associated with myriad suggestive findings on 64-section helical CT. It can be anticipated that familiarity with these findings would result in more confident diagnosis of HHT. (orig.)

  12. Performance of 18F-FDG PET/CT as a postoperative surveillance imaging modality for asymptomatic advanced gastric cancer patients

    International Nuclear Information System (INIS)

    Lee, Dong Yun; Lee, Chang Hwan; Seo, Min Jung; Lee, Suk Hyun; Ryu, Jin-Sook; Lee, Jong Jin

    2014-01-01

    The purpose of this study was to investigate the diagnostic performance of postoperative fluorine-18 fluoro-2-deoxy-D-glucose ( 18 F-FDG) positron emission tomography/computed tomography (PET/CT) as a surveillance modality for advanced gastric cancer patients who were asymptomatic and negative by conventional follow-up. We retrospectively collected 46 advanced gastric cancer patients who received approximately 1-year-postoperative 18 F-FDG PET/CT surveillance following curative resection (mean age 60.6 ± 11.5 years). 18 F-FDG PET/CT was interpreted by nuclear medicine physicians who were blind to the clinical information. Final confirmation was determined by clinical follow-up using tumor markers, conventional CT scan, upper gastrointestinal endoscopy and with/without subsequent histopathologic diagnosis. Four patients developed recurrence (8.7%; 1 local and 3 distant recurrences). For local recurrence, 18 F-FDG PET/CT found four hypermetabolic lesions and one was local recurrence. For distant recurrence, seven hypermetabolic lesions were found in six patients and true-positive was three lesions. False-positive cases were mainly turned out to be physiologic small bowel uptake. Regardless of the recurrence site, the sensitivity, specificity, positive predictive value and negative predictive value of 18 F-FDG PET/CT were 100% (4/4, 95% confidence interval (CI) 39.6-100%), 88.1% (37/42, 95% CI 73.6-95.5%), 44.4% (4/9, 95% CI 15.3-77.3%) and 100% (37/37, 95% CI 88.3-100%), respectively in the patient-based analysis. Our study showed good specificity of postoperative surveillance 18 F-FDG PET/CT for detecting recurrence. Careful caution should be made for interpreting some false-positive hypermetabolic lesions in postoperative 18 F-FDG PET/CT, especially at the local anastomosis site. (author)

  13. Clinical impact of [18F]FDG-PET in patients with suspected recurrent breast cancer based on asymptomatically elevated tumor marker serum levels. A preliminary report

    International Nuclear Information System (INIS)

    Liu, Chiu-Shong; Lin, Cheng-Chieh; Kao, Chia-Hung; Yen, Ruoh-Fang

    2002-01-01

    The purpose of this study was to evaluate retrospectively the impact of [ 18 F]fluorodeoxyglucose positron emission tomography (FDG-PET) on the detection of recurrent breast cancer based on asymptomatically elevated tumor markers levels. Whole-body FDG-PET was performed in 30 patients with suspected recurrent breast cancer and asymptomatic tumor marker increase but negative or equivocal other imaging modality results. A blood sample was drawn in each case for marker assay (CA 15-3 and CEA) on the same day as the FDG-PET. All of these 30 asymptomatic patients had either CA 15-3>32 U/ml or CEA>5 ng/ml. The final diagnosis of recurrent breast cancer was established by operation/biopsy histopathological findings or clinical follow-up for >1 year by additional morphological imaging techniques. Among the 30 patients, the final diagnosis of recurrent breast cancer was established in 38 sites in 28 patients. FDG-PET accurately detected 35/38 sites in 25/28 patients with recurrence. The diagnostic sensitivity and accuracy of FDG-PET in patients with suspected recurrent breast cancer and asymptomatically elevated tumor markers were 96 and 90%, respectively. FDG-PET is a useful technique for detecting recurrent breast cancer suspected from asymptomatically elevated tumor markers levels and has an important clinical impact on the management of these patients. (author)

  14. Clinical impact of [{sup 18}F]FDG-PET in patients with suspected recurrent breast cancer based on asymptomatically elevated tumor marker serum levels. A preliminary report

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Chiu-Shong; Lin, Cheng-Chieh; Kao, Chia-Hung [China Medical Coll., Taichung, Taiwan (China). Hospital; Shen, Yeh-You [Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (China); Yen, Ruoh-Fang [National Taiwan Univ., Taipei, Taiwan (China). Hospital

    2002-07-01

    The purpose of this study was to evaluate retrospectively the impact of [{sup 18}F]fluorodeoxyglucose positron emission tomography (FDG-PET) on the detection of recurrent breast cancer based on asymptomatically elevated tumor markers levels. Whole-body FDG-PET was performed in 30 patients with suspected recurrent breast cancer and asymptomatic tumor marker increase but negative or equivocal other imaging modality results. A blood sample was drawn in each case for marker assay (CA 15-3 and CEA) on the same day as the FDG-PET. All of these 30 asymptomatic patients had either CA 15-3>32 U/ml or CEA>5 ng/ml. The final diagnosis of recurrent breast cancer was established by operation/biopsy histopathological findings or clinical follow-up for >1 year by additional morphological imaging techniques. Among the 30 patients, the final diagnosis of recurrent breast cancer was established in 38 sites in 28 patients. FDG-PET accurately detected 35/38 sites in 25/28 patients with recurrence. The diagnostic sensitivity and accuracy of FDG-PET in patients with suspected recurrent breast cancer and asymptomatically elevated tumor markers were 96 and 90%, respectively. FDG-PET is a useful technique for detecting recurrent breast cancer suspected from asymptomatically elevated tumor markers levels and has an important clinical impact on the management of these patients. (author)

  15. Imported Asymptomatic Bancroftian Filariasis Discovered from a Plasmodium vivax Infected Patient: A Case Report from Singapore

    Directory of Open Access Journals (Sweden)

    Jean-Marc Chavatte

    2017-01-01

    Full Text Available Human lymphatic filariasis is a vector-borne disease mainly caused by the parasitic nematode Wuchereria bancrofti and transmitted worldwide within the tropical and subtropical regions. Singapore was once endemic for bancroftian filariasis but recent reports are scarce and the disease is nearly forgotten. The case report presented here reports the incidental hospital laboratory finding of an asymptomatic microfilaremia in a relapsing Plasmodium vivax imported case during a malaria treatment follow-up appointment. The parasite was identified by microscopy as W. bancrofti and retrospective investigation of the sample collected during malaria onset was found to be also positive. Additional confirmation was obtained by DNA amplification, sequencing, and phylogenetic analysis of the mitochondrial cox1 gene that further related the parasite to W. bancrofti strains from the Indian region. Considering the large proportion of asymptomatic filariasis with microfilaremia, the high number of migrants and travellers arriving from the surrounding endemic countries, and the common presence of local competent mosquito vectors, Singapore remains vulnerable to the introduction, reemergence, and the spread of lymphatic filariasis. This report brings out from the shadow the potential risk of lymphatic filariasis in Singapore and could help to maintain awareness about this parasitic disease and its public health importance.

  16. Sex-associated differences in the modulation of vascular risk in patients with asymptomatic carotid stenosis.

    Science.gov (United States)

    Buratti, Laura; Balestrini, Simona; Avitabile, Emma; Altamura, Claudia; Vernieri, Fabrizio; Viticchi, Giovanna; Falsetti, Lorenzo; Provinciali, Leandro; Silvestrini, Mauro

    2015-03-31

    In this study, we aimed to identify determinants of the different sex-related stroke risk in subjects with asymptomatic internal carotid artery (ICA) stenosis. In all, 492 women (44.4%) and 617 men (55.6%), with unilateral ⩾ 60% asymptomatic ICA stenosis, were prospectively evaluated with a median follow-up of 37 months (interquartile range, 26 to 43). Vascular risk profile, plaque characteristics, stenosis progression, and common carotid artery intima-media thickness were investigated. Outcome measure was the occurrence of ischemic stroke ipsilateral to ICA stenosis. Myocardial infarction, contralateral stroke and transient ischemic attack were considered as competing events. The incidence rate of ipsilateral stroke over the entire follow-up period was 0.16%: 0.09% (95% confidence interval (CI) 0.05 to 0.15) in women and 0.22% (95% CI 0.17 to 0.29) in men (log-rank test, P<0.001). Stenosis progression significantly influenced the risk of ipsilateral stroke in both men (subhazard ratio, SHR, 8.99) and women (SHR 4.89). Stenosis degree (71% to 90%, SHR 2.35; 91% to 99%, SHR 3.38) and irregular plaque surface (SHR 2.32) were relevant risk factors for ipsilateral stroke only in men. Our findings suggest that characteristics of the stenosis and plaque exert a different effect in modulating vascular risk in the two sexes. Understanding sex differences in cardiovascular disease could help to target sex-specific future therapies.

  17. Asymptomatic ocular sarcoidosis

    Directory of Open Access Journals (Sweden)

    Luiz Guilherme Azevedo de Freitas

    2013-04-01

    Full Text Available Sarcoidosis is an idiopathic systemic granulomatous disease. It commonly affects the skin, lungs, kidneys, and central nervous system. In the eyes it primarily affects the uveal tract, conjunctiva, lacrimal glands and optic nerve. Here in we describe the case of a patient with systemic sarcoidosis and asymptomatic eye inflammation.

  18. Prospective Coronary Heart Disease Screening in Asymptomatic Hodgkin Lymphoma Patients Using Coronary Computed Tomography Angiography: Results and Risk Factor Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Girinsky, Theodore, E-mail: girinsky.theodore@orange.fr [Department of Radiation Oncology, Institut Gustave Roussy, Villejuif (France); M’Kacher, Radhia [Laboratory of Radiobiology and Oncology, Institut de Radiobiologie Cellulaire et Moleculaire/Direction des Sciences Vivantes/Commissariat Energie Atomique, Fontenay aux Roses (France); Lessard, Nathalie [Department of Radiation Oncology, Institut Gustave Roussy, Villejuif (France); Koscielny, Serge [Biostatistics and Epidemiology Unit, Institut Gustave Roussy, Villejuif (France); Elfassy, Eric; Raoux, François [Department of Radiology, Marie Lannelongue, Chatenay-Malabry (France); Carde, Patrice [Department of Hematology, Institut Gustave Roussy, Villejuif (France); Santos, Marcos Dos [Department of Radiation Oncology, Institut Gustave Roussy, Villejuif (France); Margainaud, Jean-Pierre [Department of Head and Neck Surgery, Institut Gustave Roussy, Villejuif (France); Sabatier, Laure [Laboratory of Radiobiology and Oncology, Institut de Radiobiologie Cellulaire et Moleculaire/Direction des Sciences Vivantes/Commissariat Energie Atomique, Fontenay aux Roses (France); Ghalibafian, Mithra [Department of Radiation Oncology, Institut Gustave Roussy, Villejuif (France); Paul, Jean-François [Department of Radiology, Marie Lannelongue, Chatenay-Malabry (France)

    2014-05-01

    Purpose: To prospectively investigate the coronary artery status using coronary CT angiography (CCTA) in patients with Hodgkin lymphoma treated with combined modalities and mediastinal irradiation. Methods and Materials: All consecutive asymptomatic patients with Hodgkin lymphoma entered the study during follow-up, from August 2007 to May 2012. Coronary CT angiography was performed, and risk factors were recorded along with leukocyte telomere length (LTL) measurements. Results: One hundred seventy-nine patients entered the 5-year study. The median follow-up was 11.6 years (range, 2.1-40.2 years), and the median interval between treatment and the CCTA was 9.5 years (range, 0.5-40 years). Coronary artery abnormalities were demonstrated in 46 patients (26%). Coronary CT angiography abnormalities were detected in nearly 15% of the patients within the first 5 years after treatment. A significant increase (34%) occurred 10 years after treatment (P=.05). Stenoses were mostly nonostial. Severe stenoses were observed in 12 (6.7%) of the patients, entailing surgery with either angioplasty with stent placement or bypass grafting in 10 of them (5.5%). A multivariate analysis demonstrated that age at treatment, hypertension, and hypercholesterolemia, as well as radiation dose to the coronary artery origins, were prognostic factors. In the group of patients with LTL measurements, hypertension and LTL were the only independent risk factors. Conclusions: The findings suggest that CCTA can identify asymptomatic individuals at risk of acute coronary artery disease who might require either preventive or curative measures. Conventional risk factors and the radiation dose to coronary artery origins were independent prognostic factors. The prognostic value of LTL needs further investigation.

  19. CA-125–indicated asymptomatic relapse confers survival benefit to ovarian cancer patients who underwent secondary cytoreduction surgery

    Directory of Open Access Journals (Sweden)

    Wang Fang

    2013-02-01

    Full Text Available Abstract Background There is no consensus regarding the management of ovarian cancer patients, who have shown complete clinical response (CCR to primary therapy and have rising cancer antigen CA-125 levels but have no symptoms of recurrent disease. The present study aims to determine whether follow-up CA-125 levels can be used to identify the need for imaging studies and secondary cytoreductive surgery (CRS. Methods We identified 410 ovarian cancer patients treated at The University of Texas MD Anderson Cancer Center between 1984 and 2011. These patients had shown CCR to primary therapy. Follow-up was conducted based on the surveillance protocol of the MD Anderson Cancer Center. We used the Cox proportional hazards model and log-rank test to assess the associations between the follow-up CA-125 levels and secondary CRS and survival duration. Results The CA-125 level of 1.68 × nadir was defined as the indicator of recurrent disease (p  1.68 × nadir at relapse (55.7 and 10.4 months; p = 0.04 and 0.01, respectively. The overall and progression free survival duration of patients with asymptomatic relapse and underwent a secondary CRS was longer than that of patients with symptomatic relapse (p = 0.02 and 0.04 respectively. Conclusions The increase of serum CA-125 levels is an early warning of clinical relapse in ovarian cancer. Using CA-125 levels in guiding the treatment of patients with asymptomatic recurrent ovarian cancer, who have shown CCR to primary therapy, can facilitate optimal secondary CRS and extend the survival duration of the patients.

  20. Asymptomatic dystrophinopathy

    Energy Technology Data Exchange (ETDEWEB)

    Morrone, A. [Univ. of Pittsburgh School of Medicine, PA (United States)]|[Univ. of Florence (Italy); Hoffman, E.P.; Hoop, R.C. [Univ. of Pittsburgh School of Medicine, PA (United States)] [and others

    1997-03-31

    A 4-year-old girl was referred for evaluation for a mild but persistent serum aspartate aminotransferase (AST) elevation detected incidentally during routine blood screening for a skin infection. Serum creatine kinase activity was found to be increased. Immuno-histochemical study for dystrophin in her muscle biopsy showed results consistent with a carrier state for muscular dystrophy. Molecular work-up showed the proposita to be a carrier of a deletion mutation of exon 48 of the dystrophin gene. Four male relatives also had the deletion mutation, yet showed no clinical symptoms of muscular dystrophy (age range 8-58 yrs). Linkage analysis of the dystrophin gene in the family showed a spontaneous change of an STR45 allele, which could be due to either an intragenic double recombination event, or CA repeat length mutation leading to identical size alleles. To our knowledge, this is the first documentation of an asymptomatic dystrophinopathy in multiple males of advanced age. Based on molecular findings, this family would be given a diagnosis of Becker muscular dystrophy. This diagnosis implies the development of clinical symptoms, even though this family is clearly asymptomatic. This report underscores the caution which must be exercised when giving presymptomatic diagnoses based on molecular studies. 28 refs., 4 figs., 1 tab.

  1. Potential association between coronary artery disease and the inflammatory biomarker YKL-40 in asymptomatic patients with type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Kim Hyun

    2012-07-01

    Full Text Available Abstract Background Inflammation plays an important role in coronary artery disease from the initiation of endothelial dysfunction to plaque formation to final rupture of the plaque. In this study, we investigated the potential pathophysiological and clinical relevance of novel cytokines secreted from various cells including adipocytes, endothelial cells, and inflammatory cells, in predicting coronary artery disease (CAD in asymptomatic subjects with type 2 diabetes mellitus. Methods We enrolled a total of 70 asymptomatic type 2 diabetic patients without a documented history of cardiovascular disease, and determined serum levels of chemerin, omentin-1, YKL-40, and sCD26. We performed coronary computed tomographic angiography (cCTA in all subjects, and defined coronary artery stenosis ≥ 50 % as significant CAD in this study. Results Subjects were classified into two groups: patients with suspected coronary artery stenosis on cCTA (group I, n = 41 and patients without any evidence of stenosis on cCTA (group II, n = 29. Group I showed significantly higher YLK-40 levels and lower HDL-C levels than group II (p = 0.038, 0.036, respectively. Levels of chemerin, omentin-1, and sCD26 were not significantly different between the two groups. Serum YKL-40 levels were positively correlated with systolic/diastolic BP, fasting/postprandial triglyceride levels, and Framingham risk score. Furthermore, YKL-40 levels showed moderate correlation with the degree of coronary artery stenosis and the coronary artery calcium score determined from cCTA. In multivariate logistic analysis, after adjusting for age, gender, smoking history, hypertension, and LDL-cholesterol, YLK-40 levels showed only borderline significance. Conclusions YKL-40, which is secreted primarily from inflammatory cells, was associated with several CVD risk factors and was elevated in type 2 diabetic patients with suspected coronary artery stensosis on cCTA. These results suggest

  2. Whole body cardiovascular magnetic resonance imaging to stratify symptomatic and asymptomatic atherosclerotic burden in patients with isolated cardiovascular disease

    International Nuclear Information System (INIS)

    Weir-McCall, Jonathan R.; Duce, Suzanne L.; Gandy, Stephen J.; Matthew, Shona Z.; Martin, Patricia; Cassidy, Deirdre B.; McCormick, Lynne; Belch, Jill J. F.; Struthers, Allan D.; Colhoun, Helen M.; Houston, J. Graeme

    2016-01-01

    The aim of this study was to use whole body cardiovascular magnetic resonance imaging (WB CVMR) to assess the heart and arterial network in a single examination, so as to describe the burden of atherosclerosis and subclinical disease in participants with symptomatic single site vascular disease. 64 patients with a history of symptomatic single site vascular disease (38 coronary artery disease (CAD), 9 cerebrovascular disease, 17 peripheral arterial disease (PAD)) underwent whole body angiogram and cardiac MR in a 3 T scanner. The arterial tree was subdivided into 31 segments and each scored according to the degree of stenosis. From this a standardised atheroma score (SAS) was calculated. Cine and late gadolinium enhancement images of the left ventricle were obtained. Asymptomatic atherosclerotic disease with greater than 50 % stenosis in arteries other than that responsible for their presenting complain was detected in 37 % of CAD, 33 % of cerebrovascular and 47 % of PAD patients. Unrecognised myocardial infarcts were observed in 29 % of PAD patients. SAS was significantly higher in PAD patients 24 (17.5-30.5) compared to CAD 4 (2–11.25) or cerebrovascular disease patients 6 (2-10) (ANCOVA p < 0.001). Standardised atheroma score positively correlated with age (β 0.36 p = 0.002), smoking status (β 0.34 p = 0.002), and LV mass (β -0.61 p = 0.001) on multiple linear regression. WB CVMR is an effective method for the stratification of cardiovascular disease. The high prevalence of asymptomatic arterial disease, and silent myocardial infarctions, particularly in the peripheral arterial disease group, demonstrates the importance of a systematic approach to the assessment of cardiovascular disease

  3. Cerebral Lesions in Patients Undergoing Coronary Artery Bypass Grafting in Relation to Asymptomatic Carotid and Vertebral Artery Stenosis

    DEFF Research Database (Denmark)

    Wiberg, Sebastian; Schoos, Mikkel; Sillesen, Henrik

    2015-01-01

    OBJECTIVES: Carotid artery stenosis (CAS) and vertebral artery stenosis (VAS) are associated with cerebral infarction after coronary artery bypass graft surgery (CABG). It remains unclear whether this association is causal. We investigated the associations between neurologically asymptomatic CAS...... and VAS and the occurrence of subclinical cerebral lesions after CABG verified by magnetic resonance imaging. METHODS: CABG patients were included and CAS and VAS were identified by magnetic resonance angiography. Cerebral magnetic resonance imaging was performed to identify new post-operative subclinical...... cerebral lesions. The associations between CAS/VAS post-operative cerebral lesions were investigated. RESULTS: Forty-six patients were included in the study. 13% had significant CAS and 11% had significant VAS. Thirty-five percent had new cerebral infarction postoperatively. We found a significant...

  4. Urethritis/cervicitis pathogen prevalence and associated risk factors among asymptomatic HIV-infected patients in South Africa.

    Science.gov (United States)

    Lewis, David A; Chirwa, Tobias F; Msimang, Veerle M Y; Radebe, Frans M; Kamb, Mary L; Firnhaber, Cynthia S

    2012-07-01

    To determine sexually transmitted infection (STI) prevalence, and patient characteristics associated with detection of urethritis/cervicitis pathogens, among HIV-infected individuals offered voluntary STI screening at a South African HIV treatment center. Individuals, asymptomatic for genital discharge, were screened for Neisseria gonorrhoeae (NG), Chlamydia trachomatis, Trichomonas vaginalis (TV), Mycoplasma genitalium (MG) infections (real-time polymerase chain reaction assay), for syphilis and herpes simplex type 2 (serologically), and for bacterial vaginosis and Candida (microscopy, women only). Patients' most recent CD4 and viral load results were recorded. Demographic, clinical, and behavioral data were collected by nurse-administered questionnaire. Compared with men (n = 551), women (n = 558) were younger (mean age, 35.0 vs. 37.9 years; P urethritis/cervicitis pathogens detected (21.3% vs.16.4%, P = 0.035), and were less aware of their partner's HIV status (53.1% vs. 62.3%; P = 0.007). The overall prevalence of individual urethritis/cervicitis pathogens was TV (7.6%), MG (6.1%), NG (5.4%), and C. trachomatis (2.1%). Multivariate analysis highlighted 4 significant factors associated with the detection of specific urethritis/cervicitis pathogens, namely female gender (TV, adjusted odds ratio [aOR] 2.53, 95% confidence interval [CI]: 1.47-4.37), having a regular sexual partner in the past 3 months (NG, aOR 2.26, 95% CI: 1.01-5.08), suboptimal condom use with regular partners (TV, aOR 2.07, 95% CI: 1.25-3.42), and a history of genital warts in the past year (NG, 2.25, 95% CI: 1.26-4.03). Asymptomatic urethritis/cervicitis pathogens were highly prevalent in this population. Few urethritis/cervicitis pathogen-associated patient characteristics were identified, emphasizing the need for affordable STI diagnostics to screen HIV-infected patients.

  5. CA-125–indicated asymptomatic relapse confers survival benefit to ovarian cancer patients who underwent secondary cytoreduction surgery

    Science.gov (United States)

    2013-01-01

    Background There is no consensus regarding the management of ovarian cancer patients, who have shown complete clinical response (CCR) to primary therapy and have rising cancer antigen CA-125 levels but have no symptoms of recurrent disease. The present study aims to determine whether follow-up CA-125 levels can be used to identify the need for imaging studies and secondary cytoreductive surgery (CRS). Methods We identified 410 ovarian cancer patients treated at The University of Texas MD Anderson Cancer Center between 1984 and 2011. These patients had shown CCR to primary therapy. Follow-up was conducted based on the surveillance protocol of the MD Anderson Cancer Center. We used the Cox proportional hazards model and log-rank test to assess the associations between the follow-up CA-125 levels and secondary CRS and survival duration. Results The CA-125 level of 1.68 × nadir was defined as the indicator of recurrent disease (p CA-125 biochemical progression prior to clinically-defined relapse was 31 days (ranging from 1 to 391 days). The median number of the negative imaging studies for the clinical relapse findings in patients with a CA-125 level of CA-125 level at relapse was an independent predictor of overall and progression free survival in patients who had shown CCR to primary therapy (p = 0.04 and 0.02 respectively). The overall and progression free survival durations in patients with a CA-125 level ≤ 1.68 × nadir at relapse (69.4 and 13.8 months) were longer than those with a CA-125 level > 1.68 × nadir at relapse (55.7 and 10.4 months; p = 0.04 and 0.01, respectively). The overall and progression free survival duration of patients with asymptomatic relapse and underwent a secondary CRS was longer than that of patients with symptomatic relapse (p = 0.02 and 0.04 respectively). Conclusions The increase of serum CA-125 levels is an early warning of clinical relapse in ovarian cancer. Using CA-125 levels in

  6. Pharmacokinetics and long-term tolerance to ribavirin in asymptomatic patients infected with human immunodeficiency virus.

    Science.gov (United States)

    Lertora, J J; Rege, A B; Lacour, J T; Ferencz, N; George, W J; VanDyke, R B; Agrawal, K C; Hyslop, N E

    1991-10-01

    Single-dose and steady-state pharmacokinetics of the antiviral agent ribavirin were studied in seven male, asymptomatic, human immunodeficiency virus-seropositive subjects. After a single 400 mg intravenous infusion, mean terminal plasma half-life (t1/2) was 27.1 hours, mean volume of distribution was 802 L, and mean total plasma clearance was 26.1 L/hr. Renal clearance was 39% of total clearance and it exceeded creatinine clearance. Oral bioavailability was 44.6%. With long-term dosing (400 mg orally twice a day) ribavirin accumulated, reaching steady state in 2 to 4 weeks in plasma and red blood cells. Red blood cell concentrations greatly exceeded plasma concentrations (60:1). Plasma concentrations at steady state (trough) were 10- to 14-fold higher than the corresponding single-dose concentrations. The terminal t1/2 (washout) after 16 weeks greatly exceeded the t1/2 observed after a single oral dose (151 versus 29.6 hours). Ribavirin-induced reductions in hemoglobin ranging from 0.8 to 3.5 gm/dl were well tolerated. There was no significant reduction in CD4 lymphocytes during treatment with ribavirin for 16 weeks in subjects who had more than 200 CD4 cells at entry and who also remained free of opportunistic infections during 24 weeks of observation.

  7. Benefits of Reiki therapy for a severely neutropenic patient with associated influences on a true random number generator.

    Science.gov (United States)

    Morse, Melvin L; Beem, Lance W

    2011-12-01

    Reiki therapy is documented for relief of pain and stress. Energetic healing has been documented to alter biologic markers of illness such as hematocrit. True random number generators are reported to be affected by energy healers and spiritually oriented conscious awareness. The patient was a then 54-year-old severely ill man who had hepatitis C types 1 and 2 and who did not improve with conventional therapy. He also suffered from obesity, the metabolic syndrome, asthma, and hypertension. He was treated with experimental high-dose interferon/riboviron therapy with resultant profound anemia and neutropenia. Energetic healing and Reiki therapy was administered initially to enhance the patient's sense of well-being and to relieve anxiety. Possible effects on the patient's absolute neutrophil count and hematocrit were incidentally noted. Reiki therapy was then initiated at times of profound neutropenia to assess its possible effect on the patient's absolute neutrophil count (ANC). Reiki and other energetic healing sessions were monitored with a true random number generator (RNG). Statistically significant relationships were documented between Reiki therapy, a quieting of the electronically created white noise of the RNG during healing sessions, and improvement in the patient's ANC. The immediate clinical result was that the patient could tolerate the high-dose interferon regimen without missing doses because of absolute neutropenia. The patient was initially a late responder to interferon and had been given a 5% chance of clearing the virus. He remains clear of the virus 1 year after treatment. The association between changes in the RNG, Reiki therapy, and a patient's ANC is the first to the authors' knowledge in the medical literature. Future studies assessing the effects of energetic healing on specific biologic markers of disease are anticipated. Concurrent use of a true RNG may prove to correlate with the effectiveness of energetic therapy.

  8. Prevalence and predictors of an abnormal stress myocardial perfusion study in asymptomatic patients with type 2 diabetes mellitus

    Energy Technology Data Exchange (ETDEWEB)

    Scholte, Arthur J.H.A.; Schuijf, Joanne D.; Wall, Ernst E. van der; Bax, Jeroen J. [Leiden University Medical Center, Department of Cardiology, Albinusdreef 2, PO Box 9600, Leiden (Netherlands); Kharagjitsingh, Antje V. [Medisch Centrum Haaglanden, Department of Internal Medicine, The Hague (Netherlands); Dibbets-Schneider, Petra; Stokkel, Marcel P. [Leiden University Medical Center, Department of Nuclear Medicine, Leiden (Netherlands)

    2009-04-15

    The purpose of this study was to evaluate the prevalence of an abnormal stress myocardial perfusion study in a cohort of truly asymptomatic patients with type 2 diabetes mellitus using myocardial perfusion imaging by means of single photon emission computed tomography (SPECT). Secondly, we determined which clinical characteristics may predict an abnormal stress myocardial perfusion study in this population. A total of 120 asymptomatic patients (mean age 53{+-}10 years) with type 2 diabetes mellitus and one or more risk factors for coronary artery disease were prospectively recruited from an outpatient diabetes clinic. All patients underwent myocardial perfusion imaging by means of adenosine {sup 99m}Tc sestamibi SPECT. Images were evaluated for the presence of perfusion abnormalities as well as other nonperfusion abnormalities that may indicate extensive ischaemia, including left ventricular dysfunction (defined as a left ventricular ejection fraction <45%), transient ischaemic dilatation and adenosine-induced ST segment depression. Multivariable analysis was performed using a backward selection strategy to identify potential predictors for an abnormal stress myocardial perfusion study. Finally, all patients were followed up for 12 months to determine the occurrence of cardiovascular events: (1) cardiac death, (2) nonfatal myocardial infarction, (3) unstable angina requiring hospitalization, (4) revascularization, or (5) stroke. Of the 120 patients, 40 (33%) had an abnormal stress study, including myocardial perfusion abnormalities in 30 patients (25%). In 10 patients (8%), indicators of extensive (possibly balanced ischaemia) were observed in the absence of abnormal perfusion. The multivariable analysis identified current smoking, duration of diabetes and the cholesterol/high-density lipoprotein (HDL) ratio as independent predictors of an abnormal stress study. During a follow-up period of 12 months six patients (5%) had a cardiovascular event. The current study

  9. Predictors and prognostic impact of silent coronary artery disease in asymptomatic high-risk patients with diabetes mellitus.

    Science.gov (United States)

    Zellweger, Michael J; Haaf, Philip; Maraun, Michael; Osterhues, Hans H; Keller, Ulrich; Müller-Brand, Jan; Jeger, Raban; Pfister, Otmar; Brinkert, Miriam; Burkard, Thilo; Pfisterer, Matthias

    2017-10-01

    Evaluation of predictors of silent coronary artery disease (SCAD) in high-risk asymptomatic diabetic patients and to evaluate their two-year outcome. Four hundred diabetic patients without prior CAD but at high CAD risk underwent myocardial perfusion scintigraphy (MPS) in this prospective multicentre outcome trial. MPS were abnormal in 22% of patients. Male sex (OR 2.223, 1.152-4.290; p=0.017), diabetes duration (OR 1.049,1.015-1.085; p=0·005), peripheral artery disease (OR 2.134, 1·150-3.961; p=0.016), smoking (OR 2.064, 1.109-3.839; p=0·022), systolic blood pressure (OR 1.014, 1.00-1.03, p=0·056), brain natriuretic peptide (OR 1.002, 1.001-1.004, p=0·005) independently predicted an abnormal MPS: if 3 predictors were present, 3.2% and 47% patients had an abnormal MPS, respectively (p10%, respectively (each pSCAD. In presence of >3 predictors, almost 50% of patients had an abnormal MPS. They may benefit from screening by MPS since the extent of the MPS abnormality discriminated clearly between a favourable compared to a bad 2-year outcome. However, even highest risk patients without objective evidence of CAD had a benign prognosis without need for specific evaluation or therapy. ISRCTN87953632. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  10. Distribution and Quantitative Estimates of Variant Creutzfeldt-Jakob Disease Prions in Tissues of Clinical and Asymptomatic Patients.

    Science.gov (United States)

    Douet, Jean Y; Lacroux, Caroline; Aron, Naima; Head, Mark W; Lugan, Séverine; Tillier, Cécile; Huor, Alvina; Cassard, Hervé; Arnold, Mark; Beringue, Vincent; Ironside, James W; Andréoletti, Olivier

    2017-06-01

    In the United-Kingdom, ≈1 of 2,000 persons could be infected with variant Creutzfeldt-Jakob disease (vCJD). Therefore, risk of transmission of vCJD by medical procedures remains a major concern for public health authorities. In this study, we used in vitro amplification of prions by protein misfolding cyclic amplification (PMCA) to estimate distribution and level of the vCJD agent in 21 tissues from 4 patients who died of clinical vCJD and from 1 asymptomatic person with vCJD. PMCA identified major levels of vCJD prions in a range of tissues, including liver, salivary gland, kidney, lung, and bone marrow. Bioassays confirmed that the quantitative estimate of levels of vCJD prion accumulation provided by PMCA are indicative of vCJD infectivity levels in tissues. Findings provide critical data for the design of measures to minimize risk for iatrogenic transmission of vCJD.

  11. Amniotic fluid "sludge"; prevalence and clinical significance of it in asymptomatic patients at high risk for spontaneous preterm delivery.

    Science.gov (United States)

    Adanir, Ilknur; Ozyuncu, Ozgur; Gokmen Karasu, Ayse Filiz; Onderoglu, Lutfu S

    2018-01-01

    The aim of our study is to determine prevalence and clinical significance of the presence of amniotic fluid "sludge" among asymptomatic patients at high-risk for spontaneous preterm delivery, prospectively. In our study, 99 patients at high risk for spontaneous preterm delivery were evaluated for the presence of amniotic fluid sludge with transvaginal ultrasonography at 20-22, 26-28, and 32-34 gestational weeks, prospectively; between August 2009 and October 2010 in Hacettepe University Hospital. And, these patients were followed up for their delivery weeks and pregnancy outcomes. We defined the high-risk group as the patients possessing one or more of the followings; a history of spontaneous preterm delivery, recent urinary tract infections, polyhydramnios, uterine leiomyomas, müllerian duct anomalies, and history of cone biyopsy or LEEP. Patients with multiple gestations, placenta previa, fetal anomalies, or symptoms of preterm labor at first examination were excluded. We have obtained ethical board approval from Hacettepe University (16.07.2009-HEK/No:09-141-59). The prevalence of amniotic fluid sludge in the study population was 19,6% (18/92). The rates of spontaneous preterm delivery at preterm delivery (p = 0.002). A higher proportion of neonates born to patients with amniotic fluid sludge had a neonatal morbidity (50% (9/18) vs. 24,3% (18/74), p = 0.044) and died in the perinatal period, (p = 0,013) than those born to patients without sludge. When we combined sludge and cervical lenght (CL) (preterm delivery; it catched more women with preterm delivery, (p = 0.000). While sensitivity of sludge was 37,5%, and sensitivity of CL was 34%, sensitivity of "sludge positive or CL ≤25 mm" was 56% for preterm birth (PTB) in high-risk group. The prevalence of amniotic fluid sludge is 19,6% and "sludge" is an independent risk factor for spontaneous preterm delivery among asymptomatic patients at high-risk for spontaneous preterm delivery. PTB is

  12. Is there a role for coronary artery calcium scoring for management of asymptomatic patients at risk for coronary artery disease?: Clinical risk scores are not sufficient to define primary prevention treatment strategies among asymptomatic patients.

    Science.gov (United States)

    Blaha, Michael J; Silverman, Michael G; Budoff, Matthew J

    2014-03-01

    Although risk factors have proven to be useful therapeutic targets, they are poor predictors of risk. Traditional risk scores are moderately successful in predicting future CHD events and can be a starting place for general risk categorization. However, there is substantial heterogeneity between traditional risk and actual atherosclerosis burden, with event rates predominantly driven by burden of atherosclerosis. Serum biomarkers have yet to show any clinically significant incremental value to the FRS and even when combined cannot match the predictive value of atherosclerosis imaging. As clinicians, are we willing to base therapy decisions on risk models that lack optimum-achievable accuracy and limit personalization? The decision to treat a patient in primary prevention must be a careful one because the benefit of therapy in an asymptomatic patient must clearly outweigh the potential risk. CAC, in particular, provides a personalized assessment of risk and may identify patients who will be expected to derive the most, and the least, net absolute benefit from treatment. Emerging evidence hints that CAC may also promote long-term adherence to aspirin, exercise, diet, and statin therapy. When potentially lifelong treatment decisions are on the line, clinicians must arm their patients with the most accurate risk prediction tools, and subclinical atherosclerosis testing with CAC is, at the present time, superior to any combination of risk factors and serum biomarkers.

  13. Hybrid treatment of a true thyreocervical trunk aneurysm in a patient with Type B aortic dissection

    Directory of Open Access Journals (Sweden)

    Nikolaos G Baikoussis

    2016-01-01

    Full Text Available We would like to describe a case with a complex aortic disease treated in hybrid fashion. We present an interesting case of a 65-year-old man with a medical history of hypertension, hyperlipidemia, and coronary artery disease percutaneously treated. An acute Type B aortic dissection occurred and treated with the implantation of a stent-graft which occluded the left subclavian artery due to its extension to the aortic arch. This event required a carotid-subclavian artery bypass due to ischemia of the left arm. An aneurysm in the innominate artery also detected, was treated with another stent-graft implantation 3 months later. At 5-year follow-up, an aneurysm of the thyreocervical trunk was found while the stent-graft of the aorta was well-tolerated without endoleak and the carotid-subclavian graft was patent. The aneurysm was asymptomatic but considering the risk of spontaneous rupture of an aneurysm of this size, elective surgery was indicated. Because the aneurysm was very close to the brachiocephalic bifurcation, open surgical repair would require a sternotomy. The right common carotid artery and right subclavian artery were exposed. The thyrocervical trunk, right internal mammary artery and right vertebral artery were occluded by ligations to isolate the aneurysm. An 8-mm Dacron graft was anastomosed end-to-end to the distal part of subclavian artery. We would like through this case, discuss the role of the hybrid cardiovascular surgery to minimize the postoperative complications in complex cardiovascular pathology. We also discuss the international bibliography about the thyreocervical trunk aneurysm and the treatment options.

  14. Lack of effect of polymorphisms in dopamine metabolism related genes on imaging of TRODAT-1 in striatum of asymptomatic volunteers and patients with Parkinson's disease.

    Science.gov (United States)

    Lynch, David R; Mozley, P David; Sokol, Set; Maas, Nicole M C; Balcer, Laura J; Siderowf, Andrew D

    2003-07-01

    SPECT scanning using (99)Tc-TRODAT-1, a ligand that binds to dopamine transporters, may be useful for detection of early Parkinson's disease (PD), diagnosis of presymptomatic individuals, and monitoring disease progression. Understanding whether genetic factors contribute to inter-individual variability is crucial for interpreting imaging results in the context of disease pathophysiology. We tested whether polymorphisms in the genes for catechol-O-methyltransferase (COMT), monoamine-oxidase B (MAO-B), and the dopamine transporter (DAT) influence dopamine uptake parameters in the striatum in vivo in asymptomatic volunteers and patients with PD as measured with (99)Tc-TRODAT-1. (99)Tc-TRODAT-1 binding declined with age in both asymptomatic volunteers and PD patients, and depended on disease duration in PD patients. We found no significant association between COMT, MAO-B, and DAT polymorphisms and results of (99)Tc-TRODAT-1 testing in asymptomatic volunteers or patients with PD. In PD patients, the age of disease onset and speed of progression did not differ based on these polymorphisms. These results demonstrate that these specific genetic variations do not alter the fidelity of (99)Tc-TRODAT-1 as a measure of dopaminergic function in asymptomatic volunteer individuals or patients with PD. Copyright 2003 Movement Disorder Society

  15. Shunt malfunction causing acute neurological deterioration in 2 patients with previously asymptomatic Chiari malformation Type I. Report of two cases.

    Science.gov (United States)

    Elliott, Robert; Kalhorn, Stephen; Pacione, Donato; Weiner, Howard; Wisoff, Jeffrey; Harter, David

    2009-08-01

    Patients with symptomatic Chiari malformation Type I (CM-I) typically exhibit a chronic, slowly progressive disease course with evolution of symptoms. However, some authors have reported acute neurological deterioration in the setting of CM-I and acquired Chiari malformations. Although brainstem dysfunction has been documented in patients with CM-II and hydrocephalus or shunt malfunction, to the authors' knowledge only 1 report describing ventriculoperitoneal (VP) shunt malfunction causing neurological deterioration in a patient with CM-I exists. The authors report on their experience with the treatment of previously asymptomatic CM-I in 2 children who experienced quite different manifestations of acute neurological deterioration secondary to VP shunt malfunction. Presumably, VP shunt malfunction created a positive rostral pressure gradient across a stenotic foramen magnum, resulting in tetraparesis from foramen magnum syndrome in 1 patient and acute ataxia and cranial nerve deficits from syringobulbia in the other. Although urgent shunt revisions yielded partial recovery of neurological function in both patients, marked improvement occurred only after posterior fossa decompression.

  16. Design and development of a decision aid to enhance shared decision making by patients with an asymptomatic abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Dirk T Ubbink

    2008-11-01

    Full Text Available Dirk T Ubbink1,2, Anouk M Knops1, Sjaak Molenaar1, Astrid Goossens11Department of Quality Assurance and Process Innovation and 2Department of Surgery, Academic Medical Center, Amsterdam, The NetherlandsObjective: To design, develop, and evaluate an evidence-based decision aid (DA for patients with an asymptomatic abdominal aortic aneurysm (AAA to inform them about the pros and cons of their treatment options (ie, surgery or watchful observation and to help them make a shared decision.Methods: A multidisciplinary team defined criteria for the desired DA as to design, medical content and functionality, particularly for elderly users. Development was according to the international standard (IPDAS. Fifteen patients with an AAA, who were either treated or not yet treated, evaluated the tool.Results: A DA was developed to offer information about the disease, the risks and benefits of surgical treatment and watchful observation, and the individual possibilities and threats based on the patient’s aneurysm diameter and risk profile. The DA was improved and judged favorably by physicians and patients.Conclusion: This evidence-based DA for AAA patients, developed according to IPDAS criteria, is likely to be a simple, user-friendly tool to offer patients evidence-based information about the pros and cons of treatment options for AAA, to improve patients’ understanding of the disease and treatment options, and may support decision making based on individual values.Keywords: decision support techniques, research design, program development, abdominal aortic aneurysm, decision making

  17. Modest elevation in BNP in asymptomatic hypertensive patients reflects sub-clinical cardiac remodeling, inflammation and extracellular matrix changes.

    Directory of Open Access Journals (Sweden)

    Dermot Phelan

    Full Text Available In asymptomatic subjects B-type natriuretic peptide (BNP is associated with adverse cardiovascular outcomes even at levels well below contemporary thresholds used for the diagnosis of heart failure. The mechanisms behind these observations are unclear. We examined the hypothesis that in an asymptomatic hypertensive population BNP would be associated with sub-clinical evidence of cardiac remodeling, inflammation and extracellular matrix (ECM alterations. We performed transthoracic echocardiography and sampled coronary sinus (CS and peripheral serum from patients with low (n = 14 and high BNP (n = 27. Peripheral BNP was closely associated with CS levels (r = 0.92, p<0.001. CS BNP correlated significantly with CS levels of markers of collagen type I and III turnover including: PINP (r = 0.44, p = 0.008, CITP (r = 0.35, p = 0.03 and PIIINP (r = 0.35, p = 0.001, and with CS levels of inflammatory cytokines including: TNF-α (r = 0.49, p = 0.002, IL-6 (r = 0.35, p = 0.04, and IL-8 (r = 0.54, p<0.001. The high BNP group had greater CS expression of fibro-inflammatory biomarkers including: CITP (3.8±0.7 versus 5.1±1.9, p = 0.007, TNF-α (3.2±0.5 versus 3.7±1.1, p = 003, IL-6 (1.9±1.3 versus 3.4±2.7, p = 0.02 and hsCRP (1.2±1.1 versus 2.4±1.1, p = 0.04, and greater left ventricular mass index (97±20 versus 118±26 g/m(2, p = 0.03 and left atrial volume index (18±2 versus 21±4, p = 0.008. Our data provide insight into the mechanisms behind the observed negative prognostic impact of modest elevations in BNP and suggest that in an asymptomatic hypertensive cohort a peripheral BNP measurement may be a useful marker of an early, sub-clinical pathological process characterized by cardiac remodeling, inflammation and ECM alterations.

  18. Modest elevation in BNP in asymptomatic hypertensive patients reflects sub-clinical cardiac remodeling, inflammation and extracellular matrix changes.

    LENUS (Irish Health Repository)

    Phelan, Dermot

    2012-11-01

    In asymptomatic subjects B-type natriuretic peptide (BNP) is associated with adverse cardiovascular outcomes even at levels well below contemporary thresholds used for the diagnosis of heart failure. The mechanisms behind these observations are unclear. We examined the hypothesis that in an asymptomatic hypertensive population BNP would be associated with sub-clinical evidence of cardiac remodeling, inflammation and extracellular matrix (ECM) alterations. We performed transthoracic echocardiography and sampled coronary sinus (CS) and peripheral serum from patients with low (n = 14) and high BNP (n = 27). Peripheral BNP was closely associated with CS levels (r = 0.92, p<0.001). CS BNP correlated significantly with CS levels of markers of collagen type I and III turnover including: PINP (r = 0.44, p = 0.008), CITP (r = 0.35, p = 0.03) and PIIINP (r = 0.35, p = 0.001), and with CS levels of inflammatory cytokines including: TNF-α (r = 0.49, p = 0.002), IL-6 (r = 0.35, p = 0.04), and IL-8 (r = 0.54, p<0.001). The high BNP group had greater CS expression of fibro-inflammatory biomarkers including: CITP (3.8±0.7 versus 5.1±1.9, p = 0.007), TNF-α (3.2±0.5 versus 3.7±1.1, p = 003), IL-6 (1.9±1.3 versus 3.4±2.7, p = 0.02) and hsCRP (1.2±1.1 versus 2.4±1.1, p = 0.04), and greater left ventricular mass index (97±20 versus 118±26 g\\/m(2), p = 0.03) and left atrial volume index (18±2 versus 21±4, p = 0.008). Our data provide insight into the mechanisms behind the observed negative prognostic impact of modest elevations in BNP and suggest that in an asymptomatic hypertensive cohort a peripheral BNP measurement may be a useful marker of an early, sub-clinical pathological process characterized by cardiac remodeling, inflammation and ECM alterations.

  19. Oxidative stress parameters in patients with prostate cancer, benign prostatic hyperplasia and asymptomatic inflammatory prostatitis: A prospective controlled study.

    Science.gov (United States)

    Kaya, Engin; Ozgok, Yasar; Zor, Murat; Eken, Ayse; Bedir, Selahattin; Erdem, Onur; Ebiloglu, Turgay; Ergin, Giray

    2017-10-01

    The imbalance between oxidant and reductant mechanisms creates a nidus for the etiopathogenesis of several diseases. In this study, we aimed to compare the oxidative stress (OS) parameters in patients who were diagnosed with prostate cancer (pCa), benign prostatic hyperplasia (BPH) or asymptomatic inflammatory prostatitis (AIP), according to the histopathologic examination of transrectal ultrasonographic prostate biopsy and transurethral prostate resection specimens. In this study, we aimed to compare oxidative stress between histologically proven prostate cancer, hyperplasia and prostatitis. According to histopathologic examinations, 97 patients were divided into 3 study groups: group 1: pCa (n = 30), group 2: BPH (n = 41), and group 3: AIP (n = 26). Finally, 30 patients were enrolled in a control group. MDA levels, CuZn-SOD, Se-GPx, CAT activities, and trace element levels were evaluated. A statistically significant difference between prostate cancer and other groups were documented in terms of MDA activity. Contrary to AIP, a statistically significant difference has also been encountered between BPH and the control group. Decreased CuZn-SOD enzyme levels were found in PCa and BPH patients without statistical significance. Increased CAT activity was also documented in PCa, BPH and AIP patients. No significant difference in GPX activity was documented between the groups, except BPH and control group. Trace element levels were low in the patients with prostate cancer and BPH when compared with the control group. Despite the data regarding OS in PCa patients, there is a paucity of data regarding BPH and especially AIP patients. Our study revealed obvious oxidative stress in BPH and PCa patients as opposed to AIP. Assessing the oxidative stress in these patients may assist in the future prevention, diagnosis and also treatment. However, the question whether the presence of OS-related parameters and drugs could be used for the diagnosis or management of prostatic

  20. Asymptomatic ocular sarcoidosis

    OpenAIRE

    Freitas, Luiz Guilherme Azevedo de; Gabriel, Luiz Alexandre Rassi; Isaac, David Leonardo Cruvinel; Freitas, Clovis Arcoverde de; Ávila, Marcos Pereira de

    2013-01-01

    Sarcoidosis is an idiopathic systemic granulomatous disease. It commonly affects the skin, lungs, kidneys, and central nervous system. In the eyes it primarily affects the uveal tract, conjunctiva, lacrimal glands and optic nerve. Here in we describe the case of a patient with systemic sarcoidosis and asymptomatic eye inflammation. Sarcoidose é uma doença granulomatosa sistêmica idiopática. Afeta comumente pele, pulmões, rins e sistema nervoso central. Nos olhos afeta primariamente a úvea,...

  1. Respiratory Viral Detection in Children and Adults: Comparing Asymptomatic Controls and Patients With Community-Acquired Pneumonia.

    Science.gov (United States)

    Self, Wesley H; Williams, Derek J; Zhu, Yuwei; Ampofo, Krow; Pavia, Andrew T; Chappell, James D; Hymas, Weston C; Stockmann, Chris; Bramley, Anna M; Schneider, Eileen; Erdman, Dean; Finelli, Lyn; Jain, Seema; Edwards, Kathryn M; Grijalva, Carlos G

    2016-02-15

    The clinical significance of viruses detected in patients with community-acquired pneumonia (CAP) is often unclear. We conducted a prospective study to identify the prevalence of 13 viruses in the upper respiratory tract of patients with CAP and concurrently enrolled asymptomatic controls with real-time reverse-transcriptase polymerase chain reaction. We compared age-stratified prevalence of each virus between patients with CAP and controls and used multivariable logistic regression to calculate attributable fractions (AFs). We enrolled 1024 patients with CAP and 759 controls. Detections of influenza, respiratory syncytial virus, and human metapneumovirus were substantially more common in patients with CAP of all ages than in controls (AFs near 1.0). Parainfluenza and coronaviruses were also more common among patients with CAP (AF, 0.5-0.75). Rhinovirus was associated with CAP among adults (AF, 0.93) but not children (AF, 0.02). Adenovirus was associated with CAP only among children <2 years old (AF, 0.77). The probability that a virus detected with real-time reverse-transcriptase polymerase chain reaction in patients with CAP contributed to symptomatic disease varied by age group and specific virus. Detections of influenza, respiratory syncytial virus, and human metapneumovirus among patients with CAP of all ages probably indicate an etiologic role, whereas detections of parainfluenza, coronaviruses, rhinovirus, and adenovirus, especially in children, require further scrutiny. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  2. Randomized, Double-Blind, Phase III Trial of Ipilimumab Versus Placebo in Asymptomatic or Minimally Symptomatic Patients With Metastatic Chemotherapy-Naive Castration-Resistant Prostate Cancer

    DEFF Research Database (Denmark)

    Beer, Tomasz M; Kwon, Eugene D; Drake, Charles G

    2017-01-01

    Purpose Ipilimumab increases antitumor T-cell responses by binding to cytotoxic T-lymphocyte antigen 4. We evaluated treatment with ipilimumab in asymptomatic or minimally symptomatic patients with chemotherapy-naive metastatic castration-resistant prostate cancer without visceral metastases. Pat...

  3. [Mild intermittent aspirin-induced asthma in a patient who became asymptomatic after removal of pet hamsters from home].

    Science.gov (United States)

    Kawai, K; Shirai, T; Suzuki, K; Chida, K; Nakamura, H

    2000-04-01

    A 25-year-old woman was admitted to our hospital because of wheeze, dyspnea, nasal obstruction, epiphora, and ear fullness. These symptoms occurred 30 minutes after the intake of 200 mg of ibuprofen and 100 mg of norfloxacin, which had been prescribed by a local clinic for an upper respiratory tract infection. The patient had kept 20 hamsters indoors and a dog outside for 1 year and a half. During the 9 months prior to admission, she had experienced nocturnal asthmatic symptoms, which were controlled by oral theophylline on an as-needed basis. She had seasonal rhinitis, but no sinusitis or nasal polyps. Serum total IgE was 98 U/ml, and tests for specific IgE antibodies to hamster epithelium and dog epithelium were both positive (class 2). The provocative concentration of methacholine causing a 20% fall in FEV1 was 4.7 mg/ml. After removal of the hamsters from her home, the patient became asymptomatic without further medication, and her airway hyper-responsiveness was also alleviated. Although inhalation challenge with 5% tolmetin failed to induce a positive reaction, the diagnosis of aspirin-induced asthma was confirmed by single-blind oral challenge with 100 mg of ibuprofen. The patient exhibited mild airway responsiveness as well as mild sensitivity to nonsteroidal anti-inflammatory drugs, differing from the severe and intractable clinical features of typical aspirin-induced asthma.

  4. Comparison of different antibiotic protocols for asymptomatic bacteriuria in patients with neurogenic bladder treated with botulinum toxin A

    Directory of Open Access Journals (Sweden)

    Ana Claudia Paradella

    2016-11-01

    Full Text Available Intravesical botulinum toxin A (BoNTA injection has been widely used for the treatment of detrusor overactivity in patients with neurogenic bladder due to spinal cord injury who do not respond to conventional treatment. There is no consensus about antibiotic prophylaxis for this procedure. We conducted a retrospective analysis of medical records of adult patients with spinal cord injury who underwent detrusor BoNTA injection between January of 2007 and December of 2013 in a rehabilitation hospital. Occurrence of symptomatic urinary tract infection (UTI was assessed in 3 groups in accordance with their use of antibiotics (prophylactic dosage, 3 days, more than 3 days for the treatment of asymptomatic bacteriuria. All patients were performing self or assisted clean intermittent bladder catheterization and underwent a rigid cystoscopy, under general or regional anesthesia with sedation, and the drug used was Botox®. A total of 616 procedures were performed during the study period. There were 11 identified cases of UTI (1.8% with a trend to a higher rate in the group that used antibiotics for longer time. This report shows that a single dose of antibiotics before the detrusor BoNTA injection is enough to prevent UTI. Randomized clinical trial should be conducted for definitive conclusions.

  5. Comparison of different antibiotic protocols for asymptomatic bacteriuria in patients with neurogenic bladder treated with botulinum toxin A.

    Science.gov (United States)

    Paradella, Ana Claudia; Musegante, André Ferraz de Arruda; Brites, Carlos

    Intravesical botulinum toxin A (BoNTA) injection has been widely used for the treatment of detrusor overactivity in patients with neurogenic bladder due to spinal cord injury who do not respond to conventional treatment. There is no consensus about antibiotic prophylaxis for this procedure. We conducted a retrospective analysis of medical records of adult patients with spinal cord injury who underwent detrusor BoNTA injection between January of 2007 and December of 2013 in a rehabilitation hospital. Occurrence of symptomatic urinary tract infection (UTI) was assessed in 3 groups in accordance with their use of antibiotics (prophylactic dosage, 3 days, more than 3 days) for the treatment of asymptomatic bacteriuria. All patients were performing self or assisted clean intermittent bladder catheterization and underwent a rigid cystoscopy, under general or regional anesthesia with sedation, and the drug used was Botox ® . A total of 616 procedures were performed during the study period. There were 11 identified cases of UTI (1.8%) with a trend to a higher rate in the group that used antibiotics for longer time. This report shows that a single dose of antibiotics before the detrusor BoNTA injection is enough to prevent UTI. Randomized clinical trial should be conducted for definitive conclusions. Copyright © 2016 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. All rights reserved.

  6. Effectiveness of a cranberry (Vaccinium macrocarpon) preparation in reducing asymptomatic bacteriuria in patients with an ileal enterocystoplasty.

    Science.gov (United States)

    Botto, Henry; Neuzillet, Yann

    2010-04-01

    Bacteriuria is a usual complication of enterocystoplasty following cystectomy. Cranberry products may decrease the number of urinary tract infections because of a non-dialysable compound, a condensed tannin, the proanthocyanidin (PAC) type A. This study determined the effectiveness of treatment with a cranberry preparation highly dosed in proanthocyanidin A in prevention of repeated bacteriuria in patients with an ileal enterocystoplasty. Between November 2004 and November 2009, a controlled study was open to patients seen in consultation for follow-up after a radical cystectomy and ileal cystoplasty. Patients had a history of repeated urinary infection and/or bacteriuria during the pretreatment phase. During the treatment phase, patients received a cranberry (Vaccinium macrocarpon) preparation highly dosed in proanthocyanidin A (36 mg measured by the dimethylaminocinnamaldehyde method), one capsule a day. The primary endpoint was the absence of bacteria in urine culture. The secondary endpoints were the presence or absence of symptoms (pain, fever), continence status and upper excretory tract enlargement. Each patient was his or her own historical control. Fifteen patients were included. The median duration of the period without treatment with cranberry compound was 18.5 (1-93) months. The median duration of the period with treatment with cranberry compound was 32.8 (13-60) months. There was a significant decrease in the number of positive urine cultures during cranberry compound treatment. Treatment with a cranberry compound seems to be effective in reducing asymptomatic bacteriuria in patients with an ileal enterocystoplasty. These results need to be validated by further double-blind randomized studies.

  7. Pathogen or contaminant? Distinguishing true infection from synovial fluid culture contamination in patients with suspected septic arthritis.

    Science.gov (United States)

    Fowler, Mary Louise; Zhu, Clara; Byrne, Kevin; Lieber, Sarah B; Moore, Andrew; Shmerling, Robert H; Paz, Ziv

    2017-12-01

    Isolation of bacteria from synovial fluid (SF) is the gold standard for diagnosis of septic arthritis (SA). Contamination results in misdiagnosis and mismanagement. This study identifies clinical characteristics, microbiology, and outcomes of patients with contaminated SF and compares them with patients with true SA. We conducted a retrospective study including all patients aged 18 and older admitted to a single, tertiary-care hospital between 1998 and 2015 with suspected SA and positive SF cultures. Contamination cases were determined by infectious disease specialists involved in the patients' care and a clinical course inconsistent with SA. 398 patients with true SA and 22 with contaminated SF were identified. The SA group was younger (60.9 vs. 75.6 years; p < 0.01), had higher peripheral polymorphonuclear lymphocytes (78.0 vs. 69.4%; p < 0.01) and SF white blood cell count (91.7 vs. 25.6K/mL; p = 0.02), and longer mean length of stay (10.9 vs. 6.7 days; p = 0.02). The average time to positive culture was longer in the contaminated group (3.62 vs. 1.4 days; p < 0.01). The SA group was less likely to receive a new rheumatologic diagnosis within 1 year (3.0 vs. 36.4%; p < 0.01). This is the first study of its kind looking at clinical features and outcomes of patients with contaminated SF. These patients present with less severe disease, have better outcomes, and receive new rheumatologic diagnoses in more than a third of cases within 1 year. We recommend a conservative approach for patients with suspected contaminated SF, mild symptoms, and no bacterial growth within the first 48 h.

  8. Usefulness of magnetic resonance imaging Dobutamine stress in asymptomatic and minimally symptomatic patients with decreased cardiac reserve from congenital heart disease (Complete and corrected transposition of the great arteries and subpulmonic obstruction)

    NARCIS (Netherlands)

    Tulevski, Igor I.; van der Wall, Ernst E.; Groenink, Maarten; Dodge-Khatami, Ali; Hirsch, Alexander; Stoker, Jaap; Mulder, Barbara J. M.

    2002-01-01

    We explored the effect of dobutamine stress and its possible clinical implications in different groups of asymptomatic patients with chronic right ventricular (RV) pressure overload due to congenital heart disease. Forty-seven asymptomatic and minimally symptomatic patients with chronic RV pressure

  9. A STUDY ON ASYMPTOMATIC CARDIAC CHANGES IN TYPE 2 DIABETES PATIENTS

    OpenAIRE

    Ramchandra Rao; Kumbha; Salma Khanam; Suresh Babu

    2015-01-01

    INTRODUCTION: Majority of the time the patient of Diabetes presents with complications like Myocardial infarction, heart failure, being end stages of cardiovascular 2 disease associated with other macro and microvascular complications. If patients are screened at an early stage of Diabetes before the onset of symptoms the cardiovascular complications ...

  10. Foot Pressure Comparison Between Hallux Rigidus Patients and Normal Asymptomatic Matched Individuals Using Pedobarograph

    Directory of Open Access Journals (Sweden)

    Hadi Mohammed

    2012-06-01

    Conclusion: This study has demonstrated an increased pressure transmitted through the outer aspect of the sole of the foot in the patients suffering from hallux rigidus. This is helpful in choosing treatment options and managing hallux rigidus patients particularly when using conservative and foot wear considerations.

  11. Medulloblastoma subgroup-specific outcomes in irradiated children: who are the true high-risk patients?

    Science.gov (United States)

    Ramaswamy, Vijay; Remke, Marc; Adamski, Jennifer; Bartels, Ute; Tabori, Uri; Wang, Xin; Huang, Annie; Hawkins, Cynthia; Mabbott, Donald; Laperriere, Normand; Taylor, Michael D; Bouffet, Eric

    2016-02-01

    The advent of integrated genomics has fundamentally changed our understanding of medulloblastoma. Although survival differences exist among the 4 principal subgroups, this has yet to be elucidated in a North American cohort of irradiated patients. Ninety-two consecutive patients between the ages of 3 and 17 treated with surgery, craniospinal irradiation, and chemotherapy were identified at the Hospital for Sick Children. Molecular subgrouping was performed using nanoString. Two treatment periods were identified: prior to 2006 as per the protocols of the Children's Oncology Group, and after 2006 per the St Jude Medulloblastoma 03 protocol. Five-year progression-free survival (PFS) over the entire cohort was 0.801 (95% CI: 0.692-0.875) with no significant difference between treatment protocols. Strikingly, we found that Group 4 patients had excellent 5-year PFS of 0.959 (95% CI: 0.744-0.994) for average risk and 0.887 (95% CI: 0.727-0.956) across all Group 4 patients. Group 3 patients had 5-year PFS of 0.733 (95% CI: 0.436-0.891). Sonic hedgehog patients did poorly across both treatment protocols, with 5-year PFS of 0.613 (95% CI: 0.333-0.804), likely owing to a high proportion of TP53 mutated patients in this age group. In a cohort of irradiated patients over 3 years of age, PFS for Group 4 patients was significantly improved compared with initial reports. The impact of subgroup affiliation in these children needs to be assessed in large prospectively treated cooperative protocols to determine if more than just WNT patients can be safely selected for de-escalation of therapy. © The Author(s) 2015. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  12. Genotypic Characterization of Virulence Factors inEscherichia coliIsolated from Patients with Acute Cystitis, Pyelonephritis and Asymptomatic Bacteriuria.

    Science.gov (United States)

    Tabasi, Mohsen; Karam, Mohammad Reza Asadi; Habibi, Mehri; Mostafavi, Ehsan; Bouzari, Saeid

    2016-12-01

    Urinary Tract Infections (UTIs) caused by Uropathogenic Escherichia coli (UPEC) are among the most common infections worldwide. It is well-documented that the pathogenesis of UPEC is mediated by the production of a wide variety of Virulence Factors (VFs). Thus, detection of these VFs and evaluation of their association with different clinical types of UTIs could help to understand the role of these factors in pathogenesis of UPEC isolates. To investigate the genotypic characteristics of UPEC isolates and to examine the relationship between VFs and different clinical symptoms of UTI. In this cross-sectional study conducted at Pasteur Institute of Iran, a total of 156 UPEC isolated from outpatients and inpatients (symptomatic and asymptomatic UTI patients) visiting general and private hospitals in Tehran, Iran between March 2014 and February 2015 were included. Among them, 49 patients experienced at least one episode of recurrent UTI. A Polymerase Chain Reaction (PCR) assay was developed to detect the presence of different VFs in the isolates. Moreover, Pulsed-Field Gel Electrophoresis (PFGE) was used to characterize clonal relationships among UPEC isolates. The prevalence of virulence genes ranged from 0% for cdtB to 100% for fimH . The papEF, hlyA and aer genes were found to be significantly more frequent in UPEC isolated from patients with pyelonephritis, while the afa gene, the only indicator of recurrent UTIs, was more prevalent in UPEC isolated from patients with cystitis. In the present study, 34 PFGE clonal groups were found in the UPEC genome. Our findings showed that from outpatients and patients with pyelonephritis, isolates were more virulent than those isolated from inpatients and cystitis patients, respectively. PFGE displayed a large diversity in the UPEC isolates that could be considered as an evolutionary strategy in the survival of the bacteria.

  13. Predicting asymptomatic coronary artery disease in patients with ischemic stroke and transient ischemic attack: the PRECORIS score.

    Science.gov (United States)

    Calvet, David; Song, Dongbeom; Yoo, Joonsang; Turc, Guillaume; Sablayrolles, Jean-Louis; Choi, Byoung Wook; Heo, Ji Hoe; Mas, Jean-Louis

    2014-01-01

    Identifying occult coronary artery stenosis may improve secondary prevention of stroke patients. The aim of this study was to derive and validate a simple score to predict severe occult coronary artery stenosis in stroke patients. We derived a score from a French hospital-based cohort of consecutive patients (n=300) who had an ischemic stroke or a transient ischemic attack and no previous history of coronary heart disease (Predicting Asymptomatic Coronary Artery Disease in Patients With Ischemic Stroke and Transient Ischemic Attack [PRECORIS] score) and validated the score in a similar Korean cohort (n=1602). In both cohorts, severe coronary artery stenosis was defined by the presence of at least 1≥50% coronary artery stenosis as detected by 64-section CT coronary angiography. A 5-point score (Framingham Risk Score-predicted 10-year coronary heart disease risk [≥20%=3; 10-19%=1; disease or 3-vessel disease were considered (C-statistic=0.83 [0.74-0.92] and 0.70 [0.66-0.74] in derivation and validation cohorts, respectively). The prevalence of occult≥50% coronary artery stenosis and ≥50% left main trunk or 3-vessel disease increased gradually with the PRECORIS score, reaching 44.2% and 13.5% in derivation cohort and 49.8% and 12.8% in validation cohort in patients with a PRECORIS score≥4. The PRECORIS score can identify a population of stroke or transient ischemic attack patients with a high prevalence of occult severe coronary artery stenosis.

  14. Routine Troponin Measurements Are Unnecessary to Exclude Asymptomatic Coronary Events in Acute Ischemic Stroke Patients.

    Science.gov (United States)

    Ali, Farwa; Young, Jimmy; Rabinstein, Alejandro A; Flemming, Kelly D; Fugate, Jennifer E

    2016-05-01

    Obtaining serum troponin levels in every patient with acute stroke is recommended in recent stroke guidelines, but there is no evidence that these contribute positively to clinical care. We sought to determine the clinical significance of measuring troponin levels in acute ischemic stroke patients. We reviewed 398 consecutive patients with acute ischemic stroke at a large academic institution from 2010 to 2012. Troponin levels were measured as a result of protocol in place during part of the study period. The mean age was 70 years (standard deviation ±16 years) and 197 (49.5%) were men. Chronic kidney disease was present in 78 (19.6%), coronary artery disease in 107 (26.9%), and atrial fibrillation in 107 (26.9%). Serum troponin T was measured in 246 of 398 patients (61.8%). Troponin was elevated (>.01 ng/mL) at any point in 38 of 246 patients (15.5%) and was elevated in 28 patients at all 3 measurements (11.3% of those with troponin measured). Only 4 of 246 patients (1.6%) had a significant uptrend. Two were iatrogenic in the setting of hemodynamic augmentation using vasopressors to maintain cerebral perfusion. One case was attributed to stroke and chronic kidney disease and another case to heart failure from inflammatory fibrocalcific mitral valvular heart disease. Serum troponin elevation in patients with ischemic stroke is not usually caused by clinically significant acute myocardial ischemia unless iatrogenic in the setting of vasopressor administration. Serum troponin levels should be measured judicially, based on clinical context, rather than routinely in all stroke patients. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  15. High cardiovascular event rates in patients with asymptomatic carotid stenosis: the REACH Registry

    DEFF Research Database (Denmark)

    Aichner, F T; Topakian, R; Alberts, M J

    2009-01-01

    /absence of ACAS at the time of inclusion. RESULTS: Compared with patients without ACAS (n = 30 329), patients with ACAS (n = 3164) had higher age- and sex-adjusted 1-year rates of transient ischaemic attack (3.51% vs. 1.61%, P stroke (2.65% vs. 1.75%, P = 0.0009), fatal stroke (0.49% vs. 0...... ischaemic events as most important predictor of future stroke (HR 3.21, 95% CI 1.82-5.65, P ischaemic events. Stroke was powerfully predicted by prior cerebrovascular...... with or at risk of atherothrombosis. METHODS: The Reduction of Atherothrombosis for Continued Health Registry enrolled patients with either > or =3 atherothrombotic risk factors or established atherothrombotic disease. We investigated the 1-year follow-up data of patients for whom physicians reported presence...

  16. High prevalence of cryptococcal antigenaemia amongst asymptomatic advanced HIV patients in Pune, India

    Directory of Open Access Journals (Sweden)

    Dileep Kadam

    2017-01-01

    Full Text Available Background: The World Health Organization recommends routine cryptococcal antigen (CrAg screening in advanced AIDS patients initiating antiretroviral treatment (ART. India has yet to adopt this strategy as the burden of cryptococcal antigenaemia is unknown. Methods: A prospective study was conducted in a large public sector ART centre and the inpatient wards of Sassoon Hospital, Pune, India. All consenting patients> 18 years of age with CD4 count <100 cells/mm3 were screened for CrAg by latex agglutination assay. Those with positive CrAg underwent cerebrospinal fluid analysis, chest radiograph and abdominal ultrasound to rule out cryptococcal disease. The impact of CrAg positivity on all-cause mortality was assessed by logistic regression analysis. Results: Amongst 208 AIDS patients with CD4 cells <100 cells/mm3 who underwent CrAg testing, median age was 40 (interquartile range [IQR], 35–49 years, 134 (64% were male and median CD4 count was 64.5 cells/mm3 (IQR, 37–82. Overall, 16 (8%, 95% confidence interval [CI], 4–12 patients were positive for CrAg, of which 8 (50% had CD4 cells <50 cells/mm3 and 3 (19% CrAg-positive patients had incidental cryptococcal meningitis. At 6-month follow-up, the case fatality rate was higher amongst CrAg-positive patients (38% compared with CrAg-negative patients (18% (P = 0.06. After adjusting for age, sex, CD4 count and ART, there was a trend towards increased all-cause mortality (adjusted OR, 3.18, 95% CI, 0.60–16.88,P= 0.17. Conclusions: We found an 8% prevalence of cryptococcaemia amongst adult AIDS patients with CD4 cells <100 cells/mm3. Given the high fatality rates observed, routine screening for CrAg should be considered for all Indian persons with advanced HIV disease.

  17. Subclinical coronary atherosclerosis identified by coronary computed tomographic angiography in asymptomatic morbidly obese patients

    Directory of Open Access Journals (Sweden)

    Peter A. McCullough

    2010-09-01

    Full Text Available Obesity is a common public health problem and obese individuals in particular have a disproportionate incidence of acute coronary events. This study was undertaken to identify coronary artery lesions as well as associated clinical features, risk factors and demographics in patients with a body mass index (BMI >40 kg/m2 without known coronary artery disease (CAD. Morbidly obese subjects were prospectively recruited to undergo coronary computed tomographic angiography (CCTA using a dual-source computed tomography (CT system. CAD was defined as the presence of any atherosclerotic lesion in any one coronary artery segment. The presence, location, and severity of atherosclerosis were related to patient characteristics. Forty-one patients (28 women, mean age, 50.4±10.0 years, mean BMI, 43.8±4.8 kg/m2 served as the study population. Of these, 25 patients (61% had at least one coronary stenosis. All but 2 patients within the CAD cohort had coronary artery calcium (CAC scores >0, and most plaques identified (75.4% were non-calcified. There was a predilection of calcified and non-calcified atherosclerosis involving the left anterior descending (LAD coronary artery compared with other coronary segments. Univariate predictors of CAD included older age, dyslipidemia, and diabetes. In this preliminary study of young morbidly obese patients, CCTA detected a high prevalence of calcified and non-calcified CAD, although the later predominated.

  18. Preoperative carotid duplex findings predict carotid stump pressures during endarterectomy in symptomatic but not asymptomatic patients.

    Science.gov (United States)

    Chiriano, Jason; Abou-Zamzam, Ahmed M; Nguyen, Kahn; Molkara, Afshin M; Zhang, Wayne W; Bianchi, Christian; Teruya, Theodore H

    2010-11-01

    Carotid stump pressure (CSP) is frequently measured to determine the need for shunt use during carotid endarterectomy (CEA). We hypothesized that the preoperative carotid duplex examination correlates with preoperative symptoms and intraoperative CSP. Patients undergoing CEA over a 7-year period were identified from our vascular registry. CEA was performed with selective shunting on the basis of intraoperative CSP ASx) patients (40.72 ± 16.27 vs. 45.8 ± 17.64 mm Hg, p = 0.0167). Fifty-seven patients (19%) had contralateral severe ICA stenosis or occlusion. Contralateral ICA stenosis or occlusion had significantly lower CSP than those with lesser degrees of stenosis (39.24 ± 15 vs. 44.82 ± 17.62 mm Hg, p = 0.0267). Contralateral ICA severe stenosis or occlusion correlated with lower CSP in Sx patients (32.05 ± 8.24 vs. 42.92 ± 16.95 mm Hg, p = 0.038) but not in ASx patients (43.2 ± 16 vs. 46.29 ± 17.5 mm Hg, p = 0.39). CSP was ASx patients (p = 0.012). Overall shunt usage was 84/2,842 (9.5%). Perioperative stroke and death rate was 2.7%. Perioperative stroke did not correlate with the presence of contralateral occlusion, or severity of contralateral stenosis. Symptomatic patients undergoing CEA have lower stump pressures than ASx patients overall and also in the presence of contralateral disease. The incidence of perioperative stroke was not predicted by severity of contralateral disease. A strategy of selective shunting seems appropriate even in Sx patients with contralateral severe stenosis or occlusion. Although a high-risk cohort for perioperative neurologic events exists and may include those with symptomatic disease and contralateral severe stenosis or occlusion, further study is warranted to define the patients who will clinically benefit from shunt placement. Copyright © 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  19. Aberrant functional connectome in neurologically asymptomatic patients with end-stage renal disease.

    Directory of Open Access Journals (Sweden)

    Xiaofen Ma

    Full Text Available This study aimed to investigate the topological organization of intrinsic functional brain networks in patients with end-stage renal disease (ESRD.Resting-state functional MRI data were collected from 22 patients with ESRD (16 men, 18-61 years and 29 age- and gender-matched healthy controls (HCs, 19 men, 32-61 years. Whole-brain functional networks were obtained by calculating the interregional correlation of low-frequency fluctuations in spontaneous brain activity among 1,024 parcels that cover the entire cerebrum. Weighted graph-based models were then employed to topologically characterize these networks at different global, modular and nodal levels.Compared to HCs, the patients exhibited significant disruption in parallel information processing over the whole networks (P < 0.05. The disruption was present in all the functional modules (default mode, executive control, sensorimotor and visual networks although decreased functional connectivity was observed only within the default mode network. Regional analysis showed that the disease disproportionately weakened nodal efficiency of the default mode components and tended to preferentially affect central or hub-like regions. Intriguingly, the network abnormalities correlated with biochemical hemoglobin and serum calcium levels in the patients. Finally, the functional changes were substantively unchanged after correcting for gray matter atrophy in the patients.Our findings provide evidence for the disconnection nature of ESRD's brain and therefore have important implications for understanding the neuropathologic substrate of the disease from disrupted network organization perspective.

  20. Comparison of cellular and protein changes in bronchial lavage fluid of symptomatic and asymptomatic patients with red cedar asthma on follow-up examination.

    Science.gov (United States)

    Chan-Yeung, M; Leriche, J; Maclean, L; Lam, S

    1988-07-01

    Seventeen patients with occupational asthma due to western red cedar had bronchial lavage during follow-up examination after removal from exposure for at least 1 year. Seven patients were asymptomatic while ten continued to have symptoms of asthma requiring treatment. Symptomatic patients had evidence of airway inflammation, as reflected by a significantly higher total cell count, neutrophils and eosinophils, as well as an increase in protein and albumin in their bronchial lavage fluid compared to those without symptoms. Asymptomatic patients had no evidence of airway inflammation in the lavage fluid. There was no correlation between the degree of non-specific bronchial hyperresponsiveness and the number or percentage of inflammatory cells to suggest that cellular infiltration is the sole cause of persistent bronchial hyperresponsiveness.

  1. Extracranial Venous abnormalities: A true pathological finding in patients with multiple sclerosis or an anatomical variant?

    International Nuclear Information System (INIS)

    Torres, Carlos; Chakraborty, Santanu; Nguyen, Thanh; Thornhill, Rebecca; Lum, Cheemun; Hogan, Matthew; Freedman, Mark; Patro, Satya; Bussiere, Miguel; Dabirzadeh, Hamid; Schwarz, Betty Anne; Belanger, Stefanie; Legault-Kingstone, Lysa; Schweitzer, Mark

    2017-01-01

    To evaluate the extracranial venous anatomy with contrast-enhanced MR venogram (CE-MRV) in patients without multiple sclerosis (MS), and assess the prevalence of various venous anomalies such as asymmetry and stenosis in this population. We prospectively recruited 100 patients without MS, aged 18-60 years, referred for contrast-enhanced MRI. They underwent additional CE-MRV from skull base to mediastinum on a 3T scanner. Exclusion criteria included prior neck radiation, neck surgery, neck/mediastinal masses or significant cardiac or pulmonary disease. Two neuroradiologists independently evaluated the studies to document asymmetry and stenosis in the jugular veins and prominence of collateral veins. Asymmetry of internal jugular veins (IJVs) was found in 75 % of subjects. Both observers found stenosis in the IJVs with fair agreement. Most stenoses were located in the upper IJV segments. Asymmetrical vertebral veins and prominence of extracranial collateral veins, in particular the external jugular veins, was not uncommon. It is common to have stenoses and asymmetry of the IJVs as well as prominence of the collateral veins of the neck in patients without MS. These findings are in contrast to prior reports suggesting collateral venous drainage is rare except in MS patients. (orig.)

  2. Asymptomatic cryptococcal antigenemia is associated with mortality among HIV-positive patients in Indonesia

    NARCIS (Netherlands)

    Ganiem, A. Rizal; Indrati, A.; Wisaksana, R.; Meijerink, H.; Ven, A. van der; Alisjahbana, B.; Crevel, R. van

    2014-01-01

    Introduction: Previous studies, mostly from Africa, have shown that serum cryptococcal antigenemia may precede the development of cryptococcal meningitis and early death among patients with advanced HIV infection. We examined cryptococcal antigenemia as a risk factor for HIV-associated mortality in

  3. Extracranial Venous abnormalities: A true pathological finding in patients with multiple sclerosis or an anatomical variant?

    Energy Technology Data Exchange (ETDEWEB)

    Torres, Carlos; Chakraborty, Santanu; Nguyen, Thanh; Thornhill, Rebecca; Lum, Cheemun [University of Ottawa, Department of Radiology, Ottawa, ON (Canada); The Ottawa Hospital, Department of Medical Imaging, Ottawa, ON (Canada); Ottawa Hospital Research Institute OHRI, Ottawa, ON (Canada); Hogan, Matthew; Freedman, Mark [Ottawa Hospital Research Institute OHRI, Ottawa, ON (Canada); University of Ottawa, Department of Medicine, Ottawa, ON (Canada); The Ottawa Hospital, Division of Neurology, Ottawa, ON (Canada); Patro, Satya [University of Ottawa, Department of Radiology, Ottawa, ON (Canada); The Ottawa Hospital, Department of Medical Imaging, Ottawa, ON (Canada); Bussiere, Miguel [University of Alberta, Department of Medicine, Division of Neurology, Edmonton (Canada); Dabirzadeh, Hamid [University of Saskatchewan, Neuroradiologist, Department of Radiology, Saskatoon (Canada); Schwarz, Betty Anne; Belanger, Stefanie; Legault-Kingstone, Lysa [The Ottawa Hospital, Department of Medical Imaging, Ottawa, ON (Canada); Schweitzer, Mark [Stony Brook School of Medicine, Department of Radiology, Stony Brook, NY (United States)

    2017-01-15

    To evaluate the extracranial venous anatomy with contrast-enhanced MR venogram (CE-MRV) in patients without multiple sclerosis (MS), and assess the prevalence of various venous anomalies such as asymmetry and stenosis in this population. We prospectively recruited 100 patients without MS, aged 18-60 years, referred for contrast-enhanced MRI. They underwent additional CE-MRV from skull base to mediastinum on a 3T scanner. Exclusion criteria included prior neck radiation, neck surgery, neck/mediastinal masses or significant cardiac or pulmonary disease. Two neuroradiologists independently evaluated the studies to document asymmetry and stenosis in the jugular veins and prominence of collateral veins. Asymmetry of internal jugular veins (IJVs) was found in 75 % of subjects. Both observers found stenosis in the IJVs with fair agreement. Most stenoses were located in the upper IJV segments. Asymmetrical vertebral veins and prominence of extracranial collateral veins, in particular the external jugular veins, was not uncommon. It is common to have stenoses and asymmetry of the IJVs as well as prominence of the collateral veins of the neck in patients without MS. These findings are in contrast to prior reports suggesting collateral venous drainage is rare except in MS patients. (orig.)

  4. Liver function tests in HIV-1 infected asymptomatic patients and HIV ...

    African Journals Online (AJOL)

    Hepatic functions were assessed by serum assays of albumin (ALB), total protein (TP), total bilirubin (TB), conjugated bilirubin (CB), serum activities of alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) and gamma – glutamyl transferase (GGT) in 51 HIV-1AIDS patients, 38 HIV-1 ...

  5. Oral reading fluency analysis in patients with Alzheimer disease and asymptomatic control subjects.

    Science.gov (United States)

    Martínez-Sánchez, F; Meilán, J J G; García-Sevilla, J; Carro, J; Arana, J M

    2013-01-01

    Many studies highlight that an impaired ability to communicate is one of the key clinical features of Alzheimer disease (AD). To study temporal organisation of speech in an oral reading task in patients with AD and in matched healthy controls using a semi-automatic method, and evaluate that method's ability to discriminate between the 2 groups. A test with an oral reading task was administered to 70 subjects, comprising 35 AD patients and 35 controls. Before speech samples were recorded, participants completed a battery of neuropsychological tests. There were no differences between groups with regard to age, sex, or educational level. All of the study variables showed impairment in the AD group. According to the results, AD patients' oral reading was marked by reduced speech and articulation rates, low effectiveness of phonation time, and increases in the number and proportion of pauses. Signal processing algorithms applied to reading fluency recordings were shown to be capable of differentiating between AD patients and controls with an accuracy of 80% (specificity 74.2%, sensitivity 77.1%) based on speech rate. Analysis of oral reading fluency may be useful as a tool for the objective study and quantification of speech deficits in AD. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  6. The true cost of in-patient obesity: impact of obesity on inflammatory stress and morbidity.

    Science.gov (United States)

    Grimble, Robert F

    2010-11-01

    The objective of the present review is to provide an overview of the metabolic effects of pro-inflammatory cytokine production during infection and injury; to highlight the disadvantages of pro-inflammatory cytokine production and inflammatory stress on morbidity and mortality of patients; to identify the influence of genetics and adiposity on inflammatory stress in patients and to indicate how nutrients may modulate the inflammatory response in patients. Recent research has shown clearly that adipose tissue actively secretes a wide range of pro- and anti-inflammatory cytokines. Paradoxically, although inflammation is an essential part of the response of the body to infection, surgery and trauma, it can adversely affect patient outcome. The metabolic effects of inflammation are mediated by pro-inflammatory cytokines. Metabolic effects include insulin insensitivity, hyperlipidaemia, muscle protein loss and oxidant stress. These effects, as well as being present during infective disease, are also present in diseases with a covert inflammatory basis. These latter diseases include obesity and type 2 diabetes mellitus. Inflammatory stress also increases during aging. The level of cytokine production, within individuals, is influenced by single nucleotide polymorphisms (SNP) in cytokine genes. The combination of SNP controls the relative level of inflammatory stress in both overt and covert inflammatory diseases. The impact of cytokine genotype on the intensity of inflammatory stress derived from an obese state is unknown. While studies remain to be done in the latter context, evidence shows that these genomic characteristics influence morbidity and mortality in infectious disease and diseases with an underlying inflammatory basis and thereby influence the cost of in-patient obesity. Antioxidants and n-3 PUFA alter the intensity of the inflammatory process. Recent studies show that genotypic factors influence the effectiveness of immunonutrients. A better understanding

  7. Cold pressor test myocardial perfusion SPECT as a predictor of the development of ischemia at exercise in the follow up of asymptomatic patients with moderate cardiovascular risk

    International Nuclear Information System (INIS)

    Traverso, Sonia S.; Redruello, Marcela F.; Grynberg, Laura E.; Cragnolino, Daniel E.; Maciel, Neiva R.; Masoli, Osvaldo H.; Perez Balino, Nestor A.; Meretta, Alejandro

    2007-01-01

    Introduction: Previous studies have published the correlation between myocardial perfusion SPECT (MP) during cold pressor test (CPT) and intracoronary acetylcholine and its usefulness as independent marker of endothelial dysfunction (ED). Objective: To analyze the incidence of positivization of MP exercise studies in the follow up of asymptomatic patients with moderate cardiovascular risk (CV) and ED detected by PF. Material and Methods: Of 301 patients of the PARADIGMA Registry (normal exercise MP SPECT and clinical probability [es

  8. Elevated troponin in patients with acute stroke - Is it a true heart attack?

    Science.gov (United States)

    Dous, George V; Grigos, Angela C; Grodman, Richard

    2017-09-01

    Although the prognostic value of a positive troponin in an acute stroke patient is still uncertain, it is a commonly encountered clinical situation given that Ischemic Heart Disease (IHD) and cerebrovascular disease (CVD) frequently co-exist in the same patient and share similar risk factors. Our objectives in this review are to (1) identify the biologic relationship between acute cerebrovascular stroke and elevated troponin levels, (2) determine the pathophysiologic differences between positive troponin in the setting of acute stroke versus acute myocardial infarction (AMI), and (3) examine whether positive troponin in the setting of acute stroke has prognostic significance. We also will provide an insight analysis of some of the available studies and will provide guidance for a management approach based on the available data according to the current guidelines.

  9. Basal longitudinal strain predicts future aortic valve replacement in asymptomatic patients with aortic stenosis

    DEFF Research Database (Denmark)

    Carstensen, Helle Gervig; Larsen, Linnea Hornbech; Hassager, Christian

    2016-01-01

    analysis and coronary angiography by MDCT. The combined endpoint was indication for aortic valve replacement (AVR) and sudden cardiac death. During a median follow-up of 2.3 years (interquartile range 1.7-3.6) 43 patients (41%) met the endpoint of indication for AVR. The basal (13.4 ± 3.1% vs. 15.7 ± 3.......1%) and mid-ventricular segments (14.9 ± 2.7% vs. 16.2 ± 2.9%) were significantly reduced, but with sparing of the apical segments, in patients who later underwent AVR. In various multivariable Cox regression models, including only BLS, but not GLS, remained an independent predictor of AVR. CONCLUSION...

  10. Clinical significance of changes of serum true insulin and proinsulin levels in relations of patients with type 2 diabetes mellitus

    International Nuclear Information System (INIS)

    Tian Xiaoping; Huang Huijian; Huang Haibo; Wu Yan; He Haoming

    2004-01-01

    Objective: To explore the degree of insulin resistance and β-cell secretory function impairment in close (1st degree) relations of patients with type 2 diabetes (DMII). Methods: Serum true insulin (TI), pro-insulin (PI), immunoreactive insulin (IRI) levels at fasting and after oral 75g glucose loading were determined in: 1) patients with DM 2, n=65 2)relations of DM 2 patients with impaired glucose tolerance (IGT), n=34 3) relations of DM 2 patients with normal glucose tolerance (NGT), n=66 and 4) controls, n=48. HOMA-IR and HOMA-β cell secretory indices were calculated from the data. Results: Fasting serum PI levels were significantly higher in DM 2 patients, relations with IGT and NGT than those in the controls (t=2.38, t=2.16, t=1.95, P 1 C percentages were significantly higher in DM 2 patients and IGT, NGT groups than those in controls (t=3.67, t=2.45, t=1.97, P 1 C percentage, fasting TI and IRI levels. Conclusion: Insulin resistance was already obvious in those relations of DM 2 patients with normal glucose tolerance and β-cell secretory function impairment was also present. Early intervention in these subjects might be beneficial. (authors)

  11. Asymptomatic "placental prolapse" with cervical funneling in a patient with complete placenta previa.

    Science.gov (United States)

    Adekola, Henry; Lam-Rachlin, Jennifer; Bronshtein, Elena; Abramowicz, Jacques S

    2015-02-01

    We describe the transvaginal sonographic findings in a patient with complete placenta previa and increased risk of preterm birth owing to a prior history of mid-trimester pregnancy loss in whom we observed a short cervix and prolapse of the placenta and fetal membranes into the endocervical canal. We believe that this could lead to antepartum hemorrhage and mandate close observation when diagnosed. We introduced the term "placental prolapse" to describe our finding. © 2015 Wiley Periodicals, Inc.

  12. SuPAR predicts postoperative complications and mortality in patients with asymptomatic aortic stenosis

    DEFF Research Database (Denmark)

    Hodges, Gethin W; Bang, Casper N; Eugen-Olsen, Jesper

    2018-01-01

    . Methods: Baseline plasma suPAR levels were available in 411 patients who underwent AVR surgery during follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Cox analyses were used to evaluate suPAR in relation to all-cause mortality and the composite endpoint of postoperative...... complications (all-cause mortality, congestive heart failure, stroke and renal impairment) occurring in the 30-day postoperative period. Results: Patients with initially higher levels of suPAR were at increased risk of postoperative mortality with a HR of 3.5 (95% CI 1.4 to 9.0, P=0.008) and postoperative.......7 (95% CI 1.0 to 7.8, P=0.061); and postoperative complications with a HR of 2.5 (95% CI 1.3 to 5.0, P=0.007) and 2.4 (95% CI 1.2 to 4.8, P=0.011), respectively. Conclusion: Higher baseline suPAR levels are associated with an increased risk for postoperative complications and mortality in patients...

  13. Computed tomography evaluation of the normal craniocervical junction craniometry in 100 asymptomatic patients.

    Science.gov (United States)

    Batista, Ulysses C; Joaquim, Andrei F; Fernandes, Yvens B; Mathias, Roger N; Ghizoni, Enrico; Tedeschi, Helder

    2015-04-01

    Most of the craniometric relationships of the normal craniocervical junction (CCJ), especially those related to angular craniometry, are still poorly studied and based on measurements taken from simple plain radiographs. In this study, the authors performed a craniometric evaluation of the CCJ in a population without known CCJ anomalies. The purpose of the study was to evaluate the normal CCJ craniometry based on measurements obtained from CT scans. The authors analyzed 100 consecutive CCJ CT scans obtained in adult patients who were admitted at their tertiary hospital for treatment of non-CCJ conditions between 2010 and 2012. A total of 17 craniometrical measurements were performed, including the relation of the odontoid with the cranial base, the atlantodental interval (ADI), the clivus length, the clivus-canal angle (CCA)-the angle formed by the clivus and the upper cervical spine, and the basal angle. The mean age of the 100 patients was 50.6 years, and the group included 52 men (52%) and 48 women (48%). In 5 patients (5%), the tip of the odontoid process was more than 2 mm above the Chamberlain line, and in one of these 5 patients (1% of the study group). it was more than 5 mm above it. One patient had a Grabb-Oakes measurement above 9 mm (suggesting ventral cervicomedullary encroachment). The mean ADI value was 1.1 mm. The thickness of the external occipital protuberance ranged from 7.42 to 22.36 mm. The mean clivus length was 44.74 mm, the mean CCA was 153.68° (range 132.32°-173.95°), and the mean basal angle was 113.73° (ranging from 97.06°-133.26°). The data obtained in this study can be useful for evaluating anomalies of the CCJ in comparison with normal parameters, potentially improving the diagnostic criteria of these anomalies. When evaluating CCJ malformations, one should take into account the normal ranges based on CT scans, with more precise bone landmarks, instead of those obtained from simple plain radiographs.

  14. Role of Papanicolaou Smear in the Diagnosis of Pathologic Flora in Asymptomatic Patients in Rural Health Care Set-Up

    Directory of Open Access Journals (Sweden)

    Siona Sabu

    2017-10-01

    Full Text Available Introduction: The infections of female genital tract, especially the cervix are asymptomatic in presentation and pose a diagnostic challenge. Vaginal infections can lead to cytoplasmic and nuclear abnormalities in the epithelial cells. Additionally, these infections could augur an inflammatory response of varying nature. The most common flora include Candida albicans, Gardnerella vaginalis, Trichomonas vaginalis, Human Papilloma Virus (HPV, Human Herpes Virus (HHV and Actinomyces sp. Aim: This study seeks to measure the role of Papanicolaou smear in detection of pathologic flora: Candida albicans, Gardnerella vaginalis, Trichomonas vaginalis, HPV, HHV and Actinomyces; in a rural health care set up amongst women in the reproductive and menopausal age group. Materials and Methods: A retrospective study of cervical smears by Papanicolaou method, over a 14 month period was carried out in a tertiary care centre including a total number of 150 patients. Results: Of the total of 150 samples examined, Candida species was the most frequently detected (8.7% followed by Trichomonas vaginalis (5.3% and Gardnerella vaginalis species (4.7%. HPV-induced changes were noted in a mere 2% of cases. Actinomyces species was noted in less than 1% of cases. Conclusion: The Papanicolaou test for examining cervical smear has definite uses in detecting vaginal microorganisms. Apart from detection of the usual pathogenic flora, the test has utility in defining the degree of inflammation and additional reparative changes.

  15. Esophageal Perforation: A Rare Complication of Transesophageal Echocardiography in a Patient with Asymptomatic Esophagitis

    Directory of Open Access Journals (Sweden)

    Kabir Ahmed

    2012-12-01

    Full Text Available Transesophageal echocardiography (TEE is a commonly used procedure in patients with suspected endocarditis. A rare but dreadful complication of this procedure is perforation of the esophagus. We report the case of an elderly female with multiple comorbidities, who presented with polyarticular septic arthritis. TEE was performed to rule out endocarditis. Though the standard procedure protocol was followed, she developed esophageal perforation. It was managed with esophageal stenting but she developed multiorgan failure and did not survive. This case highlights the potential of severe morbidity and mortality associated with TEE. Appropriate screening must be done and high-risk individuals must be identified before such procedures are attempted.

  16. Cauda equina syndrome after spinal anaesthesia in a patient with asymptomatic tubercular arachnoiditis

    Directory of Open Access Journals (Sweden)

    Divya Sethi

    2011-01-01

    Full Text Available A 14-year-old boy underwent emergency debridement surgery of right foot under spinal anaesthesia. Four hours after the surgery, the patient developed symptoms of cauda equina syndrome (CES. Postoperative magnetic resonance imaging of the patient′s spine suggested underlying tubercular arachnoiditis. The boy was started on intravenous methylprednisolone and antitubercular therapy. He responded to the therapy and recovered completely in 2 weeks without any residual neurological deficits. We suggest that underlying pathological changes in the subarachnoid space due to tubercular arachnoiditis contributed to maldistribution of the local anaesthetic drug leading to CES.

  17. Single Nodula opacity of granulomatous Pneumocystis jirovecii pneumoniain an asymptomatic lymphoma patient

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Soo; Shin, Kyung Eun; Lee, Ju Hie [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    2015-04-15

    The radiologic findings of a single nodule from Pneumocystis jirovecii pneumonia (PJP) have been rarely reported. We described a case of granulomatous PJP manifesting as a solitary pulmonary nodule with a halo sign in a 69-year-old woman with diffuse large B cell lymphoma during chemotherapy. The radiologic appearance of the patient suggested an infectious lesion such as angioinvasive pulmonary aspergillosis or lymphoma involvement of the lung; however, clinical manifestations were not compatible with the diseases. The nodule was confirmed as granulomatous PJP by video-assisted thoracoscopic surgery biopsy.

  18. Prostate cancer patients' quality of life assessments across the primary treatment trajectory: 'True' change or response shift?

    Science.gov (United States)

    Gerlich, Christian; Schuler, Michael; Jelitte, Matthias; Neuderth, Silke; Flentje, Michael; Graefen, Markus; Krüger, Alexander; Mehnert, Anja; Faller, Hermann

    2016-07-01

    Background Self-report questionnaires are widely used to assess changes in quality of life (QoL) during the course of cancer treatment. However, comparing baseline scores to follow-up scores is only justified if patients' internal measurement standards have not changed over time, that is, no response shift occurred. We aimed to examine response shift in terms of reconceptualization, reprioritization and recalibration among prostate cancer patients. Material and methods We included 402 newly diagnosed patients (mean age 65 years) and assessed QoL at the beginning of cancer treatment and three months later. QoL was measured with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). We employed structural equation modeling testing measurement invariance between occasions to disentangle 'true' change and change in the measurement model (response shift). Results We found reprioritization effects for both the Physical Functioning and Role Functioning subscales of the EORTC QLQ-C30, indicating that both had gained importance for representing the latent construct of QoL at follow-up. These effects added to the worsening effect evident in the latent construct, thus rendering observed changes even more pronounced. In addition, we found recalibration effects for both the Emotional Functioning and Cognitive Functioning subscales indicating judgments becoming more lenient over time. These effects counteracted 'true' negative changes thus obscuring any substantial changes on the observed level. Conclusion Our results suggest that changes observed in some subscales of the EORTC QLQ-C30 should not be taken at face value as they may be affected by patients' changed measurement standards.

  19. Circulating Malondialdehyde-Modified LDL-Related Variables and Coronary Artery Stenosis in Asymptomatic Patients with Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Kazuya Fujihara

    2015-01-01

    Full Text Available Aims. To elucidate the levels of malondialdehyde-modified LDL (MDA-LDL-related variables for predicting coronary artery stenosis (CAS by coronary CT angiography (CCTA in asymptomatic patients with type 2 diabetes (T2DM. Methods. Enrolled were 36 Japanese patients with T2DM who underwent CCTA and in whom MDA-LDL levels were measured. Definition of CAS was luminal narrowing of ≥50%. Trends through tertiles of each MDA-LDL-related variable were analyzed with a general linear model. The ability of each MDA-LDL-related variable to predict CAS was compared to areas under the curve (AUCs in receiver operating characteristic curve (ROC analysis. Results. Seventeen patients had CAS. Each MDA-LDL-related variable was an independent predictor of CAS (P=0.039 for MDALDL, P=0.013 for MDA-LDL/LDL-C, P=0.047 for MDA-LDL/HDL-C, and P=0.013 for (MDA-LDL/LDL-C/HDL-C. AUCs of MDA-LDL, MDA-LDL/LDL-C, MDA-LDL/HDL-C, and (MDA-LDL/LDL-C/HDL-C were 0.675 (95% CI 0.496–0.854, 0.765 (0.602–0.927, 0.752 (0.592–0.913, and 0.799 (0.643–0.955, respectively, for predicting CAS. Trends throughout the tertiles showed significant associations between MDA-LDL/LDL-C, MDA-LDL/HDL-C, or (MDALDL/LDL-C/HDL-C and CAS (P=0.003 for MDA-LDL/LDL-C, P=0.042 for MDA-LDL/HDL-C, and P=0.001 for (MDA-LDL/LDL-C/HDL-C. Conclusions. Data suggest that measurements of MDA-LDL/LDL-C, MDA-LDL/HDLC, and (MDA-LDL/LDL-C/HDL-C are useful for predicting CAS.

  20. Multimodal assessment of sensorimotor shoulder function in patients with untreated anterior shoulder instability and asymptomatic handball players.

    Science.gov (United States)

    Mornieux, Guillaume; Hirschmüller, Anja; Gollhofer, Albert; Südkamp, Norbert P; Maier, Dirk

    2018-04-01

    Functional evaluation of sensorimotor function of the shoulder joint is important for guidance of sports-specific training, prevention and rehabilitation of shoulder instability. Such assessment should be multimodal and comprise all qualities of sensorimotor shoulder function. This study evaluates feasibility of such multimodal assessment of glenohumeral sensorimotor function in patients with shoulder instability and handball players. Nine patients with untreated anterior instability of their dominant shoulder and 15 asymptomatic recreational handball players performed proprioceptive joint position sense and dynamic stabilization evaluations on an isokinetic device, as well as a functional throwing performance task. Outcome measures were analysed individually and equally weighted in a Shoulder-Specific Sensorimotor Index (S-SMI). Finally, isokinetic strength evaluations were conducted. We observed comparable sensorimotor functions of unstable dominant shoulders compared to healthy, contralateral shoulders (e.g. P=0.59 for S-SMI). Handball players demonstrated superior sensorimotor function of their dominant shoulders exhibiting a significantly higher throwing performance and S-SMI (Pshoulders (P>0.22). The present study proves feasibility of multimodal assessment of shoulder sensorimotor function in overhead athletes and patients with symptomatic anterior shoulder instability. Untreated shoulder instability led to a loss of dominance-related sensorimotor superiority indicating functional internal rotation deficiency. Dominant shoulders of handball players showed a superior overall sensorimotor function but weakness of dominant internal rotation constituting a risk factor for occurrence of posterior superior impingement syndrome. The S-SMI could serve as a diagnostic tool for guidance of sports-specific training, prevention and rehabilitation of shoulder instability.

  1. Carotid Artery End-Diastolic Velocity and Future Cerebro-Cardiovascular Events in Asymptomatic High Risk Patients.

    Science.gov (United States)

    Chung, Hyemoon; Jung, Young Hak; Kim, Ki-Hyun; Kim, Jong-Youn; Min, Pil-Ki; Yoon, Young Won; Lee, Byoung Kwon; Hong, Bum-Kee; Rim, Se-Joong; Kwon, Hyuck Moon; Choi, Eui-Young

    2016-01-01

    Prognostic value of additional carotid Doppler evaluations to carotid intima-media thickness (IMT) and plaque has not been completely evaluated. A total of 1119 patients with risk factors for, but without, overt coronary artery disease (CAD), who underwent both carotid ultrasound and Doppler examination were included in the present study. Parameters of interest included peak systolic and end-diastolic velocities, resistive indices of the carotid arteries, IMT, and plaque measurements. The primary end-point was all-cause cerebro-cardiovascular events (CVEs) including acute myocardial infarction, coronary revascularization therapy, heart failure admission, stroke, and cardiovascular death. Model 1 covariates comprised age and sex; Model 2 also included hypertension, diabetes and smoking; Model 3 also had use of aspirin and statin; and Model 4 also included IMT and plaque. The mean follow-up duration was 1386±461 days and the mean age of the study population was 60±12 years. Amongst 1119 participants, 43% were women, 57% had a history of hypertension, and 23% had diabetes. During follow-up, 6.6% of patients experienced CVEs. Among carotid Doppler parameters, average common carotid artery end-diastolic velocity was the independent predictor for future CVEs after adjustments for all models variables (HR 0.95 per cm/s, 95% confident interval 0.91-0.99, p=0.034 in Model 4) and significantly increased the predictive value of Model 4 (global χ(2)=59.0 vs. 62.8, p=0.029). Carotid Doppler measurements in addition to IMT and plaque evaluation are independently associated with future CVEs in asymptomatic patients at risk for CAD.

  2. Carotid artery stenosis in asymptomatic patients who have received unilateral head-and-neck irradiation

    International Nuclear Information System (INIS)

    Martin, Joseph D.; Buckley, Anne R.; Graeb, Doug; Walman, Brenda; Salvian, Anthony; Hay, John H.

    2005-01-01

    Purpose: To determine the prevalence of carotid artery stenosis in patients who have received ipsilateral head-and-neck radiotherapy and have no symptoms of cerebrovascular disease. Methods and Materials: Forty patients underwent ultrasound and computed tomography angiography of their carotid arteries. The vessels on the irradiated side were compared with those on the unirradiated side in a matched-pair analysis with regard to any stenosis, stenosis ≥60% in the internal carotid artery/carotid bulb, intima medial thickness (IMT), and grade of wall abnormalities. History, physical, and fasting blood levels were taken to detect risk factors for carotid disease. Results: Fourteen irradiated carotid trees bore one or more stenosis vs. five in the unirradiated ones (p = 0.03). There were six bulb/internal carotid artery stenoses ≥60% in the irradiated carotids vs. one in the unirradiated (OR 6:1, p = 0.13). IMT and grade of vessel wall abnormality were higher in the irradiated carotids, but only at doses ≥50 Gy, and only at measurement points that lay within the radiation portals. Conclusion: Radiation appears to cause carotid artery stenosis. There may be a dose threshold for carotid wall changes, which has relevance for radiotherapy in several tumor sites

  3. Radiographic Subsidence in Asymptomatic Patients After THR Using the Furlong Active HAP Stem.

    Science.gov (United States)

    Cordero-Ampuero, José; Peñalver, Pablo; Antón, Rodrigo; Galán, María; Cordero, Enrique

    2013-07-01

    The short, tapered, collarless Furlong Active stem has been recently associated in the published literature with significant subsidence using Roentgen stereophotogrammetric analysis. The purpose of this study was to analyze the short-term radiographic subsidence in Furlong Active HAP stems and correlate the results with the age, gender, bone morphology, and bone quality of the proximal femur, stem diameter, and medullary canal filling. Sixty-five consecutive patients (70 hips) receiving the Furlong Active HAP stems were enrolled in this prospective series. The average follow-up was 2.99 ± 1.38 years. All patients were evaluated clinically using the Harris Hip Score (HHS) and radiographically for femoral stem subsidence. In addition, proximal femoral osteopenia, proximal femur morphology, and medullary canal filling were also evaluated. The average subsidence was 2.4 mm (from 0 to 13 mm) at the end of the follow-up period. The average HHS score at the end of follow-up was 90 (range, 81-98). There was one intraoperative fracture. Of the Furlong Active stems 61% subsided with initial weight bearing. Subsidence is higher in males, but no correlation has been found with age, stem diameter, morphology, osteopenia, or canal filling.

  4. Subclinical Coronary Plaque Burden in Asymptomatic Relatives of Patients With Documented Premature Coronary Artery Disease

    DEFF Research Database (Denmark)

    Christiansen, Morten Krogh; Jensen, Jesper Møller; Bøtker, Hans Erik

    CAD, suffer a high burden of subclinical coronary atherosclerosis. Methods: First degree relatives, aged 30-65 years, of patients with a documented coronary revascularization procedure before the age of 40 years, were invited to participate in the study. Participants were matched by age, sex...... and absence of a family history, with patients referred for coronary CT angiography (CTA) because of atypical angina or non-anginal chest pain. A pooled blinded analysis was performed. The main outcome measure was the number of plaque-affected coronary segments. Results: 88 relatives and 88 symptomatic......% having a 10-year risk of ≤1%). Relatives had significantly (p=0.006) more affected segments than controls (0 segments: 29,6% vs. 48,9%, 1-2 segments: 27,3% vs. 31,8%, 3-5 segments: 23,9% vs. 11,4% and ≥6 segments: 19,3% vs. 8,0%). In a multivariable logistic regression analysis, the presence of any CAD...

  5. Brain imaging changes associated with risk factors for cardiovascular and cerebrovascular disease in asymptomatic patients.

    Science.gov (United States)

    Friedman, Joseph I; Tang, Cheuk Y; de Haas, Hans J; Changchien, Lisa; Goliasch, Georg; Dabas, Puneet; Wang, Victoria; Fayad, Zahi A; Fuster, Valentin; Narula, Jagat

    2014-10-01

    Reviews of imaging studies assessing the brain effects of vascular risk factors typically include a substantial number of studies with subjects with a history of symptomatic cardiovascular or cerebrovascular disease and/or events, limiting our ability to disentangle the primary brain effects of vascular risk factors from those of resulting brain and cardiac damage. The objective of this study was to perform a systematic review of brain changes from imaging studies in patients with vascular risk factors but without clinically manifest cardiovascular or cerebrovascular disease or events. The 77 studies included in this review demonstrate that in persons without symptomatic cardiovascular, cerebrovascular, or peripheral vascular disease, the vascular risk factors of hypertension, diabetes mellitus, obesity, hyperlipidemia, and smoking are all independently associated with brain imaging changes before the clinical manifestation of cardiovascular or cerebrovascular disease. We conclude that the identification of brain changes associated with vascular risk factors, before the manifestation of clinically significant cerebrovascular damage, presents a window of opportunity wherein adequate treatment of these modifiable vascular risk factors may prevent the development of irreversible deleterious brain changes and potentially alter patients' clinical course. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  6. Asymptomatic choroidal tubercle in a patient with Crohn's disease on adalimumab treatment.

    Science.gov (United States)

    Asensio-Sánchez, V M; Díaz-Cabanas, L; Martín-Prieto, A; Haro-Álvarez, B

    2018-03-01

    Adalimumab, an anti-tumour necrosis factor alpha therapy for active Crohn's disease (CD), is associated with increased risks of tuberculosis infection. The case is presented of a 48 year-old male with active CD on treatment with adalimumab. After three months, he developed a miliary pulmonary tuberculosis infection, with a solitary non-reactive choroidal tubercle temporal-superior to the optic disc being found in an ophthalmological study. Fluorescein angiography showed late hyperfluorescence in a staining pattern. Optic coherence tomography showed a flat mass without serous retinal detachment. The choroidal tubercle slowly regressed with antituberculosis therapy. Choroidal tubercles with no vitreo-retinal symptomatology can be present in patients with CD and on treatment with adalimumab. Copyright © 2017 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Evaluation of the rupture of silicone breast implants by mammography, ultrasonography and magnetic resonance imaging in asymptomatic patients: correlation with surgical findings

    Directory of Open Access Journals (Sweden)

    Anabel Medeiros Scaranelo

    Full Text Available CONTEXT: Different imaging methods can identify the integrity of breast implants and also the extent of possible silicone leakage. Mammography, ultrasonography and magnetic resonance imaging are often used to evaluate the integrity of breast implants, usually in patients that are symptomatic for rupture. A group of clinically asymptomatic patients was taken as a sample. These patients wanted to remove or change their breast implants for psychological or cosmetic reasons. OBJECTIVE: The purpose of this study was to compare the efficacy of mammography, sonography and magnetic resonance imaging in the detection of breast implant rupture in an asymptomatic population. TYPE OF STUDY: Prospective study. SETTING: Department of Diagnostic Imaging, Universidade de São Paulo, São Paulo, Brazil. METHODS: The participants were 44 asymptomatic patients who subsequently had implants surgically removed. Eighty-three implants were evaluated by both film-screen mammography and high-resolution sonography and 77 implants were evaluated by magnetic resonance imaging. The sensitivity and specificity of mammography, ultrasonography and magnetic resonance imaging were assessed using predetermined diagnostic criteria for implant rupture. All radiological signs were discussed and false positives and false negatives were retrospectively evaluated to identify the pitfalls in the investigations. RESULTS: The respective sensitivity and specificity of mammography were 20% and 89%; sonography, 30% and 81%; and magnetic resonance imaging, 64% and 77%. The differences between patients with breast implants for cosmetic and oncological reasons were discussed. CONCLUSIONS: Our experience suggests that magnetic resonance imaging seems to be the best imaging method on its own for the evaluation of rupturing among asymptomatic patients.

  8. Measuring tongue volumes and visualizing the chewing and swallowing process using real-time TrueFISP imaging - initial clinical experience in healthy volunteers and patients with acromegaly

    International Nuclear Information System (INIS)

    Ajaj, W.; Goyen, M.; Herrmann, B.; Massing, S.; Goehde, S.; Lauenstein, T.; Ruehm, S.G.

    2005-01-01

    This study assessed both two-dimensional (2D) TrueFISP imaging for quantifying tongue volume and real-time TrueFISP imaging for evaluating chewing and swallowing in healthy volunteers and patients with acromegaly. In 50 healthy volunteers, tongue volumes were measured using a 2D TrueFISP sequence. Chewing and swallowing were visualized using a real-time TrueFISP sequence. Ten patients with acromegaly were examined twice with the same magnetic resonance imaging protocol: once prior to therapy and a second time 6 months after therapy. Prior to therapy, healthy volunteers had an average tongue volume of 140 ml for men and 90 ml for women, and patients with acromegaly had an average tongue volume of 180 ml for men and 145 ml for women. However, 6 months after therapy the mean tongue volumes in patients with acromegaly had decreased to 154 ml in the men and to 125 ml in the women. The chewing and swallowing process was normal in all volunteers. Prior to therapy, just two patients showed a chewing and swallowing pathology, which disappeared after therapy. Patients with acromegaly had larger tongue volumes than healthy volunteers, and TrueFISP imaging proved feasible for visualizing chewing and swallowing in real time and is capable of detecting possible pathologies. Furthermore, TrueFISP imaging can be used to monitor therapeutic approaches in patients with acromegaly. (orig.)

  9. Loop myopexy with true muscle transplantation for very large angle heavy eye syndrome patient

    Directory of Open Access Journals (Sweden)

    Jitendra Jethani

    2015-01-01

    Full Text Available A 42-year-old man presenting with complaints of squint for last 20 years. His visual acuity was 20/400 in right eye (RE and 20/30 in left eye (LE with glasses. His refraction was RE -16.75/-2.5 D cycl 180 and LE was -14.5/-1.5 D cycl 180. His axial length was 31.23 mm In RE and 29.72 mm in LE. On examination we found he had RE large esotropia with hypotropia measuring 130 pd base out and 40 pd base up in RE. A computerized tomography scan revealed that the superior rectus (SR was shifted nasally, and lateral rectus (LR was shifted inferiorly. A RE medial rectus (MR recession and LR resection with muscle transplantation on the MR was done. A loop myopexy was done to correct the path of the LR and SR. The patient had only 18 pd eso and 20 pd hypo on follow-up after 3 months. Loop myopexy in conjunction with muscle transplantation is a safe and effective procedure for large angle esotropia associated with heavy eye syndrome.

  10. "The Service I Rendered Was Just as True": African American Soldiers and Veterans as Activist Patients.

    Science.gov (United States)

    Adler, Jessica L

    2017-05-01

    In this article, I examine how African American soldiers and veterans experienced and shaped federally sponsored health care during and after World War I. Building on studies of the struggles of Black leaders and health care providers to win professional and public health advancement in the 1920s and 1930s, and of advocates to mobilize for health care rights in the mid-20th century, I focus primarily on the experiences and activism of patients in the interwar years. Private and government correspondence, congressional testimony, and reports from Black newspapers reveal that African American soldiers and veterans communicated directly with policymakers and bureaucrats regarding unequal treatment, assuming roles as "policy actors" who viewed health and medical care as "politics by other means." In the process, they drew attention to the paradoxes inherent in expanding government entitlements in the era of Jim Crow, and helped shape a veterans' health system that emerged in the 1920s and remained in place for the following century. They also laid the groundwork for the system's precedent-setting desegregation, referred to by advocates of the time as "a shining example to the rest of the country."

  11. Multiscale complexity analysis of the cardiac control identifies asymptomatic and symptomatic patients in long QT syndrome type 1.

    Directory of Open Access Journals (Sweden)

    Vlasta Bari

    Full Text Available The study assesses complexity of the cardiac control directed to the sinus node and to ventricles in long QT syndrome type 1 (LQT1 patients with KCNQ1-A341V mutation. Complexity was assessed via refined multiscale entropy (RMSE computed over the beat-to-beat variability series of heart period (HP and QT interval. HP and QT interval were approximated respectively as the temporal distance between two consecutive R-wave peaks and between the R-wave apex and T-wave end. Both measures were automatically taken from 24-hour electrocardiographic Holter traces recorded during daily activities in non mutation carriers (NMCs, n = 14 and mutation carriers (MCs, n = 34 belonging to a South African LQT1 founder population. The MC group was divided into asymptomatic (ASYMP, n = 11 and symptomatic (SYMP, n = 23 patients according to the symptom severity. Analyses were carried out during daytime (DAY, from 2PM to 6PM and nighttime (NIGHT, from 12PM to 4AM off and on beta-adrenergic blockade (BBoff and BBon. We found that the complexity of the HP variability at short time scale was under vagal control, being significantly increased during NIGHT and BBon both in ASYMP and SYMP groups, while the complexity of both HP and QT variability at long time scales was under sympathetic control, being smaller during NIGHT and BBon in SYMP subjects. Complexity indexes at long time scales in ASYMP individuals were smaller than those in SYMP ones regardless of therapy (i.e. BBoff or BBon, thus suggesting that a reduced complexity of the sympathetic regulation is protective in ASYMP individuals. RMSE analysis of HP and QT interval variability derived from routine 24-hour electrocardiographic Holter recordings might provide additional insights into the physiology of the cardiac control and might be fruitfully exploited to improve risk stratification in LQT1 population.

  12. Incidence and predictors of asymptomatic atrial fibrillation in patients older than 70 years with complete atrioventricular block and dual chamber pacemaker implantation.

    LENUS (Irish Health Repository)

    Radeljic, Vjekoslav

    2012-01-31

    AIM: To evaluate predictors of asymptomatic atrial fibrillation in patients older than 70 years with complete atrioventricular (AV) block, normal left ventricular systolic function, and implanted dual chamber (DDD) pacemaker. METHODS: Hundred and eighty six patients with complete AV block were admitted over one year to the Sisters of Mercy University Hospital. The study recruited patients older than 70 years, with no history of atrial fibrillation, heart failure, or reduced left ventricular systolic function. All the patients were implanted with the same pacemaker. Out of 103 patients who were eligible for the study, 81 (78%) were evaluated. Among those 81 (78%) were evaluated. Eighty one (78%) patients were evaluated. Follow-up time ranged from 12 to 33 months (average +\\/-standard deviation 23 +\\/- 5 months). Primary end-point was asymptomatic atrial fibrillation occurrence recorded by the pacemaker. Atrial fibrillation occurrence was defined as atrial high rate episodes (AHRE) lasting >5 minutes. Binary logistic regression was used to identify the predictors of development of asymptomatic atrial fibrillation. Results. The 81 patients were stratified into two groups depending on the presence of AHRE lasting >5 minutes (group 1 had AHRE>5 minutes and group 2 AHRE<5 minutes). AHRE lasting >5 minutes were detected in 49 (60%) patients after 3 months and in 53 (65%) patients after 18 moths. After 3 months, only hypertension (odds ratio [OR], 17.63; P = 0.020) was identified as a predictor of asymptomatic atrial fibrillation. After 18 months, hypertension (OR, 14.0; P = 0.036), P wave duration >100 ms in 12 lead ECG (OR, 16.5; P = 0.001), and intracardial atrial electrogram signal amplitude >4 mV (OR, 4.27; P = 0.045) were identified as predictors of atrial fibrillation. CONCLUSION: In our study population, hypertension was the most robust and constant predictor of asymptomatic atrial fibrillation after 3 months, while P wave duration >100 ms in 12-lead ECG and

  13. Myocardial scarring on cardiovascular magnetic resonance in asymptomatic or minimally symptomatic patients with “pure” apical hypertrophic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Kim Kyung-Hee

    2012-07-01

    Full Text Available Abstract Background Late gadolinium enhancement (LGE cardiovascular magnetic resonance (CMR enables state-of-the-art in vivo evaluations of myocardial fibrosis. Although LGE patterns have been well described in asymmetrical septal hypertrophy, conflicting results have been reported regarding the characteristics of LGE in apical hypertrophic cardiomyopathy (ApHCM. This study was undertaken to determine 1 the frequency and distribution of LGE and 2 its prognostic implication in ApHCM. Methods Forty patients with asymptomatic or minimally symptomatic pure ApHCM (age, 60.2 ± 10.4 years, 31 men were prospectively enrolled. LGE images were acquired using the inversion recovery segmented spoiled-gradient echo and phase-sensitive inversion recovery sequence, and analyzed using a 17-segment model. Summing the planimetered LGE areas in all short axis slices yielded the total volume of late enhancement, which was subsequently presented as a proportion of total LV myocardium (% LGE. Results Mean maximal apical wall thickness was 17.9±2.3mm, and mean left ventricular (LV ejection fraction was 67.7 ± 8.0%. All but one patient presented with electrocardiographic negative T wave inversion in anterolateral leads, with a mean maximum negative T wave of 7.2 ± 4.7mm. Nine patients (22.5% had giant negative T waves, defined as the amplitude of ≥10mm, in electrocardiogram. LGE was detected in 130 segments of 30 patients (75.0%, occupying 4.9 ± 5.5% of LV myocardium. LGE was mainly detected at the junction between left and right ventricles in 12 (30% and at the apex in 28 (70%, although LGE-positive areas were widely distributed, and not limited to the apex. Focal LGE at the non-hypertrophic LV segments was found in some ApHCM patients, even without LGE of hypertrophied apical segments. Over the 2-year follow-up, there was no one achieving the study end-point, defined as all-cause death, sudden cardiac death and hospitalization for heart failure

  14. Asymptomatic HIV infection

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/000682.htm Asymptomatic HIV infection To use the sharing features on this page, please enable JavaScript. Asymptomatic HIV infection is a phase of HIV/AIDS during which ...

  15. Evaluation of NT-proBNP concentrations during exercise in asymptomatic patients with severe high-gradient aortic stenosis.

    Science.gov (United States)

    Dobrowolski, Piotr; Lech, Agnieszka; Klisiewicz, Anna; Hoffman, Piotr

    2016-08-11

    INTRODUCTION The effect of asymptomatic severe aortic stenosis (ASAS) on N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels ar rest and during exercise, as well as their relevance for clinical practice remain controversial.  OBJECTIVES The aim of this study was to test the hypothesis of whether the evaluation of NT-proBNP concentrations during exercise provides additional information about the severity of aortic stenosis and left ventricular remodeling in patients with ASAS. PATIENTS AND METHODS A total of 50 patients with ASAS (mean age, 38.4 ±18.1 years) and 21 healthy subjects (mean age, 43.4 ±10.6 years) were enrolled. Rest and exercise echocardiography was performed to evaluate maximum velocity (Vmax), mean aortic gradient (AG), and aortic valve area (AVA). The left ventricular mass index (LVMI) was calculated. NT-proBNP concentrations at rest and during exercise were assessed, and the difference between the 2 values was calculated (ΔNT-proBNP). RESULTS NT-proBNP and ΔNT-proBNP levels at rest and during exercise were significantly higher in the ASAS group compared with the control group. In the ASAS group, NT-proBNP levels at rest significantly correlated with LVMI (r = 0.432; P <0.0001), AVA (r = -0.408; P <0.0001), Vmax (r = 0.375; P = 0.002), and mean AG (r = 0.257; P = 0.03). NT-proBNP levels during exercise significantly correlated with LVMI (r = 0.432; P <0.0001), mean AG (r = 0.401; P = 0.001), and AVA (r = -0.375; P = 0.001). In the multivariate logistic regression model, the factors independently associated with NT-proBNP both at rest and during exercise were age, AVA, and LVMI. CONCLUSIONS NT-proBNP levels at rest provide valuable information for identifying patients with more advanced left ventricular hypertrophy secondary to severe aortic stenosis. NT-proBNP levels during exercise do not provide new information on the severity of AS.

  16. Prevention of Asymptomatic Bacteriuria with Cranberries and Roselle Juice in Home-care Patients with Long-term Urinary Catheterization

    Directory of Open Access Journals (Sweden)

    Shu-Chuan Lin

    2014-09-01

    Conclusion: Based on our results, neither Roselle tea nor cranberry juice was able to reduce the frequency of asymptomatic bacteriuria. It is inferred that cranberry juice or Roselle tea can only be used in ordinary day health care for the urinary tract.

  17. Isolated asymptomatic masseter muscle metastasis as first sign of metastatic disease in a patient with known melanoma

    DEFF Research Database (Denmark)

    Gjorup, Caroline Asirvatham; Hendel, Helle Westergren; Svane, Inge Marie

    2016-01-01

    A 65-year-old woman diagnosed with a nodular melanoma on the right shoulder had a PET/CT scan 13 months later demonstrating a FDG-avid mass in the left masseter muscle, which was asymptomatic and not clinically evident. Pathologic analysis confirmed metastasis of melanoma. Further subcutaneous...

  18. Asymptomatic bacteriuria and urinary tract infections in special patient groups : women with diabetes mellitus and pregnant women

    NARCIS (Netherlands)

    Schneeberger, Caroline; Kazemier, Brenda M.; Geerlings, Suzanne E.

    Purpose of reviewAsymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) in women with diabetes mellitus and during pregnancy are common and can have far-reaching consequences for the woman and neonate. This review describes epidemiology, risk factors, complications and treatment of UTI

  19. Asymptomatic bacteriuria and urinary tract infections in special patient groups: women with diabetes mellitus and pregnant women

    NARCIS (Netherlands)

    Schneeberger, Caroline; Kazemier, Brenda M.; Geerlings, Suzanne E.

    2014-01-01

    Asymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) in women with diabetes mellitus and during pregnancy are common and can have far-reaching consequences for the woman and neonate. This review describes epidemiology, risk factors, complications and treatment of UTI and ASB according

  20. Long-term risk of cardiovascular disease among type 2 diabetic patients with asymptomatic intracranial atherosclerosis: a prospective cohort study.

    Science.gov (United States)

    Duan, Jian Gang; Chen, Xiang Yan; Lau, Alex; Wong, Adrian; Thomas, G Neil; Tomlinson, Brian; Liu, Roxanna; Chan, Juliana C N; Leung, Thomas W; Mok, Vincent; Wong, Ka Sing

    2014-01-01

    To investigate whether asymptomatic middle cerebral artery (MCA) stenosis is associated with risk of cardiovascular disease (CVD) in Chinese with type 2 diabetes. In this prospective cohort study, 2,144 Hong Kong Chinese with type 2 diabetes and without history of stroke or atrial fibrillation were recruited in 1994-1996 and followed up for a median of 14.51 years. Participants were assessed at baseline for MCA stenosis using transcranial Doppler. We performed survival analysis to assess the association between asymptomatic MCA stenosis and first CVD event, defined as ischemic stroke, acute coronary syndrome (ACS) or cardiovascular death. Of the 2,144 subjects, MCA stenosis at baseline was detected in 264 (12.3%). Rates of stroke, ACS and cardiovascular death per 100 were, respectively, 2.24, 2.92 and 1.11 among participants with stenosis, higher than among those without stenosis. Ten-year cumulative occurrence of stroke, ACS and cardiovascular death in subjects with MCA stenosis was 20%, 24% and 10%, respectively, higher than the corresponding values for subjects without stenosis(all Pcardiovascular death(HR 1.56, 95%CI 1.04-2.33; P = 0.03). Asymptomatic MCA stenosis is a risk factor for CVD in Chinese with type 2 diabetes, and detection of asymptomatic MCA stenosis by transcranial Doppler can identify diabetic individuals at high risk of future CVD. This finding is particularly important for diabetic individuals in Asia, where intracranial atherosclerosis is common.

  1. Cardiovascular events in Japanese asymptomatic patients with type 2 diabetes: a 1-year interim report of a J-ACCESS 2 investigation using myocardial perfusion imaging

    International Nuclear Information System (INIS)

    Nakajima, Kenichi; Yamasaki, Yoshimitsu; Kusuoka, Hideo; Izumi, Tohru; Kashiwagi, Atsunori; Kawamori, Ryuzo; Shimamoto, Kazuaki; Yamada, Nobuhiro; Nishimura, Tsunehiko

    2009-01-01

    Diabetic patients have a high risk for cardiovascular events. The role of myocardial perfusion imaging was investigated in asymptomatic diabetic patients to evaluate short-term prognosis in a Japanese population. A total of 506 asymptomatic patients ≥50 years of age who had carotid artery maximum intima-media thickness ≥1.1 mm, urinary albumin excretion of ≥30 mg/g creatinine, with additional criteria of abdominal obesity, low HDL cholesterol, high triglyceride level, and hypertension were enrolled and followed up over a 3-year period. Gated SPECT with stress-rest protocol was performed and analyzed by summed defect scores and QGS software. One-year cardiovascular events were analyzed. Myocardial ischemia was observed in 17% of patients, and abnormal perfusion findings of ischemia and/or scar were observed in 32% of patients. By the end of the 1-year follow-up, 33 (6.5%) cardiovascular events occurred including 6 all-cause deaths. Patients with summed stress score (SSS) >8 had a higher incidence of either death or cardiovascular events. Event-free survival rates for SSS 0-3, 4-8, 9-13, and ≥14 were 0.96, 0.95, 0.82, and 0.76, respectively. Multivariate Cox regression analysis showed that significant variables were SSS, history of cerebrovascular accident, and electrocardiographic abnormality at rest. The 1-year interim summary showed that cardiovascular events were significantly higher in patients with SPECT abnormality, although hard cardiac event rate was relatively low. Targeted treatment strategy is required for asymptomatic but potentially high-risk diabetic patients. (orig.)

  2. Cardiovascular events in Japanese asymptomatic patients with type 2 diabetes: a 1-year interim report of a J-ACCESS 2 investigation using myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Nakajima, Kenichi [Kanazawa University Hospital, Department of Nuclear Medicine, Kanazawa (Japan); Yamasaki, Yoshimitsu [Osaka University, Center for Advanced Science and Innovation, Osaka (Japan); Kusuoka, Hideo [National Hospital Organization Osaka National Hospital, Osaka (Japan); Izumi, Tohru [Kitasato University, Department of Cardiology and Internal Medicine, Sagamihara (Japan); Kashiwagi, Atsunori [Shiga University of Medical Science, Department of Medicine, Ohtsu (Japan); Kawamori, Ryuzo [Juntendo University, Department of Medicine, Metabolism and Endocrinology, School of Medicine, Tokyo (Japan); Shimamoto, Kazuaki [Sapporo Medical University School of Medicine, Second Department of Internal Medicine, Sapporo (Japan); Yamada, Nobuhiro [University of Tsukuba, Division of Metabolism and Endocrinology, Department of Internal Medicine, Faculty of Medicine, Tsukuba (Japan); Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Department of Radiology, Graduate School of Medical Science, 465 Kajii-cho, Kawara-machi, Hirokoji, Kamigyo-ku, Kyoto (Japan)

    2009-12-15

    Diabetic patients have a high risk for cardiovascular events. The role of myocardial perfusion imaging was investigated in asymptomatic diabetic patients to evaluate short-term prognosis in a Japanese population. A total of 506 asymptomatic patients {>=}50 years of age who had carotid artery maximum intima-media thickness {>=}1.1 mm, urinary albumin excretion of {>=}30 mg/g creatinine, with additional criteria of abdominal obesity, low HDL cholesterol, high triglyceride level, and hypertension were enrolled and followed up over a 3-year period. Gated SPECT with stress-rest protocol was performed and analyzed by summed defect scores and QGS software. One-year cardiovascular events were analyzed. Myocardial ischemia was observed in 17% of patients, and abnormal perfusion findings of ischemia and/or scar were observed in 32% of patients. By the end of the 1-year follow-up, 33 (6.5%) cardiovascular events occurred including 6 all-cause deaths. Patients with summed stress score (SSS) >8 had a higher incidence of either death or cardiovascular events. Event-free survival rates for SSS 0-3, 4-8, 9-13, and {>=}14 were 0.96, 0.95, 0.82, and 0.76, respectively. Multivariate Cox regression analysis showed that significant variables were SSS, history of cerebrovascular accident, and electrocardiographic abnormality at rest. The 1-year interim summary showed that cardiovascular events were significantly higher in patients with SPECT abnormality, although hard cardiac event rate was relatively low. Targeted treatment strategy is required for asymptomatic but potentially high-risk diabetic patients. (orig.)

  3. Evaluation of coccygeal bone variability, intercoccygeal and lumbo-sacral angles in asymptomatic patients in multislice computed tomography.

    Science.gov (United States)

    Przybylski, Piotr; Pankowicz, Marcin; Boćkowska, Agata; Czekajska-Chehab, Elżbieta; Staśkiewicz, Grzegorz; Korzec, Maria; Drop, Andrzej

    2013-09-01

    The coccyx is a highly variable structure in the human caudal spine. Previous studies have revealed a significant correlation between coccyx shape and the pain syndrome coccygodynia. The aim of this study was to carry out a complex morphological evaluation of the coccyx in a group of asymptomatic patients of different sex and age examined by multislice computed tomography (MSCT) of the pelvis for different clinical reasons. MSCT pelvis examinations from various nontraumatic clinical conditions from consecutive adult patients (250 males and 250 females of comparable age, mean 54.9 ± 14.8 years) were used. Based on middle sagittal plane reconstructions: coccyx configuration (types I-IV according to Postacchini and Massobrio classification, each successive type characterized by a more pronounced anterior position of coccyx), number of segments, length and angles (intercoccygeal and lumbo-sacral) were measured. The results obtained were analyzed statistically. The following types of coccyx were observed in the study group: type I in 16.2 %, type II 40.0 %, type III 32.4 %, and type IV 11.4 % cases. In most cases (50.8 %), three segments were noted. Lumbo-sacral angle varied from 15.6° to 66.4° (average 41.6° ± 7.7°), and intercoccygeal angle from 0° to 107° (average 51° ± 23.3°). A significant negative correlation between age and number of segments as well as age and intercoccygeal angle was observed. In males, the coccyx was significantly longer, while in females the intercoccygeal angle was significantly wider. Type I was significantly more frequent in males, while type IV was found more often in females. The results obtained differ from other results in the literature. Our research could be useful to determine population standards, and help (together with clinical history) future studies of associations between idiopathic coccygodynia and coccyx morphology.

  4. Left Ventricular Diastolic Dysfunction in Asymptomatic Type 2 Diabetic Patients: Detection and Evaluation by Tissue Doppler Imaging

    Science.gov (United States)

    Zahiti, Bedri Faik; Gashi, Fitim Bejtullah; Gjoka, Sami Bajram; Zahiti, Lorita Bedri; Haxhiu, Bekim Sylë; Kamberi, Lulzim Selim

    2013-01-01

    CONFLICT OF INTEREST: NONE DECLARED The aim of the study was detection of diastolic dysfunction of myocardium with Tissue Doppler Imaging (TDI) in asymptomatic type 2 diabetic patients, in five years duration of disease, and normal cardiac function on conventional echocardiography (CE), according to the performance showed on exercise stress test. Material and Methods We studied 300 patients, of them 150 patients with non-obese, normotensive, uncomplicated type 2 diabetes, in five years duration of disease and 150 healthy control subjects. Of all patients, 100 with type 2 diabetes, and 100 patients from the control group underwent exercise test on a treadmill. All participants underwent both CE and TDI echocardiography. With TDI, lateral E’ peak velocity, atrial velocity (A’), their ratio (E’/A’) and systolic velocity (S’) were measured. Diastolic dysfunction was diagnosed by tissue Doppler imaging, and the following criterion was met: E’/A’ ratio <1. Cardiac function with CE was without significant features in the two groups. Results and Discussion Using TDI interrogation, diabetic subjects showed a lower E’ velocity (10,75±1,2 vs. 14±3 cm/s, p<0,001), an increased A’ velocity (10,65±1,8 vs. 11±3 cm/s, p<0,02), and a reduced E/A ratio (0,82±0,04 vs. 1,17±1,4, p<0,001), S (8.92±3,80 vs. 9,30±3.30 cm/sec); E/A (1,17±0.55, p<0,01). In diabetic patients, after the exercise stress test performance, the myocardial velocity increase is registered for wave E’=1,27 cm/sec (12,01%), for wave A’=1,7 cm/sec (15,9%), reduced ratio E’/A’ (0.89±0,1 cm/sec 9,0%) and S’=1,3 cm/sec (14,77%). Whereas, mean myocardial velocity values in examined control group after the exercise stress test were higher as follows: E’=2,7 cm/sec (19%), A’=2,1 cm/sec (14%), E’/A’=0,8 cm/sec (12%), and S’=2,7 cm/sec (18%). Myocardial diastolic dysfunction due to reduced exercise tolerance can be evidenced by TDI in type 2 diabetic subjects, even in the

  5. Risk stratification of cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts by 24-hour ambulatory blood pressure monitoring

    International Nuclear Information System (INIS)

    Shiraishi, Makoto; Watanabe, Hirofumi; Sakurai, Kenzo; Kato, Bunta; Hasegawa, Yasuhiro

    2012-01-01

    Our goal was to investigate the utility of 24-hour ambulatory blood pressure monitoring (ABPM) for the risk stratification of cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts. A total of 175 hypertensive patients with MRI evidence of asymptomatic or symptomatic lacunar infarcts (92 men, mean age of 69±11 years old) were studied. Patients with symptomatic infarctions were included whose events occurred more than 6 months after the onset. ABPM was performed in all patients in the outpatient clinic. Parameters obtained from ABPM were related to the composite outcome which consisted of all death and fatal or non-fatal cardiovascular events by using the Cox proportional hazard model. Mean follow-up period was 4.8 years and the composite outcome was recorded in 38 patients. 34 of them (89%) had recurrence of lacunar infarcts. Significant association between sleep-time lowest systolic blood pressure and composite outcome was demonstrated by multivariate Cox hazard analyses (heart rate (HR) 1.025, 95% confidence interval (CI) 1.011-1.039, p<0.001). The risk for composite outcome in patients with the highest tertile of sleep-time lowest systolic blood pressure (≥133 mmHg) was significantly elevated when compared to the lowest tertile (<132 mmHg, HR 3.93, 95% CI 1.57-9.86, p=0.004). Sleep-time lowest systolic blood pressure in ABPM may be a useful parameter for the risk stratification of future cardiovascular events in hypertensive patients with asymptomatic or symptomatic lacunar infarcts, especially for the recurrence of these events. (author)

  6. The role of TNF-α, Fas/Fas ligand system and NT-proBNP in the early detection of asymptomatic left ventricular dysfunction in cancer patients treated with anthracyclines

    Directory of Open Access Journals (Sweden)

    Alexandros Kouloubinis

    2015-03-01

    Conclusion: SFas, sFas-L and NT-proBNP correlate with reductions in LVEF and could be used as sensitive biochemical indices for the detection of asymptomatic left ventricular dysfunction in cancer patients under cardiotoxic chemotherapy.

  7. The role of positron emission tomography with computed tomography in the follow-up of asymptomatic cutaneous malignant melanoma patients with a high risk of disease recurrence.

    Science.gov (United States)

    Abbott, Rachel Angharad; Acland, Katharine M; Harries, Mark; O'Doherty, Michael

    2011-10-01

    The aim of this study was to evaluate the role of [F] fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) as a surveillance tool in asymptomatic patients with primary cutaneous melanoma with the American Joint Committee on Cancer stage 3 disease. Thirty-four patients with primary cutaneous malignant melanoma with American Joint Committee on Cancer stage 3 disease, who underwent at least one annual surveillance PET/CT scan, were retrospectively identified from our PET Centre Database in May 2008 and their characteristics, PET/CT results and disease course were reviewed. In 20 patients with microscopic stage 3 disease at diagnosis, annual surveillance PET/CT detected two of three recurrences and detected one incidental breast carcinoma. In 14 patients with macroscopic stage 3 disease at, or subsequent to, their initial diagnosis, annual PET/CT detected four of four recurrences, detected metastases in one patient who remains asymptomatic and detected one incidental thyroid carcinoma. PET/CT seems to be a useful surveillance tool in patients with macroscopic stage 3 disease, although the numbers in this study are small. However, the role of PET/CT in patients initially presenting with microscopic stage 3 disease requires further confirmation.

  8. Ocularhaemodynamics parameters of asymptomatic HAART ...

    African Journals Online (AJOL)

    Objectives: Study aimed at evaluating the impacts of HAART on retinal blood flow of a symptomatic HAART - experienced HIV-infected underfive children. Method: Ethical approval and patient consents were obtained before commencement of the study in the selected hospitals. Thirty asymptomatic HAARTexperienced ...

  9. Increased Levels of Human Carotid Lesion Linoleic Acid Hydroperoxide in Symptomatic and Asymptomatic Patients Is Inversely Correlated with Serum HDL and Paraoxonase 1 Activity

    Directory of Open Access Journals (Sweden)

    Elad Cohen

    2012-01-01

    Full Text Available Human carotid plaque components interact directly with circulating blood elements and thus they might affect each other. We determined plaque paraoxonase1 (PON1 hydrolytic-catalytic activity and compared plaque and blood levels of lipids, HDL, PON1, and HbA1c, as well as plaque-oxidized lipids in symptomatic and asymptomatic patients. Human carotid plaques were obtained from symptomatic and asymptomatic patients undergoing routine endarterectomy, and the lesions were ground and extracted for PON activity and lipid content determinations. Plaque PONs preserved paraoxonase, arylesterase, and lactonase activities. The PON1-specific inhibitor 2-hydroxyquinoline almost completely inhibited paraoxonase and lactonase activities, while only moderately inhibiting arylesterase activity. Oxysterol and triglyceride levels in plaques from symptomatic and asymptomatic patients did not differ significantly, but plaques from symptomatic patients had significantly higher (135% linoleic acid hydroperoxide (LA-13OOH levels. Their serum PON1 activity, cholesterol and triglyceride levels did not differ significantly, but symptomatic patients had significantly lower (28% serum HDL levels and higher (18% HbA1c levels. Thus LA-13OOH, a major atherogenic plaque element, showed significant negative correlations with serum PON1 activity and HDL levels, and a positive correlation with the prodiabetic atherogenic HbA1c. Plaque PON1 retains its activity and may decrease plaque atherogenicity by reducing specific oxidized lipids (e.g., LA-13OOH. The inverse correlation between plaque LA-13OOH level and serum HDL level and PON1 activity suggests a role for serum HDL and PON1 in LA-13OOH accumulation.

  10. Reliability of Ultrasound Diameter Measurements in Patients with a Small Asymptomatic Popliteal Artery Aneurysm: An Intra- and Inter-observer Agreement Study.

    Science.gov (United States)

    Zwiers, I; Hoogland, C M T; Mackaay, A J C

    2016-03-01

    In this study the intra- and inter-observer variability of ultrasound measurements of the diameter of the popliteal artery were tested in a group of patients under surveillance for a small (diameter 10-20 mm), asymptomatic popliteal artery aneurysm (PAA). From a group of patients under ultrasound surveillance for bilateral, asymptomatic PAAs, 13 consecutive patients agreed to participate in the study and provided informed consent. The maximum diameter of the popliteal arteries was assessed by a vascular technologist. The same assessment was repeated by a second vascular technologist, unaware of the results of the first measurement. After a week, this protocol was repeated. The intra- and inter-observer reliability of this measurement was calculated using intra-class correlation coefficients (ICCs) and Bland and Altman plots. Of the 10 patients with bilateral and three patients with unilateral PAA, 12 completed the 2 week protocol. A total of 86 measurements were analyzed. The mean diameter of the popliteal arteries was 13.5 ± 3.4 mm. The ICC for the intra-observer reliability of observer 1 was 0.96 (95% CI 0.92-0.99), p .47. The absolute magnitude of the systematic error of both observers was less than 0.135 mm (median 0.00). Ultrasound measurement of the maximum diameter of the popliteal artery is reproducible; hence, it is suitable for making a clinical treatment decision. Its use for surveillance of small, asymptomatic PAAs is justified. Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  11. Active surveillance for asymptomatic colonisation by multidrug-resistant bacteria in patients transferred to a tertiary care hospital in the occupied Palestinian territory.

    Science.gov (United States)

    Taha, Adham Abu; Daoud, Ayman; Zaid, Sawsan; Sammour, Sajida; Belleh, Maram; Daifi, Refqa

    2018-02-21

    Active surveillance is important in infection control programmes, allowing the detection of patients colonised with multi-drug resistant organisms and preventing the spread of multi-drug resistant organisms. The aim of this study was to determine the rate of asymptomatic colonisation with multi-drug resistant organisms and the prevalence of each organism in patients transferred to An-Najah National University Hospital, Nablus, occupied Palestinian territory. Patients transferred from other hospitals between January and December, 2015, were screened at time of admission by taking nasal, groin, and axillary swabs. Swabs were cultured and assessed for the presence of multi-drug resistant organisms (extended spectrum β-lactamase producers, Pseudomonas aeroginosae, Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus, and carbapenem-resistant enterobacteriaceae. Of the 822 screened patients, 265 (32%) had infections with multi-drug resistant organisms. 394 isolates of multi-drug resistant organisms were obtained: 131 (33%) isolates were extended spectrum β-lactamase producers, 119 (30%) isolates were P aeroginosae, 26 (9%) isolates were A baumannii, 94 (24%) isolates were methicillin-resistant S aureus, 13 (3%) isolates were vancomycin-resistant enterococci, and one (<1%) isolate was carbapenem-resistant enterobacteriaceae. We identified a high prevalence of asymptomatic colonisation with multidrug-resistant bacteria in transferred patients. These findings emphasise the need for a national strategy to combat the spread of multi-drug resistant organisms in the occupied Palestinian territory. An-Najah National University. Copyright © 2018 Elsevier Ltd. All rights reserved.

  12. Immunohistochemical expression of interleukin-2 receptor and interleukin-6 in patients with prostate cancer and benign prostatic hyperplasia: association with asymptomatic inflammatory prostatitis NIH category IV.

    Science.gov (United States)

    Engelhardt, Paul Friedrich; Seklehner, Stephan; Brustmann, Hermann; Lusuardi, Lukas; Riedl, Claus R

    2015-04-01

    This study prospectively investigated the immunohistochemical expression of interleukin-2 receptor (IL-2R) and interleukin-6 (IL-6) in patients with prostate cancer and benign prostatic hyperplasia (BPH), and a possible association of these conditions with asymptomatic inflammatory prostatitis National Institutes of Health (NIH) category IV. The study included 139 consecutive patients who underwent transurethral resection of the prostate and transvesical enucleation of the prostate (n = 82) or radical prostatectomy (n = 57). To characterize inflammatory changes the criteria proposed by Irani et al. [J Urol 1997;157:1301-3] were used. IL-2R and IL-6 expression was studied by a standard immunohistochemical method. Results were correlated with tumour, node, metastasis stage, Gleason scores, total prostate-specific antigen, International Prostate Symptom Score and body mass index. IL-2R and IL-6 expression was significantly higher in neoplastic prostate cancer tissue than in normal tissue of prostate cancer patients (p Prostate cancer patients with prostatitis showed significantly higher IL-2R expression than those without inflammation (p prostatitis than in those without (p prostate cancer tissue than in normal tissue. Patients with asymptomatic inflammatory prostatitis NIH category IV showed significantly greater activity.

  13. [Ankle-brachial index screening for peripheral artery disease in high cardiovascular risk patients. Prospective observational study of 370 asymptomatic patients at high cardiovascular risk].

    Science.gov (United States)

    Rada, C; Oummou, S; Merzouk, F; Amarir, B; Boussabnia, G; Bougrini, H; Benzaroual, D; Elkarimi, S; Elhattaoui, M

    2016-12-01

    Peripheral arterial disease is a marker of systemic atherosclerosis; it is associated with a high risk of cardiovascular disease. The aim of our study was to assess the prevalence of peripheral arterial disease by measuring the ankle-brachial pressure index in patients at high cardiovascular risk and to study the risk factors associated with this disease. This was a descriptive and analytic cross-sectional study which focused on 370 patients seen at the medical consultation for atherosclerosis prevention. The ankle-brachial index was measured with a portable Doppler (BIDOP 3) using 4 and 8Hz dual frequency probes. The standards were: normal ankle-brachial index 0.9 to 1.3; peripheral artery obstructive disease ankle-brachial index less than 0.9; poorly compressible artery (medial arterial calcification) ankle-brachial index greater than 1.3. Cardiovascular risk factors were also studied. Three hundred and seventy subjects (mean age 65.5±8.7years) were screened Cardiovascular risk factors were: sedentary lifestyle (91.5 %), hypertension (68.1 %), elevated LDL-cholesterolemia (36.3 %), diabetes (48.3 %) and tobacco smoking (33.8 %). The prevalence of peripheral artery disease was 32.4 % of which 77.5 % were asymptomatic. We found a significant correlation with smoking, diabetes, dyslipidemia and the presence of coronary artery disease or vascular cerebral disease. Screening for peripheral arterial disease (PAD) with the ankle-brachial index has increased the percentage of polyvascular patients from 6.2 to 29 %. Factors independently associated with PAD were advanced age, presence of cardiovascular disease, smoking and glycated hemoglobin. PAD is a common condition in people at high cardiovascular risk, the frequency of asymptomatic forms justifies the screening with pocket Doppler which is a simple, inexpensive and effective test to assess the overall cardiovascular risk. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  14. Prognostic Implications of Magnetic Resonance - Derived Quantification in Asymptomatic Patients with Organic Mitral Regurgitation: Comparison with Doppler Echocardiography-Derived Integrative Approach.

    Science.gov (United States)

    Penicka, Martin; Vecera, Jan; Mirica, Daniela C; Kotrc, Martin; Kockova, Radka; Van Camp, Guy

    2017-12-21

    Background -Magnetic resonance imaging (MRI) is an accurate method for the quantitative assessment of organic mitral regurgitation (OMR). The aim of the present study was to compare the discriminative power of MRI quantification and the recommended Doppler-echocardiography (ECHO)-derived integrative approach to identify asymptomatic patients with OMR and adverse outcome. Methods -The study population consisted of 258 asymptomatic patients (63±14 years, 60% males) with preserved left ventricular (LV) ejection fraction (>60%) and chronic moderate and severe OMR (flail 25%, prolapse 75%) defined using the ECHO-derived integrative approach. All patients underwent MRI to quantify regurgitant volume (RV) of OMR by subtracting the aortic forward flow volume from the total LV stroke volume. Severe OMR was defined as RV≥60ml. Results -Mean ECHO-derived RV was on average 17.1ml larger than the MRI-derived RV (pderived LV end-systolic volume index, RV and OMR category (severe vs. moderate), and the ECHO-derived OMR category were independent predictors of all-cause mortality (all pderived RV showed the largest area under the curve to predict mortality (0.72) or its combination with development of indication for mitral valve surgery (0.83). Conclusions -The findings of the present study suggest that the MRI-derived assessment of OMR can better identify patients with severe OMR and adverse outcome than ECHO-derived integrative approach warranting close follow-up and perhaps, early mitral valve surgery.

  15. Asymptomatic cryptococcal antigen prevalence detected by lateral flow assay in hospitalised HIV-infected patients in São Paulo, Brazil.

    Science.gov (United States)

    Vidal, José E; Toniolo, Carolina; Paulino, Adriana; Colombo, Arnaldo; Dos Anjos Martins, Marilena; da Silva Meira, Cristina; Pereira-Chioccola, Vera Lucia; Figueiredo-Mello, Claudia; Barros, Tiago; Duarte, Jequelie; Fonseca, Fernanda; Alves Cunha, Mirella; Mendes, Clara; Ribero, Taiana; Dos Santos Lazera, Marcia; Rajasingham, Radha; Boulware, David R

    2016-12-01

    To determine the prevalence of asymptomatic cryptococcal antigen (CRAG) using lateral flow assay (LFA) in hospitalised HIV-infected patients with CD4 counts 18 years old without prior cryptococcal meningitis, without clinical suspicion of cryptococcal meningitis, regardless of antiretroviral (ART) status, and with CD4 counts <200 cells/μl. Serum CRAG was tested by LFA in all patients, and whole blood CRAG was tested by LFA in positive cases. We enrolled 163 participants of whom 61% were men. The duration of HIV diagnosis was a median of 8 (range, 1-29) years. 26% were antiretroviral (ART)-naïve, and 74% were ART-experienced. The median CD4 cell count was 25 (range, 1-192) cells/μl. Five patients (3.1%; 95%CI, 1.0-7.0%) were asymptomatic CRAG-positive. Positive results cases were cross-verified by performing LFA in whole blood. 3.1% of HIV-infected inpatients with CD4 <200 cells/μl without symptomatic meningitis had cryptococcal antigenemia in São Paulo, suggesting that routine CRAG screening may be beneficial in similar settings in South America. Our study reveals another targeted population for CRAG screening: hospitalised HIV-infected patients with CD4 <200 cells/μl, regardless of ART status. Whole blood CRAG LFA screening seems to be a simple strategy to prevention of symptomatic meningitis. © 2016 John Wiley & Sons Ltd.

  16. Imaging Factors that Distinguish Between Patients with Asymptomatic and Symptomatic Cervical Spondylotic Myelopathy with Mild to Moderate Cervical Spinal Cord Compression.

    Science.gov (United States)

    Cao, Jun Ming; Zhang, Jing Tao; Yang, Da Long; Yang, Yi Peng; Xia, He Huan; Yang, Liu

    2017-10-13

    BACKGROUND Not all patients with spinal cord compression due to cervical spondylotic myelopathy (CSM) have clinical symptoms and signs. The aim of this study was to investigate and compare the imaging findings in asymptomatic and symptomatic patients with CSM with mild to moderate cervical spinal cord compression. MATERIAL AND METHODS A retrospective clinical study included 68 patients. Group A (n=30) had no symptoms and signs; group B (n=38) had symptoms and signs of cervical myelopathy. The age, sex, body mass index (BMI), history of steroid treatment, duration of symptoms, number of spondylotic cervical segments, Torg ratio, range of motion (ROM), incidence of cervical segmental instability, overall curvature of the cervical spine, direction of spinal cord compression, and spinal cord magnetic resonance imaging (MRI) signal intensity were compared. RESULTS For groups A and B, the Torg ratio was 90.3% and 83.6% (Pvariable, independently associated with cervical segmental instability (OR=5.898, P=0.037), an MRI T2-weighted intramedullary high signal (OR=9.718, P=0.002), and Torg ratio (OR=0.155, P=0.006). CONCLUSIONS Cervical segmental instability, a high intramedullary signal on T2-weighted MRI, and the Torg ratio had the greatest capacity to distinguish between asymptomatic and symptomatic patients with CSM with mild to moderate cervical spinal cord compression.

  17. TrueFisp versus HASTE sequences in 3T cine MRI: Evaluation of image quality during phonation in patients with velopharyngeal insufficiency

    International Nuclear Information System (INIS)

    Kulinna-Cosentini, Christiane; Czerny, Christian; Weber, Michael; Baumann, Arnulf; Sinko, Klaus

    2016-01-01

    To evaluate the image quality of two fast dynamic magnetic resonance imaging (MRI) sequences: True fast imaging with steady state precession (TrueFisp) was compared with half-Fourier acquired single turbo-spin-echo (HASTE) sequence for the characterization of velopharyngeal insufficiency (VPI) in repaired cleft palate patients. Twenty-two patients (10 female and 12 male; mean age, 17.7 ± 10.6 years; range, 9-31) with suspected VPI underwent 3-T MRI using TrueFisp and HASTE sequences. Imaging was performed in the sagittal plane at rest and during phonation of ''ee'' and ''k'' to assess the velum, tongue, posterior pharyngeal wall and a potential VP closure. The results were analysed independently by one radiologist and one orthodontist. HASTE performed better than TrueFisp for all evaluated items, except the tongue evaluation by the orthodontist during phonation of ''k'' and ''ee''. A statistically significant difference in favour of HASTE was observed in assessing the velum at rest and during phonation of ''k'' and ''ee'', and also in assessing VP closure in both raters (p < 0.05). TrueFisp imaging was twice as fast as HASTE (0.36 vs. 0.75 s/image). Dynamic HASTE images were of superior quality to those obtained with TrueFisp, although TrueFisp imaging was twice as fast. (orig.)

  18. The role of primary tumor resection in colorectal cancer patients with asymptomatic, synchronous unresectable metastasis: Study protocol for a randomized controlled trial.

    Science.gov (United States)

    Kim, Chang Woo; Baek, Jeong-Heum; Choi, Gyu-Seog; Yu, Chang Sik; Kang, Sung Bum; Park, Won Cheol; Lee, Bong Hwa; Kim, Hyeong Rok; Oh, Jae Hwan; Kim, Jae-Hwang; Jeong, Seung-Yong; Ahn, Jung Bae; Baik, Seung Hyuk

    2016-01-19

    Approximately 20 % of all patients with colorectal cancer are diagnosed as having Stage IV cancer; 80 % of these present with unresectable metastatic lesions. It is controversial whether chemotherapy with or without primary tumor resection (PTR) is effective for the treatment of patients with colorectal cancer with unresectable metastasis. Primary tumor resection could prevent tumor-related complications such as intestinal obstruction, perforation, bleeding, or fistula. Moreover, it may be associated with an increase in overall survival. However, surgery delays the use of systemic chemotherapy and affects the systemic spread of malignancy. Patients with colon and upper rectal cancer patients with asymptomatic, synchronous, unresectable metastasis will be included after screening. They will be randomized and assigned to receive chemotherapy with or without PTR. The primary endpoint measure is 2-year overall survival rate and the secondary endpoint measures are primary tumor-related complications, quality of life, surgery-related morbidity and mortality, interventions with curative intent, chemotherapy-related toxicity, and total cost until death or study closing day. The authors hypothesize that the group receiving PTR following chemotherapy would show a 10 % improvement in 2-year overall survival, compared with the group receiving chemotherapy alone. The accrual period is 3 years and the follow-up period is 2 years. Based on the inequality design, a two-sided log-rank test with α-error of 0.05 and a power of 80 % was conducted. Allowing for a drop-out rate of 10 %, 480 patients (240 per group) will need to be recruited. Patients will be followed up at every 3 months for 3 years and then every 6 months for 2 years after the last patient has been randomized. This randomized controlled trial aims to investigate whether PTR with chemotherapy shows better overall survival than chemotherapy alone for patients with asymptomatic, synchronous unresectable

  19. Long-term prognostic value of Tc-99m tetrofosmin myocardial gated-SPECT imaging in asymptomatic patients after percutaneous coronary intervention.

    Science.gov (United States)

    Georgoulias, Panagiotis; Demakopoulos, Nikolaos; Tzavara, Chara; Giannakou, Stavroula; Valotassiou, Varvara; Tsougos, Ioannis; Xaplanteris, Petros; Fezoulidis, Ioannis

    2008-11-01

    To evaluate the long-term prognostic value of Tc-99m tetrofosmin myocardial gated-SPECT in asymptomatic patients after coronary artery stenting. We included 246 consecutive patients in the study. All patients underwent exercise gated-single photon emission computed tomography (SPECT) myocardial imaging 5 to 7 months after percutaneous coronary intervention (PCI) and were followed for a mean period of 8.3 years (SD = 2.9). Myocardial scintigrams were evaluated calculating the summed stress score (SSS), summed rest score, and summed difference score (SDS) indexes. Cardiovascular death and nonfatal myocardial infarction were considered hard cardiac events, whereas late revascularization (>3 months after myocardial SPECT) procedures were considered to be soft events. Cox proportional hazard models were applied to evaluate the association between several variables and the investigated outcome. During the follow-up period, hard cardiac events occurred in 32 (13%) patients (cardiac death occurred in 12 patients and nonfatal myocardial infarction in 20 patients). In addition, 60 (24.4%) patients underwent a late revascularization procedure. When multiple Cox regression analysis was implied, the factors that remained significant in the final model for soft events were SSS, SDS, and angina during exercise testing. In addition, SSS, SDS, and left ventricular dilatation were independently associated with hard cardiac events as defined from the results of multiple analysis. However, SSS and SDS were the only independent predictors for both hard and soft events. Tc-99m tetrofosmin myocardial perfusion imaging (MPI), performed 6 months post-percutaneous coronary intervention, has an independent and powerful clinical value to predict hard and soft cardiac events in asymptomatic patients after PCI.

  20. Surgical results in patients with unruptured asymptomatic cerebral aneurysms. Significance of evaluation of neuropsychological function, magnetic resonance images and cerebral blood flow

    International Nuclear Information System (INIS)

    Kumon, Yoshiaki; Watanabe, Hideaki; Igase, Keiji; Nagato, Shigeyuki; Fukumoto, Shinya; Iwata, Shinji; Ohue, Shiro; Ohnishi, Takanori

    2006-01-01

    We evaluated neuropsychological function, magnetic resonance (MR) images and cerebral blood flow (CBF) in patients with unruptured asymptomatic cerebral aneurysms. Among consecutive operations (n=73) on 70 patients since 2000, direct surgery was performed in 53 operations on 50 patients, and intravascular surgery was performed in 20 operations on 20 patients. Surgical results of direct surgery were studied. Direct surgery was selected mainly for patients with small and anterior circulation aneurysms. MR imaging was conducted 1 week after surgery, and Wechsler Adult Intelligence Scale-Revised (WAIS-R) examination and CBF measurement using 133 Xe-SPECT were done before and 1 month after surgery. Abnormal neurological findings were recognized postoperatively in 26% of surgeries. Among them, visual disturbance was permanent in 4% of surgeries, all of which were surgeries for paraclinoid internal carotid artery aneurysms. WAIS-R results deteriorated in 26% of surgeries at 1 month and at least in 5% of surgeries at 1 year after surgery. MR images at 1 week after surgery revealed brain damage in 30% of surgeries and subdural fluid collection in 19% of surgeries. Patients with large brain damage or thick subdural fluid collection frequently showed neurological deficits and/or WAISR deterioration. These complications were recognized frequently in patients with ACoA aneurysms. Resting CBF decreased significantly in the area supplied by the anterior cerebral artery and anterior border zone on the operated side postoperatively. The brain damage and subdural fluid collection were observed frequently and caused neurological deficits and neuropsychological dysfunction, although these were usually transient. It may be necessary to evaluate neuropsychological function, MRI and CBF in patients with unruptured asymptomatic cerebral aneurysms to improve surgical results. (author)

  1. Increased platelet count and reticulated platelets in recently symptomatic versus asymptomatic carotid artery stenosis and in cerebral microembolic signal-negative patient subgroups: results from the HaEmostasis In carotid STenosis (HEIST) study.

    Science.gov (United States)

    Murphy, S J X; Lim, S T; Kinsella, J A; Murphy, D; Enright, H M; McCabe, Dominick J H

    2018-02-23

    The pathophysiological mechanisms responsible for the disparity in stroke risk between asymptomatic and symptomatic carotid stenosis patients are not fully understood. The functionally important reticulated platelet fraction and reticulocytes could play a role. We performed a prospective, multi-centre, observational analytical study comparing full blood count parameters and platelet production/turnover/activation markers in patients with asymptomatic versus recently symptomatic moderate (≥ 50-69%) or severe (≥ 70-99%) carotid stenosis. Data from 34 asymptomatic patients were compared with 43 symptomatic patients in the 'early phase' (≤ 4 weeks) and 37 of these patients in the 'late phase' (≥ 3 months) after TIA/ischaemic stroke. Reticulated platelets were quantified by whole blood flow cytometry and reticulated platelets and red cell reticulocytes by 'automated assays' (Sysmex XE-2100™). Bilateral simultaneous transcranial Doppler ultrasound monitoring classified patients as micro-embolic signal (MES)+ve or MES-ve. Mean platelet count was higher in early (216 × 10 9 /L; P = 0.04) and late symptomatic (219 × 10 9 /L; P = 0.044) than asymptomatic patients (194 × 10 9 /L). Mean platelet volume was higher in early symptomatic than asymptomatic patients (10.8 vs. 10.45 fl; P = 0.045). Automated assays revealed higher % reticulated platelet fractions in early (5.78%; P < 0.001) and late symptomatic (5.11%; P = 0.01) than asymptomatic patients (3.48%). Red cell reticulocyte counts were lower in early (0.92%; P = 0.035) and late symptomatic (0.93%; P = 0.036) than asymptomatic patients (1.07%). The automated % reticulated platelet fraction was also higher in early symptomatic than asymptomatic MES-ve patients (5.7 vs. 3.55%; P = 0.001). The combination of increased platelet counts and a shift towards production of an increased population of larger, young, reticulated platelets could contribute to a higher risk of first or recurrent

  2. Dobutamine stress echocardiography in the diagnosis of asymptomatic ischemic heart disease in patients with chronic kidney disease--review of literature and single-center experience.

    Science.gov (United States)

    Januszko-Giergielewicz, B; Dębska-Ślizień, A; Górny, J; Kozak, J; Oniszczuk, K; Gromadziński, L; Dorniak, K; Dudziak, M; Malinowski, P; Rutkowski, B

    2015-03-01

    Coronary artery disease (CAD) may be present in kidney transplant (KT) candidates without the presence of CAD clinical symptoms. This study joins an ongoing discussion about appropriate noninvasive diagnostic approaches for ischemic heart disease (IHD) assessment and patient selection for revascularization procedures. The aim of this study was to evaluate the role of dobutamine stress echocardiography (DSE) in IHD diagnosis in initially asymptomatic maintenance hemodialysis (HD) patients. Forty HD patients aged 52.4 ± 2.0 years, were studied for 2.5 years. At inclusion, they were free of both symptoms and history of IHD. Standard electrocardiography (ECG), chest X-ray, standard echocardiography, DSE, 24-hour Holter ECG, and Doppler ultrasonography (carotids and lower extremities) were performed. Results were analyzed according to a predefined diagnostic algorithm. DSE yielded negative results in all patients. Left ventricular (LV) ejection fraction ≤ 60%, LV hypertrophy, and Holter ECG silent ischemia features were noticed in 15%, 70%, and 10% of patients, respectively. Atherosclerotic lesions in lower extremities and carotid arteries were present in 50% and 37.5% of patients, respectively. During the follow-up, 9/40 patients died, including 6 cardiovascular (CV) deaths: 2 with intermediate and 4 with high CV risk according to the proposed algorithm. In asymptomatic KT candidates, not only DSE, but also other noninvasive tests (eg, echocardiography and Doppler ultrasonography of the carotid and peripheral arteries) along with a detailed profile of the remaining CV risk factors should be performed and analyzed. Defined composition of risk factors and particular changes in noninvasive tests may be an indication for coronary angiography. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Prognostic significance of stress myocardial ECG-gated perfusion imaging in asymptomatic patients with diabetic chronic kidney disease on initiation of haemodialysis

    Energy Technology Data Exchange (ETDEWEB)

    Momose, Mitsuru; Kondo, Chisato; Kobayashi, Hideki; Kusakabe, Kiyoko [Tokyo Women' s Medical University, School of Medicine, Department of Radiology, Shinjuku-ku, Tokyo (Japan); Babazono, Tetsuya [Tokyo Women' s Medical University, School of Medicine, Diabetes Centre, Shinjuku-ku, Tokyo (Japan); Nakajima, Takatomo [Tokyo Women' s Medical University, School of Medicine, Department of Cardiology, Shinjuku-ku, Tokyo (Japan)

    2009-08-15

    Diabetic patients with chronic kidney disease (CKD) frequently develop cardiac events within several years of the initiation of haemodialysis. The present study assesses the prognostic significance of stress myocardial ECG-gated perfusion imaging (MPI) in patients with diabetic CKD requiring haemodialysis. Fifty-five asymptomatic patients with diabetic stage V CKD and no history of heart disease scheduled to start haemodialysis were enrolled in this study (56{+-}11 years old; 49 with type 2 diabetes mellitus). All patients underwent {sup 201}Tl stress ECG-gated MPI 1 month before or after the initiation of haemodialysis to assess myocardial involvement. We evaluated SPECT images using 17-segment defect scores graded on a 5-point scale, summed stress score (SSS) and summed difference scores (SDS). The patients were followed up for at least 2 years (42{+-}15 months) to determine coronary intervention (CI) and heart failure (HF) as soft events and acute myocardial infarction (AMI) and all causes of deaths as hard events. The frequencies of myocardial ischaemia, resting perfusion defects, low ejection fraction and left ventricular (LV) dilatation were 24,20,29 and 49%, respectively. Ten events (18%) developed during the follow-up period including four CI, one HF, one AMI and four sudden deaths. Multivariate Cox analysis selected SDS (p=0.0011) and haemoglobin A{sub 1c} (HbA{sub 1c}) (p=0.0076) as independent prognostic indicators for all events. Myocardial ischaemia, in addition to glycaemic control, is a strong prognostic marker for asymptomatic patients with diabetic CKD who are scheduled to start haemodialysis. Stress MPI is highly recommended for the management and therapeutic stratification of such patients. (orig.)

  4. Asymptomatic peripheral artery disease can limit maximal exercise capacity in chronic obstructive pulmonary disease patients regardless of airflow obstruction and lung hyperinflation.

    Science.gov (United States)

    Crisafulli, Ernesto; Scelfo, Chiara; Tzani, Panagiota; Aiello, Marina; Bertorelli, Giuseppina; Chetta, Alfredo

    2017-06-01

    Background Silent/asymptomatic peripheral artery disease may occur in patients with chronic obstructive pulmonary disease, but it is poorly investigated. The primary aim of this study was to evaluate in chronic obstructive pulmonary disease patients the impact of asymptomatic/silent peripheral artery disease on maximal exercise capacity; the secondary aim was to search for predictors of peripheral artery disease. Methods We prospectively enrolled chronic obstructive pulmonary disease outpatients. Data on anthropometric characteristics, lung function, cardiopulmonary exercise test and ankle-brachial index were recorded. The cut-off of ankle-brachial index used to define patients with peripheral artery disease was ≤0.90. Results We studied 47 patients and found 24 patients (51%) who showed peripheral artery disease. As compared to patients without peripheral artery disease, patients with peripheral artery disease had lower values of peak oxygen uptake, peak workload, energy expenditure (metabolic equivalents) and heart rate recovery, but showed the same degree of airflow obstruction and static and dynamic hyperinflation. In a multivariate linear regression model performed to identify variables predicting metabolic equivalents, ankle-brachial index (β 2.59; 95% confidence interval 0.51-4.67; p = 0.016) was an independent variable. In the search for predictors of peripheral artery disease, heart rate recovery (odds ratio 8.80; 95% confidence interval 1.30-59.35; p = 0.026) increased the risk of peripheral artery disease, whereas metabolic equivalents (odds ratio 0.50; 95% confidence interval 0.26-0.94, p = 0.033) and inhaled corticosteroids+long-acting β 2 agonists (odds ratio 0.13; 95% confidence interval 0.02-0.83; p = 0.030) reduced this risk. Conclusions In chronic obstructive pulmonary disease outpatients, asymptomatic/silent peripheral artery disease affects the maximal exercise capacity regardless of airflow obstruction and lung

  5. Delineation of the anatomical relationship of innominate artery and trachea by respiratory-gated MR imaging with true FISP sequence in patients with severe motor and intellectual disabilities

    International Nuclear Information System (INIS)

    Fujikawa, Yoshinao; Sato, Noriko; Sugai, Kenji; Endo, Yusaku; Matsufuji, Hiroki; Oomi, Tsuyoshi; Honzawa, Shiho; Sasaki, Masayuki

    2008-01-01

    Tracheoinnominate artery fistula is a well-known complication that arises on using a cannula. Therefore, routine examination of the anatomical relationship of the innominate artery and trachea should be carried out. We evaluated the usefulness of magnetic resonance imaging in 5 patients with severe motor and intellectual disabilities (SMID) using a combination of true-fast imaging of steady-state precession (true-FISP) sequences and two-dimensional prospective acquisition correction (2D-PACE). For all patients, the trachea and the innominate artery were identified without sedation and contrast media. In one patient, the innominate artery was observed to be pressing on the trachea. In three patients, the trachea and innominate artery were brought very close each other, and in the other patient the anatomical relationship of the trachea and surrounding structure was delineated before tracheotomy. The validity of true-FISP sequences combined with the respiratory-gated technique was confirmed useful for the patients who are difficult to lie quietly and to hold their breath voluntarily. (author)

  6. The reliability of rehabilitative ultrasound imaging in the measurement of infraspinatus muscle function in the symptomatic and asymptomatic shoulders of patients with unilateral shoulder impingement syndrome.

    Science.gov (United States)

    Koppenhaver, Shane; Harris, Danny; Harris, Amanda; O'Connor, Erin; Dummar, Max; Croy, Theodore; Walker, Michael; Flynn, Tim

    2015-04-01

    Rehabilitative ultrasound Imaging (RUSI) is increasingly used in the management of musculoskeletal conditions as it provides an objective measure of muscle function while being less invasive than needle electromyography. While research has documented the ability to reliably measure trunk muscles in patients with back pain, no study to date has used RUSI to quantify infraspinatus muscle function in patients with shoulder impingement syndrome (SIS). The purpose of this study was to examine the intra-rater and inter-rater reliability of measuring infraspinatus muscle thickness with RUSI and to compare such measures during resting versus contracted muscle states and in the symptomatic versus asymptomatic shoulders in patients with SIS. Cross-sectional, measurement study. Fifty-two participants with unilateral SIS underwent a standard baseline examination to include RUSI of the infraspinatus muscle bilaterally. Images were acquired at rest and during a submaximal isometric contraction, by two novice examiners. The isometric contraction was elicited by having prone participants externally rotate their shoulder from a position of 90° abduction into a dynamometer and hold a static force of 20 mmHg (approximately 20-30% maximal voluntary contraction). Images were captured using a standardized placement of the transducer placed just inferior to the spine of the scapula along the medial scapular border and measured off-line using Image J software (V1.38t, National Institutes of Health, Bethesda, Maryland). Estimates (ICCs) for thickness measurements ranged between 0.96 and 0.98 for intra-rater reliability and between 0.87 and 0.92 for inter-rater reliability. Reliability was substantially lower (ICC = 0.43 to 0.79) for calculations of percent thickness change. The infraspinatus muscle was significantly thicker when contracted (19.1mm) than during rest (16.2mm) in both shoulders (p shoulder (p = 0.026), indicating that the change in thickness that occurred during contraction

  7. Brain ventricular wall movement assessed by a gated cine MR trueFISP sequence in patients treated with endoscopic third ventriculostomy

    Energy Technology Data Exchange (ETDEWEB)

    Hodel, Jerome [Unite Analyse et Restauration du mouvement, UMR-CNRS, Paris (France); Faculte de Medecine Paris XII, Paris (France); Assistance Publique-Hopitaux de Paris, Paris (France); Hopital Henri MONDOR, Department of Neuroradiology, Creteil (France); Hopital Henri Mondor, Creteil (France); Decq, Philippe [Unite Analyse et Restauration du mouvement, UMR-CNRS, Paris (France); Faculte de Medecine Paris XII, Paris (France); Assistance Publique-Hopitaux de Paris, Paris (France); Hopital Henri MONDOR, Department of Neurosurgery, Creteil (France); Rahmouni, Alain [Faculte de Medecine Paris XII, Paris (France); Assistance Publique-Hopitaux de Paris, Paris (France); Hopital Henri MONDOR, Department of Radiology, Creteil (France); Bastuji-Garin, Sylvie [Faculte de Medecine Paris XII, Paris (France); Assistance Publique-Hopitaux de Paris, Paris (France); Hopital Henri MONDOR, Department of Public Health, Creteil (France); Maraval, Anne; Combes, Catherine; Gaston, Andre [Faculte de Medecine Paris XII, Paris (France); Assistance Publique-Hopitaux de Paris, Paris (France); Hopital Henri MONDOR, Department of Neuroradiology, Creteil (France); Jarraya, Bechir [Faculte de Medecine Paris XII, Paris (France); Assistance Publique-Hopitaux de Paris, Paris (France); Hopital Henri MONDOR, Department of Neurosurgery, Creteil (France); Le Guerinel, Caroline [Assistance Publique-Hopitaux de Paris, Paris (France); Hopital Henri MONDOR, Department of Neurosurgery, Creteil (France)

    2009-12-15

    The purpose of this study was to investigate the value of brain ventricular wall movement assessment with a gated cine trueFISP MR sequence for the diagnosis of endoscopic third ventriculostomy (ETV) patency. Sixteen healthy volunteers and ten consecutive patients with noncommunicating hydrocephalus were explored with a MR scanner (Siemens, Avanto 1.5 T) before, 1 week and 3 months after ETV. TrueFISP was evaluated qualitatively (ventricular wall movement and CSF flow through ETV) and quantitatively [distance moved (DMLT) during a cardiac cycle by the lamina terminalis]. The third ventricle volume (TVV) was assessed. Statistical analysis was performed using nonparametric tests. There was no motion of the lamina terminalis (LT) detected on preoperative data. A pulsatile motion of the LT was found for patients with a patent ETV and for controls. DMLT and TVV were correlated (r = 0.79, P = 0.006). A transient dysfunction of ETV was successfully diagnosed on the trueFISP sequence with no motion of the LT or CSF flow observed. The trueFISP sequence appears reliable for the diagnosis of ETV patency and provides non-invasive assessment of the movement of the ventricular wall related to CSF pressure changes. (orig.)

  8. NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis

    DEFF Research Database (Denmark)

    Reinhard, Henrik; Wiinberg, Niels; Hansen, Peter R

    2011-01-01

    for atherosclerosis is unclear. We examined the interrelationship between P-NT-proBNP, presence of atherosclerosis and/or vascular dysfunction in the coronary, carotid and peripheral arteries in asymptomatic type 2 diabetic patients with microalbuminuria that received intensive multifactorial treatment. METHODS...... AND RESULTS: P-NT-proBNP was measured in 200 asymptomatic type 2 patients without known cardiac disease that received intensive multifactorial treatment for CV risk reduction. Patients were examined for coronary, carotid and peripheral atherosclerosis, as defined by coronary calcium score≥400, carotid intima...

  9. NT-proBNP levels, atherosclerosis and vascular function in asymptomatic type 2 diabetic patients with microalbuminuria: peripheral reactive hyperaemia index but not NT-proBNP is an independent predictor of coronary atherosclerosis

    DEFF Research Database (Denmark)

    Reinhard, Henrik; Wiinberg, Niels; Hansen, Peter R

    2011-01-01

    for atherosclerosis is unclear. We examined the interrelationship between P-NT-proBNP, presence of atherosclerosis and/or vascular dysfunction in the coronary, carotid and peripheral arteries in asymptomatic type 2 diabetic patients with microalbuminuria that received intensive multifactorial treatment. METHODS...... AND RESULTS: P-NT-proBNP was measured in 200 asymptomatic type 2 patients without known cardiac disease that received intensive multifactorial treatment for CV risk reduction. Patients were examined for coronary, carotid and peripheral atherosclerosis, as defined by coronary calcium score=400, carotid intima...

  10. Asymptomatic cerebral hemorrhage detected by MRI

    International Nuclear Information System (INIS)

    Nakajima, Yumi; Ohsuga, Hitoshi; Yamamoto, Masahiro; Shinohara, Yukito

    1991-01-01

    Detection of previous cerebral infarction on CT films of patients with no history of stroke is a common occurrence. The incidence of silent cerebral infarction was reported to be about 10 to 11 percent, but very few reports concerning asymptomatic cerebral hemorrhage available. However, recent clinical application of MRI has resulted in the detection of old asymptomatic hemorrhage in patients with no history known stroke-like episodes. The purpose of this study was to elucidate the incidence, the cause and the character of the asymptomatic cerebral hemorrhage among patients who had undergone MRI examinations. From September 1987 through June 1990, 2757 patients have undergone 3474 MR scans of the brain with 1.0 Tesla Siemens Magneton unit in our hospital. Seventeen patients showed no clinical signs or symptoms suggesting a stroke episode corresponding to the detected hemorrhagic lesion. The 17 patients corresponded to 0.6% of the patients who underwent MRI, 1.5% of the patients with cerebrovascular disease and 9.5% of the patients with intracerebral hemorrhage(ICH), which was rather higher than expected. Among the 17 patients, 12 were diagnosed as primary ICH and 5 as secondary ICH. Most of the primary asymptomatic hemorrhage were hypertensive ones and slit-like curvilinear lesions between the putamen and claustrum or external capsule. The secondary asymptomatic hemorrhage were due to AVM and angiomas in the frontal cortex, thalamus and pons. (author)

  11. More preoperative flexibility implies adequate neural pliability for curve correction without prophylactic untethering in scoliosis patients with asymptomatic tethered spinal cord, a retrospective study.

    Science.gov (United States)

    Zhou, Zhenhai; Zhang, Hongqi; Guo, Chaofeng; Yu, Honggui; Wang, Longjie; Guo, Qiang

    2017-06-15

    Tethered spinal cord is frequently associated with scoliosis. It is still controversial whether a prophylactic untethering is necessary before correction procedure in scoliosis patients with tethered spinal cord. In this study we determined the clinical outcome of a one-stage posterior scoliosis correction without a prophylactic untethering for treating scoliosis with an asymptomatic tethered spinal cord. Seventeen (5 males and 12 females) scoliosis patients with tethered spinal cords were retrospectively reviewed. All patients underwent a one-stage posterior scoliosis correction without preventive untethering. Parameters of radiograph were used to assess correction result. The Scoliosis Research Society (SRS)-22 questionnaire was analyzed pre- and post-operatively to evaluate the clinical outcomes. The modified Japanese Orthopaedic Association (mJOA) score was used to assess the pre- and post-operative spinal cord function. The post-operative coronal Cobb angle was significantly decreased compared with preoperative. (23.8 ± 6.4° vs. 58.4 ± 12.6°, P scoliosis correction. No difference existed between the pre- and post-operative total mJOA score (26 ± 2 vs. 27 ± 2, p = 0.39), which including subjective symptom (p = 0.07), clinical symptom (p = 0.33), daily activities (p = 0.44) and bladder function (p = 0.67). One-stage posterior scoliosis correction is a safe and effective surgical procedure for scoliosis patients combined with asymptomatic tethered spinal cord who have adequate spinal cord function reserve.

  12. Atherogenic dyslipidemia and risk of silent coronary artery disease in asymptomatic patients with type 2 diabetes: a cross-sectional study.

    Science.gov (United States)

    Valensi, Paul; Avignon, Antoine; Sultan, Ariane; Chanu, Bernard; Nguyen, Minh Tuan; Cosson, Emmanuel

    2016-07-22

    To investigate whether atherogenic dyslipidemia, a dyslipidemic profile combining elevated triglycerides and low high-density lipoprotein (HDL) cholesterol, is predictive of risk of silent myocardial ischemia (SMI) or angiographic coronary artery disease (CAD) in asymptomatic patients with type 2 diabetes. Cohort study in 1080 asymptomatic patients with type 2 diabetes with a normal resting electrocardiogram, at least one additional cardiovascular risk factor and low density lipoprotein (LDL) cholesterol dyslipidemia (triglycerides ≥2.26 mmol/L and HDL cholesterol ≤0.88 mmol/L). In multivariate analyses taking into account the parameters associated in univariate analyses with SMI and then CAD, atherogenic dyslipidemia was associated with SMI (odds ratio 1.8[1.0-3.3]), as were male gender (OR 2.1[1.5-2.9]), BMI (OR 0.97[0.94-0.997]), retinopathy (OR 1.4[1.1-1.9]), peripheral occlusive arterial disease (POAD: OR 2.5[1.6-3.8]) and mean blood pressure (OR 1.01[1.00-1.03]); atherogenic dyslipidemia was associated with CAD (OR 4.0[1.7-9.2]), as were male gender (OR 3.0[1.6-5.6]), BMI (OR 0.94[0.90-0.995]), retinopathy (OR 1.7[1.0-2.9], POAD (OR 4.0[2.1-7.4]) and mean blood pressure (OR 1.03[1.01-1.05]). In the subgroup of 584 patients with LDL cholesterol dyslipidemia was also associated with CAD (OR 3.6[1.5-9.0]). Atherogenic dyslipidemia was associated with an increased risk of SMI and silent CAD in patients with type 2 diabetes and LDL cholesterol levels dyslipidemia might help reducing the high residual burden of cardiovascular disease.

  13. Differential Activation of the Dorsal Neck Muscles During a Light Arm-Elevation Task in Patients With Chronic Nonspecific Neck Pain and Asymptomatic Controls: An Ultrasonographic Study.

    Science.gov (United States)

    Baghi, Raziyeh; Rahnama, Leila; Karimi, Noureddin; Goodarzi, Fereshte; Rezasoltani, Asghar; Jaberzadeh, Shapour

    2017-07-01

    Disturbance in neck muscle function is a well-known complication of chronic nonspecific neck pain (CNNP). It is, however, unclear which muscles are more susceptible to functional impairment in patients with CNNP during upper limb tasks. To compare ultrasonographic changes in dorsal neck muscles thickness in patients with CNNP and asymptomatic controls while they performed a light load upper-limb movement. Case control. University research laboratory. Twenty individuals with CNNP with a mean age of 23.35 ± 2.94 and 20 asymptomatic controls with a mean age of 22.30 ± 2.86, without any history of cervical diskopathy, fracture, trauma, inflammation, and spinal deformity were recruited for this study. Ultrasonographic measurement of dorsal neck muscles thickness was performed during a light load 3-second arm-elevation task (shoulder scaption to 120°) in the 2 groups. Associations between pain intensity and patients' perceived disability and between pain intensity and muscle thickness also were evaluated at the state of rest. The thickness changes of the dorsal neck muscles throughout the arm elevation were calculated. The pain intensity and the patient's perceived disability also were measured. A significant main effect of muscle activity status was revealed for the multifidus and semispinalis cervicis and the splenius capitis, indicating an increase in their thickness throughout the arm elevation (P < .001). The only muscle that showed a difference between groups was the multifidus (P = .007). Direct associations between pain and disability (r = .48, P = .03) and between pain and multifidus thickness (r = -.49, P = .03) also were observed. The deteriorating effect of CNNP on the neck muscles targets the deep layer of the dorsal neck muscles (ie, the multifidus) more than the superficial muscles during light upper-limb tasks. III. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  14. Epicardial adipose tissue thickness is an indicator for coronary artery stenosis in asymptomatic type 2 diabetic patients: its assessment by cardiac magnetic resonance

    Directory of Open Access Journals (Sweden)

    Kim Hyun

    2012-07-01

    Full Text Available Abstract Background We used cardiovascular magnetic resonance (CMR to investigate the association between epicardial adipose tissue (EAT thickness and silent myocardial ischemia, as well as coronary artery stenosis, in asymptomatic type 2 diabetic patients. Methods The study included 100 type 2 diabetic subjects (51 male and 49 female; mean age: 56 ± 7 years. Silent myocardial ischemia, as determined by CMR, was defined as evidence of inducible ischemia or myocardial infarction. Signal reduction or stenosis of ≥ 50% in the vessel diameter was used as the criteria for significant coronary artery stenosis on coronary magnetic resonance (MR angiography. Results EAT thickness was positively correlated with body mass index (BMI, waist-to-hip ratio, systolic blood pressure, postprandial glucose, fasting/postprandial triglyceride (TG, serum glycated hemoglobin (HbA1c level, and homeostasis model assessment of insulin resistance (HOMA-IR score. Significant coronary artery stenosis was found in 24 patients, while 14 patients had silent myocardial ischemia in CMR (1 with silent myocardial infarction, 11 with inducible ischemia, and 2 with both. EAT thickness was greater in patients who had coronary artery stenosis (13.0 ± 2.6 mm vs. 11.5 ± 2.1 mm, p = 0.01, but did not differ between the subjects with or without silent myocardial ischemia on CMR images (12.8 ± 2.1 vs. 11.7 ± 2.3 mm, p = 0.11. Multivariate logistic regression analysis indicated that EAT thickness was an independent indicator for significant coronary artery stenosis after adjusting for traditional risk factors (OR 1.403, p = 0.026. Conclusions Increased EAT thickness assessed by CMR is an independent risk factor for significant coronary artery stenosis in asymptomatic type 2 diabetes. However, EAT thickness was not associated with silent myocardial ischemia.

  15. Discrepancy analysis between crystallized and fluid intelligence tests: a novel method to detect mild cognitive impairment in patients with asymptomatic carotid artery stenosis.

    Science.gov (United States)

    Takaiwa, A; Kuwayama, N; Akioka, N; Kashiwazaki, D; Kuroda, S

    2018-02-01

    The present study was conducted to accurately determine the presence of mild cognitive impairment, which is often difficult to evaluate using only simple tests. Our approach focused on discrepancy analysis of fluid intelligence relative to crystallized intelligence using internationally recognized neuropsychological tests. One-hundred and five patients diagnosed with asymptomatic carotid artery stenosis were assessed. The neuropsychological tests included the two subtests (information and picture completion) of Wechsler Adult Intelligence Scale-Revised (WAIS-R-two-subtests): crystallized intelligence tests and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) (immediate memory, visuospatial/constructional, language, attention, delayed memory and total score) as fluid intelligence tests. Discrepancy analysis was used to assess cognitive impairment. The score for RBANS was subtracted from the score for WAIS-R-two-subtests, and if the score difference was greater than the 5% confidence limit for statistical significance, it was defined as a decline in cognitive function. The WAIS-R-two-subsets was within normal limits when compared with the standardized values. However, all RBANS domains showed significant declines. Frequencies of decline in each RBANS domain were as follows: 69 patients (66%) in immediate memory, 26 (25%) in visuospatial/constructional, 54 (51%) in language, 63 (60%) in attention, 54 (51%) in delayed memory and 78 (74%) in the total score. Moreover, 99 patients (94%) showed decline in at least one RBANS domain. Cognitive function is only preserved in a few patients with asymptomatic carotid artery stenosis. Mild cognitive impairment can be precisely detected by performing the discrepancy analysis between crystallized and fluid intelligence tests. © 2017 EAN.

  16. Tax secretion from peripheral blood mononuclear cells and Tax detection in plasma of patients with human T-lymphotropic virus-type 1-associated myelopathy/tropical spastic paraparesis and asymptomatic carriers.

    Science.gov (United States)

    Medina, Fernando; Quintremil, Sebastián; Alberti, Carolina; Godoy, Fabián; Pando, María E; Bustamante, Andrés; Barriga, Andrés; Cartier, Luis; Puente, Javier; Tanaka, Yuetsu; Valenzuela, María A; Ramírez, Eugenio

    2016-03-01

    Human T-lymphotropic virus-type 1 (HTLV-1) is the etiologic agent of the neurologic disease HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). Tax viral protein plays a critical role in viral pathogenesis. Previous studies suggested that extracellular Tax might involve cytokine-like extracellular effects. We evaluated Tax secretion in 18 h-ex vivo peripheral blood mononuclear cells (PBMCs) cultures from 15 HAM/TSP patients and 15 asymptomatic carriers. Futhermore, Tax plasma level was evaluated from other 12 HAM/TSP patients and 10 asymptomatic carriers. Proviral load and mRNA encoding Tax were quantified by PCR and real-time RT-PCR, respectively. Intracellular Tax in CD4(+)CD25(+) cells occurred in 100% and 86.7% of HAM/TSP patients and asymptomatic carriers, respectively. Percentage of CD4(+)CD25(+) Tax+, proviral load and mRNA encoding Tax were significantly higher in HAM/TSP patients. Western blot analyses showed higher secretion levels of ubiquitinated Tax in HAM/TSP patients than in asymptomatic carriers. In HTLV-1-infected subjects, Western blot of plasma Tax showed higher levels in HAM/TSP patients than in asymptomatic carriers, whereas no Tax was found in non-infected subjects. Immunoprecipitated plasma Tax resolved on SDS-PAGE gave two major bands of 57 and 48 kDa allowing identification of Tax and Ubiquitin peptides by mass spectrometry. Relative percentage of either CD4(+)CD25(+) Tax+ cells, or Tax protein released from PBMCs, or plasma Tax, correlates neither with tax mRNA nor with proviral load. This fact could be explained by a complex regulation of Tax expression. Tax secreted from PBMCs or present in plasma could potentially become a biomarker to distinguish between HAM/TSP patients and asymptomatic carriers. © 2015 Wiley Periodicals, Inc.

  17. [Asymptomatic kidney stones: active surveillance vs. treatment].

    Science.gov (United States)

    Neisius, A; Thomas, C; Roos, F C; Hampel, C; Fritsche, H-M; Bach, T; Thüroff, J W; Knoll, T

    2015-09-01

    The prevalence of kidney stones is increasing worldwide. Asymptomatic non-obstructing kidney stones are increasingly detected as an incidental finding on radiologic imaging, which has been performed more frequently over the last decades. Beside the current interventional treatment modalities such as extracorporeal shockwave lithotripsy (ESWL), ureterorenoscopy (URS) and percutaneous nephrolithotomy (PNL), active surveillance of asymptomatic kidney stones has been a focus of discussion lately, not only for attending physicians, but even more so for patients. The current German and European guidelines recommend active surveillance for patients with asymptomatic kidney stones if no interventional therapy is mandatory because of pain or medical factors. Herein we review the current literature on risks and benefits of active surveillance of asymptomatic non-obstructing kidney stones. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Optimal treatment for asymptomatic neurosyphilis.

    Science.gov (United States)

    Tsai, H C; Sy, C L; Lee, S S J; Wann, S R; Chen, Y S

    2012-10-01

    In the pre-penicillin era, patients with asymptomatic neurosyphilis (ANS) were more likely to develop long-term neurological sequelae than those patients with normal cerebrospinal fluid (CSF). Although benzathine penicillin G cannot achieve treponemicidal levels in the CSF, decreased rates of neurological complications of syphilis and non-treponemal titre serological responses are usually observed after treatment with this antibiotic. We here a homosexual man with ANS successfully treated with benzathine penicillin G. This case suggests that reconsideration on the necessity of a lumbar puncture in HIV-infected patients with ANS is warranted.

  19. Left ventricular systolic dysfunction in asymptomatic Marfan syndrome patients is related to the severity of gene mutation: insights from the novel three dimensional speckle tracking echocardiography.

    Directory of Open Access Journals (Sweden)

    Mohamed Abd El Rahman

    Full Text Available In asymptomatic Marfan syndrome (MFS patients we evaluated the relationship between the types of fibrillin-1 (FBN1 gene mutation and possible altered left ventricular (LV function as assessed by three-dimensional speckle tracking echocardiography (3D-STE.Forty-five MFS patients (mean age 24 ± 15 years and 40 age-matched healthy controls were studied. Genetic evaluation for the FBN1 gene was carried on 32 MFS patients. Gene mutation (n = 15, 47% was classified as mild when the mutation resulted in nearly normally functioning protein, while mutations resulting in abnormally function protein were considered to be severe (n = 17, 53%. All patients and controls underwent 3D-STE for evaluation of LV function by an echocardiographer blinded to the results of the genetic testing. Compared to controls, MFS patients had significantly lower 3D-STE derived LV ejection fraction (EF, 57.43 ± 7.51 vs. 62.69 ± 4.76%, p = 0.0001, global LV longitudinal strain (LS, 14.85 ± 2.89 vs. 17.90 ± 2.01%, p = 0.0001, global LV circumferential strain (CS, 13.93 ± 2.81 vs. 16.82 ± 2.17%, p = 0.0001 and global LV area strain (AS, 25.76 ± 4.43 vs. 30.51 ± 2.61%, p = 0.0001. Apart from the global LV LS all these parameters were significantly lower in patients with severe gene mutation than in those with mild mutation (p < 0.05. In the multivariate linear regression analysis only the type of mutation had a significant influence on the 3D-STE derived LVEF (p = 0.017, global CS (p = 0.005 and global AS (p = 0.03.In asymptomatic MFS patients latent LV dysfunction can be detected using 3D STE. The LV dysfunction is mainly related to the severity of gene mutation, suggesting possible primary cardiomyopathy in MFS patients.

  20. Structural and Functional Changes in the Tight Junctions of Asymptomatic and Serology-negative First-degree Relatives of Patients With Celiac Disease.

    Science.gov (United States)

    Mishra, Asha; Prakash, Shyam; Sreenivas, Vishnubhatla; Das, Taposh K; Ahuja, Vineet; Gupta, Siddhartha D; Makharia, Govind K

    2016-08-01

    Ten to 15% of first-degree relatives (FDRs) of celiac disease (CeD) patients develop CeD. Although intestinal barrier functions (intestinal permeability) are abnormal in the subset of serology-negative FDRs, what leads to the abnormal barrier function is not known. To study the ultrastructure and functions of tight junctions in serology-negative FDRs of CeD patients. The intestinal permeability was measured in 97 asymptomatic and anti-tissue transglutaminase antibody (anti-tTG Ab)-negative FDRs (using the lactulose mannitol ratio) and in 75 controls. The ultrastructure of tight junctions using transmission electron microscopy, and the expression of key tight junction proteins (claudin-2, claudin-3, occludin, JAM-A, and ZO-1) and zonulin using real-time PCR and immunohistochemistry were assessed in anti-tTG Ab-negative, HLA-DQ2/-DQ8-positive FDRs having normal villi and in disease controls. In addition, the serum zonulin level was measured in 172 anti-tTG Ab-negative FDRs and 198 controls. The intestinal permeability was significantly increased in FDRs than in controls. Ultrastructural abnormalities such as dilatation of the tight junction (P=0.004) and loss of the pentalaminar structure (P=0.001) were more common in FDRs than in disease controls. There was significant underexpression of tight junction proteins ZO-1 (P=0.040) and occludin (P=0.041) in FDRs. There was no significant difference in the serum zonulin level between FDRs and controls (P=0.154). Even asymptomatic, anti-tTG-Ab-negative FDRs with a normal villous histology have both ultrastructural and functional abnormalities in tight junctions. These findings are indirect evidence of the presence of tight junction abnormalities before the onset of the disease and may have therapeutic implications.

  1. Comparative analysis of the diagnostic and prognostic value of exercise ECG and thallium-201 scintigraphic markers of myocardial ischemia in asymptomatic and symptomatic patients

    International Nuclear Information System (INIS)

    Gibson, R.S.

    1989-01-01

    A considerable amount of data now exists that indicates that exercise ECG--due to its suboptimal sensitivity and specificity--has limited diagnostic and prognostic value in asymptomatic subjects, patients with chest pain of unclear etiology or those with chronic stable angina pectoris, and in patients recovering from acute myocardial infarction. Because of this and the well-recognized advantages of thallium-201 scintigraphy, there appears to be a strong rationale for recommending exercise perfusion imaging, rather than exercise ECG alone, as the preferred method for detecting CAD and staging its severity. This recommendation seems justified given the fact that (1) thallium-201 scintigraphy is far more sensitive and specific in detecting myocardial ischemia than exercise testing; (2) unlike stress ECG, thallium-201 scintigraphy can localize ischemia to a specific area of areas subtended by a specific coronary artery; and (3) thallium-201 scintigraphy has been shown to be more reliable to risk stratification of individual patients than exercise testing alone. The more optimal prognostic efficiency of thallium-201 scintigraphy is due, in part, to the fact that the error rate in falsely classifying patients as low-risk is substantially and significantly smaller with thallium-201 scintigraphy than with stress ECG. 52 references

  2. Prevalence and risk factors accounting for true silent myocardial ischemia: a pilot case-control study comparing type 2 diabetic with non-diabetic control subjects

    Directory of Open Access Journals (Sweden)

    Ciudin Andreea

    2011-01-01

    Full Text Available Abstract Background Given the elevated risk of cardiovascular events and the higher prevalence of silent coronary artery disease (CAD in diabetic versus non-diabetic patients, the need to screen asymptomatic diabetic patients for CAD assumes increasing importante. The aims of the study were to assess prospectively the prevalence and risk factor predictors of true silent myocardial ischemia (myocardial perfusion defects in the absence of both angina and ST-segment depression in asymptomatic type 2 diabetic patients. Methods Stress myocardial perfusion gated SPECT (Single Photon Emission Computed Tomography was carried out in 41 type 2 diabetic patients without history of cardiovascular disease (CVD and 41 nondiabetic patients matched by age and gender. Results There were no significant differences between the two groups regarding either the classic CVD risk factors or left ventricular function. True silent ischemia was detected in 21.9% of diabetic patients but only in 2.4% of controls (p Conclusions True silent myocardial ischemia is a high prevalent condition in asymptomatic type 2 diabetic patients. Male gender and the presence of DR are the risk factors related to its development.

  3. Relevance of Electrical Remodeling in Human Atrial Fibrillation Results of the Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial Mechanisms of Atrial Fibrillation Study

    NARCIS (Netherlands)

    Healey, Jeff S.; Israel, Carsten W.; Connolly, Stuart J.; Hohnloser, Stefan H.; Nair, Girish M.; Divakaramenon, Syamkumar; Capucci, Alessandro; Van Gelder, Isabelle C.; Lau, Chu-Pak; Gold, Michael R.; Carlson, Mark; Themeles, Ellison; Morillo, Carlos A.

    Background-In animal models of atrial fibrillation (AF), changes in atrial electrophysiological properties are associated with the development of AF. Their relevance to human AF is unclear. Methods and Results-The Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the

  4. Resting and Post-Exercise Ankle-Brachial Index Measurements to Diagnose Asymptomatic Peripheral Arterial Disease in Middle Aged and Elderly Chronic Obstructive Pulmonary Disease Patients: A Pilot Study.

    Science.gov (United States)

    Alagiakrishnan, Kannayiram; Brokop, Michael; Cave, Andrew; Rowe, Brian H; Wong, Eric; Senthilselvan, Ambikaipakan

    2016-04-01

    Chronic obstructive pulmonary disease (COPD) patients are at risk for asymptomatic peripheral arterial disease (PAD) because smoking is a risk factor for COPD and PAD. The objectives of this study were to determine the proportion of COPD patients with asymptomatic PAD and to investigate whether the estimated risk of asymptomatic PAD in subjects with COPD differs using resting and exercise ankle-brachial index (ABI) in smokers. Using a cross-sectional study design, consecutive smokers > 50 years old were recruited over 2 months from the inpatient units and the outpatient clinics. Subjects previously diagnosed with PAD, unstable angina, recent (< 3 months) myocardial infarction or abdominal, intracranial, eye or lung surgery, and palliative care patients were excluded. Vascular risk factors, ABI (supine and post-3-minute walk supine), self-reported PAD symptoms, and spirometry were obtained. Two measurements of systolic blood pressure on all limbs were obtained using a sphygmomanometer and a Doppler ultrasound, and the ABI was calculated. Data were expressed as means ± standard deviation (SD). Dichotomous outcomes were assessed using Chi-square statistics; P-values of < 0.05 were considered significant. Thirty patients with no previous diagnosis of PAD were recruited. Mean age was 67.7 years (SD: 10.5). Overall, 21 subjects (70%) had spirometry-proven COPD. Significant ABI for PAD (< 0.9) was seen in 7/21 COPD (33.5%) and 0/9 non-COPD subjects in the supine resting position (P = 0.07), and in 9/21 COPD (42.9%) vs. 0/9 non-COPD subjects after exercise (P = 0.03). A significant proportion of patients with spirometry-proven COPD screened positive for asymptomatic PAD after exercise. Resting ABI may not be very sensitive to diagnose asymptomatic PAD in COPD subjects. ABI may be a reliable, sensitive and practical screening tool to assess cardiovascular risk in COPD patients. Future large-scale studies are required to confirm this finding.

  5. Comparison of lumbo-pelvic kinematics during trunk forward bending and backward return between patients with acute low back pain and asymptomatic controls.

    Science.gov (United States)

    Shojaei, Iman; Salt, Elizabeth G; Hooker, Quenten; Van Dillen, Linda R; Bazrgari, Babak

    2017-01-01

    Prior studies have reported differences in lumbo-pelvic kinematics during a trunk forward bending and backward return task between individuals with and without chronic low back pain; yet, the literature on lumbo-pelvic kinematics of patients with acute low back pain is scant. Therefore, the purpose of this study was set to investigate lumbo-pelvic kinematics in this cohort. A case-control study was conducted to investigate the differences in pelvic and thoracic rotation along with lumbar flexion as well as their first and second time derivatives between females with and without acute low back pain. Participants in each group completed one experimental session wherein they performed trunk forward bending and backward return at self-selected and fast paces. Compared to controls, individuals with acute low back pain had larger pelvic range of rotations and smaller lumbar range of flexions. Patients with acute low back pain also adopted a slower pace compared to asymptomatic controls which was reflected in smaller maximum values for angular velocity, deceleration and acceleration of lumbar flexion. Irrespective of participant group, smaller pelvic range of rotation and larger lumbar range of flexion were observed in younger vs. older participants. Reduced lumbar range of flexion and slower task pace, observed in patients with acute low back pain, may be the result of a neuromuscular adaptation to reduce the forces and deformation in the lower back tissues and avoid pain aggravation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. Impact of hypertension on left ventricular structure in patients with asymptomatic aortic valve stenosis (a SEAS substudy)

    DEFF Research Database (Denmark)

    Rieck, Ashild E; Cramariuc, Dana; Staal, Eva M

    2010-01-01

    Both hypertension and aortic valve stenosis induce left ventricular hypertrophy. However, less is known about the influence of concomitant hypertension on left ventricular structure in patients with aortic valve stenosis.......Both hypertension and aortic valve stenosis induce left ventricular hypertrophy. However, less is known about the influence of concomitant hypertension on left ventricular structure in patients with aortic valve stenosis....

  7. Detecting asymptomatic coronary artery disease using routine ...

    African Journals Online (AJOL)

    ECG-monitored exercise testing has been proposed as a relatively inexpensive and effective means of screening for asymptomatic coronary artery disease in patients presenting for peripheral vascular surgery. Despite the fact that exercise thallium scintigraphy is also dependent on the patient's ability to exercise, using this ...

  8. Asymptomatic cerebral hemorrhage detected by MRI

    International Nuclear Information System (INIS)

    Shinohara, Y.; Nakajima, Y.; Ohsuga, H.; Yamamoto, M.

    1991-01-01

    In a period of nearly three years, 2757 patients have undergone magnetic resonance scans of the brain. The purpose of this study was to elucidate the incidence and the cause of asymptomatic cerebral hemorrhage among the patients who had been diagnosed as having apparent cerebral hemorrhage. (author). 2 refs.; 1 tab

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

    DEFF Research Database (Denmark)

    Licht, Rasmus W; Martiny, Klaus Per Juul

    2013-01-01

    BACKGROUND: We compared citalopram and clomipramine against placebo with respect to recurrence prevention as opposed to relapse prevention in patients with recurrent depression, independently of any acute response to the test drug(s). METHODS: Patients with recurrent depressive disorder...... with a current depressive episode of moderate to severe degree were recruited over a period of 6.5 years. After 6-15 months of routine open acute and continuation therapy, and a discontinuation/drug-free period of one month following sustained response (at least 3 consecutive monthly ratings with a HAM-D-17...... of the randomised patients met the criterion for recurrence. LIMITATIONS: The size of the randomised sample was considerably smaller than the planned size. CONCLUSIONS: The high risk of drop out prior to randomisation among the eligible patients was presumably caused by an interaction between the study design...

  10. Noninvasive Cardiovascular Risk Assessment of the Asymptomatic Diabetic Patient The Imaging Council of the American College of Cardiology

    OpenAIRE

    Budoff, MJ; Raggi, P; Beller, GA; Berman, DS; Druz, RS; Malik, S; Rigolin, VH; Weigold, WG; Soman, P; Coll, ICA

    2016-01-01

    Increased cardiovascular morbidity and mortality in patients with type 2 diabetes is well established; diabetes is associated with at least a 2-fold increased risk of coronary heart disease. Approximately two-thirds of deaths among persons with diabetes are related to cardiovascular disease. Previously, diabetes was regarded as a "coronary risk equivalent," implying a high 10-year cardiovascular risk for every diabetes patient. Following the original study by Haffner et al., multiple studies ...

  11. Noninvasive Cardiovascular Risk Assessment of the Asymptomatic Diabetic Patient: The Imaging Council of the American College of Cardiology

    OpenAIRE

    Budoff, Matthew J.; Raggi, Paolo; Beller, George A.; Berman, Daniel S.; Druz, Regina S.; Malik, Shaista; Rigolin, Vera H.; Weigold, Wm. Guy; Soman, Prem

    2016-01-01

    Increased cardiovascular morbidity and mortality in patients with type 2 diabetes is well established; diabetes is associated with at least a 2-fold increased risk of coronary heart disease. Approximately two-thirds of deaths among persons with diabetes are related to cardiovascular disease. Previously, diabetes was regarded as a ?coronary risk equivalent,? implying a high 10-year cardiovascular risk for every diabetes patient. Following the original study by Haffner et al., multiple studies ...

  12. Blood Culture Contamination and the Type of Microorganisms in True and False Positive Results in Patients Admitted at Avicenna Qazvin

    OpenAIRE

    E Sajadi; S Asefzade; M Asefzade; F Manuchehri

    2010-01-01

    Introduction: Diagnosis of infection based on blood culture alone is not a suitable method, but it is important to understand the clinical diagnosis for interpreting blood cultures. The goal of this study was to determine blood culture contamination and the type of microorganisms in false and real positive cases in patients admitted at Avicenna Hospital. Methods: This cross sectional study was done on all patients in the emergency and internal medicine departments from April, 2008 to October,...

  13. 99mTc-MIBI/123I-Na subtraction scanning for localized parathyroid adenoma in patients with asymptomatic/mild primary hyperparathyroidism

    International Nuclear Information System (INIS)

    Tanaka, Yuji; Funahashi, Hiroomi; Imai, Tsuneo

    1996-01-01

    Primary hyperparathyroidism is most commonly detected as a mild elevation of the serum calcium concentration. In the present study, the utility of 99m Tc-methoxyisobutylisonitrile (MIBI) imaging before initial surgery was evaluated for localizing abnormal parathyroid glands in patients with asymptomatic and mild primary hyperparathyroidism. The results were compared with those of thallium-technetium subtraction scanning (TTSS). 99m Tc-MIBI/ 123 I-Na subtraction scanning was performed in 11 patients, and TTSS was performed in 10 of them. The sensitivity was 100% and the positive predictive value was 92% for 99m Tc-MIBI/ 123 I-Na, while the sensitivity was 50% and the positive predictive value was 100% for TTSS. The smallest gland detected weighed 85 mg in 99m Tc-MIBI/ 123 I-Na, and 570 mg in TTSS. There was a difference between the median weight of adenomas which were detected by 99m Tc-MIBI/ 123 I-Na (754 mg), and those which were detected by TTSS (1,195 mg). These results suggest that TTSS parathyroid scintigraphy could give way to 99m Tc-MIBI/ 123 I-Na parathyroid scintigraphy for improved detection of low-weight abnormal parathyroid glands. (author)

  14. Added clinical value of 'true' whole body F-FDG PET/CT imaging in patients with malignant melanoma

    International Nuclear Information System (INIS)

    Kovacs, Julie C.

    2009-01-01

    Full text: Accurate and reliable staging of disease extent in patients with malignant melanoma is essential to ensure appropriate treatment planning. The detection of recurrent or residual malignancy after primary treatment allows for early intervention and optimises patient survival. FDG PET/CT is indicated for surveillance of malignant melanoma due to its high sensitivity and specificity for soft-tissue or nodal recurrences and metastases. It has been claimed that routinely scanning lower extremities and skull in addition to 'eyes to thigh' images in PET/CT evaluation of metastatic melanoma is warranted. Whole-body PET/CT scan reports in patients with melanoma scanned from April 2005 to December 2008 were retrospectively reviewed. PET abnormalities in the brain/scalp and lower extremities were tabulated by location and whether they were 'expected'. Findings were correlated with pathology, other imaging studies and clinical follow-up. 94 PET/CT examinations in 268 patients with melanoma were included. 9 of 294 (3.1 %) scans showed brain/scalp abnormalities, with only 4 (1.3%) showing unexpected abnormalities. 24 of 294 (8.1 %) scans showed lower extremity abnormalities, with only 5 (1.6%) showing unexpected abnormalities. In no case was an unexpected solitary malignant lesion identified in the brain/scalp or lower extremities. In patients with no known or suspected primary or metastatic melanoma involving the head or lower extremities, inclusion of these regions on PET/CT is of low yield and appears to seldom offer significant additional benefit, as detection of additional metastases in these patients is unlikely to change clinical management. Routine 'eyes to thighs' images is adequate for this subset of patients.

  15. Effect of proximal vagotomy and Roux-en-Y diversion on gastric emptying kinetics in asymptomatic patients

    Energy Technology Data Exchange (ETDEWEB)

    Urbain, J.L.; Penninckx, F.; Siegel, J.A.; Vandenborre, P.; Van Cutsem, E.; Vandenmaegdenbergh, V.; De Roo, M. (Univ. Hospital Gasthuisberg, Leuven (Belgium))

    1990-10-01

    The role of the distal stomach in gastric emptying was studied. Ten patients with proximal gastric vagotomy (PV) and 10 age-matched patients with Roux-en-Y gastro-jejunostomy (R-Y) were compared with 10 healthy controls. Gastric emptying of solids and liquids was determined by the use of Tc-99m SC scrambled eggs and In-111 DTPA. In PV, gastric emptying of both solids and liquids was delayed; the prolongation with solids was mainly accounted for by an abnormal lag phase. In R-Y patients, no lag phase was observed, and the solid emptying curve pattern was characterized by early rapid emptying followed by very slow emptying. Both the solid and liquid phases were prolonged. The lag phase is affected by proximal vagotomy and is mainly determined by the distal stomach, which appears to be essential for normal emptying.

  16. Effect of proximal vagotomy and Roux-en-Y diversion on gastric emptying kinetics in asymptomatic patients.

    Science.gov (United States)

    Urbain, J L; Penninckx, F; Siegel, J A; Vandenborre, P; Van Cutsem, E; Vandenmaegdenbergh, V; De Roo, M

    1990-10-01

    The role of the distal stomach in gastric emptying was studied. Ten patients with proximal gastric vagotomy (PV) and 10 age-matched patients with Roux-en-Y gastro-jejunostomy (R-Y) were compared with 10 healthy controls. Gastric emptying of solids and liquids was determined by the use of Tc-99m SC scrambled eggs and In-111 DTPA. In PV, gastric emptying of both solids and liquids was delayed; the prolongation with solids was mainly accounted for by an abnormal lag phase. In R-Y patients, no lag phase was observed, and the solid emptying curve pattern was characterized by early rapid emptying followed by very slow emptying. Both the solid and liquid phases were prolonged. The lag phase is affected by proximal vagotomy and is mainly determined by the distal stomach, which appears to be essential for normal emptying.

  17. Effect of proximal vagotomy and Roux-en-Y diversion on gastric emptying kinetics in asymptomatic patients

    International Nuclear Information System (INIS)

    Urbain, J.L.; Penninckx, F.; Siegel, J.A.; Vandenborre, P.; Van Cutsem, E.; Vandenmaegdenbergh, V.; De Roo, M.

    1990-01-01

    The role of the distal stomach in gastric emptying was studied. Ten patients with proximal gastric vagotomy (PV) and 10 age-matched patients with Roux-en-Y gastro-jejunostomy (R-Y) were compared with 10 healthy controls. Gastric emptying of solids and liquids was determined by the use of Tc-99m SC scrambled eggs and In-111 DTPA. In PV, gastric emptying of both solids and liquids was delayed; the prolongation with solids was mainly accounted for by an abnormal lag phase. In R-Y patients, no lag phase was observed, and the solid emptying curve pattern was characterized by early rapid emptying followed by very slow emptying. Both the solid and liquid phases were prolonged. The lag phase is affected by proximal vagotomy and is mainly determined by the distal stomach, which appears to be essential for normal emptying

  18. Antihypertensive treatment with β-blockade in patients with asymptomatic aortic stenosis and association with cardiovascular events

    DEFF Research Database (Denmark)

    Bang, Casper N.; Greve, Anders M.; Rossebø, Anne B.

    2017-01-01

    Background--Patients with aortic stenosis (AS) often have concomitant hypertension. Antihypertensive treatment with a β-blocker (Bbl) is frequently avoided because of fear of depression of left ventricular function. However, it remains unclear whether antihypertensive treatment with a Bbl is asso...

  19. Effect of fosinopril on progression of the asymptomatic carotid atherosclerosis and left ventricular hypertrophy in hypertensive patients

    Directory of Open Access Journals (Sweden)

    Tasić Ivan

    2006-01-01

    Full Text Available INTRODUCTION The cardiovascular changes (vascular structure changes, hypertrophy of the left ventricle contribute to both the increased cardiovascular morbidity and the mortality of essential hypertension. Therefore, modern treatment strategies should not only target blood pressure (BP reduction but also normalize cardiovascular structure and function. OBJECTIVE Aim of the study was to determine the effect of the ACE inhibitor Fosinopril on the Intima-media thickness of the common carotid artery and on the left ventricle mass after 9-month treatment of hypertensive patients. METHOD The study included 40 patients with the arterial hypertension and the left ventricle hypertrophy verified by echocardiography. The patients were randomized on A ACE-inhibitor - Fosinopril and 6 without ACE inhibitor - atenolol, and they were followed up 9 months. The groups were not different by age, sex, and metabolic status. Color Duplex ultrasonography of the carotid arteries was performed by Acuson Sequia C236 with high-frequency linear probe of 8 MHz. The Intima-media thickness of the common carotids on the left and the right was measured in diastole at 1.5. cm from the highest point of bifurcation under maximal magnification. Using the same device, the left ventricle mass and other parameters of the left ventricle were determined in M-mode and by means of 2D image. RESULTS After 9 months, BP In both groups Was reduced In similar range (group A: systolic BP from 158 to 137 mmHg, and diastolic BP from 94 to 85 mmHg, and group B; systolic BP from 164 to 137 mmHg, and diastolic BP from 87 to 84 mmHg. The thickness of the intimomedial complex in patients using Fosinopril was decreased by 0.0278 ± 0.03 mm, while in the group of patients that did not use the ACE-inhibitor, it was increased by 0.078 ±0.13 mm. The left ventricle mass in patients using Fosinopril was decreased by 5 grams (312 ± 72 g vs. 307 ± 77 g, while in group B patients, it was increased by 15

  20. Impact of final kissing balloon inflation after simple stent implantation for the treatment of non-left main true coronary bifurcation lesions in patients with acute coronary syndrome.

    Science.gov (United States)

    Kim, Tae-Hoon; Lee, Hyun Jong; Jang, Ho-Jun; Kim, Je Sang; Park, Jin Sik; Choi, Rak Kyeong; Choi, Young Jin; Shim, Won-Heum; Ro, Young Moo; Yu, Cheol Woong; Kwon, Sung Woo

    2014-12-20

    We sought to evaluate the impact of final kissing balloon inflation (FKBI) after simple stent implantation for the treatment of non-left main true coronary bifurcation lesions in patients with acute coronary syndrome (ACS). Whether FKBI should be mandatory after simple stent implantation for the treatment of coronary bifurcation lesion is controversial. Besides, ACS patients who have undergone bifurcation percutaneous coronary intervention with simple stent implantation may experience worse prognosis compared to stable angina pectoris patients. Two hundred and fifty one eligible patients (67.7% male, mean age 61.7 ± 10.4 years) were enrolled. The study population was divided into two groups according to the performance of FKBI. The primary end points were major adverse cardiac event (MACE); target lesion revascularization (TLR), non-fatal myocardial infarction (MI) and cardiac death during the follow-up period. Over a mean follow-up period of 3.0 ± 1.9 years, there were 29 MACEs (10 TLR, 6 non-fatal MI, and 13 cardiac deaths), representing an event rate of 11.6%. Kaplan-Meier survival analysis revealed that FBKI group had favorable outcome compared to non-FKBI group with regard to hard events (p = 0.010) as well as composite MACEs (p = 0.008). In multivariable analysis, FKBI was a significant predictor of composite MACEs [hazard ratio 0.398 (95% confidence interval 0.190-0.836, p = 0.015)] and hard events [hazard ratio 0.325 (95% confidence interval 0.130-0.811, p = 0.016)]. In terms of prognosis, performing FKBI after simple stent implantation for the treatment of non-left main true coronary bifurcation lesions may be mandatory in ACS patients. Copyright © 2014. Published by Elsevier Ireland Ltd.

  1. Pneumocystis jirovecii detection in asymptomatic patients: what does its natural history tell us? [version 1; referees: 3 approved

    Directory of Open Access Journals (Sweden)

    Alexandre Alanio

    2017-05-01

    Full Text Available Pneumocystis jirovecii is an unusual ascomycetous fungus that can be detected in the lungs of healthy individuals. Transmission from human to human is one of its main characteristics in comparison with other fungi responsible for invasive infections. P. jirovecii is transmitted through the air between healthy individuals, who are considered to be the natural reservoir, at least transiently. In immunocompromised patients, P. jirovecii multiplies, leading to subacute infections and acute life-threatening pneumonia, called Pneumocystis pneumonia [PCP]. PCP is caused by genotypically distinct mixtures of organisms in more than 90% of cases, reinforcing the hypothesis that there is constant inhalation of P. jirovecii from different contacts over time, although reactivation of latent organisms from previous exposures may be possible. Detection of P. jirovecii DNA without any symptoms or related radiological signs has been called “colonization”. This situation could be considered as the result of recent exposure to P. jirovecii that could evolve towards PCP, raising the issue of cotrimoxazole prophylaxis for at-risk quantitative polymerase chain reaction (qPCR-positive immunocompromised patients. The more accurate way to diagnose PCP is the use of real-time quantitative PCR, which prevents amplicon contamination and allows determination of the fungal load that is mandatory to interpret the qPCR results and manage the patient appropriately. The detection of P. jirovecii in respiratory samples of immunocompromised patients should be considered for potential risk of developing PCP. Many challenges still need to be addressed, including a better description of transmission, characterization of organisms present at low level, and prevention of environmental exposure during immunodepression.

  2. Pharmacokinetics and Pharmacodynamics during Treatment with the Omeprazole 20 mg Enteric-Coated Tablet and 20 mg Capsule in Asymptomatic Duodenal Ulcer Patients

    Directory of Open Access Journals (Sweden)

    ABR Thomson

    1997-01-01

    Full Text Available This study compared the 24 h intragastric pH profile and bioavailability at repeated dosing conditions of the omeprazole 20 mg enteric-coated tablet versus the 20 mg capsule. Forty duodenal ulcer patients in asymptomatic remission completed this randomized open two-way crossover study. Omeprazole 20 mg tablets or capsules were administered for seven days in each period. A 24 h pH recording was performed before the start of treatment and on day 7 of each treatment period. Plasma concentrations of omeprazole were determined 24 h after the dose. The treatment periods were separated by two to four weeks. The difference in percentage of time with pH of at least 3 was less than 16% in favour of the tablet (not significant. The estimated mean area under the plasma concentration-time curve as well as the maximum plasma concentration (Cmax for omeprazole were 18% and 41% higher, respectively, for the tablet versus the capsule, with the latter percentage being statistically significant. The time to reach Cmax (tmax with the tablet was, on average, about 0.5 h longer than to reach the tmax of the capsule. This study indicates that the enteric-coated tablet formulation of omeprazole is biodynamically equivalent to the capsule regarding their effects on intragastric pH during repeated dosing.

  3. Differences in cardiovascular risk profile between electrocardiographic hypertrophy versus strain in asymptomatic patients with aortic stenosis (from SEAS data)

    DEFF Research Database (Denmark)

    Greve, Anders M; Gerdts, Eva; Boman, Kurt

    2011-01-01

    -Lyon voltage and Cornell voltage-duration criteria; and strain by T-wave inversion and ST-segment depression. Degree of AS severity was evaluated by echocardiography as peak aortic jet velocity and LV mass was indexed by body surface area. After adjustment for age, gender, LV mass index, heart rate, systolic...... and diastolic blood pressures, blood glucose, digoxin, antiarrhythmic drugs, drugs acting on the renin-angiotensin system, diuretics, β blockers and calcium receptor blockers; peak aortic jet velocity was significantly greater in patients with electrocardiographic strain (mean difference 0.13 m/s, p...

  4. Differences in cardiovascular risk profile between electrocardiographic hypertrophy versus strain in asymptomatic patients with aortic stenosis (from SEAS data)

    DEFF Research Database (Denmark)

    Greve, Anders M; Gerdts, Eva; Boman, Kurt

    2011-01-01

    -Lyon voltage and Cornell voltage-duration criteria; and strain by T-wave inversion and ST-segment depression. Degree of AS severity was evaluated by echocardiography as peak aortic jet velocity and LV mass was indexed by body surface area. After adjustment for age, gender, LV mass index, heart rate, systolic...... and diastolic blood pressures, blood glucose, digoxin, antiarrhythmic drugs, drugs acting on the renin-angiotensin system, diuretics, ß blockers and calcium receptor blockers; peak aortic jet velocity was significantly greater in patients with electrocardiographic strain (mean difference 0.13 m/s, p...

  5. NEPHRITOGENIC ACTIVITY OF STREPTOCOCCUS PYOGENES emm1 AND emm12 GENOTYPES ISOLATED FROM PATIENTS AND ASYMPTOMATIC CARRIERS

    Directory of Open Access Journals (Sweden)

    L. A. Burova

    2015-01-01

    Full Text Available In this paper the nephritogenic activity of Streptococcus pyogenes genotype emm1 and emm12 clinical isolates from scarlet fever patients and healthy children was considered. As earlier established, strains of these types differ in Fc-binding profile, interacting with native IgG and immune complexes (IC, respectively. As expected, all the type emm1 strains bound native IgG; besides, ICs interacted only with strains from patients but not with those from carriers. In contrast, all type emm12 strains appeared to be negative for native IgG, whereas ICs were bound by strains from patients exclusively. None of the tested strains bound IgG3. By immunization of rabbits, binding of native IgG as well as ICs was associated with increasing of anti-IgG antibodies titer, formation of ICs, «crescent» deposition of IgG and C3-complement, local production of the proinflammatory cytokine TNFα, аnd also with accumulation of lymphocytes in kidney tissue. These signs indicated immune inflammation, leading to experimental membrane-proliferative glomerulonephritis (PSGN. It is known that PSGN development depends on IC-binding by tissue FcγR, on complement activation as well as on tissue infiltration by macrophages/monocytes. According to the data of morphometric evaluation the nephritogenic activity of the type emm12 strains exceeded those of type emm1. On testing of three IC-binding emm12 strains in six rabbits, typical PSGN developed in 5 of them and an abortive process in 1 animal. In case of five IgG-binding type emm1 strains, out of ten rabbits full-blown PSGN was observed only in 3 of them, but abortive changes in 5 and negative result in 2 animals. No pathologic changes were elicited by the «carrier» strains of either genotype; the inability of these to bind ICs, according to literature data, could be explained by mutation in the Mga-regulator gene thereby impeding M-proteins synthesis. We conclude that isolation of type emm12 IC-binding strains at acute

  6. Tried and true: self-regulation theory as a guiding framework for teaching parents diabetes education using human patient simulation.

    Science.gov (United States)

    Sullivan-Bolyai, Susan; Johnson, Kimberly; Cullen, Karen; Hamm, Terry; Bisordi, Jean; Blaney, Kathleen; Maguire, Laura; Melkus, Gail

    2014-01-01

    Parents become emotionally upset when learning that their child has type 1 diabetes, yet they are expected to quickly learn functional diabetes management. The purpose of this article is to describe the application of self-regulation theory to guide a family-focused education intervention using human patient simulation to enhance the initial education of parents in diabetes management. A brief description is provided of the intervention framed by self-regulation theory. On the basis of the literature, we describe the educational vignettes used based on self-regulation in the randomized controlled trial entitled "Parent Education Through Simulation-Diabetes." Examples of theory-in-practice will be illustrated by parental learning responses to this alternative educational innovation.

  7. Mitral annulus caseous calcification mimicking cardiac mass in asymptomatic patient – multimodality imaging approach to incidental echocardiographic finding

    International Nuclear Information System (INIS)

    Możeńska, Olga; Sypuła, Sławomir; Celińska-Spoder, Małgorzata; Walecki, Jerzy; Kosior, Dariusz A.

    2014-01-01

    Caseous calcification of mitral annulus is rather rare echocardiographic finding with prevalence of 0.6% in pts. with proven mitral annular calcification and 0.06% to 0.07% in large series of subjects in all ages. Echocardiographic images of caseous calcification are often heterogenous due to calcium and lipid deposits, and the masses show hyperechogenic and hypoechogenic areas. However the appearance of caseous calcification can imitate that of abscess, tumors and cysts, surgical treatment may not be needed when there is no obstruction. 76-year old obese (BMI 32 kg/m 2 ), female patient with history of hypertension, stable coronary artery disease, diabetes type 2 and hyperlipidemia presented with no symptoms of mitral valve dysfunction and had no abnormalities on physical exam. Transesophageal echocardiography identified well-organized, composite, immobile lesion (22×15 mm) localized in the posterior part of the mitral annulus, with markedly calcified margins, and no significant impact on the valve function. In computed tomography (CT) lesion was described as calcified (24×22×17.5 mm), connected with posterior leaflet and posterior part of the mitral annulus, reducing posterior leaflet mobility. CT brought the suggestion of caseous mitral annular calcification. Coming to a conclusion, bearing in mind no mitral valve dysfunction at that time, patient was offered conservative treatment. Although caseous mitral annular calcification is typically an incidental finding, accurate recognition is needed to avoid mistaking the lesion for a tumor or abscess, which may result in unnecessary cardiac surgery. However this entity is diagnosed on cardiac MRI, multi-modality imaging, especially non-contrast CT, allows for the confident, prospective diagnosis

  8. Asymptomatic Esophageal Varices Should Be Endoscopically Treated

    Directory of Open Access Journals (Sweden)

    Nib Soehendra

    1998-01-01

    Full Text Available Endoscopic treatment has generally been accepted in the management of bleeding esophageal varices. Both the control of acute variceal bleeding and elective variceal eradication to prevent recurrent bleeding can be achieved via endoscopic methods. In contrast to acute and elective treatment, the role of endoscopic therapy in asymptomatic patients who have never had variceal bleeding remains controversial because of the rather disappointing results obtained from prophylactic sclerotherapy. Most published randomized controlled trials showed that prophylactic sclerotherapy had no effect on survival. In some studies, neither survival rate nor bleeding risk was improved. In this article, the author champions the view that asymptomatic esophageal varices should be endoscopically treated.

  9. Urogenital Tract Infection in Asymptomatic Male Patients with Infertility in University of Benin Teaching Hospital, Benin City, Edo State

    Directory of Open Access Journals (Sweden)

    Ibadin, K. O.

    2012-01-01

    Full Text Available Aims: Urogenital tract infection (UTI contributes to the commonest single defined cause of infertility worldwide. To evaluate the role of urogenital tract infection in male with infertility and its association with sperm quality. Methodology and Results: Three hundred and twenty three (323 samples from infertile male subject were screened microbiologically for microorganisms associated with urogenital tract infection with seventy-two (72 age-matched male as controls using microbiological standard procedure. 164 (50.8% infection rate was recorded. The dorminant uropathogen detected or isolated were Staphylococcus aureus (14.0%, Chlamydia trachomatis (11.4%, Escherichia coli (4.3%, Micoplasma genitalium (4.0% Klebsielli aerogenes (4.0%. Others were Staphylococus saprophyticus, Pseudomonas aeruginosa, Protein mirabilis with 2.7% each respectively, Protein vulgaria treponema pallidum (2.1%, Schistosoma haematobium (0.9% Wulchereria Bancrofti (0.3%, Human immune virus (2.7%. Semen profile of the male patients with urogenital tract infection had abnormal semen quality in this study P<0.05. Conclusion, significance and impact of study: Oligospermic infertile male subjects should be screened for urogenital tract infection to further enhance good quality sperms and functions.

  10. Alterations in the echocardiographic variables of the right ventricle in asymptomatic patients with breast cancer during anthracycline chemotherapy.

    Science.gov (United States)

    Abdar Esfahani, Morteza; Mokarian, Fariborz; Karimipanah, Mohammad

    2017-05-01

    Anthracycline-induced cardiotoxicity can reach an irreversible phase; therefore great efforts are made to diagnose it early. As the right ventricle (RV) is smaller than the left, the right side of the heart is probably influenced by anthracycline to a greater extent and in a shorter time. The purpose of the present study was to investigate the early effects of chemotherapy on the right side of the heart. This cross-sectional study was performed in Isfahan University hospitals from August 2014 to December 2015. Subjects were 67 patients with breast cancer who were planned to receive anthracycline for the first time. Echocardiography was performed before administration of anthracycline and 6 months later. Variables included right heart measures (RV end-diastolic dimensions, right atrium length and diameter), RV fractional area change (RVFAC), index of myocardial performance (Tei index), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure, lateral tricuspid annular early and late diastolic velocities, and tissue Doppler diastolic and systolic velocities. Forty-nine of the subjects completed the study. RV end-diastolic diameters and Tei index (0.31 to 0.37) were significantly increased (prights-and-licensing/.

  11. No Difference in Transverse Abdominis Activation Ratio between Healthy and Asymptomatic Low Back Pain Patients during Therapeutic Exercise

    Directory of Open Access Journals (Sweden)

    Nathaniel Gorbet

    2010-01-01

    Full Text Available Dysfunction of the transverse abdominis (TrA has been associated with LBP. Several therapeutic exercises are prescribed to help target the TrA. Rehabilitative ultrasound imaging (RUSI is used to capture activation of the TrA during exercise. The purpose was to examine TrA activation during the ADIM and quadruped exercises between healthy and nonsymptomatic LBP patients. We instructed the subjects how to perform the exercises and measured muscle thickness of the TrA at rest and during the exercises using RUSI. This allowed us to calculate TrA activation ratio during these exercises. We found no significant differences between activation ratios of the two groups during either exercise; however TrA activation during the ADIM was higher than the quadruped exercise. These exercises were capable of activating the TrA, which may be in part due to the verbal instruction they received. These exercises could be used during prevention or rehabilitation programs, since the TrA is activated.

  12. Asymptomatic Incisional Endometrioma Presenting as Abdominal ...

    African Journals Online (AJOL)

    Asymptomatic incisional endometrioma of the anterior abdominal wall is rare. Clinical diagnosis may be difficult. We present a 26 year old woman with incisional abdominal wall endometrioma discovered 5 years after caeserian section. It was painless and there was no change in size with menstruation. The patient's body ...

  13. Clinical characteristics of potential kidney donors with asymptomatic kidney stones

    OpenAIRE

    Lorenz, Elizabeth C.; Lieske, John C.; Vrtiska, Terri J.; Krambeck, Amy E.; Li, Xujian; Bergstralh, Eric J.; Melton, L. Joseph; Rule, Andrew D.

    2011-01-01

    Background. Patients with symptomatic kidney stones are characterized by older age, male gender, white race, hypertension, obesity, metabolic syndrome and chronic kidney disease. Whether these characteristics differ in patients with asymptomatic kidney stones is unknown.

  14. Identification and characterization of HIV-2 strains obtained from asymptomatic patients that do not use CCR5 or CXCR4 coreceptors

    International Nuclear Information System (INIS)

    Azevedo-Pereira, J.M.; Santos-Costa, Q.; Mansinho, K.; Moniz-Pereira, J.

    2003-01-01

    In vivo, human immunodeficiency virus type 2 (HIV-2) infection reveals several unique characteristics when compared to HIV-1 infection, the most remarkable of which is the extraordinarily long asymptomatic period. Here we describe two HIV-2 primary isolates, obtained from asymptomatic individuals, which do not infect any coreceptor-expressing cell lines tested. In those cells, we show that the absence of replication is directly related to cell entry events. Furthermore, productive infection observed in peripheral blood mononuclear cells (PBMC) was not inhibited by natural ligands and monoclonal antibodies directed to CCR5 and CXCR4. Finally, viral entry efficiency and viral progeny production of these viruses are markedly impaired in PBMC, indicating a reduced replicative fitness of both viruses. In conclusion, our data suggest that in some HIV-2 asymptomatic individuals, the circulating viruses are unable to use the major coreceptors to infect PBMC. This fact should have important implications in HIV-2 pathogenesis and transmission

  15. Your True Freedom

    Directory of Open Access Journals (Sweden)

    Jena Rausch

    2015-02-01

    Full Text Available Your True Freedom is about my journey teaching inmates the fundamental truths of self worth, self acceptance and self love--through writing, mindfulness meditation and emotional healing. It is a journey that continues to enlighten me and to heal and free the inmates with whom I work.

  16. Heart rate variability and turbulence to determine true coronary artery disease in patients with ST segment depression without angina during exercise stress testing.

    Science.gov (United States)

    Celik, Atac; Ozturk, Ahmet; Ozbek, Kerem; Kadi, Hasan; Koc, Fatih; Ceyhan, Koksal; Erkorkmaz, Unal

    2011-12-01

    ST segment depression without angina during an exercise stress test causes diagnostic problems, particularly in non-diabetic patients. Heart rate variability (HRV) and heart rate turbulence (HRT) are used to evaluate the changes in cardiac autonomic functions and are also both decreased in patients with coronary artery disease. The aim of this study was determine the values of HRV and HRT that discriminate true coronary artery disease from false positive stress test results. Ninety non-diabetic patients who underwent diagnostic coronary angiography (CA) due to suspected coronary artery disease after ST segment depression without angina during an exercise stress test were enrolled in the study. Prior to CA, 24 hour ambulatory electrocardiogram recordings were taken and HRV and HRT parameters were calculated. Patients were divided into three groups according to the severity of their coronary lesions: (group 1 normal, group 2 non-obstructive and group 3 obstructive. There were no differences among the groups with regards to age, sex, medical history, medications, systolic and diastolic blood pressures, body mass index, fasting glucose, anemia and thyroid status, lipid profile and creatinine clearance. HRV parameters and turbulence slope (TS) were significantly lower while turbulence onset (TO) was significantly higher in group 3 than groups 1 and 2. According to the cut-off values calculated using ROC analysis, SDNN≤69.63 msec, TO > 0.14%, and TS≤2.78 msec/RR have high diagnostic accuracy for predicting obstructive coronary artery disease. HRV and HRT parameters may provide additional information for discriminating between patients who do and do not truly need CA.

  17. Asymptomatic atlantoaxial subluxation in rheumatoid arthritis.

    OpenAIRE

    Mohammadali Nazarinia; Reza Jalli; Eskandar Kamali Sarvestani; Siamak Farahangiz; Maryam Ataollahi

    2014-01-01

    This cross-sectional study is conducted to determine the prevalence of asymptomatic cervical spine subluxation in rheumatoid arthritis patients by plain radiographs and its relation to demographic and clinical characteristics, disease activity measures and medications. 100 rheumatoid arthritis patients (18 male and 82 female) were selected randomly, according to the American college of Rheumatology Criteria, who were under follow up in the rheumatology clinic. A complete history was taken, an...

  18. [Asymptomatic infections in man: a Trojan horse for the introduction and spread of mosquito-borne arboviruses in non-endemic areas?].

    Science.gov (United States)

    Chastel, C

    2011-08-01

    In mosquito-borne arbovirus infections in man the asymptomatic cases are much more frequent than the symptomatic ones, but their true role in the introduction and subsequent spread of such diseases in non-endemic areas remains to be clarified. We have collected pertinent data from English and French literature from 1952 to 2010 through Pubmed and other bibliographic sources. Data were analysed to assess if viremia in asymptomatic human arbovirus infections might be sufficient to represent a true risk for introduction in non-endemic areas. During dengue and chikungunya fever outbreaks, humans are believed to be the only vertebrate hosts. Since a very large number of individuals are infected and since viremic levels are known to vary by many orders of magnitude in symptomatic patients, it is reasonable to augur that a proportion of asymptomatic cases might reach levels of viremia sufficient to infect competent mosquitoes. Moreover, in both dengue and chikungunya fever, nosocomial infections have been identified representing an alternative opportunity for virus introduction in non-endemic areas. In zoonotic mosquito-borne arbovirus infections such as Japanese encephalitis or West Nile infection, the situation is quite different since humans are considered as "dead-end" hosts. However, the very large number of asymptomatic cases arising during outbreaks and the existence of newly recognised ways of contamination (blood transfusion, organ transplantation, transplacental way etc.) may also ensure their introduction and subsequent spread in new areas.

  19. Asymptomatic atlantoaxial subluxation in rheumatoid arthritis.

    Directory of Open Access Journals (Sweden)

    Mohammadali Nazarinia

    2014-06-01

    Full Text Available This cross-sectional study is conducted to determine the prevalence of asymptomatic cervical spine subluxation in rheumatoid arthritis patients by plain radiographs and its relation to demographic and clinical characteristics, disease activity measures and medications. 100 rheumatoid arthritis patients (18 male and 82 female were selected randomly, according to the American college of Rheumatology Criteria, who were under follow up in the rheumatology clinic. A complete history was taken, and physical examination has been done with focus on the cervical spine to determine their demographic data, disease duration, age of disease onset, drug history, swollen and tender joint counts, and ESR, Hb, CRP, RF levels. The disease activity of patients with rheumatoid arthritis was measured using the disease activity score 28. Radiographs of the cervical spine included lateral views taken in flexion, extension, neutral position of the neck and anterioposterior and odontoid projection view. Asymptomatic cervical spine subluxation was found in 17 of the 100 patients (17%. The prevalence of, anterior atlantoaxial subluxation, atlantoaxial impaction and subaxial subluxation was 10(10%, 5(5% and 6(6%, respectively. Posterior subluxation was not detected. The only characteristic that showed meaningful relationship with cervical spine subluxation was CRP (P=0.036. Our results showed that patients with RA, who have cervical spine subluxation cannot be distinguished on the basis of symptoms. Cervical spine involvement is common and may be asymptomatic, indicating routine cervical spine imaging is needed in patients with RA.

  20. Asymptomatic atlantoaxial subluxation in rheumatoid arthritis.

    Science.gov (United States)

    Nazarinia, Mohammadali; Jalli, Reza; Kamali Sarvestani, Eskandar; Farahangiz, Siamak; Ataollahi, Maryam

    2014-01-01

    This cross-sectional study is conducted to determine the prevalence of asymptomatic cervical spine subluxation in rheumatoid arthritis patients by plain radiographs and its relation to demographic and clinical characteristics, disease activity measures and medications. 100 rheumatoid arthritis patients (18 male and 82 female) were selected randomly, according to the American college of Rheumatology Criteria, who were under follow up in the rheumatology clinic. A complete history was taken, and physical examination has been done with focus on the cervical spine to determine their demographic data, disease duration, age of disease onset, drug history, swollen and tender joint counts, and ESR, Hb, CRP, RF levels. The disease activity of patients with rheumatoid arthritis was measured using the disease activity score 28. Radiographs of the cervical spine included lateral views taken in flexion, extension, neutral position of the neck and anterioposterior and odontoid projection view. Asymptomatic cervical spine subluxation was found in 17 of the 100 patients (17%). The prevalence of, anterior atlantoaxial subluxation, atlantoaxial impaction and subaxial subluxation was 10(10%), 5(5%) and 6(6%), respectively. Posterior subluxation was not detected. The only characteristic that showed meaningful relationship with cervical spine subluxation was CRP (P=0.036). Our results showed that patients with RA, who have cervical spine subluxation cannot be distinguished on the basis of symptoms. Cervical spine involvement is common and may be asymptomatic, indicating routine cervical spine imaging is needed in patients with RA.

  1. Inhotim. Tunga. True Rouge.

    Directory of Open Access Journals (Sweden)

    André Maya Monteiro

    2011-12-01

    Full Text Available This article examines the art installation True Rouge, by the artist Tunga, from its assembly which is in Inhotim. Here there are some of the recurrent procedures, and individualities, which the artist employs in this work, in order to locate it in the corpus of the artist’s work. For this reason, beyond the formal analysis of the work itself, we studied some relationships between the triad artist - work - museum.

  2. Inhotim. Tunga. True Rouge.

    OpenAIRE

    André Maya Monteiro

    2011-01-01

    This article examines the art installation True Rouge, by the artist Tunga, from its assembly which is in Inhotim. Here there are some of the recurrent procedures, and individualities, which the artist employs in this work, in order to locate it in the corpus of the artist’s work. For this reason, beyond the formal analysis of the work itself, we studied some relationships between the triad artist - work - museum.

  3. Did true frogs 'dispersify'?

    Science.gov (United States)

    Chan, Kin Onn; Brown, Rafe M

    2017-08-01

    The interplay between range expansion and concomitant diversification is of fundamental interest to evolutionary biologists, particularly when linked to intercontinental dispersal and/or large scale extinctions. The evolutionary history of true frogs has been characterized by circumglobal range expansion. As a lineage that survived the Eocene-Oligocene extinction event (EOEE), the group provides an ideal system to test the prediction that range expansion triggers increased net diversification. We constructed the most densely sampled, time-calibrated phylogeny to date in order to: (i) characterize tempo and patterns of diversification; (ii) assess the impact of the EOEE; and (iii) test the hypothesis that range expansion was followed by increased net diversification. We show that late Eocene colonization of novel biogeographic regions was not affected by the EOEE and surprisingly, global expansion was not followed by increased net diversification. On the contrary, the diversification rate declined or did not shift following geographical expansion. Thus, the diversification history of true frogs contradicts the prevailing expectation that amphibian net diversification accelerated towards the present or increased following range expansion. Rather, our results demonstrate that despite their dynamic biogeographic history, true frogs diversified at a relatively constantly rate, even as they colonized the major land masses of Earth. © 2017 The Author(s).

  4. Asymptomatic immunoglobulin light chain amyloidosis (AL) at the time of diagnostic bone marrow biopsy in newly diagnosed patients with multiple myeloma and smoldering myeloma. A series of 144 cases and a review of the literature.

    Science.gov (United States)

    Siragusa, Sergio; Morice, William; Gertz, Morie A; Kyle, Robert A; Greipp, Philip R; Lust, John A; Witzig, Thomas E; Lacy, Martha Q; Zeldenrust, Steven R; Rajkumar, S Vincent; Russell, Stephen J; Hayman, Suzanne R; Buadi, Francis; Kumar, Shaji K; Dingli, David; Dispenzieri, Angela

    2011-01-01

    The rate of asymptomatic amyloidosis (AL) among patients with newly diagnosed multiple myeloma (MM) or smoldering multiple myeloma (SMM) is unknown. We evaluated number and clinical significance of asymptomatic AL in consecutive MM and SMM patients, not having recognition of symptomatic AL at the time of their diagnostic bone marrow biopsy. Bone marrow biopsies were stained with Congo red and considered diagnostic for AL in case of positive Congo red staining with apple-green birefringence. Biopsies from 144 patients were evaluated: 77 had a diagnosis of MM and 67 of SMM. The median age was 59 (range 26-84) years; the median follow-up was 76 months (range 0-216). Immunoglobulin isotypes were 96/144 (67%), IgG; 23/144 (16%), IgA; 12/144 (8%), light chain only; 1/77 (1%), IgD; and biclonal or indeterminate, 12/144 (8%). Fifty-eight percent (84/144) were κ restricted. The presence of amyloid was found in two cases (1%, 95% CI -0.6 to 3.2), one in MM, and one in SMM group, and none had or developed signs or symptoms suggestive of organ involvement by amyloid. Among the 142 other patients without amyloid deposition in their index bone marrow, one (0.7%, 95% CI -0.6 to 2.0) developed symptomatic AL after 119 months.

  5. Asymptomatic bacteriuria among pregnant women

    OpenAIRE

    Sudha Biradar Kerure; Rajeshwari Surpur; Sheela S. Sagarad; Sneha Hegadi

    2013-01-01

    Background: Urinary tract infections (UTIs) are the most common bacterial infections during pregnancy. Asymptomatic bacteriuria (ASB) is a major risk factor for the development of urinary tract infections during pregnancy and with further risk of preterm birth & pyelonephritis if untreated. Aims & Objectives: This study was carried out to determine the prevalence of asymptomatic bacteriuria (ASB) in pregnant women & to isolate, identify and establish antimicrobial susceptibility of pathogens....

  6. Prognostic importance of atrial fibrillation in asymptomatic aortic stenosis

    DEFF Research Database (Denmark)

    Greve, Anders; Gerdts, Eva; Boman, Kurt

    2013-01-01

    BACKGROUND: The frequency and prognostic importance of atrial fibrillation (AF) in asymptomatic mild-to-moderate aortic stenosis (AS) has not been well described. METHODS: Clinical examination, electrocardiography and echocardiography were obtained in asymptomatic patients with mild-to-moderate A......BACKGROUND: The frequency and prognostic importance of atrial fibrillation (AF) in asymptomatic mild-to-moderate aortic stenosis (AS) has not been well described. METHODS: Clinical examination, electrocardiography and echocardiography were obtained in asymptomatic patients with mild......-to-moderate AS and preserved left ventricular (LV) systolic function, randomized to simvastatin/ezetimibe combination vs. placebo in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. At inclusion, AF was categorized as episodic or longstanding. Rhythm change was assessed on annual in-study electrocardiograms...

  7. Symptomatic and asymptomatic candidiasis in a pediatric intensive care unit.

    Science.gov (United States)

    Arslankoylu, Ali Ertug; Kuyucu, Necdet; Yilmaz, Berna Seker; Erdogan, Semra

    2011-11-21

    This study aimed to examine the incidence, epidemiology, and clinical characteristics of symptomatic and asymptomatic candidiasis in a pediatric intensive care unit (PICU), and to determine the risk factors associated with symptomatic candidiasis. This retrospective study included 67 patients from a 7-bed PICU in a tertiary care hospital that had Candida-positive cultures between April 2007 and July 2009. Demographic and clinical characteristics of the patients, Candida isolates, antimicrobial and antifungal treatments, and previously identified risk factors for symptomatic candidiasis were recorded, and symptomatic and asymptomatic patients were compared. In all, 36 (53.7%) of the patients with Candida-positive cultures had asymptomatic candidiasis and 31 (46.3%) had symptomatic candidiasis. Candida albicans was the most common Candida sp. in the asymptomatic patients (n = 20, 55.6%), versus Candida parapsilosis in the symptomatic patients (n = 15, 48.4%). The incidence of central venous catheter indwelling, blood transfusion, parenteral nutrition, and surgery was higher in the symptomatic patient group than in the asymptomatic patient group (P candidiasis according to forward stepwise multivariate logistic regression analysis (OR: 6.1; 95% CI: 1.798-20.692). Surgery was the only risk factor significantly associated with symptomatic candidiasis and non-albicans Candida species were more common among the patients with symptomatic candidiasis. While treating symptomatic candidiasis in any PICU an increase in the incidence of non-albicans candidiasis should be considered.

  8. True bursal pigmented villonodular synovitis

    International Nuclear Information System (INIS)

    Abdelwahab, Ibrahim Fikry; Kenan, Samuel; Steiner, German C.; Abdul-Quader, Mohammed

    2002-01-01

    We describe two cases of pigmented villonodular synovitis affecting true bursae. This study was also designed to discuss the term ''pigmented villonodular bursitis'', not confined to true synovial bursae, sometimes creating misunderstanding. (orig.)

  9. True bursal pigmented villonodular synovitis

    Energy Technology Data Exchange (ETDEWEB)

    Abdelwahab, Ibrahim Fikry [Department of Radiology, New York Methodist Hospital, Affiliated with New York Hospital-Cornell Medical Center, Brooklyn, NY (United States); Kenan, Samuel [Department of Orthopedics, New York University Medical Center, NY (United States); Steiner, German C. [Department of Pathology, Hospital for Joint Diseases/Orthopedic Institute, New York, NY (United States); Abdul-Quader, Mohammed [Department of Radiology, New York Presbyterian Hospital, Columbia University, New York, NY (United States)

    2002-06-01

    We describe two cases of pigmented villonodular synovitis affecting true bursae. This study was also designed to discuss the term ''pigmented villonodular bursitis'', not confined to true synovial bursae, sometimes creating misunderstanding. (orig.)

  10. Rationale for and design of the TRUE-AHF trial : The effects of ularitide on the short-term clinical course and long-term mortality of patients with acute heart failure

    NARCIS (Netherlands)

    Packer, Milton; Holcomb, Richard; Abraham, William T.; Anker, Stefan; Dickstein, Kenneth; Filippatos, Gerasimos; Krum, Henry; Maggioni, Aldo P.; McMurray, John J. V.; Mebazaa, Alexandre; O'Connor, Christopher; Peacock, Frank; Ponikowski, Piotr; Ruschitzka, Frank; van Veldhuisen, Dirk J.; Holzmeister, Johannes

    The TRUE-AHF is a randomized, double-blind, parallel-group, placebo-controlled trial which is evaluating the effects of a 48-h infusion of ularitide (15 ng/kg/min) on the short- and long-term clinical course of patients with acute heart failure. Noteworthy features of the study include the early

  11. True and intentionally fabricated memories

    OpenAIRE

    Justice, L.V.; Morrison, C.M.; Conway, M. A.

    2012-01-01

    The aim of the experiment reported here was to investigate the processes underlying the construction of truthful and deliberately fabricated memories. Properties of memories created to be intentionally false - fabricated memories - were compared to properties of memories believed to be true - true memories. Participants recalled and then wrote or spoke true memories and fabricated memories of everyday events. It was found that true memories were reliably more vivid than fabricated memories an...

  12. True and common balsams

    Directory of Open Access Journals (Sweden)

    Dayana L. Custódio

    2012-12-01

    Full Text Available Balsams have been used since ancient times, due to their therapeutic and healing properties; in the perfume industry, they are used as fixatives, and in the cosmetics industry and in cookery, they are used as preservatives and aromatizers. They are generally defined as vegetable material with highly aromatic properties that supposedly have the ability to heal diseases, not only of the body, but also of the soul. When viewed according to this concept, many substances can be considered balsams. A more modern concept is based on its chemical composition and origin: a secretion or exudate of plants that contain cinnamic and benzoic acids, and their derivatives, in their composition. The most common naturally-occurring balsams (i.e. true balsams are the Benzoins, Liquid Storaque and the Balsams of Tolu and Peru. Many other aromatic exudates, such as Copaiba Oil and Canada Balsam, are wrongly called balsam. These usually belong to other classes of natural products, such as essential oils, resins and oleoresins. Despite the understanding of some plants, many plants are still called balsams. This article presents a chemical and pharmacological review of the most common balsams.

  13. True and common balsams

    Directory of Open Access Journals (Sweden)

    Dayana L. Custódio

    2012-08-01

    Full Text Available Balsams have been used since ancient times, due to their therapeutic and healing properties; in the perfume industry, they are used as fixatives, and in the cosmetics industry and in cookery, they are used as preservatives and aromatizers. They are generally defined as vegetable material with highly aromatic properties that supposedly have the ability to heal diseases, not only of the body, but also of the soul. When viewed according to this concept, many substances can be considered balsams. A more modern concept is based on its chemical composition and origin: a secretion or exudate of plants that contain cinnamic and benzoic acids, and their derivatives, in their composition. The most common naturally-occurring balsams (i.e. true balsams are the Benzoins, Liquid Storaque and the Balsams of Tolu and Peru. Many other aromatic exudates, such as Copaiba Oil and Canada Balsam, are wrongly called balsam. These usually belong to other classes of natural products, such as essential oils, resins and oleoresins. Despite the understanding of some plants, many plants are still called balsams. This article presents a chemical and pharmacological review of the most common balsams.

  14. Asymptomatic bacteriuria among an obstetric population in Ibadan.

    Science.gov (United States)

    Awonuga, D O; Dada-Adegbola, H O; Fawole, A O; Olala, F A; Onimisi-Smith, H O

    2011-01-01

    Asymptomatic bacteriuria in pregnancy is the major risk factor for symptomatic urinary tract infection during pregnancy. Screening and identification of bacteriuria during pregnancy have been recommended. To determine the prevalence and pattern of asymptomatic bacteriuria associated with pregnancy. The study was a descriptive, cross sectional survey of pattern of asymptomatic bacteriuria among consecutive patients presenting for the first antenatal visit at a University College Hospital, during a period of two months. Relevant information obtained from all the patients recruited for the study included age, parity, educational level, gestational age and occupation of participant. Haemoglobin electrophoresis patterns were also retrieved and recorded. Main outcome measures were prevalence of asymptomatic bacteriuria, bacterial isolates and their antibiotic sensitivities. There were 205 eligible participants with a mean age of 30.6 ± 4.3 years and a mean gestational age at booking of 20.9 ±7.0 weeks. The prevalence of asymptomatic bacteriuria was 22(10.7%). The isolated pathogens were predominantly coliforms (Klebsiella and E. coli) accounting for 45.5% and Staphylococcus saprophyticus (27.3%). Only gentamycin, nitrofurantoin and ofloxacin demonstrated high efficacy against these uropathogens with antibiotic sensitivity rates of 72.7%-81.8%. Prevalence of asymptomatic bacteriuria in this centre is relatively high. This underscores the need for routine screening of pregnant women for bacteriuria.

  15. A true case story

    Directory of Open Access Journals (Sweden)

    Hanne Bjørg Walker

    2012-08-01

    Full Text Available Autism is not generally recognized as a condition which can be bio-medically influenced. As of today, there are no biomarkers for autism that are recognized by traditional medicine. Treating autism medically is a difficult and hopeless task according to official guidelines (even though it is seldom written in official documents. Parents of many children who have or had an ASD diagnosis have witnessed significant improvements in their children after dietary interventions as well as after interventions with vitamins, minerals and biogene substances which can be bought over the counter. The parents of individual children are their best observers. With a high degree of certainty, they are able to see which substances improve or weaken their children. Their observations are usually accurate, but their rationale for why is often wrong. Observations from parents can often be of greater importance for the child than advice from so called experts. This is a true story about a girl whose parents lost contact with her when she was only 6 months old. In her first 14 days she lost her ability to roll over, to babble and make sounds. She did not look at her parents any more – just stared up at the roof. At 9 months she did not respond to words such as, ‘look at mommy’. Through the parents own experiences with her older siblings and 4 months of frantic searching for a diet that would agree with the child, she made a remarkable journey from 10 months of age to 18 months. There is one thing worth mentioning – she refused to eat solid food throughout this time. The story does not end there. Today she is 12 years old and has had to be regulated with diet and biogene substances every day since she was 4 years old. During the last 5 months she has shown more stability and can even go a day or two without biogene substances as long as she keeps to her dietary plan. If you had just met her and spent a day with her, you would never know.

  16. A true case story.

    Science.gov (United States)

    Walker, Hanne Bjørg

    2012-01-01

    Autism is not generally recognized as a condition which can be bio-medically influenced. As of today, there are no biomarkers for autism that are recognized by traditional medicine. Treating autism medically is a difficult and hopeless task according to official guidelines (even though it is seldom written in official documents). Parents of many children who have or had an ASD diagnosis have witnessed significant improvements in their children after dietary interventions as well as after interventions with vitamins, minerals and biogene substances which can be bought over the counter. The parents of individual children are their best observers. With a high degree of certainty, they are able to see which substances improve or weaken their children. Their observations are usually accurate, but their rationale for why is often wrong. Observations from parents can often be of greater importance for the child than advice from so called experts. This is a true story about a girl whose parents lost contact with her when she was only 6 months old. In her first 14 days she lost her ability to roll over, to babble and make sounds. She did not look at her parents any more - just stared up at the roof. At 9 months she did not respond to words such as, 'look at mommy'. Through the parents own experiences with her older siblings and 4 months of frantic searching for a diet that would agree with the child, she made a remarkable journey from 10 months of age to 18 months. There is one thing worth mentioning - she refused to eat solid food throughout this time. The story does not end there. Today she is 12 years old and has had to be regulated with diet and biogene substances every day since she was 4 years old. During the last 5 months she has shown more stability and can even go a day or two without biogene substances as long as she keeps to her dietary plan. If you had just met her and spent a day with her, you would never know.

  17. Asymptomatic carotid artery stenosis: state of the art management.

    Science.gov (United States)

    Naylor, A R

    2013-02-01

    In 2011, numerous guidelines were updated to advise on the optimal management of patients with asymptomatic carotid disease. Despite being based on interpretation of the same body of literature, there was actually little international consensus. Whilst we now know much more about what constitutes "state of the art" medical management, we still cannot identify the small proportion of "high risk for stroke" patients in whom to target carotid endarterectomy or carotid artery stenting. This is essential, as about 95% of patients undergoing either treatment strategy will ultimately undergo an unnecessary intervention. There is compelling evidence that the annual risk of stroke (on medical therapy) in patients with asymptomatic carotid disease has declined significantly. Guideline makers cannot continue to extrapolate rationales for justifying "mass interventions" in contemporary practice that are based on historical trial data. Accordingly, there is no consensus as to what should be considered "state of the art" management of asymptomatic carotid disease.

  18. Giant true celiac artery aneurysm

    International Nuclear Information System (INIS)

    Aljabri, Badr

    2009-01-01

    Celiac artery aneurysms are rare and usually asymptomatic. The management of these aneurysms is challenging, especially when they are large and involve the confluence of the trifurcation. We present here a case of a large celiac artery aneurysm involving its branches in a young woman. Preoperative investigations, intraoperative findings, and the operative procedure are also presented and discussed. (author

  19. Asymptomatic carriers contribute to nosocomial Clostridium difficile infection

    DEFF Research Database (Denmark)

    Blixt, Thomas; Gradel, Kim Oren; Homann, Christian

    2017-01-01

    BACKGROUND & AIMS: Nosocomial infection with Clostridium difficile pose a considerable problem despite numerous attempts by health care workers to reduce risk of transmission. Asymptomatic carriers of C difficile might spread their infection to other patients. We investigated the effects of of as......BACKGROUND & AIMS: Nosocomial infection with Clostridium difficile pose a considerable problem despite numerous attempts by health care workers to reduce risk of transmission. Asymptomatic carriers of C difficile might spread their infection to other patients. We investigated the effects...... quartile to 4.2% in the highest quartile of exposed patients (P=.026). Combining the load of exposure to carriers and length of stay seemed to have an additive effect on the risk of contracting C difficile. CONCLUSIONS: In a population-based prospective cohort study in Denmark, we found that asymptomatic...

  20. The true cost of burn.

    Science.gov (United States)

    Ahn, Chris S; Maitz, Peter K M

    2012-11-01

    It is difficult to define the true cost of a burns injury, however there has always been a consensus that the costs associated with burns care are high. This study aims to achieve an accurate calculation of the cost of acute burns care in an Australian context. A retrospective review of 20 adult burn patients treated at our Centre was performed. An itemized price list was prepared based on items, services and equipment actually utilized in the care of burns patients. Case records were reviewed for a count of quantities to calculate costs for each item. Regression analysis was performed to produce a cost vs %TBSA curve for cost prediction. A cost breakdown was also performed for analysis of the most significant areas of expenditure and their trends with %TBSA. The cost calculated for an average adult burns patient was AU$71,056 (US$73,532). The total cost of all 20 patients was AU$2,449,112 (US$2,534,464). %TBSA injured was confirmed as the primary determinant of cost. Hospital length of stay, operative costs, dressings and staffing were found to be the most significant components of cost and increased most prominently with %TBSA. Compared to our findings, expenditure for prevention and education programs is minimal. There is limited conclusive evidence that changes in management protocols have had successful impact on the cost of burns treatment. Future progress in burns management may effect factors such as hospital length of stay, however until such changes, resource allocation should recognize the importance of prevention and its success at reduction of injury severity for real reductions in cost of burns care. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

  1. Prevalence and pattern of asymptomatic bacteriuria among ...

    African Journals Online (AJOL)

    Most of the cultured organism (89%) were sensitive to Nitrofurantoin. Conclusion: The prevalence of asymptomatic bacteriuria among pregnant women at the UPTH is high. The most prevalent organism was Klebsiella. Keywords: Asymptomatic bacteriuria, Prevalence, Pattern, Klebsiella, Nitrofurantion, Morbidity ...

  2. Clinical evaluation of asymptomatic sinus disease detected by MRI

    International Nuclear Information System (INIS)

    Iwabuchi, Yasuo; Hanamure, Yutaka; Hirota, Johji; Ohyama, Masaru

    1994-01-01

    The detection of lesions of the paranasal sinuses as incidental findings during magnetic resonance imaging of patients suspected of intracranial disease who have no nasal symptoms has been far more common than we expected. The present study was performed on 325 patients with a mean age of 60.7 years. Medical histories were taken whether they had any nasal symptoms or not. Asymptomatic sinus disease was present in 41.6% of the 257 patients who had no nasal symptoms, and 9.7% of the patients had either marked mucosal thickening, excessive fluid or polyps in the maxillary sinuses. Although the mean age of these patients was comparatively high, we can infer that 1 in 10 have relatively severe sinus lesions. Mucociliary transport time was measured using the saccharin method in 15 patients who had sinus disease but no nasal symptoms. The mean transport time was 15.6 minutes and within normal limits. Routine ENT examination revealed no lesions in the nasal cavity of any of the subjects. We classified the patients with asymptomatic sinus disease into two groups -- group A: patients with sinus disease associated with some nasal manifestations but who did not complain about them, and group B: patients who had sinus disease but did not have any nasal problems. Group B represents genuine asymptomatic sinus disease in the narrow sense. Most asymptomatic patients in this study appeared to belong to group B. They had some sinus disease, but because their mucociliary function in their nasal cavity was normal, they did not have any nasal symptoms. When we find patients with asymptomatic sinus disease, we have to determine which group they belong to by examining their nasal cavity and measuring their saccharin time. Patients in group A should be medically treated, but those in group B should be followed without medical treatment. (author)

  3. Petechiae and vasculitis in asymptomatic primary biliary cirrhosis

    DEFF Research Database (Denmark)

    Diederichsen, H; Sørensen, P G; Mickley, H

    1985-01-01

    Recurrent petechiae of the lower legs and signs of asymptomatic primary biliary cirrhosis have been found in three women. Large immune complexes were identified in the serum of three and cryoglobulin/cryofibrinogen in two. Histological examination of skin biopsies revealed a leukocytoclastic...... vasculitis in all three patients. Direct immunofluorescent studies showed deposits of IgM, C3 and fibrinogen in and around the walls of the small vessels of the skin of two and C3 as well as fibrinogen in one patient. It is suggested that leukocytoclastic vasculitis may be a microscopic feature...... of the systemic involvement in asymptomatic primary biliary cirrhosis, and petechiae the clinical manifestation....

  4. Clonal Diversity of Chilean Isolates of Enterohemorrhagic Escherichia coli from Patients with Hemolytic-Uremic Syndrome, Asymptomatic Subjects, Animal Reservoirs, and Food Products

    Science.gov (United States)

    Rios, Maritza; Prado, Valeria; Trucksis, Michele; Arellano, Carolina; Borie, Consuelo; Alexandre, Marcela; Fica, Alberto; Levine, Myron M.

    1999-01-01

    To determine clonal relationship among Chilean enterohemorrhagic Escherichia coli (EHEC) strains from different sources (clinical infections, animal reservoirs, and food), 54 EHEC isolates (44 of E. coli O157, 5 of E. coli O111, and 5 of E. coli O26) were characterized for virulence genes by colony blot hybridization and by pulsed-field gel electrophoresis (PFGE). By colony blotting, 12 different genotypes were identified among the 44 E. coli O157 isolates analyzed, of which the genetic profile stx1+ stx2+ hly+ eae+ was the most prevalent. All human O157 strains that were associated with sporadic cases of hemolytic-uremic syndrome (HUS) carried both the stx1 and stx2 toxin-encoding genes and were eaeA positive. Only 9 of 13 isolates from human controls were stx1+ stx2+, and 8 carried the eaeA gene. Comparison of profiles obtained by PFGE of XbaI-digested genomic DNA showed a great diversity among the E. coli O157 isolates, with 37 different profiles among 39 isolates analyzed. Cluster analysis of PFGE profiles showed a wide distribution of clinical isolates obtained from HUS cases and asymptomatic individuals and a clonal relationship among O157 isolates obtained from HUS cases and pigs. Analysis of virulence genes showed that a correlation exists among strains with the genotype stx1+ stx2+ eae+ and pathogenic potential. A larger difference in the PFGE restriction patterns was observed among the EHEC strains of serogroups O26 and O111. These results indicate that several different EHEC clones circulate in Chile and suggest that pigs are an important animal reservoir for human infections by EHEC. Guidelines have been proposed for better practices in the slaughter of animals in Chile. PMID:9986852

  5. Spirometry screening for airway obstruction in asymptomatic smokers.

    Science.gov (United States)

    Wisnivesky, Juan; Skloot, Gwen; Rundle, Andrew; Revenson, Tracey A; Neugut, Alfred

    2014-07-01

    Screening spirometry might help identify patients with chronic obstructive pulmonary disease (COPD) at an earlier stage. In this study, we evaluated the prevalence of airway obstruction in a cohort of asymptomatic smokers who underwent spirometry as part of a routine health maintenance examination. The study cohort consisted of a consecutive sample of 386 asymptomatic smokers (≥5 pack-years) without a history of COPD or asthma, who completed spirometry testing as part of a routine health maintenance examination. Overall, 9 study subjects (2.3%, 95% confidence interval: 1.1-4.4%) had evidence of airway obstruction on spirometry. Univariate and multiple regression analyses showed that the risk of airway obstruction was not significantly associated with age, sex, race, smoking history or past history of respiratory symptoms. Spirometry screening of asymptomatic smokers may help detect a small number of patients with airway obstruction who are at high risk for COPD.

  6. Evolution of subclinical myocardial dysfunction detected by two-dimensional and three-dimensional speckle tracking in asymptomatic type 1 diabetic patients: a long‑-term follow-up study

    Directory of Open Access Journals (Sweden)

    Anne Ringle

    2017-11-01

    Full Text Available Background: We sought to assess the long-term evolution of left ventricular (LV function using two-dimensional (2D and three-dimensional (3D speckle tracking echocardiography (STE for the detection of preclinical diabetic cardiomyopathy, in asymptomatic type 1 diabetic patients, over a 6-year follow-up. Design and methods: Sixty-six asymptomatic type 1 diabetic patients with no cardiovascular risk factors were compared to 26 matched healthy controls. Conventional, 2D and 3D-STE were performed at baseline. A subgroup of 14 patients underwent a 6-year follow-up evaluation. Results: At baseline, diabetic patients had similar LV ejection fraction (60 vs 61%; P = NS, but impaired longitudinal function, as assessed by 2D-global longitudinal strain (GLS (−18.9 ± 2 vs −20.5 ± 2; P = 0.0002 and 3D-GLS (−17.5 ± 2 vs −19 ± 2; P = 0.003. At follow-up, diabetic patients had worsened longitudinal function compared to baseline (2D-GLS: −18.4 ± 1 vs −19.2 ± 1; P = 0.03. Global circumferential (GCS and radial (GRS strains were unchanged at baseline and during follow-up. Metabolic status did not correlate with GLS, whereas GCS and GRS showed a good correlation, suggestive of a compensatory increase of circumferential and radial functions in advanced stages of the disease – long-term diabetes (GCS: −26 ± 3 vs −23.3 ± 3; P = 0.008 and in the presence of microvascular complications (GRS: 38.8 ± 9 vs 34.3 ± 8; P = 0.04. Conclusions: Subclinical myocardial dysfunction can be detected by 2D and 3D-STE in type 1 diabetic patients, independently of any other cardiovascular risk factors. Diabetic cardiomyopathy progression was suggested by a mild decrease in longitudinal function at the follow-up, but did not extend to a clinical expression of the disease, as no death or over heart failure was reported.

  7. VAGINAL PROGESTERONE IN WOMEN WITH AN ASYMPTOMATIC SONOGRAPHIC SHORT CERVIX IN THE MIDTRIMESTER DECREASES PRETERM DELIVERY AND NEONATAL MORBIDITY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF INDIVIDUAL PATIENT DATA

    Science.gov (United States)

    ROMERO, Roberto; NICOLAIDES, Kypros; CONDE-AGUDELO, Agustin; TABOR, Ann; O’BRIEN, John M.; CETINGOZ, Elcin; DA FONSECA, Eduardo; CREASY, George; KLEIN, Katharina; RODE, Line; SOMA-PILLAY, Priya; FUSEY, Shalini; CAM, Cetin; ALFIREVIC, Zarko; HASSAN, Sonia S.

    2012-01-01

    OBJECTIVE To determine whether the use of vaginal progesterone in asymptomatic women with a sonographic short cervix in the mid-trimester reduces the risk of preterm birth and improves neonatal morbidity and mortality. STUDY DESIGN Individual patient data meta-analysis of randomized controlled trials. RESULTS Five trials of high quality were included with a total of 775 women and 827 infants. Treatment with vaginal progesterone was associated with a significant reduction in the rate of preterm birth <33 weeks (RR 0.58, 95% CI 0.42–0.80), <35 weeks (RR 0.69, 95% CI 0.55–0.88) and <28 weeks (RR 0.50, 95% CI 0.30–0.81), respiratory distress syndrome (RR 0.48, 95% CI 0.30–0.76), composite neonatal morbidity and mortality (RR 0.57, 95% CI 0.40–0.81), birth weight <1500 g (RR 0.55, 95% CI 0.38–0.80), admission to NICU (RR 0.75, 95% CI 0.59–0.94), and requirement for mechanical ventilation (RR 0.66, 95% CI 0.44–0.98). There were no significant differences between the vaginal progesterone and placebo groups in the rate of adverse maternal events or congenital anomalies. CONCLUSION Vaginal progesterone administration to asymptomatic women with a sonographic short cervix reduces the risk of preterm birth and neonatal morbidity and mortality. PMID:22284156

  8. Asymptomatic population reference values for three knee patient-reported outcomes measures: evaluation of an electronic data collection system and implications for future international, multi-centre cohort studies.

    Science.gov (United States)

    McLean, James M; Brumby-Rendell, Oscar; Lisle, Ryan; Brazier, Jacob; Dunn, Kieran; Gill, Tiffany; Hill, Catherine L; Mandziak, Daniel; Leith, Jordan

    2018-05-01

    The aim was to assess whether the Knee Society Score, Oxford Knee Score (OKS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) were comparable in asymptomatic, healthy, individuals of different age, gender and ethnicity, across two remote continents. The purpose of this study was to establish normal population values for these scores using an electronic data collection system. There is no difference in clinical knee scores in an asymptomatic population when comparing age, gender and ethnicity, across two remote continents. 312 Australian and 314 Canadian citizens, aged 18-94 years, with no active knee pain, injury or pathology in the ipsilateral knee corresponding to their dominant arm, were evaluated. A knee examination was performed and participants completed an electronically administered questionnaire covering the subjective components of the knee scores. The cohorts were age- and gender-matched. Chi-square tests, Fisher's exact test and Poisson regression models were used where appropriate, to investigate the association between knee scores, age, gender, ethnicity and nationality. There was a significant inverse relationship between age and all assessment tools. OKS recorded a significant difference between gender with females scoring on average 1% lower score. There was no significant difference between international cohorts when comparing all assessment tools. An electronic, multi-centre data collection system can be effectively utilized to assess remote international cohorts. Differences in gender, age, ethnicity and nationality should be taken into consideration when using knee scores to compare to pathological patient scores. This study has established an electronic, normal control group for future studies using the Knee society, Oxford, and KOOS knee scores. Diagnostic Level II.

  9. An application of structural equation modeling to detect response shifts and true change in quality of life data from cancer patients undergoing invasive surgery

    NARCIS (Netherlands)

    Oort, Frans J.; Visser, Mechteld R. M.; Sprangers, Mirjam A. G.

    2005-01-01

    The objective is to show how structural equation modeling can be used to detect reconceptualization, reprioritization, and recalibration response shifts in quality of life data from cancer patients undergoing invasive surgery. A consecutive series of 170 newly diagnosed cancer patients,

  10. Insight into alteration of gut microbiota in Clostridium difficile infection and asymptomatic C. difficile colonization.

    Science.gov (United States)

    Zhang, Lihua; Dong, Danfeng; Jiang, Cen; Li, Zhen; Wang, Xuefeng; Peng, Yibing

    2015-08-01

    Clostridium difficile is well recognized as the common pathogen of nosocomial diarrhea, meanwhile, asymptomatic colonization with C. difficile in part of the population has also drawn public attention. Although gut microbiota is known to play an important role in the pathogenesis of C. difficile infection (CDI), whether there is any alteration of gut microbial composition in asymptomatic C. difficile carriers hasn't been clearly described. The purpose of this study was to explore the differences in gut microbiome among CDI patients, asymptomatic C. difficile carriers and healthy individuals. We performed fecal microbiota analysis on the samples of eight CDI patients, eight asymptomatic C. difficile carriers and nine healthy subjects using 16S rRNA gene pyrosequencing. CDI patients and asymptomatic carriers showed reduced microbial richness and diversity compared with healthy subjects, accompanied with a paucity of phylum Bacteroidetes and Firmicutes as well as an overabundance of Proteobacteria. Some normally commensal bacteria, especially butyrate producers, were significantly depleted in CDI patients and asymptomatic carriers. Furthermore, the differences observed in microbial community structure between CDI patients and asymptomatic carriers suggested that the gut microbiota may be a potential factor of disease state for CDI. Our study demonstrates the characterization and diversity of gut microbiota in CDI and asymptomatic C. difficile colonization, which will provide new ideas for surveillance of the disease state and development of microbiota-targeted agents for CDI prevention and treatment. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Multislice computed tomography in an asymptomatic high-risk population.

    Science.gov (United States)

    Romeo, Francesco; Leo, Roberto; Clementi, Fabrizio; Razzini, Cinzia; Borzi, Mauro; Martuscelli, Eugenio; Pizzuto, Francesco; Chiricolo, Gaetano; Mehta, Jawahar L

    2007-02-01

    Approximately 50% of all acute coronary syndromes occur in previously asymptomatic patients. This study evaluated the value of multislice computed tomography for early detection of significant coronary artery disease (CAD) in high-risk asymptomatic subjects. One hundred sixty-eight asymptomatic subjects with >or=1 major risk factor (hypertension, diabetes, hypercholesterolemia, family history, or smoking) and an inconclusive or unfeasible noninvasive stress test result (stress electrocardiography, echocardiography, or nuclear scintigraphy) were evaluated in an outpatient setting. After clinical examination and laboratory risk analysis, all patients underwent multislice computed tomographic (MSCT) coronary angiography within 1 week. In all subjects, conventional coronary angiography was also carried out. Multislice computed tomography displayed single-vessel CAD in 16% of patients, 2-vessel CAD in 7%, and 3-vessel CAD in 4%. Selective coronary angiography confirmed the results of multislice computed tomography in 99% of all patients. Sensitivity and specificity of MSCT coronary angiography were 100% and 98%, respectively, with a positive predictive value of 95% and a negative predictive value of 100%. In conclusion, MSCT coronary angiography is an excellent noninvasive technique for early identification of significant CAD in high-risk asymptomatic patients with inconclusive or unfeasible noninvasive stress test results.

  12. True constructive interference in the steady state (trueCISS).

    Science.gov (United States)

    Hilbert, Tom; Nguyen, Damien; Thiran, Jean-Philippe; Krueger, Gunnar; Kober, Tobias; Bieri, Oliver

    2018-04-01

    To introduce a novel time-efficient method, termed true constructive interference in the steady state (trueCISS), that not only solves the problem of banding artifacts for balanced steady-state free precession (bSSFP) but also provides its genuine, that is, true, on-resonant signal. After a compressed sensing reconstruction from a set of highly undersampled phase-cycled bSSFP scans, the local off-resonance, relaxation time ratio, and equilibrium magnetization are voxel-wise estimated using a dictionary-based fitting routine. Subsequently, on-resonant bSSFP images are generated using the previously estimated parameters. Due to the high undersampling factors used, the acquisition time is not prolonged with respect to a standard CISS acquisition. From a set of 16 phase-cycled SSFP scans in combination with an eightfold undersampling, both phantom and in vivo whole-brain experiments demonstrate that banding successfully can be removed. Additionally, trueCISS allows the derivation of synthetic bSSFP images with arbitrary flip angles, which enables image contrasts that may not be possible to acquire in practice due to safety constraints. TrueCISS offers banding-free bSSFP images with on-resonant signal intensity and without requiring additional acquisition time compared to conventional methods. Magn Reson Med 79:1901-1910, 2018. © 2017 International Society for Magnetic Resonance in Medicine. © 2017 International Society for Magnetic Resonance in Medicine.

  13. Coronary artery calcium score using electron beam tomography in the patients with acute obstructive coronary arterial disease : comparative study within asymptomatic high-risk group of atherosclerosis and chronic obstructive coronary arterial disease group

    International Nuclear Information System (INIS)

    Ryu, Seok Jong; Choi, Byoung Wook; Choe, Kyu Ok

    2001-01-01

    To compare, through analysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrome between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD croup (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. The mean CA score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.0006). The mean CAC score at the sixth decade was also significantly different between group I(81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC +1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly

  14. Coronary artery calcium score using electron beam tomography in the patients with acute obstructive coronary arterial disease : comparative study within asymptomatic high-risk group of atherosclerosis and chronic obstructive coronary arterial disease group

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Seok Jong; Choi, Byoung Wook; Choe, Kyu Ok [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    2001-04-01

    To compare, through analysis of the coronary artery calcium (CAC) score and the risk factors for atherosclerosis, the characteristics of acute coronary syndrome between an asymptomatic high-risk group of atherosclerosis patients and a chronic coronary arterial obstructive disease(CAOD) group. The CAC scores of an asymptomatic high-risk group of atherosclerosis patients (group I, n=284), a chronic CAOD croup (group II, n=39) and an acute coronary syndrome group (group III, n=21) were measured by electron beam tomography. Forty-seven patients with CAOD from groups II and III underwent coronary angiography, and we scrutinized age, sex and risk factors including diabetes mellitus, hypertension, obesity, smoking, hypercholesterolemia and low high-density lipoproteinemia. The numbers of stenotic coronary arterial branches and degree of stenosis revealed by coronary angiography were also recorded. We determined the differences between the three groups in terms of CAC score and the risk factors, the relationship between CAC score and risk factors, and the characteristic features of each type of CAOD group. The mean CA score of group III (135.1) was not statistically different from that of group I (135.7) or group II (365.8). Among patients aged below 50, the mean CAC score of group III (127.4) was significantly higher than that of group I (6.2), (p=0.0006). The mean CAC score at the sixth decade was also significantly different between group I(81.5) and group II (266.9). The mean age of group III (54.2 years) was significantly lower than that of group I (58.1 years) (p=0.047) and of group II (60.1) (p=0.022). There was significant correlation between the number of stenotic coronary arterial branches and log(CAC +1) (p<.01). The square root of the CAC score and the maximal degree of stenosis was also well correlated (p<.01). There was no difference in the mean number of risk factors among the three groups, though the incidence of smoking in group III was significantly

  15. Time and money: the true costs of health care utilization for patients receiving ‘free’ HIV/TB care and treatment in rural KwaZulu-Natal

    Science.gov (United States)

    Chimbindi, Natsayi; Bor, Jacob; Newell, Marie-Louise; Tanser, Frank; Baltusen, Rob; Hontelez, Jan; de Vlas, Sake; Lurie, Mark; Pillay, Deenan; Bärnighausen, Till

    2015-01-01

    Background HIV and TB services are provided free-of-charge in many sub-Saharan African countries, but patients still incur costs. Methods Patient-exit interviews were conducted with a representative sample of 200 HIV-infected patients not yet on ART (pre-ART), 300 ART patients, and 300 TB patients receiving public sector care in rural South Africa. For each group, we calculated health expenditures across different spending categories, time spent traveling to and utilizing services, and how patients financed their spending. Associations between patient group and costs were assessed in multivariate regression models. Results Total monthly health expenditures (1 USD = 7.3 South African Rand, ZAR) were: ZAR 171 (95% CI 134, 207) for pre-ART, ZAR 164 (95% CI 141, 187) for ART, and ZAR 122 (95% CI 105, 140) for TB patients (p=0.01). Total monthly time costs (in hours) were: 3.4 (95% CI 3.3, 3.5) for pre-ART, 5.0 (95% CI 4.7, 5.3) for ART and 3.2 (95% CI 2.9, 3.4) for TB patients (pART patients spent on average ZAR 29.2 more on traditional healers and ZAR 25.9 more on chemists and private doctors than ART patients, while ART patients spent ZAR 34.0 more than pre-ART patients on transport to clinics (pART, 39% of ART and 41% of TB patients borrowed money or sold assets to finance health costs. Conclusions Patients receiving nominally free care for HIV/TB face large private costs, commonly leading to financial distress. Subsidized transport, fewer clinic visits, and drug pickup points closer to home could reduce costs for ART patients, potentially improving retention and adherence. Large expenditure on alternative care among pre-ART patients suggests that transitioning patients to ART earlier, as under HIV treatment-as-prevention policies, may not substantially increase patients’ financial burden. PMID:26371611

  16. Prevalence and risk factors of asymptomatic bacteriuria in pregnancy

    Directory of Open Access Journals (Sweden)

    Ghafarnezhad M

    2001-07-01

    Full Text Available Asymptomatic bacteriuria is prevalent during pregnancy. It can lead to pyelonephritis, premature pregnancy and low birth weight. In this prospective study, to determine prevalence and risk factors of asymptomatic bacteriuria, 205 consecutive pregnant women who visited our prenatal care clinic in Mirza-Koochakkhan Hospital and had no urinary symptom were entered. Patients data were recorded using a questionnaire and urine samples were obtained for urinalysis and urine culture. We analysed data by using fisher exact and chi-squared test. 14 cases had positive urine culture (6.8%. Significant correlation was seen between asymptomatic bacteriuria and age, parity, past history of kidney stone, pyelonephritis, urinary tract infection, preterm delivery and pyuria pvalue <0.05. We suggest routine urine culture in first visit of high risk and 16th week of low risk pregnancies.

  17. Giant Dissecting Aortic Aneurysm in an Asymptomatic Young Male

    Directory of Open Access Journals (Sweden)

    Priyank Shah

    2015-01-01

    Full Text Available Giant aortic aneurysm is defined as aneurysm in the aorta greater than 10 cm in diameter. It is a rare finding since most patients will present with complications of dissection or rupture before the size of aneurysm reaches that magnitude. Etiological factors include atherosclerosis, Marfan’s syndrome, giant cell arteritis, tuberculosis, syphilis, HIV-associated vasculitis, hereditary hemorrhagic telangiectasia, and medial agenesis. Once diagnosed, prompt surgical intervention is the treatment of choice. Although asymptomatic unruptured giant aortic aneurysm has been reported in the literature, there has not been any case of asymptomatic giant dissecting aortic aneurysm reported in the literature thus far. We report a case of giant dissecting ascending aortic aneurysm in an asymptomatic young male who was referred to our institution for abnormal findings on physical exam.

  18. Asymptomatic malaria and associated factors among blood donors ...

    African Journals Online (AJOL)

    Dr.Mirambo

    and Allied Sciences, Mwanza, Tanzania. Abstract. Background: Blood transfusion saves life of patients with severe anaemia. However, blood transfusion can transmit blood-borne parasites. Despite malaria being endemic in Tanzania, there is limited information on asymptomatic malaria among blood donors. This study ...

  19. Asymptomatic Bacteriuria in Diabetes Mellitus | Joffe | South African ...

    African Journals Online (AJOL)

    A study was undertaken to determine the frequency of asymptomatic bacteriuria among 100 ambulant diabetic patients attending a diabetic outpatient clinic. At the same time, we assessed the reliability of the Uricult dip-slide method for detecting urinary bacterial growth. Significant bacteriuria occurred in 9% of the total ...

  20. The Prevalence and Outcome of Asymptomatic Chlamydial Infection ...

    African Journals Online (AJOL)

    the prevalence of asymptomatic Chlamydia trachomatis is more than or equal to 3%.[12,13] They argued that such screening will assist in further evaluation of the patient's previous STIs and also prevent flaring of a sub‑clinical infection after instrumentation procedures such as HSG, laparoscopy and or endometrial biopsy.

  1. Asymptomatic bacteriuria Escherichia coli strains

    DEFF Research Database (Denmark)

    Hancock, Viktoria; Nielsen, E.M.; Klemm, Per

    2006-01-01

    Urinary tract infections (UTIs) affect millions of people each year. Escherichia coli is the most common organism associated with asymptomatic bacteriuria (ABU) in humans. Persons affected by ABU may carry a particular E. coli strain for extended periods of time without any symptoms. In contrast...... to uropathogenic E. coli (UPEC) that cause symptomatic UTI, very little is known about the mechanisms by which these strains colonize the urinary tract. Here, we have investigated the growth characteristics in human urine as well as adhesin repertoire of nine ABU strains; the ability of ABU strains to compete...

  2. A phase 2 study of OSI-906 (linsitinib, an insulin-like growth factor receptor-1 inhibitor) in patients with asymptomatic or mildly symptomatic (non-opioid requiring) metastatic castrate resistant prostate cancer (CRPC).

    Science.gov (United States)

    Barata, Pedro; Cooney, Matthew; Tyler, Allison; Wright, John; Dreicer, Robert; Garcia, Jorge A

    2018-02-23

    Background The inhibition of insulin-like growth factor receptor-1 (IGF-1R) induces cell cycle arrest and enhancing the effect of castration by delay of progression of human prostate cancer models. Linsitinib is a small molecule and potent dual inhibitor of IGF-1R and insulin receptor tyrosine kinase activity. We report results of a single-arm, phase II study evaluating the safety and efficacy of linsitinib in men with chemotherapy-naïve asymptomatic or mildly symptomatic metastatic castration resistant prostate cancer (mCRPC). Methods Patients received at 150 mg orally twice daily on a 28-day cycle. The primary endpoint was prostate specific (PSA) response at 12 weeks and correlative studies included circulating tumor cells (CTCs) and circulating endothelial cells (CECs). Results Seventeen patients, median age 68 (55-78) and pre-treatment PSA of 55.23 (2.46-277.60) were enrolled and completed 12 weeks of therapy. All but two patients discontinued therapy secondary to PSA progression, which met the predefined futility criteria and led to early termination of this study. Overall best response (RECIST v1.1) included a partial response in 1 patient and stable disease in 8 patients. Higher baseline CTCs were associated with higher pre-treatment PSA levels (Spearman r = 0.49, p = 0.04) but no correlation between PSA progression and CTCs/CECs were observed. Most common adverse events included fatigue, nausea/vomiting, AST/ALT changes and prolonged QT interval. Conclusions Single-agent linsitinib was safe and well tolerated but failed to show activity in men with mCRPC. These results highlight the complexity of using IGF-1R as a therapeutic target in this patient population. ClinicalTrials.gov NCT01533246.

  3. Ameloblastic fibroma: a stage in the development of a hamartomatous odontoma or a true neoplasm? Critical analysis of 162 previously reported cases plus 10 new cases.

    Science.gov (United States)

    Buchner, Amos; Vered, Marilena

    2013-11-01

    To analyze neoplastic and hamartomatous variants of ameloblastic fibromas (AFs). Analysis of 172 cases (162 previously reported, 10 new). AF emerged as a lesion primarily of children and adolescents (mean age, 14.9 years), with about 80% diagnosed when odontogenesis is completed (age, 22 years are considered true neoplasms, while those in younger patients may be either true neoplasms or odontomas in early stages of development. Although the histopathology of hamartomatous and neoplastic variants of AF are indistinguishable, clinical and radiologic features can be of some help to distinguish between them. Asymptomatic small unilocular lesions with no or minimal bone expansion in young individuals are likely to be developing odontomas, and large, expansile lesions with extensive bone destruction are neoplasms. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Management of Asymptomatic Renal Stones in Astronauts

    Science.gov (United States)

    Reyes, David; Locke, James

    2016-01-01

    significance. However, a small asymptomatic MRM or stone within the renal collecting system may become symptomatic, and so affect launch and flight schedules, cause incapacitation during flight, and ultimately require medical evacuation. For exploration class missions, evacuation is unlikely. The new screening and management algorithm allows better management of mission risks, and will define the true incidence of renal stones in U.S. astronauts. This information will be used to refine future screening, countermeasures and treatment methods; and will also inform the needed capabilities to be flown on exploration-class missions.

  5. Pacientes assintomáticos apresentam infecção relacionada ao cateter venoso utilizado para terapia nutricional parenteral Asymptomatic patients present infection related to the central venous catheter used for total parenteral nutrition

    Directory of Open Access Journals (Sweden)

    Juliana Deh Carvalho Machado

    2009-12-01

    . Sixty-eight percent of the catheters were infected: 72% of them were from Group 1 and 28% from Group 2 (asymptomatic patients. Systemic infection was diagnosed in 70% of the patients from Group 1. Positive blood culture was found in 17% of the patients from Group 2. The microorganisms found were: Staphylococcus sp. (48%, Candida sp. (21%, Enterococcus faecalis (16%, Pseudomonas aerurginosa (10% and Proteus sp. (5%. CONCLUSION: Central venous catheter infection is common in hospitalized asymptomatic patients. Patients receiving total parenteral nutrition are most frequently infected with Candida sp. Therefore, the creation of barriers that block colonization in the central venous catheter is essential to decrease the morbidity and mortality among patients that depend on total parenteral nutrition.

  6. Development and pilot feasibility study of a health information technology tool to calculate mortality risk for patients with asymptomatic carotid stenosis: the Carotid Risk Assessment Tool (CARAT).

    Science.gov (United States)

    Faerber, Adrienne E; Horvath, Rebecca; Stillman, Carey; O'Connell, Melissa L; Hamilton, Amy L; Newhall, Karina A; Likosky, Donald S; Goodney, Philip P

    2015-03-24

    Patients with no history of stroke but with stenosis of the carotid arteries can reduce the risk of future stroke with surgery or stenting. At present, a physicians' ability to recommend optimal treatments based on an individual's risk profile requires estimating the likelihood that a patient will have a poor peri-operative outcomes and the likelihood that the patient will survive long enough to gain benefit from the procedure. We describe the development of the CArotid Risk Assessment Tool (CARAT) into a 2-year mortality risk calculator within the electronic medical record, integrating the tool into the clinical workflow, training the clinical team to use the tool, and assessing the feasibility and acceptability of the tool in one clinic setting. We modified an existing clinical flowsheet with the local electronic medical record for the CARAT risk model. To understand how CARAT would fit into the existing clinical workflow, we observed the clinic and talked with the clinical staff to develop a process map for the existing clinical workflow. CARAT was completed by the clinic nurse for patients identified on the clinic schedule as having carotid narrowing. We analyzed post-implementation assessment in two ways: quantifying the proportion of eligible patients with whom CARAT was utilized, and surveying surgeons to understand the impact of CARAT on decision-making and clinical workflow. With minimum investment of institutional resources, we were able to produce a workable tool and pilot the tool in our clinic within a 6 month time period. Over 4 months, 287 patients were seen in the clinic with carotid narrowing, and clinic staff completed CARAT for 195 (68%). Per-surgeon completion rates ranged from 29 to 81%. Most patients (191 of 195, 98%) patients had a low 2-year calculated mortality risk. Most surgeons believed the risk assessment aligned with their expectations of patient predicted risk. We successfully integrated CARAT into the existing electronic medical

  7. Advanced Asymptomatic Carotid Disease and Cognitive Impairment: An Understated Link?

    Directory of Open Access Journals (Sweden)

    Irena Martinić-Popović

    2012-01-01

    Full Text Available Advanced carotid disease is known to be associated with symptomatic cerebrovascular diseases, such as stroke or transient ischemic attack (TIA, as well as with poststroke cognitive impairment. However, cognitive decline often occurs in patients with advanced carotid stenosis without clinically evident stroke or TIA, so it is also suspected to be an independent risk factor for dementia. Neurosonological methods enable simple and noninvasive assessment of carotid stenosis in patients at risk of advanced atherosclerosis. Cognitive status in patients diagnosed with advanced carotid stenosis is routinely not taken into consideration, although if cognitive impairment is present, such patients should probably be called symptomatic. In this paper, we discuss results of some most important studies that investigated cognitive status of patients with asymptomatic advanced carotid disease and possible mechanisms involved in the causal relationship between asymptomatic advanced carotid disease and cognitive decline.

  8. Incidental demyelinating inflammatory lesions in asymptomatic patients: a Brazilian cohort with radiologically isolated syndrome and a critical review of current literature

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Martins Maia Jr.

    2012-01-01

    Full Text Available Despite the definition of specific diagnostic criteria to identify radiologically isolated syndrome (RIS suggestive of multiple sclerosis, its natural history remains incompletely understood. We retrospectively analyzed a Brazilian cohort of 12 patients to clarify their features and to emphasize the role of imaging predictors in clinical conversion. We demonstrated that, although some individuals did not exhibit progression over a lengthy follow-up period (16.7%, most patients will progress clinically or radiologically in the initial years of the follow-up (83.3%. Infratentorial and spinal cord involvement, as well as the total number of lesions, were more relevant predictors of progression than gadolinium enhancement. Further studies remain necessary to define the risk of conversion in males and to clarify the cognitive abilities of RIS patients. This study may provide an improved understanding of the natural course and evolution of incidental magnetic resonance imaging lesions, and further assists with the management of RIS in clinical practice.

  9. Survival Outcomes in Asymptomatic Patients With Normal Conventional Imaging but Raised Carcinoembryonic Antigen Levels in Colorectal Cancer Following Positron Emission Tomography-Computed Tomography Imaging.

    Science.gov (United States)

    Khan, Khurum; Athauda, Avani; Aitken, Katharine; Cunningham, David; Watkins, David; Starling, Naureen; Cook, Gary J; Kalaitzaki, Eleftheria; Chau, Ian; Rao, Sheela

    2016-12-01

    This study had two aims: (a) to evaluate the utility of fluorine 18-fluorodeoxyglucose (FDG) positron emission tomography (PET)-computed tomography (CT) in detecting occult disease recurrence with raised carcinoembryonic antigen (CEA) and (b) to establish the prognostic effects of early detection of disease recurrence in patients with colorectal cancer (CRC). Clinico-pathological data were obtained from all consecutive patients undergoing CRC surveillance from 2004 to 2010 who had an elevated CEA level (>3 ng/mL in nonsmokers, >5 ng/mL in smokers) but normal or equivocal conventional investigations. Histopathological confirmation or a minimum of 12 months' clinical and radiological follow-up were required to ascertain disease relapse. A total of 1,200 patients were screened; of those, 88 (59% men; mean age, 66 years [SD, 9.6]) eligible patients (67 with normal and 21 with equivocal results on conventional investigations) were identified. Recurrent disease was detected in 56 of 88 patients (64%). The sensitivity of FDG PET-CT to detect recurrence was 49 of 56 (88%; 95% confidence interval [CI], 76%-95%) and specificity was 28 of 32 (88%; 95% CI, 71%-97%). Twenty-seven of 49 (55%) patients with PET-CT-detected relapsed disease were deemed eligible for further curative therapy; 19 (70%) went on to receive potentially curative therapy. The median time to progression (8.8 months [interquartile range (IQR), 4.5-19.1 months] vs. 2.2 months [IQR, 0.7-5.6]), median overall survival (39.9 months [IQR, 23.6-65.4 months] vs. 15.6 months [IQR, 7.3-25.7 months]), and 5-year survival (36.8% [95% CI, 16.5%-57.5%] vs. 6.1% [95% CI, 1.1%-17.6%]; p ≤ .001) were higher in patients who received potentially curative therapy than in those who received noncurative therapy. FDG PET-CT is a highly sensitive and specific tool for the detection of occult CRC recurrence. In >50% of patients, recurrent disease may still be potentially amenable to curative therapy. Long-term survival can be

  10. Cardiopulmonary Exercise Testing in Patients with Asymptomatic or Equivocal Symptomatic Aortic Stenosis: Feasibility, Reproducibility, Safety and Information Obtained on Exercise Physiology.

    Science.gov (United States)

    van Le, Douet; Jensen, Gunnar Vagn Hagemann; Carstensen, Steen; Kjøller-Hansen, Lars

    2016-01-01

    The aim of this study was to determine the feasibility, reproducibility, safety and information obtained on exercise physiology from cardiopulmonary exercise testing (CPX) in patients with aortic stenosis. Patients with an aortic valve area (AVA) exercise, lower peak heart rate and FEV1, and higher VE/VCO2, but not by AVA index. Equivocal symptomatic status and a low gradient but high valvulo-arterial impedance were associated with a lower pVO2, but not with an inability to increase stroke volume. In total, 18 patients were referred for valve replacement. At 1 year, no cardiovascular deaths had occurred. CPX was feasible and reproducible and provided comprehensive data on exercise physiology. A CPX-guided treatment strategy was safe up to 1 year. © 2015 S. Karger AG, Basel.

  11. Is it time for preemptive drug treatment of asymptomatic (smoldering) multiple myeloma?

    Science.gov (United States)

    Fawole, Adewale; Abonour, Rafat; Stender, Michael; Shatavi, Seerin; Gaikazian, Susanna; Anderson, Joseph; Jaiyesimi, Ishmael

    2015-01-01

    Asymptomatic (smoldering) multiple myeloma is a heterogeneous plasma cell proliferative disorder with a variable rate of progression to active multiple myeloma or related disorders. Hypercalcemia, renal insufficiency, anemia, bone lesions or recurrent bacterial infections characterize active multiple myeloma. Some patients with asymptomatic myeloma develop active disease rapidly, and others can stay asymptomatic for many years. Those who are likely to progress within the first 2 years of diagnosis have been categorized as having high-risk disease. The availability of novel agents in the treatment of active multiple myeloma and our better understanding of the heterogeneity of asymptomatic multiple myeloma have spurred interest in the early treatment of these patients. We have reviewed the current proposed definitions of high-risk asymptomatic multiple myeloma, the concerns about future therapy in view of the transient nature, remissions and toxicities of the therapies, and the eventual relapses that characterize this incurable disease.

  12. Preliminary study on serum paraoxonase-1 status and chemokine (C-C motif) ligand 2 in hospitalized elderly patients with catheter-associated asymptomatic bacteriuria.

    Science.gov (United States)

    Iftimie, S; García-Heredia, A; Pujol, I; Ballester, F; Fort-Gallifa, I; Simó, J M; Joven, J; Camps, J; Castro, A

    2016-09-01

    Urinary tract infections (UTI) are common among elderly patients in residential care facilities, as well as in the hospital setting. Identifying new biochemical markers of UTI is an active line of research since UTI management is resource intensive. Paraoxonase-1 (PON1) forms part of the patient's immune system, the response-to-injury and inflammation. Our study sought to evaluate alterations in inflammation-related paraoxonase-1 (PON1) and chemokine (C-C motif) ligand 2 (CCL2) in patients with an indwelling catheter to assess their potential usefulness as biomarkers of infection. Patients (n = 142) who had had the urinary catheter removed and 100 healthy volunteers were recruited. In all participants we measured serum PON1 activity, PON1 concentration, CCL2, procalcitonin and C-reactive protein (CRP). Results indicated that patients had higher CCL2, CRP and procalcitonin concentrations than the control group, and lower paraoxonase activity. There were no significant differences in PON1 concentrations. When comparing the diagnostic accuracy of CRP, procalcitonin, CCL2 and the PON1-related variables in discriminating between patients with and those without UTI, we found a considerable degree of overlap between groups, i.e., a low diagnostic accuracy. However, there were significant inverse logarithmic correlations between serum paraoxonase activity and the number of days the urinary catheter had been in situ. Our results suggest that measurement of these biochemical variables may be useful in investigating complications of long-term use of these devices and help to improve the economic and clinical investment required in the management of the often-associated infection.

  13. Intracranial developmental venous anomaly: is it asymptomatic?

    Science.gov (United States)

    Puente, A Bolívar; de Asís Bravo Rodríguez, F; Bravo Rey, I; Romero, E Roldán

    2018-03-16

    Intracranial developmental venous anomalies are the most common vascular malformation. In the immense majority of cases, these anomalies are asymptomatic and discovered incidentally, and they are considered benign. Very exceptionally, however, they can cause neurological symptoms. In this article, we present three cases of patients with developmental venous anomalies that presented with different symptoms owing to complications derived from altered venous drainage. These anomalies were located in the left insula, right temporal lobe, and cerebellum. The exceptionality of the cases presented as well as of the images associated, which show the mechanism through which the symptoms developed, lies in the low incidence of symptomatic developmental venous anomalies reported in the literature. Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Elevated NT-proBNP and coronary calcium score in relation to coronary artery disease in asymptomatic type 2 diabetic patients with elevated urinary albumin excretion rate

    DEFF Research Database (Denmark)

    Reinhard, Henrik; Hansen, Peter R; Persson, Frederik

    2011-01-01

    Elevated plasma N-terminal (NT)-proBNP levels and coronary calcium score (CCS) not only predicts myocardial ischaemia and coronary artery stenosis but also adverse cardiovascular events and mortality in type 2 diabetic patients with an increased urinary albumin excretion rate (UAER), whereas low...

  15. True microbiota involved in chronic lung infection of cystic fibrosis patients found by culturing and 16S rRNA gene analysis

    DEFF Research Database (Denmark)

    Rudkjøbing, Vibeke Børsholt; Thomsen, Trine R; Alhede, Morten

    2011-01-01

    Patients suffering from cystic fibrosis (CF) develop chronic lung infection. In this study, we investigated the microorganisms present in transplanted CF lungs (n = 5) by standard culturing and 16S rRNA gene analysis. A correspondence between culturing and the molecular methods was observed. In c...

  16. Course of contact allergy in consecutive eczema patients patch tested with TRUE Test panels 1 and 2 at least twice over a 12-year period

    DEFF Research Database (Denmark)

    Jensen, Charlotte D; Andersen, Klaus E

    2005-01-01

    and 2, methodological factors are minimized. The variation in patch test positivity may then be attributed to biological variation, which depends on several individual factors such as patch test reading, patient-related factors such as changed immunological sensitivity, regional variation of the skin...

  17. Cardiac (82)Rb PET/CT for fast and non-invasive assessment of microvascular function and structure in asymptomatic patients with type 2 diabetes

    DEFF Research Database (Denmark)

    von Scholten, Bernt J; Hasbak, Philip; Christensen, Thomas E

    2016-01-01

    AIMS/HYPOTHESIS: Coronary flow reserve (CFR) and coronary artery calcium (CAC) represent functional and structural aspects of atherosclerosis. We examined the prevalence of reduced CFR and high CAC scores in three predefined groups of participants without known cardiovascular disease: (1) patient...

  18. Dishonest responding or true virtue?

    DEFF Research Database (Denmark)

    Zettler, Ingo; Hilbig, Benjamin E.; Moshagen, Morten

    2015-01-01

    management scores indeed reflect true virtues rather than dishonesty under such conditions. We found support for this idea by replicating previous correlations between impression management scores and virtue-related basic personality traits (including honesty-humility), and additionally provided conclusive...

  19. True Fibroma of Alveolar Mucosa

    Directory of Open Access Journals (Sweden)

    Shankargouda Patil

    2014-01-01

    Full Text Available Benign fibrous overgrowths are often found in the oral cavity, almost always being reactive/irritational in nature. However, benign mesenchymal neoplasms of the fibroblasts are extremely uncommon. Here we report a case of “True Fibroma of Alveolar Mucosa” for its rarity.

  20. Visual pattern and serial quantitation of {sup 18}F-sodium fluoride PET/CT in asymptomatic patients after hip and knee arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Son, Hye Joo; Jeong, Young Jin; Yoon, Hyun Jin; Wang, Lih; Kim, Hyeon Jun; Kang, Do Young [Dong-A University Medical Center, Dong-A University College of Medicine, Busan (Korea, Republic of); Park, Jong Hwan [Institute of Convergence Bio-Health, Dong-A University, Busan (Korea, Republic of)

    2016-12-15

    We investigated the visual tracer distribution pattern and serial changes in uptake ratio in different anatomical zones during the natural postoperative course in order to establish a reference for evaluation of patients with complications. A total of 36 patients without symptoms after hip or knee arthroplasty were grouped according to the interval between surgery and the scan. The serial changes in SUVmean in each periprosthetic zone were quantified using the volume of interest isocontour method. Images were classified according to the uptake distribution pattern. The uptake ratios in the postoperative period groups were then compared using the Kruskal-Wallis test. The correlation between uptake ratio and postoperative period was then determined. Tracer distribution patterns in hip prostheses were classified into three types and the patterns in knee prostheses into five types. In hip prostheses, intense osteoblastic activity was observed during 3-6 months and then declined in most patients, but showed a slight increase over 15-25 months in 5-10 % of patients. The correlation coefficients varied among the zones. Significant differences in uptake ratios among the period groups was found for all zones, except zone 8. Porous coated areas showed higher uptake than uncoated areas only for the period the 3-6 months. In knee prostheses, uptake ratios showed a curvilinear pattern, increasing from 3-6 to 8-15 months and declining later. The uptake ratios were different among the period groups. Every zone showed a positive correlation from 3-6 to 8-15 months, and negative correlations from 8-15 to 22-25 months. This is the first {sup 18}F-sodium fluoride PET/CT study investigating the stability of implants and sets a reference for evaluation of patients with complications.

  1. Baseline and ongoing PET-derived factors predict detrimental effect or potential utility of 18F-FDG PET/CT (FDG-PET/CT) performed for surveillance in asymptomatic lymphoma patients in first remission

    Energy Technology Data Exchange (ETDEWEB)

    Morbelli, Silvia; Capitanio, Selene; Bongioanni, Francesca; Verardi, Maria Teresa; Buschiazzo, Ambra; Fiz, Francesco; Pomposelli, Elena; Sambuceti, Gianmario [IRCCS AOU San Martino - IST, Nuclear Medicine Unit, Genoa (Italy); De Carli, Fabrizio; Marini, Cecilia [Institute of Molecular Bioimaging and Physiology, CNR, Genoa-Milan (Italy); De Astis, Enrico; Miglino, Maurizio [IRCCS AOU San Martino-IST, Department of Hematology and Oncology, Genoa (Italy)

    2016-02-15

    To identify both clinical and FDG PET/CT-derived factors predicting the occurrence of relapse, or conversely, the likelihood of false positive findings in surveillance FDG-PET/CT studies (PETsv). The study included 149 asymptomatic patients with Hodgkin's lymphoma (HL) (n = 55) or diffuse large B cell lymphoma (DLBCL) (n = 94) in first remission. PETSv studies were performed 12, 18, 24 and 36 months thereafter. Logistic regression analysis was performed to identify clinical and imaging-derived predictors of either PET-detected relapse or false-positive (FP) results. Tested clinical variables were:(1) age, (2) HL vs. DLBCL, (3) stage of disease, (4) bulky disease, (5) previous radiotherapy. PET/CT-derived variables were: (1) maximum standardized uptake value at baseline, (2) size-incorporated maximum standardized uptake value (SIMaxSUV) at baseline, (3) positive interim PET(PET-2), (4) presence of hot spots likely to be unrelated to the disease in final PET, (5) residual non-FDG avid mass. Accuracy was 88 % for PETsv1, 95 % for PETsv2, 95 % for PETsv3 and 91 % for PETsv4. However, PPV was relatively low in all PETsv. Best predictors of relapse were result of interim PET, HL versus NHL type, SIMaxSUV, age ≥ 60. Best predictors of FP were previous radiotherapy and hot spots unrelated to the disease in final PET. The present study confirms the need of restricting the use of surveillance PET/CT to patients at high risk of relapse. Information derived from PET/CT performed at baseline (metabolic disease burden), in the course (PET2) and at the end of therapy (unrelated hot spots) can help to select high-risk patients and also to identify patients more likely to present equivocal findings at PETsv. (orig.)

  2. Rationale for and design of the TRUE-AHF trial: the effects of ularitide on the short-term clinical course and long-term mortality of patients with acute heart failure.

    Science.gov (United States)

    Packer, Milton; Holcomb, Richard; Abraham, William T; Anker, Stefan; Dickstein, Kenneth; Filippatos, Gerasimos; Krum, Henry; Maggioni, Aldo P; McMurray, John J V; Mebazaa, Alexandre; O'Connor, Christopher; Peacock, Frank; Ponikowski, Piotr; Ruschitzka, Frank; van Veldhuisen, Dirk J; Holzmeister, Johannes

    2017-05-01

    The TRUE-AHF is a randomized, double-blind, parallel-group, placebo-controlled trial which is evaluating the effects of a 48-h infusion of ularitide (15 ng/kg/min) on the short- and long-term clinical course of patients with acute heart failure. Noteworthy features of the study include the early enrolment of patients following their initial clinical presentation (within 12 h), and entry blood pressure criteria and thresholds for the adjustment of drug infusion rates, which aim to minimize the risk of hypotension. The trial has two primary endpoints: (i) cardiovascular mortality during long-term follow-up; and (ii) the clinical course of patients during their index hospitalization. Cardiovascular mortality is evaluated in this event-driven trial by following all randomized patients for the occurrence of death until the end of the entire study without truncation at an arbitrarily determined early time point. The clinical course during the index hospitalization is evaluated using the hierarchical clinical composite endpoint, which combines information regarding changes in symptoms and the occurrence of in-hospital worsening heart failure events and death into a single ranked metric that captures interval clinical events and minimizes the likelihood of missing data and confounding due to intensification of background therapy. The design of the TRUE-AHF trial capitalizes on lessons learned from earlier trials and aims to evaluate definitively the potential benefit of ularitide in patients with acute heart failure. NCT01661634. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

  3. Cryptococcal Antigen Screening in Asymptomatic HIV-Infected Antiretroviral Naïve Patients in Cameroon and Evaluation of the New Semi-Quantitative Biosynex CryptoPS Test

    Directory of Open Access Journals (Sweden)

    Elvis Temfack

    2018-03-01

    Full Text Available Background: Cryptococcal meningitis (CM is a major cause of AIDS-related mortality in Africa. Detection of serum cryptococcal antigen (CrAg predicts development of CM in antiretroviral (ART naïve HIV-infected patients with severe immune depression. Systematic pre-ART CrAg screening and pre-emptive oral fluconazole is thus recommended. We postulated that a semi-quantitative CrAg screening approach could offer clinically relevant advantages.Methods: ART-naïve asymptomatic adult outpatients with <100 CD4 cells/mm3 presenting to the Yaoundé Central Hospital, Cameroon were screened for CrAg using the IMMY lateral flow assay (LFA. CrAg positive patients were consented for lumbar puncture and those with proven CM were treated with combination antifungal therapy and those with no CM were offered long-term oral fluconazole. Simultaneous on-site evaluation of CrAg detection using the new LFA Biosynex® CryptoPS test was performed and both tests were subsequently compared to a reference commercialized CrAg enzyme immunoassay (EIA.Results: Prevalence of serum CrAg in 186 screened adults was 7.5% (95%CI: 4.5–12.4. In CrAg positive patients, CM prevalence was 45.5% (95%CI: 18.3–75.7. IMMY and Biosynex CryptoPS strongly agreed in serum, plasma, and cerebrospinal fluid (Kappa: 98.4, 99.5, 100%, respectively, p < 0.001, and disagreed in urine (29 isolated positive CrAg in urine with IMMY, none with Biosynex and none of whom had proven CM. Compared to EIA, serum specificities were 96.6 and 98.3%, respectively. With Biosynex CryptoPS, all CM patients were serum T2-band positive compared to nonewithout CM. Median EIA reciprocal titre was 160 (IQR: 13.5–718.8 and titres >160 strongly correlated with proven CM and Biosynex CryptoPS T2-band positivity. During the 1-year follow up period, there was no incident case of CM among screened patients and overall incidence of all-cause mortality was 31.5 per 100 person-years-at-risk (95%CI: 23.0–43.1.Conclusion

  4. Identification of asymptomatic type 2 diabetes mellitus patients with a low, intermediate and high risk of ischaemic heart disease: is there an algorithm?

    DEFF Research Database (Denmark)

    Poulsen, Mikael Kjær; Henriksen, Jan Erik; Vach, W

    2010-01-01

    index >32 ml/m2, left ventricular ejection fraction algorithm identified low (n=96), intermediate (n=65) and high risk groups (n=115), in which the prevalence of myocardial ischaemia was 15%,23% and 43%, respectively. Overall the algorithm reduced...... the number of patients referred to MPS from 305 to 144.However, the sensitivity and specificity of the algorithm was just 68% and 62%, respectively.CONCLUSIONS/INTERPRETATION: Our algorithm was able to stratify which patients had a low, intermediate or high risk of myocardial ischaemia based on MPS. However......, the algorithm had low sensitivity and specificity, combined with high cost and time requirements.Trial registration: clinicaltrials.gov NCT00298844 Funding: The study was funded by the Danish Cardio vascular Research Academy (DaCRA), The Danish Diabetes Association and The Danish Heart Foundation....

  5. Head repositioning accuracy in patients with neck pain and asymptomatic subjects: concurrent validity, influence of motion speed, motion direction and target distance.

    Science.gov (United States)

    Dugailly, Pierre-Michel; De Santis, Roberta; Tits, Mathieu; Sobczak, Stéphane; Vigne, Anna; Feipel, Véronique

    2015-12-01

    Cervicocephalic kinesthetic deficiencies have been demonstrated in patients with chronic neck pain (NP). On the other hand, authors emphasized the use of different motion speeds for assessing functional impairment of the cervical spine. The objectives of this study were (1) to investigate the head repositioning accuracy in NP patients and control subjects and (2) to assess the influence of target distance, motion speed, motion direction and pain. Seventy-one subjects (36 healthy subjects and 35 NP patients; age 30-55 years) performed the head repositioning test (HRT) at two different speeds for horizontal and vertical movements and at two different distances. For each condition, six consecutive trials were sampled. The study showed the validity and reproducibility of the HRT, confirming a dysfunctional threshold of 4.5°. Normative values of head repositioning error up to 3.6° and 7.1° were identified for healthy and NP subjects, respectively. A distance of 180 cm from the target and a natural motion speed increased HRT accuracy. Repositioning after extension movement showed a significantly larger error in both groups. Intensity, duration of pain as well as pain level did not significantly alter head repositioning error. The assessment of proprioceptive performance in healthy and NP subjects allowed the validation of the HRT. The HRT is a simple, not expensive and fast test, easily implementable in daily practice to assess and monitor treatment and evolution of proprioceptive cervical deficits.

  6. The report of male gender and retinopathy status improves the current consensus guidelines for the screening of myocardial ischemia in asymptomatic type 2 diabetic patients.

    Science.gov (United States)

    Cosson, E; Nguyen, M T; Chanu, B; Balta, S; Takbou, K; Valensi, P

    2013-06-01

    American Diabetes Association (ADA), French-speaking Societies for diabetes & cardiology (ALFEDIAM-SFC) and Cardiac Radionuclide Imaging (CRI) have proposed guidelines for the screening of silent myocardial ischemia (SMI). The aim of the study was to evaluate their diagnostic values and how to improve them. 731 consecutive type 2 diabetic patients with ≥1 additional risk factor were screened between 1992 and 2006 for SMI by stress myocardial scintigraphy and for silent coronary artery disease (CAD) by coronary angiography. A total of 215 (29.4%) patients had SMI, and 79 of them had CAD. ADA (Odds Ratio 1.7 [95% Confidence Interval: 1.2-2.5]; p predicted SMI. Considering the presence of male gender and retinopathy added to the prediction of SMI allowed by ADA criteria (c statistic: area under the curve AROC 0.651 [0.605-0.697] versus 0.582 [0.534-0.630]), p prediction of SMI was improved by considering the presence of macroproteinuria and retinopathy (AROC 0.621 [0.575-0.667] versus 0.594 [0.548-0.641], p retinopathy (OR 3.4 [1.2-9.4], p predict SMI but prediction may be improved by considering male gender and the presence of retinopathy. CAD is more frequent in the patients with SMI who are current smokers, have severe retinopathy and higher triglyceride levels. Copyright © 2012 Elsevier B.V. All rights reserved.

  7. Rupture of a True Profunda Femoris Artery Aneurysm: Two Case Reports and Review of the English Language Literature.

    Science.gov (United States)

    Reslan, Ossama M; Sundick, Scott; Razayat, Combiz; Brener, Bruce J; Raffetto, Joseph D

    2017-02-01

    Profunda femoris artery aneurysms (PFAAs) are very rare and easily overlooked because they are located deeply within thigh muscle. PFAAs have a high rate of rupture in comparison with other peripheral arterial aneurysms, resulting in emergency surgical procedures with significant morbidity. PFAA is diagnosed with color arterial Doppler ultrasound, although computed tomography angiography remains the best imaging method to precisely define the exact site and length of arterial involvement. PFAAs should be treated surgically once diagnosed, even if they are asymptomatic due to the high incidence of complications. Currently, around 28 patients with PFAA rupture, including the 2 cases from this report, have been described in the English language literature. In this report, we describe the diagnosis and treatment of 2 true ruptured aneurysms of the profunda femoris artery with 2 different approaches, and will review the relevant literature. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Incidental findings of liver, biliary system, pancreas and spleen in asymptomatic patients. Assessment and management recommendations; Zufallsbefunde von Leber, Gallensystem, Pankreas und Milz bei asymptomatischen Patienten. Bewertung und Managementempfehlung

    Energy Technology Data Exchange (ETDEWEB)

    Scharitzer, M.; Tamandl, D.; Ba-Ssalamah, A. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Wien (Austria)

    2017-04-15

    The increased use of highly developed imaging procedures, such as multidetector-row computed tomography and magnetic resonance imaging has led to a substantial increase of asymptomatic and unexpected findings. Abdominal CT investigations are particularly affected with a large number of incidental findings. This valuable diagnostic procedure also entails the risk of complex and cost-intensive subsequent investigations with partly invasive procedures. For this reason radiologists are more often confronted with the difficult task of correctly assessing these lesions, to decide on the need for additional investigations and to inform the patient in detail about the clinical relevance. The aims of this article are to describe the most common abdominal incidentalomas, to assist with the interpretation and differential diagnosis and to give recommendations for further management. (orig.) [German] Die vermehrte Verwendung hoch entwickelter bildgebender Verfahren wie Multidetektorcomputertomographie und Magnetresonanztomographie hat zu einer betraechtlichen Zunahme asymptomatischer und unerwarteter Befunde gefuehrt. Besonders betroffen sind abdominelle CT-Untersuchungen mit einer Vielzahl inzidenteller Befunde. Dieses wertvolle Diagnoseverfahren birgt auch die Gefahr aufwendiger und auch kostenintensiver Folgeuntersuchungen mit z. T. invasiven Verfahren. Vor diesem Hintergrund stellt sich fuer den Radiologen immer haeufiger die schwierige Aufgabe, diese Laesionen korrekt einzuschaetzen, ueber die Notwendigkeit einer weiteren Abklaerung zu entscheiden und den Patienten umfassend ueber die klinische Relevanz zu informieren. Das Ziel dieses Artikels ist es, die am haeufigsten vorkommenden abdominellen Zufallsbefunde zu beschreiben sowie Hilfestellung bei ihrer Interpretation und Differenzialdiagnose mit Empfehlungen fuer das weitere Management zu geben. (orig.)

  9. Short-term oral treatment with the angiotensin II receptor antagonist losartan does not improve coronary vasomotor function in asymptomatic type 2 diabetes patients

    DEFF Research Database (Denmark)

    Kjaer, Andreas; Kristoffersen, Ulrik Sloth; Tarnow, Lise

    2009-01-01

    BACKGROUND: We have previously found that acute intravenous infusion of an ACE inhibitor normalized the reduced coronary vasomotor function in type 2 diabetes. The aim of the present study was to extend this investigation to an angiotensin II receptor blocker (ARB) administered orally in normoten...... with an ARB did not normalize coronary vasomotor function in type 2 diabetes patients without cardiovascular disease.......BACKGROUND: We have previously found that acute intravenous infusion of an ACE inhibitor normalized the reduced coronary vasomotor function in type 2 diabetes. The aim of the present study was to extend this investigation to an angiotensin II receptor blocker (ARB) administered orally...

  10. Clinical features and course of ulcerative colitis diagnosed in asymptomatic subjects.

    Science.gov (United States)

    Park, Soo-Kyung; Ye, Byong Duk; Yang, Suk-Kyun; Kim, Seon-Ok; Kim, Jihun; Kim, Jong Wook; Park, Sang Hyoung; Yang, Dong-Hoon; Jung, Kee Wook; Kim, Kyung-Jo; Byeon, Jeong-Sik; Myung, Seung-Jae; Kim, Jin-Ho

    2014-10-01

    Although some ulcerative colitis (UC) patients are diagnosed when they do not have any UC-related symptoms, clinical features and prognosis of UC diagnosed in asymptomatic patients remain unclear. Data for UC patients who were asymptomatic at diagnosis were retrospectively reviewed from the IBD database of the Asan Medical Center. The clinical characteristics and prognosis of those patients were analyzed and compared with matched (1:4) symptomatic UC patients. Only nineteen asymptomatic UC patients (1.1%) were identified from 1665 UC patients. The proportion of males was 78.9% (n=15), and their median age at diagnosis was 48 years (range, 34-71 years). At diagnosis, proctitis was noted in 11 patients (57.9%), left-sided colitis in 4 (21.1%), extensive colitis in 0 (0%), and atypical distribution in 4 (21.1%). The 5-year cumulative probability of symptom development was 68.5% (95% confidence interval [CI], 62.8%-74.2%). After UC diagnosis, oral 5-aminisalicylic acid (ASA) and topical 5-ASA were used in 14 (73.7%) and 16 (84.2%) patients, respectively. During follow-up (3.7-year median for asymptomatic patients versus 3.7-year median for symptomatic patients; P=0.961), the 5-year cumulative probability of corticosteroids (23.7% versus 57.1%; P=0.022) and azathioprine (0% versus 24.7%; P=0.003) use was higher in symptomatic patients than in asymptomatic patients. The frequency of asymptomatic UC patients was 1.1% in our UC patient cohort. A majority of these patients became symptomatic during follow-up. Asymptomatic UC patients at diagnosis appear to have a better prognosis than symptomatic UC patients. Copyright © 2014 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  11. Coronariopatia assintomática em chagásicos com insuficiência cardíaca: prevalência e fatores de risco Asymptomatic coronary artery disease in chagasic patients

    Directory of Open Access Journals (Sweden)

    Gustavo Carvalho

    2011-11-01

    Full Text Available FUNDAMENTO: A concomitância de doença arterial coronária assintomática em pacientes com cardiomiopatia chagásica em IC é controversa na literatura médica, pois ambas as doenças se mostram prevalentes em algumas regiões do Brasil. Objetivo: Determinar a prevalência da coronariopatia (lesões > 50% em uma população específica de pacientes com cardiomiopatia chagásica em IC classes funcionais III e IV, que não apresentavam eventos coronarianos prévios. OBJETIVO: Determinar a prevalência da coronariopatia (lesões > 50% em uma população específica de pacientes com cardiomiopatia chagásica em IC classes funcionais III e IV, que não apresentavam eventos coronarianos prévios. MÉTODOS: Realizou-se cineangiocoronariografia em 61 pacientes consecutivos, portadores de cardiomiopatia chagásica, em IC classes funcionais III e IV, para se excluir coronariopatia. Esses pacientes faziam parte do protocolo do Estudo de Terapia Celular em Cardiopatias, o qual exigia a realização de cineangiocoronariografia antes de se injetarem células-tronco. Os fatores de risco para aterosclerose também analisados nessa população foram: idade, hipertensão arterial, diabetes, dislipidemia, tabagismo e sobrepeso. RESULTADOS: Idade média 51,6 + 9,6 anos, 65,5% (n = 40 homens. A prevalência de coronariopatia encontrada nessa população foi de 1,6% (1. As prevalências dos fatores de risco foram: hipertensão arterial 18% (11, tabagismo 59% (36, diabetes 1,6% (1 e dislipidemia 6,5% (4. CONCLUSÃO: A prevalência da coronariopatia assintomática em pacientes com IC grave de etiologia chagásica é baixa e, entre os fatores de risco para doença coronária, o tabagismo foi o mais prevalente.BACKGROUND: Concomitant asymptomatic coronary artery disease in patients with Chagas cardiomyopathy in heart failure is controversial in the medical literature, as both diseases are prevalent in some regions of Brazil. OBJECTIVE: To determine the prevalence of

  12. Value of CACS compared with ETT and myocardial perfusion imaging for predicting long-term cardiac outcome in asymptomatic and symptomatic patients at low risk for coronary disease: clinical implications in a multimodality imaging world.

    Science.gov (United States)

    Chang, Su Min; Nabi, Faisal; Xu, Jiaqiong; Pratt, Craig M; Mahmarian, Angela C; Frias, Maria E; Mahmarian, John J

    2015-02-01

    This prospective, observational study in 988 asymptomatic or symptomatic low-risk patients without prior coronary artery disease was conducted to define the relative value of coronary artery calcium score (CACS), exercise treadmill testing (ETT), and stress myocardial perfusion single-photon emission computed tomography (SPECT) variables in predicting long-term risk stratification. CACS, ETT, and stress myocardial perfusion SPECT results predict patients' outcome. There are currently no data comparing their relative value in long-term risk stratification. Patients were stratified by Framingham risk score (FRS), with a median follow-up of 6.9 years. Cardiac events were defined as a composite of cardiac death, nonfatal myocardial infarction, and the need for coronary revascularization. Most patients (87%) were considered appropriate candidates for functional testing as defined by current appropriate use criteria. The long-term cardiac event rate was 11.2% (1.6% per year). Multivariate risk predictors in all patients and in the appropriate use cohort were abnormal SPECT (hazard ratio [HR]: 1.83 and 1.99), ETT ischemia (HR: 1.70 and 1.76), decreasing exercise capacity (HR: 1.11 and 1.17), decreasing Duke treadmill score (HR: 1.07 for both), and CACS severity (HR: 1.29 for both), respectively. Throughout the 10-year follow-up, CACS improved risk prediction, with event rates ranging from 0.6% per year (CACS ≤10) to 3.7% per year (CACS >400) (p risk prediction in all patients, in the appropriate use cohort and among those with low-risk ETT and SPECT results (all, p risk stratification beyond FRS, ETT, and SPECT results across the spectrum of clinical risk and importantly even among those who are currently considered appropriate candidates for functional testing or have low-risk functional test results. Our findings support CACS as a first-line test over ETT or SPECT for accurately assessing long-term risk in such patients. Copyright © 2015 American College of

  13. Epidemiological Study Of Asymptomatic Bacteriuria Among Nursery ...

    African Journals Online (AJOL)

    This study was undertaken to determine the prevalence of asymptomatic bateriuria in preschool children of different age and sex groups and to isolate the organisms responsible for asymptomatic bacteriuria and determine their antimicrobial susceptibility pattern. A total of 475 children from 17 nurseries in Ahvaz city, Iran ...

  14. Prevalence Of Asymptomatic Significant Bacteriuria In Schoolgirls ...

    African Journals Online (AJOL)

    Enterococcus faecalis was found to be the predominant bacteria cause instead of Escherichia coli as reported in some literature. Girls in the age group 11 – 12 years had the highest prevalence of asymptomatic significant bacteriuria. Prevention of asymptomatic significant bacteriuria in schoolgirls rely on strict and proper ...

  15. Carcinoid Tumor in Accidental, Asymptomatic Meckel's Diverticulum ...

    African Journals Online (AJOL)

    Carcinoid Tumor in Accidental, Asymptomatic Meckel's Diverticulum. Z Baranyai, V Jósa, K Merkel, Z Zolnai. Abstract. Although Meckel's diverticulum is the most common congenital gastrointestinal disorder, it is controversial whether asymptomatic diverticula in adults should be respected. The authors report the case of a ...

  16. In search of true friendship

    Directory of Open Access Journals (Sweden)

    Luciana Karine de Souza

    2008-01-01

    Full Text Available The present text proposes a discussion on the concept of true friendship. The argument is grounded mostly on Aristotle's Nicomachean Ethics, Owen Flanagan's ethics as human ecology, and on contemporary authors' works about the Greek philosopher's concept of friendship. Given that human beings flourish through 1 exercising capacities, 2 being moral, and 3 having true friendships, difficulties to establish the level of trust required by true friendships turns the search itself (for them morally valid.O presente texto propõe uma discussão sobre o conceito de amizade verdadeira. A argumentação que fundamenta o trabalho baseia-se em grande parte na Ética a Nicômaco de Aristóteles, na ética como ecologia humana de Owen Flanagan, e em autores contemporâneos sobre o conceito de amizade do filósofo grego. Considerando-se que seres humanos encontram a felicidade mediante 1 o exercício de suas capacidades, 2 ser um ente moral, e 3 ter amizades verdadeiras, as dificuldades no estabelecimento do nível de amizade requerido nas amizades verdadeiras torna a busca (por elas, por si só, algo moralmente válido.

  17. [Screening of parasitic diseases in the asymptomatic immigrant population].

    Science.gov (United States)

    Goterris, Lidia; Bocanegra, Cristina; Serre-Delcor, Núria; Moure, Zaira; Treviño, Begoña; Zarzuela, Francesc; Espasa, Mateu; Sulleiro, Elena

    2016-07-01

    Parasitic diseases suppose an important health problem in people from high endemic areas, so these must be discarded properly. Usually, these infections develop asymptomatically but, in propitious situations, are likely to reactivate themselves and can cause clinical symptoms and/or complications in the receiving country. Moreover, in some cases it is possible local transmission. Early diagnosis of these parasitic diseases made by appropriate parasitological techniques and its specific treatment will benefit both, the individual and the community. These techniques must be selected according to geoepidemiological criteria, patient's origin, migration route or time spent outside the endemic area; but other factors must also be considered as its sensitivity and specificity, implementation experience and availability. Given the high prevalence of intestinal parasites on asymptomatic immigrants, it is recommended to conduct a study by coproparasitological techniques. Because of its potential severity, the screening of asymptomatic malaria with sensitive techniques such as PCR (polymerase chain reaction) is also advisable. Serological screening for Chagas disease should be performed on all Latin American immigrants, except for people from the Caribbean islands. Other important parasites, which should be excluded, are filariasis and urinary schistosomiasis, by using microscopic examination. The aim of this paper is to review the different techniques for the screening of parasitic diseases and its advices within the care protocols for asymptomatic immigrants. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  18. Distinct repeat motifs at the C-terminal region of CagA of Helicobacter pylori strains isolated from diseased patients and asymptomatic individuals in West Bengal, India

    Directory of Open Access Journals (Sweden)

    Chattopadhyay Santanu

    2012-05-01

    Full Text Available Abstract Background Infection with Helicobacter pylori strains that express CagA is associated with gastritis, peptic ulcer disease, and gastric adenocarcinoma. The biological function of CagA depends on tyrosine phosphorylation by a cellular kinase. The phosphate acceptor tyrosine moiety is present within the EPIYA motif at the C-terminal region of the protein. This region is highly polymorphic due to variations in the number of EPIYA motifs and the polymorphism found in spacer regions among EPIYA motifs. The aim of this study was to analyze the polymorphism at the C-terminal end of CagA and to evaluate its association with the clinical status of the host in West Bengal, India. Results Seventy-seven H. pylori strains isolated from patients with various clinical statuses were used to characterize the C-ternimal polymorphic region of CagA. Our analysis showed that there is no correlation between the previously described CagA types and various disease outcomes in Indian context. Further analyses of different CagA structures revealed that the repeat units in the spacer sequences within the EPIYA motifs are actually more discrete than the previously proposed models of CagA variants. Conclusion Our analyses suggest that EPIYA motifs as well as the spacer sequence units are present as distinct insertions and deletions, which possibly have arisen from extensive recombination events. Moreover, we have identified several new CagA types, which could not be typed by the existing systems and therefore, we have proposed a new typing system. We hypothesize that a cagA gene encoding higher number EPIYA motifs may perhaps have arisen from cagA genes that encode lesser EPIYA motifs by acquisition of DNA segments through recombination events.

  19. Are lipid profiles true surrogate biomarkers of coronary heart disease in periodontitis patients?: A case-control study in a south Indian population.

    Science.gov (United States)

    Gita, Bagavad; Sajja, Chandrasekaran; Padmanabhan, Preethi

    2012-01-01

    There is abundant literature delving into whether periodontal infection contributes to atherosclerosis. However, whether periodontitis is a definite risk factor for atherosclerosis still remains empirical, with no systematic reviews or longitudinal studies to confirm this hypothesis. The prevalence of periodontitis and coronary artery disease also varies among racial and ethnic groups based on various factors such as diet, lifestyle, and genetic predisposition. This study was designed in a south Indian population with the aim of assessing and correlating the lipid levels (a surrogate biomarker for coronary heart disease) in patients with periodontitis and health. (1) To assess the levels of total cholesterol, low density lipoproteins (LDL), high density lipoproteins (HDL), and triglycerides in periodontal disease, and health in a south Indian population. (2) To assess associations between elevated lipid profiles and periodontal disease. This case control study included 60 individuals. Blood sampling for lipid levels and periodontal examination were performed for each study group. Appropriate statistical tools like Chi-square (P0.05) after eliminating confounding factors. Odds Ratio=(Total cholesterol (1.005), HDL (0.971), LDL (1.006), VLDL (0.997), CHO-HDL (1.358), TGL (1.007), LDL-HDL (1.180)). The odds ratio stated that there is no significant relation between the lipid levels and periodontal condition. The above findings confirm that there is still no concrete evidence which determines if periodontitis is an independent risk factor for atherosclerotic cardiovascular disease. Future periodontal interventional studies and assessment of genetic markers can ascertain the validity of this hypothesis. There is no association among periodontal disease and the levels of total cholesterol, LDL, HDL, and triglycerides.

  20. Inter-session reliability of the measurement of the deep and superficial layer of lumbar multifidus in young asymptomatic people and patients with low back pain using ultrasonography.

    Science.gov (United States)

    Liu, I-Shan; Chai, Huei-Ming; Yang, Jing-Lan; Wang, Shwu-Fen

    2013-12-01

    Reliability study. To investigate the inter-session reliability of measuring the thickness of deep (dMF) and superficial layer of lumbar multifidus (sMF) using ultrasonography for participants with and without low back pain (LBP). The lumbar multifidus is an important muscle in maintaining spinal stability. The dMF is considered important in maintaining tonic contraction and joint stability. Motor control impairment is also discovered in patients with LBP. However, no study to date has investigated the method of observing both the sMF and dMF through ultrasound imaging (USI). Twenty subjects aged 18-35 years old with LBP (N=10) and without LBP (N=10) were recruited. Every subject extended the upper trunk in prone lying with maximal isometric contraction. Simultaneously, the examiner measured the thickness of the dMF and the sMF using ultrasonography after ensuring the muscle belly was located. The participants performed three trials of isometric trunk extension in each session, with 30 min between each session. The reliability of measuring the change of thickness is represented by the intra-class correlation coefficient (ICC). Through averaging three trials of measurement, the reliability of measuring the thickness of the dMF or the sMF in static or in the contracted condition, and the change of the thickness during contraction, is reliable (ICC=0.84-1.00). The intra-rater inter-session reliability of measurement of the dMF and the sMF with USI has been established. This method could be applied to the qualification of the activation level of the dMF and the sMF with specific tasks. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. A Randomized Controlled Trial of the Effects of Febuxostat Therapy on Adipokines and Markers of Kidney Fibrosis in Asymptomatic Hyperuricemic Patients With Diabetic Nephropathy

    Directory of Open Access Journals (Sweden)

    Srinivasan Beddhu

    2016-12-01

    Full Text Available Background: In observational studies, higher uric acid levels are associated with metabolic syndrome, diabetes, and kidney disease. Objective: The objective of this study is to examine whether reduction of plasma uric acid with febuxostat, a xanthine oxido reductase inhibitor, impacts adipose tissue oxidative stress, adipokines, and markers of systemic inflammation or kidney fibrosis. Design: This was a double-blinded randomized controlled trial. Setting: Academic university setting was used. Patients: Overweight or obese adults with hyperuricemia and type 2 diabetic nephropathy were included. Measurements: Adipose tissue thiobarbituric acid reducing substances (TBARS and adiponectin concentrations and urinary transforming growth factor–β (TGF-β were primary endpoints. Plasma C-reactive protein, high molecular weight–adiponectin, interleukin–6, tumor necrosis factor–α, and TBARS and albuminuria were among predefined secondary endpoints. Methods: Participants were randomly assigned to febuxostat (n = 40 or matching placebo (n = 40 and followed for 24 weeks. Results: Baseline plasma uric acid levels were 426 ± 83 µmol/L; 95% completed the study. Estimated glomerular filtration rate (eGFR declined from 54 ± 17 mL/min/1.73 m 2 at baseline to 51 ± 17 mL/min/1.73 m 2 at 24 weeks ( P = .05. In separate mixed-effects models, compared with placebo, febuxostat reduced uric acid by 50% ( P < .001 but had no significant effects on subcutaneous adipose tissue TBARS (−7.4%, 95% confidence interval [CI], 57.4%-101.4% or adiponectin (6.7%, 95% CI, 26.0%-53.8% levels or urinary TGF-β/creatinine ratio (18.0%, 95% CI, 10.0%-54.8% or secondary endpoints. Limitations: Relatively modest sample size and short duration of follow-up. Conclusions: In this population with progressive diabetic nephropathy, febuxostat effectively reduced plasma uric acid. However, no detectable effects were observed for the prespecified primary or secondary endpoints

  2. TrueFISP MR imaging to determine the influence of hemodialysis on the myocardial functional parameters in patients with terminal renal insufficiency; TrueFISP-MR-Bildgebung zur Bestimmung des Einflusses der Haemodialyse auf myokardiale Funktionsparameter bei Patienten mit terminaler Niereninsuffizienz

    Energy Technology Data Exchange (ETDEWEB)

    Kramer, U.; Fenchel, M.; Kraft, A.; Tomaschko, K.; Stauder, N.; Claussen, C.D.; Miller, S. [Tuebingen Univ. (Germany). Radiologische Klinik; Wolf, S.; Risler, T. [Tuebingen Univ. (Germany). Medizinische Klinik

    2004-03-01

    Purpose: To assess the characteristic signs of uremic cardiomyopathy in patients with chronic renal failure (CRF) in comparison with healthy volunteers and to determine changes of left ventricular (LV) functional parameters in patients undergoing hemodialysis (HD). Methods and Materials: Using a 1.5 T Magnetron Sonata system (Siemens, Erlangen), cardiac MR imaging was performed on 26 patients (20 men, 6 women, mean age 54.7 years) and 14 volunteers (8 men, 6 women, mean age 27.7 years). Single-slice true FISP sequences (TR 3.2 ms, TE 1.6 ms, flip angel 58 , matrix 256 x 208, slice thickness 5 mm) were used to obtain contiguous short axis slices covering the whole left ventricle. Patients were examined before and immediately afte HD. Cardiodynamic parameters end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), myocardial mass (MM), cardiac output (CO) were calculated using the modified Simpson's rule (Argus Software, Siemens). Patient data were compared to reference values taken from healthy volunteers. Results: As a consequence of HD, significant differences (p<0.01) were observed for EDV (150+47 ml/114+49 ml), ESV (71+46 ml/60+56 ml), SV (79+25 ml/57+27 ml) and CO (3.6+1.0 l/min x m{sup 2}/2.6+1.1 l/min x m{sup 2}). Although EF (56+15%/53+18%) was decreased after HD, values did not differ significantly (p>0.05). MM (148+47 g/148+52 g) and myocardial mass index (80.7{+-}27.4 g/m{sup 2}/80.1{+-}9.1 g/m{sup 2}) did not change before and after HD. In all patients, signs of LV-hypertrophy (LVH) and increased CO were diagnosed compared to reference values. In 8 of 26 patients, additional pathology, such as valvular dysfunction or global cardiac insufficiency, was detected. Conclusion: Cardiac MRI is an accurate tool to identify uremic cardiomyopathy in patients with chronic renal failure undergoing HD. LV functional parameters could be monitored reliably. [German] Zielsetzung: Die vorliegende Studie an Patienten mit

  3. Validation of conventional and simplified methods to calculate projected valve area at normal flow rate in patients with low flow, low gradient aortic stenosis: the multicenter TOPAS (True or Pseudo Severe Aortic Stenosis) study.

    Science.gov (United States)

    Clavel, Marie-Annick; Burwash, Ian G; Mundigler, Gerald; Dumesnil, Jean G; Baumgartner, Helmut; Bergler-Klein, Jutta; Sénéchal, Mario; Mathieu, Patrick; Couture, Christian; Beanlands, Rob; Pibarot, Philippe

    2010-04-01

    It has been previously demonstrated that a new index of aortic stenosis (AS) severity derived from dobutamine stress echocardiography (DSE), the projected aortic valve area (AVA) at a normal transvalvular flow rate (AVA(proj)), is superior to traditional Doppler echocardiographic indices to discriminate true severe from pseudosevere low-gradient AS. The objectives of this study were to prospectively validate the diagnostic and prognostic value of AVA(proj) in a large series of patients and to propose a new clinically applicable simplified method to estimate AVA(proj). AVA(proj) was calculated in 142 patients with low-flow AS using 2 methods. In the conventional method, AVA was plotted against mean transvalvular flow (Q) at each stage of DSE, and AVA at a standardized flow rate of 250 ml/s was projected from the slope of the regression line fitting the plot of AVA versus Q: AVA(proj) = AVA(rest) + slope x (250 - Q(rest)). In the simplified method, using this equation, the slope of the regression line was estimated by dividing the DSE-induced change in AVA from baseline to the peak stage of DSE by the change in Q. There was a strong correlation between AVA(proj) calculated by the two methods (r = 0.95, P < .0001). Among the 142 patients, 52 underwent aortic valve replacement and had underlying AS severity assessed by the surgeon. Conventional and simplified AVA(proj) demonstrated similar performance in discriminating true severe from pseudosevere AS (percentage of correct classification of AVA(proj) < or = 1 cm(2), 94% and 92%, respectively) and were superior to traditional dobutamine stress echocardiographic indices (percentage of correct classification, 60%-77%). Both conventional and simplified AVA(proj) correlated well with valve weight (r = 0.52 and r = 0.58, respectively), whereas traditional dobutamine stress echocardiographic indices did not. In the 84 patients who were treated medically, conventional AVA(proj) < or = 1.2 cm(2) (hazard ratio, 1.65; P = .02

  4. Asymptomatic Pulmonary Hypertension in Systemic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    Shereen R. Kamel

    2011-01-01

    Full Text Available Introduction Pulmonary arterial hypertension (PAH is a serious and often fatal complication of systemic lupus erythematosus (SLE. Because the diagnosis of PAH often is made years after symptom onset, early diagnostic strategies are essential. Doppler echocardiography currently is considered the noninvasive screening test of choice for evaluating pulmonary hypertension. Aim Screening for asymptomatic pulmonary hypertension in systemic lupus erythematosus patients using Doppler echocardiography, and correlating it with inflammatory parameters of the disease. Patients and Methods Doppler echocardiography was performed in 74 patients with systemic lupus erythematosus over one year (66 adult and 8 juvenile, adult SLE included 57 patients with adult-onset and 9 patients with childhood-onset. Pulmonary hypertension was diagnosed if the peak systolic pressure gradient at the tricuspid valve was more than 30 mmHg. All patients were subjected to full history taking, rheumatological examination, laboratory studies and chest x-ray. Results In seventy four SLE patients, the pulmonary hypertension was detected in 8 patients (10.8%, 7 adult-onset SLE patients (aged from 19 to 30 years and 1 juvenile SLE (aged 12 years. The range of pulmonary artery systolic pressure was 34–61.2 mmHg (43.19 ± 9.28. No significant differences between patients with and those without pulmonary hypertension as regard clinical features. Significantly higher frequencies of rheumatoid factor and anti-cardiolipin antibodies were found in patients with pulmonary hypertension versus those without ( P = 0.02, P = 0.008 respectively. Positive rheumatoid factor and ACL were significantly associated with occurrence of PAH in SLE ( P = 0.007, P = 0.006 respectively. No significant correlations were found between pulmonary artery pressure, disease duration, SLE Disease Activity Index (SLEDAI, ESR, and anti-ds DNA. Conclusion Patients with SLE have an increased risk of pulmonary arterial

  5. Urinary Tract Infection and Asymptomatic Bacteriuria in Older Adults

    Science.gov (United States)

    Cortes-Penfield, Nicolas W.; Trautner, Barbara W.; Jump, Robin

    2018-01-01

    Synopsis Urinary tract infections (UTIs) are a significant cause of morbidity among older adults; however, antibiotic prescriptions for clinically suspected UTIs are often inappropriate. Healthcare providers frequently struggle to differentiate UTI from asymptomatic bacteriuria, particularly in patients presenting with nonspecific symptoms. Patients with baseline cognitive impairments that limit history-taking can be particularly challenging. Here, we review the epidemiology and pathogenesis of UTI in older adults. We also discuss an approach to the diagnosis and treatment of UTIs, focusing on recognizing patients who would likely benefit from antibiotic treatment and on identifying patients for whom empiric antibiotic therapy should not be given. PMID:29079155

  6. Prevalence of Trichomonas vaginalis infection in symptomatic and asymptomatic women in Central Vietnam.

    Science.gov (United States)

    Ton Nu, Phuong Anh; Nguyen, Vu Quoc Huy; Cao, Ngoc Thanh; Dessì, Daniele; Rappelli, Paola; Fiori, Pier Luigi

    2015-07-04

    The diffusion of trichomoniasis in Vietnam has been scarcely studied. The aim of this study was to investigate the prevalence of trichomoniasis in a group of symptomatic and asymptomatic women in Central Vietnam. Relationships between education, socioeconomical and marital status, and sexual behavior with infection have also been investigated. 249 symptomatic and 534 asymptomatic women from Hue City, Vietnam, were enrolled in this study. All women were interviewed about socioeconomical and behavioral status. They underwent clinical examination, and vaginal swabs were taken to assess T. vaginalis infection by wet mount microscopy examination. In addition, an ELISA test to detect antibodies to T. vaginalis in patients' sera was used. The overall prevalence of trichomoniasis assessed by microscopic examination was 6.6%. A significant difference between symptomatic and asymptomatic groups was observed, resulting in 19.3% and 0.7%, respectively. Anti- T. vaginalis antibodies were detected in 31.3% of symptomatic and in 13.3% of asymptomatic women. High-risk sexual behaviour, residence in urban areas, and low level of education were positively associated with infection. This is the first report on the diffusion of trichomoniasis in Central Vietnam on symptomatic and asymptomatic subjects. Data demonstrated that T. vaginalis is a common cause of vaginal infection in the Hue province. The prevalence detected by microscopic examination was high in symptomatic subjects, while serological ELISA test detected infection also in asymptomatic patients, who tested negative by microscopy. The ELISA test may be useful to detect infection, especially in asymptomatic population.

  7. Asymptomatic Wolff-Parkinson-White Syndrome: Incidental EKG

    Directory of Open Access Journals (Sweden)

    Samer Assaf

    2017-07-01

    Full Text Available History of present illness: A 38-year-old male presents to the emergency department for a minor trauma evaluation after falling off a bicycle at a moderate rate of speed. The patient was not wearing a helmet when he hit his head with unknown loss of consciousness. Focused assessment with sonography for trauma (FAST exam and head computed tomography (CT were negative. Routine electrocardiogram (ECG showed sinus rhythm with pre-excitation indicative of Wolff-Parkinson-White Syndrome (WPW. The patient confirmed a previous diagnosis of WPW, but had not previously followed up with a cardiologist. Significant findings: The ECG shows slurred up-stroking of the QRS complexes characteristic of a delta wave. The PR interval is normal; however, the QT interval is greater than 110ms. Discussion: Wolff-Parkinson-White Syndrome (WPW is a frequently encountered macro-reentrant arrhythmia characterized by a shortened PR interval less than 120ms, prolonged QRS greater than 120ms with an up-stroking QRS complex (delta wave, and occasional ST abnormalities.1 The incidence is reported to be 0.9%-3% of the general population and most diagnoses are made on routine EKGs.2,3 WPW is thought to be caused by abnormalities of conduction through the accessory pathway, also known as the Bundle of Kent, causing premature excitation of the ventricles. The complications from WPW are supraventricular tachycardia, atrial arrhythmias, and ventricular fibrillation leading to sudden cardiac death.3 Approximately 40-50% of patients who die from sudden cardiac arrest associated with WPW were previously asymptomatic.4 Unfortunately, it is agreed that approximately 50% of patients with WPW are asymptomatic and unaware of their diagnosis.5 The definitive treatment for WPW is radiofrequency catheter ablation (RFCA. However, it comes with a low risk of complications including arrhythmias and death.6 For asymptomatic WPW, children are at the highest risk for ventricular arrhythmias while

  8. Abnormal findings on knee magnetic resonance imaging in asymptomatic NBA players.

    Science.gov (United States)

    Walczak, Brian E; McCulloch, Patrick C; Kang, Richard W; Zelazny, Anthony; Tedeschi, Fred; Cole, Brian J

    2008-01-01

    The purpose of this study was to evaluate the knees of asymptomatic National Basketball Association (NBA) players via magnetic resonance imaging (MRI) and confirm or dispute findings reported in the previous literature. It is thought that a variety of significant abnormalities affecting the knee exist in asymptomatic patients and that these findings can be accurately identified on MRI. Two months prior to the 2005 season, bilateral knee MRI examinations of 14 asymptomatic NBA players (28 knees) were evaluated for abnormalities of the articular cartilage, menisci, and patellar and quadriceps tendons. The presence of joint effusion, subchondral edema, and cystic lesions and the integrity of the collateral and cruciate ligaments were also assessed.

  9. Tissue Velocities and Myocardial Deformation in Asymptomatic and Symptomatic Aortic Stenosis

    DEFF Research Database (Denmark)

    Carstensen, Helle Gervig; Larsen, Linnea Hornbech; Hassager, Christian

    2015-01-01

    was to compare velocity (color Doppler tissue imaging) and deformation (two-dimensional speckle-tracking echocardiography) in relation to global and regional longitudinal function in asymptomatic and severe symptomatic aortic stenosis. METHODS: In a cross-sectional design, 231 patients with aortic stenosis were...... divided into four groups: asymptomatic moderate aortic stenosis (aortic valve area, 1.0-1.5 cm(2); n = 38), asymptomatic severe aortic stenosis (aortic valve area reduced (... to be symptomatic (odds ratio, 4.97; 95% CI, 2.6-9.4; P velocity...

  10. True photographs and false memories.

    Science.gov (United States)

    Lindsay, D Stephen; Hagen, Lisa; Read, J Don; Wade, Kimberley A; Garry, Maryanne

    2004-03-01

    Some trauma-memory-oriented psychotherapists advise clients to review old family photo albums to cue suspected "repressed" memories of childhood sexual abuse. Old photos might cue long-forgotten memories, but when combined with other suggestive influences they might also contribute to false memories. We asked 45 undergraduates to work at remembering three school-related childhood events (two true events provided by parents and one pseudoevent). By random assignment, 23 subjects were also given their school classes' group photos from the years of the to-be-recalled events as memory cues. As predicted, the rate of false-memory reports was dramatically higher in the photo condition than in the no-photo condition. Indeed, the rate of false-memory reports in the photo condition was substantially higher than the rate in any previously published study.

  11. Symptomatic and asymptomatic accessory navicular bones: Findings of Tc-99m MDP bone scintigraphy

    International Nuclear Information System (INIS)

    Chiu, N.-T.; Jou, I.-M.; Lee, B.-F.; Yao, W.-J.; Tu, D.-G.; Wu, P.-S.

    2000-01-01

    AIM: The accuracy of bone scintigraphy in diagnosing symptomatic accessory navicular bones has not been well studied. We conducted a retrospective study to explore the results and use of scintigraphy in symptomatic and asymptomatic accessory navicular bones. MATERIALS AND METHODS: Thirteen patients with a total of 13 symptomatic and 10 asymptomatic accessory navicular bones were included in the study. We used a scoring system to grade the scintigraphic abnormalities. The patients' symptoms and scintigraphic findings were recorded. RESULTS: Though focally increased radiopharmaceutical uptake was observed in all symptomatic accessory naviculars, half of the asymptomatic accessory navicular bones had the same manifestations. The scoring system was of no value in differentiating symptomatic from asymptomatic accessory navicular bones. CONCLUSION: Bone scintigraphy is a sensitive but not a specific tool for diagnosing a symptomatic accessory navicular. Chiu, N.-T. (2000)

  12. Unsuspected urological anomalies in asymptomatic cryptorchid boys

    Energy Technology Data Exchange (ETDEWEB)

    Pappis, C.H.; Argianas, S.A.; Bousgas, D.; Athanasiades, E.

    1988-01-01

    In a period of 6 years 144 asymptomatic boys with cryptorchidism, of mean age 7 +- SD 3.5 years, underwent orchiopexy. None of these boys referred to a history of a known urological anomaly, urinary tract infection haematuria, palpable mass in the renal region, bladder extrophy, epispadias, hypospadias or anorectal malformation. On the third day after orchiopexy an intravenous pyelography was done in every boy following testicular protection against irradiation. Ultrasonic investigation was not available at that time. There were minor urological abnormalities in 36 (25%) boys and major ones in 8 (5.5%) boys. A major anomaly is defined as one resulting in significant loss of renal substance (one case of single kidney and three cases of unilateral renal hypoplasia), or requiring surgical correction for conservation of the renal substance (one case of ureterocele, two cases of pelviureteric stenosis and one case of vesicoureteric stenosis with ipsilateral hydronephrosis). The unsuspected major urological abnormalities are usually ipsilateral to the more undescended testis. They may be associated with a hernia and are more frequent in bilateral cryptorchidism. In conclusion we encourage the routine use of IVP, or ultrasonic investigation or dynamic renal scanning (99/sup mTc/-DTPA), if it is possible, in all patients undergoing orchiopexy for the detection of an unsuspected major renal anomaly.

  13. [Prevention of spontaneous preterm birth in asymptomatic twin pregnancies].

    Science.gov (United States)

    Sentilhes, L; Bouhours, A-C; Bouet, P-E; Boussion, F; Biquard, F; Gillard, P; Descamps, P

    2009-12-01

    To determine prenatal methods to predict and prevent spontaneous preterm birth in asymptomatic twin pregnancies. Articles were searched using PubMed, Embase and Cochrane library. Uterine activity monitoring and bacterial vaginosis screening are not useful to predict preterm birth (EL2 and EL3 respectively). Current literature data are contradictory and insufficient to determine whether fetal fibronectin and digital cervical assessment are predictors of preterm birth. History of preterm birth (EL4), and cervical length measurement by transvaginal ultrasonography (EL2) predict preterm birth. Nevertheless, there are no intervention studies that have evaluated cervical length measurement in the prevention of preterm birth. Hospital bedrest, prophylactic tocolytic and progesterone therapy, and prophylactic cervical cerclage in patients with or without short cervix have not been shown to be effective in preventing preterm birth. Prenatal methods to prevent spontaneous preterm birth in asymptomatic twin pregnancies are currently very limited. Copyright © 2009 Elsevier Masson SAS. All rights reserved.

  14. Isolated Asymptomatic Short Sternum in a Healthy Young Girl

    Directory of Open Access Journals (Sweden)

    Francesco Turturro

    2014-01-01

    Full Text Available Congenital sternal defects are rare deformities frequently associated with other anomalies of the chest wall and other organ systems. Although pectus excavatum, pectus carinatum, and cleft sternum can present as isolated deformity, in most cases they are associated with heart and inner organs anomalies and described as symptoms of syndromes like Marfan syndrome, Noonan syndrome, Poland anomaly, and Cantrell pentalogy. In contrast, the etiology of an isolated defect is not well understood. We observed a short sternum (dysmorphic manubrium, hypoplastic body, and complete absence of the xiphoid process in a completely asymptomatic 13-year-old woman. A comprehensive instrumental exams panel was performed to exclude associated anomalies of the heart and of the other organ systems. The patient was completely asymptomatic and she did not need any medical or surgical treatment. To our knowledge, this is the first case of isolated short sternum reported in literature.

  15. Increased platelet count and leucocyte-platelet complex formation in acute symptomatic compared with asymptomatic severe carotid stenosis.

    LENUS (Irish Health Repository)

    McCabe, D J H

    2005-09-01

    The risk of stroke in patients with recently symptomatic carotid stenosis is considerably higher than in patients with asymptomatic stenosis. In the present study it was hypothesised that excessive platelet activation might partly contribute to this difference.

  16. True mean rate measuring system

    International Nuclear Information System (INIS)

    Eichenlaub, D.P.

    1980-01-01

    A digital radiation-monitoring system for nuclear power plants uses digital and microprocessor circuitry to enable rapid processing of pulse information from remote radiation monitors. The pulse rates are analyzed to determine whether new pulse-rate information is statisticaly the same as that previously received and to determine the best possible averaging time, which can be changed so that the statistical error remains below a specified level while the system response time remains short. Several data modules each process the pulse-rate information from several remote radiation monitors. Each data module accepts pulse data from each radiation monitor and measures the true average or mean pulse rate of events occurring with a Poisson distribution to determine the radiation level. They then develop digital output signals which indciate the respective radiation levels and which can be transmitted via multiplexer circuits for additional processing and display. The data modules can accept signals from remote control stations or computer stations via the multiplexer circuit to change operating thresholds and alarm levels in their memories. A check module scans the various data modules to determine whether the output signals are valid. It also acts as a redundant data module and will automatically replace an inoperative unit. (DN)

  17. A Rare Entity: Adult Asymptomatic Giant Vallecular Cyst

    Directory of Open Access Journals (Sweden)

    Mümtaz Taner Torun

    2015-01-01

    Full Text Available Background. Cysts in the larynx are rare and generally asymptomatic. However, large cysts in adults can be symptomatic. If they are symptomatic, they typically present with respiratory and feeding difficulties. They are usually benign in terms of pathology. Several surgical techniques may be used for treatment. Case Report. A 56-year-old man presented to our clinic with hoarseness. Routine laryngeal examination revealed a giant mass and the larynx could not be visualized. At magnetic resonance imaging (MRI, a cystic mass originating from the vallecula was detected. There was no pathology at the glottic level. We planned tracheotomy for the airway and endoscopic surgery for excision. The mass was excised using CO2 laser and was reported as benign. Conclusion. An asymptomatic vallecular cyst may cause difficult intubation in any operation. It may also cause respiratory or other complications. Airway management should be led by an ear, nose, and throat surgeon, since tracheotomy may be required. Endoscopic excision with CO2 laser is a good choice for treatment in elective cases. In this report, we discuss the diagnosis and treatment of a patient with an asymptomatic giant vallecular cyst.

  18. Functional Connectivity Networks in Asymptomatic and Symptomatic DYT1 Carriers.

    Science.gov (United States)

    Premi, Enrico; Diano, Matteo; Gazzina, Stefano; Cauda, Franco; Gualeni, Vera; Tinazzi, Michele; Fiorio, Mirta; Liberini, Paolo; Lazzarini, Clara; Archetti, Silvana; Biasiotto, Giorgio; Turla, Marinella; Bertasi, Valeria; Cotelli, Maria; Gasparotti, Roberto; Padovani, Alessandro; Borroni, Barbara

    2016-11-01

    DYT1 mutation is characterized by focal to generalized dystonia and incomplete penetrance. To explore the complex perturbations in the different neural networks and the mutual interactions among them, we studied symptomatic and asymptomatic DTY1 mutation carriers by resting-state functional MRI. A total of 7 symptomatic DYT1, 10 asymptomatic DYT1, and 26 healthy controls were considered. Resting-state functional MRI (Oxford Centre for Functional MRI of the Brain) [FMRIB] Software Library) (FSL) MELODIC, dual regression, (as a toolbox of FSL, with Nets is referred to "networks") (FSLNets) (http://fsl.fmrib.ox.ac.uk/fsl/fslwiki/FSLNets) was performed on 9 resting-state neural networks. DYT1 mutation signature (symptomatic DYT1 and asymptomatic DYT1) was characterized by increased connectivity in the dorsal attention network and in the left fronto-parietal network. Functional correlates of symptomatic DYT1 patients (symptomatic DYT1 vs healthy controls) showed increased connectivity in the sensorimotor network. This study argues that DYT1 dystonia is a network disorder, with crucial nodes in sensory-motor integration of posterior parietal structures. A better characterization of cortical networks involved in dystonia is crucial for possible neurophysiological therapeutic interventions. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

  19. Direct detection of incidental asymptomatic aneurysm by computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Asari, S.; Sakurai, M.; Yamamoto, Y.; Suzuki, K. (Matsuyama Shimin Hospital, Ehime (Japan)); Sadamoto, K.

    1981-02-01

    Incidental asymptomatic aneurysms were found in 9 of 52 patients with intracranial aneurysms from February, 1978 to March, 1980. They had only mild initial symptoms, namely, headache, dysarthria, aphasis, light hemiparesis and others. No patients had severe neurological deficits. In eight of 9 patients with asymptomatic aneurysm, except one case of hypertensive intracerebral hematoma, 9 aneurysms (8 patients) were directly detected by high resolution CT (GE CT/T 8800) and confirmed by angiography. Location of these aneurysms as follows: three at the middle cerebral artery trifurcation, two at the internal carotisposterior communicans junction, one at anterior communication artery, one at the basilar top, one at the basilaris artery-superior cerebelli artery junction and one at the posterior cerebral artery. The smallest aneurysm detected by CT as 5 x 4 x 4 mm in size on angiography. The aneurysm may be suggested by small round or oval defect in the Sylvian fissure or suprasellar cistern, defect of the edge of the so called ''pentagon'' in the plain CT and then if its density is highly and homogeneously increased after contrast-enhanced (CE) scan. As the circle of Willis and other major cerebral arteries can often be demonstrated on CE.CT images, the aneurysm is frequently seen on these cerebral arteries. Limiting factors to direct CT detection of intracranial aneurysms are seemed to be size and location of aneurysm, anatomic location of circle of Willis and motion of patients etc. It may be considered, in our experiences, that the CT is useful in diagnosis of asymptomatic aneurysm and the higher direct CT detection rate to aneurysms, small or medium sized as well as giant aneurysms, will be obtained by devising scanning method, namely, multiprojection scans, multiple overlapping method and improvement of enhanced method.

  20. Measuring the true success of laparoscopic pyeloplasty.

    Science.gov (United States)

    Maynes, Lincoln J; Levin, Brian M; Webster, Todd M; Baldwin, Duane; Herrell, S Duke

    2008-06-01

    Laparoscopic pyeloplasty (LP) is a highly successful minimally invasive management option for ureteropelvic junction obstruction (UPJO) with success rates equaling or surpassing open repair. Definitions of success have varied greatly among reports of series in the literature. We propose that true success or failure be strictly defined by resolution of obstruction on objective physiologic testing (diuretic renography or Whitaker testing) and accordingly present our results. We prospectively gathered data on all LP from December 2001 to November 2006. Ninety-two patients have matured to follow-up testing (> 3 months). Primary uncomplicated procedures were completed in 62/92 (67%) while secondary and/or complex repairs were performed in 30/92 (33%). Rigorous follow-up with physiologic testing was performed postoperatively. Patients with equivocal diuretic renal scans were evaluated with Whitaker pressure-flow studies. The subjective symptom score was assessed for our first 47 patients using a visual analog scale (VAS). Treatment in patients who lacked objective evidence of resolution of UPJO was considered a failure. The mean age of the cohort was 39 years (range 18-69 yrs). Average operating room time was 250 minutes (range 138-488 min), and estimated blood loss was 63 mL (range 10-500 mL). Average hospital length of stay was 1.2 days (range 1-6 d). Crossing vessels were identified in 47/92 (51%) patients. Overall mean follow-up was 13 months (range 2-54 months). There were no intraoperative complications and three perioperative complications. Overall, 85/92 (92%) patients were found to have resolution of UPJO on postoperative physiologic testing. The primary uncomplicated cohort success rate was 98%, while that for the secondary or complex repair cohort was 80%. The mean overall VAS pain score was 84%. Objective physiologic testing should be used as the measurement of true success after LP. A uniform definition of success will allow improved comparison of results

  1. Asymptomatic group B streptococcal bacteriuria among pregnant women in Saudi Arabia.

    Science.gov (United States)

    Ahmad, S

    2015-01-01

    This study aims to determine the asymptomatic bacteriuria in pregnancy due to GBS and its antimicrobial sensitivity pattern for planning strategy for the management of these cases and also to determine the relationship between asymptomatic bacteriuria and pyuria. A total of 3863 consecutive urine specimens were collected from 3863 pregnant women with asymptomatic bacteriuria attending the obstetrics and gynaecology department of our hospital over a period of two years. Specimens were processed using standard microbiological procedures. All the subjects were evaluated for bacteriuria. The prevalence of asymptomatic bacteriuria due to group B streptococci (GBS) was 82/3863 (2.1%) among pregnant women in Saudi Arabia. Among these, 69/82 patients (84.2%) had clinical and microbiological features consistent with cystitis, versus 13/82 (15.8%) for pyelonephritis. About 51.2% (42/82) of the patients who had urine analysis performed had positive results based on positive urinary leucocyte esterase and pyuria. Disc-diffusion analysis of all 82 GBS isolates showed that they were highly susceptible to Augmentin and linezolid. Screening for bacteriuria in pregnancy and proper treatment must be considered as an essential part of antenatal care in this community. To prevent asymptomatic bacteriuria complications, all pregnant women should be screened at the first antenatal visit. A negative test for pyuria is not a reliable indicator of the absence of asymptomatic bacteriuria in pregnant women. Further, ongoing surveillance and evaluation of outcomes in pregnancies complicated by GBS bacteriuria is required to optimise maternal and newborn care.

  2. The incidence and risk factors of asymptomatic primary spontaneous pneumothorax detected during health check-ups.

    Science.gov (United States)

    Mitani, Akihisa; Hakamata, Yukichika; Hosoi, Megumi; Horie, Masafumi; Murano, Yoko; Saito, Akira; Yanagimoto, Shintaro; Tsuji, Shoji; Yamamoto, Kazuhiko; Nagase, Takahide

    2017-12-07

    Patients with primary spontaneous pneumothorax (PSP) usually complain of sudden-onset dyspnea and pleuritic chest pain. However, asymptomatic PSP has been incidentally detected on chest X-rays. In this study, we analyzed the incidence, characteristics, risk factors, and prognosis of asymptomatic PSP detected during regular medical check-ups in university students. In this study, 101,709 chest X-rays were performed during medical check-ups for students at the University of Tokyo between April 2011 and March 2016. Among them, 43 cases of asymptomatic PSP (0.042%) were detected. We calculated the lung collapse rate of pneumothorax using Kircher's method. We also analyzed risk factors associated with asymptomatic PSP using characteristics inspected in medical check-ups. The incidence of asymptomatic PSP was significantly higher in men than in women (0.050% vs 0.018%). Multivariate analysis revealed an association of younger age, greater height, lower body mass index, and greater height growth per year with an increased risk of asymptomatic PSP in male students. Mild lung collapse (up is very important because a considerable number of patients with mild lung collapse eventually require an invasive medical procedure.

  3. Asymptomatic Preclinical Rheumatoid Arthritis-Associated Interstitial Lung Disease

    Directory of Open Access Journals (Sweden)

    Juan Chen

    2013-01-01

    Full Text Available Objective. Interstitial lung disease (ILD is a common extra-articular manifestation of rheumatoid arthritis (RA and a significant cause of morbidity and mortality. The objective of this study was to define high-resolution chest CT (HRCT and pulmonary function test (PFT abnormalities capable of identifying asymptomatic, preclinical forms of RA-ILD that may represent precursors to more severe fibrotic lung disease. Methods. We analyzed chest HRCTs in consecutively enrolled RA patients and subsequently classified these individuals as RA-ILD or RA-no ILD based on the presence/absence of ground glass opacification, septal thickening, reticulation, traction bronchiectasis, and/or honeycombing. Coexisting PFT abnormalities (reductions in percent predicted FEV1, FVC, TLC, and/or DLCO were also used to further characterize occult respiratory defects. Results. 61% (63/103 of RA patients were classified as RA-ILD based on HRCT and PFT abnormalities, while 39% (40/103 were designated as RA-no ILD. 57/63 RA-ILD patients lacked symptoms of significant dyspnea or cough at the time of HRCT and PFT assessment. Compared with RA-no ILD, RA-ILD patients were older and had longer disease duration, higher articular disease activity, and more significant PFT abnormalities. Conclusion. HRCT represents an effective tool to detect occult/asymptomatic ILD that is highly prevalent in our unselected, university-based cohort of RA patients.

  4. [Asymptomatic polymyositis with pulmonary disease].

    Science.gov (United States)

    Acosta Fernández, O; Alfonso Déniz, J; Morales Umpiérrez, A; Rodríguez de Castro, F; Esparza Morera, R

    1994-02-01

    We present the case of a medium-aged patient with a alveolo-interstitial pulmonary affection after 5 months of evolution, characterized by cough and progressive dyspnea accompanied by sustained febricula, slight constitutional syndrome and dermatological and articular manifestations. It was finally concluded that the patient had a polymyositis, relating form of affection a secondary interstitial pneumopathy. The aim of this study has been to highlight a rare case of diffuse interstitial disease in the context of a polymyositis in which we obtained an excellent therapeutical response, as well as to make some considerations regarding its etiology and its clinical and pathological expression.

  5. True pancreaticoduodenal artery aneurysms: A decision analysis

    International Nuclear Information System (INIS)

    Takao, Hidemasa; Nojo, Takeshi; Ohtomo, Kuni

    2010-01-01

    Purpose: True pancreaticoduodenal artery aneurysms are rare. No definitive study evaluating the natural history of these lesions or their preferred method of treatment has been published. The purpose of this study was to evaluate the outcome of preventive treatment of unruptured pancreaticoduodenal artery aneurysms using a Markov model. Materials and methods: With the use of a Markov model, we performed a decision analysis to evaluate the outcome of preventive treatment of unruptured pancreaticoduodenal artery aneurysms. The risk of rupture and the mortality of preventive treatment are unknown. Therefore, we performed sensitivity analysis using these parameters. Effectiveness was measured in life expectancy. Results: For 80-year-old patients, preventive treatment was dominated by no treatment if mortality rates of preventive treatment were greater than 1.4%, greater than 2.6%, greater than 3.8%, and greater than 4.8% at annual rupture rates of 1%, 2%, 3%, and 4%, respectively. For 50-year-old patients, preventive treatment was dominated by no treatment if mortality rates of preventive treatment were greater than 3.3%, greater than 5.9%, greater than 8.0%, and greater than 9.7% at annual rupture rates of 1%, 2%, 3%, and 4%, respectively. Conclusion: The effectiveness of preventive treatment of unruptured pancreaticoduodenal artery aneurysms depends on the aneurysm rupture rate, mortality rate of preventive treatment, and patient age. Taking into account the effects of these parameters is important in making treatment decisions.

  6. A comparison of true and premodulated interferential currents.

    Science.gov (United States)

    Ozcan, John; Ward, Alex R; Robertson, Valma J

    2004-03-01

    To compare true and premodulated interferential currents (IFCs) in terms of sensory, motor, and pain thresholds; maximum electrically induced torque (MEIT); and comfort. Repeated-measures design. Laboratory setting. University student and staff volunteers. Participants were exposed to 4 different conditions, chosen to evaluate 2 fundamental differences between true and premodulated IFCs. The conditions were different combinations of (1) premodulated or constant-amplitude currents applied at the skin and (2) crossed or parallel current paths. Sensory, motor, and pain thresholds; MEIT; and subjective reports of relative discomfort were recorded for each of the 4 conditions. Motor to sensory threshold ratios were subsequently calculated to assess depth efficiency of stimulation. The major findings were that crossed currents (true IFC) had no advantage over parallel currents (premodulated IFC) in terms of motor to sensory threshold ratio, MEIT, or comfort, and that premodulated currents produced higher torque values and less discomfort than constant-amplitude currents (true IFC). These results contradict the claimed superiority of true IFC. The findings indicate that premodulated IFC, delivered via 2 large electrodes, may be clinically more effective than the traditional true IFC arrangement in terms of depth efficiency, torque production, and patient comfort.

  7. Concept of true and perceived placebo effects.

    OpenAIRE

    Ernst, E.; Resch, K. L.

    1995-01-01

    We often and wrongly equate the response seen in the placebo arm of a clinical trial with the placebo effect. In order to obtain the true placebo effect, other non-specific effects can be identified by including an untreated control group in clinical trials. A review of the literature shows that most authors confuse the perceived placebo effect with the true placebo effect. The true placebo effect is highly variable, depending on several factors that are not fully understood. A distinction be...

  8. Sports Eligibility After Risk Assessment and Treatment in Children with Asymptomatic Ventricular Pre-excitation.

    Science.gov (United States)

    Di Mambro, Corrado; Drago, F; Milioni, M; Russo, M S; Righi, D; Placidi, S; Remoli, R; Palmieri, R; Gimigliano, F; Santucci, L M; Silvetti, M S; Prosperi, M

    2016-08-01

    Many studies concern the management of young patients with symptomatic Wolff-Parkinson-White (WPW) syndrome, but little information exists on the significance and prognosis of ventricular pre-excitation (VPE) in asymptomatic children. The aim of the study was to evaluate the risk of sudden death in young athletes with asymptomatic VPE by transesophageal electrophysiological study (TEEPS) and their sports eligibility after the risk assessment and/or ablative treatment. Ninety-one asymptomatic children and adolescents underwent TEEPS both at rest and during adrenergic stress (exercise testing or isoproterenol infusion). After electrophysiological testing, patients were assessed in the 36 months of follow-up. Thirty-three patients (36.3 %) had a benign form of VPE and were allowed to participate in competitions. Ten patients (11 %) were at borderline risk; thus, sport eligibility was evaluated individually. Forty-eight patients (52.7 %) showed inducible sustained atrioventricular reentrant tachycardia and/or atrial fibrillation (AF), 11 of whom (12.1 % of total population) had a potential risk of sudden cardiac death due to AF inducibility during physical stress. Forty-five young athletes underwent transcatheter ablation (TCA). TCA was interrupted in 12 patients (26.7 %) because of the high procedural risk linked to septal accessory pathway (AP) location. There were no TCA-related complications, and all patients remained asymptomatic during follow-up. Most of the young athletes with asymptomatic VPE may be allowed to participate in competitive sports after an adequate risk assessment and/or ablative treatment. However, in our opinion, special care should be taken to avoid procedural complications, which are unacceptable in asymptomatic patients.

  9. Intelligence and Academic Achievement With Asymptomatic Congenital Cytomegalovirus Infection.

    Science.gov (United States)

    Lopez, Adriana S; Lanzieri, Tatiana M; Claussen, Angelika H; Vinson, Sherry S; Turcich, Marie R; Iovino, Isabella R; Voigt, Robert G; Caviness, A Chantal; Miller, Jerry A; Williamson, W Daniel; Hales, Craig M; Bialek, Stephanie R; Demmler-Harrison, Gail

    2017-11-01

    To examine intelligence, language, and academic achievement through 18 years of age among children with congenital cytomegalovirus infection identified through hospital-based newborn screening who were asymptomatic at birth compared with uninfected infants. We used growth curve modeling to analyze trends in IQ (full-scale, verbal, and nonverbal intelligence), receptive and expressive vocabulary, and academic achievement in math and reading. Separate models were fit for each outcome, modeling the change in overall scores with increasing age for patients with normal hearing ( n = 78) or with sensorineural hearing loss (SNHL) diagnosed by 2 years of age ( n = 11) and controls ( n = 40). Patients with SNHL had full-scale intelligence and receptive vocabulary scores that were 7.0 and 13.1 points lower, respectively, compared with controls, but no significant differences were noted in these scores among patients with normal hearing and controls. No significant differences were noted in scores for verbal and nonverbal intelligence, expressive vocabulary, and academic achievement in math and reading among patients with normal hearing or with SNHL and controls. Infants with asymptomatic congenital cytomegalovirus infection identified through newborn screening with normal hearing by age 2 years do not appear to have differences in IQ, vocabulary or academic achievement scores during childhood, or adolescence compared with uninfected children. Copyright © 2017 by the American Academy of Pediatrics.

  10. Plastin 3 is upregulated in iPSC-derived motoneurons from asymptomatic SMN1-deleted individuals.

    Science.gov (United States)

    Heesen, Ludwig; Peitz, Michael; Torres-Benito, Laura; Hölker, Irmgard; Hupperich, Kristina; Dobrindt, Kristina; Jungverdorben, Johannes; Ritzenhofen, Swetlana; Weykopf, Beatrice; Eckert, Daniela; Hosseini-Barkooie, Seyyed Mohsen; Storbeck, Markus; Fusaki, Noemi; Lonigro, Renata; Heller, Raoul; Kye, Min Jeong; Brüstle, Oliver; Wirth, Brunhilde

    2016-05-01

    Spinal muscular atrophy (SMA) is a devastating motoneuron (MN) disorder caused by homozygous loss of SMN1. Rarely, SMN1-deleted individuals are fully asymptomatic despite carrying identical SMN2 copies as their SMA III-affected siblings suggesting protection by genetic modifiers other than SMN2. High plastin 3 (PLS3) expression has previously been found in lymphoblastoid cells but not in fibroblasts of asymptomatic compared to symptomatic siblings. To find out whether PLS3 is also upregulated in MNs of asymptomatic individuals and thus a convincing SMA protective modifier, we generated induced pluripotent stem cells (iPSCs) from fibroblasts of three asymptomatic and three SMA III-affected siblings from two families and compared these to iPSCs from a SMA I patient and control individuals. MNs were differentiated from iPSC-derived small molecule neural precursor cells (smNPCs). All four genotype classes showed similar capacity to differentiate into MNs at day 8. However, SMA I-derived MN survival was significantly decreased while SMA III- and asymptomatic-derived MN survival was moderately reduced compared to controls at day 27. SMN expression levels and concomitant gem numbers broadly matched SMN2 copy number distribution; SMA I presented the lowest levels, whereas SMA III and asymptomatic showed similar levels. In contrast, PLS3 was significantly upregulated in mixed MN cultures from asymptomatic individuals pinpointing a tissue-specific regulation. Evidence for strong PLS3 accumulation in shaft and rim of growth cones in MN cultures from asymptomatic individuals implies an important role in neuromuscular synapse formation and maintenance. These findings provide strong evidence that PLS3 is a genuine SMA protective modifier.

  11. Microbial aetiology and sensitivity of asymptomatic bacteriuria ...

    African Journals Online (AJOL)

    Results: Twenty nine (13.3%) of the samples had significant bacterial growth and E.coli was the commonest isolate (51.2%). There was a high level (20- 62%) of anti-bacterial resistance to the commonly used antibiotics. Conclusion: Asymptomatic bacteriuria is common among ante-natal mothers in Mulago. E. Coli that is ...

  12. Asymptomatic Malaria Parasitaemia - A Suitable Index for

    African Journals Online (AJOL)

    Orogade AA, Ogala WN, Aikhionbare HA. Asymptomatic Malaria Parasitaemia - A Suitable. Index for Evaluation of Malaria Vector Control Measures. Nigerian journal of Paediatrics 2002;. 29: 23. To evaluate the impact of malaria vector control measures which form an integral part of the ational guidelines for malaria control, ...

  13. Asymptomatic body packers should be treated conservatively

    DEFF Research Database (Denmark)

    Glovinski, Peter V; Lauritsen, Morten L; Bay-Nielsen, Morten

    2013-01-01

    Body packing takes advantage of the human storage capacity within the alimentary tract. Body packing is used for the smuggling of drugs such as heroin, cocaine, amphetamine, hashish and ecstasy. Most body packers are asymptomatic. However, packets may rupture or obstruct the alimentary tract...

  14. Carcinoid Tumor in Accidental, Asymptomatic Meckel's Diverticulum

    African Journals Online (AJOL)

    asymptomatic diverticula in adults should be respected. The authors report the ... proved the suspected diagnosis of carcinoid tumor. They were ... Clarifying these clinical conundrums. World J Surg 2005;29:92-101. 2. Longo WE, Vernava AM 3rd. Clinical implications of jejunoileal diverticular disease. Dis Colon Rectum ...

  15. Detecting asymptomatic coronary artery disease using routine ...

    African Journals Online (AJOL)

    1990-09-01

    Sep 1, 1990 ... Detecting asymptomatic coronary artery disease using routine ... monitored exercise testing for detecting coronary artery disease was ... Images were photographed in 32 steps over 1800 rotation. Redistribution images were photographed approximately 3 hours later. Pre-processing of the data was ...

  16. Prevalence of Asymptomatic Genital Infection among Pregnant ...

    African Journals Online (AJOL)

    All the isolates except Streptococcus faecalis were resistant to ampicillin. These results show a high rate of asymptomatic genital tract infections among pregnant women in Benin City, which have implications for adverse maternal and neonatal outcomes. (Afr J Reprod Health 2002; 6[3]: 93-97) Résumé Prévalence de ...

  17. Asymptomatic Bacteriuria among Pregnant Women Attending ...

    African Journals Online (AJOL)

    The apparent decline in immunity of pregnant women appears to promote the growth of both com-mensal and non-commensal microorganisms. The objective of the study was to determine the prevalence of asymptomatic bacteriuria in pregnant women visiting the University hospital, Ku-masi. This prospective ...

  18. Tetanus toxoid antibody level in asymptomatic Plasmodium ...

    African Journals Online (AJOL)

    The present study was designed to investigate if the presence of asymptomatic malaria parasiteamia in pregnant women will compromise their ability to respond to full dose of tetanus toxoid immunization during their antenatal clinic visits. Hence, 90 apparently healthy pregnant women who had completed the tetanus toxoid ...

  19. Asymptomatic Bacteriuria in HIV Positive Nigerian Children ...

    African Journals Online (AJOL)

    This study was carried out to determine the prevalence of asymptomatic bacteriuria in HIV positive children and to identify the causative organisms. We studied 155 Human Immunodeficiency Virus (HIV) infected children aged 10 months to 17 years attending the Paediatric HIV clinics of the University of Benin Teaching ...

  20. Prevalence and Parasite Density of Asymptomatic Malaria ...

    African Journals Online (AJOL)

    Background: Malaria in pregnancy has contributed significantly to maternal morbidity and mortality in our environment. Aim: This study was aimed at determining the prevalence, and parasite density of asymptomatic malaria parasitemia among unbooked paturients at Federal Teaching Hospital Abakaliki. Subjects and ...

  1. Asymptomatic proteinuria and elevated blood pressure among ...

    African Journals Online (AJOL)

    Background: Hypertension and proteinuria are known risk factors for cardiovascular disease and renal impairment. Early detection and treatment will reduce morbidity and mortality associated with them. Objective: To determine the prevalence of asymptomatic proteinuria with or without elevated blood pressure among ...

  2. Asymptomatic solitary mediastinal cystic lymphangioma: a rare entity.

    Science.gov (United States)

    Misthos, Panagiotis; Sepsas, Evangelos; Kokotsakis, Ioannis; Skottis, Ion

    2006-12-01

    Solitary mediastinal cystic lymphangioma is an extremely rare tumor-like abnormality of the lymphatic system, of congenital origin. From 1996 to 2003, 4 cases of solitary mediastinal cystic lymphangioma were managed in our department. The clinicopathologic characteristics were recorded and analyzed. The incidence proved to be 1.2% among all cases of mediastinal masses admitted to our department. All patients were asymptomatic, they shared common radiologic features, and all were managed by radical surgical excision. No recurrence or mortality were noted during follow-up ranging from 2 to 7 years. Complete excision of this benign entity has an excellent prognosis.

  3. Identification of Human T-lymphotropic Virus Type I (HTLV-I Subtypes Using Restrited Fragment Length Polymorphism in a Cohort of Asymptomatic Carriers and Patients with HTLV-I-associated Myelopathy/tropical Spastic Paraparesis from São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Aluisio AC Segurado

    2002-04-01

    Full Text Available Although human T-lymphotropic virus type I (HTLV-I exhibits high genetic stability, as compared to other RNA viruses and particularly to human immunodeficiency virus (HIV, genotypic subtypes of this human retrovirus have been characterized in isolates from diverse geographical areas. These are currently believed not to be associated with different pathogenetic outcomes of infection. The present study aimed at characterizing genotypic subtypes of viral isolates from 70 HTLV-I-infected individuals from São Paulo, Brazil, including 42 asymptomatic carriers and 28 patients with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP, using restricted fragment length polymorphism (RFLP analysis of long terminal repeat (LTR HTLV-I proviral DNA sequences. Peripheral blood mononuclear cell lysates were amplified by nested polymerase chain reaction (PCR and amplicons submitted to enzymatic digestion using a panel of endonucleases. Among HTLV-I asymptomatic carriers, viral cosmopolitan subtypes A, B, C and E were identified in 73.8%, 7.1%, 7.1% and 12% of tested samples, respectively, whereas among HAM/TSP patients, cosmopolitan A (89.3%, cosmopolitan C (7.1% and cosmopolitan E (3.6% subtypes were detected. HTLV-I subtypes were not statistically significant associated with patients' clinical status. We also conclude that RFLP analysis is a suitable tool for descriptive studies on the molecular epidemiology of HTLV-I infections in our environment.

  4. Clinical Expression of Calcium Sensing Receptor Polymorphism (A986S) in Normocalcemic and Asymptomatic Hyperparathyroidism.

    Science.gov (United States)

    Díaz-Soto, G; Romero, E; Castrillón, J L P; Jauregui, O I; de Luis Román, D

    2016-03-01

    Normocalcemic and asymptomatic hyperparathyroidism diagnosis are becoming more common. However, their pathophysiology is incompletely known. The aim of the present study was to evaluate the clinical effect of calcium-sensing receptor polymorphism (A986S) in normocalcemic and asymtomatic HPT. Prospective study conducted with 61 consecutive normocalcemic and asymptomatic HPT patients was followed up during a minimum period of 1 year. Secondary causes of hyperparathyroidism were ruled out. Calcium and phosphorus metabolism parameters were evaluated in at least 2 determinations during follow-up to classify as normocalcemic or asymptomatic hyperparathyroidism. Bone mineral density and A986S polymorphism genotype were also analyzed. Thiry-eight patients (62.3%) had the genotype A986A, and 23 (36.7%) patients had A986S (20 patients, 32.8%) or S986S (3 patients, 4.9%). Age, sex, and genotype distributions were comparable in both normocalcemic and asymptomatic hyperparathyroidism. In normocalcemic patients, S allele genotype was associated to statistically significant higher level of intact PTH: 92.0 (SD 18.5) vs. 110.6 (SD 24.4) pg/ml, phyperparathyroidism, A986A genotype resulted in a statistically significant higher level of intact PTH, alkaline phosphatase and procollagen amino-terminal propeptide; but only serum calcium remained as an independent predictor of serum intact PTH levels after a multiple linear regression. Bone mineral densitometry between genotypes did not show statistically significant differences. A986S polymorphism of CaSR is an independent predictor of PTH level in normocalcemic hyperparathyroidism patients, but not in asymptomatic hyperparathyroidism. More studies are needed to evaluate the effect of other polymorphisms in normocalcemic and asymptomatic hyperparathyroidism. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Prevalence of asymptomatic coronary disease in fibrosing idiopathic interstitial pneumonias

    Energy Technology Data Exchange (ETDEWEB)

    Cassagnes, Lucie; Gaillard, Vianney [Department of Thoracic Imaging (EA 2694), Hospital Calmette, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France); Monge, Emmanuel [Department of Pulmonology, Center of Competence for Rare Pulmonary Diseases, Hospital Calmette, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France); Faivre, Jean-Baptiste [Department of Thoracic Imaging (EA 2694), Hospital Calmette, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France); Delhaye, Cédric [Department of Cardiology, Cardiology Hospital, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France); Molinari, Francesco [Department of Thoracic Imaging (EA 2694), Hospital Calmette, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France); Petyt, Grégory; Hossein-Foucher, Claude [Department of Nuclear Medicine, Hospital Salengro, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France); Wallaert, Benoit [Department of Pulmonology, Center of Competence for Rare Pulmonary Diseases, Hospital Calmette, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France); Duhamel, Alain [Department of Medical Statistics (EA 2694), Univ Lille Nord de France, F-59000 Lille (France); Remy, Jacques [Department of Thoracic Imaging (EA 2694), Hospital Calmette, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France); Remy-Jardin, Martine, E-mail: martine.remy@chru-lille.fr [Department of Thoracic Imaging (EA 2694), Hospital Calmette, CHRU and Univ Lille 2 Nord de France, F-59000 Lille (France)

    2015-01-15

    Background: Because of growing body of interest on the association between fibrosing idiopathic interstitial pneumonias (f-IIP) and ischaemic heart disease, we initiated this prospective study to evaluate the prevalence of asymptomatic coronary artery disease (CAD) in patients with f-IIP. Methods: Forty-two patients with f-IIP underwent noninvasive screening for CAD that included (a) a chest CT examination enabling calculation of the coronary artery calcium (CAC) score, then depiction of coronary artery stenosis; and (b) stress myocardial perfusion scintigraphy (MPS). Patients with significant coronary abnormalities, defined by a CAC score >400 or coronary artery stenosis >50% at CT and/or perfusion defect >5% at MPS, were referred to the cardiologist. Coronary angiography was indicated in presence of a perfusion defect >10% at MPS or significant left main or proximal left anterior descending stenosis whatever MPS findings. Results: Combining CT and MPS, significant abnormalities were detected in 32/42 patients (76%). The cardiologist: (a) did not consider further investigation in 21 patients (CT abnormalities but no ischaemia at MPS: 12/21; false-positive findings at MPS: 3/21; poor respiratory condition: 6/21); (b) proceeded to coronary angiography in 11 patients which confirmed significant stenoses in 5 patients (5/42; 12%). In the worst-case-scenario (i.e., inclusion of 6 patients with significant coronary artery abnormalities who were not investigated due to poor respiratory condition), the prevalence of CAD reached 26% (11/42). Conclusion: In the studied population of patients with f-IIP, asymptomatic CAD ranged between 12% and 26%.

  6. Ectodermal dysplasia with true anodontia.

    Science.gov (United States)

    Bala, Madhu; Pathak, Anuradha

    2011-05-01

    The hereditary condition known as ectodermal dysplasia is characterized by the absence or defect of two or more ectodermally derived structures. The most commonly observed forms of ectodermal dysplasia are the hidrotic and hypohidrotic types; discrimination is based on the absence or presence of sweat glands. A case of 8-year-old male child with hypohidrotic ectodermal dysplasia with complete anodontia of primary as well as secondary dentitions is presented. The child had a short stature, low intelligent quotient (I.Q.,), and was underweight. The patient experienced episodes of high fever, was intolerant to heat, and did not sweat. He exhibited smooth and dry skin, sparse light-colored eyebrows. Dental clinicians can be the first to diagnose ectodermal dysplasia due to the absence of teeth.

  7. Asymptomatic vallecular cyst: case report.

    Science.gov (United States)

    Yuce, Yucel; Uzun, Sennur; Aypar, Ulku

    2013-01-01

    A 56-year-old man presented himself for an intracranial glioblastoma multiforme excision. After being routinely monitored, he was preoxygenated. We induced anesthesia and paralysis with 200 mg propofol, 50 μg fentanyl and 9 mg vecuronium. Direct laryngoscopy with a Macintosh 3 blade revealed a 2x2 cm cyst, pedunculated, arising from the right side of the vallecula preventing the endotracheal intubation. While the patient remained anesthetized, we urgently consulted an otolaryngologist and aspirated the cyst with a 22-gauge needle and syringe under direct laryngoscopy. We aspirated 10 cc of liquid content. This was followed by an uneventful tracheal intubation with a 9.0 enforced spiral cuffed tube. An alternative to fiberoptic intubation may be careful cyst aspiration to facilitate the intubation.

  8. Optimal timing of valve replacement in asymptomatic severe aortic stenosis.

    Science.gov (United States)

    Bilen, Emine; Ipek, Gökürk; Ayhan, Huseyin; Nacar, Alper Bugra; Kasapkara, Haci Ahmet; Sani, Cenk; Basbug, Serdar; Kurt, Mustafa; Bozkurt, Engin

    2014-09-01

    Patients with asymptomatic severe aortic stenosis (AS) constitute a heterogeneous group which includes not only certain cases who are at high risk of sudden death and valve-related heart failure, but also those at low risk for these events. Degenerative AS, which includes a majority of patients with AS, is characterized by stricture of the valve, increased arterial stiffness, and diverse left ventricular response to the valvular plus arterial vascular load. In addition to using traditional primary parameters, the severity of AS and the total left ventricular load should be assessed using new measures such as energy loss index and valvulo-arterial impedance. Natriuretic peptide levels and global longitudinal strain imaging may also be used as secondary parameters to obtain information about left ventricular systolic function, although these parameters do not correlate with the severity of AS. Exercise stress testing and exercise echocardiography are also beneficial when assessing the patient if they are symptomatic, and for determining valvular and left ventricular contractile reserves. The aim of this review was to emphasize the importance of risk stratifications in asymptomatic severe AS cases, and to assess the severity of AS using not only conventional methods but also new methods on which much emphasis has been placed during recent years.

  9. Celiac axis stenosis: incidence and etiologies in asymptomatic individuals

    International Nuclear Information System (INIS)

    Park, Chang Min; Chung, Jin Wook; Kim, Hyun Beom; Shin, Sang June; Park, Jae Hyung

    2000-01-01

    To determine the incidence and etiologies of celiac axis stenosis in asymptomatic individuals. This prospective study involved 400 consecutive patients (male: 319, female: 81) referred to us for celiac arteriography between April and July 1999. When celiac axis branches were opacified by collateral circulation during superior mesenteric arteriography, the presence of celiac axis stenosis was suspected; lateral projection celiac arteriography was performed and the pressure gradient was measured. The indicators used to determine whether or not celiac axis stenosis was significant were luminal narrowing of more than 50% and a resultant pressure gradient of at least 10 mmHg. Its etiology was determined on the basis of angiographic appearances and CT findings. Twenty-nine patients (7.3%) had celiac axis stenosis. The etiology of the condition was extrinsic compression due to the median arcuate ligament in 16 patients (55%) and atherosclerosis in three (10%), while in ten (35%) it was not determined. The incidence of celiac axis stenosis did not vary significantly according to sex, age and the presence of calcified aortic plaque representing atherosclerosis. The incidence of hemodynamically significant celiac axis stenosis in this asymptomatic Korean population was 7.3% and the most important etiology was extrinsic compression by the median arcuate ligament of the diaphragm. Atherosclerosis was only a minor cause of the condition

  10. Asymptomatic middle cerebral artery stenosis diagnosed by magnetic resonance angiography

    Energy Technology Data Exchange (ETDEWEB)

    Zaidat, O.O. [Duke University Medical Center, NC 27710, Durham (United States); Department of Neurology, University Hospitals of Cleveland/Case Western Reserve University School of Medicine Cleveland, Ohio, Cleveland, Ohio (United States); Zahuranec, D.B. [Department of Internal Medicine, University Hospitals of Cleveland and Louis Stokes Cleveland VAMC/Case Western Reserve University School of Medicine Cleveland, Cleveland, Ohio (United States); Ubogu, E.E.; Fernandes-Filho, J.A.; Suarez, J.I.; Landis, D.M.D. [Department of Neurology, University Hospitals of Cleveland/Case Western Reserve University School of Medicine Cleveland, Ohio, Cleveland, Ohio (United States); Sunshine, J.L.; Tarr, R.W.; Mirarchi, S.; Nour, S.G. [Department of Neuroradiology, University Hospitals of Cleveland and Louis Stokes Cleveland VAMC/Case Western Reserve University School of Medicine Cleveland, Cleveland, Ohio (United States); Selman, W.R. [Department of Neurosurgery, University Hospitals of Cleveland/Case Western Reserve University School of Medicine Cleveland, Cleveland, Ohio (United States)

    2004-01-01

    We reviewed 1440 MRA studies to identify patients with middle cerebral artery stenosis (MCAS). We identified 99 cases, and after reviewing the clinical records, classified 28 as asymptomatic MCAS (AMCAS), a prevalence of 2%. Suspected stroke was the most frequent indication for MRA. Follow-up was available for 21, mean 46.7 months (range 2.4-75.6 months). One stroke occurred in the AMCAS territory (5%), other strokes in five patients (24%). There were five deaths in patients with MCAS; age >69 (P =0.045) was the only associated risk factor. This study suggests that patients in whom MRA is performed and shows AMCAS may be at increased risk of strokes in any vascular distribution or of death. (orig.)

  11. The effect of medical treatments on stroke risk in asymptomatic carotid stenosis.

    Science.gov (United States)

    King, Alice; Shipley, Martin; Markus, Hugh

    2013-02-01

    Recent evidence suggests current best medical treatment may be sufficient to prevent stroke in patients with asymptomatic carotid stenosis. If this is the case, then it is important to determine risk reduction provided by treatments. Using Asymptomatic Carotid Emboli Study (ACES) prospective data, the effect of current treatment and risk factors on future stroke and transient ischemic attack risk were determined. Four-hundred seventy-seven patients with asymptomatic carotid stenosis were followed-up every 6 months for 2 years. Changes in risk factors and stroke prevention therapies were reviewed at each visit. Using time-dependent Cox regression, the relationship between current treatment over time was determined and presented as hazard ratios and 95% confidence intervals for risk of stroke, transient ischemic attack, and cardiovascular death end points. On multivariate analysis, antiplatelets (P=0.001) and lower mean blood pressure (P=0.002) were independent predictors of reduced risk of ipsilateral stroke and transient ischemic attack. Antiplatelets (Pstroke or cardiovascular death. Antiplatelet therapy and blood pressure control are the most important factors in reducing short-term stroke and cardiovascular risk in patients with asymptomatic carotid stenosis. More prospective data are required for medical treatments in asymptomatic carotid stenosis in particular for current statin usage.

  12. Obesity, bariatric surgery, and iron deficiency: true, true, true and related.

    Science.gov (United States)

    Love, Aileen L; Billett, Henny H

    2008-05-01

    Morbid obesity is a health problem that has been shown to be refractory to diet, exercise, and medical treatment. Surgeries designed to promote weight loss, termed bariatric surgery and typically involving a gastric bypass procedure, have recently been implemented to treat obesity with high success rates. However, long-term sequelae can result in micronutrient deficiencies. This review will focus on iron deficiency and its association with obesity and bariatric surgery. Iron deficiency develops after gastric bypass for several reasons including intolerance for red meat, diminished gastric acid secretion, and exclusion of the duodenum from the alimentary tract. Menstruating women, pregnant women, and adolescents may be particularly predisposed toward developing iron deficiency and microcytic anemias after bypass surgery. Preoperative assessment of patients should include a complete hematological work-up, including measurement of iron stores. Postoperatively, oral iron prophylaxis and vitamin C in addition to a multivitamin should be prescribed for bypass patients, especially for vulnerable populations. Once iron deficiency has developed, it may prove refractory to oral treatment, and require parenteral iron, blood transfusions, or surgical interventions. Bariatric surgery patients require lifelong follow-up of hematological and iron parameters since iron deficiency and anemia may develop years after surgery. Copyright 2008 Wiley-Liss, Inc.

  13. Practises and controversies in the management of asymptomatic aneurysms: Results of an international survey.

    Science.gov (United States)

    Alshafai, Nabeel; Falenchuk, Olesya; Cusimano, Michael D

    2015-01-01

    Asymptomatic aneurysms that are increasingly discovered on cranial diagnostic imaging are a growing management dilemma. Large-scale studies have shown that in most instances, conservative management is appropriate for the majority of patients with aneurysms less than 7 mm in maximum diameter. It is unclear whether international practise mirrors practise in these large trials. To determine how neurosurgeons around the world manage patients with asymptomatic aneurysms. Electronic survey of 283 clinicians managing patients with aneurysms using a 55-item questionnaire detailing characteristics of their experience, their hospitals and their present and future practises and insights regarding the management of patients with intracerebral aneurysms. The 203 neurosurgeons (72%) who responded had a median of 17 years of practise with aneurysms and managed a median of 25 aneurysms annually. The majority of neurosurgeons endorsed treatment of all asymptomatic aneurysms regardless of size. Only four out of 10 neurosurgeons would manage patients with 4 mm anterior communicating artery or middle cerebral artery aneurysms non-surgically, whereas fewer than 2% would conservatively manage asymptomatic patients with 10 or 16 mm aneurysms. Neurosurgeons were split as to the recommended techniques for asymptomatic aneurysms of 10 or 16 mm with about half of them electing clipping and half coiling for ACoA and nearly three quarters favouring clipping for the MCA aneurysm. Although international differences exist between Europe, North America and the rest of the world, most state that their choice of treatment related to decisions around what option would provide the best neurological outcome and prevention of long-term bleeding. Despite large trials supporting the management of small asymptomatic aneurysms, most neurosurgeons internationally chooses to treat them with surgery or endovascular means. Since clinicians use a number of factors beyond the maximum diameter when

  14. Low frequency of asymptomatic carriage of toxigenic Clostridium difficile in an acute care geriatric hospital: prospective cohort study in Switzerland

    Directory of Open Access Journals (Sweden)

    Daniela Pires

    2016-06-01

    Full Text Available Abstract Background The role of asymptomatic carriers of toxigenic Clostridium difficile (TCD in nosocomial cross-transmission remains debatable. Moreover, its relevance in the elderly has been sparsely studied. Objectives To assess asymptomatic TCD carriage in an acute care geriatric population. Methods We performed a prospective cohort study at the 296-bed geriatric hospital of the Geneva University Hospitals. We consecutively recruited all patients admitted to two 15-bed acute-care wards. Patients with C. difficile infection (CDI or diarrhoea at admission were excluded. First bowel movement after admission and every two weeks thereafter were sampled. C. difficile toxin B gene was identified using real-time polymerase chain-reaction (BD MAXTMCdiff. Asymptomatic TCD carriage was defined by the presence of the C. difficile toxin B gene without diarrhoea. Results A total of 102 patients were admitted between March and June 2015. Two patients were excluded. Among the 100 patients included in the study, 63 were hospitalized and 1 had CDI in the previous year, and 36 were exposed to systemic antibiotics within 90 days prior to admission. Overall, 199 stool samples were collected (median 2 per patient, IQR 1-3. Asymptomatic TCD carriage was identified in two patients (2 %. Conclusions We found a low prevalence of asymptomatic TCD carriage in a geriatric population frequently exposed to antibiotics and healthcare. Our findings suggest that asymptomatic TCD carriage might contribute only marginally to nosocomial TCD cross-transmission in our and similar healthcare settings.

  15. Asymptomatic memory CD8+ T cells

    Science.gov (United States)

    Khan, Arif Azam; Srivastava, Ruchi; Lopes, Patricia Prado; Wang, Christine; Pham, Thanh T; Cochrane, Justin; Thai, Nhi Thi Uyen; Gutierrez, Lucas; BenMohamed, Lbachir

    2014-01-01

    Generation and maintenance of high quantity and quality memory CD8+ T cells determine the level of protection from viral, bacterial, and parasitic re-infections, and hence constitutes a primary goal for T cell epitope-based human vaccines and immunotherapeutics. Phenotypically and functionally characterizing memory CD8+ T cells that provide protection against herpes simplex virus type 1 and type 2 (HSV-1 and HSV-2) infections, which cause blinding ocular herpes, genital herpes, and oro-facial herpes, is critical for better vaccine design. We have recently categorized 2 new major sub-populations of memory symptomatic and asymptomatic CD8+ T cells based on their phenotype, protective vs. pathogenic function, and anatomical locations. In this report we are discussing a new direction in developing T cell-based human herpes vaccines and immunotherapeutics based on the emerging new concept of “symptomatic and asymptomatic memory CD8+ T cells.” PMID:24499824

  16. Asymptomatic Bladder Metastasis from Breast Cancer

    Directory of Open Access Journals (Sweden)

    Luigi Cormio

    2014-01-01

    Full Text Available Introduction. Breast cancer is the most common nondermatologic cancer in women. Common metastatic sites include lymph nodes, lung, liver, and bone. Metastases to the bladder are extremely rare, with all reported cases presenting with urinary symptoms. Case Report. Herein, we report the first case of completely asymptomatic bladder metastasis from breast cancer, occasionally revealed, 98 months after the initial diagnosis of lobular breast carcinoma, by a follow-up computed tomography scanning showing thickening of left bladder wall and grade II left hydronephrosis. A positive staining for estrogen and progesterone receptors was confirmed by immunohistochemistry. Discussion. The reported case confirms that bladder metastases from breast cancer tend to occur late after the diagnosis of the primary tumor and, for the first time, points out they can be asymptomatic. Conclusion. Such data support the need for careful follow-up and early intervention whenever such clinical situation is suspected.

  17. Cerebral blood flow in asymptomatic individuals

    International Nuclear Information System (INIS)

    Isaka, Yoshinari; Iiji, Osamu; Ashida, Keiichi; Imaizumi, Masatoshi

    1993-01-01

    We studied the relationship between cortical grey matter flow (CBF) and age, cerebrovascular risk factors and the severity of subcortical hypersignals (HS, hyperintensity score in MRI) in 47 asymptomatic subjects with cerebrovascular risk factors. Multiple regression analysis revealed that HS was most strongly related to CBF, and that hematocrit, age and evidence of ischemic change detected in the electrocardiogram also appeared to be independent determinants of CBF. Both the severity and location of hypersignals were correlated with CBF. The most significant negative correlation observed was that between CBF and HS in the basal ganglia-thalamic region, where the degree of signal abnormality was modest. Decreased CBF in asymptomatic subjects with cerebrovascular risk factors may be related to microcirculatory disturbance associated with elevated hematocrit and an increase in the number of risk factors, and functional suppression of cerebral cortex due to the neuronal disconnection associated with subcortical lesions. In addition, impaired cerebral circulation may be related to MRI signal abnormalities. (author)

  18. Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection

    DEFF Research Database (Denmark)

    Lundgren, Jens D; Babiker, Abdel G; Gordin, Fred

    2015-01-01

    BACKGROUND: Data from randomized trials are lacking on the benefits and risks of initiating antiretroviral therapy in patients with asymptomatic human immunodeficiency virus (HIV) infection who have a CD4+ count of more than 350 cells per cubic millimeter. METHODS: We randomly assigned HIV...... entry, the median HIV viral load was 12,759 copies per milliliter, and the median CD4+ count was 651 cells per cubic millimeter. On May 15, 2015, on the basis of an interim analysis, the data and safety monitoring board determined that the study question had been answered and recommended that patients...... in patients with a CD4+ count of more than 500 cells per cubic millimeter. The risks of a grade 4 event were similar in the two groups, as were the risks of unscheduled hospital admissions. CONCLUSIONS: The initiation of antiretroviral therapy in HIV-positive adults with a CD4+ count of more than 500 cells...

  19. Increased platelet activation in early symptomatic versus asymptomatic carotid stenosis and relationship with microembolic status: Results from the Platelets And Carotid Stenosis (PACS) Study.

    LENUS (Irish Health Repository)

    Kinsella, Ja

    2013-04-26

    BACKGROUND: Cerebral microembolic signals (MES) may predict increased stroke risk in carotid stenosis. However, the relationship between platelet counts or platelet activation status and MES in symptomatic versus asymptomatic carotid stenosis has not been comprehensively assessed. SETTING: University teaching hospitals. METHODS: This prospective, pilot observational study assessed platelet counts and platelet activation status, and the relationship between platelet activation and MES in asymptomatic versus early (≤4 weeks after TIA\\/stroke) and late phase (≥3 months) symptomatic moderate or severe (≥50%) carotid stenosis patients. Full blood count measurements were performed, and whole blood flow cytometry was used to quantify platelet surface activation marker expression (CD62P and CD63) and circulating leucocyte-platelet complexes. Bilateral simultaneous transcranial Doppler ultrasound monitoring of the middle cerebral arteries was performed for 1 hour to classify patients as MES-positive or MES-negative. RESULTS: Data from 31 asymptomatic patients were compared with 46 symptomatic patients in the early phase, and 35 of these patients followed up to the late phase after symptom onset. The median platelet count (211 vs. 200 x 10(9) \\/L; p=0.03) and the median% lymphocyte-platelet complexes were higher in early symptomatic than asymptomatic patients (2.8 vs. 2.4%, p=0.001). The% lymphocyte-platelet complexes was higher in early symptomatic than asymptomatic patients with ≥70% carotid stenosis (p=0.0005), and in symptomatic patients recruited within 7 days of symptom onset (p=0.028). Complete TCD data were available in 25 asymptomatic and 31 early phase symptomatic, and 27 late phase symptomatic patients. 12% of asymptomatic versus 32% of early phase symptomatic (p=0.02) and 19% of late phase symptomatic patients (p=0.2) were MES-positive. Early symptomatic MES-negative patients had a higher% lymphocyte-platelet complexes than asymptomatic MES

  20. Asymptomatic deer excrete infectious prions in feces

    OpenAIRE

    Tamg?ney, G?ltekin; Miller, Michael W.; Wolfe, Lisa L.; Sirochman, Tracey M.; Glidden, David V.; Palmer, Christina; Lemus, Azucena; DeArmond, Stephen J.; Prusiner, Stanley B.

    2009-01-01

    Infectious prion diseases 1 ? scrapie of sheep 2 and chronic wasting disease (CWD) of several species in the deer family 3,4 ? are transmitted naturally within affected host populations. Although several possible sources of contagion have been identified in excretions and secretions from symptomatic animals 5?8 , the biological importance of these sources in sustaining epidemics remains unclear. Here we show that asymptomatic CWD-infected mule deer (Odocoileus hemionus) excrete CWD prions in ...

  1. Asymptomatic deer excrete infectious prions in faeces

    OpenAIRE

    Tamgüney, G; Miller, MW; Wolfe, LL; Sirochman, TM; Glidden, DV; Palmer, C; Lemus, A; Dearmond, SJ; Prusiner, SB

    2009-01-01

    Infectious prion diseasesĝ€"scrapie of sheep and chronic wasting disease (CWD) of several species in the deer familyĝ€" are transmitted naturally within affected host populations. Although several possible sources of contagion have been identified in excretions and secretions from symptomatic animals, the biological importance of these sources in sustaining epidemics remains unclear. Here we show that asymptomatic CWD-infected mule deer (Odocoileus hemionus) excrete CWD prions in their faeces...

  2. Defecographic findings of young asymptomatic volunteers

    International Nuclear Information System (INIS)

    Yoon, Sang Wook; Park, Hyo Jin; Kim, Ki Whang; Ji, Hoon

    1994-01-01

    Defacography is a technique of examining the rectum and anal canal by using fluoroscopy during detection. This study was done to determine the range of normal findings of defecography in young asymptomatic Korean volunteers. Twenty nine asymptomatic young volunteers underwent defecography. Anorectal angle, perineal descent, length and width of anal, rectocele, rectal intussusception and incontinence were evaluated. The range of anorectal angle was 82 .deg- 149 .deg in resting state, compared to the 63 .deg-116 .deg in squeezing state, and 95 .deg- 116 .deg in straining state respectively. The pelvic floor in straining state descended on average of 1.62 cm from the inferior margin of ischial tuberosity that its broad range of position from-5.2 cm to 0.8 cm implies a wide variation of anorectal angle and perineal descent. Mild degree of rectocele with less than 2 cm of depth was found in 12 out of 29 cases. Rectal intussusception was noted in six and rectal incontinence was seen in one case. Formation of rectocele and intussusception during defecation was common in asymptomatic young volunteers. The wide range of defacographic measurements warrants the necessity of other complementary studies on anorectal function to improve the diagnostic accuracy. The interpretation of defecographic measurement should therefore be made with caution and should not be used as the sole criteria for selection of treatment modality

  3. Apparent and true resistant hypertension: definition, prevalence and outcomes.

    Science.gov (United States)

    Judd, E; Calhoun, D A

    2014-08-01

    Resistant hypertension, defined as blood pressure (BP) remaining above goal despite the use of > or =3 antihypertensive medications at maximally tolerated doses (one ideally being a diuretic) or BP that requires > or =4 agents to achieve control, has received more attention with increased efforts to improve BP control rates and the emergence of device-based therapies for hypertension. This classically defined resistant group consists of patients with true resistant hypertension, controlled resistant hypertension and pseudo-resistant hypertension. In studies where pseudo-resistant hypertension cannot be excluded (for example, 24-h ambulatory BP not obtained), the term apparent resistant hypertension has been used to identify 'apparent' lack of control on > or =3 medications. Large, well-designed studies have recently reported the prevalence of resistant hypertension. Pooling prevalence data from these studies and others within North America and Europe with a combined sample size of >600,000 hypertensive participants, the prevalence of resistant hypertension is 14.8% of treated hypertensive patients and 12.5% of all hypertensives. However, the prevalence of true resistant hypertension, defined as uncontrolled both by office and 24-h ambulatory BP monitoring with confirmed medication adherence, may be more meaningful in terms of identifying risk and estimating benefit from newer therapies like renal denervation. Rates of cardiovascular events and mortality follow mean 24-h ambulatory BPs in patients with resistant hypertension, and true resistant hypertension represents the highest risk. The prevalence of true resistant hypertension has not been directly measured in large trials; however, combined data from smaller studies suggest that true resistant hypertension is present in half of the patients with resistant hypertension who are uncontrolled in the office. Our pooled analysis shows prevalence rates of 10.1% and 7.9% for uncontrolled resistant hypertension among

  4. Prevalence and risk factors of asymptomatic peptic ulcer disease in Taiwan

    Science.gov (United States)

    Wang, Fu-Wei; Tu, Ming-Shium; Mar, Guang-Yuan; Chuang, Hung-Yi; Yu, Hsien-Chung; Cheng, Lung-Chih; Hsu, Ping-I

    2011-01-01

    AIM: To investigate the prevalence and risk factors of asymptomatic peptic ulcer disease (PUD) in a general Taiwanese population. METHODS: From January to August 2008, consecutive asymptomatic subjects undergoing a routine health check-up were evaluated by upper gastrointestinal endoscopy. Gastroduodenal mucosal breaks were carefully assessed, and a complete medical history and demographic data were obtained from each patient. Logistic regression analysis was conducted to identify independent risk factors for asymptomatic PUD. RESULTS: Of the 572 asymptomatic subjects, 54 (9.4%) were diagnosed as having PUD. The prevalence of gastric ulcer, duodenal ulcer and both gastric and duodenal ulcers were 4.7%, 3.9%, and 0.9%, respectively. Multivariate analysis revealed that prior history of PUD [odds ratio (OR), 2.0, 95% CI: 1.3-2.9], high body mass index [body mass index (BMI) 25-30: OR, 1.5, 95% CI: 1.0-2.2; BMI > 30 kg/m2: OR, 3.6, 95% CI: 1.5-8.7] and current smoker (OR, 2.6, 95% CI: 1.6-4.4) were independent predictors of asymptomatic PUD. In contrast, high education level was a negative predictor of PUD (years of education 10-12: OR, 0.5, 95% CI: 0.3-0.8; years of education > 12: OR, 0.6, 95% CI: 0.3-0.9). CONCLUSION: The prevalence of PUD in asymptomatic subjects is 9.4% in Taiwan. Prior history of PUD, low education level, a high BMI and current smoker are independent risk factors for developing asymptomatic PUD. PMID:21448426

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