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Sample records for twelve patients presented

  1. Hyperinsulinism and hyperammonemia syndrome: report of twelve unrelated patients.

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    De Lonlay, P; Benelli, C; Fouque, F; Ganguly, A; Aral, B; Dionisi-Vici, C; Touati, G; Heinrichs, C; Rabier, D; Kamoun, P; Robert, J J; Stanley, C; Saudubray, J M

    2001-09-01

    Hyperinsulinism and hyperammonemia syndrome has been reported as a cause of moderately severe hyperinsulinism with diffuse involvement of the pancreas. The disorder is caused by gain of function mutations in the GLUD1 gene, resulting in a decreased inhibitory effect of guanosine triphosphate on the glutamate dehydrogenase (GDH) enzyme. Twelve unrelated patients (six males, six females) with hyperinsulinism and hyperammonemia syndrome have been investigated. The phenotypes were clinically heterogeneous, with neonatal and infancy-onset hypoglycemia and variable responsiveness to medical (diazoxide) and dietary (leucine-restricted diet) treatment. Hyperammonemia (90-200 micromol/L, normal carbamylglutamate administration. The patients had mean basal GDH activity (18.3 +/- 0.9 nmol/min/mg protein) not different from controls (17.9 +/- 1.8 nmol/min/mg protein) in cultured lymphoblasts. The sensitivity of GDH activity to inhibition by guanosine triphosphate was reduced in all patient lymphoblast cultures (IC(50), or concentrations required for 50% inhibition of GDH activity, ranging from 140 to 580 nM, compared with control IC(50) value of 83 +/- 1.0 nmol/L). The allosteric effect of ADP was within the normal range. The activating effect of leucine on GDH activity varied among the patients, with a significant decrease of sensitivity that was correlated with the negative clinical response to a leucine-restricted diet in plasma glucose levels in four patients. Molecular studies were performed in 11 patients. Heterozygous mutations were localized in the antenna region (four patients in exon 11, two patients in exon 12) as well as in the guanosine triphosphate binding site (two patients in exon 6, two patients in exon 7) of the GLUD1 gene. No mutation has been found in one patient after sequencing the exons 5-13 of the gene.

  2. Twelve novel Atm mutations identified in Chinese ataxia telangiectasia patients.

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    Huang, Yu; Yang, Lu; Wang, Jianchun; Yang, Fan; Xiao, Ying; Xia, Rongjun; Yuan, Xianhou; Yan, Mingshan

    2013-09-01

    Ataxia telangiectasia (A-T) is an autosomal recessive disease characterized mainly by progressive cerebellar ataxia, oculocutaneous telangiectasia, and immunodeficiency. This disease is caused by mutations of the ataxia telangiectasia mutated (Atm) gene. More than 500 Atm mutations that are responsible for A-T have been identified so far. However, there have been very few A-T cases reported in China, and only two Chinese A-T patients have undergone Atm gene analysis. In order to systemically investigate A-T in China and map their Atm mutation spectrum, we recruited eight Chinese A-T patients from six unrelated families nationwide. Using direct sequencing of genomic DNA and the multiplex ligation-dependent probe amplification, we identified twelve pathogenic Atm mutations, including one missense, four nonsense, five frameshift, one splicing, and one large genomic deletion. All the Atm mutations we identified were novel, and no homozygous mutation and founder-effect mutation were found. These results suggest that Atm mutations in Chinese populations are diverse and distinct largely from those in other ethnic areas.

  3. The OCCASO survey: Presentation and radial velocities of twelve Milky Way Open Clusters

    CERN Document Server

    Casamiquela, L; Jordi, C; Balaguer-Núñez, L; Pancino, E; Hidalgo, S L; Martínez-Vázquez, C E; Murabito, S; del Pino, A; Aparicio, A; Blanco-Cuaresma, S; Gallart, C

    2016-01-01

    Open clusters (OCs) are crucial for studying the formation and evolution of the Galactic disc. However, the lack of a large number of OCs analyzed homogeneously hampers the investigations about chemical patterns and the existence of Galactocentric radial and vertical gradients, or an age-metallicity relation. To overcome this, we have designed the Open Cluster Chemical Abundances from Spanish Observatories survey (OCCASO). We aim to provide homogeneous radial velocities, physical parameters and individual chemical abundances of six or more Red Clump stars for a sample of 25 old and intermediate-age OCs visible from the Northern hemisphere. To do so, we use high resolution spectroscopic facilities (R> 62,000) available at Spanish observatories. We present the motivation, design and current status of the survey, together with the first data release of radial velocities for 77 stars in 12 OCs, which represents about 50% of the survey. We include clusters never studied with high-resolution spectroscopy before (NG...

  4. Twelve novel HGD gene variants identified in 99 alkaptonuria patients: focus on 'black bone disease' in Italy.

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    Nemethova, Martina; Radvanszky, Jan; Kadasi, Ludevit; Ascher, David B; Pires, Douglas E V; Blundell, Tom L; Porfirio, Berardino; Mannoni, Alessandro; Santucci, Annalisa; Milucci, Lia; Sestini, Silvia; Biolcati, Gianfranco; Sorge, Fiammetta; Aurizi, Caterina; Aquaron, Robert; Alsbou, Mohammed; Lourenço, Charles Marques; Ramadevi, Kanakasabapathi; Ranganath, Lakshminarayan R; Gallagher, James A; van Kan, Christa; Hall, Anthony K; Olsson, Birgitta; Sireau, Nicolas; Ayoob, Hana; Timmis, Oliver G; Sang, Kim-Hanh Le Quan; Genovese, Federica; Imrich, Richard; Rovensky, Jozef; Srinivasaraghavan, Rangan; Bharadwaj, Shruthi K; Spiegel, Ronen; Zatkova, Andrea

    2016-01-01

    Alkaptonuria (AKU) is an autosomal recessive disorder caused by mutations in homogentisate-1,2-dioxygenase (HGD) gene leading to the deficiency of HGD enzyme activity. The DevelopAKUre project is underway to test nitisinone as a specific treatment to counteract this derangement of the phenylalanine-tyrosine catabolic pathway. We analysed DNA of 40 AKU patients enrolled for SONIA1, the first study in DevelopAKUre, and of 59 other AKU patients sent to our laboratory for molecular diagnostics. We identified 12 novel DNA variants: one was identified in patients from Brazil (c.557T>A), Slovakia (c.500C>T) and France (c.440T>C), three in patients from India (c.469+6T>C, c.650-85A>G, c.158G>A), and six in patients from Italy (c.742A>G, c.614G>A, c.1057A>C, c.752G>A, c.119A>C, c.926G>T). Thus, the total number of potential AKU-causing variants found in 380 patients reported in the HGD mutation database is now 129. Using mCSM and DUET, computational approaches based on the protein 3D structure, the novel missense variants are predicted to affect the activity of the enzyme by three mechanisms: decrease of stability of individual protomers, disruption of protomer-protomer interactions or modification of residues in the region of the active site. We also present an overview of AKU in Italy, where so far about 60 AKU cases are known and DNA analysis has been reported for 34 of them. In this rather small group, 26 different HGD variants affecting function were described, indicating rather high heterogeneity. Twelve of these variants seem to be specific for Italy.

  5. Twelve novel HGD gene variants identified in 99 alkaptonuria patients: focus on ‘black bone disease' in Italy

    Science.gov (United States)

    Nemethova, Martina; Radvanszky, Jan; Kadasi, Ludevit; Ascher, David B; Pires, Douglas E V; Blundell, Tom L; Porfirio, Berardino; Mannoni, Alessandro; Santucci, Annalisa; Milucci, Lia; Sestini, Silvia; Biolcati, Gianfranco; Sorge, Fiammetta; Aurizi, Caterina; Aquaron, Robert; Alsbou, Mohammed; Marques Lourenço, Charles; Ramadevi, Kanakasabapathi; Ranganath, Lakshminarayan R; Gallagher, James A; van Kan, Christa; Hall, Anthony K; Olsson, Birgitta; Sireau, Nicolas; Ayoob, Hana; Timmis, Oliver G; Le Quan Sang, Kim-Hanh; Genovese, Federica; Imrich, Richard; Rovensky, Jozef; Srinivasaraghavan, Rangan; Bharadwaj, Shruthi K; Spiegel, Ronen; Zatkova, Andrea

    2016-01-01

    Alkaptonuria (AKU) is an autosomal recessive disorder caused by mutations in homogentisate-1,2-dioxygenase (HGD) gene leading to the deficiency of HGD enzyme activity. The DevelopAKUre project is underway to test nitisinone as a specific treatment to counteract this derangement of the phenylalanine-tyrosine catabolic pathway. We analysed DNA of 40 AKU patients enrolled for SONIA1, the first study in DevelopAKUre, and of 59 other AKU patients sent to our laboratory for molecular diagnostics. We identified 12 novel DNA variants: one was identified in patients from Brazil (c.557T>A), Slovakia (c.500C>T) and France (c.440T>C), three in patients from India (c.469+6T>C, c.650–85A>G, c.158G>A), and six in patients from Italy (c.742A>G, c.614G>A, c.1057A>C, c.752G>A, c.119A>C, c.926G>T). Thus, the total number of potential AKU-causing variants found in 380 patients reported in the HGD mutation database is now 129. Using mCSM and DUET, computational approaches based on the protein 3D structure, the novel missense variants are predicted to affect the activity of the enzyme by three mechanisms: decrease of stability of individual protomers, disruption of protomer-protomer interactions or modification of residues in the region of the active site. We also present an overview of AKU in Italy, where so far about 60 AKU cases are known and DNA analysis has been reported for 34 of them. In this rather small group, 26 different HGD variants affecting function were described, indicating rather high heterogeneity. Twelve of these variants seem to be specific for Italy. PMID:25804398

  6. Rheumatoid Arthritis and Incidence of Twelve Initial Presentations of Cardiovascular Disease: A Population Record-Linkage Cohort Study in England.

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    Mar Pujades-Rodriguez

    Full Text Available While rheumatoid arthritis is an established risk factor for cardiovascular disease (CVD, our knowledge of how the pattern of risk varies for different cardiovascular phenotypes is incomplete. The association between rheumatoid arthritis and the initial presentation of 12 types of CVDs were examined in a contemporary population of men and women of a wide age range.CALIBER data, which links primary care, hospital and mortality data in England, was analysed. A cohort of people aged ≥18 years and without history of CVD was assembled and included all patients with prospectively recorded rheumatoid arthritis from January 1997, until March 2010, matched with up to ten people without rheumatoid arthritis by age, sex and general practice. The associations between rheumatoid arthritis and the initial presentation of 12 types of CVDs were estimated using multivariable random effects Poisson regression models.The analysis included 12,120 individuals with rheumatoid arthritis and 121,191 comparators. Of these, 2,525 patients with and 18,146 without rheumatoid arthritis developed CVDs during a median of 4.2 years of follow-up. Patients with rheumatoid arthritis had higher rates of myocardial infarction (adjusted incidence ratio [IRR] = 1.43, 95%CI 1.21-1.70, unheralded coronary death (IRR = 1.60, 95%CI 1.18-2.18, heart failure (IRR = 1.61, 95%CI 1.43-1.83, cardiac arrest (HR = 2.26, 95%CI 1.69-3.02 and peripheral arterial disease (HR = 1.36, 95%CI 1.14-1.62; and lower rates of stable angina (HR = 0.83, 95%CI 0.73-0.95. There was no evidence of association with cerebrovascular diseases, abdominal aortic aneurysm or unstable angina, or of interactions with sex or age.The observed associations with some but not all types of CVDs inform both clinical practice and the selection of cardiovascular endpoints for trials and for the development of prognostic models for patients with rheumatoid arthritis.

  7. Altered Lipid Metabolism in Recovered SARS Patients Twelve Years after Infection.

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    Wu, Qi; Zhou, Lina; Sun, Xin; Yan, Zhongfang; Hu, Chunxiu; Wu, Junping; Xu, Long; Li, Xue; Liu, Huiling; Yin, Peiyuan; Li, Kuan; Zhao, Jieyu; Li, Yanli; Wang, Xiaolin; Li, Yu; Zhang, Qiuyang; Xu, Guowang; Chen, Huaiyong

    2017-08-22

    Severe acute respiratory syndrome-coronavirus (SARS-CoV) and SARS-like coronavirus are a potential threat to global health. However, reviews of the long-term effects of clinical treatments in SARS patients are lacking. Here a total of 25 recovered SARS patients were recruited 12 years after infection. Clinical questionnaire responses and examination findings indicated that the patients had experienced various diseases, including lung susceptibility to infections, tumors, cardiovascular disorders, and abnormal glucose metabolism. As compared to healthy controls, metabolomic analyses identified significant differences in the serum metabolomes of SARS survivors. The most significant metabolic disruptions were the comprehensive increase of phosphatidylinositol and lysophospha tidylinositol levels in recovered SARS patients, which coincided with the effect of methylprednisolone administration investigated further in the steroid treated non-SARS patients with severe pneumonia. These results suggested that high-dose pulses of methylprednisolone might cause long-term systemic damage associated with serum metabolic alterations. The present study provided information for an improved understanding of coronavirus-associated pathologies, which might permit further optimization of clinical treatments.

  8. Surgical treatment of aneurysms of the ascending aorta. Twelve years' experience in 66 patients.

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    Markewitz, A; Weinhold, C; Kemkes, B M; Reichart, B; Hemmer, W; Klinner, W

    1986-10-01

    This study presents the results in 66 patients undergoing surgery for concomitant supracoronary vascular interposition and valve replacement carried out at the Department of Cardiac Surgery of the University of Munich, West-Germany, over a period of 12 years (from July 1, 1973 to June 30, 1985) using a technique similar to that described by Wheat. Forty-seven percent of the cases were true aneurysms and 20% chronic dissections. Thirty-three percent of patients had acute dissections. Early mortality was 16% in the total patient population, 9% in the group having true aneurysm and 32% in the group having acute dissection. No early death was observed in association with chronic dissections. The actuarial one-year survival rate in patients with true aneurysm or chronic dissection was 83.6%, and 54.1% in patients with acute dissection. The corresponding 4-year survival rates were 76.4% and 54.1%, respectively. The average improvement according to the New York Heart Association classification was 1.5 grades. These results confirm that the operative approach to ascending aortic aneurysms is superior to medical treatment, with the operative method involving vascular graft without concomitant aortic valve replacement as well as the method described by Wheat having both proved successful.

  9. Branding your practice: twelve practical steps to creating lifelong patient relationships.

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    Neely, Melinda Hinson

    2005-01-01

    The concept of branding is not limited to large companies. It can be successfully applied in medical practices to those individuals or groups that wish to establish a distinct identity in the marketplace. Branding a medical practice establishes a competitive advantage, ensures a more predictable flow of patients, and ultimately enhances patient satisfaction. This article conceptualizes the branding process and provides guidelines for implementation that are applicable to a variety of budgets.

  10. Twelve tips for better communication with patients during history-taking.

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    Rahman, Aminur; Tasnim, Saria

    2007-04-30

    Eliciting proper history from a patient is of paramount importance to establish an accurate diagnosis and management in medical practice. Good communication skill is a prerequisite for an effective physician patient relationship. A systematic search of medical literature has been made to formulate a guideline for better communication during history taking. The guideline emphasizes on both physical environment and emotional encounter and the key points are expressed as tips on relevant issues.

  11. Twelve Tips for Better Communication with Patients During History-Taking

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    Aminur Rahman

    2007-01-01

    Full Text Available Eliciting proper history from a patient is of paramount importance to establish an accurate diagnosis and management in medical practice. Good communication skill is a prerequisite for an effective physician patient relationship. A systematic search of medical literature has been made to formulate a guideline for better communication during history taking. The guideline emphasizes on both physical environment and emotional encounter and the key points are expressed as tips on relevant issues.

  12. Etodolac, aspirin, and placebo in patients with degenerative joint disease: a twelve-week study.

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    Andelman, S Y

    1983-01-01

    Thirty patients from a private practice were enrolled in an investigation designed to compare the efficacy and safety of a new nonsteroidal anti-inflammatory drug, etodolac, with those of aspirin and placebo in ameliorating pain, inflammation, and functional deficits associated with degenerative joint disease. The 12-week, double-blind, parallel-group study was divided into drug-titration and maintenance periods and was preceded by a washout period of up to two weeks. There were ten patients in each of the three treatment groups. The mean daily maintenance dosages of etodolac and aspirin were 384 mg and 4,322 mg, respectively. Etodolac was significantly (less than or equal to 0.05) more effective than placebo according to 11 of 15 clinical indexes of efficacy: three assessments of the range of motion of the knee joint, and one each of pain while standing, pain while walking, pain while climbing stairs, the average of pains while bearing weight, pain at night, joint tenderness, patient's self-evaluation, and the time required to walk 50 feet. Aspirin was significantly more effective than placebo in only three assessments: two of the range of motion of the knee joint and one of pain while standing. One patient taking etodolac, three patients taking aspirin, and six patients taking placebo withdrew from the trial because of insufficient therapeutic response. There were four withdrawals due to adverse effects, two in the aspirin group and two in the placebo group. Adverse effects (tinnitus and hearing loss) leading to withdrawal of one of the two aspirin patients were probably due to drug administration. No significant side effects were reported by patients in the etodolac group.

  13. Cytogenetic studies in twelve patients with primary myelofibrosis and myeloid metaplasia.

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    Smadja, N; Krulik, M; de Gramont, A; Sirinelli, A; Brissaud, P; Dray, C; Audebert, A A; Debray, J

    1987-01-01

    Chromosome studies on bone marrow and/or peripheral blood cells without phytohemagglutinin were performed on 12 patients with primary myelofibrosis with myeloid meta-plasia (PMMM) between 1980 and 1984. Abnormal clones were found in six patients (50%). In five cases the abnormal clone involved the long arm of chromosome #7, two of which also had partial trisomy of chromosome #1 and trisomy of 9. Additional abnormalities involving chromosomes #3, #5, #11, #13, #15, and #21 were each found once. Review of the literature showed few studies on the cytogenetics of PMMM. No specific chromosomal pattern can be established; however, abnormalities described are nonrandom.

  14. Twelve-Month and Lifetime Prevalence of Mental Disorders in Cancer Patients.

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    Kuhnt, Susanne; Brähler, Elmar; Faller, Hermann; Härter, Martin; Keller, Monika; Schulz, Holger; Wegscheider, Karl; Weis, Joachim; Boehncke, Anna; Hund, Bianca; Reuter, Katrin; Richard, Matthias; Sehner, Susanne; Wittchen, Hans-Ulrich; Koch, Uwe; Mehnert, Anja

    2016-01-01

    Psychological problems are common in cancer patients. For the purpose of planning psycho-oncological interventions and services tailored to the specific needs of different cancer patient populations, it is necessary to know to what extent psychological problems meet the criteria of mental disorders. The purpose of this study was to estimate the 12-month and lifetime prevalence rates of mental disorders in cancer patients. A representative sample of patients with different tumour entities and tumour stages (n = 2,141) in outpatient, inpatient and rehabilitation settings underwent the standardized computer-assisted Composite International Diagnostic Interview for mental disorders adapted for cancer patients (CIDI-O). The overall 12-month prevalence for any mental disorder was 39.4% (95% CI: 37.3-41.5), that for anxiety disorders was 15.8% (95% CI: 14.4-17.4), 12.5% (95% CI: 11.3-14.0) for mood disorders, 9.5% (95% CI: 8.3-10.9) for somatoform disorders, 7.3% (95% CI: 6.2-8.5) for nicotine dependence, 3.7% (95% CI: 3.0-4.6) for disorders due to general medical condition, and 1.1% (95% CI: 0.7-1.6) for alcohol abuse or dependence. Lifetime prevalence for any mental disorder was 56.3% (95% CI 54.1-58.6), that for anxiety disorders was 24.1% (95% CI: 22.3-25.9), 20.5% (95% CI: 18.9-22.3) for mood disorders, 19.9% (95% CI: 18.3-21.7) for somatoform disorders, 18.2% (95% CI: 16.6-20.0) for nicotine dependence, 6.4% (95% CI: 5.4-7.6) for alcohol abuse or dependence, 4.6% (95% CI: 3.8-5.6) for disorders due to general medical condition, and 0.2% (95% CI: 0.1-0.6) for eating disorders. Mental disorders are highly prevalent in cancer patients, indicating the need for provision of continuous psycho-oncological support from inpatient to outpatient care, leading to an appropriate allocation of direct personnel and other resources. © 2016 S. Karger AG, Basel.

  15. An evaluation of the resistance to flow through the patient valves of twelve adult manual resuscitators.

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    Hess, D; Simmons, M

    1992-05-01

    What is the inspiratory and expiratory resistance to flow through the patient valves of adult manual resuscitators? We evaluated the resistance to flow through the patient valves of 12 adult resuscitators (Ambu, Code Blue, DMR, Hope 4, Hospitak, Hudson, Intertech, Laerdal, Mercury, Respironics, SPUR, Vitalograph). Expiratory resistance was evaluated by directing a flow of oxygen through the valve in the direction that the patient expires. Inspiratory resistance was evaluated by directing oxygen through the valve in the direction of flow when the bag is squeezed. Flow was controlled by a Timeter 0-75 flowmeter, and measured using a calibrated Timeter RT-200. Flows of 10, 20, 30, 40, 50, 60, 70, 80, and 90 L/min were used. Resistive back pressure of the resuscitator valves was measured using a calibrated Timeter RT-200. Resistance was calculated by dividing back pressure by flow. Five measurements were made at each flow setting for each resuscitator. Significant differences in back pressures and resistances existed between the resuscitators for both expiratory and inspiratory flows (p less than 0.001 in each case). Significant interaction effects also existed between resuscitator brands and flows (p less than 0.001 in each case). At an expiratory flow of 50 L/min, all resuscitators except the Hospitak and Vitalograph produced a back pressure less than 5 cm H2O (the International Standards Organization standard). At an inspiratory flow of 50 L/min, all resuscitators but the Hospitak, Mercury, and Vitalograph produced a back pressure less than 5 cm H2O. Significant differences existed in the back pressures produced due to the flow resistance through the patient valves of these resuscitators, and these might be considered excessive in some cases. Because this was a bench study, further work is needed to determine the clinical importance of these findings.

  16. Twelve tips to support the development of clinical reasoning skills using virtual patient cases.

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    Posel, Nancy; Mcgee, James B; Fleiszer, David M

    2015-01-01

    Clinical reasoning is a critical core competency in medical education. Strategies to support the development of clinical reasoning skills have focused on methodologies used in traditional settings, including lectures, small groups, activities within Simulation Centers and the clinical arena. However, the evolving role and growing utilization of virtual patients (VPs) in undergraduate medical education; as well as an increased emphasis on blended learning, multi-modal models that include VPs in core curricula; suggest a growing requirement for strategies or guidelines that directly focus on VPs. The authors have developed 12 practical tips that can be used in VP cases to support the development of clinical reasoning. These are based on teaching strategies and principles of instructional design and pedagogy, already used to teach and assess clinical reasoning in other settings. Their application within VPs will support educators who author or use VP cases that promote the development of clinical reasoning.

  17. Effect of Blood-letting Puncture at Twelve Well-Points of Hand on Consciousness and Heart Rate in Patients with Apoplexy

    Institute of Scientific and Technical Information of China (English)

    Guo Yi; Wang Xiuyun; Xu Tangping; Dai Zhihua; Li Yunchen

    2005-01-01

    Objective: To observe the effect of blood-letting puncture at Twelve Well-Points of Hand on consciousness and heart rate in patients with early apoplexy. Method: Under observation were patients with disturbance of consciousness within 3 days after the apoplectic seizure. The patients were divided into a large injury team, a moderate injury team and a mild injury team. Each team was again randomly divided into a puncture group and a control group, with routine treatment in both groups but bloodletting puncture only in the puncture group. Quantitative changes in consciousness, blood pressure and heart rate of the patients were observed. Result: Blood-letting puncture at Twelve Well-Points of Hand can improve the consciousness and raise the systolic pressure in patients of the mild injury team, and accelerate the heart rate in all the patients in the puncture group. Conclusion: Blood-letting puncture at Twelve Well-Points of Hand can improve the consciousness of patients with brain injury in small area.

  18. [Periodic fever: a description of twelve patients with periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA)].

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    De Cunto, Carmen; Britos, María; Eymann, Alfredo; Deltetto, Noelia; Liberatore, Diana

    2010-10-01

    PFAPA is a periodic fever syndrome characterized by: fever, aphthous stomatitis, pharyngitis and cervical adenitis. It is one of the autoinflammatory syndromes, but yet of unknown etiology. Our aim is to report our experience, describe clinical manifestations, laboratory findings, relapses occurrence and response to treatment. We present 12 PFAPA patients. Median age at onset: 1.15 years, mean duration of febrile episodes: 4 days, and relapses at regular intervals. All children received prednisone (1-2 mg/kg/dose) one to two doses, 9 patients responded immediately after the first dose and all experienced a lower periodicity of attacks. PFAPA is the most frequent periodic fever syndrome. To our knowledge, there are no other local series of PFAPA patients published. Recognizing this syndrome will prevent from ordering unnecessary studies and will favor family coping.

  19. Cardiac asthma in elderly patients: incidence, clinical presentation and outcome

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    Ray Patrick

    2007-05-01

    Full Text Available Abstract Background Cardiac asthma is common, but has been poorly investigated. The objective was to compare the characteristics and outcome of cardiac asthma with that of classical congestive heart failure (CHF in elderly patients. Methods Prospective study in an 1,800-bed teaching hospital. Results Two hundred and twelve consecutive patients aged ≥ 65 years presenting with dyspnea due to CHF (mean age of 82 ± 8 years were included. Findings of cardiac echocardiography and natriuretic peptides levels were used to confirm CHF. Cardiac asthma patients were defined as a patient with CHF and wheezing reported by attending physician upon admission to the emergency department. The CHF group (n = 137 and the cardiac asthma group (n = 75, differed for tobacco use (34% vs. 59%, p 2 (47 ± 15 vs. 41 ± 11 mmHg, p Conclusion Patients with cardiac asthma represented one third of CHF in elderly patients. They were more hypercapnic and experienced more distal airway obstruction. However, outcomes were similar.

  20. MEFV Gene Profile in Northwest of Iran, Twelve Common MEFV Gene Mutations Analysis in 216 Patients with Familial Mediterranean Fever

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    Farhad Salehzadeh

    2015-01-01

    Full Text Available Familial Mediterranean Fever (FMF is a hereditary autoinflammatory disease with autosomal recessive inheritance pattern often seen around the Mediterranean Sea. It is characterized by recurrent episodes of fever and polyserositis and rash. Recently, MEFV gene analysis determines the definitive diagnosis of FMF. In this study, we analyzed 12 MEFV gene mutations in more than 200 FMF patients, previously diagnosed by Tel-Hashomer clinical criteria, in northwest of Iran, located in the proximity of the Mediterranean Sea. In the northwest of Iran (Ardabil, 216 patients with FMF diagnosis, based on Tel-Hashomer criteria, referred to the genetic laboratory to be tested for the following mutations; P369S, F479L, M680I(G/C, M680I(G/A, I692del, M694V, M694I, K695R, V726A, A744S, R761H, E148Q. All patients were screened for MEFV gene mutations by a reverse hybridization assay (FMF Strip Assay, Vienna lab, Vienna, Austria according to manufacturer’s instructions. Among these FMF patients, no mutation was detected in 51 (23/62% patients, but 165 (76/38% patients had one or two mutations, 33 patients (15/28% homozygous, 86 patients (39/81% compound heterozygous and 46 patients (21/29% were heterozygous. The most common mutations were M694V (23/61%, V726A (11/11% and E148Q (9/95% respectively. MEFV gene mutations showed similarities and dissimilarities in different ethnic groups, while it is common among Arabs and Armenians genotype. Since common 12 MEFV gene analysis could not detect up to 50% of our patients, who had FMF on the basis of clinical Tel-Hashomer criteria, clinical criteria is still the best way in the diagnosis of FMF in this area.

  1. Diagnostic evaluation of patients presenting with hirsutism

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    İsmail Zeki Tekiş

    2014-03-01

    Full Text Available Objective: Hirsutism, similar to men, is the presence of terminal hairs in androgen-to sensitive areas in women. The present report aimed to study etiology and determine the prevalence of the diseases that causes hirsutism in these patients. Methods: In this study, total number of 40 patients who admitted because of hirsutism to Department of Endocrinology and Metabolism clinic was enrolled. Demographic, clinical and laboratory parameters of the patients were evaluated. Results: Result of the study showed that polycystic ovary syndrome is the most common cause of hirsutism. The second most common cause was found as idiopathic hirsutism. Conclusion: By the present study, etiologic factors of hirsutism were examined firstly in our region in which Ethnic and cultural diversity is concentrated. In rare cases like Cushing's syndrome, hyperprolactinemia, non-classic adrenal hyperplasia, androgen-secreting tumors should be considered in the differential diagnosis of hirsutism. J Clin Exp Invest 2014; 5 (1: 69-75

  2. Transanal rectopexy - twelve case studies

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    Rubens Henrique Oleques Fernandes

    2012-06-01

    Full Text Available OBJECTIVES: This study analyzed the results of transanal rectopexy and showed the benefits of this surgical technique. METHOD: Twelve patients were submitted to rectopexy between 1997 and 2011. The surgical technique used was transanal rectopexy, where the mesorectum was fixed to the sacrum with nonabsorbable suture. Three patients had been submitted to previous surgery, two by the Delorme technique and one by the Thiersch technique. RESULTS: Postoperative hospital stay ranged from 1 to 4 days. One patient (8.3% had intraoperative hematoma, which was treated with local compression and antibiotics. One patient (8.3% had residual mucosal prolapse, which was resected. Prolapse recurrence was seen in one case (8.3%. Improved incontinence occurred in 75% of patients and one patient reported obstructed evacuation in the first month after surgery. No death occurred. CONCLUSION: Transanal rectopexy is a simple, low cost technique, which has shown good efficacy in rectal prolapse control.OBJETIVO: O presente estudo analisou os resultados da retopexia pela via transanal e expôs os benefícios desta técnica cirúrgica. MÉTODO: Doze pacientes com prolapso foram operados no período de 1997 a 2011. A técnica cirúrgica usada foi a retopexia transanal, onde o mesorreto foi fixado ao sacro com fio inabsorvível. Três pacientes tinham cirurgia prévia, dois pela técnica de Delorme e um pela técnica de Thiersch. RESULTADOS: A permanência hospitalar pós-operatória variou de 1- 4 dias. Uma paciente (8,3% apresentou hematoma transoperatório que foi tratado com compressão local e antibioticoterapia. Um paciente apresentou prolapso mucoso residual (8,3%, que foi ressecado. Houve recidiva da procidência em um caso (8,3%. A melhora da incontinência ocorreu em 75% dos pacientes e uma paciente apresentou bloqueio evacuatório no primeiro mês após a cirurgia. Não houve mortalidade entre os pacientes operados. CONCLUSÃO: A retopexia transanal é uma t

  3. Twelve-year results of a direct-bonded partial prosthesis in a patient with advanced periodontitis: a clinical report.

    Science.gov (United States)

    Minami, Hiroyuki; Minesaki, Yoshito; Suzuki, Shiro; Tanaka, Takuo

    2012-08-01

    Prosthodontic treatment for patients with advanced periodontitis is a therapeutic challenge. A minimally invasive technique is preferred to preserve the remaining mobile abutment teeth. This report describes the initial clinical treatment and 12-year follow-up of a direct-bonded prosthesis reinforced with a cast metal framework, used as a conservative treatment option to replace periodontally involved maxillary lateral incisors.

  4. Improving Physical Health in Patients With Chronic Mental Disorders: Twelve-Month Results From a Randomized Controlled Collaborative Care Trial.

    Science.gov (United States)

    Kilbourne, Amy M; Barbaresso, Michelle M; Lai, Zongshan; Nord, Kristina M; Bramlet, Margretta; Goodrich, David E; Post, Edward P; Almirall, Daniel; Bauer, Mark S

    2017-01-01

    Persons with chronic mental disorders are disproportionately burdened with physical health conditions. We determined whether Life Goals Collaborative Care compared to usual care improves physical health in patients with mental disorders within 12 months. This single-blind randomized controlled effectiveness study of a collaborative care model was conducted at a midwestern Veterans Affairs urban outpatient mental health clinic. Patients (N = 293 out of 474 eligible approached) with an ICD-9-CM diagnosis of schizophrenia, bipolar disorder, or major depressive disorder and at least 1 cardiovascular disease risk factor provided informed consent and were randomized (February 24, 2010, to April 29, 2015) to Life Goals (n = 146) or usual care (n = 147). A total of 287 completed baseline assessments, and 245 completed 12-month follow-up assessments. Life Goals included 5 weekly sessions that provided semistructured guidance on managing physical and mental health symptoms through healthy behavior changes, augmented by ongoing care coordination. The primary outcome was change in physical health-related quality of life score (Veterans RAND 12-item Short Form Health Survey [VR-12] physical health component score). Secondary outcomes included control of cardiovascular risk factors from baseline to 12 months (blood pressure, lipids, weight), mental health-related quality of life, and mental health symptoms. Among patients completing baseline and 12-month outcomes assessments (N = 245), the mean age was 55.3 years (SD = 10.8; range, 25-78 years), and 15.4% were female. Intent-to-treat analysis revealed that compared to those in usual care, patients randomized to Life Goals had slightly increased VR-12 physical health scores (coefficient = 3.21; P = .01). Patients with chronic mental disorders and cardiovascular disease risk who received Life Goals had improved physical health-related quality of life. ClinicalTrials.gov identifiers: NCT01487668 and NCT01244854.

  5. Twelve-year experience of radioembolization for colorectal hepatic metastases in 214 patients: survival by era and chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Lewandowski, Robert J.; Memon, Khairuddin; Hickey, Ryan; Gates, Vanessa L.; Atassi, Bassel; Vouche, Michael; Atassi, Rohi; Desai, Kush; Hohlastos, Elias; Sato, Kent; Habib, Ali [Robert H. Lurie Comprehensive Cancer Center, Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL (United States); Mulcahy, Mary F.; Kircher, Sheetal; Newman, Steven B.; Nimeiri, Halla; Benson, Al B. [Northwestern University, Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL (United States); Marshall, Karen; Williams, Melissa; Salzig, Krystina; Salem, Riad [Robert H. Lurie Comprehensive Cancer Center, Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL (United States); Northwestern University, Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL (United States)

    2014-10-15

    The aim of this study was to analyze the safety, treatment characteristics and survival outcomes of Yttrium-90 (Y90) radioembolization for unresectable colorectal carcinoma (CRC) liver metastases refractory to standard of care therapy. A total of 214 patients with CRC metastases were treated with Y90 radioembolization over 12 years. Toxicity was assessed using National Cancer Institute common terminology criteria. Overall survival was analyzed from date of diagnosis of primary cancer, hepatic metastases and from the first Y90. Uni/multivariate analyses were performed. Substratification by era of chemotherapeutics was performed. Most patients were male (60 %) and <65 years old (61 %). Of them, 98 % had been exposed to chemotherapy. Grade 3 lymphocyte, bilirubin, albumin, ALP and AST toxicities were observed in 39 %, 11 %, 10 %, 8 % and 4 % of patients, respectively. Grade 4 lymphocyte and ALP toxicities were observed in 5 % and 3 % of patients, respectively. Median overall survival was 43.0, 34.6, and 10.6 months from date of diagnosis of primary cancer, hepatic metastases and first Y90, respectively. Survival was significantly longer in patients: (1) who received ≤2 cytotoxic drugs (n = 104) than those who received 3 (n = 110) (15.2 vs. 7.5 months, p = 0.0001); and (2) who received no biologic agents (n = 52) compared with those that did (n = 162) (18.6 vs. 9.4 months, p = 0.0001). Multivariate analyses identified ≤2 cytotoxic agents, no exposure to biologics, ECOG 0, tumor burden <25 %, lack of extrahepatic disease and albumin >3 g/dL as independent predictors of survival. In this largest metastatic CRC series published to date, Y90 radioembolization was found to be safe; survival varied by prior therapy. Further studies are required to further refine the role of Y90 in metastatic CRC. (orig.)

  6. Metabolic status of 1088 patients after renal transplantation: Assessment of twelve years monitoring in Algiers Mustapha Hospital

    Directory of Open Access Journals (Sweden)

    Lyece Yargui

    2014-01-01

    Full Text Available Since the introduction of monitoring levels of immunosuppressive medications in our service in July 2000, 1088 kidney transplant patients were received for therapeutic drug monitoring and regular follow-up. The aim of this study was to retrospectively analyze the data on these renal graft patients in Algeria and correlate with our 12 years′ experience with calcineurin inhibitor (CNI measurements. In addition, during this period, we also examined other bioche-mical parameters. The analysis was focused on the difference of effect of cyclosporin A (CsA; 623 patients and Tacrolimus (Tac; 465 patients on lipid and glucose metabolism and their side-effects, if any, on the renal function. The mean age at the time of transplantation was 36.1 years. A great majority of the transplanted kidneys had been taken from living related donors (88.6%. Three-quarters of all grafts were transplanted in our country (79.5%. Dyslipidemia and renal dysfunction were the most common adverse effects of CsA and Tac exposure, with a frequency of 21.4% and 10.3%, respectively. Both the CNIs had a similar effect on the lipid levels. The highest incidence occurred at 3-12 months after renal graft. Tac seemed to have more side-effects on glycemia, causing the onset of diabetes mellitus more than two-fold than CsA (6.9% vs. 3.1%. A significant difference was observed during 12-24 months after transplantation. However, Tac was associated with the most favorable effects on renal function estimated with the Modification of Diet in Renal Disease (MDRD formula.

  7. Annual economic burden of hepatitis B virus-related diseases among hospitalized patients in twelve cities in China.

    Science.gov (United States)

    Zhang, S; Ma, Q; Liang, S; Xiao, H; Zhuang, G; Zou, Y; Tan, H; Liu, J; Zhang, Y; Zhang, L; Feng, X; Xue, L; Hu, D; Cui, F; Liang, X

    2016-03-01

    A nationwide survey of hepatitis B virus (HBV)-associated economic burden has not previously been performed in China. The purpose of this study was to examine the direct, indirect, and intangible costs of HBV-related diseases within the span of one year. A random sample was taken from specialty and general hospitals across 12 cities in six provinces of China. Intangible costs were estimated based on willingness to pay or open-ended answers provided by patients. The results showed that 27 hospitals were enrolled, with a sample population of 4726 patients (77.7% response rate). The average annual costs were $4454.0 (direct), $924.3 (indirect), and $6611.10 (intangible), corresponding to 37.3%, 7.7%, and 55.1% of the total costs, respectively. The direct medical fees were substantially greater than the non-medical fees. Annual indirect costs were divided into outpatient ($112.9) and inpatient ($811.40) loss of income. The intangible costs of chronic HBV were notably higher than either the direct or indirect costs, consistent with the social stigma in China. The comparison amongst individual cities for the average ratio of direct to indirect costs revealed that the sizes of ratios were negatively correlated with the socioeconomic status of the regions. This study suggested that as a whole in China, the HBV-related diseases caused a heavy financial burden which was positively associated with disease severity. Although the intangible costs coincided with a high prevalence of discrimination against CHB patients in Chinese society, our study may serve as future reference for detailed exploration.

  8. Digging into the Past, Exploring the Present: Richard Flanagan’s Gould’s Book of Fish: A Novel in Twelve Fish

    Directory of Open Access Journals (Sweden)

    Maria Renata Dolce

    2015-07-01

    Full Text Available Abstract – This paper will analyze the ‘historical’ novel Gould’s Book of Fish (2001 by the Tasmanian writer Richard Flanagan with the aim of reflecting upon the power of the creative word as a means to forge reality, shape identities, mask or unmask truths, and also to prefigure a different, alternative world order based on commonly negotiated and thus shared values. The postmodernist revisiting of the traditional genre of the historical novel does not compromise the postcolonial commitment of the writer: Flanagan’s incursions into the Australian colonial past are informed by his concern for urgent social and political causes which has characterized his unswerving fight against all systems of inequality and exploitation. In his novel, the subversion of the linear causal relation of events which calls into question the truthfulness and objectivity of history, together with the foregrounded metanarrative reflection on the art of writing, contribute to the revisiting and re-discussing of the myth of progress and the cult of rationality at the very roots of Western civilization and of its imperialistic enterprise. Flanagan’s ‘anti-historical’ historical novel tackles urgent questions about modernity interrogating the founding narratives of the Australian national identity, in order to explore the uncontrollable and shifting areas of the contemporary ‘transnation’ in which the traditional categories shaping subjectivities are disrupted. As the paper will demonstrate, the writer digs into the past of his nation not simply in order to unravel its hidden histories but to detect the profound, inextricable interconnections with the present across different times and spaces. Feelings and experiences that exist above and beyond historical contingencies and cultural differences represent the writer’s privileged area of investigation as they trespass upon conventional and artificial boundaries revealing what it is that makes us all

  9. Twelve-month outcomes in patients with retinal vein occlusion treated with low-frequency intravitreal ranibizumab

    Directory of Open Access Journals (Sweden)

    Sakanishi Y

    2016-06-01

    Full Text Available Yoshihito Sakanishi, Ami Lee, Ayumi Usui-Ouchi, Rei Ito, Nobuyuki Ebihara Department of Ophthalmology, Juntendo University Urayasu Hospital, Urayasu City, Chiba, Japan Purpose: The purpose of this study was to determine the clinical efficacy of low-frequency intravitreal ranibizumab to treat macular edema due to retinal vein occlusion (RVO.Patients and methods: This was a retrospective examination of cases that received intravitreal ranibizumab for untreated RVO over a period of 12 months. Instead of the conventional three monthly injections, injections were given once during the introductory period. If the recurrence of macular edema was diagnosed during the monthly visit, additional injections were given as needed. There were 21 eyes of 21 patients with branch RVO (BRVO and ten eyes of ten patients with central RVO (CRVO. The parameters examined included the number of injections over the 12-month period, improvements in best-corrected visual acuity (BCVA, and the central macular thickness (CMT. For BRVO, preinjection parameters that had an effect on the prognosis of BCVA after the 12-month period were also examined.Results: The total mean number of injections over the 12-month period was 3.4 for CRVO and 2.1 for BRVO. For CRVO, the BCVA in log minimum angular resolution changed from a preinjection value of 0.80 to 0.55 at 12 months. For BRVO, the change was from 0.51 to 0.30. For all diseases, BCVA improved after 12 months compared with the preinjection values (P<0.05. There was improvement in the CMT, and the CRVO changed from 765.0 µm at preinjection to 253.5 µm 12 months later. BRVO changed from 524.1 to 250.1 µm, and preinjection BCVA was associated with a prognosis of visual acuity after 12 months of the initial injection (P=0.0485.Conclusion: Even with a low number of injections during the introductory period, there were still improvements in both visual acuity and CMT in RVO patients after 12 months, indicating that it was

  10. Neglected Alkaptonuric Patient Presenting with Steppage Gait

    Directory of Open Access Journals (Sweden)

    Babak Mirzashahi

    2016-04-01

    Full Text Available Even though intervertebral disc degeneration can be found in the natural course of alkaptonuria, detection of the disease by black disc color change in a patient without any other presentation of alkaptonuria is an exceptionally rare condition. We have reported a very rare case of alkaptonuria presented with low back pain and steppage gait in a 51-year-old male with a complaint of chronic low-back pain and steppage gait who was operated on for prolapsed lumbar disc herniation. Intraoperatively his lumbar disk was discovered to be black. The alkaptonuria diagnosis was considered after histopathological examination of the black disc material and elevated urinary concentration of homogentisic acid confirmed the diagnosis. To our knowledge, this presentation has not been reported previously in literature.

  11. Verrucous presentation in patients with mycosis fungoides.

    Science.gov (United States)

    Schlichte, Megan J; Talpur, Rakhshandra; Venkatarajan, Sangeetha; Curry, Jonathan L; Nagarajan, Priyadharsini; Duvic, Madeleine

    2016-03-01

    Mycosis fungoides is a potentially fatal skin condition whose variable clinical appearance may mimic a variety of benign, inflammatory dermatoses, making it a diagnostic challenge. Three patients with mycosis fungoides, treated with multiple approved topical and systemic therapies, presented with acquired verrucous lesions on the extremities. The verrucous presentation of mycosis fungoides is one of the many atypical forms of the disease, with a paucity of documented cases in the medical literature. Although rare, verrucous and hyperkeratotic lesions in mycosis fungoides may increase the risk of considerable diagnostic delay if clinicians do not maintain a high degree of suspicion in cases of acquired verrucous lesions in the appropriate clinical setting. © 2015 The International Society of Dermatology.

  12. Acute presentation of the pregnant patient.

    Science.gov (United States)

    Neuberger, Francesca; Nelson-Piercy, Catherine

    2015-08-01

    Three-quarters of maternal deaths are in women with coexisting medical complications. It can be challenging to differentiate symptoms of normal pregnancy from pathological symptomatology, and physicians need to be mindful of special considerations in assessing and managing acute medical problems in pregnancy. This article focuses on women presenting with shortness of breath, chest pain and palpitations. © Royal College of Physicians 2015. All rights reserved.

  13. Botox, tratamiento fútil en pacientes menores de doce años de edad con espasticidad Botox: A futile treatment for patients under twelve years of age suffering from muscle spasticity

    Directory of Open Access Journals (Sweden)

    Lira López Lirled

    2008-08-01

    Full Text Available El artículo sostiene la futilidad del Botox cuando éste se aplica en pacientes menores de doce años de edad con espasticidad, basándose principalmente en estudios realizados por diversos investigadores que plantean el actuar del fármaco sobre el cuerpo. Al tiempo que propone ampliar la visión en la atención de la discapacidad, partiendo de la persona como un ser integral, ubicándolo en su historia personal, en sus capacidades y etapa de la vida en que se encuentra, sin que se restrinja solo a la corporeidad del paciente. Plantea que los pacientes menores de doce años con espasticidad son personas que se encuentran en proceso de desarrollar sus capacidades y potencializarlas, la espasticidad se manifiesta por una triada: hipertonía, hiperrreflexia y reflejos patológicos, lo que limita la movilidad pero no la obstruye. Es resultado de la secuela de una lesión en las vías córtico espinales, por lo que el tratamiento debe de ir más allá de las expresiones corporales que el paciente hace evidente durante la realización de movimientos voluntarios.The following article presents the research of multiple investigators about the futility of Botox when this drug is applied on patients younger than twelve years old and the effects of the body of the subjects. At the same time invites to amply the vision on the attention of disability, taking the person as a complete being, placing his or hers personal history, his or hers capacities and the life phase he or she is living actually. Also shows that the patients with spasticity younger than twelve years old are people who is on process of developing his or hers capabilities and potencialize them, the spasticity is a sequel of injury on cortical spinal routes that manifest hypertonic, hiperreflex and pathologic reflexes that limit the mobility but do not impede it, so the treatment must be beyond corporal expressions that the patient made evident during the voluntary movement realization.

  14. [Systemic loxoscelism presented in a pregnant patient].

    Science.gov (United States)

    Sánchez-Villegas, María del Carmen; Rodríguez-Álvarez, Daniel; Ortega-Carrillo, Concepción; Alagón-Cano, Alejandro; Zaldívar-Cervera, Jaime; Loría-Castellanos, Jorge; Urzúa-Rodríguez, Norma Alicia

    2014-01-01

    INTRODUCCIÓN: el loxoscelismo se debe a la inoculación de un conjunto de enzimas proteolíticas por la mordedura de la araña Loxosceles. Puede tener una expresión local, sin embargo, la forma viscerocutánea o sistémica tiene una evolución grave. Se presenta el primer caso de la variante sistémica en una mujer embarazada. CASO CLÍNICO: mujer con embarazo normoevolutivo de 28 semanas. Después de estar expuesta a un ambiente semirrural, presentó placa plana eritematosa en el glúteo derecho, con aumento de la temperatura e hiperestesia local. Fue hospitalizada para administrarle antibióticos parenterales, por considerarse que se trataba de la picadura de un insecto. A las cuatro horas se incrementó el dolor y la paciente desarrolló deshidratación e hipotensión severas hasta llegar al choque, por lo que se inició tratamiento con cristaloides, aminas vasopresoras y protección de la vía aérea. Se realizó operación cesárea, de la que se obtuvo un niño, y se efectuó desbridación en el glúteo derecho. El diagnóstico fue loxoscelismo sistémico, por lo que se administró el antiveneno específico. La paciente fue egresada a los dos meses.

  15. The Twelve Hotel, Barna : Video

    OpenAIRE

    Irish Food Channel

    2014-01-01

    Fergus O'Halloran, Managing Director of The Twelve Hotel in Barna in County Galway, talks about his philosophy in running this unique boutique hotel. Reproduced with kind permission from John & Sally McKenna. 3.35 mins

  16. Characteristics of patients presenting with erythema nodosum and sarcoidosis.

    LENUS (Irish Health Repository)

    O'Connor, T M

    2012-01-31

    We explored the relationship between erythema nodosum (EN) and sex, age, serum angiotensin converting enzyme (ACE), bronchoalveolar lavage lymphocytosis (BAL-I), interstitial granulomas and radiological stage in patients presenting with pulmonary sarcoidosis in Ireland. Sixty-nine patients diagnosed with sarcoidosis between 2003 and 2006 were studied. Forty one patients (59%) were male. Sixteen patients (23%) presented with EN. Forty one patients of 65 (63%) had transbronchial biopsies demonstrating non-caseating granulomas. Patients with sarcoidosis presenting with EN were more likely to be female (p=0.042), younger (p=0.012) and have earlier stage pulmonary disease (p=0.02). There were no correlations between serum ACE, interstitial granulomas and disease stage. BAL-I did however predict increasing disease radiological stage (p=0.042). In this study, one quarter of patients with sarcoidosis presented with EN among their presenting features. These patients were more likely to be young females with early stage radiological disease.

  17. Other Skin Conditions Often Present in Rosacea Patients

    Science.gov (United States)

    ... Treatment Survey: Other Skin Conditions Often Present in Rosacea Patients Although rosacea patients often have to cope ... Migraine Headaches up Tips on Identifying Rosacea Triggers › Rosacea Review Current Issue Past Issues Index by Topic ...

  18. Varied presentations of Sheehan′s syndrome at diagnosis: A review of 18 patients

    Directory of Open Access Journals (Sweden)

    Delmalya Sanyal

    2012-01-01

    Full Text Available Introduction: Sheehan′s syndrome (SS occurs due to ischemic pituitary necrosis as a result of severe postpartum hemorrhage (PPH. Aims and Objectives: The aim of the present study was to review the presenting features of SS at diagnosis. Materials and Methods: We retrospectively reviewed 18 cases of SS at diagnosis. Presenting clinical features, laboratory data, pituitary hormone deficiencies, and magnetic resonance imaging (MRI of the sella were analyzed. Results: Age ranged from 28-71 years with a mean age of 47 ± 14.44 years. Time to diagnosis of SS was 6-33 years with a mean of 15.35 ± 6.74 years. Four (22.2% patients were referred from emergency for hyponatremia, one each (5.6% for hypotension, hypoglycemia, and vomiting. Three (16.7% patients presented with asthenia and weight loss, two (11.1% with slightly raised thyroid stimulating hormone (TSH. Only six (33.3% presented with classic features of amenorrhea. None presented with isolated lactational failure or apoplexy after PPH. Seventeen (94.4% patients had lactational failure; thirteen (72.2% did not menstruate following last delivery. Lactotroph and gonadotroph failure were present in all at diagnosis but corticotrophs preservation was documented in three (16.7% and thyrotroph in two (11.1% patients. Twelve (66.7% patients had empty sella while six (33.3% had partial empty sella on MRI. Conclusion: SS has variable features at diagnosis and may present to different specialties. The clinical features of hypopituitarism are often subtle, leading to delay in diagnosis. History of PPH, lactational failure and cessation of menses are important clues. Thyrotroph, corticotroph axis may be preserved in some SS patients.

  19. HLA compatibility assessment and management of highly sensitized patients under the new kidney allocation system (KAS): A 2016 status report from twelve HLA laboratories across the U.S.

    Science.gov (United States)

    Kamoun, M; Phelan, D; Noreen, H; Marcus, N; Klingman, L; Gebel, H M

    2017-01-01

    Twelve HLA laboratories were surveyed to assess the methods and operational issues involved to define highly sensitized patients and to assess HLA compatibility under the new kidney allocation system (KAS) in the U.S. All laboratories used single antigen bead assays both pre- and post-KAS to define both broad and allele-specific HLA antibodies. The methods and threshold used to list HLA unacceptable antigens in UNet for virtual crossmatch (vXM) and the criteria used for determining HLA compatibility varied among laboratories. Laboratories reported several limitations of the current assays including the accuracy of quantifiable antibody fluorescence values, inadequate coverage of common alleles on the bead panels, and challenges in calibrating the vXM. The new KAS has resulted in a significant surge of deceased donor organ offers requiring vXM evaluation under tight time constraints. In the post-KAS period, eight of twelve laboratories (67%) indicated that their center did not proceed to transplant based on vXM without a prospective lymphocyte crossmatch. In conclusion, HLA laboratories play a critical role in deceased donor allocation for highly sensitized patients under the new KAS. Significant opportunities exist to improve the methods used in the assessment of HLA compatibility to safely transplant highly sensitized patients.

  20. Hepatic Angiosarcoma: a Review of Twelve Cases

    Institute of Scientific and Technical Information of China (English)

    Qiang Li; Xishan Hao

    2005-01-01

    OBJECTIVE Hepatic angiosarcoma (HAS), a lethal disease, is the most common sarcoma arising in the liver. Little information about the epidemiology, etiology, diagnosis and management of HAS has been reported. Increased familiarity with this disease will facilitate correct diagnosis and help to improve management of this condition in the future.The objective of this study was to describe cases of hepatic angiosarcoma and to discuss the etiologic, diagnostic, therapeutic features and prognosis of this tumor. This report not only serves to give more evidence of the relationship between hepatic angiosarcoma and carcinogenic exposure, but also demonstrates the key points in different methods of diagnosis and the optimal treatment of hepatic angiosarcoma.METHODS Twelve cases of hepatic angiosareoma were analyzed retrospectively, representing the different character in clinical presentations and laboratory computed tomographical scans; pathological data and treatment are described. Clinical and biologic follow-up was carried out for two years after surgical treatment.RESULTS There were nine men and three women varying in ages from 57 to 71 years with an average of 64.3 years. Ten patientshad a history of exposure to vinyl chloride or thorotrast. Mild or moderate abdominal pain and bloating, abdominal mass and fever were the common clinical presentations. Tumors were visualized by ultrasonography and CT scans in all patients. Biochemical profiles yielded variable results and proved to be of little value in detection or diagnosis. Surgical resection was feasible for each patient who was treated as follows: two wedge resections, six segementectomies and four bisegmentectomies. Five patients received Neoadjuvant chemotherapy postoperatively. The survival rate of those cases was poor. The maximum survival time was fourteen months. The mean survival time for this chemotherapeutic group was 11 months. The difference between the survival time of those treated with an operation

  1. Clinico-epidemiological characteristics of patients presenting with organophosphorus poisoning

    Directory of Open Access Journals (Sweden)

    Indranil Banerjee

    2012-01-01

    Full Text Available Background: Organophosphorus (OP poisoning is a major health problem all over the world, particularly in the developing countries. Aim: The present study aims to explore the clinical and epidemiological features found in patients presenting with OP poisoning. Materials and Methods: A 1-year cross-sectional study was conducted on patients presenting with clinical features of OP poisoning in a tertiary care medical college. Results: A total of 968 patients presented during the study period. Poisoning with suicidal intent (82.02% was more common than the accidental one (17.98%. Majority of the patients were housewives (42% followed by farmers, shopkeepers, laborers, students. Methyl parathion was the most common poison consumed by the patients (35.74% followed by diazinon, chlorpyriphos, dimicron. Nausea and vomiting (85.02% was the most common symptom while miosis was the most common sign observed in 91.94% patients. A total of 56 patients of OP poisoning died (5.78% with respiratory failure being the primary cause of death followed by CNS depression, cardiac arrest, and septicaemia. Conclusion: The present study showed that majority of the patients were of young age with females outnumbering males. Poisoning with suicidal intent was more common than accidental. Nausea and vomiting was the most common symptom reported by the patients while miosis was the most common sign observed by the treating physicians of the research team.

  2. Indian patients with nonalcoholic fatty liver disease presenting with raised transaminases are different at presentation

    Institute of Scientific and Technical Information of China (English)

    Ajay Duseja; Naveen Kaita; Ashim Das; Radha Krishan Dhiman; Yogesh Kumar Chawla; Reena Das; Sanjay Bhadada; Ravinder Sialy; Kiran Kumar Thumburu; Anil Bhansali

    2007-01-01

    @@ TO THE EDITOR We read with great interest the article, "Non-alcoholic fatty liver disease may not be a severe disease at presentation among Asian Indians" by Madan et al in the recent issue of WJG. Twenty-eight (55%) out of 51 patients with nonalcoholic fatty liver disease (NAFLD) who presented with abnormal transaminases had histological evidence of nonalcoholic steatohepatitis (NASH).

  3. Panic in otolaryngology patients presenting with dizziness or hearing loss.

    Science.gov (United States)

    Clark, D B; Hirsch, B E; Smith, M G; Furman, J M; Jacob, R G

    1994-08-01

    This study compared 50 patients presenting to an otolaryngology clinic with a complaint of dizziness and 50 patients presenting with hearing loss on questionnaire measures of panic, phobic avoidance, generalized anxiety, and depression. Clinical and laboratory evaluations of vestibular and audiological complaints were also completed. Twenty percent of the group with dizziness and none of the group with hearing loss reported symptoms that met DSM-III-R criteria for panic disorder. Patients with dizziness and peripheral vestibulopathy had more symptoms of phobic avoidance, generalized anxiety, and depression than patients with confirmed hearing loss.

  4. Clinical presentation and mutations in Danish patients with Wilson disease

    DEFF Research Database (Denmark)

    Møller, Lisbeth Birk; Horn, Nina; Jeppesen, Tina Dysgaard

    2011-01-01

    This study describes the clinical presentation and diagnosis in all Danish patients (49, 41 unrelated) with Wilson disease (WND). On the basis of the number of diagnosed patients from 1990-2008, the prevalence was estimated to be 1:49¿500. Among routinely used diagnostic tests, none were consiste......This study describes the clinical presentation and diagnosis in all Danish patients (49, 41 unrelated) with Wilson disease (WND). On the basis of the number of diagnosed patients from 1990-2008, the prevalence was estimated to be 1:49¿500. Among routinely used diagnostic tests, none were...

  5. Clinical presentation and mutations in Danish patients with Wilson disease

    DEFF Research Database (Denmark)

    Møller, Lisbeth Birk; Horn, Nina; Jeppesen, Tina Dysgaard

    2011-01-01

    This study describes the clinical presentation and diagnosis in all Danish patients (49, 41 unrelated) with Wilson disease (WND). On the basis of the number of diagnosed patients from 1990-2008, the prevalence was estimated to be 1:49 500. Among routinely used diagnostic tests, none were consiste......This study describes the clinical presentation and diagnosis in all Danish patients (49, 41 unrelated) with Wilson disease (WND). On the basis of the number of diagnosed patients from 1990-2008, the prevalence was estimated to be 1:49 500. Among routinely used diagnostic tests, none were...

  6. Unusual presentations of osteoarticular tuberculosis in two paediatric patients

    Science.gov (United States)

    Cheung, Jason Pui Yin; Ho, Kenneth Wai Yip; Lam, Ying Lee; Shek, Tony Wai Hung

    2012-01-01

    Tuberculosis is a universal mimicker and thus could be a differential diagnosis of any osteolytic lesion. Bone biopsy is crucial in these cases for culture and histological proof of tuberculous infection. This is a case report of two paediatric patients with unusual presentations of tuberculosis. One patient presented with knee pain and had imaged findings of an osteolytic lesion at the epiphysis. Interval scan showed spread of the lesion through the physis to the metaphyseal region. The second patient presented with hip pain and an osteolytic lesion of the acetabulum. He was subsequently found to have involvement of the brain and spine as well. Both patients were diagnosed with tuberculosis by bone biopsy for culture and pathological examination. They were treated successfully with antituberculous medications without chronic sequelae. These two patients showed that early recognition and prompt treatment are critical for management of tuberculosis to avoid chronic sequelae. PMID:23087272

  7. [Self presentation of patients disfigured by head and neck cancer].

    Science.gov (United States)

    Miyata, R

    1996-01-01

    Surgery for maxilofacial cancer is often radical and disfiguring, and therefore can have an influence on patient's interpersonal relationship and social activities. However, little is known about self-presentation of disfigured patients during rehabilitation. This is an inductive and qualitative study based on 26 extensive interviews. The results demonstrate that patients with disfigurement cope actively with problems in their interpersonal relationship and even go through the empowerment process. Self-presentation of the disfigured patients consisted of four dimensions: (1)self-evaluation: (2)judgment of others' reactions; (3)intention of personal relations and style of self-presentation; and (4) concrete self-presentation using six "strategies". Each of the dimensions 1-3 included several processes that were generally taken in sequence according to time after surgery, but also strongly influenced by behaviors of family members or medical staff. "Strategies" chosen in dimension 4 depending upon the situations in dimensions 1-3 corresponded to the five type of "self-presentation" reported by Goffman (1959), except for "letting others be used to the patients", which was one of the continuous efforts to overcome their chronic disfigurement. Importantly, the patients became confident by focusing upon their chronic disfigurement. Importantly, the patients became confident by focusing upon their healthy parts such as maxiofacial functions recovered to some degree, and this confidence led to the acceptance of disfigurement and further to the expansion of their social behaviors.

  8. Use of Pentamidine As Secondary Prophylaxis to Prevent Visceral Leishmaniasis Relapse in HIV Infected Patients, the First Twelve Months of a Prospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Ermias Diro

    Full Text Available Visceral leishmaniasis (VL has become an important opportunistic infection in persons with HIV-infection in VL-endemic areas. The co-infection leads to profound immunosuppression and high rate of annual VL recurrence. This study assessed the effectiveness, safety and feasibility of monthly pentamidine infusions to prevent recurrence of VL in HIV co-infected patients.A single-arm, open-label trial was conducted at two leishmaniasis treatment centers in northwest Ethiopia. HIV-infected patients with a VL episode were included after parasitological cure. Monthly infusions of 4 mg/kg pentamidine-isethionate diluted in normal-saline were started for 12 months. All received antiretroviral therapy (ART. Time-to-relapse or death was the primary end point.Seventy-four patients were included. The probability of relapse-free survival at 6 months and at 12 months was 79% and 71% respectively. Renal failure, a possible drug-related serious adverse event, occurred in two patients with severe pneumonia. Forty-one patients completed the regimen taking at least 11 of the 12 doses. Main reasons to discontinue were: 15 relapsed, five died and seven became lost to follow-up. More patients failed among those with a CD4+cell count ≤ 50 cells/μl, 5/7 (71.4% than those with counts above 200 cells/μl, 2/12 (16.7%, (p = 0.005.Pentamidine secondary prophylaxis led to a 29% failure rate within one year, much lower than reported in historical controls (50%-100%. Patients with low CD4+cell counts are at increased risk of relapse despite effective initial VL treatment, ART and secondary prophylaxis. VL should be detected and treated early enough in patients with HIV infection before profound immune deficiency installs.

  9. Patients radiation protection in medical imaging. Conference proceedings; Radioprotection des patients en imagerie medicale. Recueil des presentations

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-12-15

    This document brings together the available presentations given at the conference organised by the French society of radiation protection about patients radiation protection in medical imaging. Twelve presentations (slides) are compiled in this document and deal with: 1 - Medical exposure of the French population: methodology and results (Bernard Aubert, IRSN); 2 - What indicators for the medical exposure? (Cecile Etard, IRSN); 3 - Guidebook of correct usage of medical imaging examination (Philippe Grenier, Pitie-Salpetriere hospital); 4 - Radiation protection optimization in pediatric imaging (Hubert Ducou-Le-Pointe, Aurelien Bouette (Armand-Trousseau children hospital); 5 - Children's exposure to image scanners: epidemiological survey (Marie-Odile Bernier, IRSN); 6 - Management of patient's irradiation: from image quality to good practice (Thierry Solaire, General Electric); 7 - Dose optimization in radiology (Cecile Salvat (Lariboisiere hospital); 8 - Cancer detection in the breast cancer planned screening program - 2004-2009 era (Agnes Rogel, InVS); 9 - Mammographic exposures - radiobiological effects - radio-induced DNA damages (Catherine Colin, Lyon Sud hospital); 10 - Breast cancer screening program - importance of non-irradiating techniques (Anne Tardivon, Institut Curie); 11 - Radiation protection justification for the medical imaging of patients over the age of 50 (Michel Bourguignon, ASN); 12 - Search for a molecular imprint for the discrimination between radio-induced and sporadic tumors (Sylvie Chevillard, CEA)

  10. Neuroimaging and other investigations in patients presenting with headache

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    Callum W Duncan

    2012-01-01

    Full Text Available Headache is very common. In the United Kingdom, it accounts for 4.4% of primary care consultations, 30% of referrals to neurology services and 0.5-0.8% of alert patients presenting to emergency departments. Primary headache disorders account for the majority of patients and most patients do not require investigation. Warning features (red flags in the history and on examination help target those who need investigation and what investigations are required. This article summarizes the typical presentations of the common secondary headaches and what neuroimaging and other investigations are appropriate for each headache type.

  11. Renal Abscess in a Patient Presenting with Persistent Hiccups

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    Mark Flanagan

    2013-01-01

    Full Text Available Hiccups are common, typically limited, and rarely present with adverse complications. In the context of persistent or intractable episodes, however, hiccups may signal a more serious underlying cause. Here, we present an unexpected and pathologic case of hiccups in a patient who was ultimately diagnosed with renal abscesses.

  12. Chinese patients with Huntington's disease initially presenting with spinocerebellar ataxia.

    Science.gov (United States)

    Dong, Y; Sun, Y-M; Liu, Z-J; Ni, W; Shi, S-S; Wu, Z-Y

    2013-04-01

    Recent studies have described Huntington's disease (HD) patients with atypical onset of ataxia. Symptoms in these patients can overlap with those of spinocerebellar ataxia (SCA). We retrospectively examined clinical data for 82 HD probands and found 7 had initially been clinically diagnosed as SCA cases. Clinical features in these patients were further investigated and the number of CAG repeats in the huntingtin (HTT) gene was determined by direct sequencing. Genetic screenings for SCAs in the 7 patients were all negative. By contrast, HTT was heterozygous in each patient. The distribution of CAG number in the 7 patients was statistically the same as that in the other 75 patients. Each of 7 HD patients had presented with atypical onset of ataxia. The mean time from onset to HTT genetic testing was 5.6 ± 5.52 years. Three of the patients developed chorea, but the others did not. Our observations confirm the clinical heterogeneity of HD in Han Chinese. Based on these findings, testing for HTT expansions should be considered for clinically diagnosed SCA patients who test negatively in genetic screening of SCA genes.

  13. Three Presentations of Takayasu’s Arteritis in Hispanic Patients

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    Ramy Magdy Hanna

    2012-01-01

    Full Text Available Takayasu’s arteritis (TA is a medium and large vessel vasculitis, defined as a nonspecific aortitis that usually involves the aorta and its branches Kobayashi and Numano (2002. Its etiology remains unclear, and its complications are diverse and severe, including stenosis of the thoracic and abdominal aorta, aortic valve damage and regurgitation, and stenosis of the branches of the aorta. Carotid stenosis, coronary artery aneurysms, and renal artery stenosis resulting in renovascular hypertension are also reported sequellae of TA Kobayashi and Numano (2002. The disease was first described in Japan, but has also been diagnosed in India and Mexico Johnston (2002. Its incidence in the United States has been quoted as 2.6 patients per 1,000,000 people/year Johnston (2002. In Japan, its incidence is 3.6 patients per 1,000,000 patients/year and prevalence is 7.85 patients per 100,000 per year Morita et al. (1996. The natural history of this disease, which is commonly present in Asian populations, has only recently been studied in Hispanic patients despite the notable incidence and prevalence of TA in Mexican, South American, and Indian populations (Johnston 2002, Gamarra et al. 2010 . We present three cases of Hispanic patients who presented with TA at Olive-View-UCLA Medical Center (OVMC. We review their clinical and radiographic presentations. Finally, we review the literature to compare the clinical features of our three patients with data regarding the presentation of TA in more traditional Asian populations.

  14. Unique Presentation of Hematuria in a Patient with Arterioureteral Fistula

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    Tomas Mujo

    2016-01-01

    Full Text Available Active extravasation via an arterioureteral fistula (AUF is a rare and life-threatening emergency that requires efficient algorithms to save a patient’s life. Unfortunately, physicians may not be aware of its presence until the patient is in extremis. An AUF typically develops in a patient with multiple pelvic and aortoiliac vascular surgeries, prior radiation therapy for pelvic tumors, and chronic indwelling ureteral stents. We present a patient with a left internal iliac arterial-ureteral fistula and describe the evolution of management and treatment algorithms based on review of the literature.

  15. Pseudohypertension-Like Presentation: An Exceptionally Rare Presentation in an Athletic Female Patient with Morphea

    Science.gov (United States)

    2016-01-01

    Introduction. Pseudohypertension is a condition which mainly occurs due to thickening-calcification of tunica intima of the arterial wall, leading to a faulty measurement of the intra-arterial blood pressure. To the best of our knowledge, this is the first case report in literature, of a pseudohypertension-like presentation in association with Morphea en plaque. Case Presentation. This is a rare presentation of a young athletic female and a professional tennis player, with pseudohypertension-like presentation. The patient had a traumatic injury to the right elbow joint; the injury occurred during a professional tennis match. The injury was managed by immobilization, physiotherapy, and Low-Level Laser Therapy. Soon after that, the patient had a circumscribed sclerotic ivory plaque affecting the skin of the right cubital fossa. The histopathology analysis, together with the serological-hematological tests and the clinical picture, along with positive Osler's signs, leads to the conclusive diagnosis of Morphea en plaque. The peculiar anatomic localization of the plaque anterior to the brachial artery leads to faulty blood pressure measurement as recorded by mercurial sphygmomanometer. Conclusion. This unique presentation of Morphea en plaque carries an important message in relation to the basic medical practice and in relation to the accurate measurement of the vital signs. PMID:28127475

  16. The need for skull radiography in patients presenting for CT

    Energy Technology Data Exchange (ETDEWEB)

    Tress, B.M.

    1983-01-01

    One thousand patients had both CT of the head and a conventional skull series of radiographs. Radiographic findings were abnormal in 250 patients (25%), but only 64 patients (6.4%) had diagnostically significant abnormalities at radiography that were not detected by CT. If the 163 patients who presented after acute trauma were excluded from the series, only 39 (4.7%) of the remaining patients had radiographically significant abnormal findings that were not seen at CT, and only two (0.2%) of these abnormalities could not be diagnosed by a lateral skull radiograph alone. In only five patients (0.5%) was the management actively changed because an abnormaltiy that was detected at skull radiography was not detected at CT. Thus, in nontrauma patients who have stroke, epilepsy, dementia, or non-specific symptoms without focal signs, or have recently undergone craniotomy, and who have been referred for CT, skull radiographs are not justified. In the patient with a history and findings that are strongly suggestive of a pathological disorder anywhere other than in the sella turcica, cerebello-pontine angle, and paranasal sinuses, only the lateral skull radiograph should be obtained after CT, and only if CT is equivocal.

  17. Inflammation's Association with Metabolic Profiles before and after a Twelve-Week Clinical Trial in Drug-Naive Patients with Bipolar II Disorder.

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    Sheng-Yu Lee

    Full Text Available Inflammation is thought to be involved in the pathophysiology of bipolar disorder (BP and metabolic syndrome. Prior studies evaluated the association between metabolic profiles and cytokines only during certain mood states instead of their changes during treatment. We enrolled drug-naïve patients with BP-II and investigated the correlation between changes in mood symptoms and metabolic indices with changes in plasma cytokine levels after 12 weeks of pharmacological treatment. Drug-naïve patients (n = 117 diagnosed with BP-II according to DSM-IV criteria were recruited. Metabolic profiles (cholesterol, triglyceride, HbA1C, fasting serum glucose, body mass index (BMI and plasma cytokines (TNF-α, CRP, IL-6, and TGF-β were measured at baseline and 2, 8, and 12 weeks post-treatment. To adjust within-subject dependence over repeated assessments, multiple linear regressions with generalized estimating equation methods were used. Seventy-six (65.0% patients completed the intervention. Changes in plasma CRP were significantly associated with changes in BMI (P = 1.7E-7 and triglyceride (P = 0.005 levels. Changes in plasma TGF-β1 were significantly associated with changes in BMI (P = 8.2E-6, cholesterol (P = 0.004, and triglyceride (P = 0.006 levels. However, changes in plasma TNF-α and IL-6 were not associated with changes in any of the metabolic indices. Changes in Hamilton Depression Rating Scale scores were significantly associated with changes in IL-6 (P = 0.003 levels; changes in Young Mania Rating Scale scores were significantly associated with changes in CRP (P = 0.006 and TNF-α (P = 0.039 levels. Plasma CRP and TGF-β1 levels were positively correlated with several metabolic indices in BP-II after 12 weeks of pharmacological intervention. We also hypothesize that clinical symptoms are correlated with certain cytokines. These new findings might be important evidence that inflammation is the pathophysiology

  18. AETIOLOGICAL PROFILE OF PATIENTS PRESENTING WITH UPPER GASTROINTESTINAL BLEEDING

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    Amit Govind Kamat

    2017-06-01

    Full Text Available BACKGROUND In the recent years, the number of studies exclusively examining epidemiologic patterns of Upper Gastrointestinal Bleeding (UGIB has been quite limited. However, most epidemiologic studies have shown a decrease in the incidence of all causes of upper gastrointestinal bleeding. Although, the incidences of peptic ulcers have remained unchanged. Gastrointestinal bleeding is a very common emergency accounting for 7-8% of acute medical admissions. UGIB is 4-5 times more common than the lower GI haemorrhage. Acute erosive gastritis is the most common cause followed by oesophageal varices, peptic ulcer and reflux oesophagitis. Upper GI bleed is more common in men than women (ratio 3:2 and the frequency increases with age. Hence, the present study was designed to study the aetiological profile of patients presenting with upper gastrointestinal bleeding. MATERIALS AND METHODS This one year cross-sectional study was conducted from January 2013 to December 2013. Sample size of 50 was considered. Patients aged 18 years and above presenting with upper gastrointestinal bleeding and who are fit for endoscopy were selected. Endoscopy was performed in all patients within 24 hrs. of admission and data was plotted in terms of rates, ratios and percentages and continuous data was expressed as mean ± standard deviation. RESULTS In the present study, most of the patients reported past history of liver disease and intake of NSAIDs and aspirins. In the present study, on clinical examination, most of the patients had pallor followed by tenderness. In the present study, the commonest diagnosis was cirrhosis of liver due to alcohol-induced with portal hypertension. CONCLUSION Upper GI endoscopy revealed varices as most common cause of upper gastrointestinal bleeding.

  19. Patient with Takayasu arteritis presented as cardiogenic shock.

    Science.gov (United States)

    Tacoy, Gulten; Akyel, Ahmet; Tavil, Yusuf; Cengel, Atiye

    2010-11-01

    Takayasu arteritis is a chronic inflammatory disease involving the aorta, its main branches and affects particularly young women. Symptomatic coronary artery disease and cardiogenic shock are rare signs of Takayasu arteritis. We describe a 47-year-old male patient in whom cardiogenic shock was the initial presentation of Takayasu arteritis with coronary, subclavian, celiac and total abdominal aortic occlusion.

  20. HIV diagnosis in a patient presenting with vasculitis.

    Science.gov (United States)

    Sharif, M; Hameed, S; Akin, I; Natarajan, U

    2016-02-01

    A patient with digital ischaemia and gangrene was treated with iloprost and antiplatelets for two weeks. His vasculitic screen was negative except for a positive HIV test. His vasculitis improved three weeks after treatment with antiretroviral medications. Though vasculitis is well known to be associated with HIV infection, very few cases of HIV present as vasculitis.

  1. Anaesthetic challenges in a patient presenting with huge neck teratoma

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    Gaurav Jain

    2013-01-01

    Full Text Available Paediatric airway management is a great challenge even for an experienced anaesthesiologist. Difficult airway in huge cervical teratoma further exaggerates the complexity. This case report is intended at describing the intubation difficulties that were confronted during the airway management of a three year old girl presenting with huge neck teratoma and respiratory distress. This patient was successfully intubated with uncuffed endotracheal tubes in second attempt under inhalational anaesthesia with halothane and spontaneous ventilation. This case exemplifies the importance of careful preoperative workup of an anticipated difficult airway in paediatric patients with neck swelling to minimize any perioperative complications.

  2. Patients with Acromegaly Presenting with Colon Cancer: A Case Series

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    Murray B. Gordon

    2016-01-01

    Full Text Available Introduction. Frequent colonoscopy screenings are critical for early diagnosis of colon cancer in patients with acromegaly. Case Presentations. We performed a retrospective analysis of the incidental diagnoses of colon cancer from the ACCESS trial (ClinicalTrials.gov identifier: NCT01995734. Colon cancer was identified in 2 patients (4.5%. Case  1 patient was a 36-year-old male with acromegaly who underwent transsphenoidal surgery to remove the pituitary adenoma. After surgery, the patient underwent routine colonoscopy screening, which revealed a 40 mm tubular adenoma in the descending colon. A T1N1a carcinoma was surgically removed, and 1 of 22 lymph nodes was positive for metastatic disease, leading to a diagnosis of stage 3 colon cancer. Case  2 patient was a 50-year-old male with acromegaly who underwent transsphenoidal surgery to remove a 2 cm pituitary adenoma. The patient reported severe cramping and lower abdominal pain, and an invasive 8.1 cm3 grade 2 adenocarcinoma with signet rings was identified in the ascending colon and removed. Of the 37 lymph nodes, 34 were positive for the presence of tumor cells, and stage 3c colon cancer was confirmed. Conclusion. Current guidelines for colonoscopy screening at the time of diagnosis of acromegaly and at appropriate follow-up intervals should be followed.

  3. Patients with Acromegaly Presenting with Colon Cancer: A Case Series

    Science.gov (United States)

    Nakhle, Samer; Ludlam, William H.

    2016-01-01

    Introduction. Frequent colonoscopy screenings are critical for early diagnosis of colon cancer in patients with acromegaly. Case Presentations. We performed a retrospective analysis of the incidental diagnoses of colon cancer from the ACCESS trial (ClinicalTrials.gov identifier: NCT01995734). Colon cancer was identified in 2 patients (4.5%). Case  1 patient was a 36-year-old male with acromegaly who underwent transsphenoidal surgery to remove the pituitary adenoma. After surgery, the patient underwent routine colonoscopy screening, which revealed a 40 mm tubular adenoma in the descending colon. A T1N1a carcinoma was surgically removed, and 1 of 22 lymph nodes was positive for metastatic disease, leading to a diagnosis of stage 3 colon cancer. Case  2 patient was a 50-year-old male with acromegaly who underwent transsphenoidal surgery to remove a 2 cm pituitary adenoma. The patient reported severe cramping and lower abdominal pain, and an invasive 8.1 cm3 grade 2 adenocarcinoma with signet rings was identified in the ascending colon and removed. Of the 37 lymph nodes, 34 were positive for the presence of tumor cells, and stage 3c colon cancer was confirmed. Conclusion. Current guidelines for colonoscopy screening at the time of diagnosis of acromegaly and at appropriate follow-up intervals should be followed. PMID:28025627

  4. Alcoholics anonymous and other twelve-step programs in recovery.

    Science.gov (United States)

    Detar, D Todd

    2011-03-01

    Recovery is a new way of life for many patients; a life without substances to alter their moods but with a major change improving the physical, psychological, and emotional stability with improved overall health outcomes. The Twelve Steps of the Alcoholics Anonymous (AA) are the foundation of the AA, describing both the necessary actions and the spiritual basis for the recovery program of the AA. The Twelve Steps of the AA provide a structure for which a patient with alcoholism may turn for an answer to their problem of alcohol use, abuse, or dependence. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. Body Dysmorphic Disorder in Patients Presenting for Cosmetic Treatment

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    Ebru Altintas

    2015-09-01

    Full Text Available Body dysmorphic disorder is an obsessive-compulsive related psychiatric disorder characterized by excessive preoccupation about an imagined or slight defect in appearance. Preoccupation of the appearance with the skin, hair and nose are most common. Impairment of the quality of life, comorbidity of the psychiatric and personality disorder are related with body dysmorphic disorder. Nowadays, cosmetic procedure has become increasingly popular especially among women. The prevalence of body dysmorphic disorder among patients seeking cosmetic treatment in surgery or dermatology clinics is higher than general population. As postoperatively some patients dissatisfied with the surgery, dermatologists and surgeons should be informed about body dysmorphic disorder. This aim of this review was to assess prevalance, clinical features, motivational factors of patients with body dysmorphic disorder presenting for cosmetic medical treatments. [Archives Medical Review Journal 2015; 24(3.000: 324-338

  6. Mortality in patients presenting with fever of unknown origin.

    Science.gov (United States)

    Vanderschueren, S; Eyckmans, T; De Munter, P; Knockaert, D

    2014-01-01

    Few data exist on the contemporary prognosis of patients presenting with fever of unknown origin (FUO). The data of 436 adult immunocompetent patients presenting with FUO between 2000 and 2010 and followed for at least 6 months were analyzed, with a focus on FUO-related deaths. The following variables were assessed in survivors and non-survivors: age, underlying diagnosis, and, in a nested case-control design, fever periodicity, selected laboratory parameters (including peripheral blood counts, enzymes, and inflammatory markers) and organomegaly. Thirty FUO-related deaths occurred (6·9%). Malignancy accounted for 11% of fevers but for 60% of deaths. Especially non-Hodgkin lymphoma carried a disproportionally high death toll. In the non-malignant categories, fatality rates were below 6%. All patients discharged without diagnosis in spite of ample investigations (n = 164) survived. Besides malignancy, age, continuous (as opposed to episodic) fever, anaemia, leucopenia, LDH levels, and hepatomegaly were associated with mortality. Fatality rates of FUO have continuously declined over the past decades. Malignancy, including lymphoma, remains a cardinal cause of death. Patients with FUO discharged without diagnosis survive.

  7. Allergic bronchopulmonary aspergillosis: a unique presentation in a pediatric patient

    Energy Technology Data Exchange (ETDEWEB)

    Huppmann, Michael V.; Monson, Matthew [Walter Reed Army Medical Center, Department of Radiology, Washington, DC (United States)

    2008-08-15

    Infection by the Aspergillus species of fungus can result in a variety of clinically and radiographically unique pulmonary diseases. The specific disease manifested is most dependent upon the immunocompetency of the infected individual. Allergic bronchopulmonary aspergillosis (ABPA) is most commonly seen in patients with asthma and cystic fibrosis. Since its original description in 1952, much has been published describing the radiographic manifestations of this disease. In this article, we present the unusual case of a 13-year-old whose initial radiographic presentation was that of a dense lobar consolidation. Additionally, we highlight the contributory role of the radiologist in guiding the appropriate clinical work-up and treatment of this disease. (orig.)

  8. Presentation

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    Paulo Henrique Freire Vieira

    2013-12-01

    Full Text Available This dossier focuses on one of the essential debate topics today about the territorial dimension of the new development strategies concerned with the worsening of the global socioecological crisis, that is: the challenges related to the activation and integration in networks of localized agri-food systems. For its composition, some contributions presented and debated during the VI International Conference on Localized Agri-food System - The LAFS facing the opportunities and challenges of the new global context have been gathered. The event took place in the city of Florianópolis, from May 21th to 25th of 2013. The event was promoted by the Federal University of Santa Catarina (UFSC and by the Center for the International Cooperation on Agricultural Research for Development (CIRAD. Besides UFSC and CIRAD, EPAGRI, State University of Santa Catarina (UDESC, as well as research institutes and universities from other states (UFMG, IEA/SP, UFS, UFRGS and Mexican and Argentinian partners from the RED SIAL Latino Americana also participated in the organization of lectures, discussion tables and workshops.

  9. Presentation

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    Eduardo Vicente

    2013-06-01

    Full Text Available In the present edition of Significação – Scientific Journal for Audiovisual Culture and in the others to follow something new is brought: the presence of thematic dossiers which are to be organized by invited scholars. The appointed subject for the very first one of them was Radio and the invited scholar, Eduardo Vicente, professor at the Graduate Course in Audiovisual and at the Postgraduate Program in Audiovisual Media and Processes of the School of Communication and Arts of the University of São Paulo (ECA-USP. Entitled Radio Beyond Borders the dossier gathers six articles and the intention of reuniting works on the perspectives of usage of such media as much as on the new possibilities of aesthetical experimenting being build up for it, especially considering the new digital technologies and technological convergences. It also intends to present works with original theoretical approach and original reflections able to reset the way we look at what is today already a centennial media. Having broadened the meaning of “beyond borders”, four foreign authors were invited to join the dossier. This is the first time they are being published in this country and so, in all cases, the articles where either written or translated into Portuguese.The dossier begins with “Radio is dead…Long live to the sound”, which is the transcription of a thought provoking lecture given by Armand Balsebre (Autonomous University of Barcelona – one of the most influential authors in the world on the Radio study field. It addresses the challenges such media is to face so that it can become “a new sound media, in the context of a new soundscape or sound-sphere, for the new listeners”. Andrew Dubber (Birmingham City University regarding the challenges posed by a Digital Era argues for a theoretical approach in radio studies which can consider a Media Ecology. The author understands the form and discourse of radio as a negotiation of affordances and

  10. Presentation

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    Helmut Renders

    2008-10-01

    Full Text Available We present to our esteemed readers the second edition of our journal for 2008. We have chosen the theme “The life and work of Prof. Dr. Jürgen Moltmann” as its special emphasis. It is our way to pay homage to J. Moltmann in the year the Universidade Metodista de São Paulo awards him an honorary Doctor Honoris Causa degree. Sincethe seventies, Moltmann and Latin America have been in dialog. In his emblematic work “A Theology of Liberation”, Gustavo Gutiérrez, the Catholic, discussed with Moltmann, the Reformed, the relationship between eschatology and history (GUTIÉRREZ, Gustavo.Teologia da Libertação. 5ª edição. Petrópolis, RJ: Vozes, 1985, p. 27, 137-139. A dialog held in the premises of IMS, which nowadays is called UMESP, has produced the little book “Passion for life” (MOLTMANN, Jürgen. Paixão pela vida. São Paulo, SP: ASTE - Associaçãode Seminários Teológicos Evangélicos, 1978.In the following years, the wide theological work of J. Moltmann went all the way from debates to congresses and has conquered the classrooms. Most probably, J. Moltmann is nowadays the most widely read European author in Brazilian theological seminaries. Thisrecognition can only be held in unison and the wide response to our request for articles confirms the huge repercussion that Moltmann’s work has been having up to today in Brazil. The ecumenical theologian J. Moltmann is ecumenically read. We believe that thisway we may be better equipped to answer to anyone who asks us for the reason there is hope in us. We have organized the articles on J. Moltmann’s theology according to the original publication date of the books dealt with in each essay. We also communicate that some articles which were originally requested for this edition of the journal will be published in the journal Estudos de Regilião in May 2009.As it is usual with the journal Caminhando, we have, besides this thematic emphasis, yet other contributions in the areas of

  11. Burkitt Lymphoma Presenting as Unilateral Deafness in an Immunocompetent Patient

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    Andre Pinto

    2012-01-01

    Full Text Available A 55-year-old HIV-negative white male presented with right ear deafness, right axillary lymphadenopathy, and weight loss. Laboratory findings included anemia, marked leukocytosis, and thrombocytopenia. Examination of the peripheral smear demonstrated the presence of increased circulating blast-like cells of intermediate size, with basophilic cytoplasm and nuclei with open chromatin. MRI of the brain was compatible with hemorrhagic labyrinthitis. Excisional biopsy of the axillary mass revealed an enlarged lymph node with effaced architecture and “starry sky” appearance. The cells expressed CD20, CD10, BCL6, and surface kappa immunoglobulin light chain, with a high proliferative index by immunohistochemistry and flow cytometry. Subsequent bone marrow biopsy was hypercellular (approximately 95%, with blast-like cells virtually replacing all hematopoietic elements. Routine karyotype as well as FISH analysis of bone marrow cells demonstrated rearrangement of the MYC gene at chromosome 8q24 region, IGH/MYC fusion, and additional signal for IGH gene. We present herein a case of sporadic Burkitt lymphoma occurring in a previously healthy HIV-negative male. The unusual clinical findings in this case include the relatively older age at presentation (55 years, an immunocompetent patient who had nodal involvement and leukemic phase of Burkitt, coupled with partial deafness. A brief educational review of this neoplasm is made.

  12. A delayed presentation of ameloblastic fibrosarcoma in an African patient.

    Science.gov (United States)

    Chauke, Nkhensani Yvonne; Sofianos, Chrysis; Liakos, Dimitri; Ndobe, Elias

    2017-08-01

    A 24-year-old womanpresented with ameloblastic fibrosarcoma arising from ameloblastic fibroma. The delayed presentation accounted for the extensive destruction of the mandible and complete occlusion of her oral cavity. This resulted in an inability to eat and maintain oral hygiene. A multidisciplinary team management approach involved nutritional optimisation, segmental mandibulectomy, reconstruction with a reconstructive plate and a free anterolateral thigh flap to line the the floor of mouth. Functional and aesthetic outcome was acceptable, and the patient is planned for secondary free fibular flap bony reconstruction. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Presentation

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    Nicanor Lopes

    2010-11-01

    Full Text Available The Journal Caminhando debuts with a new editorial format: eachmagazine will have a Dossier.In 2010 Christianity celebrated the centenary of Edinburgh. TheWorld Missionary Conference in Edinburgh in 1910 is regarded by manyas missiological watershed in the missionary and ecumenical movement.So the Faculty of Theology of the Methodist Church (FATEO decidedto organize a Wesleyan Week discussing the issue of mission. For anevent of this magnitude FATEO invited the Rev. Dr. Wesley Ariarajah,Methodist pastor and teacher of Sri Lanka with extensive experience inpastoral ministry in local churches and professor of History of Religionsand the New Testament at the Theological College of Lanka, maintainedby the Protestant Churches in Sri Lanka. In 1981 he was invited to jointhe World Council of Churches, where he presided for over ten years theCouncil of Interreligious Dialogue. From 1992 he served as Deputy GeneralSecretary of the WCC.The following texts are not the speeches of the Rev. Dr. WesleyAriarajah, for they will be published separately. Nevertheless, the journaldialogs with the celebrations of the centenary of Edinburgh, parting formthe intriguing theme: "Mission in the 21st century in Brazil". After all, howis it that mission takes place among us in personal, church, and communityactivities?Within the Dossier, as common to the journal, the textos are organizedas follows: Bible, Theology / History and Pastoral Care. Other items thatdo not fit within the Dossier, but, do articulate mission, can be found inthe section Declarations and Documents and Book Reviews.The authors of the Dossier have important considerations in buildinga contemporary missiological concept considering Brazilian reality.Anderson de Oliveira, in the Bible-Section, presents a significantexegeses of Matthew 26.6-13. What does it mean when Jesus is quotedwith the words: "For the poor always ye have with you, but me ye havenot always." Is this declaration challenging the gospels

  14. Unusual presentation of tuberculosis in chronic hemodialysis patients.

    Science.gov (United States)

    Amedia, C; Oettinger, C W

    1977-08-01

    Four patients developed miliary tuberculosis while undergoing chronic hemodialysis. Two patients had diabetes mellitus. Three of the four patients were hemodialyzed 18--24 months prior to the onset of symptoms. Signs and symptoms included prolonged fever, pleural effusion, pericarditis with pericardial effusion, abdominal pain, weight loss, and ascites. All patients were PPD negative and without historical or radiographic evidence of latent tuberculosis. Disseminated tuberculosis was proven at autopsy in three patients. M. tuberculosis was eventually recovered from pleural fluid and urine in the fourth patient. The immune deficiencies of chronic renal failure and diabetes mellitus are suspected predisposing factors to the development of miliary tuberculosis in these patients.

  15. The twelve dimensional super (2+2)-brane

    CERN Document Server

    Hewson, S F

    1996-01-01

    We discuss supersymmetry in twelve dimensions and present a covariant supersymmetric action for a brane with worldsheet signature (2,2), called a super (2+2)-brane, propagating in the osp(64,12) superspace. This superspace is explicitly constructed, and is trivial in the sense that the spinorial part is a trivial bundle over spacetime, unlike the twisted superspace of usual Poincare supersymmetry. For consistency, it is necessary to take a projection of the superspace. This is the same as the projection required for worldvolume supersymmetry. Upon compactification of this superspace, a torsion is naturally introduced and we produce the membrane and type IIB string actions in 11 and 10 dimensional Minkowski spacetimes. In addition, the compactification of the twelve dimensional supersymmetry algebra produces the correct algebras for these theories, including central charges. These considerations thus give the type IIB string and M-theory a single twelve dimensional origin.

  16. A rare presentation of tuberculous prostatic abscess in young patient

    Directory of Open Access Journals (Sweden)

    Santosh Kumar

    2015-01-01

    Conclusion: Tuberculous prostatic abscess although very uncommon in immunocompetent patient, we should have high index of suspicion in patients of PUO. Once diagnosed it should be treated with complete drainage of abscess and ATT with close follow up.

  17. EFFORTS Technical annex for the twelve month progress report

    DEFF Research Database (Denmark)

    Andreasen, Jan Lasson; Eriksen, Morten; Thomas christensen, Thomas Vennick;

    The present report is documentation for the work carried out at DTU during the second year of project activity. The report describes the work completed by DTU in general as well as on the active sub-tasks within materials properties, friction modelling and physical modelling, over the last twelve...

  18. Psoriatic triad in a patient presenting with oligodontia

    Directory of Open Access Journals (Sweden)

    Rai P

    2010-01-01

    Full Text Available Psoriasis is a common dermatological disease. It can occur at any age but usually develops between 15 and 35 years of age and may persist throughout a person′s lifetime with periods of exacerbation and remission. The hyperproliferative state of the affected epidermis produces a turnover rate that is up to eight times greater than normal. Instead of being shed, the skin cells pile up, causing the visible lesions. Oral manifestations of psoriasis are rare clinical observations. Lesions have been reported on the lips, buccal mucosa, palate, gingiva, and floor of the mouth. We document a presentation of psoriasis showing a triad: skin lesions, arthritis, and oral manifestations (oligodontia being patient′s chief concern. Dental rehabilitation done was in the form of partial dentures. This was done to address the immediate concern of the patient, that is, inability to chew properly. As put forth through this case report, a potential link between psoriasis and oligodontia has scope for further study.

  19. CASE REPORT Acalculous cholecystitis presenting in an out-patient ...

    African Journals Online (AJOL)

    of diabetes mellitus, auto-immune disease or any other significant illness. On examination, the patient ... He tested HIV- negative. Plain films of ... The pathogenetic mechanisms of AAC in patients with no risk factors is as yet unclear; however, ...

  20. Two patients with osteoporosis : initial presentation of systemic mastocytosis

    NARCIS (Netherlands)

    Donker, Marjolein L.; Bakker, Nicolaas A.; Jaspers, Wim J. M.; Verhage, Albert H.

    2008-01-01

    In two patients with osteoporosis, systemic mastocytosis ultimately turned out to be the underlying disease. Both patients had a history of anaphylactic reactions caused by wasp stings but did not have any skin or other symptoms. This observation reflects the need for careful history taking and phys

  1. Presentation of pain in patients suffering from systemic sclerosis

    Directory of Open Access Journals (Sweden)

    Janković Katarina

    2016-01-01

    Full Text Available Introduction: Systemic sclerosis (SSc is a chronic autoimmune disease with very heterogeneous clinical manifestations. There are not many studies which directly research the pain experienced by patients with SSc. Aim: Evaluation of pain in patients with verified systemic sclerosis; making comparison in the two subsets of SSc (diffuse and limited and in the anti-centromere antibodies (ACA and anti-topoisomerase-I antibodies (ATA detected in patients. Material and methods: The study group included 42 patients with SSc. The research was conducted at the Institute of Rheumatology in Belgrade. Each patient was asked to complete the questionnaire, which included the questions about frequency, location and intensity of the pain. Two statistical methodologies were used in the data analysis: descriptive and analytical statistics. Results: Most of the patients (93% confirmed they had some kind of pain . Arthralgia was the most common pain symptom (78,6%, 29 (69% suffered from pain during Raynaud phenomenon, the back pain was found in 20 (47,6%, a headache in 13 (31%, the chest pain in 10 (23,8%, odynophagia in 9 (21,4% and in 8 (19% patients painful digital ulcers. The pain from digital ulcers was rated as the most intensive with the average value of 8,5/10. The patients with diffuse subset of SSc had a higher average intensity score of arthralgia (7,6, compared to those with limited SSc (5,5. The statistically significant difference in the frequency and intensity of the pain in the patients with anti-topoisomerase-I antibodies and the patients with anti-centromere antibodies was not found. Conclusion: Most of the patients suffer from some kind of pain. The most common pain was arthralgia, and the most intensive one was from digital ulcers, although it was the rarest. The pain frequency and intensity were not significantly different in patients with anti-topoisomerase-I and anti-centromere antibodies. There was a statisticaly significant difference in the

  2. Late presentation of acromegaly in medically controlled prolactinoma patients

    Directory of Open Access Journals (Sweden)

    Ekaterina Manuylova

    2016-10-01

    Full Text Available Co-secretion of growth hormone (GH and prolactin (PRL from a single pituitary adenoma is common. In fact, up to 25% of patients with acromegaly may have PRL co-secretion. The prevalence of acromegaly among patients with a newly diagnosed prolactinoma is unknown. Given the possibility of mixed GH and PRL co-secretion, the current recommendation is to obtain an insulin-like growth factor-1 (IGF-1 in patients with prolactinoma at the initial diagnosis. Long-term follow-up of IGF-1 is not routinely done. Here, we report two cases of well-controlled prolactinoma on dopamine agonists with the development of acromegaly 10–20 years after the initial diagnoses. In both patients, a mixed PRL/GH-cosecreting adenoma was confirmed on the pathology examination after transsphenoidal surgery (TSS. Therefore, periodic routine measurements of IGF-1 should be considered regardless of the duration and biochemical control of prolactinoma.

  3. Late presentation of acromegaly in medically controlled prolactinoma patients

    Science.gov (United States)

    Manuylova, Ekaterina; Calvi, Laura M; Hastings, Catherine; Vates, G Edward; Johnson, Mahlon D; Cave, William T

    2016-01-01

    Summary Co-secretion of growth hormone (GH) and prolactin (PRL) from a single pituitary adenoma is common. In fact, up to 25% of patients with acromegaly may have PRL co-secretion. The prevalence of acromegaly among patients with a newly diagnosed prolactinoma is unknown. Given the possibility of mixed GH and PRL co-secretion, the current recommendation is to obtain an insulin-like growth factor-1 (IGF-1) in patients with prolactinoma at the initial diagnosis. Long-term follow-up of IGF-1 is not routinely done. Here, we report two cases of well-controlled prolactinoma on dopamine agonists with the development of acromegaly 10–20 years after the initial diagnoses. In both patients, a mixed PRL/GH-cosecreting adenoma was confirmed on the pathology examination after transsphenoidal surgery (TSS). Therefore, periodic routine measurements of IGF-1 should be considered regardless of the duration and biochemical control of prolactinoma. Learning points: Acromegaly can develop in patients with well-controlled prolactinoma on dopamine agonists. The interval between prolactinoma and acromegaly diagnoses can be several decades. Periodic screening of patients with prolactinoma for growth hormone excess should be considered and can 
lead to an early diagnosis of acromegaly before the development of complications. PMID:27855229

  4. American cutaneous leishmaniasis: presentation and problems of patient management

    Directory of Open Access Journals (Sweden)

    Jeffrey D. Chulay

    1988-12-01

    Full Text Available We report our experience with the diagnosis and treatment of 60 patients with American cutaneous leishmaniasis. They were infected in Panama (55, Brazil (4 or Colombia (I. Among 35 patients with a 3 week exposure in Panama, the mean maximum incubation period was 33 days (range 4-81 days. Diagnosis was delayed an average of 93 days after onset of skin lesions, due to the patient's delay in seeking medical attention (31 days, medical personnel's delay in considering the diagnosis (45 days, and the laboratory's delay in confirming the diagnosis (17 days. Forty-four patients (73% developed ulcers typical of cutaneous leishmaniasis. Sixteen additional patients (27% had atypical macular, papular, squamous, verrucous or acneiform skin lesions that were diagnosed only because leishmanial cultures were obtained. Of the 59 patients treated with pentavalent antimonial drugs, only 34 (58% were cured after the first course of treatment. Lesions which were at least 2 cm in diameter, ulcerated, or caused by Leishmania braziliensis were less likely to be cured after a single course of treatment than were lesions smaller than 2 cm, nonulcerated or caused by Leishmania mexicana or Leishmania donovani.

  5. DOES PRESENTING PATIENT'S BMI INCREASE DOCUMENTATION OF OBESITY?

    Directory of Open Access Journals (Sweden)

    Norm Clothier, MD, M. Kim Marvel, PhD, Courtney S. Cruickshank, MS

    2002-09-01

    Full Text Available Purpose: Despite the associated health consequences, obesity is infrequently documented as a problem in medical charts. The purpose of this study is to determine whether a simple intervention (routine listing of the BMI on the medical chart will increase physician documentation of obesity in the medical record. Methods: Participants were resident physicians in a family medicine residency program. Participants were randomly assigned to either an experimental group or a control group. For experimental group physicians, the Body Mass Index was listed alongside other vital signs of patients seen in an ambulatory setting. Physician documentation of patient obesity was assessed by chart review after patient visits. Documentation was defined as inclusion of obesity on the problem list or in the progress note. Results: The intervention did not significantly increase the rate of documentation of obesity in the medical chart. Several reasons for the lack of change are explored, including the difficulty of treating obesity successfully.

  6. Myocarditis in Patients With Antisynthetase Syndrome: Prevalence, Presentation, and Outcomes.

    Science.gov (United States)

    Dieval, Céline; Deligny, Christophe; Meyer, Alain; Cluzel, Philippe; Champtiaux, Nicolas; Lefevre, Guillaume; Saadoun, David; Sibilia, Jean; Pellegrin, Jean-Luc; Hachulla, Eric; Benveniste, Olivier; Hervier, Baptiste

    2015-07-01

    Antisynthetase syndrome (aSS) corresponds to an overlapping inflammatory myopathy identified by various myositis-specific autoantibodies (directed against tRNA-synthetases). Myocardial involvement in this condition is poorly described.From a registry of 352 aSS patients, 12 cases of myocarditis were retrospectively identified on the basis of an unexplained increase in troponin T/I levels associated with either suggestive cardiac magnetic resonance imaging (MRI) findings, nonsignificant coronary artery abnormalities or positive endomyocardial biopsy.The prevalence of myocarditis in aSS is 3.4% and was not linked to any autoantibody specificity: anti-Jo1 (n = 8), anti-PL7 (n = 3), and anti-PL12 (n = 1). Myocarditis was a part of the first aSS manifestations in 42% of the cases and was asymptomatic (n = 2) or revealed by an acute (n = 4) or a subacute (n = 6) cardiac failure. It should be noted that myocarditis was always associated with an active myositis. When performed (n = 11), cardiac MRI revealed a late hypersignal in the T1-images in 73% of the cases (n = 8). Half of the patients required intensive care. Ten patients (83%) received dedicated cardiotropic drugs. Steroids and at least 1 immunosuppressive drug were given in all cases. After a median follow-up of 11 months (range 0-84) 9 (75%) patients recovered whereas 3 (25%) developed a chronic cardiac insufficiency. No patient died.The prevalence of myocarditis in aSS is similar to that of other inflammatory myopathies. Although the prognosis is relatively good, myocarditis is a severe condition and should be carefully considered as a possible manifestation in active aSS patients.

  7. Clinical Presentation and Patient Evaluation in Nonalcoholic Fatty Liver Disease.

    Science.gov (United States)

    Patel, Vaishali; Sanyal, Arun J; Sterling, Richard

    2016-05-01

    Nonalcoholic fatty liver disease (NAFLD) is a diagnosis of exclusion. Most patients are asymptomatic and diagnosed incidentally. Most patients remain undiagnosed. A high index of suspicion and serologic work-up to rule out alternative causes of liver disease is required. In NALFD, fibrosis correlates with outcomes, including mortality. To diagnose, assess severity, and monitor fibrosis, 2 noninvasive methods can be used. However, noninvasive tests are more helpful at extremes of fibrosis: excluding it or diagnosing advanced fibrosis. Liver biopsy is usually reserved for cases whereby noninvasive tests fail to accurately determine the degree of fibrosis or the diagnosis is unclear.

  8. Mythematics Solving the Twelve Labors of Hercules

    CERN Document Server

    Huber, Michael

    2009-01-01

    How might Hercules, the most famous of the Greek heroes, have used mathematics to complete his astonishing Twelve Labors? From conquering the Nemean Lion and cleaning out the Augean Stables, to capturing the Erymanthean Boar and entering the Underworld to defeat the three-headed dog Cerberus, Hercules and his legend are the inspiration for this book of fun and original math puzzles. While Hercules relied on superhuman strength to accomplish the Twelve Labors, Mythematics shows how math could have helped during his quest. How does Hercules defeat the Lernean Hydra and stop its heads from multip

  9. How to present online information to older cancer patients

    NARCIS (Netherlands)

    Bol, N.

    2015-01-01

    Providing information to cancer patients is crucial within cancer care. As the Internet is becoming an increasingly valuable source of cancer information, it is important to consider the rapidly aging population when designing online cancer materials. Yet, the lack of studies and inconsistent findin

  10. Acute kidney injury in patients presenting with hyponatremia

    NARCIS (Netherlands)

    D. Adams (Denise); R. de Jonge (Robert); T.J.M. van der Cammen (Tischa); R. Zietse (Robert); E.J. Hoorn (Ewout)

    2011-01-01

    textabstractBackground: Hyponatremia is the most common electrolyte disorder, but a lack of well-characterized cohorts is hindering a full appreciation of this complex and heterogeneous disorder. Methods: During 4 months, clinical, biochemical, treatment and outcome data were collected for patients

  11. Typical neuroleptic malignant syndrome presented in patient on maintenance quetiapine

    Directory of Open Access Journals (Sweden)

    Chintan Madhusudan Raval

    2014-01-01

    Full Text Available Neuroleptic malignant syndrome is an acute, life-threatening medical complication caused by antipsychotics. It is commonly seen with typical antipsychotics and very rare with atypicals. Cases have been reported with quetiapine also, but this case is of special interest because it occurred in patient who was stable on maintenance quetiapine 200 mg/day for last 5 years.

  12. Prevalence and presentation of spinal injury in patients with major ...

    African Journals Online (AJOL)

    dell

    Method: A Cross-sectional descriptive study was done on 669 patients with major trauma admitted in ... injury5. The common causes of these injuries include road traffic crushes, falls, and acts of violence .... The Frankel's grading in this study is similar to a study done in Pakistan ... abdominal and other orthopedic injuries34.

  13. Neurological presentations, imaging, and associated anomalies in 50 patients with sacral agenesis.

    Science.gov (United States)

    Emami-Naeini, Parisa; Rahbar, Ziba; Nejat, Farideh; Kajbafzadeh, Abdolmohammad; El Khashab, Mostafa

    2010-10-01

    Sacral agenesis is an uncommon congenital disorder that involves multiple organs. We studied neurological manifestations of the disease, common associated disorders, and their relation with extent of bony malformation. We investigated neurological manifestations of 50 patients with sacral agenesis. Patients were evaluated for previous procedures, ambulation, limb abnormalities, vertebral alignment, recurrent urinary tract infection, urinary incontinence, dribbling, dimple, lower extremities weakness, myelomeningocele (MMC), and lipomyelomenangocele. Weakness of lower extremities was seen in 37 (74%) patients. Concurrent weakness of proximal and distal muscles of the lower limb was statistically associated with a type of bony aplasia (P = .001). However, paraplegia was seen in only 2 of 44 children over the age of 1, and the rest could walk. Myelodysplastic syndromes were seen in 21 patients. Sacral agenesis is diagnosed in children with concomitant MMC at younger ages and reveals more severe symptoms. Progression of neurological disorders was seen in 19 patients, in all of whom MRI showed tethering of the spinal cord. Urinary disorders including diurnal urinary incontinence (in 30 of 35 children over age 4) and recurrent urinary tract infections (in 37) were also common. Imperforate anus was seen in 11 patients. Twelve children over age 4 reported fecal incontinence, a problem that had statistically significant association with imperforate anus (P = .013). Different disorders can concurrently affect patients with sacral agenesis that may have profound impressions on patients and their families. Early diagnosis, thorough evaluation, and proper intervention are of utmost importance as they can prevent or lessen future complications.

  14. Wernicke Encephalopathy Presenting in a Patient with Severe Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Ana Cecilia Arana-Guajardo

    2012-01-01

    Full Text Available Context Acute pancreatitis can lead to prolonged fasting and malnutrition. Many metabolic changes, including thiamine deficiency, may lead to the well know pancreatic encephalopathy. In this condition however the thiamine deficiency is rarely suspected. Case report We report the case of a 17-year-old woman with severe acute pancreatitis who developed mental status changes and ophthalmoplegia. A magnetic resonance image showed hyperintensive signals in periventricular areas, medial thalamus, and mammillary bodies, findings consistent with the diagnosis of Wernicke encephalopathy. Thiamine treatment reversed neurological complications. Conclusion Wernicke encephalopathy secondary to thiamine deficiency should be considered as a possible cause of acute mental status changes in patients with acute pancreatitis and malnutrition. Prophylactic doses of thiamine could be considered in susceptible patients.

  15. Dental extraction for patients presenting at oral surgery student clinic.

    Science.gov (United States)

    Baqain, Zaid H; Khraisat, Ameen; Sawair, Faleh; Ghanam, Sana; Shaini, Firas J; Rajab, Lamis D

    2007-03-01

    The aim of this study was to examine the reasons for dental extraction and to determine the pattern of tooth loss in patients seeking care at the oral surgery teaching clinics in the Faculty of Dentistry of the University of Jordan, Amman, Jordan, over a 3-year period. Data pertaining to the dental extractions of 2435 patients were analyzed. The results showed that 63.8% of the teeth included in this study were extracted because of dental caries, 22.9% because of periodontal disease, and 11.0% for prosthetic reasons. Pericoronitis, orthodontic treatment, trauma, and eruption problems accounted for 2.4% of the reported extractions. The upper premolars were the teeth most commonly extracted, and the lower first and second molars were the teeth most commonly extracted because of dental caries. The logistic regression test revealed that extraction because of dental caries occurred mostly in the group aged 21 to 30 years (P Periodontal disease was not likely the cause of extraction in patients younger than 40 years. Mandibular incisors were the teeth least likely extracted because of dental caries (P periodontal disease (P orthodontic reasons mostly involved the premolars (P periodontal disease (P < .05 and P < .001, respectively) and were more likely to lose teeth for prosthetic reasons and trauma. The information gained from this study is useful to shift oral health planning toward emphasizing the importance of maintaining natural dentition and preventing dental disease.

  16. Prognostic relevance of epilepsy at presentation in glioblastoma patients

    NARCIS (Netherlands)

    Berendsen, Sharon; Varkila, Meri; Kroonen, Jérôme; Seute, Tatjana; Snijders, Tom J; Kauw, Frans; Spliet, Wim G M; Willems, Marie; Poulet, Christophe; Broekman, Marike L; Bours, Vincent; Robe, Pierre A

    2016-01-01

    BACKGROUND: Epileptogenic glioblastomas are thought to convey a favorable prognosis, either due to early diagnosis or potential antitumor effects of antiepileptic drugs. We investigated the relationship between survival and epilepsy at presentation, early diagnosis, and antiepileptic drug therapy in

  17. American cutaneous leishmaniasis: presentation and problems of patient management

    Directory of Open Access Journals (Sweden)

    Jeffrey D. Chulay

    1988-12-01

    Full Text Available We report our experience with the diagnosis and treatment of 60 patients with American cutaneous leishmaniasis. They were infected in Panama (55, Brazil (4 or Colombia (I. Among 35 patients with a 3 week exposure in Panama, the mean maximum incubation period was 33 days (range 4-81 days. Diagnosis was delayed an average of 93 days after onset of skin lesions, due to the patient's delay in seeking medical attention (31 days, medical personnel's delay in considering the diagnosis (45 days, and the laboratory's delay in confirming the diagnosis (17 days. Forty-four patients (73% developed ulcers typical of cutaneous leishmaniasis. Sixteen additional patients (27% had atypical macular, papular, squamous, verrucous or acneiform skin lesions that were diagnosed only because leishmanial cultures were obtained. Of the 59 patients treated with pentavalent antimonial drugs, only 34 (58% were cured after the first course of treatment. Lesions which were at least 2 cm in diameter, ulcerated, or caused by Leishmania braziliensis were less likely to be cured after a single course of treatment than were lesions smaller than 2 cm, nonulcerated or caused by Leishmania mexicana or Leishmania donovani.Relatamos nossa experiência em 60 pacientes com leishmaniose tegumentar americana diagnosticada e tratada entre 1977 e 1982. Cinqüenta e cinco pacientes foram infectados no Panamá, 4 no Brasil, e 1 na Colômbia. Entre 35 pacientes com uma exposição de 3 semanas no Panamá, a média do período de incubação foi 33 dias (limite sobre 4 e 81 dias. O diagnóstico foi feito, em média, 93 dias depois do início das lesões de pele, devido a demora do paciente em procurar o serviço médico (31 dias, a demora do médico em considerar o diagnóstico (45 dias, e a demora do laboratório em confirmar o diagnóstico (17 dias. Quarenta e quatro pacientes (73% desenvolveram úlceras típicas de leishmaniose cutânea. Porém, 16 pacientes (27% tiveram lesões de pele at

  18. Percutaneous treatment in patients presenting with malignant cardiac tamponade

    Energy Technology Data Exchange (ETDEWEB)

    Marcy, P.Y. [Antoine Lacassagne Center, Interventional Radiology Department, Nice (France); Bondiau, P.Y. [Antoine Lacassagne Center, Radiation Therapy Department, Nice (France); Brunner, P. [Centre Hospitalier Princesse, Grace (Monaco). Interventional Radiology Department

    2005-09-01

    The percutaneous treatment of pericardial effusion resulting in cardiac tamponade has undergone an evolution in recent years with the use of less invasive drainage techniques in selected cases. To determine optimal therapy modalities for oncology patients with malignant pericardial tamponade (MPT), the authors review their institutional experience with percutaneous needle puncture routes, means of imaging-guided drainage and percutaneous management of the pericardial fluid effusion (pericardial sclerosis and balloon pericardiotomy). Advantages and limits of the percutaneous techniques will be compared to the surgical treatment. (orig.)

  19. Microproteinuria Predicts Organ Failure in Patients Presenting with Acute Pancreatitis

    DEFF Research Database (Denmark)

    Bertilsson, Sara; Swärd, Per; Håkansson, Anders

    2016-01-01

    Background and Aims: The disease course of acute pancreatitis (AP) ranges from mild and self-limiting to severe inflammation, associated with significant morbidity and mortality. At present, there are no universally accepted and reliable predictors for severity. Microproteinuria has been associated...

  20. Application of Antigen Cross-Presentation Research into Patient Care

    NARCIS (Netherlands)

    2017-01-01

    The activation of adaptive immune responses requires the processing and presentation of protein antigens to lymphocytes. Especially dendritic cells are effective at display of antigen-derived peptides in the form of immunogenic peptide/MHC complexes to CD4 and CD8-positive T cells, and can stimulate

  1. Endometrial Adenocarcinoma Presenting in a Premenopausal Patient with Tuberous Sclerosis

    Science.gov (United States)

    Jaffe, J. S.; Chambers, J. T.

    2005-01-01

    Background: Endometrial adenocarcinoma is very uncommon in women under 40 years of age. Case: A 39-year-old woman with tuberous sclerosis and severe intellectual disability presented with irregular bleeding unresponsive to oral contraceptive therapy. She was subsequently found to have a deeply invasive endometrial adenocarcinoma. Conclusion:…

  2. Twelve Theses on Reactive Rules for the Web

    OpenAIRE

    Bry, François; Eckert, Michael

    2007-01-01

    Reactivity, the ability to detect and react to events, is an essential functionality in many information systems. In particular, Web systems such as online marketplaces, adaptive (e.g., recommender) sys- tems, and Web services, react to events such as Web page updates or data posted to a server. This article investigates issues of relevance in designing high-level programming languages dedicated to reactivity on the Web. It presents twelve theses on features desira...

  3. [Urticaria pigmentosa: two different clinical presentations in pediatric patients].

    Science.gov (United States)

    Spada, Julieta; Lequio, Mariana; Pyke, María de los Ángeles; Hernández, Marisa; Chouela, Edgardo

    2011-08-01

    Urticaria pigmentosa (UP) is the most frequent clinical feature of cutaneous mastocytosis. It usually begins in a bimodal way: a peak of incidence from birth to the age of 3 and the other one between 2(nd) and 6(th) decades of life. Darier's sign is constant over the affected skin without affecting the surrounding skin. When UP starts early, it has a good prognosis disappearing into adolescence, while late onset is often associated with persistent or systemic involvement. This article reports two cases of UP, one with the classic description of the disease and the other with an unusual clinical presentation, prompting the pediatrician to incorporate both forms as different manifestations of the same entity.

  4. Comparative analysis of twelve Dothideomycete plant pathogens

    Energy Technology Data Exchange (ETDEWEB)

    Ohm, Robin; Aerts, Andrea; Salamov, Asaf; Goodwin, Stephen B.; Grigoriev, Igor

    2011-03-11

    The Dothideomycetes are one of the largest and most diverse groups of fungi. Many are plant pathogens and pose a serious threat to agricultural crops grown for biofuel, food or feed. Most Dothideomycetes have only a single host and related Dothideomycete species can have very diverse host plants. Twelve Dothideomycete genomes have currently been sequenced by the Joint Genome Institute and other sequencing centers. They can be accessed via Mycocosm which has tools for comparative analysis

  5. Twelve tips for peer observation of teaching.

    Science.gov (United States)

    Siddiqui, Zarrin Seema; Jonas-Dwyer, Diana; Carr, Sandra E

    2007-05-01

    This paper outlines twelve tips for undertaking peer observation of teaching in medical education, using the peer review model and the experiences of the authors. An accurate understanding of teaching effectiveness is required by individuals, medical schools, and universities to evaluate the learning environment and to substantiate academic and institutional performance. Peer Observation of Teaching is one tool that provides rich, qualitative evidence for teachers, quite different from closed-ended student evaluations. When Peer Observation of Teaching is incorporated into university practice and culture, and is conducted in a mutually respectful and supportive way, it has the potential to facilitate reflective change and growth for teachers.

  6. Holocord spinal epidural abscess in a pregnant patient presenting as premature labour: a rare presentation of an unusual diagnosis.

    Science.gov (United States)

    Burton, Kirsteen R; Wang, Xi; Dhanoa, Deljit

    2014-07-01

    Spinal epidural abscess (SEA) is a rare clinical entity. It is less common when the entire epidural space is involved, known as a holocord or panspinal SEA, and it is even less common in a pregnant patient. We report a case of methicillin-resistant Staphylococcus aureus holocord SEA in a 30-year-old female at approximately 22 weeks' gestational age who presented with lumbar pain and pelvic pressure and the urge to bear down. Magnetic resonance imaging of the spine demonstrated extensive SEA and meningitis from the foramen magnum to the lumbar spine that was treated both medically and surgically. The incidence of, clinical presentation of, and risk factors for developing SEA are discussed. If untreated, expanding SEAs produce sensory symptoms and signs, motor dysfunction, and, eventually, paralysis and death. The medical and surgical management of SEA is also discussed. SEA can have an insidious and atypical presentation despite extensive involvement of the epidural space. Therefore, the diagnosis of SEA should always be considered in patients who present to the emergency department with back pain.

  7. The impact of alcoholics anonymous on other substance abuse-related twelve-step programs.

    Science.gov (United States)

    Laudet, Alexandre B

    2008-01-01

    This chapter explores the influence of the AA model on self-help fellowships addressing problems of drug dependence. Fellowships that have adapted the twelve-step recovery model to other substances of abuse are reviewed; next similarities and differences between AA and drug-recovery twelve-step organizations are examined; finally, we present empirical findings on patterns of attendance and perceptions of AA and Narcotics Anonymous (NA) among polydrug-dependent populations, many of whom are cross-addicted to alcohol. Future directions in twelve-step research are noted in closing.

  8. Combining ability of twelve maize populations

    Directory of Open Access Journals (Sweden)

    Vacaro Elton

    2002-01-01

    Full Text Available Genetic progress depends on germplasm quality and breeding methods. Twelve maize populations and their crosses were evaluated to estimate combining ability and potential to be included as source populations in breeding programs. Plant height, point of insertion of the first ear, number of ears per plant, number of grains per ear, root and stalk lodging and grain yield were studied in two locations in Brazil, during the 1997/98 season. Genotype sum of squares was divided into general (GCA and specific (SCA combining ability. Results indicated the existence of genetic divergence for all traits analyzed, where additive effects were predominant. The high heterosis levels observed, mainly in Xanxerê, suggested the environmental influence on the manifestation of this genetic phenomenon. Populations revealed potential to be used in breeding programs; however, those more intensively submitted to selection could provide larger genetic progress, showing the importance of population improvement for the increment of the heterosis in maize.

  9. Late presentation of congenital diaphragmatic hernia in patients with cystic fibrosis.

    Science.gov (United States)

    Goetz, Danielle M; Burns, Cartland; Segura, Bradley J; Weiner, Daniel J

    2010-04-01

    Late presentation of congenital diaphragmatic hernia (CDH) is unusual, especially in patients with cystic fibrosis (CF). To our knowledge, cases of CDH in CF patients and the combined effects on lung function have not been previously described. Here we report two cases of late presenting CDH in CF patients and describe effects on lung function. Late presentation of CDH in CF patients can cause gastrointestinal or respiratory symptoms and requires a high index of suspicion as well as proper interpretation of imaging. In patients with CF and CDH, lung function abnormalities could include obstructive, restrictive defects, or combined defects.

  10. Cerebral venous thrombosis presenting with intracerebral hemorrhage in a patient with paroxysmal nocturnal hemoglobinuria

    Directory of Open Access Journals (Sweden)

    Gentle Sunder Shrestha

    2016-01-01

    Full Text Available Cerebral venous thrombosis (CVT is an uncommon cause of stroke. Paroxysmal nocturnal hemoglobinuria (PNH is a rare type of hemolytic anemia, frequently associated with thrombophilia. PNH may rarely present with CVT. Approximately, one-third of the patients with CVT develop cerebral hemorrhage. Here, we present a rare combination of CVT presenting with intracerebral hemorrhage in a patient with PNH. High index of suspicion is needed to avoid misdiagnosis. Patient was successfully managed with anticoagulation therapy.

  11. A twelve-week randomized controlled study of the cognitive-behavioral Integrated Psychological Therapy program: positive effect on the social functioning of schizophrenic patients Estudo controlado randomizado de 12 semanas do programa cognitivo-comportamental IPT (Terapia Psicológica Integrada com efeito positivo sobre o funcionamento social em pacientes com esquizofrenia

    Directory of Open Access Journals (Sweden)

    Marilene Zimmer

    2007-06-01

    Full Text Available OBJECTIVES: The present study was designed to evaluate the effect of twelve weekly sessions of the cognitive-behavioral program originally known as the Integriertes Psychologisches Therapieprogramm für Schizophrene Patienten, designated the Integrated Psychological Therapy (IPT program in English, on cognition, social adjustment and quality of life in schizophrenic outpatients, comparing it to the effect of treating such patients as usual. METHOD: Fifty-six adult outpatients (from 18 to 65 years of age with ICD-10-based diagnoses of schizophrenia were randomly assigned to two different groups: active intervention (IPT group; and treatment as usual (control group. Outcome measures were quality of life (as determined using the WHOQOL-Bref, cognition (Mini-Mental State Examination and Word Recall Test, global functioning (DSM-IV Global Assessment of Functioning Scale, social functioning (Social and Occupational Functioning Assessment Scale and social adjustment (Social Adjustment Scale. RESULTS: The findings suggest that, in comparison with treatment as usual (control group, the twelve-session IPT program had a positive effect on several outcome measures: cognition in the domains of spatiotemporal orientation (p = 0.051 and memory (p = 0.031; overall social adjustment (p = 0.037, leisure/social life (p = 0.051 and family relations (p = 0.008; overall functioning (p = 0.000; social-occupational functioning (p = 0.000; and quality of life in the psychological domain (p = 0.021. CONCLUSIONS: The twelve-session cognitive-behavioral IPT intervention demonstrated superiority over treatment as usual in its effects on cognition, social adjustment and quality of life. Studies involving larger samples, longer follow-up periods and additional outcome measures are needed in order to assess the specific effects on dimensions of social functioning, cognitive functioning and quality of life in patients with schizophrenia.OBJETIVOS: O presente estudo foi

  12. Primary Metastatic Osteosarcoma: Presentation and Outcome of Patients Treated on Neoadjuvant Cooperative Osteosarcoma Study Group Protocols

    National Research Council Canada - National Science Library

    Leo Kager; Andreas Zoubek; Ulrike Pötschger; Ulrike Kastner; Silke Flege; Beate Kempf-Bielack; Detlev Branscheid; Rainer Kotz; Mechthild Salzer-Kuntschik; Winfried Winkelmann; Gernot Jundt; Hartmut Kabisch; Peter Reichardt; Heribert Jürgens; Helmut Gadner; Stefan S. Bielack; for the Cooperative German-Austrian-Swiss Osteosarcoma Study Group

    2003-01-01

    To determine demographic data and define prognostic factors for long-term outcome in patients presenting with high-grade osteosarcoma of bone with clinically detectable metastases at initial presentation...

  13. Xeroderma pigmentosum. Case presentation.

    Directory of Open Access Journals (Sweden)

    Damaris Díaz Leonard

    2008-08-01

    Full Text Available Twelve years old patient (YGS, female, white, of rural origin; with history of facial and truncal bullae since the age of eight months when exposed to the sun light. It was first diagnosed as solar dermatitis. At the age of 6 it was assessed as xeroderma pigmentosum. This diagnosis was confirmed at the age of 10 by the histopathology department and reassessed by the National Reference Centre. For the infrequency of this disease, a bibliographic revision was carried out to make a report for this case presentation.

  14. Twelve tips for getting your manuscript published.

    Science.gov (United States)

    Cook, David A

    2016-01-01

    The author shares twelve practical tips on how to navigate the process of getting a manuscript published. These tips, which apply to all fields of academic writing, advise that during the initial preparation phase authors should: (1) plan early to get it out the door; (2) address authorship and writing group expectations up front; (3) maintain control of the writing; (4) ensure complete reporting; (5) use electronic reference management software; (6) polish carefully before they submit; (7) select the right journal; and (8) follow journal instructions precisely. Rejection after the first submission is likely, and when this occurs authors should (9) get it back out the door quickly, but first (10) take seriously all reviewer and editor suggestions. Finally, when the invitation comes to revise and resubmit, authors should (11) respond carefully to every reviewer suggestion, even if they disagree, and (12) get input from others as they revise. The author also shares detailed suggestions on the creation of effective tables and figures, and on how to respond to reviewer critiques.

  15. Antifouling activity of twelve demosponges from Brazil

    Directory of Open Access Journals (Sweden)

    SM. Ribeiro

    Full Text Available Benthic marine organisms are constantly exposed to fouling, which is harmful to most host species. Thus, the production of secondary metabolites containing antifouling properties is an important ecological advantage for sessile organisms and may also provide leading compounds for the development of antifouling paints. High antifouling potential of sponges has been demonstrated in the Indian and Pacific oceans and in the Caribbean and Mediterranean seas. Brazilian sponges remain understudied concerning antifouling activities. Only two scientific articles reported this activity in sponges of Brazil. The objective of this study was to test crude extracts of twelve species of sponges from Brazil against the attachment of the mussel Perna perna through laboratorial assays, and highlight promising species for future studies. The species Petromica citrina, Amphimedon viridis, Desmapsamma anchorata, Chondrosia sp., Polymastia janeirensis, Tedania ignis, Aplysina fulva, Mycale angulosa, Hymeniacidon heliophila, Dysidea etheria, Tethya rubra, and Tethya maza were frozen and freeze-dried before extraction with acetone or dichloromethane. The crude extract of four species significantly inhibited the attachment of byssus: Tethya rubra (p = 0.0009, Tethya maza (p = 0.0039, Petromica citrina (p = 0.0277, and Hymeniacidon heliophila (p = 0.00003. These species, specially, should be the target of future studies to detail the substances involved in the ability antifouling well as to define its amplitude of action.

  16. Twelve Elastic Constants of Betula platyphylla Suk.

    Institute of Scientific and Technical Information of China (English)

    Wang Liyu; Lu Zhenyou

    2004-01-01

    Wood elastic constants are needed to describe the elastic behaviors of wood and be taken as an important design parameter for wood-based composite materials and structural materials. This paper clarified the relationships between compliance coefficients and engineering elastic constants combined with orthotropic properties of wood, and twelve elastic constants of Betula platyphylla Suk. were measured by electrical strain gauges. Spreading the adhesive quantity cannot be excessive or too little when the strain flakes were glued. If excessive, the glue layer was too thick which would influence the strain flakes' performance, and if too little, glues plastered were not firm, which could not accurately transmit the strain. Wood as an orthotropic material, its modulus of elasticity and poisson's ratios are related by two formulas:μij /Ei =μji /Ej and μij 0.95) between the reciprocal of elastic modulus MOE-1 and the square of the ratio of depth to length (h/l)2, which indicate that shear modulus values measured were reliable by three point bending experiment.

  17. Trauma patients who present in a delayed fashion: a unique and challenging population.

    Science.gov (United States)

    Kao, Mary J; Nunez, Hector; Monaghan, Sean F; Heffernan, Daithi S; Adams, Charles A; Lueckel, Stephanie N; Stephen, Andrew H

    2017-02-01

    A proportion of trauma patients present for evaluation in a delayed fashion after injury, likely due to a variety of medical and nonmedical reasons. There has been little investigation into the characteristics and outcomes of trauma patients who present delayed. We hypothesize that trauma patients who present in a delayed fashion are a unique population at risk of increased trauma-related complications. This was a retrospective review from 2010-2015 at a Level I trauma center. Patients were termed delayed if they presented >24 hours after injury. Patients admitted within 24 hours of their injury were the comparison group. Charts were reviewed for demographics, mechanism, comorbidities, complications and outcomes. A subgroup analysis was done on patients who suffered falls. During the 5-y period, 11,705 patients were admitted. A total of 588 patients (5%) presented >24 h after their injury. Patients in the delayed group were older (65 versus 55 y, P fashion have unique characteristics and are more likely to suffer negative outcomes including substance withdrawal. Future goals will include exploring strategies for early intervention, such as automatic withdrawal monitoring and social work referral for all patients who present in a delayed fashion. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Twelve-week efficacy and safety study of mometasone furoate/formoterol 200/10 microg and 400/10 microg combination treatments in patients with persistent asthma previously receiving high-dose inhaled corticosteroids

    DEFF Research Database (Denmark)

    Weinstein, Steven F; Corren, Jonathan; Murphy, Kevin;

    2010-01-01

    A significant unmet medical need exists in patients with uncontrolled asthma. The purpose of this study was to evaluate the efficacy and safety of mometasone furoate/formoterol (MF/F) 400/10 microg versus MF 400 microg administered twice-daily (b.i.d.) via metered-dose inhaler in patients...

  19. Relationship of time to presentation after onset of upper GI bleeding with patient characteristics and outcomes

    DEFF Research Database (Denmark)

    Laine, Loren; Laursen, Stig B; Dalton, Harry R

    2017-01-01

    BACKGROUND & AIMS: We performed a prospective multi-national study of patients presenting to the emergency department with upper gastrointestinal bleeding (UGIB) and assessed the relationship of time to presentation after onset of UGIB symptoms with patient characteristics and outcomes. METHODS: ...

  20. Crusted Scabies: Presenting as erythroderma in a human immunodeficiency virus-seropositive patient

    Directory of Open Access Journals (Sweden)

    Shruti Kulkarni

    2016-01-01

    Full Text Available Crusted scabies is a rare manifestation of scabies characterized by uncontrolled proliferation of mites in the skin. It is common in patients with sensory neuropathy, mentally retarded persons and in patients who are immunosuppressed. Further, crusted scabies can rarely present as erythroderma (<0.5% cases necessitating a high index of suspicion for its diagnosis. Because of its rare occurrence, we are reporting a case of crusted scabies presenting as erythroderma, in a human immunodeficiency virus seropositive patient.

  1. Evaluation of New-Onset Diabetes in Patients Presenting Emergency Service with a Diabetic Ketoacidosis Attack

    Directory of Open Access Journals (Sweden)

    Yavuz Yiğit

    2013-12-01

    Full Text Available Aim: The aim of this study was to investigate the rate of new-onset diabetes mellitus (DM in patients presenting to our emergency department with diabetic ketoacidosis. Methods: We retrospectively evaluated hospital records of patients who presented to the Emergency Department at Istanbul Goztepe Research and Training Hospital between 01 April 2009 and 01 April 2011 and were diagnosed with diabetic ketoacidosis. 57 patients having complete clinical data were included in the study. Results: 45.6%of patients had type 1 DM, 33.3%- type 2 DM, and 21%of them were with new-onset DM. No statistically significant difference was found between type 1 DM, type 2 DM and new-onset DM patients with respect to arterial blood pH and HCO3 levels and serum sodium, potassium and plasma glucose levels at presentation as well as time of presentation (p>0.05, while HbA1c levels showed statistically significant difference in new-onset DM patients. Conclusion: No statistically significant difference was found between types of DM in patients diagnosed with diabetic ketoacidosis except for precipitating factors, age and HbA1c. Detecting high blood glucose levels in patients presenting to emergency room for reasons other than DM is not a rare condition. Cautious evaluation and recognition of these patients in emergency room for the possibility of undiagnosed DM is important for prevention of future diabetic ketoacidosis episodes. (The Medical Bulletin of Haseki 2013; 51: 168-72

  2. Disseminated histoplasmosis presenting as diabetic keto-acidosis in an immunocompetent patient.

    Science.gov (United States)

    Niknam, Negin; Malhotra, Prashant; Kim, Angela; Koenig, Seth

    2017-01-06

    Histoplasma capsulatum causes a spectrum of manifestations from asymptomatic to fatal disseminated disease. Disseminated histoplasmosis is mostly seen in endemic areas among immunocompromised patients such as those with AIDS. Here, we present a patient living in a non-endemic area with previously undiagnosed diabetes mellitus, who presented with septic shock and diabetic ketoacidosis (DKA), and was ultimately diagnosed with disseminated histoplasmosis. The patient rapidly recovered on administration of intravenous liposomal amphotericin followed by oral itraconazole. Uncontrolled diabetes may be a risk factor for disseminated or severe histoplasmosis in otherwise immunocompetent patients.

  3. Patient advisory groups in practice improvement: sample case presentation with a discussion of best practices.

    Science.gov (United States)

    Angstman, Kurt B; Bender, Robert O; Bruce, Steven M

    2009-01-01

    Using patient advisory groups can affect practice changes and create a patient-centric focus for a primary care practice. A successful patient advisory group has been developed for our primary care clinics. Utilizing this group, we have implemented practice improvement changes that have had a significant impact in patient care. This will be demonstrated in a case presentation involving the implementation of depression care managers at our practice sites. We will review key "best practices," as defined by the group, regarding size, composition, and meeting frequency that can be used for the development of a clinical patient advisory group.

  4. Twelve weeks treatment with the DPP-4 inhibitor, sitagliptin, prevents degradation of peptide YY and improves glucose and non-glucose induced insulin secretion in patients with type 2 diabetes mellitus

    DEFF Research Database (Denmark)

    Aaboe, K; Knop, F K; Vilsbøll, T

    2010-01-01

    To examine the effects of 12 weeks of treatment with the DPP-4 inhibitor, sitagliptin, on gastrointestinal hormone responses to a standardized mixed meal and beta cell secretory capacity, measured as glucose and non-glucose induced insulin secretion during a hyperglycaemic clamp, in patients with...

  5. Slow pathway modification in patients presenting with only two consecutive AV nodal echo beats.

    Science.gov (United States)

    Wegner, Felix K; Silvano, Maria; Bögeholz, Nils; Leitz, Patrick R; Frommeyer, Gerrit; Dechering, Dirk G; Zellerhoff, Stephan; Kochhäuser, Simon; Lange, Philipp S; Köbe, Julia; Wasmer, Kristina; Mönnig, Gerold; Eckardt, Lars; Pott, Christian

    2017-02-01

    Slow pathway modification (SPM) is the therapy of choice for AV-nodal reentry tachycardia (AVNRT). When AVNRT is not inducible, empirical ablation can be considered, however, the outcome in patients with two AV nodal echo beats (AVNEBs) is unknown. Out of a population of 3003 patients who underwent slow pathway modification at our institution between 1993 and 2013, we retrospectively included 32 patients with a history of symptomatic tachycardia, lack of paroxysmal supraventricular tachycardia (pSVT) inducibility but occurrence of two AVNEBs. pSVT documentation by electrocardiography (ECG) was present in 20 patients. The procedural endpoint was inducibility of less than two AVNEBs. This was reached in 31 (97%) patients. Long-term success was assessed by a telephone questionnaire (follow-up time 63±9 months). A total 94% of the patients benefited from the procedure (59% freedom from symptoms; 34% improvement in symptoms). Among those patients in whom ECG documentation was not present, 100% benefited (58% freedom from symptoms, 42% improvement). This is the first collective analysis of a group of patients presenting with symptoms of pSVT and inducibility of only two AVNEBs. Procedural success and clinical long-term follow-up were in the range of the reported success rates of slow pathway modification of inducible AVNRT, independent of whether ECG documentation was present. Thus, SPM is a safe and effective therapy in patients with two AVNEBs. Copyright © 2016. Published by Elsevier Ltd.

  6. Patients presenting for colonoscopy: A great opportunity to screen for sleep apnea

    Science.gov (United States)

    Harvin, Glenn; Ali, Eslam; Raina, Amit; Leland, William; Abid, Sabeen; Vahora, Zahid; Movahed, Hossein; Kachru, Sumyra; Tee, Rick

    2016-01-01

    AIM To discover the prevalence and the feasibility of screening for obstructive sleep apnea (OSA) in patients presenting for routine colonoscopy. METHODS Adult patients having a colonoscopy for routine indications at our outpatient endoscopy center were eligible if they did not carry a diagnosis of OSA or had not had a prior sleep study. All patients were administered the Berlin questionnaire prior to the procedure. Mallampati, neck circumference, height, weight, and BMI were obtained for each patient. Patients were observed for any drops in oxygen saturation 10 s. Patients were determined to be high-risk if they met at least 2 of the 3 symptom categories for the Berlin questionnaire. RESULTS A total of 60 patients were enrolled and completed the study; mean age was 56 years (range 23-72 year). Twenty-six patients had a positive Berlin questionnaire (43.3%), 31 patients had a negative Berlin questionnaire (51.6%) and 3 patients had an equivocal result (5.0%). Patients with a positive Berlin questionnaire were more likely to be of increased weight (mean 210.5 lbs vs mean 169.8 lbs, P = 0.003), increased BMI (33.0 kg/m2 vs 26.8 kg/m2, P = 0.0016), and have an increased neck circumference (38.4 cm vs 35.5 cm, P = 0.012). Patients with a positive Berlin questionnaire were more likely to have a drop in oxygen saturation < 92% (76.9% vs 36.4%, P = 0.01). Patients with snoring were more likely to have a positive Berlin questionnaire (8/9 patients vs 1/31 patients with negative Berlin questionnaire; P = 0.0045). CONCLUSION Risk for OSA is extremely common in a population presenting for a routine colonoscopy, and screening at the time of a colonoscopy offers an excellent opportunity to identify these patients. PMID:27909549

  7. Retrospective Analysis of Patient Presentations at the Sydney (Australia) Royal Easter Show from 2012 to 2014.

    Science.gov (United States)

    Crabtree, Nathan; Mo, Shirley; Ong, Leon; Jegathees, Thuvarahan; Wei, Daniel; Fahey, David; Liu, Jia Jenny

    2017-04-01

    Introduction Comprehensive studies on the relationship between patient demographics and subsequent treatment and disposition at a single mass-gathering event are lacking. The Sydney Royal Easter Show (SRES; Sydney Olympic Park, New South Wales, Australia) is an annual, 14-day, agricultural mass-gathering event occurring around the Easter weekend, attracting more than 800,000 patrons per year. In this study, patient records from the SRES were analyzed to examine relationships between weather, crowd size, day of week, and demographics on treatment and disposition. This information would help to predict factors affecting patient treatment and disposition to guide ongoing training of first responders and to evaluate the appropriateness of staffing skills mix at future events. Hypothesis Patient demographics, environmental factors, and attendance would influence the nature and severity of presentations at the SRES, which would influence staffing requirements. A retrospective analysis of 4,141 patient record forms was performed for patients who presented to St John Ambulance (Australian Capital Territory, Australia) at the SRES between 2012 and 2014 inclusive. Presentation type was classified using a previously published minimum data set. Data on weather and crowd size were obtained from the Australian Bureau of Meteorology (Melbourne, Victoria, Australia) and the SRES, respectively. Statistical analyses were performed using SPSS v22 (IBM; Armonk, New York USA). Between 2012 to 2014, over 2.5 million people attended the SRES with 4,141 patients treated onsite. As expected, the majority of presentations were injuries (49%) and illnesses (46%). Although patient demographics and presentation types did not change over time, the duration of treatment increased. A higher proportion of patients were discharged to hospital or home compared to the proportion of patients discharged back to the event. Patients from rural/regional locations (accounting for 15% of all patients) were

  8. Superior Vena Cava Obstruction in Hemodialysis Patients: Symptoms, Clinical Presentation and Outcomes Compared to Other Etiologies.

    Science.gov (United States)

    Siegel, Yoel; Kuker, Russ

    2016-08-01

    The incidence of superior vena cava (SVC) obstruction associated with non-malignant diseases is on the rise, and a large percentage of these patients are on hemodialysis (HD). The objective was to characterize the presentation, symptoms and outcomes of HD patients with SVC obstruction identified on computerized tomography (CT) compared to patients with other etiologies such as neoplasm. A search was performed through the PACS system using key words to identify patients with SVC obstruction. The CT scans and charts were reviewed for degree of obstruction, signs, symptoms and outcomes. Thirty-six patients were included in the study. Thirteen were on HD and of these, five had symptoms associated with SVC obstruction and one had concordant findings on physical exam. In comparison, thirteen patients with a chest neoplasm had symptoms and four had concordant findings on physical exam. On follow up, 31% of the HD patients died and of these 60% were symptomatic and died within 2 years. 29% of lung cancer patients died within 16 months. The majority of the HD patients had complete SVC obstruction (85%) as opposed to those with a chest neoplasm who mostly had partial SVC occlusion (67%). In conclusion, patients on HD with SVC obstruction are less often symptomatic than those with a neoplasm. However, these HD patients had a death rate similar to the patients with cancer. This risk seems to increase in those who are symptomatic. Diagnosis of SVC obstruction by CT in HD patients may help identify those with less favorable prognosis.

  9. [Ozonotherapy as an efficient component of the combined treatment of the patients presenting with bacterial vaginosis].

    Science.gov (United States)

    Yarustovskaya, O V; Kulikov, A G; Shtro, L P

    2015-01-01

    The objective of the present study was to evaluate the effectiveness of the combined treatment of the patients suffering from bacterial vaginosis using various methods of ozone therapy. The comprehensive clinical and laboratory examination and treatment involved 102 patients of the child-bearing age divided into 3 groups, matched for the age and the main clinical manifestations of the disease. All the patients comprising group IlIl received basic therapy alone while the treatment of the patients of group I consisted of local ozone therapy and that of the patients of group 11 of the combination of local and general ozone therapy. The study has demonstrated the enhanced effectiveness of the combined local and general ozone therapy compared with the two other modalities and the feasibility of its application for the treatment of the patients presenting with bacterial vaginosis.

  10. Toxoplasmosis of spinal cord in acquired immunodeficiency syndrome patient presenting as paraparesis: A rare entity

    Directory of Open Access Journals (Sweden)

    Sachin R Agrawal

    2014-01-01

    Full Text Available Although brain has been the most common site for toxoplasma infection in acquired immunodeficiency syndrome patients, involvement of spinal cord by toxoplasma has been rarely found. Spinal cord toxoplasmosis can present as acute onset weakness in both lower limbs associated with sensory and bladder dysfunction. A presumptive diagnosis can be made in patients with CD4 count <100/mm 3 based on a positive serum Toxoplasma gondii IgG antibodies, no recent prophylaxis against toxoplasmosis, intramedullary ring enhancing lesion in spinal cord supported by similar lesions in brain parenchyma. Institutions of antitoxoplasma treatment in such patients result in prompt clinical response and therefore avoiding the need of unnecessary invasive diagnostic tests. Here, we report a case of toxoplasmic myelitis in immunocompromised patient presenting as myelopathy who showed significant clinical improvement after starting antitoxoplasma treatment. Hence toxoplasmic myelitis should be considered in toxoplasma seropositive immunocompromised patients presenting as myelopathy and imaging studies showing ring enhancing intramedullary lesion.

  11. PULMONARY LANGERHANS CELL HISTIOCYTOSIS PRESENTING AS SIMULTANEOUS BILATERAL SPONTANEOUS PNEUMOTHORAX IN A NON-SMOKER PATIENT

    Directory of Open Access Journals (Sweden)

    M. Vaziri

    2008-06-01

    Full Text Available Pulmonary Langerhans Cell Histiocytosis (PLCH is a rare idiopathic disorder that primarily affects young adult cigarette smokers. Affected patients often present with cough and dyspnea and about 20% of patients present with or later develop pneumothorax. It is striking that more than 90% of patients are smokers. We report a very unusual case of PLCH in a 20-year- old male patient with no smoking history in whom a life- threatening complication such as simultaneous bilateral pneumothorax was the presenting feature. The final diagnosis was made by open surgical biopsy and recurrent pneumothoraces necessitated surgical management with pleurodesis. We emphasize the early use of pleurodesis in managing patients with PLCH and spontaneous pneumothorax.

  12. Twelve-week efficacy and safety study of mometasone furoate/formoterol 200/10 microg and 400/10 microg combination treatments in patients with persistent asthma previously receiving high-dose inhaled corticosteroids

    DEFF Research Database (Denmark)

    Weinstein, Steven F; Corren, Jonathan; Murphy, Kevin

    2010-01-01

    with asthma uncontrolled on high-dose inhaled corticosteroids (ICS). In a 12-week, randomized, multicenter, double-blind, parallel-group study, patients (>or=12 years of age) were randomized to MF/F 200/10 microg, MF/F 400/10 microg, or MF 400 microg, b.i.d. after a 2- to 3-week open-label run in with MF 400...

  13. Twelve tips for teaching medical students with dyslexia.

    Science.gov (United States)

    Shaw, Sebastian Charles Keith; Anderson, John Leeds

    2017-07-01

    Dyslexia is a common learning difficulty. As a result of SS' own experiences as a medical student with dyslexia, we have been researching and teaching on this topic for the past two years. Here, we present twelve tips for teaching medical students with dyslexia. These are gathered from our personal experiences and research, discussions with other educators, and wider literature on the topic. This article aims to shed some light on dyslexia, and also to make practical suggestions. Teaching students with dyslexia should not be a daunting experience. Small changes to existing methods, at minor effort, can make a difference - for example, adding pastel colors to slide backgrounds or avoiding Serif fonts. These tips can help educators gain more insight into dyslexia and incorporate small, beneficial adaptations into their teaching.

  14. Spectroscopy of twelve Type Ia supernovae at intermediate redshift

    CERN Document Server

    Balland, C; Pain, R; Walton, N A; Amanullah, R; Astier, Pierre; Ellis, Richard S; Fabbro, S; Goobar, A; Hardin, D; Hook, I M; Irwin, M J; McMahon, R M; Mendez, J M; Ruiz-Lapuente, P; Sainton, G; Schahmaneche, K; Stanishev, V

    2005-01-01

    We present spectra of twelve Type Ia supernovae obtained in 1999 at the William Herschel Telescope and the Nordic Optical Telescope during a search for Type Ia supernovae (SN Ia) at intermediate redshift. The spectra range from z=0.178 to z=0.493, including five high signal-to-noise ratio SN Ia spectra in the still largely unexplored range 0.15 < z < 0.3. Most of the spectra were obtained before or around restframe B-band maximum light. None of them shows the peculiar spectral features found in low-redshift over- or under-luminous SN Ia. Expansion velocities of characteristic spectral absorption features such as SiII at 6355 angs., SII at 5640 angs. and CaII at 3945 angs. are found consistent with their low-z SN Ia counterparts.

  15. Diagnostic evaluation and treatment of the patient presenting with idiopathic environmental intolerance.

    Science.gov (United States)

    Sparks, P J

    2000-01-01

    This chapter addresses the diagnostic evaluation and treatment of the patient presenting with idiopathic environmental intolerance (IEI). Clinicians with different views about the pathogenesis of IEI may agree on clinical management programs aimed at improved symptom control and functional ability.

  16. Toxoplasmosis of Spinal Cord in Acquired Immunodeficiency Syndrome Patient Presenting as Paraparesis: A Rare Entity

    OpenAIRE

    2014-01-01

    Although brain has been the most common site for toxoplasma infection in acquired immunodeficiency syndrome patients, involvement of spinal cord by toxoplasma has been rarely found. Spinal cord toxoplasmosis can present as acute onset weakness in both lower limbs associated with sensory and bladder dysfunction. A presumptive diagnosis can be made in patients with CD4 count

  17. Malnourished Malawian patients presenting with large Wilms tumours have a decreased vincristine clearance rate

    NARCIS (Netherlands)

    T. Israels; C.W.N. Damen; M. Cole; N. van Geloven; A.V. Boddy; H.N. Caron; J.H. Beijnen; E.M. Molyneux; G.J. Veal

    2010-01-01

    Introduction: In developing countries, patients with a Wilms' tumour often present late with a high degree of malnutrition and large tumours. We investigated whether this affects vincristine pharmacokinetics. Methods: Patients newly diagnosed with Wilms' tumour in Malawi and the UK were included. We

  18. Atypical Presentation of Disseminated Zoster in a Patient with Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    Nirav Patel

    2015-01-01

    Full Text Available Patients with rheumatoid arthritis (RA have 2-fold increased risk of herpes zoster. In literature, limited information exists about disseminated cutaneous zoster in RA patients. An 83-year-old African-American female with RA presented with generalized and widespread vesicular rash covering her entire body. Comorbidities include hypertension, type II diabetes, and dyslipidemia. Patient was on methotrexate 12.5 mg and was not receiving any corticosteroids, anti-TNF therapy, or other biological agents. The patient was afebrile (98 F with no SIRS criteria. Multiple vesicular lesions were present covering patient’s entire body including face. Lesions were in different stages, some umbilicated with diameter of 2–7 cm. Many lesions have a rim of erythema with no discharge. On admission, patient was also pancytopenic with leukocyte count of 1.70 k/mm3. Biopsies of lesions were performed, which were positive for Varicella antigen. Subsequently, patient was started on Acyclovir. The patient’s clinical status improved and rash resolved. Our patient presented with “atypical” clinical picture of disseminated cutaneous zoster with no obvious dermatome involvement. Disseminated zoster is a potentially serious infection that can have an atypical presentation in patients with immunocompromised status. High index of suspicion is needed to make the diagnosis promptly and to initiate therapy to decrease mortality and morbidity.

  19. Congenital portosystemic shunts: Imaging findings and clinical presentations in 11 patients

    Energy Technology Data Exchange (ETDEWEB)

    Konstas, Angelos A., E-mail: akonstas@partners.org [Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114 (United States); Digumarthy, Subba R.; Avery, Laura L. [Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114 (United States); Wallace, Karen L. [Department of Radiology, Mount Auburn Hospital and Harvard Medical School, 330 Mount Auburn St, Cambridge, MA 02138 (United States); Lisovsky, Mikhail; Misdraji, Joseph [Department of Pathology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114 (United States); Hahn, Peter F. [Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114 (United States)

    2011-11-15

    Objective: To evaluate the clinical anatomy and presentations of congenital portosystemic shunts, and determine features that promote recognition on imaging. Materials and methods: Institutional review board approval was obtained for this HIPAA-compliant study. The requirement for written informed consent was waived. Radiology reports were retrospectively reviewed from non-cirrhotic patients who underwent imaging studies from January 1999 through February 2009. Clinical sources reviewed included electronic medical records, archived images and histopathological material. Results: Eleven patients with congenital portosystemic shunts were identified (six male and five female; age range 20 days to 84 years). Seven patients had extrahepatic and four patients had intrahepatic shunts. All 11 patients had absent or hypoplastic intrahepatic portal veins, a feature detected by CT and MRI, but not by US. Seven patients presented with shunt complications and four with presentations unrelated to shunt pathophysiology. Three adult patients had four splenic artery aneurysms. Prospective radiological evaluation of five adult patients with cross-sectional imaging had failed prospectively to recognize the presence of congenital portosystemic shunts on one or more imaging examinations. Conclusions: Congenital portosystemic shunts are associated with splenic artery aneurysms, a previously unrecognized association. Portosystemic shunts were undetected during prospective radiologic evaluation in the majority of adult patients, highlighting the need to alert radiologists to this congenital anomaly.

  20. Psychological distress in Rome III functional dyspepsia patients presenting for testing of gastric emptying.

    Science.gov (United States)

    Dibaise, J K; Islam, R S; Dueck, A C; Roarke, M C; Crowell, M D

    2016-02-01

    There have been conflicting results from studies that have evaluated psychological disturbances in functional dyspepsia (FD). We conducted a comprehensive survey of psychological measures in patients undergoing gastric emptying testing (GET) in order to determine the relationship among psychological distress, gastric emptying, and dyspeptic symptoms. Consecutive patients referred for GET were prospectively enrolled. Details regarding patient characteristics, health care utilization, dyspeptic symptoms, quality of life, and psychological dysfunction were obtained. Depression, anxiety, somatization, stress, positive and negative affect, and alexithymia were queried using validated questionnaires. We compared those dyspeptic patients who met Rome III criteria for FD to those who did not meet these criteria. Two hundred and nine patients (160 female; mean age 46.6 years ± 17.3 years) participated. Around 151 patients (72%) met Rome III criteria for FD. In the entire group, a high level of depression, anxiety, somatization, and perceived stress was present compared to population norms. Health care seeking behavior and symptom severity were greater in those with FD and quality of life was lower compared to non-FD. Gastric emptying did not differentiate the two groups and similar degrees of psychological distress were present whether emptying was delayed or normal. In patients referred for GET, substantial psychological distress is present. The degree of distress was similar regardless of whether the patient met Rome III FD criteria or not. Further evaluation of psychological dysfunction in FD patients may lead to improved diagnosis and determination of the most appropriate treatment. © 2015 John Wiley & Sons Ltd.

  1. Folic acid use in pregnant patients presenting to the emergency department

    OpenAIRE

    Steenblik, Jacob; Schroeder, Erika; Hatch, Burke; Groke, Steven; Broadwater-Hollifield, Camille; Mallin, Michael; Ahern, Matthew; Madsen, Troy

    2011-01-01

    Background The US Preventive Services Task Force has recommended daily folic acid supplementation for women planning on becoming pregnant in an effort to prevent fetal neural tube defects. We evaluated pregnant patients presenting to the emergency department to determine rates of folic acid supplementation. Methods We surveyed a convenience sample of pregnant patients who presented to the University of Utah Emergency Department (ED) between 1 January 2008, and 30 April 2009, regarding pregnan...

  2. Lichenoid drug reaction to isoniazid presenting as exfoliative dermatitis in a patient with acquired immunodeficiency syndrome.

    Science.gov (United States)

    Thakur, B K; Verma, S; Mishra, J

    2015-06-01

    Human immunodeficiency virus-infected patients are at increased risk of drug reactions because of immune dysregulation and multiple drug intake. Lichenoid drug reactions to isoniazid have been reported previously in the literature. However, for lichenoid drug reaction to isoniazid to be so extensive to present as exfoliative dermatitis is rare. We report here a rare case of lichenoid drug reaction to isoniazid presenting as exfoliative dermatitis in a patient with acquired immunodeficiency syndrome.

  3. Delay in Presentation, Diagnosis, and Treatment for Breast Cancer Patients in Jordan.

    Science.gov (United States)

    Abu-Helalah, Ahmad Munir; Alshraideh, Ahmad Hussam; Al-Hanaqtah, Mo'tasem; Da'na, Moh'd; Al-Omari, Asim; Mubaidin, Rasmi

    2016-01-01

    Breast cancer is the most common cancer, and one of the leading causes of death for females in Jordan and many countries in the world. Studies have shown that delay in symptoms presentation, diagnosis or treatment would result in poor prognosis. There has been no published study from Jordan on delays in patient presentation, delays in diagnosis, or delays in treatment. Therefore, we conducted this study to assess these important quality indicators aiming to improve prognosis for breast cancer patients in Jordan. This project was a cross-sectional study on female breast cancer patients in Jordan. The total number of participants was 327. The proportion of patients with presentation delay, diagnosis delay, and treatment delay was 32.2%, 49.1%, or 32.4%, respectively. The main reported reasons for delay in presentation were ignorance of the nature of the problem (65.6%), limited/lack of knowledge that symptoms were suggestive of cancer diagnosis (16.7%), and misdiagnosis (16.7%). Predictors of delay and mean time for presentation, diagnosis, and treatment were identified. Our results reveal that breast cancer patients in Jordan are experiencing delays in presentation, diagnosis, and treatment. This could justify the advanced stages at diagnosis and poor outcomes for breast cancer patients in Jordan. We recommend revising the current early detection and down-staging programs in Jordan.

  4. Synchronous presentation of trigeminal, glossopharyngeal and geniculate neuralgias in a single patient.

    Science.gov (United States)

    Homeida, Lujain; Elmuradi, Sophia; Sollecito, Thomas P; Stoopler, Eric T

    2016-06-01

    Orofacial pain disorders can present as a diagnostic and therapeutic challenge for oral health care providers. Odontogenic and nonodontogenic sources of orofacial pain should be considered and cranial neuralgias may be included in the differential diagnosis. Synchronous presentation of multiple cranial neuralgias is a rare occurrence. We report a case of a patient with a synchronous presentation of trigeminal, glossopharyngeal, and geniculate neuralgias. To our knowledge, this is the first case of a synchronous presentation of these conditions reported to date.

  5. [The color test: psychodiagnostic opportunities for the patients presenting with chronic somatic diseases].

    Science.gov (United States)

    Aĭvazian, T A; Zaĭtsev, V P

    2014-01-01

    The objective of the present study was to estimate the diagnostic potential of the Luscher color test. A total of 1083 patients presenting with chronic somatic diseases were available for the psychodiagnostic examination. It was shown that the color test makes it possible to evaluate clinically significant psychological characteristics as well as dynamics of anxiety and stress-resistance in this group of patients. Specifically, in the cases of chronic somatic diseases, the test can be used as one of the psychodiagnostic methods especially for mass screening and in the situations when the application of the standard questionnaires encounters difficulties (for example, in the patients with disturbed cognitive functions).

  6. [The influence of general magnetic therapy on the psychological status of the patients presenting with osteoarthrosis].

    Science.gov (United States)

    Degtiarev, V K; Aleksandrov, A V; Nenasheva, N V; Cherkashina, I V; Nikitin, M V

    2013-01-01

    The present study was designed to estimate the influence of general magnetic therapy on the psychical conditions of 151 patients presenting with degenerative joint diseases including osteoarthritis (OA). It was shown that the application of general magnetic therapy for the rehabilitative treatment of osteoarthrosis promotes the improvement of the psycho-emotional state of the patients. It is concluded that prescription of general magnetic therapy to the patients with OA suffering from serious psycho-emotional disorders brings about beneficial changes in their anxiety- and depression-related personality traits.

  7. Acute interstitial nephritis in patients with viperine snake bite: Single center experience of a rare presentation

    Directory of Open Access Journals (Sweden)

    Vishal Golay

    2012-01-01

    Full Text Available Acute renal failure following vasculotoxic viperine snake bites is very common in South Asia. Acute tubular necrosis and acute cortical necrosis are the common findings, with acute interstitial nephritis (AIN being a rare presentation. We conducted renal biopsies in all patients who were admitted in our institute with viperine snake bite-related acute kidney injury (AKI and who did not improve after three weeks of supportive care. Patients who had findings of AIN on renal histology were included for this study. Of a total of 42 patients, there were five patients (11.9% with AIN. Our series of five patients is the largest series of this rare presentation in the literature. All of these five patients had features of severe envenomation, severe AKI network stage of AKI and very high antivenom requirements. They had a very prolonged stay in the hospital, and four of the five patients developed chronic kidney disease on follow-up. The overall outcome in this group was worse as compared with those who did not have AIN. AIN following viperine snake bites is not a very rare presentation. The reason for the development of this pathology is unclear, but direct venom-related effects are possible. This presentation portends a poor overall long-term prognosis as demonstrated in our case series.

  8. Posttransplantation malignancy in a patient presenting with weight loss and changed bowel habits: a case report

    Directory of Open Access Journals (Sweden)

    Luft Friedrich C

    2006-05-01

    Full Text Available Abstract Backround Advancements in immunosuppressive therapy have significantly improved patient and graft survival following renal transplantation. This is paralleled by an increasing occurrence of posttransplantation malignancy. Case presentation We report on a patient who presented with a history reminding of colon cancer seven years after receiving a kidney transplant. Initial diagnostic imaging seemed to confirm this diagnosis showing a constricting colonic lesion. To our surprise, colonoscopy findings were unremarkable. Review of the imaging studies revealed that the tumor-like picture was caused by the renal graft impressing the intestine. The following search for malignancy in other locations resulted in the diagnosis of glioblastoma multiforme of which the patient died several weeks later. Conclusion Follow-up of renal transplant patients must include screening tests directed at tumor detection. Imaging studies and other tests in this patient group should be interpreted by physicians who are familiar with transplant related peculiarities.

  9. Clinical presentation of parvovirus B19 infection in HIV-infected patients with and without AIDS

    Directory of Open Access Journals (Sweden)

    Setúbal Sérgio

    2003-01-01

    Full Text Available Human parvovirus B19 replicates in erythrocyte precursors. Usually, there are no apparent hematological manifestations. However, in individuals with high erythrocyte turnover, as in patients with sickle-cell disease and in the fetus, the infection may lead to severe transient aplasia and hydrops fetalis, respectively. In AIDS patients, persistent infection may result in chronic anemia. By contrast, in HIV-positive patients without AIDS the infection evolves as a mild exanthematous disease. Two clinical descriptions exemplify these forms of presentation. In the first, an AIDS patient presented with bone marrow failure that responded to immunoglobulin. In the second, an HIV-positive patient without AIDS had a morbilliform rash, and needed no treatment. Knowing that an AIDS patient has chronic B19 anemia lessens concern about drug anemia; protects the patient from invasive diagnostic maneuvers; and prevents the patient from disseminating the infection. In AIDS patients with pure red cell aplasia, a search for parvovirus B19 DNA in the serum or in the bone marrow is warranted.

  10. Bite wounds and antibiotic prescription among patients presenting to an Australian emergency department.

    Science.gov (United States)

    Birdsey, Matthew; Edwards, Gail; Abetz, Jeremy; Jennings, Natasha; Mitra, Biswadev

    2016-07-01

    Emergency department presentations after mammalian bites may be associated with injection of bacteria into broken skin and may require prophylactic antibiotics to prevent subsequent infection. We aim to describe the epidemiology of patients presenting with a mammalian bite injury and antibiotic choice to an Australian adult tertiary centre. A retrospective cohort study was performed capturing all presentations after mammalian bite wounds between 01 Jan 2014 and 31 Dec 2014. An explicit chart review was conducted to determine management of each case. Cases were subgrouped into high- and low-risk groups as defined by the Australian Therapeutic Guidelines for animal bites. There were 160 cases of mammalian bite wounds included, with 143 (89.4%) patients grouped as high-risk and 17 (10.6%) patients identified as low-risk. High-risk features were delayed presentation > 8 hours (57 patients, 35.6%), bites to the head, hand or face (113 patients, 70.6%), and puncture wounds unable to be adequately debrided (74 patients, 46.3%). There was a significant association with delayed presentation of more than eight hours and clinically established infection [OR 36.2; 95% CI: 12.6-103.6; P antibiotics that adhered to current guidelines occurred in 99 (61.9%) cases. This study highlights variability in antibiotic prescription practice among clinicians and the need for ongoing education on antibiotic stewardship. Intervention strategies, including ongoing education, are indicated to improve adherence to antibiotic guidelines. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Twelve tips for creating trigger images for problem-based learning cases.

    Science.gov (United States)

    Azer, Samy A

    2007-03-01

    A trigger is the starting point of problem-based learning (PBL) cases. It is usually in the form of 5-6 text lines that provide the key information about the main character (usually the patient), including 3-4 of patient's presenting problems. In addition to the trigger text, most programs using PBL include a visual trigger. This might be in the form of a single image, a series of images, a video clip, a cartoon, or even one of the patient's investigation results (e.g. chest X-ray, pathology report, or urine sample analysis). The main educational objectives of the trigger image are as follows: (1) to introduce the patient to the students; (2) to enhance students' observation skills; (3) to provide them with new information to add to the cues obtained from the trigger text; and (4) to stimulate students to ask questions as they develop their enquiry plan. When planned and delivered effectively, trigger images should be engaging and stimulate group discussion. Understanding the educational objectives of using trigger images and choosing appropriate images are the keys for constructing successful PBL cases. These twelve tips highlight the key steps in the successful creation of trigger images.

  12. Serum levels of immunoglobulin free light chains in patients with chronic hepatitis C presenting cryoglobulinemia.

    Science.gov (United States)

    Oliveira, Isabela S; Cabral, Milena S; Jesus, Larissa S; Paraná, Raymundo; Atta, Ajax M; Sousa Atta, Maria Luiza B

    2014-01-01

    Hepatitis C virus (HCV) infects B-lymphocytes, provokes cellular dysfunction and causes lymphoproliferative diseases such as cryoglobulinemia and non-Hodgkin's B-cell lymphoma. In the present study, we investigated the serum levels of kappa and lambda free light chains (FLC) of immunoglobulins and the kappa/lambda FLC ratio in Brazilian patients with chronic HCV infection and cryoglobulinemia. We also analyzed the immunochemical composition of the cryoglobulins in these patients. Twenty-eight cryoglobulinemic HCV patients composed the target group, while 37 HCV patients without cryoglobulinemia were included as controls. The median levels of kappa and lambda FLC were higher in patients with cryoglobulinemia compared to controls (p=0.001 and p=0.003, respectively), but the kappa/lambda FLC ratio was similar in patients with and without cryoglobulinemia (p>0.05). The median FLC ratio was higher in HCV patients presenting with advanced fibrosis of the liver compared to HCV patients without fibrosis (p=0.004). Kappa and lambda FLC levels were strongly correlated with the IgA, IgG and IgM levels in the patients with cryoglobulinemia. In patients without cryoglobulinemia, the kappa FLC level was only correlated with the IgG level, whereas the lambda FLC were weakly correlated with the IgA, IgG and IgM levels. An immunochemical pattern of mixed cryoglobulins (MC), predominantly IgM, IgG, IgA and kappa light chain, was verified in these immune complexes. We concluded that HCV-infected patients presenting cryoglobulinemia have vigorous polyclonal B-lymphocyte activation due to chronic HCV infection and persistent immune stimulation.

  13. Endemic Burkitt Lymphoma: Long-term Outcome in 87 Patients Who Presented With Paraplegia in Cameroon.

    Science.gov (United States)

    Hesseling, P B; Mbah, G; Kouya, F; Kimbi, C; Nfor, P; Kaah, J; Kuruvilla, R; Best, A; Wharin, P

    2015-01-01

    The reported long-term outcome of endemic Burkitt lymphoma (eBL) patients who present with paraplegia is largely unknown. Records of BL patients treated with comparable short-interval cyclophosphamide chemotherapy schedules between 2004 and 2014 at three Baptist mission hospitals in Cameroon were reviewed. Survivors were followed up and examined at home or in hospital. Eighty-seven of 948 (9.2%) patients had paraplegia at diagnosis. The survival rate in eBL patients with paraplegia at diagnosis was 33% (n = 29) after follow-up of between 2 and 96 (median 40) months. Seven patients (24%) had neurological sequelae and needed rehabilitation. There was no relationship between the duration of symptoms (4 weeks) and the survival rate or the risk to have neurological sequelae. The survival rate and risk for sequelae were similar in patients with confirmed St. Jude stage III and IV diseases.

  14. Clinical and genetic study of twelve Chinese patients with Alexander disease%亚历山大病12例中国患儿临床及遗传学研究

    Institute of Scientific and Technical Information of China (English)

    臧莉莉; 吴晔; 王静敏; 顾强; 姜玉武; 高志杰; 杨艳玲; 肖江喜; 吴希如

    2012-01-01

    Objective To delineate the phenotype and genotype characteristics in 12 Chinese children with Alexander disease ( AD),which is helpful for the molecular diagnosis and genetic counseling in China.Methods Clinical diagnosis of AD was based on MRI criteria proposed by van der Knaarp in 2001.Included AD patients were followed up for 0.50-3.67 years.Mutations in GFAP were detected by DNA sequencing.Results The 12 cases of AD were clinically diagnosed.Age of first visit was 4.87 years (0.75-12.00 years),with 3 type s of chief complaints:developmental delay in 3,recurrent seizures in 7,unable to walk after falling in 2.Average head circumference was 52.34 cm (44-58 cm),which larger than age-matched average by 6.45% ( 1.80% -13.95% ).On the first visit,scaling according to Gross motor functional classification system ( GMFCS ) was performed,with GMFCS Ⅰ in 8,Ⅱ in 3,V in 1.Mild to severe cognitive dysfunction were found in 8,and seizures in 11 cases.The 12 patients were followed up for 0.50-3.67 years,their motor and cognitive function remained stable. Episodic aggravations provoked by fever or falling were observed in 5 cases (41.67%). Heterozygous missense mutations of GFAP were detected in 12 patients.All mutations were de novo; 3 out of 10 mutations identified were novel.R79 and P239 were hot mutations,which was consistent with previous reports.Mutations were located in exon 1 in 8 cases.Conclusions The phenotype in these patients is characterized by slower progression compared with reports from other population and high incidence of seizures.And episodic aggravations provoked by fever or falling were more common.The genotype characteristics are consistent with previous reports.The results of this research expanded the number of patients with Alexander disease found to have GFAP coding mutations in China.%目的 了解12例中国亚历山大病(Alexander disease,AD)患儿的临床表型及遗传学特点,为在国内开展该病的分子诊断及

  15. Clinical presentation and visual status of retinitis pigmentosa patients: a multicenter study in southwestern Nigeria

    Directory of Open Access Journals (Sweden)

    Onakpoya OH

    2016-08-01

    Full Text Available Oluwatoyin Helen Onakpoya,1 Caroline Olufunlayo Adeoti,2 Tunji Sunday Oluleye,3 Iyiade Adeseye Ajayi,4 Timothy Majengbasan,4,5 Olayemi Kolawole Olorundare1 1Department of Ophthalmology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, 2Department of Ophthalmology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, 3Department of Ophthalmology, University College Hospital, Ibadan, 4Department of Ophthalmology, University Teaching Hospital, Ado-Ekiti, 5Department of Ophthalmology, Federal Medical Centre, Ido-Ekiti, Nigeria Background: To review the visual status and clinical presentation of patients with retinitis pigmentosa (RP.Methodology: Multicenter, retrospective, and analytical review was conducted of the visual status and clinical characteristics of patients with RP at first presentation from January 2007 to December 2011. Main outcome measure was the World Health Organization’s visual status classification in relation to sex and age at presentation. Data analysis by SPSS (version 15 and statistical significance was assumed at P<0.05.Results: One hundred and ninety-two eyes of 96 patients with mean age of 39.08±18.5 years and mode of 25 years constituted the study population; 55 (57.3% were males and 41 (42.7% females. Loss of vision 67 (69.8% and night blindness 56 (58.3% were the leading symptoms. Twenty-one (21.9% patients had a positive family history, with RP present in their siblings 15 (71.4%, grandparents 11 (52.3%, and parents 4 (19.4%. Forty (41.7% were blind at presentation and 23 (24% were visually impaired. Blindness in six (15% patients was secondary to glaucoma. Retinal vascular narrowing and retinal pigmentary changes of varying severity were present in all patients. Thirty-five (36.5% had maculopathy, 36 (37.5% refractive error, 19 (20% lenticular opacities, and eleven (11.5% had glaucoma. RP was typical in 85 patients (88.5%. Older patients had higher rates of blindness at presentation (P=0

  16. A Presentation of Massive Hemoptysis in a Patient with Churg-Strauss Syndrome

    Directory of Open Access Journals (Sweden)

    Fadi Hikmat

    2014-01-01

    Full Text Available Given that Churg-Strauss syndrome is a systemic small-vessel vasculitis, it is not usually considered in patients who present with massive hemoptysis, which is typically caused by bronchiectasis, cancer or, in some cases, aberrant bronchial arteries. This article, however, describes a novel case involving a 50-year-old Churg-Strauss patient who presented with sudden-onset massive hemoptysis. Details of the physical examination, laboratory investigations and several imaging studies, including computed tomography, bronchoscopy and three-dimensional imaging, are presented.

  17. Combined chronic lymphocytic leukemia and prolactinoma: a rare occurrence in a patient presenting with pituitary apoplexy.

    Science.gov (United States)

    Krisht, Khaled M; Palmer, Cheryl A; Couldwell, William T

    2013-10-01

    The authors describe a rare case of combined pituitary chronic lymphocytic leukemia (CLL) and prolactinoma in a 77-year-old man presenting with apoplexy. This case highlights the importance of evaluating the pituitary gland in patients with CLL who present with clinical manifestations of apoplexy as well as the need to carefully evaluate pathological specimens from the gland for the presence of lymphocytic cells in those patients. This is the first reported case of a combined CLL-prolactinoma pituitary lesion presenting with apoplexy.

  18. High frequency of the c.3207CA (p.H1069Q) mutation in A TP7B gene of Lithuanian patients with hepatic presentation of Wilson's disease

    Institute of Scientific and Technical Information of China (English)

    Laimutis Kucinskas; Jolanta Jeroch; Astra Vitkauskiene; Raimundas Sakalauskas; Vitalija Petrenkiene; Vaidutis Kucinskas; Rima Naginiene; Hartmut Schmidt; Limas Kupcinskas

    2008-01-01

    AIM: To investigate the prevalence of the ATP7B gene mutation in patients with hepatic presentation of Wilson's disease (WD) in Lithuania.METHODS: Eleven unrelated Lithuanian families, including 13 WD patients were tested. Clinically WD diagnosis was established in accordance to the Leipzig scoring system. Genomic DNA was extracted from whole venous blood using a salt precipitation method. Firstly, the semi-nested polymerase chain reaction (PCR) technique was used to detect the c.3207CA (p.H1069Q) mutation. Patients not homozygous for the c.3207CA (p.H1069Q) mutation were further analyzed. The 21 exons of the WD gene were amplified in a thermal cycler (Biometra T3 Thermocycler, G6ttingen, Germany). Direct sequencing of the amplified PCR products was performed by cycle sequencing using fluorescent dye terminators in an automatic sequencer (Applied Biosystems, Darmstadt, Germany).RESULTS: Total of 13 WD patients (mean age 26.4 years; range 17-40; male/female 3/10) presented with hepatic disorders and 16 their first degree relatives (including 12 siblings) were studied. Some of WD patients, in addition to hepatic symptoms, have had extrahepatic disorders (hemolytic anemia 3; Fanconi syndrome 1; neurophsychiatric and behavioural disorder 2). Liver biopsy specimens were available in all of 13 WD patients (8 had cirrhosis; 1-chronic hepatitis; 3-acute liver failure, l-liver steatosis). Twelve of 13 (92.3%) WD patients had the c.3207CA (p.H1069Q) mutation, 6 of them in both chromosomes, 6 were presented as compound heterozygotes with additional c.3472-82delGGTTTAACCAT, c.3402delC, c.3121CT (p.R1041W) or unknown mutations. For one patient with liver cirrhosis and psychiatric disorder (Leipzig score 6), no mutations were found. Out of 16 first degree WD relatives, 11 (68.7%) were heterozygous for the c.3207CA (p.H1069Q) mutation. Two patients with fulminant WD died from acute liver failure and 11 are in full remission under penicillamine or zinc acetate treatment. Three

  19. Burkitt's non-Hodgkins lymphoma presenting as facial nerve palsy in HIV-positive patients.

    Science.gov (United States)

    Woodcock, H; Nelson, M

    2011-02-01

    An isolated facial nerve palsy is rare as the presentation of a central nervous system lymphoma. In this case series, we present the clinical features of three HIV-positive patients presenting with facial nerve palsies due to HIV-associated Burkitt's lymphoma. These patients had a non-resolving facial paralysis, which occurred during a late stage of HIV. Magnetic resonance imaging (MRI) did not show leptomeningeal enhancement. Cerebrospinal fluid revealed a lymphocytosis with elevated protein and low glucose levels. The diagnosis of Burkitt's lymphoma was made on histology which showed the characteristic 'starry sky' appearance due to scattered tangible body-laden macrophages. The patients were commenced on the intensive chemotherapy regimen of CODOX-M/IVAC. Two patients died of disease progression and the third patient died of chemotherapy toxicity. This case series highlights the need for a high index of suspicion for underlying malignancy when a patient presents with a persistent facial paralysis in the later stages of HIV infection.

  20. Balancing the presentation of information and options in patient decision aids: an updated review

    OpenAIRE

    Abhyankar, P.; Volk, R.J.; Blumenthal-Barby, J.; Bravo, P.; A. Buchholz; Ozanne, E.; Vidal, D.C.; Col, N; Stalmeier, P F M

    2013-01-01

    Background Standards for patient decision aids require that information and options be presented in a balanced manner; this requirement is based on the argument that balanced presentation is essential to foster informed decision making. If information is presented in an incomplete/non-neutral manner, it can stimulate cognitive biases that can unduly affect individuals’ knowledge, perceptions of risks and benefits, and, ultimately, preferences. However, there is little clarity about what const...

  1. STUDY OF CLINICAL PROFILE OF PATIENTS PRESENTING WITH SEXUAL PRECOCITY TO A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Binoy Kumar Mohanty

    2016-07-01

    Full Text Available BACKGROUND Precocious puberty is a common paediatric endocrine disorder seen in clinical practice. OBJECTIVE To study the various aetiologies and clinical presentations of patients presenting with sexual precocity to a tertiary care hospital. DESIGN Cross sectional study. MATERIAL AND METHODS We collected and analysed the clinical data including hormonal status of 24 consecutive patients who presented to our department from January 2014 to December 2015 for evaluation of sexual precocity. RESULTS Most of the patients presenting to us had evidence of precocious puberty (n=16, followed by premature adrenarche (n=5 and premature thelarche (n=3 respectively. The females outnumbered males in our study (68.75% of total cases. Females presenting with central precocious puberty had no appreciable cause (idiopathic in majority (85.72% of cases. While, males presenting with central precocious puberty had an organic cause (60% in majority of cases. CONCLUSIONS Precocious puberty is more common among females as compared to males. Organic lesion must be ruled out in all patients presenting with central precocious puberty especially in males.

  2. Colon cancer: association of histopathological parameters and patients' survival with clinical presentation.

    Science.gov (United States)

    Alexiusdottir, Kristin K; Snaebjornsson, Petur; Tryggvadottir, Laufey; Jonasson, Larus; Olafsdottir, Elinborg J; Björnsson, Einar Stefan; Möller, Pall Helgi; Jonasson, Jon G

    2013-10-01

    Available data correlating symptoms of colon cancer patients with the severity of the disease are very limited. In a population-based setting, we correlated information on symptoms of colon cancer patients with several pathological tumor parameters and survival. Information on all patients diagnosed with colon cancer in Iceland in 1995-2004 for this retrospective, population-based study was obtained from the Icelandic Cancer Registry. Information on symptoms of patients and blood hemoglobin was collected from patients' files. Pathological parameters were obtained from a previously performed standardized tumor review. A total of 768 patients entered this study; the median age was 73 years. Tumors in patients presenting at diagnosis with visible blood in stools were significantly more likely to be of lower grade, having pushing border, conspicuous peritumoral lymphocytic infiltration, and lower frequency of vessel invasion. Patients with abdominal pain and anemia were significantly more likely to have vessel invasion. Logistic regression showed that visible blood in stools was significantly associated with protecting pathological factors (OR range 0.38-0.83, p < 0.05). Tumors in patients presenting with abdominal pain were strongly associated with infiltrative margin and scarce peritumoral lymphocytic infiltration (OR = 1.95; 2.18 respectively, p < 0.05). Changes in bowel habits were strongly associated with vessel invasion (OR = 2.03, p < 0.05). Cox regression showed that blood in stools predicted survival (HR = 0.54). In conclusion, visible blood in stools correlates significantly with all the beneficial pathological parameters analyzed and with better survival of patients. Anemia, general symptoms, changes in bowel habits, acute symptoms, and abdominal pain correlate with more aggressive tumor characteristics and adverse outcome for patients.

  3. Spectrum of Clinical Presentations in Human Immunodeficiency Virus (HIV) Infected Patients with Renal Disease.

    Science.gov (United States)

    Okafor, U H; Unuigbe, E I; Wokoma, F S

    2011-01-01

    HIV infection is a multiorgan disease with the kidney not spared. A variety of renal syndromes with varying clinical presentations has been reported amongst HIV infected patients. This study aims to highlight the spectrum of clinical presentations in HIV infected patients with renal disease. HIV infected patients presenting at University of Benin Teaching Hospital (UBTH) Benin City were the study population. A total of 383 patients were studied. Their biodata, clinical presentations and laboratory investigations including serum urea, creatinine and albumin, urine protein and creatinine were assessed. Their glomerular filtration rate (GFR) and protein urine excretion were calculated using six equations of modification of diet in renal disease (MDRD) and protein: creatinine ratio respectively. Patients were stratified according to their renal functions into normal, mild, moderate and severe renal function impairment. The data was analysed using statistical software program SPSS Vs 15.0. 53.3% of 383 patients screened had renal function impairment, 40.2% mild, 37.7% moderate and 22.2% severe impairment. Mean age was 35.6±8.3, 36.0±9.9 and 36.3±8.3 years for mild, moderate and severe renal function impairment (RFI) respectively. Easy fatigability was the commonest symptoms occurring in 47.5%, 30.0%, 37.5% and 22.5% of control, mild RFI, moderate RFI and severe RFI subjects respectively (p = 0.568). Oliguria, facial and body swelling occurred more in patients with RFI especially in patients with severe renal impairment. The difference is statistically significant (p = 0.046, 0.041, and 0.033 respectively). Pallor was the commonest clinical sign occurring in 32.5%, 50.0%, 35.0% and 62.5% of control and patients with mild, moderate, and severe RFI respectively; the difference was not statistically significant (p = 0.459). Ascites, facial puffiness and pedal oedema were commoner in patients with RFI especially those with severe RFI. The differences were statistically

  4. Patient with signs and symptoms of myocardial infarction, presenting to a chiropractic office: a case report

    OpenAIRE

    Erfanian, Parham

    2001-01-01

    A 53-year-old female presented to a chiropractic office with signs and symptoms of heart attack (myocardial infarction). Although she was complaining of neck and upper back pain, the cause of her condition was due to an incident of acute myocardial infarction (MI). Other than anterior chest pain, patients with MI could experience pain over lower jaw and teeth, both arms, shoulders, neck, upper back and epigastrium. Recognizing the possible underlying cause of the patient's complaints, and dir...

  5. Axillary sentinel node identification in breast cancer patients: degree of radioactivity present at biopsy is critical

    DEFF Research Database (Denmark)

    Nielsen, Kristina R; Oturai, Peter S; Friis, Esbern

    2011-01-01

    The radioactivity present in the patient (Act(rem) ) at sentinel node (SN) biopsy will depend on injected activity amount as well as on the time interval from tracer injection to biopsy, which both show great variations in the literature. The purpose of this study was to analyse the influence...... of varying Act(rem) levels on the outcome of axillary SN biopsy in patients with breast cancer (BC)....

  6. Suicidality in primary care patients who present with sadness and anhedonia: a prospective European study

    OpenAIRE

    Moreno-Küstner, Berta; Jones, Rebeca; Švab, Igor; Maaroos, Heidi; Xavier, Miguel; Geerlings, Mirjam; TORRES-GONZÁLEZ, FRANCISCO; Nazareth, Irwin; Motrico-Martínez, Emma; Montón-Franco, Carmen; Gil-de-Gómez, María José; Sánchez-Celaya, Marta; Díaz-Barreiros, Miguel Ángel; Vicens-Caldentey, Catalina; King, Michael

    2016-01-01

    Background Sadness and anhedonia (loss of interest in activities) are central symptoms of major depression. However, not all people with these symptoms meet diagnostic criteria for major depression. We aimed to assess the importance of suicidality in the outcomes for primary care patients who present with sadness and anhedonia. Method Cohort study of 2,599 unselected primary care attenders in six European countries followed up at 6 and 12 months. Results 1) In patients with sadness and/or anh...

  7. Palmar-plantar erythrodysesthesia, clinical case presentation in a patient with craniopharyngioma and sickle cell anemia

    OpenAIRE

    Lora-Fernández Alberto Carlos; Arias-Arias Ramón

    2010-01-01

    The sickle-cell disease complicatiosn include acute isquemic crisis in extremities and organs, occur to fuctional and estructural alteration in oxigen transport toward tissue, our case of a patient with craniopharyngioma after posoperatory tumoral resection show necrosis in hand and foot, conduce to amputation, describe this clinic presentation after a allergic reaction to vancomicine and ceftriazone associated the hemoglobinopatie of the patient and management instaurated.RESUMENLas complica...

  8. Prevalence of intimate partner violence in patients presenting with traumatic injuries to a Guyanese emergency department

    OpenAIRE

    2012-01-01

    Background Intimate partner violence (IPV) occurs throughout the world, and has both short- term and long- term negative health effects. Little is know about the prevalence of IPV in patients presenting to Emergency Departments (EDs) in the developing world. This information is needed to help delineate the scope of the problem and shape effective interventions to combat IPV. The purpose of this study was to determine the prevalence of intimate partner violence in adult patients with acute tra...

  9. The influence of punctural millimeter wave therapy on clinical presentation of patients with essential hypertention

    Directory of Open Access Journals (Sweden)

    Kotenko К.V.

    2013-12-01

    Full Text Available Aim: to estimate the influence of punctural millimeter wave therapy on clinical presentation. Material and methods. This study includes 102 patients with essential hypertension the I and II stage. Patients were divided into three equal groups depending on the method of treatment: some of them received procedures of punctural millimeter wave therapy, some of them received these procedures as the "placebo" and those who had not received specified procedures. Dynamics of clinical symptomatology and condition of eye bottom vessels was estimated. It was shown that addition of punctural millimeter wave therapy in complex therapy of patients with essential hypertension promotes the expressed regress of clinical symptomatology and state normalization the retinal vessels at these patients. Results. Addition of punctural millimeter wave therapy into the complex therapy was shown to lead to pronounced regress of clinical symptoms. Conclusion. The received results allow to recommend this method to be used in clinical practice for treating patients with essential hypertension.

  10. Pleural and pericardial effusion in a patient with polymyalgia rheumatica: a case presentation.

    Science.gov (United States)

    Sánchez Ruiz-Granados, Elena; del Castillo Madrigal, Matilde; Romero Jiménez, Manuel Jesús

    2013-01-01

    Polymyalgia rheumatica is an inflammatory rheumatic disease that presents with bilateral pain and stiffness affecting mainly proximal muscles. It affects individuals over 50 years of age and it is usually associated with a raised erythrocyte sedimentation rate. Classically, treatment with low-dose corticosteroids results in a dramatic improvement in both symptoms and laboratory findings. We report the case of an 80 years old patient presenting polymyalgia rheumatica coinciding with pleuropericardial effusion. The patient had a very good response to treatment with rapid improvement in the symptomatology and laboratory findings. Polymyalgia Rheumatica is a common disease but it is rarely associated to pleuropericardial effusion. It should be considered in the differential diagnostic in patients presenting with pericardial effusion over 50 of age years due to the good response to treatment. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  11. Characterizing T Cells in SCID Patients Presenting with Reactive or Residual T Lymphocytes

    Directory of Open Access Journals (Sweden)

    Atar Lev

    2012-01-01

    Full Text Available Introduction. Patients with severe combined immunodeficiency (SCID may present with residual circulating T cells. While all cells are functionally deficient, resulting in high susceptibility to infections, only some of these cells are causing autoimmune symptoms. Methods. Here we compared T-cell functions including the number of circulating CD3+ T cells, in vitro responses to mitogens, T-cell receptor (TCR repertoire, TCR excision circles (TREC levels, and regulatory T cells (Tregs enumeration in several immunodeficinecy subtypes, clinically presenting with nonreactive residual cells (MHC-II deficiency or reactive cells. The latter includes patients with autoreactive clonal expanded T cell and patients with alloreactive transplacentally maternal T cells. Results. MHC-II deficient patients had slightly reduced T-cell function, normal TRECs, TCR repertoires, and normal Tregs enumeration. In contrast, patients with reactive T cells exhibited poor T-cell differentiation and activity. While the autoreactive cells displayed significantly reduced Tregs numbers, the alloreactive transplacentally acquired maternal lymphocytes had high functional Tregs. Conclusion. SCID patients presenting with circulating T cells show different patterns of T-cell activity and regulatory T cells enumeration that dictates the immunodeficient and autoimmune manifestations. We suggest that a high-tolerance capacity of the alloreactive transplacentally acquired maternal lymphocytes represents a toleration advantage, yet still associated with severe immunodeficiency.

  12. Characterizing T cells in SCID patients presenting with reactive or residual T lymphocytes.

    Science.gov (United States)

    Lev, Atar; Simon, Amos J; Trakhtenbrot, Luba; Goldstein, Itamar; Nagar, Meital; Stepensky, Polina; Rechavi, Gideon; Amariglio, Ninette; Somech, Raz

    2012-01-01

    Patients with severe combined immunodeficiency (SCID) may present with residual circulating T cells. While all cells are functionally deficient, resulting in high susceptibility to infections, only some of these cells are causing autoimmune symptoms. Here we compared T-cell functions including the number of circulating CD3(+) T cells, in vitro responses to mitogens, T-cell receptor (TCR) repertoire, TCR excision circles (TREC) levels, and regulatory T cells (Tregs) enumeration in several immunodeficinecy subtypes, clinically presenting with nonreactive residual cells (MHC-II deficiency) or reactive cells. The latter includes patients with autoreactive clonal expanded T cell and patients with alloreactive transplacentally maternal T cells. MHC-II deficient patients had slightly reduced T-cell function, normal TRECs, TCR repertoires, and normal Tregs enumeration. In contrast, patients with reactive T cells exhibited poor T-cell differentiation and activity. While the autoreactive cells displayed significantly reduced Tregs numbers, the alloreactive transplacentally acquired maternal lymphocytes had high functional Tregs. SCID patients presenting with circulating T cells show different patterns of T-cell activity and regulatory T cells enumeration that dictates the immunodeficient and autoimmune manifestations. We suggest that a high-tolerance capacity of the alloreactive transplacentally acquired maternal lymphocytes represents a toleration advantage, yet still associated with severe immunodeficiency.

  13. Pantomime to visual presentation of objects: left hand dyspraxia in patients with complete callosotomy.

    Science.gov (United States)

    Lausberg, Hedda; Cruz, Robyn F; Kita, Sotaro; Zaidel, Eran; Ptito, Alain

    2003-02-01

    Investigations of left hand praxis in imitation and object use in patients with callosal disconnection have yielded divergent results, inducing a debate between two theoretical positions. Whereas Liepmann suggested that the left hemisphere is motor dominant, others maintain that both hemispheres have equal motor competences and propose that left hand apraxia in patients with callosal disconnection is secondary to left hemispheric specialization for language or other task modalities. The present study aims to gain further insight into the motor competence of the right hemisphere by investigating pantomime of object use in split-brain patients. Three patients with complete callosotomy and, as control groups, five patients with partial callosotomy and nine healthy subjects were examined for their ability to pantomime object use to visual object presentation and demonstrate object manipulation. In each condition, 11 objects were presented to the subjects who pantomimed or demonstrated the object use with either hand. In addition, six object pairs were presented to test bimanual coordination. Two independent raters evaluated the videotaped movement demonstrations. While object use demonstrations were perfect in all three groups, the split-brain patients displayed apraxic errors only with their left hands in the pantomime condition. The movement analysis of concept and execution errors included the examination of ipsilateral versus contralateral motor control. As the right hand/left hemisphere performances demonstrated retrieval of the correct movement concepts, concept errors by the left hand were taken as evidence for right hemisphere control. Several types of execution errors reflected a lack of distal motor control indicating the use of ipsilateral pathways. While one split-brain patient controlled his left hand predominantly by ipsilateral pathways in the pantomime condition, the error profile in the other two split-brain patients suggested that the right hemisphere

  14. Relationship between complaints presented by emergency patients and the final outcome

    Directory of Open Access Journals (Sweden)

    Helisamara Mota Guedes

    2015-08-01

    Full Text Available AbstractObjective: to relate complaints presented by emergency room patients, classified using the Manchester Triage System, with the final outcome (discharge/death/transfer.Methods: prospective cohort study, involving 509 patients who were admitted to the emergency room and remained there for more than 24 hours after admission, being monitored to the final outcome. Data were analyzed with a statistical program using descriptive and analytical statistics.Results: the mean age of the patients was 59.1 years and 59.3% were male. The main complaints were unwell adult (130 - 22.5%, shortness of breath in adults (81 - 14.0%, abdominal pain in adults (58 - 10.0% and behaving strangely (34 - 5.9%, with 87% of the patients being discharged. More deaths were found in the patients classified in the severe colors, with 42.8% classified as red, 17.0% as orange and 8.9% as yellow. Among the patients classified as green, 9.6% died.Conclusion: in the various colors of the Manchester Triage System, death prevailed in patients that presented the complaints of unwell adult, shortness of breath, head injury, major trauma, diarrhea and vomiting. The higher the clinical priority the greater the prevalence of death.

  15. One patient with Sjogren’s syndrome presenting schizophrenia-like symptoms

    Directory of Open Access Journals (Sweden)

    Lin CE

    2016-03-01

    Full Text Available Ching-En Lin1,2 1Department of Psychiatry, Taipei Tzu-Chi Hospital, Buddhist Medical Foundation, Taiwan, Republic of China; 2School of Medicine, Tzu-Chi University, Hualien, Taiwan, Republic of China Abstract: Comorbid depression in patients with Sjogren’s syndrome has been reported frequently, while comorbid psychosis in subjects with Sjogren’s syndrome has rarely been reported. Here we report a patient with Sjogren’s syndrome who presented with schizophrenia-like symptoms such as persecutory delusions and auditory hallucinations in contrast to her previous psychiatric presentations, which only included depression and anxiety. Keywords: mental illness, psychosis, Sjogren’s syndrome, schizophrenia

  16. Clinical Presentation of a Patient with Localized Acquired Cutis Laxa of Abdomen: A Case Report

    Directory of Open Access Journals (Sweden)

    Tugomir Gverić

    2010-01-01

    Objective. The aim of this case report was to present our patient suffering from CL, and to evaluate clinical presentation, diagnostic and therapeutic difficulties in this rare condition. Case Report. A 30-year-old female patient was admitted to our Hospital due to localized loose and sagging skin of abdomen, induced by prior cesarean section 6 years ago. CL has been diagnosed based on the clinical picture and pathohistological appearance. Conclusion. Reconstructive surgery provides a dramatic cosmetic improvement with significant psychosocial benefit. Repeated surgical procedures may be required to correct the lax skin, which worsens with age.

  17. Outcome and Risk Factors Presented in Old Patients Above 80 Years of Age Versus Younger Patients After Ischemic Stroke

    DEFF Research Database (Denmark)

    Bentsen, Line; Christensen, Louisa; Christensen, Anders

    2014-01-01

    . METHODS: The analysis was based on consecutive patients admitted within 6 hours after stroke onset and discharged with ischemic stroke, surviving at least 3 months after ictus. To prevent bias, the analysis was based on a registry from before implementation of tissue plasminogen activator treatment; all...... of age or older presented with significantly more severe strokes than younger patients, median Scandinavian Stroke Scale score 39 vs 42 (P = .003). Median mRS score before stroke was significantly higher in patients aged 80 years or older (P ictus (P...

  18. Tuberculosis and pulmonary candidiasis co-infection present in a previously healthy patient

    Science.gov (United States)

    Jiménez Borré, Gustavo; Gómez Camargo, Doris; Chalavé Jiménez, Neylor; Bellido Rodríguez, Javier; Cuadrado Cano, Bernarda; Navarro Gómez, Shirley

    2016-01-01

    Background: The coexistance among fungal pathogens and tuberculosis pulmonary is a clinical condition that generally occurs in immunosuppressive patients, however, immunocompetent patients may have this condition less frequently. Objective: We report the case of an immunocompetent patient diagnosed with coinfection Mycobacterium tuberculosis and Candida albicans. Case Description: A female patient, who is a 22-years old, with fever and a new onset of hemoptysis. Clinical findings and diagnosis: Diminished vesicular breath sounds in the apical region and basal crackling rales in the left lung base were found in the physical examination. Microbiological tests include: chest radiography and CAT scan pictograms in high resolution, Ziehl-Neelsen stain, growth medium for fungus and mycobacteria through Sabouraudís agar method with D-glucose. Medical examinations showed Candida albicans fungus and Mycobacterium tuberculosis present in the patient. Treatment and Outcome: Patient was treated with anti-tuberculosis and anti-fungal medications, which produced good responses. Clinical relevance: Pulmonary tuberculosis and fungal co-infection are not common in immunocompetent patients. However, we can suspect that there is a presence of these diseases by detecting new onset of hemoptysis in patients. PMID:27546933

  19. Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care

    Directory of Open Access Journals (Sweden)

    Shafazand Masoud

    2012-03-01

    Full Text Available Abstract Background Chronic heart failure (CHF is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method Patients (n = 2,648 seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.

  20. Magnetic resonance imaging findings in patients presenting with (sub)acute cerebellar ataxia

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, Tanja [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg (Germany); The Johns Hopkins Hospital School of Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Neuroradiology, Baltimore, MD (United States); Thomalla, Goetz [University Medical Center Hamburg-Eppendorf, Department of Neurology, Hamburg (Germany); Goebell, Einar [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Neuroradiology, Hamburg (Germany); Piotrowski, Anna [The Johns Hopkins University School of Medicine, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (United States); Yousem, David Mark [The Johns Hopkins Hospital School of Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Neuroradiology, Baltimore, MD (United States)

    2015-02-17

    Acute or subacute cerebellar inflammation is mainly caused by postinfectious, toxic, neoplastic, vascular, or idiopathic processes and can result in cerebellar ataxia. Previous magnetic resonance (MR) studies in single patients who developed acute or subacute ataxia showed varying imaging features. Eighteen patients presenting with acute and subacute onset of ataxia were included in this study. Cases of chronic-progressive/hereditary and noncerebellar causes (ischemia, multiple sclerosis lesions, metastasis, bleedings) were excluded. MR imaging findings were then matched with the clinical history of the patient. An underlying etiology for ataxic symptoms were found in 14/18 patients (postinfectious/infectious, paraneoplastic, autoimmune, drug-induced). In two of five patients without MR imaging findings and three of eight patients with minimal imaging features (cerebellar atrophy, slight signal alterations, and small areas of restricted diffusion), adverse clinical outcomes were documented. Of the five patients with prominent MR findings (cerebellar swelling, contrast enhancement, or broad signal abnormalities), two were lost to follow-up and two showed long-term sequelae. No correlation was found between the presence of initial MRI findings in subacute or acute ataxia patients and their long-term clinical outcome. MR imaging was more flagrantly positive in cases due to encephalitis. (orig.)

  1. Low evaluation rate for osteoporosis among patients presenting with a rib fracture.

    Science.gov (United States)

    Kim, Whang; Gong, Hyun Sik; Lee, Seung Hoo; Park, Jin Woo; Kim, Kahyun; Baek, Goo Hyun

    2017-12-01

    This study in a regional hospital setting found a low evaluation rate for osteoporosis among patients presenting with a rib fracture. Increased emphasis or education for osteoporosis evaluation may be necessary in case of rib fractures. Rib fractures from a low-energy trauma are common in the elderly, and a history of rib fracture has been reported to increase the risk for a subsequent osteoporotic fracture. The purpose of this study was to evaluate how many of the patients presenting with an isolated rib fracture were being evaluated for osteoporosis and the risk for a subsequent fracture. We retrospectively reviewed all patients aged 50 years or older who were diagnosed with a rib fracture between January 2011 and April 2016 at a regional tertiary care university hospital near Seoul, South Korea. We excluded those who had been treated for osteoporosis or those with other concomitant fractures or fractures from a motor vehicle accident or cancer. We evaluated the frequency of dual energy X-ray absorptiometry (DXA) scan examinations in these patients. There were 231 patients with isolated rib fractures (132 men and 99 women). The mean age was 65 years. Rib fractures were most commonly diagnosed at the emergency department and most of the patients were referred to the department of thoracic surgery for follow-up evaluations. Of these 231 patients, 29 (12%) had DXA examinations after the injury, and only 9 (4%) of them did so within 6 months. Physicians specializing in orthopedic surgery, family medicine, internal medicine, rehabilitation medicine, and emergency medicine were ordering the examination. This study in a regional hospital setting found a low evaluation rate for osteoporosis among patients presenting with a rib fracture. This study suggests that increased emphasis or education for osteoporosis evaluation may be necessary for physicians who are often referred to for care of rib fractures.

  2. Endobronchial Enigma: A Clinically Rare Presentation of Nocardia beijingensis in an Immunocompetent Patient

    Directory of Open Access Journals (Sweden)

    Nader Abdel-Rahman

    2015-01-01

    Full Text Available Nocardiosis is an opportunistic infection caused by the Gram-positive weakly acid-fast, filamentous aerobic Actinomycetes. The lungs are the primary site of infection mainly affecting immunocompromised patients. In rare circumstances even immunocompetent hosts may also develop infection. Diagnosis of pulmonary nocardiosis is usually delayed due to nonspecific clinical and radiological presentations which mimic fungal, tuberculous, or neoplastic processes. The present report describes a rare bronchoscopic presentation of an endobronchial nocardial mass in a 55-year-old immunocompetent woman without underlying lung disease. The patient exhibited signs and symptoms of unresolving community-acquired pneumonia with a computed tomography (CT scan that showed a space-occupying lesion and enlarged paratracheal lymph node. This patient represents the unusual presentation of pulmonary Nocardia beijingensis as an endobronchial mass. Pathology obtained during bronchoscopy demonstrated polymerase chain reaction (PCR confirmation of nocardiosis. Symptoms and clinical findings improved with antibiotic treatment. This patient emphasizes the challenge in making the diagnosis of pulmonary nocardiosis, especially in a low risk host. A literature review presents the difficulties and pitfalls in the clinical assessment of such an individual.

  3. Tethered cord due to spina bifida occulta presenting in adulthood: a tricenter review of 61 patients.

    Science.gov (United States)

    Rajpal, Sharad; Tubbs, R Shane; George, Timothy; Oakes, W Jerry; Fuchs, Herbert E; Hadley, Mark N; Iskandar, Bermans J

    2007-03-01

    Children with spina bifida occulta require early surgery to prevent neurological deficits. The treatment of patients with a congenitally tethered cord who present in adulthood remains controversial. The authors studied the medical records of 61 adult patients who underwent surgical untethering for spina bifida occulta at three institutions between 1994 and 2003. Patients who had undergone prior myelomeningocele repair or tethered cord release surgery were excluded. The most common intraoperative findings were lipomyelomeningocele (41%) and a tight terminal filum (36%). The follow-up duration ranged from 10.8 to 149.5 months. Of the 34 patients with back pain, status improved in 65%, worsened in 3%, remained unchanged in 18%, and improved and later recurred in 15%. Lower-extremity pain improved in 16 patients (53%), remained unchanged in 23%, improved and then recurred in 17%, and worsened in 7%. Lower-extremity weakness improved in 47%, remained unchanged in 47%, and improved and then recurred in 5%. Finally, of the 17 patients with lower-extremity sensory changes, status improved in 35%, remained unchanged in 35%, and the information on five patients was unavailable. Surgical complications included three wound infections, one cerebrospinal fluid leak, and two pseudomeningoceles requiring surgical revision. One patient developed acute respiratory distress syndrome and sepsis postoperatively and died several days later. Adult-age presentation of a congenital tethered cord is unusual. Despite a slight increase in postoperative neurological injury in adults, surgery has relatively low risk and offers good potential for neurological improvement or stabilization. As they do in children, the authors recommend early surgery in adults with this disorder. The decision to undertake surgery, however, should be modulated by other factors such as a patient's general medical condition and risk posed by anesthesia.

  4. A Prospective Analysis of Patients Presenting for Medical Attention at a Large Electronic Dance Music Festival.

    Science.gov (United States)

    Friedman, Matt S; Plocki, Alex; Likourezos, Antonios; Pushkar, Illya; Bazos, Andrew N; Fromm, Christian; Friedman, Benjamin W

    2017-02-01

    Mass-Gathering Medicine studies have identified variables that predict greater patient presentation rates (PPRs) and transport to hospital rates (TTHRs). This is a descriptive report of patients who presented for medical attention at an annual electronic dance music festival (EDMF). At this large, single EDMF in New York City (NYC; New York, USA), the frequency of patient presentation, the range of presentations, and interventions performed were identified. This descriptive report examined consecutive patients who presented to the medical tent of a summertime EDMF held at an outdoor venue with an active, mobile, bounded crowd. Alcohol was available for sale. Entry was restricted to persons 18 years and older. The festival occurred on three consecutive days with a total cumulative attendance of 58,000. Medical staffing included two Emergency Medicine physicians, four registered nurses, and 86 Emergency Medical Services (EMS) providers. Data collected included demographics, past medical history, vital signs, physical exam, drug and alcohol use, interventions performed, and transport decisions. Eighty-four patients were enrolled over 2.5 days. Six were transported and zero died. The ages of the subjects ranged from 17 to 61 years. Forty-three (51%) were male. Thirty-eight (45%) initially presented with abnormal vital signs; four (5%) were hyperthermic. Of these latter patients, 34 (90%) reported ingestions with 3,4-methylenedioxymethamphetamine (MDMA) or other drugs. Eleven (65%) patients were diaphoretic or mydriatic. The most common prehospital interventions were intravenous normal saline (8/84; 10%), ondansetron (6/84; 7%), and midazolam (3/84; 4%). Electronic dance music festivals are a growing trend and a new challenge for Mass-Gathering Medicine as new strategies must be employed to decrease TTHR and mortality. Addressing common and expected medical emergencies at mass-gathering events through awareness, preparation, and early, focused medical interventions may

  5. An Unusual Presentation of Disseminated Histoplasmosis: Case Report and Review of Pediatric Immunocompetent Patients from India.

    Science.gov (United States)

    Agarwal, Poojan; Capoor, Malini R; Singh, Mukul; Gupta, Arpita; Chhakchhuak, Arini; Debatta, Pradeep

    2015-12-01

    Histoplasmosis is a progressive disease caused by dimorphic intracellular fungi and can prove fatal. Usually, it is present in immunocompromised individuals and immunocompetent individuals in the endemic zones. We report an unusual presentation of progressive disseminated histoplasmosis. The patient in the present case report was immunocompetent child and had fever, bone pains, gradual weight loss, lymphadenopathy and hepatosplenomegaly. Disseminated histoplasmosis (DH) was diagnosed on microscopic examination and fungal culture of bone marrow, blood, skin biopsy and lymph node aspirate. The patient died on seventh day of amphotericin B. In the absence of predisposing factors and classical clinical presentation of febrile neutropenia, lung, adrenal and oropharyngeal lesions, the disease posed a diagnostic challenge. Progressive disseminated histoplasmosis in children can be fatal despite timely diagnosis and therapy. In India, disseminated histoplasmosis is seen in immunocompetent hosts. All the pediatrics immunocompetent cases from India are also reviewed.

  6. An atypical presentation of sinus mucopyocele in a pediatric cystic fibrosis patient

    Directory of Open Access Journals (Sweden)

    Horesh E

    2015-05-01

    Full Text Available Elan Horesh, Andrew A Colin, Roy Casiano, Sara T WesterBascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USAAbstract: This case report details an association of chronic allergic conjunctivitis and respiratory tract colonization in a cystic fibrosis (CF patient due to an ethmoidal mucocele infected with Escherichia coli. A 3-year-old CF patient presented for evaluation with complaints of chronic periocular erythema, conjunctival injection, and irritation for 2 years. He was treated for presumed allergic conjunctivitis with no improvement and continued to have overall worsening of symptoms on the right greater than the left eye in a waxing and waning pattern. On presentation to the Bascom Palmer Eye Institute, he was noted to have telecanthus and prominent erythema in the region of the medial canthus. Orbital imaging disclosed a mucocele in the right ethmoid sinus. The patient underwent functional endoscopic sinus surgery, with successful marsupialization of the ethmoidal mucocele, which was found on culture to be infected with E. coli. Post-operatively with continuous pulmonary care, the patient remains free of allergic conjunctivitis and E. coli colonization of the upper airway. This case highlights the importance of analyzing the adjacent sinus in patients with chronic, relapsing allergic conjunctivitis refractory to medical management, particularly in patients with underlying systemic diseases such as CF.Keywords: allergic conjuncitivitis, Escherichia Coli, cystic fibrosis, mucocele

  7. A patient with Crohn's disease who presented with thrombotic thrombocytopenic purpura/hemolytic uremic syndrome.

    Science.gov (United States)

    Unverdi, Selman; Ceri, Mevlut; Öztürk, Mehmet Akif; Akbal, Erdem; Ensari, Arzu; Yılmaz, Rahmi; Kocak, Erdem; Inal, Salih; Koklu, Seyfettin; Duranay, Murat

    2011-01-01

    Thrombotic thrombocytopenic purpura (TTP)/hemolytic uremic syndrome (HUS) is characterized with fever, purpura, anemia due to microangiopathic hemolysis, thrombocytopenia, kidney damage, and neurologic symptoms. The development of TTP/HUS during the course of inflammatory bowel diseases was rarely reported. However, coexistence of TTP/HUS and Crohn's disease in the same patient has not been reported previously. We herein present a case of TTP/HUS who presented with Crohn's disease. He responded to cyclosporine treatment.

  8. Correlation between female sex and allergy was significant in patients presenting with dysphonia.

    Science.gov (United States)

    Lauriello, M; Angelone, A M; Businco, L Di Rienzo; Passali, D; Bellussi, L M; Passali, F M

    2011-06-01

    Aim of the present study was to investigate the prevalence of allergy in patients affected by both organic and/or functional vocal fold disorders. The secondary aim was to assess the correlation between sex and allergy in dysphonic patients. A retrospective chart review was performed on dysphonic patients. A total of 76 patients underwent fiberoptic endoscopy to assess the objective picture. Logistic regression analyses have been conducted to assess the association between sex and the outcome variables. The laryngoscopic examination revealed the presence of poor glottic closure in 32.9%, hyperkinesias in 11.8%, redness in 11.84%, polyps in 5.3%, oedema in 3.95%, vocal fold hypertrophy in 5.3%, nodules in 42.1%, cordectomy in 2.6%. Allergic rhinitis was present in 56.6%, milk intolerance in 13.2%, asthma in 9.2%, atopic dermatitis in 3.9%, drugs intolerance in 11.8%. A total of 76.32% patients presenting with dysphonia were allergic. A statistically significant association was found between female sex and presence of allergy. In conclusion, allergy testing should be performed routinely on female professional voice users. Mild respiratory disorders must be taken into serious consideration in female professional voice users, who may primarily complain of vocal dysfunction rather than upper and lower respiratory diseases.

  9. State-of-the-Art Evaluation of Emergency Department Patients Presenting With Potential Acute Coronary Syndromes.

    Science.gov (United States)

    Hollander, Judd E; Than, Martin; Mueller, Christian

    2016-08-16

    It is well established that clinicians cannot use clinical judgment alone to determine whether an individual patient who presents to the emergency department has an acute coronary syndrome. The history and physical examination do not distinguish sufficiently between the many conditions that can cause acute chest pain syndromes. Cardiac risk factors do not have sufficient discriminatory ability in symptomatic patients presenting to the emergency department. Most patients with non-ST-segment-elevation myocardial infarction do not present with electrocardiographic evidence of active ischemia. The improvement in cardiac troponin assays, especially in conjunction with well-validated clinical decision algorithms, now enables the clinician to rapidly exclude myocardial infarction. In patients in whom unstable angina remains a concern or there is a desire to evaluate for underlying coronary artery disease, coronary computed tomography angiography can be used in the emergency department. Once a process that took ≥24 hours, computed tomography angiography now can rapidly exclude myocardial infarction and coronary artery disease in patients in the emergency department. © 2016 American Heart Association, Inc.

  10. A systemic lupus erythematosus patient presenting as type B insulin resistance complicated with cryoglobulinemia.

    Science.gov (United States)

    Huang, Q; Yan, Y; Zhao, H; Zuo, L

    2017-01-01

    Systemic lupus erythematosus (SLE) patients may present with various symptoms and multisystem damage. We reported a 63-year-old male patient with SLE presenting as type B insulin resistance (TBIR) complicated with cryoglobulinemia. TBIR is an extremely rare disease, which is a manifestation of anti-insulin receptor antibodies (AIRA). Clinical feature is a sudden onset of hyperglycemia with major weight loss; however, the ensuing refractory hypoglycemia is more fatal. The average dosage of exogenous insulin is 5100 U/d. SLE patients with AIRA had poor prognosis, most of whom died of SLE activity. Cryoglobulins are immunoglobulins that reversibly precipitate in the cold, which will induce clinical symptoms. Non-infectious mixed cryoglobulinemia is frequently secondary to autoimmune diseases, such as SLE. Our patient was prescribed methylprednisolone (MP) and cyclophosphamide (CTX). Finally he had remission during the short-term follow-up. To our knowledge, this is the first case report of an SLE patient presenting as TBIR complicated with cryoglobulinemia.

  11. Twelve tips for designing and running longitudinal integrated clerkships.

    Science.gov (United States)

    Ellaway, Rachel; Graves, Lisa; Berry, Sue; Myhre, Doug; Cummings, Beth-Ann; Konkin, Jill

    2013-12-01

    Longitudinal integrated clerkships (LICs) involve learners spending an extended time in a clinical setting (or a variety of interlinked clinical settings) where their clinical learning opportunities are interwoven through continuities of patient contact and care, continuities of assessment and supervision, and continuities of clinical and cultural learning. Our twelve tips are grounded in the lived experiences of designing, implementing, maintaining, and evaluating LICs, and in the extant literature on LICs. We consider: general issues (anticipated benefits and challenges associated with starting and running an LIC); logistical issues (how long each longitudinal experience should last, where it will take place, the number of learners who can be accommodated); and integration issues (how the LIC interfaces with the rest of the program, and the need for evaluation that aligns with the dynamics of the LIC model). Although this paper is primarily aimed at those who are considering setting up an LIC in their own institutions or who are already running an LIC we also offer our recommendations as a reflection on the broader dynamics of medical education and on the priorities and issues we all face in designing and running educational programs.

  12. ANTIBIOTIC SUSCEPTIBILITY OF ORGANISMS CAUSING URINARY TRACT INFECTION IN PATIENTS PRESENTING AT KENYATTA NATIONAL HOSPITAL, NAIROBI

    Science.gov (United States)

    Magale, H. I.; Kassim, I. A.; Odera, S. A.; Omolo, M. J.; Jaoko, W. G.; Jolly, P. E.

    2016-01-01

    Background Changes in susceptibility patterns of bacterial pathogens isolated from urinary tract infections emphasize the need for regional surveillance to generate information that can be used in management of patients. Knowledge on the current status of antimicrobial resistance in uropathogens, and the prevalence of expanding spectrum beta-lactamases (ESBLs) in the isolates will guide policy formulations and encourage prudent use of antimicrobials. Objective Identify bacterial pathogens causing UTI and determine the association between the pathogens isolated from patients attending KNH. Determine antimicrobial susceptibility patterns of the UTI pathogens and the prevalence of ESBL in the isolated pathogens. Design Laboratory-based study. Setting Department of Medical Microbiology University of Nairobi and Kenyatta National Hospital microbiology laboratory, Nairobi, Kenya. Subjects Nine hundred and forty eight patients presenting directly to the Kenyatta National Hospital’s diagnostic lab. Patients were only classified as in-patients if at the time of specimen collection they were being admitted to one of KNH wards. Results Out of the 948 urine samples processed, 189 in-patients and 37 out-patients samples had significant bacterial growth. The uropathogens identified from in-patient specimens were Escherichia coli (56), Klebsiellapneumoniae (33), Enterococcus spp. (34) and Entrobacter (16) making up 30%, 18%, 18% and 9% respectively. ESBL isolates were found to be resistant to the locally administered antibiotics; Augmentin (37%), Levofloxacin (37%), Cefoperazone (37%), Ampicillin (39%), Doxycyline (41%), Gentamicin (30%) and Nalidixic Acid (38%). Conclusion The increased prevalence of multidrug resistant ESBL pathogens poses challenges for health care providers at KNH and signifies the need for new approach to treat UTI. It would be prudent for laboratories to include specialized tests for detection of ESBL producing pathogens from isolates obtained from in-patients

  13. Diagnosis of coronary vasospasm in patients with clinical presentation of unstable angina pectoris using ergonovine echocardiography.

    Science.gov (United States)

    Song, J K; Park, S W; Kang, D H; Lee, C W; Choi, K J; Hong, M K; Kim, J J; Kim, Y H; Park, S J

    1998-12-15

    Although coronary vasospasm can contribute to the development of unstable angina, the definite diagnostic method has not been established. The purpose of this study was to determine if ergonovine echocardiography (detection of regional wall motion abnormality during bedside ergonovine challenge) after angiographic confirmation of insignificant fixed disease would be useful and safe in detecting coronary vasospasm in patients with unstable angina. After control of chest pain with medications in patients admitted to the coronary care unit under the tentative diagnosis of unstable angina, diagnostic coronary angiography was performed. All patients with normal or insignificant fixed disease underwent ergonovine echocardiography after discontinuation of medications for 4+/-1 days. Among 208 consecutive patients enrolled for this study, 75% (156 of 208) showed significant fixed disease in the angiography. Ergonovine echocardiography was performed in 52 patients with insignificant disease, and coronary vasospasm was documented in 33 (63%, 33 of 52). No serious procedure-related arrhythmia or myocardial infarction occurred. Esophageal motility disorder and hypertrophic cardiomyopathy were diagnosed in 6 and 3 patients, respectively. Chest pain of undetermined etiology was the final diagnosis at discharge in 10 patients (5%, 10 of 208); among them chest pain redeveloped in 2 patients, and repeated ergonovine echocardiography revealed positive results. Our data suggest that among patients with the clinical presentation of unstable angina, coronary vasospasm is the main cause of myocardial ischemia in a considerable number of patients with a normal or near-normal angiogram, and ergonovine echocardiography after confirmation of absence of significant fixed disease is useful and safe for noninvasive diagnosis of coronary vasospasm in this setting.

  14. Characteristics of cancer patients presenting to an integrative medicine practice-based research network.

    Science.gov (United States)

    Edman, Joel S; Roberts, Rhonda S; Dusek, Jeffery A; Dolor, Rowena; Wolever, Ruth Q; Abrams, Donald I

    2014-09-01

    To assess psychosocial characteristics, symptoms and reasons for seeking integrative medicine (IM) care in cancer patients presenting to IM clinical practices. A survey of 3940 patients was conducted at 8 IM sites. Patient reported outcome measures were collected and clinicians provided health status data. This analysis compares 353 participants self-identified as cancer patients with the larger noncancer cohort. Mean age of the cancer cohort was 55.0 years. Participants were predominantly white (85.9%), female (76.4%), and well educated (80.5% completed college). For 15.2% of cancer patients, depression scores were consistent with depressive symptoms, and average scores for perceived stress were higher than normal, but neither were significantly different from noncancer patients. The most prevalent comorbid symptoms were chronic pain (39.8%), fatigue (33.5%), and insomnia (23.3%). In the cancer cohort, perceived stress was significantly associated with depression, fatigue, insomnia, pain, and QOL. Cancer patients who chose an IM clinical practice "seeking healthcare settings that address spirituality as an aspect of care" had significantly higher levels of perceived stress, depression, and pain than those not selecting this reason. Demographic characteristics, depression scores, perceived stress scores, and reasons for seeking integrative cancer care were not significantly different between cancer patients and noncancer patients. Perceived stress may be an important indicator of QOL. The association of perceived stress, depression and pain with seeking spirituality suggests that providing IM interventions, such as effective stress management techniques and pastoral or spiritual counseling, may be helpful to patients living with cancer. © The Author(s) 2014.

  15. Metastatic adenocarcinoma of the colon presenting as a monarthritis of the hip in a young patient

    Directory of Open Access Journals (Sweden)

    Cobiella Carlos

    2006-12-01

    Full Text Available Abstract Background Malignant arthritis is a rare manifestation of metastatic disease. We describe the case of a previously well 28 year old man in whom hip pain was the presenting symptom of disease. We describe the case and discuss the aetiology of colorectal cancer in young patients. We then review the literature and discuss the investigation and management of malignant joint arthritis. Case presentation We present the case of a 28 year old man who presented to the emergency department with an acute monoarthritis of the hip. He had an unremarkable past medical history and was systemically well. A diagnosis of malignant joint effusion was reached after a heightened index of clinical suspicion, magnetic resonance imaging and cytological evaluation of the synovial fluid. Computed tomography and bone scan confirmed widespread metastatic disease from a primary colonic adenocarcinoma. The patient tolerated three cycles of oxaliplatin and capecitabine but died 4 months after presentation. Conclusion The metastatic spread of cancer to the joint and the synovium is one of the rarest manifestations of malignant disease and has not been previously reported as the presenting symptom of disease. The diagnosis is a difficult one to reach and is associated with a poor prognosis. This case illustrates the importance of thorough investigation in reaching this diagnosis and entertaining the possibility in individuals who do not respond to conventional management of acute monoarthritis, even in young patients and individuals who do not display any other symptoms of disease.

  16. The accuracy of ultrasonography in the diagnosis of superficial bladder tumors in patients presenting with hematuria

    Science.gov (United States)

    Stamatiou, Konstantinos; Papadoliopoulos, Ioannis; Dahanis, Stefanos; Zafiropoulos, Grigoris; Polizois, Konstantinos

    2009-01-01

    Ultrasonography has been proposed as the initial test for detection of bladder carcinomas in patients presenting with hematuria, but the accuracy of transabdominal ultrasonography in the diagnosis of superficial bladder carcinoma has not been assessed. We prospectively evaluated 173 patients presenting to the outpatient department with painless hematuria by transabdominal ultrasound and cystoscopy. The tolerability of cystoscopy was also assessed. Of 148 patients who met the inclusion criteria, 39 with bladder carcinoma were identified by cystoscopy as having bladder carcinoma, while 34 were identified by ultrasonography. For ultrasonography, the sensitivity (87.1%), specificity (98.1%), positive predictive value (94.4%) and negative predictive value (95.4%) were good but not as good as cystoscopy. While the tolerability of cystoscopy is relatively low, it is still superior to ultrasonography in the evaluation of the bladder as a possible source of hematuria. PMID:19318748

  17. [The state of the larynx in the patients presenting with chronic obstructive pulmonary disease].

    Science.gov (United States)

    Gilifanov, E A; Nevzorova, V A; Artyushkin, S A; Ivanets, I V

    2016-01-01

    The objective of the present study was to evaluate the clinical state of the larynx and its microbial population in 49 patients examined at the stage of stable condition of chronic obstructive pulmonary disease. Examination of the larynx was carried out with the use of a rigid laryngoscope having a visual angle of 70 degrees, videofibrolaryngoscopy, and stroboscopy using a «TelePac» videocomplex (Karl Storz, Germany). It was supplemented by the study of the bacteriological and mycological paysage. The acoustic analysis of the voice was performed with the help of the Specta PLUS computer program. It was shown that more than 70% of the examined patients presented with various forms of chronic laryngitis. Potentially pathogenic St. pyogenes and yeast-like fungi C. albicans were isolated from 59% and 29% of the patients respectively.

  18. Single port laparoscopic sacrohysteropexy in a young patient presenting with grade III uterine prolapse and rectocele.

    Science.gov (United States)

    Marcus-Braun, Naama; von Theobald, Peter

    2013-09-01

    Uterine preservation in patients with uterine prolapse is a common practice in the last decade and the reconstructive pelvic operation can be done either by vaginal, abdominal or laparoscopic approach. In young patients, uterine preservation is a legitimate option and one of the proposed operations is sacro-hystero-pexy. Single Port Laparoscopy (SPL) is a relatively new technique. This is a case of a young patient presented with grade III uterine prolapse and rectocele. The video presents the surgical technique of sacro-hystero-pexy as was described in 2001 by von Theobald, adapted specifically for the SPL technique. The Single Port laparoscopy is an advanced laparoscopic technique. This video demonstrate that scaro-hystero-pexy can be done safely and efficacy with Single Port Laparoscopy without prolonging the operation time significantly.

  19. Cardiac and metabolic effects in patients who present with a multinodular goitre

    NARCIS (Netherlands)

    A. Berghout (Arie); J. van de Wetering (Jacqueline); A.P.J. Klootwijk (Peter)

    2003-01-01

    textabstractTwenty-six consecutive patients who presented with clinically euthyroid multinodular goitre were studied for an overnight fasting serum lipid profile and 24 h Holter monitoring. Mean serum TSH was 0.6 +/- 0.4 vs 2.4 +/- 1.3 mU/l (p < 0.0001) and mean TT3 2.4 +/- 0.4 vs

  20. Ataxia-telangiectasia patients presenting with hyper-IgM syndrome.

    NARCIS (Netherlands)

    Noordzij, J.G.; Wulffraat, N.M.; Haraldsson, A.; Meyts, I.; Veer, L.J. van 't; Hogervorst, F.B.L.; Warris, A.; Weemaes, C.M.R.

    2009-01-01

    Ataxia-telangiectasia (A-T) is characterised by progressive neurological abnormalities, oculocutaneous telangiectasias and immunodeficiency (decreased serum IgG subclass and/or IgA levels and lymphopenia). However, 10% of A-T patients present with decreased serum IgG and IgA with normal or raised Ig

  1. Axillary sentinel node identification in breast cancer patients: degree of radioactivity present at biopsy is critical

    DEFF Research Database (Denmark)

    Nielsen, Kristina R; Oturai, Peter S; Friis, Esbern;

    2011-01-01

    The radioactivity present in the patient (Act(rem) ) at sentinel node (SN) biopsy will depend on injected activity amount as well as on the time interval from tracer injection to biopsy, which both show great variations in the literature. The purpose of this study was to analyse the influence...

  2. Descending colon interposition in a patient presenting with abdominal pain and acute appendicitis

    Directory of Open Access Journals (Sweden)

    Eiref SD

    2010-09-01

    Full Text Available Interposition of the descending colon between the kidney and the psoas major muscle is a rare hindgut anatomic variant. Presented herein is a case of descending colon interposition in a patient admitted with abdominal pain and acute appendicitis. Internal hernia was ruled out by laparoscopy.

  3. Cardiac and metabolic effects in patients who present with a multinodular goitre

    NARCIS (Netherlands)

    A. Berghout (Arie); J. van de Wetering (Jacqueline); A.P.J. Klootwijk (Peter)

    2003-01-01

    textabstractTwenty-six consecutive patients who presented with clinically euthyroid multinodular goitre were studied for an overnight fasting serum lipid profile and 24 h Holter monitoring. Mean serum TSH was 0.6 +/- 0.4 vs 2.4 +/- 1.3 mU/l (p < 0.0001) and mean TT3 2.4 +/- 0.4 vs

  4. Two simultaneous autoimmune processes in a patient presenting with respiratory insufficiency.

    Science.gov (United States)

    Troy, Lauren; Hamor, Paul; Bleasel, Jane; Corte, Tamera

    2014-03-01

    The idiopathic inflammatory myopathies, including dermatomyositis, are uncommon acquired autoimmune diseases, sometimes associated with interstitial lung disease. Myasthenia gravis, a separate autoimmune disorder involving the neuromuscular junction, has some overlapping clinical features but has only rarely been reported to occur simultaneously within the same patient. Here we present the first reported case of concomitant dermatomyositis, myasthenia gravis, and interstitial lung disease.

  5. Obsessive slowness presenting as catatonia in a patient with Borderline Intelligence.

    Science.gov (United States)

    Saha, Rahul; Singh, Shubh Mohan; Nischal, Anil

    2015-12-01

    Obsessive slowness is described to be a syndrome of extreme slowness in ways various tasks are performed. Its existence as an independent syndrome is challenged by authors, who regard it to be a part of obsessive compulsive disorder. We describe here a case of a 24-year-old male patient who presented with catatonic symptoms. Diagnostic difficulties and management issues are highlighted.

  6. Choledochoduodenal fistula presenting with pneumobilia in a patient with gallbladder cancer: a case report

    Directory of Open Access Journals (Sweden)

    Dadzan Elham

    2012-02-01

    Full Text Available Abstract Introduction Spontaneous biliary tract fistulas are rare entities. Most of them are associated with long-standing gallstones (especially common bile duct stones, or recurrent biliary tract infections, some with more uncommon diseases such as gallbladder cancer. Some authors believe that back flow from fistulas predisposes patients to gallbladder cancer and some believe that cancer causes necrosis and fistula formation. Gallbladder cancer has a dismal prognosis and 85% of patients are dead within a year of diagnosis. A common complication of gallbladder cancer is obstruction of the common bile duct, which may produce multiple intra-hepatic abscesses in or near the tumor-laden gallbladder. Fistula formation may further complicate the clinical picture. Case presentation We present a case of choledochoduodenal fistula in a 60-year-old diabetic African-American woman with gallbladder cancer. The initial clinical presentation was confusing and complex. Our patient was also found to have a gallbladder fossa abscess that was drained percutaneously as another complicating factor relating to her cancer. She developed myocardial infarction, massive upper gastrointestinal bleeding and respiratory arrest during her stay in hospital. Computed tomography was very helpful in assessing our patient and we discuss how, in a patient with pneumobilia, it can be helpful for detecting fistula, air in bile ducts or to show contractions of the gallbladder. Conclusions We believe this case merits reporting as it shows an entity that is not frequently thought of, is hard to diagnose and can be fatal, as in our patient. Careful evaluation, and computed tomography studies and endoscopic retrograde cholangio-pancreatography are helpful in early diagnosis and finding better management options for these patients.

  7. Clinical predictors for Legionella in patients presenting with community-acquired pneumonia to the emergency department

    Directory of Open Access Journals (Sweden)

    Frei Reno

    2009-01-01

    Full Text Available Abstract Background Legionella species cause severe forms of pneumonia with high mortality and complication rates. Accurate clinical predictors to assess the likelihood of Legionella community-acquired pneumonia (CAP in patients presenting to the emergency department are lacking. Methods We retrospectively compared clinical and laboratory data of 82 consecutive patients with Legionella CAP with 368 consecutive patients with non-Legionella CAP included in two studies at the same institution. Results In multivariate logistic regression analysis we identified six parameters, namely high body temperature (OR 1.67, p Legionella CAP. Using optimal cut off values of these six parameters, we calculated a diagnostic score for Legionella CAP. The median score was significantly higher in Legionella CAP as compared to patients without Legionella (4 (IQR 3–4 vs 2 (IQR 1–2, p Legionella pneumonia. Conversely, of the 73 patients (16% with ≥4 points, 66% of patients had Legionella CAP. Conclusion Six clinical and laboratory parameters embedded in a simple diagnostic score accurately identified patients with Legionella CAP. If validated in future studies, this score might aid in the management of suspected Legionella CAP.

  8. Evaluation of knee extensor mechanism disorders: clinical presentation of 1 12 patients*.

    Science.gov (United States)

    Antich, T J; Randall, C C; Westbrook, R A; Morrissey, M C; Brewster, C E

    1986-01-01

    Results of physical therapy evaluation of 112 patients with extensor mechanism disorders (chondromalacia patella, infrapatellar tendinitis, and peripatellar pain) are presented. An equal number of male and female patients were evaluated and of the 73 patients with unilateral involvement (65%) there were equal numbers of right and left involved knees. Running was the activity most commonly associated with pain, followed by basketball and tennis. Stairclimbing was painful in 79% of the patients, with ascending being more painful than descending in patients reporting a clear-cut difference. Hamstring and quadriceps tightness was statistically significant relative to the uninvolved limb although clinically, negligible differences were measured. The inferior pole of the patella was the most tender site to palpation, followed by medial peripatellar structures, then lateral sites. Biomechanical malalignment was not detected by the attending therapist in the majority of patients. The authors emphasize careful assessment of flexibility, quadriceps (VMOIVL) imbalance, and biomechanical alignment in performing a thorough evaluation of patients with extensor mechanism disorders. J Orthop Sports Phys Ther 1986;8(5):248-254.

  9. Oral cancer presentation among Malay patients in hospital Universiti Sains Malaysia, Kelantan.

    Science.gov (United States)

    Razak, Asmani Abdul; Saddki, Norkhafizah; Naing, Nyi Nyi; Abdullah, Nizam

    2009-01-01

    The objective of this study was to identify the characteristics of oral cancer among Malay patients in Hospital Universiti Sains Malaysia (HUSM), Kelantan. A retrospective record review was conducted from August to December 2006 in HUSM. Of 133 patients with oral cancer diagnosed from 1986 to 2005, 118 were Malay. Data on socio-demographic background, high-risk habits practiced, clinical and histological characteristics, and treatment profile of the patients were obtained. Malay patients with oral cancer were predominantly elderly, aged 60 years old and above (51.7%) at the time of diagnosis, with a mean age of 58.1 years (SD 16.81). Most patients were males (64.4%) and the majority of them were married (83.9%). More than half (58.5%) had been smokers, and of those who smoked, 89.9% were males. Some had a betel quid chewing habit (22.9%) but none ever consumed alcohol. The majority of the patients (77.1%) were diagnosed at stage IV. The tongue was the most usual site involved (37.3%) and squamous cell carcinoma was the most common histological type seen (75.4%). The prevalence of oral cancer among Malay patients in HUSM is high (88.7%). It is predominantly found in elderly males and the majority of cases present at advanced stage.

  10. Macrophage response in patients diagnosed with aseptic necrosis of the femoral head presenting different risk factors.

    Science.gov (United States)

    Kamal, Diana; Trăistaru, Rodica; Kamal, Constantin Kamal; Alexandru, Dragoş Ovidiu; Ion, Daniela Adriana; Grecu, Dan Cristian

    2015-01-01

    Aseptic necrosis of the femoral head is a condition caused by partial or total interruption of blood supply to the femoral head. The diminished blood supply causes necrosis of the cellular elements and of the bone marrow, followed by the collapse of the bone structure, events that ultimately lead to the destruction of the bone tissue, the appearance of local pain and loss of function in the affected coxofemoral joint. The importance of this condition is that it mainly affects young adults aged 30-50 years, active from a socio-professional standpoint, and increased life expectancy. The material studied to achieve CD68 immunostaining was represented by bone fragments from the area of necrosis and from the adjacent areas of the femoral heads, harvested from 39 patients when performing hip arthroplasty surgery. The patients were diagnosed with aseptic necrosis of the femoral head and hospitalized in the Clinic of Orthopedics and Traumatology, Emergency County Hospital of Craiova, Romania, from June 2014 to January 2015. The 39 patients included in the study were divided into four categories according to presented risk factors (alcohol, alcohol and smoking, trauma, corticosteroids). All the 39 cases had positive immunostaining for CD68, macrophage being highlighted both in the area of necrosis and in the adjacent areas. We noted significant differences in the number and arrangement of macrophages in patients presenting different risk factors. The highest number of macrophages was present in patients presenting a risk factor corticosteroids, and the lowest number of macrophages was found in patients who had trauma as the main risk factor.

  11. Spontaneous Cervico-Thoracic Spinal Epidural Hematoma in an Elderly Patient: A Rare Presentation

    Directory of Open Access Journals (Sweden)

    Reyaz Ahmed Para,Muzamil Latief,Huma Noor

    2013-08-01

    Full Text Available Spontaneous spinal epidural hematoma (SSEH is a rare entity.SSEH is an accumulation of blood in the vertebral epidural space in the absence of trauma or iatrogenic procedure like lumbar puncture.The incidence of SSEH has been estimated at 0.1 patients per 100,000 individuals and represents less than 1% of spinal space-occupying lesions .Here we are presenting case of a 65year old female hypertensive on treatment with controlled blood pressure, who presented with sudden onset paraplegia and weakness of muscles of hand, associated with urinary and bowel incontinence that started 6 hours before presenting to Emergency Room .Patient was subjected to MRI spine that revealed a collection in spinal epidural space ,hypointense in T1W images and hyperintense in T2W images, extending from C6-C7 to T1-T2 suggestive of acute / subacute epidural hematoma (fig 1.In our case all possible causes of an epidural haematoma were ruled out by relevant investigations.Patient was subjected to surgical evacuation of hematoma after 48 hours of presentation.Perioperative and Postoperative period was uneventfull . Sensations over involved areas improved. Motor weakness also improved from Grade III to Grade IV+ in bilateral lower limbs and from Grade II to Grade IV in small muscles of hand and triceps, however Patient persisited with urinary incontinence.CONCLUSION: When a patient receiving anticoagulant therapy complains of sudden and unexplained neck or back pain, we should suspect the possibility of SSEH. For early diagnosis, immediate MRI is essential .In addition, we should consider SSEH as one of the important differential diagnoses in elderly patients who have developed acute myelopathy. [Natl J Med Res 2013; 3(4.000: 424-427

  12. SALINE INFUSION SONOGRAPHY IN ASSESSMENT OF ENDOMETRIAL PATHOLOGIES IN PATIENTS WITH THICKENED ENDOMETRIUM PRESENTING WITH AUB

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    Poornima

    2016-05-01

    Full Text Available Abnormal Uterine Bleeding (AUB is one of the commonest complaint of adult females presenting into the gynaecologic departments. In most of the patients the bleeding is due to the functional endometrial lesion, while the cause is hormonal in rest of the patients. These patients usually need invasive procedures like hysteroscopy or HSG for evaluation of intracavitary lesion. The aim of this study is to assess the role of Saline Infusion Sonography (SIS in detecting the intracavitary (endometrial lesions of uterus in patient with abnormal uterine bleeding and thickened endometrium on Transvaginal Ultrasound (TVS and establishing its diagnostic accuracy. METHOD This prospective hospital-based study includes SIS examination of 80 adult female patients who presented with abnormal uterine bleeding and demonstrated thickened endometrium on transvaginal ultrasound at Department of Radiodiagnosis and Imaging, Gandhi Medical College and Hamidia Hospital, Bhopal (Madhya Pradesh, for the period of six months. Written informed consent from all the patients taken. All patients were evaluated on the same day and findings were recorded. RESULT 60 patients out of 80 showed presence of functional endometrial lesion. Most common endometrial pathology was submucosal myoma followed by endometrial polyps. Most rare cases were of Uterine Synechiae {2 in number}. SIS yielded high sensitivity and specificity for intracavitary lesions and diagnostic accuracy for submucosal myoma and endometrial polyp was 100%. CONCLUSION SIS proved to be highly sensitive and specific method to diagnose intracavitary lesion of uterus. The method is minimally invasive, well tolerated and easy to carry out under hospital settings with very less incidence of post-procedural complications (No major complication in this study. It can be used to replace hysteroscopy to diagnose various intracavitary (endometrial lesion of uterus.

  13. Presenting phenotype and clinical evaluation in a cohort of 22 Williams-Beuren syndrome patients.

    Science.gov (United States)

    Ferrero, Giovanni Battista; Biamino, Elisa; Sorasio, Lorena; Banaudi, Elena; Peruzzi, Licia; Forzano, Serena; di Cantogno, Ludovica Verdun; Silengo, Margherita Cirillo

    2007-01-01

    Williams-Beuren syndrome (WS) is a rare multi-system genomic disorder, caused by 7q11.23 microdeletion with a prevalence of 1/7500-1/20,000 live births. Clinical phenotype includes typical facial dysmorphism (elfin face), mental retardation associated with a peculiar neuropsychological profile and congenital heart defects. We investigated 22 WS patients (mean age of 9.7 years, range 1 day to 39 years) with a multi-specialist follow-up protocol comprehensive of neuropsychological, cardiologic, nephrologic, ophthalmologic, endocrinologic, gastroenterologic, odontostomatologic and orthopaedic evaluations. The mean age at diagnosis was 5.38 years, being 1.02 years when genetic evaluation was requested for congenital heart defects (CHD) and 10.68 years in case of mental retardation and/or abnormal neuropsychological profile without an evident CHD. All patients showed facial dysmorphisms, with supravalvular aortic stenosis (SVAS) as the most common cardiovascular anomaly (12/22), followed by peripheral pulmonary stenosis (9/22); interestingly, in one patient we detected a total anomalous pulmonary venous return (TAPVR), confirming the possible association of this rare CHD with WS. Hypertension was detected by 24-h ambulatory blood pressure monitoring in 7/22 cases. A cognitive assessment was performed in 13 patients older than 6 years, showing various degrees of mental retardation in 12 and a normal intelligence quotient (IQ) in a single patient; evaluation of developmental milestones revealed various grades of developmental delay in all the patients younger than 6 years. Chiari malformation type 1 was found in 3 patients. Our study underlines a remarkable diagnostic delay in patients who present to genetic evaluation because of mental retardation and/or peculiar neuropsychological profile lacking an evident cardiopathy and confirms the multi-systemic nature of WS leading to a high clinical presentation's variability and complex follow-up strategies.

  14. A young female patient of neuromyelitis optica presenting with hypocalcemic tetany.

    Science.gov (United States)

    Tirkey, Naveen Kumar; Mandavi, Sanjay; Gupta, Shashank

    2011-09-01

    Neuromyelitis optica, a variant of multiple sclerosis, presenting with hypocalcemic tetany is an unusual presentation. We report here a case of 25 years old female who was a case of neuromyelitis optica and had hypocalcemic tetany as the initial presentation among others. The case is interesting in that the hypocalcemic tetany was not coincidental. The patient had low vitamin D status and probably, this was correlated etiologically to neuromyelitis optica. Vitamin D has immunomodulatory effect and low vitamin D status has been implicated in the etiology of autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, insulin-dependent diabetes mellitus, and inflammatory bowel disease.

  15. Congenital tracheoesophageal fistula: A rare and late presentation in adult patient

    Directory of Open Access Journals (Sweden)

    Waseem M Hajjar

    2012-01-01

    Full Text Available Congenital H-type tracheoesophageal fistula (TEF in adults is a rare presentation and can test the diagnostic acumen of a surgeon, endoscopist, and the radiologist. These undetected fistulas may present as chronic lung disease of unknown origin because repeated aspirations can lead to recurrent lung infections and bronchiectasis. Congenital TEFs should be considered in the diagnosis of infants and young adults with recurrent respiratory distress and/or infections. Here, we present the successful management of this rare case in an adult patient.

  16. Impetigo presenting as an acute necrotizing swelling of the lower lip in an adult patient.

    Science.gov (United States)

    Ghafoor, Mohammed; Halsnad, Moorthy; Fowell, Christopher; Millar, Brian G

    2012-06-01

    The authors present an unusual case of an acute swelling of the lower lip and septicemia in a 35-year-old, recent immigrant male arriving from India. The patient presented in our emergency department with a 48-hour history of a worsening, painful swelling of the lower lip. On presentation, he was pyrexial and the lip was found to be acutely inflamed with honey-colored crusting, pustular lesions, and induration . A diagnosis of impetigo leading to necrosis of the lip was established, a rare phenomenon potentially resulting in significant tissue destruction. Appropriate medical management achieved a good outcome and prevented disabling tissue loss of the orofacial region.

  17. Classical presentation of Gardner's syndrome in an Indian patient: A case report

    Science.gov (United States)

    Verma, Priyanka; Surya, Varun; Kadam, Sonali; Umarji, Hemant R.

    2016-01-01

    Gardner's syndrome is an autosomal dominant disease characterized by the presence of colonic polyposis, osteomas, and a multitude of soft-tissue tumors. Dental anomalies are present in estimated 30% of all affected individuals of Gardner's syndrome, so dental professionals play an important role in determining the early signs of the syndrome. The intestinal polyps have a 100% risk of undergoing malignant transformation if not treated thus, early diagnosis and regular surveillance are important. In this report, we describe classical presentation of Gardner's syndrome in a patient who presented with bilateral swellings on palate along with multiple impacted teeth. PMID:27307686

  18. Telling the patient's story: using theatre training to improve case presentation skills.

    Science.gov (United States)

    Hammer, Rachel R; Rian, Johanna D; Gregory, Jeremy K; Bostwick, J Michael; Barrett Birk, Candace; Chalfant, Louise; Scanlon, Paul D; Hall-Flavin, Daniel K

    2011-06-01

    A medical student's ability to present a case history is a critical skill that is difficult to teach. Case histories presented without theatrical engagement may fail to catch the attention of their intended recipients. More engaging presentations incorporate 'stage presence', eye contact, vocal inflection, interesting detail and succinct, well organised performances. They convey stories effectively without wasting time. To address the didactic challenge for instructing future doctors in how to 'act', the Mayo Medical School and The Mayo Clinic Center for Humanities in Medicine partnered with the Guthrie Theater to pilot the programme 'Telling the Patient's Story'. Guthrie teaching artists taught storytelling skills to medical students through improvisation, writing, movement and acting exercises. Mayo Clinic doctors participated and provided students with feedback on presentations and stories from their own experiences in patient care. The course's primary objective was to build students' confidence and expertise in storytelling. These skills were then applied to presenting cases and communicating with patients in a fresher, more engaging way. This paper outlines the instructional activities as aligned with course objectives. Progress was tracked by comparing pre-course and post-course surveys from the seven participating students. All agreed that the theatrical techniques were effective teaching methods. Moreover, this project can serve as an innovative model for how arts and humanities professionals can be incorporated for teaching and professional development initiatives at all levels of medical education.

  19. A Turkish patient with large 17p11.2 deletion presenting with Smith Magenis syndrome.

    Science.gov (United States)

    Tug, E; Cine, N; Aydin, H

    2011-01-01

    Smith-Magenis syndrome (SMS), which occurs as a result of an interstitial deletion within chromosome 17p11.2-p12, is a disorder that presents itself with minor dysmorphic features, brachydactyly, short stature, hypotonia, delayed speech, cognitive deficits and neurobehavioral problems including sleep disturbances and maladaptive repetitive and self-injurious behavior. We present a girl with full SMS phenotype. G-banding cytogenetic analysis showed normal 46,XX karyotype. Whole-genome array comparative genomic hybridization (CGH) was performed due to the severity of the phenotype and the unusual features present in the patient. An interstitial deletion in 17p11.2-p12, approximately 4.73 Mb in size was determined. Characteristic physical and behavioral phenotype strongly suggested SMS. This, to the best of our knowledge is the first patient with SMS reported in Turkey. We emphasize the need for whole genome analysis in multiple congenital abnormalities/mental retardation disorders with unusual and severe phenotypes.

  20. Fibromuscular Dysplasia in a Normotensive Patient Presented With Renal Infarct: Case Report and Endovascular Technique.

    Science.gov (United States)

    Rostambeigi, Nassir; Goldfarb, Robert; Hunter, David W; Anderson, James Kyle

    2015-10-01

    Fibromuscular dysplasia (FMD) is a well-known disease, but its diagnosis can be challenging. Typically, the symptomatic FMD are reported by young and middle aged people with high blood pressure refractory to medical treatment. We present a rare case of a young, healthy, and normotensive patient who presented with pain secondary to renal infarction, without any prior signs or symptoms or history of hypertension. This presentation of FMD has not been previously described. The typical but subtle angiographic findings of the macro-aneurysmal FMD as well as the successful endovascular treatment are discussed herein. The macro-aneurysmal form of FMD should be considered in the differential diagnosis of acute renal infarction in young and middle aged patients even if they do not have a history of hypertension.

  1. [Analysis of the data of patients presenting for emergency treatment with vertigo].

    Science.gov (United States)

    Varga, Csaba; Nagy, Ferenc; Drubits, Katalin; Lelovics, Zsuzsanna; Varga Györfi, Krisztina; Oláh, Tibor

    2014-05-30

    Analyzing the medical record data of patients with the main symptom of vertigo in "Kaposi M6r" Hospital's Emergency Department. Retrospective evaluation of patients's medical history with vertigo related diagnoses according to BNO classification. In the year of 2010, 18 000 patients were presented to ED. In 471 cases the symptoms were vertigo related which makes up 3% of the total. Almost half, 46% of these patients were brought in by ambulance medical car. The ratio of women was twice as high as of the men. One fifth, 19% of patients with vertigo gained admission to the ward and 81% of them were discharged in 24 hours. According to the interviews, 4 types of vertigo have been identified: "whirling style" vertigo in 37% of the cases, dizziness in 33% of the cases, presyncope in 12% and "light headedness" in 9%. The remaining 9% couldn't be classified. Vertigo is common presenting symptom in emergency department, however it rarely indicates severe condition. The diagnostic value of vertigo classification based on history and brain CT result in identifying the severity of the background condition is questionable. We found that in recognizing the cases which need prompt intervention, thorough neurological examination and the clarification of the vertigo's circumstances proved to be helpful.

  2. Metabolomic Analysis of Clinical Plasma from Cerebral Infarction Patients Presenting with Blood Stasis

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    Min Ho Cha

    2015-01-01

    Full Text Available Blood stasis (BS is characterized as a disorder of blood circulation. In traditional Korean medicine (TKM, it is viewed as a cause factor of diseases such as multiple sclerosis and stroke. This study investigated differences in the plasma metabolites profiles of subjects displaying BS or non-BS patterns. Thirty-one patients with cerebral infarction diagnosed with BS and an equal number of sex- and age-matched non-BS patients were enrolled. Metabolic profiling was performed using UPLC-MS. The ratio of subjects with a rough pulse and purple coloration of the tongue was higher in patients presenting with BS pattern. Through metabolomics analysis, 82 metabolites that differed significantly between the BS and non-BS pattern were identified, and the two groups were significantly separated using an orthogonal partial least square-discriminant analysis model (P<0.001. Of these 82 metabolites, acetyl carnitine, leucine, kynurenine, phosphocholine, hexanoyl carnitine, and decanoyl carnitine were present in significantly higher levels in patients with a BS pattern than those with a non-BS pattern. Our results also demonstrated that seven plasma metabolites, including acyl-carnitines and kynurenine, were associated with a BS pattern, suggesting that variant plasma metabolic profiles may serve as a biomarker for diagnosis of BS in patients with cerebral infarction.

  3. Prognosis of patients presenting extreme acidosis (pH <7) on admission to intensive care unit.

    Science.gov (United States)

    Allyn, Jérôme; Vandroux, David; Jabot, Julien; Brulliard, Caroline; Galliot, Richard; Tabatchnik, Xavier; Combe, Patrice; Martinet, Olivier; Allou, Nicolas

    2016-02-01

    The purpose was to determine prognosis of patients presenting extreme acidosis (pH acidosis within 24 hours of admission to a polyvalent ICU in a university hospital between January 2011 and July 2013. Multivariate analysis and survival analysis were used. Among the 2156 patients admitted, 77 patients (3.6%) presented extreme acidosis. Thirty (39%) patients suffered cardiac arrest before admission. Although the mortality rate predicted by severity score was 93.6%, death occurred in 52 cases (67.5%) in a median delay of 13 (5-27) hours. Mortality rate depended on reason for admission, varying between 22% for cases linked to diabetes mellitus and 100% for cases of mesenteric infarction (P = .002), cardiac arrest before admission (P acidosis (P = .007), high Simplified Acute Physiology Score II (P = .008), and low serum creatinine (P = .012). Patients with extreme acidosis on admission to ICU have a less severe than expected prognosis. Whereas mortality is almost 100% in cases of cardiac arrest before admission, mortality is much lower in the absence of cardiac arrest before admission, which justifies aggressive ICU therapies. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Acute Presentation of Chiari I Malformation with Hemiparesis in a Pediatric Patient.

    Science.gov (United States)

    Miranda, Stephen P; Kimmell, Kristopher T; Silberstein, Howard J

    2016-01-01

    Chiari I malformation (CM-I) is defined by cerebellar tonsillar herniation through the foramen magnum. Patients typically present with chronic complaints, including headache, dizziness, and numbness, although there are few reports in the literature of pediatric patients presenting acutely with neurological deficit caused by CM-I. We report a child who presented acutely with hemiparesis and magnetic resonance imaging findings consistent with CM-I and spinal cord edema. A 3-year old boy with normal development presented with difficulty walking and increased drooling. His mother stated he was running into objects and had balance issues for several days. Neurological examination showed ataxia with falling to the right after a few steps and weakness of the right arm and leg. His medical history was remarkable only for mild asthma, although he had recently been treated for an upper respiratory viral infection. Computed tomography of the head demonstrated no brainstem mass. Magnetic resonance imaging of the head and cervical spine showed tonsillar ectopia approximately 2 cm below the craniocervical junction with increased T2 signal in the spinal cord from C1 to C3 consistent with syringomyelia and cord edema. The patient underwent suboccipital craniectomy with removal of the posterior arch of C1 and dural patch graft. His postoperative course was unremarkable, with complete resolution of his symptoms at his 1-month follow-up visit. This case highlights an unusual presentation of CM-I with neurological deficit related to spinal cord edema, possibly precipitated by the "water-hammer" effect of this patient's coughing fits. Providers should be aware of the acute presentations of CM-I. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. [Paratonsillar abscess in the patients presenting with the non-anginous form of chronic tonsillitis].

    Science.gov (United States)

    Arzamazov, C G; Ivanets, I V

    2013-01-01

    The present study was undertaken for the purpose of the comparative analysis of the degree of severity and inflammation-induced changes in palatine tonsils of the patients presenting with non-anginous forms of chronic tonsillitis both on the side of development of paratonsillitis and on the opposite side showing no visually visible signs of the acute inflammatory process. The secondary objective of the study was to compare pain syndrome during abscess-tonsillectomy and tonsillectomy proper, respectively. We analysed the causes behind the reduction of the total number of tonsillectomies for the treatment of chronic tonsillitis available from the accessible literature for the past 10 years. Moreover the analysis of medical records of the patients with chronic tonsillitis and delayed paratonsillar abscess was performed based on the results of the treatment of the patients admitted to the Otorhinolaryngological Department of the City Clinical Hospital No 1 during the period from 2002 and 2011. The severity of clinical manifestations of the inflammatory process was estimated based on the study of palatine tonsil biopsies removed during surgery using the radioautographic technique. The severity of pain syndrome during abscess-tonsillectomy and tonsillectomy proper was evaluated based on the McGill pain questionnaire. The results of the study confirmed apparent tonsillar inflammation in the patients presenting with chronic tonsillitis including its non-anginous forms.

  6. Cognard Type V intracranial dural arteriovenous fistula presenting in a pediatric patient with rapid, progressive myelopathy.

    Science.gov (United States)

    Jermakowicz, Walter J; Weil, Alexander G; Vlasenko, Artyom; Bhatia, Sanjiv; Niazi, Toba N

    2017-08-01

    Cognard Type V dural arteriovenous fistulas (dAVFs) are a unique type of cranial vascular malformation characterized by congestion of the perimedullary venous system that may lead to devastating spinal cord pathology if left untreated. The authors present the first known case of a pediatric patient diagnosed with a Type V dAVF. A 14-year-old girl presented with a 3-week history of slowly progressive unilateral leg weakness that quickly progressed to bilateral leg paralysis, sphincter dysfunction, and complete sensory loss the day of her presentation. MRI revealed an extensive T2 signal change in the cervical spine and tortuous perimedullary veins along the entire length of the cord. An emergency cranial angiogram showed a Type V dAVF fed by the posterior meningeal artery with drainage into the perimedullary veins of the cervical spine. The fistula was not amenable to embolization because vascular access was difficult; therefore, the patient underwent urgent suboccipital craniotomy and ligation of the arterialized venous drainage from the fistula. The patient's clinical course immediately reversed; she had a complete recovery over the course of a year, and she remains asymptomatic at the 2-year follow-up. This report adds to a growing body of evidence that describes the diverse and unpredictable nature of Type V dAVFs and highlights the need to obtain a cranial angiogram in pediatric patients with unexplained myelopathy and cervical cord T2 signal change on MRI.

  7. What do Alzheimer's disease patients know about animals? It depends on task structure and presentation format.

    Science.gov (United States)

    Rich, Jill B; Park, Norman W; Dopkins, Stephen; Brandt, Jason

    2002-01-01

    Deficits on tasks requiring semantic memory in Alzheimer's disease (AD) may be due to storage loss, a retrieval deficit, or both. To address this question, we administered multiple tasks involving 9 exemplars of the category "animals," presented as both words and pictures, to 12 AD patients and 12 nondemented individuals. Participants made semantic judgments by class (sorting task), similarity (triadic comparison task), and dimensional attributes (ordering task). Relative to control participants, AD patients were impaired on an unstructured sorting task, but did not differ on a constrained sorting task. On the triadic comparison task, the patients were as likely to make judgments based on size as domesticity attributes, whereas control participants made judgments based primarily on domesticity. The patients' judgments were also less consistent across tasks than those of control participants. On the ordering tasks, performance was generally comparable between groups with pictures but not words, suggesting that pictures enable AD patients to access information from semantic memory that is less accessible with lexical stimuli. These results suggest that AD patients' semantic judgments are impaired when the retrieval context is unstructured, but perform normally under supportive retrieval conditions.

  8. Fournier’s gangrene: Causes, presentation and survival of sixty-five patients

    Science.gov (United States)

    Taken, Kerem; Oncu, Mehmet Resit; Ergun, Muslum; Eryilmaz, Recep; Demir, Canser Yilmaz; Demir, Murat; Gunes, Mustafa

    2016-01-01

    Objective: To report our experience with Fournier’s Gangrene (FG) over the past eight years and evaluate the predisposing factors which affect the mortality. Methods: Sixty-five patients who were admitted to emergency surgical unit of our institution presenting with FG between January 2006 and August 2014 were included. The anatomical site of infective gangrene, predisposing factors, etiological factors, and outcomes were retrospectively reviewed. Results: Our cases included 8 women and 57 men. The average age of men was 51±13.9 (range 19-75) and the average age of women was 63±10.5 (range 52-76). Average hospitalization time was 9.2±6.6 days (range 5-25) days. The most frequent comorbid disease was diabetes mellitus and the most frequent etiology was perianal abscess. Colostomy was performed in 11 patients, orchidectomy in two patients, cystostomy in two patients. Notably, all of the 8 (12.3%) patients who died from FG had diabetes and low socioeconomic status. A total of six patients who died required more than one surgical debridement. Conclusions: Fournier’s gangrene is a severe surgical emergency, with a high mortality rate. Low socioeconomic status, diabetes and more than one debridement play a major role in mortality and morbidity. PMID:27375726

  9. Idiopathic membranous nephropathy in pediatric patients: presentation, response to therapy, and long-term outcome

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    Valderrama Elsa

    2007-08-01

    Full Text Available Abstract Background Idiopathic membranous nephropathy (IMN is one of the most common causes of primary nephrotic syndrome in adults. However, it is a relatively rare entity in the pediatric population and there is a paucity of data about the incidence, prognosis, and optimal treatment of IMN in children and adolescents. We conducted this study to evaluate pediatric patients with IMN in order to clarify the presentation, response to therapy, and clinical outcome. Methods A retrospective chart review was performed on patients identified with biopsy-proven IMN between 1988–2005. Patients with systemic lupus erythematosus or hepatitis-related lesions were excluded. The following data were tabulated: age, gender, ethnicity, presenting clinical and laboratory findings, proteinuria in a first morning urine specimen, estimated glomerular filtration rate (GFRe, histopathology, type and duration of treatment, and clinical status at final evaluation. Results 13 cases of IMN were identified out of 460 renal biopsies performed for evaluation of primary kidney disease during the study interval. Mean age was 9.6 ± 4.6, gender 6 M:7 F, ethnicity 8 W:2 B:3 H. At the initial visit hematuria was present in 9 patients, edema in 5, nephrotic-range proteinuria in 5, and hypertension in 3. Mean urinary protein:creatinine ratio 3.3 ± 2.5 and all patients had a normal GFRe. Classic glomerular findings of IMN were seen in all renal specimens, with concomitant interstitial changes in 2 cases. Treatment included an angiotensin converting enzyme inhibitor or angiotensin receptor blocker in 11 cases. Most patients were also given immunosuppressive medications – prednisone in 10, a calcineurin inhibitor in 5, and mycophenolate mofetil or azathioprine in 3 patients. At the last follow-up, 42 ± 35 months after the diagnostic biopsy, 7 children were hypertensive and the urine protein:creatinine ratio was 2.3 ± 3.1. The mean GFRe was 127 ± 57 mL/min/m2. Three patients

  10. Delay in diagnosis amongst carcinoma lung patients presenting at a tertiary respiratory centre

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    Ruchi Sachdeva

    2014-01-01

    Full Text Available Objective: To determine time delay from the onset of initial symptoms to diagnosis of primary lung cancer. Materials and Methods: Selected information was captured from 49 consecutive pathologically proven cancer lung patients presenting to a tertiary respiratory centre during 1 st January to 30 th June 2012 using semi-structured interview schedule. All patients underwent suitable protocol based diagnostic work-up and referral. Results: Background profile of patient was as follows: Male:Female = 7.1:1; mean age was 61.2 (±9.7 years; Nine out of 49 (18.4% patients were illiterate; Forty-three out of 49 (87.8% belonged to rural native place; Forty-three out of 49 (87.7% were smokers with 25 years as median pack-years. Histological profile showed that adenocarcinoma (40.8% was the predominant form followed by small cell carcinoma (32.7%. Time (median delay in diagnosis was 3.0 days (home remedies/quack therapy, 60.0 days (primary/secondary level and 8 days at tertiary level. Twenty seven of 49 patients (55.1% presented in stage-IV. Higher proportion of patients residing outside the district of study institute had longer delay in diagnosis but did not reach statistical significance (P > 0.05. The most important patient reasons for the delay in diagnosis was procrastinate/did not took symptoms seriously (19/49, 38.7%; no-body to escort (13/49, 26.5%, long distance (5/49, 10.2%, financial constraints (4/49, 8.1%, preferred local practitioner (2/49, 4.0%, family commitment/marriage (2/49, 4.0%, fear of death (1/49, 2.0% and no reason cited (3/49, 6.1%. Three patients were inadvertently diagnosed as tuberculosis and hence the delay. Conclusion: Patient presented at a higher stage within a short span of time; however, there is scope of increasing health system capacity at primary/secondary level including sensitization training, health communication and appropriate referral to higher center.

  11. The Prevalence of Anti-Aquaporin 4 Antibody in Patients with Idiopathic Inflammatory Demyelinating Diseases Presented to a Tertiary Hospital in Malaysia: Presentation and Prognosis

    Science.gov (United States)

    Tan, C. T.

    2017-01-01

    Background. There have been inconsistent reports on the prevalence and pathogenicity of anti-Aquaporin 4 (AQP4) in patients presented with idiopathic inflammatory demyelinating diseases (IIDDs). Objective. To estimate the prevalence of anti-AQP4 antibody in patients with IIDDs presented to University Malaya Medical Centre in terms of patients' clinical and radiological presentations and prognoses. Methods. Retrospective data review of IIDDs patients presented from 2005 to 2015. Patients were classified into classical multiple sclerosis (CMS), opticospinal (OS) presentation, optic neuritis (ON), transverse myelitis (TM), brainstem syndrome (BS), and tumefactive MS. Anti-Aquaporin 4 antibody was tested using the Indirect Immunofluorescence Test (IIFT) cell-based assay. Statistical analysis was done using the SPSS version 20. Results. Anti-AQP4 antibody was detected in 53% of patients presented with IIDDs. CMS was more common in the seronegative group, 27/47 (57.45%; p < 0.001). Conversely, OS involvement was more common in the seropositive group, 26/53 (49.06%; p < 0.001). Longitudinally extensive spinal cord lesions (LESCLs) on MRI were also more common in the seropositive group, 29/40 (72.50%; p = 0.004). Only 2/40 (5.00%) had MRI evidence of patchy or multiple short-segment spinal cord lesions in the AQP4-positive group (p = 0.003). The relapse rate and Expanded Disability Status Scale (EDSS) were also higher in the seropositive group (5.43 versus 3.17, p = 0.005; 4.07 versus 2.51, p = 0.006, resp.). Typical clinical presentations that defined NMO were also seen in the seronegative patients, but in a lower frequency. Conclusion. Our cohort of patients had a higher prevalence of seropositivity of anti-AQP4 antibody as compared to those in Western countries. This was also associated with a more typical presentation of opticospinal involvement with LESCLs on MRI, a higher rate of relapse, and EDSS. PMID:28203460

  12. Lhermitte sign and urinary retention: atypical presentation of oxaliplatin neurotoxicity in four patients.

    Science.gov (United States)

    Taieb, Sarah; Trillet-Lenoir, Véronique; Rambaud, Loïc; Descos, Louis; Freyer, Gilles

    2002-05-01

    Regimens combining oxaliplatin with fluorouracil and folinic acid are standard therapeutic options for patients with metastatic colorectal carcinoma. Oxaliplatin has a good safety profile, although it is responsible for dose-limiting neurotoxicity typically consisting of two distinct clusters of symptoms. Cold-induced distal paresthesiae occur during or shortly after infusion in most patients and are usually transient and mild. A persistent sensory peripheral neuropathy may develop with prolonged treatment, eventually causing superficial and deep sensory loss, sensory ataxia and functional impairment. The authors report four cases of atypical neurotoxicity induced by oxaliplatin in patients treated for metastatic colorectal carcinoma. Two patients were male and two were female, with an age range of 52-59 years. Three patients experienced Lhermitte sign and two experienced urinary retention. In all cases, the cumulative dose of oxaliplatin was higher than 1000 mg (range, 1248-2040 mg). Brain and spinal magnetic resonance imaging was performed in two patients and was normal. Somatosensory evoked potentials were recorded in two patients and suggested cervical dorsal column dysfunction. Symptoms resolved a few weeks after discontinuation of oxaliplatin. Lhermitte sign may be induced via a neurotoxic effect on the ascending axons of these T-shaped neurons. An atonic bladder may be the result of damage to the sensory portion of the sacral reflex arc, either in the dorsal roots, as for example in diabetic neuropathy, or in the posterior columns, as in tabes dorsalis. Alternatively, it may result from a paralysis of the parasympathetic fibers that control the bladder musculature. It is unclear at present whether the micturition difficulties observed in patients in the current series are due to sensory neuropathy or to autonomic neuropathy, event if the former hypothesis seems more likely, as autonomic neuropathy has not been previously observed with oxaliplatin, and its

  13. Male genitoplasty for 46 XX congenital adrenal hyperplasia patients presenting late and reared as males

    Science.gov (United States)

    Sharma, Shilpa; Gupta, Devendra K.

    2012-01-01

    Aim: To evaluate the clinical profile and management of 46 XX Congenital Adrenal Hyperplasia (CAH) patients presenting with severe virilization and assigned a male gender. Materials and Methods: Of 173 children diagnosed with CAH at the Pediatric Intersex Clinic since 1980, seven children with CAH presented late with severe virilization and were reared as males. All of them were assigned the male sex with removal of the female adnexa. Six were treated with male genitoplasty. Appropriate hormonal supplementation was offered after puberty. Results: The mean age at presentation was 14.2 years (7 – 21). Six patients had presented after puberty, only one at seven years of age. Staged male genitoplasty comprising of chordee correction, male urethroplasty, and bilateral testicular prosthesis was performed. The female adnexa (uterus, ovaries, most of the upper vagina, and the fallopian tubes) were removed. The mental makeup was masculine in six and bigender in one. Bilateral mastectomy was performed at puberty in all. Hormonal treatment comprised of glucocorticoids and testosterone. Six patients were comfortable with the outcome of the masculinizing genitoplasty. One had a short-sized phallus. One had repeated attacks of urinary tract infection arising from the retained lower vaginal pouch. Social adjustments were good in all, except in one who had a bigender mental makeup. Conclusion: CAH patients with severe virilization presenting late and reared as males are extremely rare. However, the assigned gender can be retained adequately as males, meeting the socioeconomic compulsions of the society. The results are satisfactory following appropriate surgical procedures and hormonal supplementation. PMID:23226638

  14. Male genitoplasty for 46 XX congenital adrenal hyperplasia patients presenting late and reared as males

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    Shilpa Sharma

    2012-01-01

    Full Text Available Aim: To evaluate the clinical profile and management of 46 XX Congenital Adrenal Hyperplasia (CAH patients presenting with severe virilization and assigned a male gender. Materials and Methods: Of 173 children diagnosed with CAH at the Pediatric Intersex Clinic since 1980, seven children with CAH presented late with severe virilization and were reared as males. All of them were assigned the male sex with removal of the female adnexa. Six were treated with male genitoplasty. Appropriate hormonal supplementation was offered after puberty. Results: The mean age at presentation was 14.2 years (7 - 21. Six patients had presented after puberty, only one at seven years of age. Staged male genitoplasty comprising of chordee correction, male urethroplasty, and bilateral testicular prosthesis was performed. The female adnexa (uterus, ovaries, most of the upper vagina, and the fallopian tubes were removed. The mental makeup was masculine in six and bigender in one. Bilateral mastectomy was performed at puberty in all. Hormonal treatment comprised of glucocorticoids and testosterone. Six patients were comfortable with the outcome of the masculinizing genitoplasty. One had a short-sized phallus. One had repeated attacks of urinary tract infection arising from the retained lower vaginal pouch. Social adjustments were good in all, except in one who had a bigender mental makeup. Conclusion: CAH patients with severe virilization presenting late and reared as males are extremely rare. However, the assigned gender can be retained adequately as males, meeting the socioeconomic compulsions of the society. The results are satisfactory following appropriate surgical procedures and hormonal supplementation.

  15. STUDY OF CLINICAL PRESENTATIONS OF PATIENTS WITH HYPERPROLACTINAEMIA VISITING A TERTIARY CARE HOSPITAL

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    Binoy Kumar Mohanty

    2016-06-01

    Full Text Available BACKGROUND Hyperprolactinaemia is one of the common endocrine disorders seen in clinical practice. It may result due to various causes and elucidating the exact cause is necessary to formulate the right therapy. OBJECTIVE To study the various aetiologies and clinical presentation of patients presenting with hyperprolactinaemia to a tertiary care hospital. DESIGN Cross-sectional study. MATERIAL AND METHODS We collected and analysed the clinical data including hormonal status of 74 consecutive patients who presented to our department from June 2015 to May 2016 for evaluation of hyperprolactinaemia. RESULTS Majority of the subjects studied belonged to 20-29 years group (47.29% followed by 30-39 years age group (24.32%. The most common cause in our population was due to drug-induced causes (35.13%. The next common causes included idiopathic group (20.4% followed by pituitary adenomas (16.21%. There was significant female predominance (83.78% among total cases. Among women who presented with hyperprolactinaemia, menstrual irregularity (69.35% followed by galactorrhoea (35.48% were the most common presentations. CONCLUSIONS Hyperprolactinaemia is frequently seen among women who presented with either menstrual irregularity or galactorrhoea or both. Drug-induced hyperprolactinaemia is the most common cause seen in our study population.

  16. Oral papillary squamous cell carcinoma in twelve dogs.

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    Nemec, A; Murphy, B G; Jordan, R C; Kass, P H; Verstraete, F J M

    2014-01-01

    Papillary squamous cell carcinoma (PSCC) is a distinct histological subtype of oral squamous cell carcinoma (SCC), described in both dogs and man. In dogs, PSCC has long been considered a malignant oral tumour of very young animals, but it has recently been reported to occur in adult dogs as well. The aim of this study was to describe the major clinicopathological characteristics of canine oral PSCC (COPSCC). Twelve dogs diagnosed with COPSCC were included in this retrospective study (1990-2012). The majority (75%) of the dogs were >6 years of age (median age 9 years). All tumours were derived from the gingiva of dentate jaws, with 66.7% affecting the rostral aspects of the jaws. The gross appearance of the lesions varied, with one having an intraosseous component only. The majority (91.7%) of the tumours were advanced lesions (T2 and T3), but no local or distant metastases were noted. Microscopically, two patterns were seen: (1) invasion of bone forming a cup-shaped indentation in the bone or a deeply cavitating cyst within the bone (cavitating pattern), (2) histologically malignant growth, but lack of apparent bone invasion (non-cavitating pattern). The microscopical appearance corresponded to imaging findings in a majority of cases, with cavitating forms presenting with a cyst-like pattern of bone loss or an expansile mass on imaging and non-cavitating forms showing an infiltrative pattern of bone destruction on imaging. These features suggest two distinct biological behaviours of COPSCC.

  17. Necrotizing Myositis in a Neutropenic Patient: The Use of Ultrasound in the Diagnosis of Atypical Presentations

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    Maria Del Carmen Torrejón

    2014-01-01

    Full Text Available We report a case of fatal necrotizing soft tissue infection (NSTI due to Clostridium perfringens (CP in a neutropenic patient with diabetes mellitus. As in many cases, by the time a diagnosis was made, the condition had rapidly progressed to its late stages, resulting in a fatal outcome. The emergency physician should be aware of NSTI as a complication when patients present with pain out of proportion to physical findings and/or signs of soft tissue compromise. Negative prognostic factors for survival are diabetes mellitus, immunosuppression, age, and toxic shock syndrome. A bedside ultrasound scan allows for rapid evaluation in time-sensitive critically ill patients and can promote prompt treatment without the need to delay for further imaging studies.

  18. Brugada syndrome masquerading as acute myocardial infarction in a patient presenting with ventricular fibrillation

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    @@ Idiopathic ventricular fibrillation (VF) has been reported to account for 3%-9% of all sudden arrhythmic deaths.1 In 1991, Pedro and Josep Brugada first described a subgroup of patients with idiopathic VF who presented with a right bundle branch block (RBBB) pattern and marked ST-segment elevation in the right precordial leads V1-V3 during sinus rhythm in the absence of any structural heart disease.2 This is now known as the Brugada syndrome. In Hong Kong the first two cases of Brugada syndrome were reported in April 1999 in local medical literature. Since then more patients from different local hospitals were identified to suffer from the syndrome. We report here a male patient suffering from Brugada syndrome which masqueraded as an acute anteroseptal myocardial infarction 10 years ago.

  19. PATIENT WITH HUNTINGTON’S DISEASE, PRESENTING AS PSYCHOTIC DISORDER – CASE REPORT

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    Lilijana Horvat

    2001-06-01

    Full Text Available Background. Huntington’s disease (HD is rare. It usually starts with choreatic movements and cognitive impairment, progressing to dementia. A case report revealing diagnostic difficulties in a patient with HD, which began as psychotic disorder is presented. Patient was treated for almost five years in psychiatric outpatients’ service and psychiatric hospital due to a treatment-resistant psychotic disorder. Choreatic movements emerged during the fourth year of the treatment and were misdiagnosed as tardive dyskinesia. Prominent deterioration of cognitive functions demanded further diagnostics. With genetic tests HD was diagnosed.Conclusions. The start of HD with psychotic disorder is less common. In patients with treatment-resistant psychoses other somatic disorders should be considered.

  20. Psychiatric symptoms are present in most of the patients with idiopathic normal pressure hydrocephalus

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    Matheus F. Oliveira

    2014-06-01

    Full Text Available Normal pressure hydrocephalus (NPH is characterized by gait disturbance, dementia and/or urinary incontinence associated with dilation of ventricular system with normal opening cerebrospinal fluid pressure. Wide scientifical evidence confirms association between NPH and psychiatric symptoms. We selected 35 patients with idiopathic normal pressure hydrocephalus from January 2010 to January 2012 in a Brazilian tertiary hospital and performed a formal psychiatric evaluation to identify psychiatric disorders. Psychiatric disorders were present in 71% of these patients, especially anxiety, depression and psychotic syndromes. NPH patients may develop symptoms with frontal dominance, such as personality changes, anxiety, depression, psychotic syndromes, obsessive compulsive disorder, Othello syndrome; shoplifting and mania. Unusual appearances of NPH symptoms may hinder early diagnosis and consequently proper treatment.

  1. Increased plasma dopamine in patients presenting with the pseudopheochromocytoma quandary: retrospective analysis of 10 years' experience.

    Science.gov (United States)

    Kuchel, O

    1998-10-01

    A retrospective analysis was made to determine alternative diagnoses in patients with predominantly hypertensive episodes who were suspected of having pheochromocytoma but in whom this diagnosis was eliminated. Analysis of a random university hospital population referred over a period of 10 years. Episodic clinical presentations of pheochromocytoma symptoms combined with a comparison of baseline and episodic radioenzymatically determined levels of plasma free norepinephrine and epinephrine were examined, together with prospective levels of plasma free and sulfated dopamine. Out of 63 patients presenting with episodes of palpitations, headaches, flushing, sweating and hyperventilation (associated with hypertension in 49 patients, with hypotension in six patients and with alternating hyper- and hypotension in eight patients), 14 were diagnosed as having idiopathic hypovolemia, nine as having mastocytosis, nine as having an adrenal tumor, four as having neurogenic hypertension and one each with cocaine abuse and reninoma. Both baseline and symptomatic levels of plasma free norepinephrine and epinephrine remained within physiological limits (exceeding them moderately in baroreceptor dysfunction only), but all subgroups had a mean episodic increase over baseline in plasma dopamine sulfate (mean+/-SEM 16.7+/-5.9 to 53.2+/-19 pmol/ml; P pheochromocytoma in hemodynamic instability and frequent flushing formed a heterogeneous group, with plasma norepinephrine and epinephrine usually within physiological limits but an overall mean threefold increase in dopamine sulfate concentrations. With the various diagnoses of idiopathic hypovolemia, mastocytosis, neurogenic, secondary hypertension and cocaine abuse eliminated as a cause of pheochromocytoma-like symptoms, at least half of these patients still had unexplained, predominantly emotionally or proprioreceptive stimulation-provoked, bouts of hypertension. Sympathetic arousal dominated by an increase in dopamine sulfate without

  2. Diabetes Is Associated with Worse Clinical Presentation in Tuberculosis Patients from Brazil: A Retrospective Cohort Study.

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    Leonardo Gil-Santana

    Full Text Available The rising prevalence of diabetes mellitus (DM worldwide, especially in developing countries, and the persistence of tuberculosis (TB as a major public health issue in these same regions, emphasize the importance of investigating this association. Here, we compared the clinical profile and disease outcomes of TB patients with or without coincident DM in a TB reference center in Brazil.We performed a retrospective analysis of a TB patient cohort (treatment naïve of 408 individuals recruited at a TB primary care center in Brazil between 2004 and 2010. Data on diagnosis of TB and DM were used to define the groups. The study groups were compared with regard to TB disease presentation at diagnosis as well as to clinical outcomes such as cure and mortality rates upon anti-tuberculosis therapy (ATT initiation. A composite score utilizing clinical, radiological and microbiological parameters was used to compare TB severity between the groups.DM patients were older than non-diabetic TB patients. In addition, diabetic individuals more frequently presented with cough, night sweats, hemoptysis and malaise than those without DM. The overall pattern of lung lesions assessed by chest radiographic examination was similar between the groups. Compared to non-diabetic patients, those with TB-diabetes exhibited positive acid-fast bacilli in sputum samples more frequently at diagnosis and at 30 days after ATT initiation. Notably, higher values of the TB severity score were significantly associated with TB-diabetes comorbidity after adjustment for confounding factors. Moreover, during ATT, diabetic patients required more frequent transfers to TB reference hospitals for complex clinical management. Nevertheless, overall mortality and cure rates were indistinguishable between the study groups.These findings reinforce the idea that diabetes negatively impacts pulmonary TB severity. Our study argues for the systematic screening for DM in TB reference centers in endemic

  3. Diabetes Is Associated with Worse Clinical Presentation in Tuberculosis Patients from Brazil: A Retrospective Cohort Study

    Science.gov (United States)

    Hickson, Lucas S.; Daltro, Carla; Castro, Simone; Kornfeld, Hardy; Netto, Eduardo M.; Andrade, Bruno B.

    2016-01-01

    Background The rising prevalence of diabetes mellitus (DM) worldwide, especially in developing countries, and the persistence of tuberculosis (TB) as a major public health issue in these same regions, emphasize the importance of investigating this association. Here, we compared the clinical profile and disease outcomes of TB patients with or without coincident DM in a TB reference center in Brazil. Methods We performed a retrospective analysis of a TB patient cohort (treatment naïve) of 408 individuals recruited at a TB primary care center in Brazil between 2004 and 2010. Data on diagnosis of TB and DM were used to define the groups. The study groups were compared with regard to TB disease presentation at diagnosis as well as to clinical outcomes such as cure and mortality rates upon anti-tuberculosis therapy (ATT) initiation. A composite score utilizing clinical, radiological and microbiological parameters was used to compare TB severity between the groups. Results DM patients were older than non-diabetic TB patients. In addition, diabetic individuals more frequently presented with cough, night sweats, hemoptysis and malaise than those without DM. The overall pattern of lung lesions assessed by chest radiographic examination was similar between the groups. Compared to non-diabetic patients, those with TB-diabetes exhibited positive acid-fast bacilli in sputum samples more frequently at diagnosis and at 30 days after ATT initiation. Notably, higher values of the TB severity score were significantly associated with TB-diabetes comorbidity after adjustment for confounding factors. Moreover, during ATT, diabetic patients required more frequent transfers to TB reference hospitals for complex clinical management. Nevertheless, overall mortality and cure rates were indistinguishable between the study groups. Conclusions These findings reinforce the idea that diabetes negatively impacts pulmonary TB severity. Our study argues for the systematic screening for DM in TB

  4. [Fever as the presenting manifestation of colon cancer: a case series of 11 patients].

    Science.gov (United States)

    Lecoules, S; Carmoi, T; Klotz, C; Rapp, C; Perrot, G; Galeano, C; Algayres, J-P

    2013-03-01

    Fever happens frequently in colon cancer but it is rarely the presenting manifestation. We report a case series of patients with colon cancer revealed by fever in the three military hospitals in Paris. Of the 11 patients studied, seven were men and four were women, and their mean age was 70 years. Cancer was localized in the sigmoid colon (n=6), left colon (n=3) and right colon (n=2). Cancer staging (UICC TNM classification 2002) was respectively pTis (n=1), I (n=4), II (n=3) and III (n=3). Fever was the only reason for admission and two patients had a recurrent fever of unknown origin. All patients but one had bacterial infection. Blood cultures grew up in six cases, Escherichia coli (n=3), Streptococcus gallolyticus (ex bovis) (n=2) and anaerobic bacteria (n=1). There was one case of infective endocarditis caused by S. gallolyticus. Imaging showed a liver abscess (n=3) and a colon cancer complicated by an abscess (n=3). In seven patients, a familial history of colon cancer and symptoms of underlying colic disease were present (neglected rectal bleeding, iron deficiency anaemia, clinical evidence of an abdominal mass). Fever may reveal colon cancer at an early stage. Its main cause is a bacterial infection, such as bacteremia or abscess. Fever of unknown origin is a rare presentation. Detailed history, careful clinical examination and analysis of imaging contribute to recommend the prescription of colonoscopy. Copyright © 2012 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  5. Transient ischemic attack presenting in an elderly patient with transient ophthalmic manifestations

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    Sparshi Jain

    2016-01-01

    Full Text Available Transient ischemic attack (TIA is a transient neurological deficit of cerebrovascular origin without infarction which may last only for a short period and can have varying presentations. We report a case of 58-year-old male with presenting features of sudden onset transient vertical diplopia and transient rotatory nystagmus which self-resolved within 12 h. Patient had no history of any systemic illness. On investigating, hematological investigations and neuroimaging could not explain these sudden and transient findings. A TIA could possibly explain these sudden and transient ocular findings in our patient. This case report aims to highlight the importance of TIA for ophthalmologists. We must not ignore these findings as these could be warning signs of an impending stroke which may or may not be detected on neuroimaging. Thus, early recognition, primary prevention strategies, and timely intervention are needed.

  6. Disseminated tuberculosis presenting with finger swelling in a patient with tuberculous osteomyelitis: a case report

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    Caplivski Daniel

    2005-11-01

    Full Text Available Abstract Background Extrapulmonary manifestations of tuberculosis have become increasingly important in the era of HIV/AIDS. Case presentation We describe a case of tuberculosis (TB dactylitis in a patient with AIDS who originated from the Ivory Coast. The diagnosis was established by direct visualization of acid-fast bacilli on joint fluid and bone biopsy of the proximal phalanx. Imaging of the chest revealed multiple bilateral nodules. Confirmation of the diagnosis was made by isolation of Mycobacterium tuberculosis from sputum and bone cultures. Conclusion Tuberculosis should be considered in patients with unusual soft tissue or skeletal lesions, especially when an immunosuppressive condition is present. Ziehl-Neelsen staining and culture of tissue obtained via surgical biopsy offer the most direct approach to diagnosis.

  7. Transient ischemic attack presenting in an elderly patient with transient ophthalmic manifestations.

    Science.gov (United States)

    Jain, Sparshi; Saxena, Tishu; Singh, Sweta; Singh, Nidhi

    2016-01-01

    Transient ischemic attack (TIA) is a transient neurological deficit of cerebrovascular origin without infarction which may last only for a short period and can have varying presentations. We report a case of 58-year-old male with presenting features of sudden onset transient vertical diplopia and transient rotatory nystagmus which self-resolved within 12 h. Patient had no history of any systemic illness. On investigating, hematological investigations and neuroimaging could not explain these sudden and transient findings. A TIA could possibly explain these sudden and transient ocular findings in our patient. This case report aims to highlight the importance of TIA for ophthalmologists. We must not ignore these findings as these could be warning signs of an impending stroke which may or may not be detected on neuroimaging. Thus, early recognition, primary prevention strategies, and timely intervention are needed.

  8. Predictors of Recurrent Hospital Admission for Patients Presenting With Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State

    Science.gov (United States)

    Bradford, Annabel L.; Crider, Courtney Champagne; Xu, Xizheng; Naqvi, Syed Hasan

    2017-01-01

    Background Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are two serious, preventable complications of diabetes mellitus. Analysis of variables associated with recurrent DKA and HHS admission has the potential to improve patient outcomes by identifying possible areas for intervention. The aim of this study was to evaluate potential predictors of recurrent DKA or HHS admission. Methods This was a retrospective case-control study of 367 patients presenting during a 5-year period with DKA or HHS at a US tertiary academic medical center. Six potential readmission risk factors identified via literature review were coded as “1” if present and “0” if absent. Readmission odds ratios (ORs) for each risk factor and for the combined score of significant risk factors were calculated by logistic regression. Results Readmission odds were significantly increased for patients with age 10.6% on admission and ethnic minority status did not significantly increase readmission odds, with inadequate study power for these variables. A total “ABCD” score, based on Age (< 35 years), Behavioral health (depression), insurance Coverage (self-pay/publicly funded insurance), and Drug/alcohol abuse, also had a significant effect on readmission odds. Conclusions Consideration of individual risk factors and the use of a scoring system based on objective predictors of recurrent DKA and HHS admission could be of value in helping identify patients with high readmission risk, allowing interventions to be targeted most effectively to reduce readmission rates, associated morbidity, and mortality. PMID:27924173

  9. Leptomeningeal metastases presenting exclusively with ocular disturbance in 34 patients: A tertiary care cancer hospital experience.

    Science.gov (United States)

    Mayer, Rory Richard; Frankfort, Benjamin Jay; Strickland, Ben A; Debnam, James Matthew; McCutcheon, Ian E; Groves, Morris D; Weinberg, Jeffrey S

    2017-02-16

    Leptomeningeal disease (LMD) represents disseminated intracranial metastatic disease that requires early detection and initiation of therapy. Patients with LMD typically present with a variety of neurologic problems, including ocular disturbances. However, little is reported on LMD presenting exclusively with ocular-related disturbances in the absence of any other central nervous system (CNS) dysfunction. Our goal was to describe the workup for ocular disturbances in the setting of known cancer diagnosis. Retrospective case study utilizing prospectively collected database at a tertiary cancer care center for all patients with diagnosis of LMD between 2001 and 2009. Main outcome was descriptive analysis of ocular findings by primary or admitting service with or without formal ophthalmology exam in workup for LMD. 34 patients demonstrated ocular disturbances without any other CNS manifestations. Our findings demonstrate that 71% of ocular disturbances were detected by the primary admitting services. Formal consultation with ophthalmology resulted in the detection of the remaining cases. The most common findings were cranial nerve deficits, papilledema, and optic disc or retinal infiltration by tumor. These findings supported a further work-up for CNS disease. Therefore, it is appropriate to refer cancer patients with visual complaints or findings on exam to ophthalmology to evaluate for evidence suggestive of LMD that may support a further work-up.

  10. [The early postoperative rehabilitation of the patients presenting with cholelithiasis and experiencing psychoemotional stress].

    Science.gov (United States)

    Poddubnaia, O A; Marsheva, S I

    2013-01-01

    Early postoperative rehabilitation of the patients presenting with cholelithiasis and experiencing psychoemotional stress is designed to restore the function of bile secretion, enhance their adaptive capabilities, and normalize the psychovegetative status for the purpose of preventing further progress of the disease and reducing the risk of the development of post-cholecystectomy syndrome. The inclusion of drinking mineral water, magnetic laser therapy, and UHF therapy in the combined rehabilitative treatment of such patients results in the appreciable enhancement of all functional abilities of the body manifest as the significant improvement and normalization of clinical and laboratory characteristics (elimination of clinical symptoms of the disease, improvement of general and biochemycal parameters of peripheral blood). Simultaneously, the adaptive capabilities and the psychovegetative status of the patients improved as apparent from the increased lymphocyte count, normalization of the Kerdo and Hildebrandt indices and indices of stress level, decreased psychoemotional stress, enhancement of physical functioning characteristics. Taken together, these changes account for the high effectiveness of the above procedures of early postoperative rehabilitation of the patients presenting with cholelithiasisand experiencing psychoemotional stress (94.7%).

  11. Factors Associated with Opioid Use in a Cohort of Patients Presenting for Surgery

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    Jennifer M. Hah

    2015-01-01

    Full Text Available Objectives. Patients taking opioids prior to surgery experience prolonged postoperative opioid use, worse clinical outcomes, increased pain, and more postoperative complications. We aimed to compare preoperative opioid users to their opioid naïve counterparts to identify differences in baseline characteristics. Methods. 107 patients presenting for thoracotomy, total knee replacement, total hip replacement, radical mastectomy, and lumpectomy were investigated in a cross-sectional study to characterize the associations between measures of pain, substance use, abuse, addiction, sleep, and psychological measures (depressive symptoms, Posttraumatic Stress Disorder symptoms, somatic fear and anxiety, and fear of pain with opioid use. Results. Every 9-point increase in the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R score was associated with 2.37 (95% CI 1.29–4.32 increased odds of preoperative opioid use (p=0.0005. The SOAPP-R score was also associated with 3.02 (95% CI 1.36–6.70 increased odds of illicit preoperative opioid use (p=0.007. Also, every 4-point increase in baseline pain at the future surgical site was associated with 2.85 (95% CI 1.12–7.27 increased odds of legitimate preoperative opioid use (p=0.03. Discussion. Patients presenting with preoperative opioid use have higher SOAPP-R scores potentially indicating an increased risk for opioid misuse after surgery. In addition, legitimate preoperative opioid use is associated with preexisting pain.

  12. Epidermal Nevus Presenting in a Pediatric Patient With Pallister-Killian Syndrome.

    Science.gov (United States)

    Nelson, Garrett; Iyengar, Sanjana; Shenefelt, Philip

    2016-01-01

    A six-year-old boy with Pallister-Killian syndrome (PKS) presented to the clinic with extensive lesions on his body (Figure 1). The patient was not born with the lesions but began developing them on the head and neck, extending to his lower extremities, at 2 years of age. These lesions had been evaluated by his primary care physician and were previously treated with desonide and ketoconazole cream with little improvement.

  13. Do patients suffering from Alzheimer's disease present an own-age bias in face recognition?

    Science.gov (United States)

    Bortolon, Catherine; Louche, Aurore; Gély-Nargeot, Marie-Christine; Raffard, Stéphane

    2015-10-01

    Face perception depends both on the face and on the individual who perceives it. Some factors such as gender, ethnicity or age may influence face perception processing. For instance, recognition memory for faces of one's own age group is often superior to memory for other-age group faces. This bias is known as the Own-Age-Bias (OAB). OAB has been extensively studied in healthy subjects. However, to our knowledge, no article has been published on elder adults suffering from Alzheimer Disease (AD). Therefore, the present research aimed at studying the OAB in patients with AD in comparison with healthy old adults and healthy young adults. Sixty participants were included: 20 young adults, 20 healthy old adults, and 20 elder patients who met NINCDS-ADRDA criteria for probable AD. Participants performed an age estimation task followed by a face recognition task. Indeed, for each photograph, subjects were asked to say if the face looked young or old and to give a yes/no judgment of familiarity (after an encoding phase). Participants also completed a questionnaire assessing their frequency of contact with young and old adults. Although estimates of sensitivity indicated no age bias in AD patients, when memory bias was corrected according to their performance we found evidence in favor of an OAB in this group. Both healthy groups presented an OAB, in particular when the corrected memory bias was considered. However, no significant correlations were found between their frequency of contact with young/older people and the number of correctly identified faces, false alarms, sensitivity and corrected memory bias. Therefore, although AD patients present a deficit in face-memory, they still present memory bias towards same-age group faces when their difficulties in face memory are controlled.

  14. Progressive multifocal leukoence-phalopathy presenting as homonymous hemianopia in a patient with acquired immunodeficiency syndrome

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    Amit Pandey

    2012-01-01

    Full Text Available We present a case of a Human Immunodeficiency Virus (HIV positive patient who was referred for retinal evaluation to rule out ophthalmic manifestations of Acquired Immunodeficiency Syndrome (AIDS. She complained of some disturbance in vision in both eyes. Fundus examination showed no abnormality. Perimetry, done to rule out optic nerve pathology, showed a left homonymous hemianopia. Magnetic Resonance Imaging (MRI scan showed features of Progressive Multifocal Leukoencephalopathy (PML. She had no other neurological symptoms or signs.

  15. [Acute cerebral ischemia: an unusual clinical presentation of isolated left ventricular noncompaction in an adult patient].

    Science.gov (United States)

    Fiorencis, Andrea; Quadretti, Laura; Bacich, Daniela; Chiodi, Elisabetta; Mele, Donato; Fiorencis, Roberto

    2013-01-01

    Isolated left ventricular noncompaction in adults is uncommon. The most frequent clinical manifestations are heart failure due to left ventricular systolic dysfunction and supraventricular and ventricular arrhythmias, which may be sustained and associated with sudden death. Thromboembolic complications are also possible. We report the case of an adult patient with isolated left ventricular noncompaction who came to our observation because of acute cerebral ischemia, an initial presentation of the disease only rarely described.

  16. Situs inversus totalis with azoospermia in a patient presenting with liver abscess

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    P. Mohan Rao

    2014-04-01

    Full Text Available Situs inversus with dextrocardia is a rare congenital anomaly. Azoospermia and situs inversus may be encountered in ciliary dyskinesia syndromes. We report the case of a 30-year-old male who manifested situs inversus totalis, dextrocardia and azoospermia with maturation arrest at primary spermatogenesis who presented with liver abscess. The patient responded well to treatment with i.v. metronidazole and oral chloroquine.

  17. Lenalidomide and Dexamethasone for a Patient of POEMS Syndrome Presenting with Massive Ascites

    OpenAIRE

    Shuji Ueda; Sayoko Yonemoto; Kazumasa Oka; Naohiko Fujii; Keiichi Nakata; Hitomi Matsunaga; Seiko Kataoka; Yuki Iwama; Hiroyuki Narahara; Yuichi Yasunaga; Yoshiaki Inui; Sumio Kawata

    2014-01-01

    POEMS syndrome is a multisystem disorder characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes. POEMS syndrome is a rare cause of refractory ascites. We report the case of a patient with POEMS syndrome presenting with massive ascites who was treated with very-low-dose lenalidomide and dexamethasone. A 57-year-old Japanese man was admitted to our hospital with pleural effusion, massive ascites, and leg edema. The diagnosis of POEMS syndrome was ...

  18. Primary Neuritic Hansen's Disease presenting as Ulnar Nerve Abscess in a Human Immunodeficiency Virus Positive Patient.

    Science.gov (United States)

    Karjigi, S; Herakal, K; Murthy, S C; Bathina, A; Kusuma, M R; Nikhil, K R Y

    2015-01-01

    Leprosy has been increasingly known to have an enigmatic relationship with human immunodeficiency virus infection. Co-infection may result in atypical manifestations of leprosy. A 45-year old human immunodeficiency virus-positive male; agricultural laborer presented with a swelling over right elbow, right hand deformity, generalized itching and recurrent vesicles overthe perinasal area. Clinical and investigational findings were consistent with mononeuritic type of Hansen's disease with right sided silent ulnar nerve abscess, partial claw hand. CD4+ count of the patientwas 430 cells/cmm. This patient also hadherpes simplex labialis, with HIV-associated pruritus. To the best of our knowledge such an atypical presentation has not been reported earlier.

  19. Unusual Presentation of Central Diabetes Insipidus in a Patient With Neurosarcoidosis.

    Science.gov (United States)

    Sanghi, Vedha; Kapoor, Aanchal

    2016-01-01

    Hypernatremia is a frequent cause of intensive care unit admission. The patient presented in this article had hypernatremia refractory to D5W (dextrose 5% water) therapy, which led to a complex investigation. Workup revealed central diabetes insipidus most likely secondary to flare up of neurosarcoidosis. The challenge in terms of diagnosis was a presentation with low urine output in the setting of hypernatremia resistant to treatment with desmopressin. This case unfolded the role of hypothyroidism causing secondary renal dysfunction and hence needed continued treatment with thyroxine in addition to treatment for hypernatremia.

  20. A pilot cross-sectional study of patients presenting with cellulitis to emergency departments.

    LENUS (Irish Health Repository)

    Quirke, M

    2014-11-01

    To characterise the Emergency Department (ED) prevalence of cellulitis, factors predicting oral antibiotic therapy and the utility of the Clinical Resource Efficiency Support Team (CREST) guideline in predicting patient management in the ED setting, a prospective, cross-sectional study of consecutive adult patients presenting to 3 Irish EDs was performed. The overall prevalence of cellulitis was 12 per 1,000 ED visits. Of 59 patients enrolled, 45.8% were discharged. Predictors of treatment with oral antibiotics were: CREST, Class 1 allocation (odds ratio (OR) 6.81, 95% Cl =1.5-30.1, p=0.012), patient self-referral (OR= 6.2, 95% Cl 1.9- 20.0, p=0.03) and symptom duration longer than 48 hours (OR 1.2, 95% Cl = 1.0-1.5,p=0.049). In conflict with guideline recommendation, 43% of patients in CREST Class 1 received IV therapy. Treatment with oral antibiotics was predicted by CREST Class 1 allocation, self-referral, symptom duration of more than 48 hours and absence of pre-EO antibiotic therapy.

  1. Three patients presenting with severe macrosomia and congenital hypertrophic cardiomyopathy: a case series.

    Science.gov (United States)

    Vincent, Marie; Benbrik, Nadir; Romefort, Bénédicte; Colombel, Agnès; Bézieau, Stéphane; Isidor, Bertrand

    2017-03-24

    Macrosomia and hypertrophic cardiomyopathy are two features often associated in neonates of diabetic mothers. We report the cases of three patients with severe macrosomia and critical hypertrophic cardiomyopathy without severely unbalanced maternal diabetes. Only three patients with those two features and no uncontrolled maternal diabetes have been previously reported. The first patient was a 39-week-old girl, the second patient was a 39-week-old girl, and the third patient was a 41-week-old boy. The two French girls and the French boy had severe macrosomia and hypertrophic cardiomyopathy, leading to the death of the boy. The outcome of the two girls was favorable, with a standardization of growth curves and ventricular hypertrophy. Their mothers presented with high body mass index but no severe documented maternal diabetes; glycemic imbalance was only suspected on postnatal analyses. There was no hydramnios during pregnancy and no other environmental factor, especially toxic exposure. Their parents are from Mayotte, Guadeloupe, and Guinea-Conakry. The usual genetics causes, Beckwith-Wiedemann syndrome, and chromosomal copy number variation, were also excluded. This report suggests the implication of other factors in addition to glycemic disorders, including genetic factors, in the occurrence of macrosomia and severe hypertrophic cardiomyopathy in neonates. These three original observations indicate that gynecologists and neonatologists should pay attention to neonates from mothers with a high body mass index and when maternal diabetes is not documented.

  2. Prevalence of immune disease in patients with wounds presenting to a tertiary wound healing centre.

    Science.gov (United States)

    Shanmugam, Victoria K; Schilling, Amber; Germinario, Anthony; Mete, Mihriye; Kim, Paul; Steinberg, John; Attinger, Christopher E

    2012-08-01

    Chronic leg ulcers are a significant cause of morbidity and mortality and account for considerable healthcare and socioeconomic costs. Leg ulcers are a recognised complication of immune disease, and the purpose of this study was to establish the prevalence of immune disease in a cohort of patients with chronic wounds, and to compare wound outcomes in the subjects with and without immune disease. Retrospective chart review was completed on consecutive patients scheduled with the plastic surgeon in the Georgetown University Center for Wound Healing between 1 January 2009 and 31 March 2009. Of the 520 patients scheduled for appointments, 340 were eligible for inclusion. The prevalence of immune disease was higher than expected with 78 of 340 patients (23%) having associated immune disease. At presentation, wounds in patients with immune disease had a significantly larger mean surface area [33·4 cm(2) (69·05) compared to 22·5 cm(2) (63·65), P = 0·02]. Split thickness skin graft (STSG) and bioengineered alternative tissue (BAT) graft data was available on 177 grafts from 55 subjects. There was a significantly lower response rate to STSG in subjects with immune disease (50% compared to 97%, P = 0·0002), but response rates to BAT were not different. The association between immune diseases and chronic wounds may provide unique insights into pathways of wound healing, and warrants further study.

  3. [Balanitis xerotica obliterans with phimosis in elderly patients presenting with difficulty in urination].

    Science.gov (United States)

    Nemoto, Kaoru; Ishidate, Takuzo

    2013-06-01

    Eight elderly patients (average age 76.1±4.3 years) with balanitis xerotica obliterans (BXO) accompanied by phimosis presented with difficulty in urination. Preoperative average international prostate symptom score, average maximum urinary flow rate, and average volume of residual urine were 20.7±6.3 points (n=8), 5.1±3.6 ml/s (n=5), and 85.4±77.3 ml (n=8), respectively. Some of the patient's complaints, such as severe dribbling of urine, urinary stream division, and ballooning of the foreskin, were not included in the items of the major questionnaire on urination. Dorsal incision and circumcision was performed in all patients, and all were pathologically diagnosed with BXO. Meatoplasty was performed in one patient with a meatal stenosis. No coexistence of penile cancer was observed. Statistically significant improvements were observed in subjective and objective findings after treatment. In conclusion, BXO with phimosis in elderly patients should be considered as a cause of lower urinary tract symptoms.

  4. Campylobacter concisus pathotypes are present at significant levels in patients with gastroenteritis.

    Science.gov (United States)

    Underwood, Alexander P; Kaakoush, Nadeem O; Sodhi, Nidhi; Merif, Juan; Seah Lee, Way; Riordan, Stephen M; Rawlinson, William D; Mitchell, Hazel M

    2016-03-01

    Given that Campylobacter jejuni is recognized as the most common cause of bacterial gastroenteritis worldwide, recent findings showing comparable levels of Campylobacter concisus in patients with gastroenteritis would suggest that this bacterium is clinically important. The prevalence and abundance of Campylobacter concisus in stool samples collected from patients with acute gastroenteritis was examined using quantitative real-time PCR. The associated virulence determinants exotoxin 9 and zonula occludens toxin DNA were detected for Campylobacter concisus-infected samples using real-time PCR. Campylobacter concisus was detected at high prevalence in patients with gastroenteritis (49.7 %), higher than that observed for Campylobacter jejuni (∼5 %). The levels of Campylobacter concisus were putatively classified into clinically relevant and potentially transient subgroups based on a threshold developed using Campylobacter jejuni levels, as the highly sensitive real-time PCR probably detected transient passage of the bacterium from the oral cavity. A total of 18 % of patients were found to have clinically relevant levels of Campylobacter concisus, a significant number of which also had high levels of one of the virulence determinants. Of these patients, 78 % were found to have no other gastrointestinal pathogen identified in the stool, which strongly suggests a role for Campylobacter concisus in the aetiology of gastroenteritis in these patients. These results emphasize the need for diagnostic laboratories to employ identification protocols for emerging Campylobacter species. Clinical follow-up in patients presenting with high levels of Campylobacter concisus in the intestinal tract is needed, given that it has been associated with more chronic sequelae.

  5. Respiratory Presentation of Pediatric Patients in the 2014 Enterovirus D68 Outbreak

    Directory of Open Access Journals (Sweden)

    Georgina Martin

    2016-01-01

    Full Text Available Background. In the fall of 2014, a North American outbreak of enterovirus D68 resulted in a significant number of pediatric hospital admissions for respiratory illness throughout North America. This study characterized the clinical presentation and risk factors for a severe clinical course in children admitted to British Columbia Children’s Hospital during the 2014 outbreak. Methods. Retrospective chart review of patients with confirmed EV-D68 infection admitted to BCCH with respiratory symptoms in the fall of 2014. Past medical history, clinical presentation, management, and course in hospital was collected and analyzed using descriptive statistics. Comparison was made between those that did and did not require ICU admission to identify risk factors. Results. Thirty-four patients were included (median age 7.5 years. Fifty-three percent of children had a prior history of wheeze, 32% had other preexisting medical comorbidities, and 15% were previously healthy. Ten children (29% were admitted to the pediatric intensive care unit. The presence of complex medical conditions (excluding wheezing (P=0.03 and copathogens was associated with PICU admission (P=0.02. Conclusions. EV-D68 infection resulted in severe, prolonged presentations of asthma-like illness in the hospitalized pediatric population. Patients with a prior history of wheeze and preexisting medical comorbidities appear to be most severely affected, but the virus can also cause wheezing in previously well children.

  6. Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions

    DEFF Research Database (Denmark)

    El-Galaly, Tarec Christoffer; Hutchings, Martin; Juul Mylam, Karen;

    Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions......Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions...

  7. Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions

    DEFF Research Database (Denmark)

    El-Galaly, Tarec Christoffer; Hutchings, Martin; Juul Mylam, Karen

    Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions......Clinical Features and Outcome in Newly Diagnosed Hodgkin Lymphoma Patients Presenting with PET/CT-Ascertained Focal Skeletal Lesions...

  8. Severe disease presentation and poor outcomes among pediatric systemic lupus erythematosus patients in South Africa.

    Science.gov (United States)

    Lewandowski, L B; Schanberg, L E; Thielman, N; Phuti, A; Kalla, A A; Okpechi, I; Nourse, P; Gajjar, P; Faller, G; Ambaram, P; Reuter, H; Spittal, G; Scott, C

    2016-08-03

    Systemic lupus erythematosus (SLE) is a life-threatening multisystem autoimmune disease that is more severe in patients of African ancestry and children, yet pediatric SLE on the African continent has been understudied. This study describes a cohort of pediatric SLE (PULSE) patients in South Africa. Patients with a diagnosis of SLE (1997 American College of Rheumatology criteria) diagnosed prior to age 19 years in Cape Town, South Africa, were enrolled in this cross-sectional study from September 2013 to December 2014. Information on clinical and serological characteristics was extracted from medical records. Results were compared to a well-described North American pediatric SLE cohort. Seventy-two South African patients were enrolled in the study; mean age 11.5 years; 82% were girls. The racial distribution was 68% Coloured, 24% Black, 5% White and 3% Asian/Indian. Most patients presented with severe lupus nephritis documented by renal biopsy (61%). Of patients with lupus nephritis, 63% presented with International Society of Nephrology/Renal Pathology Society class III or IV. Patients in the PULSE cohort were more likely to be treated with cyclophosphamide, methotrexate and azathioprine. The PULSE cohort had high disease activity at diagnosis (mean Systemic Lupus Erythematosus Disease Activity Index-2K (SLEDAI-2K) 20.6). The SLEDAI-2K at enrolment in the PULSE cohort (5.0) did not differ from the North American pediatric SLE cohort (4.8). Sixty-three per cent of the PULSE cohort had end organ damage with Systemic Lupus International Collaborating Clinics Damage Index (SLICC-DI) score >0 (mean SLICC-DI 1.9), compared to 23% in a previously reported US cohort. Within the PULSE cohort, nine (13%) developed end-stage renal disease with six (8%) requiring transplant, strikingly higher than North American peers (transplant rate diagnosis and significant disease damage at enrolment in the South African registry. South African patients have severe lupus nephritis and

  9. Effect of music on pain, anxiety, and patient satisfaction in patients who present to the emergency department in Turkey.

    Science.gov (United States)

    Parlar Kilic, Serap; Karadag, Gulendam; Oyucu, Serpil; Kale, Ozlem; Zengin, Suat; Ozdemir, Emine; Korhan, Esra Akin

    2015-01-01

    The objective of this study is to evaluate the effect of music therapy on pain, anxiety, and patient satisfaction in patients who present to the emergency department in Turkey. This controlled and experimental study was conducted in the emergency department of a hospital in Turkey between July and October 2012. The study sample consisted of 200 patients in total, 100 forming the intervention group and 100 being the control group, who fell under color code green in the triage system and came with complaints of pain due to nausea/vomiting and diarrhea, abdominal pain, headaches, and joint pain. A questionnaire, the State Anxiety Scale, and the Visual Analog Scale to measure the patients' level of pain were used in the study. The questionnaires of the intervention group were administered after playing the music. When the intervention and control groups were compared, it was observed that there was a significant decrease in the VASP and STAI-S scores in favor of the intervention group. It was observed that 21.0% of the patients in the intervention group were very pleased to hear music in the emergency department, 58% of them were moderately or at least a little pleased, and 21.0% were not pleased at all. The results showed that music therapy had a positive effect in terms of reducing the severity of pain and the level of anxiety in patients, that only a very small portion of the patients were not pleased to listen to music in the emergency department. © 2014 The Authors. Japan Journal of Nursing Science © 2014 Japan Academy of Nursing Science.

  10. Patients hospitalized for community-acquired pneumonia present reduced functional performance

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    Anderson José

    2013-08-01

    Full Text Available BACKGROUND: Symptoms of fatigue and dyspnea, treatment with oral corticosteroids, high circulating levels of cytokines, and oxidant/antioxidant imbalance in patients hospitalized with community-acquired pneumonia (CAP could affect the patients' exercise tolerance and peripheral muscle strength (PMS. OBJECTIVE: To evaluate the functional capacity (FC of patients hospitalized for CAP and to correlate the FC with length of hospital stay. METHOD: We prospectively evaluated 45 patients (49±16 years; CAP group and 20 healthy subjects (53±17 years; control group. They were randomized to perform, on separate days, a 6-minute walk test (6MWT, a test of PMS, and the Glittre test (GT. Additionally, the SF-36 questionnaire and the MRC scale were completed and evaluated. RESULTS: There were significant differences between the groups (CAP and controls for the 6MWT (381.3±108 vs. 587.1±86.8 m and GT (272.8±104.3 vs. 174±39 sec. The CAP group also presented worse health-related quality of life (HRQoL scores, reduced strength (quadriceps and biceps, and higher scores of dyspnea. The time required to perform the GT correlated with the length of hospital stay (r=0.35, P=0.02 and dyspnea (r=0.36, P=0.02. Significant correlations were observed between GT and 6MWT (r=-0.66, P=0.0001 and between GT with the physical functioning domain of SF-36 (r=-0.51, P=0.0001. CONCLUSIONS: Patients hospitalized for CAP presented with reduced FC, PMS, and HRQoL during hospitalization. In addition, GT performance was related to the length of hospital stay.

  11. Domestic Minor Sex Trafficking Patients: A Retrospective Analysis of Medical Presentation.

    Science.gov (United States)

    Goldberg, Amy P; Moore, Jessica L; Houck, Christopher; Kaplan, Dana M; Barron, Christine E

    2017-02-01

    To describe the clinical characteristics of patients referred for domestic minor sex trafficking (DMST) to improve identification and intervention. Retrospective cohort study. The Lawrence A. Aubin, Sr Child Protection Center at Hasbro Children's Hospital where patients are evaluated by child abuse pediatricians in outpatient, emergency department, and inpatient settings. A total of 41 patients younger than the age of 18 years referred for the evaluation of DMST involvement between August 1, 2013 and March 30, 2015. We collected demographic, social-environmental, medical, and psychiatric variables from the medical records of patients referred for evaluation who have self-disclosed, been reported with evidence, and/or have histories that place them at high risk for DMST involvement. Children had frequent contact with medical providers, with 81% seen in the year before referral for DMST. Childhood maltreatment and family dysfunction were identified (sexual abuse, 21/37 or 57%; parental substance abuse, 22/37 or 60%) in the 41 patients. Children had medical problems (eg, sexually transmitted infection, 13/41 or 32%), psychiatric needs (eg, acute suicidality, 8/41 or 20%; at least 1 previous psychiatric admission, 19/41 or 46%), and substance use (36/41 or 88%). Although 26/41 (63%) had runaway and 17/41 (42%) lived in a group home placement, 28/41 (68%) currently lived at home and 29/41 (71%) presented with a parent/guardian or relative. Children referred for DMST present frequently to physicians and have complex medical and psychiatric needs. Medical providers' increased awareness of this health issue would inform victim identification and intervention. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  12. Spectrum of kidney diseases in patients presented for acute hemodialysis in Kasr Al-Aini School of Medicine

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    Khaled M Sadek

    2017-01-01

    Full Text Available Acute kidney injury (AKI is common in hospitalized patients with mortality varying from 10% to 80%. It is crucial to know the incidence and etiology of AKI to promote prevention strategies. Our study aimed at obtaining a comprehensive review of the pattern and spectrum of patients who presented for emergency hemodialysis to Kasr Al-Aini Hospital between October 2012 and October 2014. We analyzed clinical and laboratory factors in all such patients. Two thousand twenty three patients were included of which patients with AKI were 728 patients (36%. Cardiac diseases were the cause of AKI in 171 patients, other prerenal causes were found in 55 patients, drug induced AKI in 113 patients, and obstetric causes in 48 patients. Glomerulonephritis was responsible for AKI in 101 patients, lupus nephritis was found in 33 patients of them. Patients with chronic kidney disease who presented with acute exacerbation were 243 patients (12%. Patients who were discovered to be with end-stage renal disease during their first presentation itself were 1052 patients (52 %. Diabetes mellitus was present in 50.12%, while hypertension was present in 29.56%. Hepatitis C virus was present in 17.3%, while HBsAg was present in 0.8%. Drugs and obstetric causes represented a larger fraction among our cases than seen in developed countries. Lupus nephritis was also a common cause of AKI.

  13. Antigen presenting cells in the skin of a patient with hair loss and systemic lupus erythematosus

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    Ana Maria Abreu Velez

    2009-01-01

    Full Text Available Context: Hair loss is one of the most striking clinical features of active systemic lupus erythematosus (SLE, however, very few studies have investigated the immunological features of this process. Case report: We describe a 33 years old female who presented with scalp hair loss and arthralgias. Physical examination revealed erythematous plaques on the nose and scalp, with bitemporal hair loss. Scalp biopsies revealed epidermal hyperkeratosis, with a mild interface infiltrate of lymphocytes and histiocytes and a superficial and deep, perivascular and periadnexal infiltrate of mostly CD4 positive cells. Antibodies to HAM 56, CD68, CD1a, S-100, mast cell tryptase and c-kit/CD117 were strongly positive around the hair follicles, and in the adjacent sebaceous glands. Conclusion : We present the first report showing a significant presence of several antigen presenting cells around the hair follicular units in a patient with alopecia in active SLE. Today, antigen presenting cells and dendritic cells (DC are modeled as the master regulators of human immunity. One aspect that has become clearly appreciated is the great diversity of DC subtypes, each with considerable functional differences. Thus, we suggest that APC and DCs are equipped with Pattern Recognition Receptors (PRRs to some hair follicular unit antigens; that these innate sensors recognize conserved molecular patterns on self- tissue, and play a significant role in the pathophysiology of alopecia in SLE patients

  14. An Unusual Presentation of Pseudothrombotic Microangiopathy in a Patient with Autoimmune Atrophic Gastritis

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    Alexandre Malek

    2016-01-01

    Full Text Available Introduction. We hereby describe the case of a young female patient who presented with pseudothrombotic microangiopathy, as well as pancytopenia accompanied by autoimmune atrophic gastritis. Case Presentation. A 36-year-old Caucasian woman presented to the emergency department with fatigue and dyspnea on minimal exertion. Physical examination was unremarkable except for pallor and noninjected conjunctiva. Laboratory tests revealed high LDH and low hemoglobin, white blood cells, platelets, and haptoglobin. The peripheral blood smear showed schistocytes suggestive of pseudothrombotic microangiopathy. Low cobalamin level and hyperhomocysteinemia were also detected. Autoimmune atrophic gastritis was confirmed by gastric biopsy and positive anti-intrinsic factor antibodies. Vitamin B12 supplements were given which led to rapid recovery and normalization of blood parameters. Conclusion. This case highlights the importance and serves as a reminder to clinicians to rule out cobalamin deficiency and autoimmune atrophic gastritis in patients presenting with a picture suggestive of thrombotic thrombocytopenic purpura and pancytopenia, which was completely reversible after appropriate replacement therapy without recurring to unnecessary and invasive procedures such as plasma exchange.

  15. Predictors of a variceal source among patients presenting with upper gastrointestinal bleeding.

    Science.gov (United States)

    Alharbi, Ahmad; Almadi, Majid; Barkun, Alan; Martel, Myriam

    2012-04-01

    Patients with upper gastrointestinal bleeding (UGIB) require an early, tailored approach best guided by knowledge of the bleeding lesion, especially a variceal versus a nonvariceal source. To identify, by investigating a large national registry, variables that would be predictive of a variceal origin of UGIB using clinical parameters before endoscopic evaluation. A retrospective study was conducted in 21 Canadian hospitals during the period from January 2004 until the end of May 2005. Consecutive charts for hospitalized patients with a primary or secondary discharge diagnosis of UGIB were reviewed. Data regarding demographics, including historical, physical examination, initial laboratory investigations, endoscopic and pharmacological therapies administered, as well as clinical outcomes, were collected. Multivariable logistic regression modelling was performed to identify clinical predictors of a variceal source of bleeding. The patient population included 2020 patients (mean [± SD] age 66.3±16.4 years; 38.4% female). Overall, 215 (10.6%) were found to be bleeding from upper gastrointestinal varices. Among 26 patient characteristics, variables predicting a variceal source of bleeding included history of liver disease (OR 6.36 [95% CI 3.59 to 11.3]), excessive alcohol use (OR 2.28 [95% CI 1.37 to 3.77]), hematemesis (OR 2.65 [95% CI 1.61 to 4.36]), hematochezia (OR 3.02 [95% CI 1.46 to 6.22]) and stigmata of chronic liver disease (OR 2.49 [95% CI 1.46 to 4.25]). Patients treated with antithrombotic therapy were more likely to experience other causes of hemorrhage (OR 0.44 [95% CI 0.35 to 0.78]). Presenting historical and physical examination data, and initial laboratory tests carry significant predictive ability in discriminating variceal versus nonvariceal sources of bleeding.

  16. Predictors of a variceal source among patients presenting with upper gastrointestinal bleeding

    Science.gov (United States)

    Alharbi, Ahmad; Almadi, Majid; Barkun, Alan; Martel, Myriam

    2012-01-01

    BACKGROUND: Patients with upper gastrointestinal bleeding (UGIB) require an early, tailored approach best guided by knowledge of the bleeding lesion, especially a variceal versus a nonvariceal source. OBJECTIVE: To identify, by investigating a large national registry, variables that would be predictive of a variceal origin of UGIB using clinical parameters before endoscopic evaluation. METHODS: A retrospective study was conducted in 21 Canadian hospitals during the period from January 2004 until the end of May 2005. Consecutive charts for hospitalized patients with a primary or secondary discharge diagnosis of UGIB were reviewed. Data regarding demographics, including historical, physical examination, initial laboratory investigations, endoscopic and pharmacological therapies administered, as well as clinical outcomes, were collected. Multivariable logistic regression modelling was performed to identify clinical predictors of a variceal source of bleeding. RESULTS: The patient population included 2020 patients (mean [± SD] age 66.3±16.4 years; 38.4% female). Overall, 215 (10.6%) were found to be bleeding from upper gastrointestinal varices. Among 26 patient characteristics, variables predicting a variceal source of bleeding included history of liver disease (OR 6.36 [95% CI 3.59 to 11.3]), excessive alcohol use (OR 2.28 [95% CI 1.37 to 3.77]), hematemesis (OR 2.65 [95% CI 1.61 to 4.36]), hematochezia (OR 3.02 [95% CI 1.46 to 6.22]) and stigmata of chronic liver disease (OR 2.49 [95% CI 1.46 to 4.25]). Patients treated with antithrombotic therapy were more likely to experience other causes of hemorrhage (OR 0.44 [95% CI 0.35 to 0.78]). CONCLUSION: Presenting historical and physical examination data, and initial laboratory tests carry significant predictive ability in discriminating variceal versus nonvariceal sources of bleeding. PMID:22506257

  17. Predictors of Outcome in Patients Presenting with Acute Ischemic Stroke and Mild Stroke Scale Scores.

    Science.gov (United States)

    Kenmuir, Cynthia L; Hammer, Maxim; Jovin, Tudor; Reddy, Vivek; Wechsler, Lawrence; Jadhav, Ashutosh

    2015-07-01

    Although National Institutes of Health Stroke Scale (NIHSS) is a known predictor of outcome in acute ischemic stroke, there are other factors like age, ambulatory status, and ability to swallow that may be predictors of outcome but are not assessed by the traditional NIHSS. The aim of this retrospective review was to identify predictors of outcome in mild ischemic stroke. Discharge outcomes from patients who presented to our large academic stroke center with acute ischemic stroke from 2005 to 2013 were retrospectively reviewed. Of 7189 patients reviewed, 2597 had initial NIHSS less than 5. Outcome measures were modified Rankin Scale (MRS) score 0-1 and discharge to home. In all, 65% of patients with NIHSS 0-4 were discharged directly home independent of treatment. Of those patients discharged to home, 74% were able to ambulate independently and 98% passed their dysphagia screen. Of patients not discharged directly home, 66% were unable to ambulate independently and 21% did not pass their dysphagia screen. Multivariate logistic regression analysis revealed a significant effect of dysphagia screen (P = .001), ability to ambulate independently (P = .002), age (P = .016), and NIHSS (P = .005) on discharge to home but not MRS of 0-1 (P = .564). In patients with mild stroke scale scores defined as NIHSS 0-4, several factors including age, NIHSS, ambulatory status, and ability to swallow may be independent predictors of functional outcome and discharge home. These data support the development of a modified grading system for assessing functional outcome in mild stroke that considers these factors. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. [Twelve years of working of Brazzaville cancer registry].

    Science.gov (United States)

    Nsondé Malanda, Judith; Nkoua Mbon, Jean Bernard; Bambara, Augustin Tozoula; Ibara, Gérard; Minga, Benoît; Nkoua Epala, Brice; Gombé Mbalawa, Charles

    2013-02-01

    The Brazzaville cancer registry was created in 1996 with the support of the International Agency Research against Cancer (IARC) which is located in Lyon, France. The Brazzaville cancer registry is a registry which is based on population which records new cancer cases occurring in Brazzaville by using Canreg 4.0 Software. Its aim is to supply useful information to fight against cancer to physicians and to decision makers. We conducted this study whose target was to determine the incidence of cancer in Brazzaville during twelve years, from January 1st, 1998 to December 31, 2009. During that period 6,048 new cancer cases were recorded: 3,377 women (55.8%), 2,384 men (39.4%), and 287 children (4.8%) from 0 to 14 years old with an annual average of 504 cases. Middle age to the patient's diagnosis was 49.5 years in female sex and 505.5 years old for male sex. The incidence rate of cancers in Brazzaville was 39.8 or 100.000 inhabitants per year and by sex we observed 49 to female sex and 35.2 for male sex. The first cancers localizations observed to women were in order of frequency: breast, cervix uterine, liver ovaries, hematopoietic system, to men : liver, prostate, hematopoietic system, colon and stomach; to children : retina, kidney, hematopoietic system, liver and bones. These rates are the basis to know the burden of cancer among all pathologies of Brazzaville and the achievement of a national cancer control program.

  19. Biventricular noncompaction cardiomyopathy in a patient presenting with new onset seizure: case report.

    Science.gov (United States)

    Odiete, Oghenerukevwe; Nagendra, Ramanna; Lawson, Mark A; Okafor, Henry

    2012-01-01

    Ventricular noncompaction (VNC) of the myocardium is a rare genetic cardiomyopathy caused by a disorder during endocardial morphogenesis and could be accompanied by life-threatening complications. The major clinical manifestations of VNC are heart failure, arrhythmias, and embolic events. The left ventricle is the most commonly reported affected site, but a few cases of right ventricular involvement have also been reported. We report a case of biventricular noncompaction cardiomyopathy in a 31-year-old woman presenting with a new onset seizure. On the second day of her telemetry-monitored hospitalization, she suffered a witnessed ventricular fibrillation arrest requiring emergency direct-current cardioversion and induced hypothermia. Transthoracic echocardiography (TTE) showed isolated left ventricular (LV) noncompaction and depressed LV systolic function. Subsequent cardiac magnetic resonance imaging (MRI) revealed both left and right ventricular noncompaction. This unusual presentation highlights the importance of a complete and thorough evaluation of patients even when presenting with apparently noncardiac symptom(s).

  20. Rare presentation of gall bladder tuberculosis in a non immuno-compromised patient

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    Pawan Kumar

    2015-06-01

    Full Text Available The gall bladder is least common intraabdominal organ to be involved by tuberculosis. It is either part of systemic miliary tuberculosis or abdominal tuberculosis. Isolated gall bladder tuberculosis is even rarer, can presents either as calculus or acalculus cholecystitis. Gall bladder tuberculosis presenting as a localized perforation with a sinus formation into anterior abdominal wall is unreported complication in a non immuno-compromised person. A 48-year old female presented with a gradually increasing swelling in right hypochondrium. Abdominal ultrasound showed superficial collection over right hypochondrium with intraperitoneal extension. Computed tomography showed localized gall bladder perforation with extension to the abdominal wall. Patient underwent emergency exploration and cholecystectomy with excision of sinus tract and drainage of abdominal wall abscess. Histopathological examination showed granulomatous cholecystitis suggestive of tuberculosis of gall bladder with extension into the sinus tract. She had an uneventful recovery and was treated with 6-month antitubercular therapy after surgery.

  1. Aphasic Dystextia as Presenting Feature of Ischemic Stroke in a Pediatric Patient

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    Arpita Lakhotia

    2016-01-01

    Full Text Available Aphasia is an important presenting symptom of acute stroke. With increasing reliance on electronic communication, incoherent texting or “dystextia,” which is a subset of aphasia that is reflected in text messages, can be a useful tool for symptom recognition and analysis. It can be a red flag for the family and therefore can help in early identification of an acute neurological deficit. It is also useful for providers to reliably analyze the deficit as well as establish a timeline of evolution of symptoms. There have been case reports where dystextia has been the presenting feature of stroke or complicated migraine and in one case of meningioma. We present the case of a teenage patient that in our knowledge is the youngest reported case of dystextia, whose aphasia recorded in a text message assisted with stroke localization. This also adds to the literature of dystextia which so far has only seven other cases reported.

  2. Ageing exacerbates damage of systemic and salivary neutrophils from patients presenting Candida-related denture stomatitis

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    Porto Vinicius

    2009-03-01

    Full Text Available Abstract Background Ageing leads to a decline in the function of the immune system, increasing the body's susceptibility to infections through the impairment of T-cells, macrophages, neutrophils and dendritic cells Denture stomatitis is a primary oral disease affecting elderly denture wearers. The major etiologic factor involved in this pathology is the infection by Candida albicans, an opportunistic pathogen that causes local and disseminated diseases in immunosuppressed humans. Neutrophils play a critical role in the immune response against C. albicans and are continually present in the salivary fluid and in the blood. The aim of this study was to determine ageing-related changes in salivary and blood neutrophils and their potential implications in Candida-related denture stomatitis. Results Our results showed a lower number of neutrophils in the saliva from patients presenting Candida-related denture stomatitis in comparison to their matched controls. Furthermore, fewer neutrophils were isolated from the saliva of aged control individuals in comparison to matched younger subjects. CXCR1, CD62L and CD11b expression were significantly greater on systemic neutrophils from younger control individuals. Elderly individuals showed more apoptotic salivary neutrophils and lower GM-CSF levels than younger ones, regardless of the occurrence of Candida infection. On the other hand, CXCL-8 concentrations were higher in the saliva from elderly individuals. Besides, TNF-α was detected at elevated levels in the saliva from infected elderly subjects. Salivary neutrophils from elderly and young patients presented impaired phagocytic activity against C. albicans. However, just systemic neutrophils from elderly showed decreased phagocytosis when compared to the younger ones, regardless of the occurrence of infection. In addition, neutrophils from aged individuals and young patients presented low fungicidal activity. Conclusion The data suggests that the Candida

  3. Bilateral perisylvian ulegyria: clinicopathological study of patients presenting with pseudobulbar palsy and epilepsy.

    Science.gov (United States)

    Kim, Hyoung-Ihl; Lee, Min-Cheol; Lee, Ji-Shin; Kim, Hyung-Seok; Kim, Myeong-Kyu; Woo, Young-Jong; Kim, Jae-Hyoo; Jung, Shin; Palmini, Andre; Kim, Seung U

    2006-06-01

    Structural abnormalities related with pseudobulbar palsy have been gaining attention because of their characteristic symptoms and unique pathogenesis. We present five cases of bilateral perisylvian ulegyria (BPU) presenting epilepsy and pseudobulbar palsy with pathogenesis different from previously reported syndromes. All patients showed medically intractable seizures, complex partial seizures with secondary generalization and clinical symptoms of pseudobulbar palsy, including dysarthria, limitation of tongue movement and drooling. MRI revealed BPU in all patients, and BPU associated with hippocampal sclerosis in four patients. Intracranial EEG recording with subdural grip and stripe was helpful for localizing the area of ictal generation. Resective surgeries, including the temporal lobe, central area and parietal lobe, were performed depending on the localizing information. The surgical outcome was favorable after 9.8 years of follow-up. Characteristic features of ulegyria were confirmed on pathological examination. Ulegyria is considered to be another important perinatal or postnatal structural abnormality which can explain the etiological heterogeneity for pseudobulbar palsy, which results from bilateral perisylvian lesions. Awareness of this disorder can provide a useful strategy for evaluation and treatment which differs from that in perisylvian polymicrogyria.

  4. The neglected topic: presentation of cost information in patient decision AIDS.

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    Blumenthal-Barby, J S; Robinson, Emily; Cantor, Scott B; Naik, Aanand D; Russell, Heidi Voelker; Volk, Robert J

    2015-05-01

    Costs are an important component of patients' decision making, but a comparatively underemphasized aspect of formal shared decision making. We hypothesized that decision aids also avoid discussion of costs, despite their being tools designed to facilitate shared decision making about patient-centered outcomes. We sought to define the frequency of cost-related information and identify the common modes of presenting cost and cost-related information in the 290 decision aids catalogued in the Ottawa Hospital Research Institute's Decision Aid Library Inventory (DALI) system. We found that 56% (n = 161) of the decision aids mentioned cost in some way, but only 13% (n = 37) gave a specific price or range of prices. We identified 9 different ways in which cost was mentioned. The most common approach was as a "pro" of one of the treatment options (e.g., "you avoid the cost of medication"). Of the 37 decision aids that gave specific prices or ranges of prices for treatment options, only 2 were about surgery decisions despite the fact that surgery decision aids were the most common. Our findings suggest that presentation of cost information in decision aids is highly variable. Evidence-based guidelines should be developed by the International Patient Decision Aid Standards (IPDAS) Collaboration.

  5. THE STUDY OF MICRONUCLUES INDEX IN PATIENTS PRESENTING WITH MALIGNANT LESIONS

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    Archana

    2015-08-01

    Full Text Available Micronucleus is the nucleus that expresses the genotypic alterations caused in the process of malignancy. It is characteristically seen in exfoliated epithelial cells like Buccal Mucosa and urinary bladder wall during pre - cancerous and cancerous conditions in less and large proportions respectively. It is commonly used as a Biomarker to assess the stage and severity of neoplasm. Aim of our study is to observe the micronucleus Index in patients presenting with malignant oral lesions. 30 patients with maligna nt lesions from the Department of oral medicine, Vydehi Institute of Dental Sciences and Research Centre were screened for the presence of micronucleus . The buccal scrapings were obtained from the site of the lesion in the oral cavity by conventional metho ds. The obtained slides were stained by using Haematoxylin& Eosin stains and the micronucleus index was calculated. The results showed that the alteration of micronucleus count was observed in malignant conditions with respect to age and gender. Hence it c an be concluded that the micronucleus index can be used as a biomarker or as a screening test in patients presenting with pre malignant conditions

  6. Evaluation of awareness of risk factors for kidney cancer among patients presenting to a urology clinic.

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    Parker, Alexander S; Arnold, Michelle L; Diehl, Nancy D; Hassan, Lauren; Thiel, David D

    2014-06-01

    This study aimed to evaluate awareness of risk factors for kidney cancer among patients presenting to a urology clinic. Smoking, obesity and hypertension are widely accepted as risk factors for kidney cancer; however, there are limited data regarding awareness of these risk factors. The researchers prospectively identified 172 patients presenting to a urology clinic between 1 May 2009 and 31 August 2009. Each patient completed a questionnaire that requested responses to whether certain lifestyle factors increased the risk of a variety of cancers. Information on demographics and other covariates was collected via questionnaires and medical chart abstraction. To estimate and compare risk factor awareness levels for different cancers, 95% confidence intervals (95% CIs) were constructed and Fisher's exact tests performed. Logistic regression analysis was used to evaluate covariates associated with risk factor awareness. The percentage reporting that smoking increases the risk of kidney cancer (36%, 95% CI 29-44%) was lower than for lung cancer (96%, 95% CI 92-99%). Similarly, the percentage reporting that obesity increases the risk of kidney cancer (32%, 95% CI 25-40%) was lower than for colon cancer (45%, 95% CI 37-53% CI). Only 18% (95% CI 13-25%) identified hypertension as a risk factor for kidney cancer. Female gender and younger age were associated with increased levels of awareness of the association with smoking and obesity, respectively. The data support a low level of awareness of kidney cancer risk factors and underscore an opportunity for urologists to engage in education efforts.

  7. Lenalidomide and Dexamethasone for a Patient of POEMS Syndrome Presenting with Massive Ascites.

    Science.gov (United States)

    Ueda, Shuji; Yonemoto, Sayoko; Oka, Kazumasa; Fujii, Naohiko; Nakata, Keiichi; Matsunaga, Hitomi; Kataoka, Seiko; Iwama, Yuki; Narahara, Hiroyuki; Yasunaga, Yuichi; Inui, Yoshiaki; Kawata, Sumio

    2014-01-01

    POEMS syndrome is a multisystem disorder characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes. POEMS syndrome is a rare cause of refractory ascites. We report the case of a patient with POEMS syndrome presenting with massive ascites who was treated with very-low-dose lenalidomide and dexamethasone. A 57-year-old Japanese man was admitted to our hospital with pleural effusion, massive ascites, and leg edema. The diagnosis of POEMS syndrome was made based on the combination of the following findings: peripheral neuropathy, organomegaly, endocrinopathy, serum monoclonal protein elevation, skin changes, plasma VEGF elevation, and evidence of extravascular volume overload. Renal dysfunction induced by biopsy-proven renal involvement of POEMS syndrome was observed. Massive ascites of the patient dramatically diminished with long-time treatment of very-low-dose lenalidomide and dexamethasone. Lenalidomide seems to be a very promising therapy for POEMS syndrome presenting with extravascular volume overload such as edema, pleural effusion, and ascites. Very-low-dose lenalidomide might be effective especially for the patients with POEMS-related nephropathy.

  8. Lenalidomide and Dexamethasone for a Patient of POEMS Syndrome Presenting with Massive Ascites

    Directory of Open Access Journals (Sweden)

    Shuji Ueda

    2014-01-01

    Full Text Available POEMS syndrome is a multisystem disorder characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes. POEMS syndrome is a rare cause of refractory ascites. We report the case of a patient with POEMS syndrome presenting with massive ascites who was treated with very-low-dose lenalidomide and dexamethasone. A 57-year-old Japanese man was admitted to our hospital with pleural effusion, massive ascites, and leg edema. The diagnosis of POEMS syndrome was made based on the combination of the following findings: peripheral neuropathy, organomegaly, endocrinopathy, serum monoclonal protein elevation, skin changes, plasma VEGF elevation, and evidence of extravascular volume overload. Renal dysfunction induced by biopsy-proven renal involvement of POEMS syndrome was observed. Massive ascites of the patient dramatically diminished with long-time treatment of very-low-dose lenalidomide and dexamethasone. Lenalidomide seems to be a very promising therapy for POEMS syndrome presenting with extravascular volume overload such as edema, pleural effusion, and ascites. Very-low-dose lenalidomide might be effective especially for the patients with POEMS-related nephropathy.

  9. Clinical presentation and management practice of systemic mastocytosis. A survey on 460 Italian patients.

    Science.gov (United States)

    Pieri, Lisa; Bonadonna, Patrizia; Elena, Chiara; Papayannidis, Cristina; Grifoni, Federica Irene; Rondoni, Michela; Girlanda, Stefania; Mauro, Marina; Magliacane, Diomira; Elli, Elena Maria; Iorno, Maria Loredana; Almerigogna, Fabio; Scarfì, Federica; Salerno, Roberto; Fanelli, Tiziana; Gesullo, Francesca; Corbizi Fattori, Giuditta; Bonifacio, Massimiliano; Perbellini, Omar; Artuso, Anna; Soverini, Simona; De Benedittis, Caterina; Muratori, Simona; Pravettoni, Valerio; Cova, Vittoria; Cortellini, Gabriele; Ciceri, Fabio; Cortelezzi, Agostino; Martinelli, Giovanni; Triggiani, Massimo; Merante, Serena; Vannucchi, Alessandro Maria; Zanotti, Roberta

    2016-07-01

    Systemic mastocytosis is a rare heterogeneous myeloproliferative neoplasm characterized by abnormal proliferation and activation of mast cells. We describe a large multicentre series of 460 adult patients with systemic mastocytosis, with a diagnosis based on WHO 2008 criteria, in a "real-life" setting of ten Italian centers with dedicated multidisciplinary programs. We included indolent forms with (n = 255) and without (n = 165) skin lesions, smouldering (n = 20), aggressive (n = 28), associated with other hematological diseases mastocytosis (n = 21) and mast cell leukemia (n = 1). This series was uniquely characterized by a substantial proportion of patients with low burden of neoplastic mast cells; notably, 38% of cases were diagnosed using only minor diagnostic criteria according to WHO 2008 classification, underlying the feasibility of early diagnosis where all diagnostic approaches are made available. This has particular clinical relevance for prevention of anaphylaxis manifestations, that were typically associated with indolent forms. In multivariate analysis, the most important features associated with shortened overall survival were disease subtype and age at diagnosis >60 years. Disease progression was correlated with mastocytosis subtype and thrombocytopenia. As many as 32% of patients with aggressive mastocytosis suffered from early evolution into acute leukemia. Overall, this study provides novel information about diagnostic approaches and current presentation of patients with SM and underlines the importance of networks and specialized centers to facilitate early diagnosis and prevent disease-associated manifestations. Am. J. Hematol. 91:692-699, 2016. © 2016 Wiley Periodicals, Inc.

  10. Classic Kaposi's sarcoma presenting in the oral cavity of two HIV-negative Quechua patients.

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    Mohanna, Salim; Bravo, Francisco; Ferrufino, Juan Carlos; Sanchez, Juvenal; Gotuzzo, Eduardo

    2007-09-01

    Traditionally, classic KS lesions have a general distribution, often involving the skin of the feet and legs, and to a lesser extent, that of the hands, arms, and trunk. Oral involvement is a rare manifestation. Initial oral involvement is an even rarer occurrence. We report two unusual cases of classic KS presenting in the oral cavity of two patients from indigenous origin; the first patient with primary oral KS lesion on the hard palate, with no other signs of the condition in any other region of the body; the second patient with generalized dermal KS lesions with lymph node and lower lip involvement. In conclusion, clinicians and pathologists should be aware of the typical clinical, gross, and histologic features of KS. Moreover, we would like to emphasize that oral KS may affect patients without AIDS or exposure to immunosuppression. The awareness of oral classic KS as a diagnostic possibility is important in the work-up of vascular lesions in the oral cavity of non-immunosuppressed individuals.

  11. Refsum disease: the presentation and ophthalmic aspects of Refsum disease in a series of 23 patients.

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    Claridge, K G; Gibberd, F B; Sidey, M C

    1992-01-01

    Refsum disease (heredopathia atactica polyneuritiformis) was first described in 1946 and is a rare recessively inherited metabolic disease affecting phytanic acid metabolism. It causes retinitis pigmentosa, cataracts, a chronic polyneuropathy, cerebellar ataxia and cardiac arrhythmias amongst other clinical signs. By limiting dietary intake, plasma phytanic acid levels fall with an improvement in the neurological signs. The onset of retinitis pigmentosa usually precedes biochemical diagnosis by several years by which time the retinal damage is severe. A series of 23 patients have been reviewed. There was an average delay of 11 years (range 1-28 years) between the patient presenting to the ophthalmologist and being diagnosed as having Refsum disease. Although serial examinations have failed to show a definite change in the course of visual deterioration with treatment, early diagnosis is important to prevent the development of neurological disease.

  12. Cortical blindness in obstetric patients: case report of two different presentations.

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    Edomwonyi, N P; Idehen, H

    2013-06-01

    Cortical blindness can complicate pre-eclampsia/eclampsia. This normally resolves between a few hours and days with full restoration of patients sight. In this case report, we present the clinical course of two women in whom eclampsia was further complicated with blindness. One had pre-partum blindness which resolved after few hours while the second developed post-partum blindness that occurred after an episode of ischaemic cerebrovascular accident (CVA) and it became persistent. The patients were managed by standard pre-eclampsia/ eclampsia regimen; these entail the use of intravenous magnesium sulphate, i/v hydralazine and fluid restriction, as well as expedite delivery. Diagnosis was further confirmed by computed tomography (CT) that demonstrated low density areas localised predominantly in the occipital areas.

  13. Retrieval by a patient with apraxia of sensorimotor information from visually presented objects.

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    Kobayakawa, Mutsutaka; Ohigashi, Yoshitaka

    2007-06-01

    Motor representations are reported to be implicitly evoked when one observes manipulatable objects (action potentiation). The relationship was examined between action potentiation and pantomime deficit in apraxia. Participants responded to line drawings of manipulatable objects with either the left or right hand, according to the color of the stimulus. In normal participants (N= 10, four women, six men, M age = 28.5 yr., SD = 5.6), responses were faster when the orientation of the stimulus was compatible with the response-hand grasp. However, the apraxic patient did not exhibit this compatibility effect. On a control task in which a nonobject (circle) was presented, all participants exhibited the compatibility effect. These results indicated that the apraxic patient was impaired in evoking motor representation associated with objects. Thus, in some cases, apraxic disorders may be attributable to a deficit in retrieving object-specific information for manipulation.

  14. Oral presentation of histoplasmosis in an immunocompetent patient: a diagnostic challenge.

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    Iqbal, F; Schifter, M; Coleman, H G

    2014-09-01

    Histoplasmosis is a rare systemic fungal infection, primarily affecting the pulmonary system. Oral lesions are usually a manifestation of the disseminated form of the disease and most frequently observed in severely immunocompromised patients, such as those with advanced human immunodeficiency virus infection and/or frank acquired immune deficiency syndrome. The clinical presentation of the oral lesions may be difficult to distinguish from oral squamous cell carcinoma. The histopathological features are usually characteristic, but occasionally the organisms are scanty and not readily identified, which can preclude obtaining the correct diagnosis and ensuring appropriate management. Histoplasmosis is an unusual and rare cause of chronic non-healing ulceration in the oral cavity. A case of histoplasmosis involving the oral cavity in an immunocompetent patient is reported, which was not recognized, resulting in the inappropriate management of the condition.

  15. Cytodiagnosis of histoplasmosis: case reports from two patients with variable clinical presentation.

    Science.gov (United States)

    Singh, Sunita; Chhabra, Sonia; Goyal, Ruchi; Garg, Shilpa

    2012-12-01

    Histoplasmosis has emerged as an important opportunistic fungal infection in immunocompromised patients. Histoplasma is a dimorphic fungus that primarily involves lung and the environmental reservoir is soil. Although several cases of histoplasmosis have been reported in India but cytological diagnosis was made in a few cases. We are presenting two cases of histoplasmosis diagnosed on fine-needle aspiration cytology. In the first case, pulmonary histoplasmosis was diagnosed on transbronchial needle aspiration of lung in a 41-year-old immunocompetent male, while second case was of disseminated histoplasmosis in 40-year-old immunocompromised female diagnosed on cytology of cervical lymph node. FNAC is a simple, safe, and rapid technique to establish the initial diagnosis, thus promoting early treatment and favorable outcome especially in the immunocompromised patients.

  16. Variations in otological presentation of lightning strike victims: Clinical report of 3 patients.

    Science.gov (United States)

    Kılıç, Erbil; Genç, Hakan; Aydın, Ümit; Aşık, Burak; Satar, Bülent

    2017-03-01

    Lightning strike can cause fatal or nonfatal injuries. Some nonfatal injuries are associated with otological symptoms and findings. Conductive hearing loss due to rupture of the tympanic membrane is the most common audiovestibular lesion of lightning strike. Various forms of sensorineural hearing loss and dizziness have also been reported. Presently described are 3 cases of lightning strike injury. First patient had mid-frequency hearing loss in right ear and high frequency sensorineural hearing loss in left ear. Second patient had high frequency sensorineural hearing loss in left ear, and the third had peripheral facial palsy with perilymphatic fistula on same side. This is the first documented case of mid-frequency hearing loss occurring after lightning strike.

  17. The Patient Educator Presentation in Dental Education: Reinforcing the Importance of Learning About Rare Conditions.

    Science.gov (United States)

    Edwards, Paul C; Graham, Jasmine; Oling, Rebecca; Frantz, Kate E

    2016-05-01

    The aim of this study was to determine whether a patient educator presentation (PEP) on pemphigus vulgaris would increase second-year dental students' awareness of the importance of learning about rare conditions and improve their retention of rare disease knowledge. The study involved students' subjective assessments of a PEP experience at two U.S. dental schools. In this mixed methods study, cross-sectional data were obtained by surveys and in-depth interviews. Questions focused on students' assessment of the messages acquired from the PEP and its likely impact on their future clinical care. At University 1, students completed paper surveys with open-ended questions and participated in a focus group. At University 2, students completed an online survey consisting of rating scale and open-ended questions. Responses to open-ended questions were categorized into themes. At University 1, 79 students (out of a possible 102; response rate 77.5%) completed the survey, and an additional ten students participated in a focus group. At University 2, 30 students (out of a possible 104; response rate 28.8%) completed the survey. At Universities 1 and 2, 88% and 100%, respectively, of respondents stated the PEP would influence their future clinical decision making. The vast majority of respondents (94% and 100% at University 1 and University 2, respectively) were of the opinion that the personal testimonial from a patient would help them recall information about pemphigus vulgaris in five years' time. Respondents from both universities commented that the PEP emphasized the importance of not dismissing a patient's concerns. These results suggest that a presentation by a patient with a rare condition can be an effective educational tool for preclinical dental students.

  18. Ovarian metastasis in patient with endometrial carcinoma or synchronous tumors: Presentation of a case

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    Đorđević Momčilo

    2010-01-01

    Full Text Available Introduction. Synchronous, independent tumors are two or more tumors which appear independently from each other at the same moment. Metastatic tumors originate by disseminating malignant cells from other organs. Synchronous, primary malignities make 1.7% of all genitals malignities. Joined endometrial and ovarian carcinomas are found in 5% of cases. Presentation of a case. In this research, we present the case of an obese woman, 37 years old, who had associated endometrial tumors of uterus and ovary, without malign cells in peritoneal dilution, positive estrogen, negative progestine and focal expression of p53 receptors present in about 10-15% tumor cells. Discussion. This patient underwent the classic hysterectomy with reciprocal adnexectomy. After the operation, complete radial and hemiotheraphy was performed. The patient was without recurrence of the disease 30 months after the operation. The differentiation of primary independent synchronous and metastatic tumors is important not only for the prognosis, but also for the choice of the therapy. Conclusion. There are no reliable clinical and histological criteria for diagnoses. Most cases are most frequently regarded as higher stages.

  19. E. coli Meningitis Presenting in a Patient with Disseminated Strongyloides stercoralis

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    Juliana B. Gomez

    2013-01-01

    Full Text Available Introduction. Spontaneous Escherichia coli meningitis is an infrequent condition in adults and is associated with some predisposing factors, including severe Strongyloides stercoralis (SS infections. Case Presentation. A 43-year-old Hispanic man, with history of travelling to the jungle regions of Peru and Brazil two decades ago, and who received prednisone due to Bell’s palsy for three weeks before admission, presented to the Emergency Department with diarrhea, fever, and hematochezia. A week after admission he developed drowsiness, meningeal signs, abdominal distension, and constipation. A cerebrospinal fluid culture showed extended spectrum β-lactamase producing E. coli. A colonoscopy was performed and showed pancolitis. Three days after the procedure the patient became unstable and developed peritoneal signs. He underwent a laparotomy, which ended up in a total colectomy and partial proctectomy due to toxic megacolon. Three days later the patient died in the intensive care unit due to septic shock. Autopsy was performed and microscopic examination revealed the presence of multiple Strongyloides larvae throughout the body. Conclusion. Strongyloides stercoralis infection should be excluded in adults with spontaneous E. coli meningitis, especially, if gastrointestinal symptoms and history of travelling to an endemic area are present. Even with a proper diagnosis and management, disseminated strongyloidiasis has a poor prognosis.

  20. Presenting Symptoms and Dysphagia Screen Predict Outcome in Mild and Rapidly Improving Acute Ischemic Stroke Patients.

    Science.gov (United States)

    Gadodia, Gaurav; Rizk, Nibal; Camp, Deborah; Bryant, Katja; Zimmerman, Susan; Brasher, Cynthia; Connelly, Kerrin; Dunn, Joshua; Frankel, Michael; Ido, Moges Seymour; Lugtu, James; Nahab, Fadi

    2016-12-01

    There are limited data on which patients not treated with intravenous (IV) tissue-type plasminogen activator (tPA) due to mild and rapidly improving stroke symptoms (MaRISS) have unfavorable outcomes. Acute ischemic stroke (AIS) patients not treated with IV tPA due to MaRISS from January 1, 2009 to December 31, 2013 were identified as part of the Georgia Coverdell Acute Stroke Registry. Multivariable regression analysis was used to identify factors associated with a lower likelihood of favorable outcome, defined as discharge to home. There were 1614 AIS patients who did not receive IV tPA due to MaRISS (median National Institutes of Health stroke scale [NIHSS] 1], of which 305 (19%) did not have a favorable outcome. Factors associated with lower likelihood of favorable outcome included Medicare insurance status (odds ratio [OR]: .53, 95% confidence interval [CI]: .34-.84), arrival by emergency medical services (OR: .46, 95% CI: .29-.73), increasing NIHSS score (per unit OR: .89, 95% CI: .84-.93), weakness as the presenting symptom (OR: .50, 95% CI: .30-.84), and a failed dysphagia screen (OR: .43, 95% CI: .23-.80). During the study period, dysphagia screen identify a subgroup of patients who are more likely to have an unfavorable outcome. Whether IV tPA treatment can improve the outcome in this subgroup of patients needs to be evaluated in a randomized placebo-controlled trial. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  1. Comparison of buying behavior in depressed patients presenting with or without compulsive buying.

    Science.gov (United States)

    Lejoyeux, M; Haberman, N; Solomon, J; Adès, J

    1999-01-01

    Compulsive buying is defined as repetitive impulsive and excessive buying leading to personal and familial distress. This study compares the buying behavior of depressed patients presenting with or without compulsive buying. The weight of promotional factors such as sales and advertising campaigns was systematically assessed. The impulsive nature of compulsive buying and the choice of items purchased were also investigated. For this purpose, we studied buying behavior among 52 inpatients diagnosed for major depressive episode with DSM-IV criteria. None of the patients presented mania or hypomania, obsessive-compulsive disorder, or alcohol or drug abuse or dependence disorder. We assessed the prevalence of compulsive buying and compared the "buying style" among patients with (CB+) and without (CB-) compulsive buying. The diagnosis of depression was assessed with the Mini International Neuropsychiatric Interview (MINI). The diagnosis of compulsive buying was made using standardized criteria and a specific rating scale. All patients answered a specific questionnaire assessing the phenomenology of the buying behavior. Twenty-one of 52 depressives presented with compulsive buying. The CB+ group was not more sensitive to promotional factors. They did not seek sales or use loans significantly more than others. Upon entering a shop, the CB+ subjects did not change their choice more often than others. CB+ subjects were significantly more often alone while shopping (85% of cases v61% of CB- group, p = .05). Most purchases from the CB+ group were self-gifts or gifts to others (50.4% v 23.5%, p = .003); 14.4% of purchases in the CB+ group (v 2.2% in CB- group, P = .045) were made because the patients believed their social status requires acquisition. Items to be bought were more often considered by CB+ subjects as occasions not to be missed (31.4% v15.1%, P = .03). Purchases were significantly (57% v 16%) less often used than expected by the CB+ group (P = .002). Most

  2. Gender Differences in Clinical Presentations of Cystic Fibrosis Patients in Azeri Turkish Population

    Science.gov (United States)

    Vahedi, Leila; Jabarpoor-Bonyadi, Morteza; Ghojazadeh, Morteza; Vahedi, Amir

    2016-01-01

    Background Cystic fibrosis (CF) is an autosomal recessive disorder with several clinical presentations. This study was undertaken in the Azeri Turkish population in Iran, to investigate gender differences in the age at onset and diagnosis, age of death, and duration of illness of CF. Methods The data of 331 CF patients from 2001 to 2015 was surveyed. Parameters including age, sex, ΔF508 mutation, age at onset, age at diagnosis, age of death and clinical presentations were evaluated for both sexes, using descriptive analysis. The association of gender with these variables was studied using logistic regression, chi-square test and Mann-Whitney U test by SPSS version 18. Odds ratio with a confidence interval of 95% and p≤0.05 was considered statistically significant. Results The study included 191 males (57.7%) and 140 females (42.3%), all showing statistically significant difference (p<0.001). Age duration differed between genders. Male and female patients were further under 9 and 4 years, respectively. The occurrence of ΔF508 mutation was 0.51 times more in females than in males. Age, diagnosis and sex were closely associated: males were diagnosed at a significantly later age than females (p=0.05). While this compression performed based on clinical presentations, males with respiratory disease had a later median age at diagnosis than females at lifespan (p=0.001). The risk of infertility in males was approximately two times greater than in females (p=0.02). Conclusion These findings indicate gender differences in CF patients. Future studies are needed to establish other differences and evaluate the causes for the gender variations.

  3. Bilateral Intracavernous Carotid Artery Aneurysms Presenting as Diplopia in a Young Patient

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    Nikolaos Kopsachilis

    2013-01-01

    Full Text Available Introduction. Bilateral intracavernous carotid artery aneurysms (ICAAs are extremely rare and difficult to treat. Case Report. A 26-year-old female presented in our clinic with acute diplopia due to oculomotor nerve palsy on the left side. Magnetic resonance imaging of the brain showed two heterogeneously enhanced masses indicating bilateral ICAA. An endovascular coil embolization was performed on the left side successfully, resulting in resolution of her symptoms. Conclusion. Thorough systemic evaluation in young patients with diplopia can reveal life-threatening underlying pathology and prevent major complications.

  4. T-cell prolymphocytic leukemia presenting with leukemic serous effusion in a prostate cancer patient

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    Ozan Salim

    2015-01-01

    Full Text Available T-cell prolymphocytic leukemia (T-PLL is highly aggressive mature postthymic lymphoproliferative disorder, which is characterized by several clinical features. Leukemic prolymphocytes are found in the peripheral blood, bone marrow, lymph nodes, spleen, liver, and sometimes skin. T-PLL and solid tumor coincidence was reported by only four previous cases. Solid tumor components included breast cancer, classic Kaposi sarcoma, gastric cancer, and lung cancer in those cases. We report the first case of T-PLL, an extremely rare disease, presented with serous effusion in an elderly prostate cancer patient in literature.

  5. Endovascular stenting of the transverse sinus in a patient presenting with benign intracranial hypertension.

    Science.gov (United States)

    Ogungbo, B; Roy, D; Gholkar, A; Mendelow, A D

    2003-12-01

    The authors present a 37-year-old lady with symptoms and signs suggestive of benign intracranial hypertension (BIH). Routine CT and MRI scans were normal. Further investigations were performed with magnetic resonance venography (MRV) and cerebral venography. These revealed obstruction of the right transverse sinus with high pressure (40 mmHg) proximal to the obstruction and low pressure (15 mmHg) distally. She was treated by transvenous stent deployment with resolution of her symptoms and the bilateral papilloedema. Evaluation of the cerebral venous system with MRV and or with formal cerebral venography should be included in routine investigations of patients with suspected BIH.

  6. Neurofibromatosis Type 1 Presenting with Plexiform Neurofibromas in Two Patients: MRI Features

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    Ahmet Mesrur Halefoglu

    2012-01-01

    Full Text Available Neurofibromatosis type 1 (NF1, also known as peripheral neurofibromatosis or von Recklinghausen’s disease, is one of the most common genetic disorders. It is inherited in an autosomal dominant pattern. Multiple cutaneous neurofibromas are hallmark lesions of NF1. Localized and plexiform neurofibromas of the paraspinal and sacral region are the most common abdominal neoplasms in NF1. Herein, we report two patients with a known history of NF1 presenting with multiple, extensive localized and plexiform neurofibromas. We describe the important distinguishing features of these tumors as seen on magnetic resonance imaging (MRI, including very bright signal intensity and target sign on T2 weighted images.

  7. Management of Low-Flow Vascular Malformations: Clinical Presentation, Classification, Patient Selection, Imaging and Treatment

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    McCafferty, Ian, E-mail: ian.mccafferty@uhb.nhs.uk [Queen Elizabeth Hospital Birmingham (QEHB) & Birmingham Children’s Hospital (BCH) (United Kingdom)

    2015-10-15

    This review article aims to give an overview of the current state of imaging, patient selection, agents and techniques used in the management of low-flow vascular malformations. The review includes the current classifications for low-flow vascular malformations including the 2014 updates. Clinical presentation and assessment is covered with a detailed section on the common sclerosant agents used to treat low-flow vascular malformations, including dosing and common complications. Imaging is described with a guide to a simple stratification of the use of imaging for diagnosis and interventional techniques.

  8. Pseudotumoral presentation of fungating mycetoma caused by Phaeoacremonium fuscum in a renal transplant patient.

    Science.gov (United States)

    McGrogan, D; David, M D; Roberts, C; Borman, A M; Nath, J; Inston, N G; Mellor, S

    2015-12-01

    Eumycetoma is an unusual infection in immunocompromised patients outside the tropics, caused by a variety of fungal pathogens. We describe the case of a 51-year-old renal transplant recipient who presented with a large pseudotumoral foot lesion necessitating complete surgical excision of the lesion. Cultures and molecular diagnosis confirmed Phaeoacremonium fuscum. This is the first case, to our knowledge, of fungating mycetoma caused by this fungal species in a solid organ transplant recipient. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  9. Case presentation of an intranasal ectopic tooth in a pediatric patient.

    Science.gov (United States)

    Yu, Chao; Gu, Deying; An, Junnan; Tang, Yuedi

    2015-01-01

    An ectopic tooth in the nasal cavity is a rare phenomenon, especially on the inferior turbinate. In most of the reported cases, no etiological explanation of the intranasal teeth has been suggested or found. In children, intranasal ectopic teeth are usually associated with cleft lip and alveolus. Here, we report a rare case of a pediatric patient with unilateral nasal obstruction due to an intranasal ectopic tooth originating from the inferior turbinate without any facial and dental deformities. This case is unique due to the unusual location of the ectopic tooth and its presentation in a child without facial and dental deformities.

  10. The Synthesis and Antitumor Activity of Twelve Galloyl Glucosides

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    Chang-Wei Li

    2015-01-01

    Full Text Available Twelve galloyl glucosides 1–12, showing diverse substitution patterns with two or three galloyl groups, were synthesized using commercially available, low-cost D-glucose and gallic acid as starting materials. Among them, three compounds, methyl 3,6-di-O-galloyl-α-D-glucopyranoside (9, ethyl 2,3-di-O-galloyl-α-D-glucopyranoside (11 and ethyl 2,3-di-O-galloyl-β-D-glucopyranoside (12, are new compounds and other six, 1,6-di-O-galloyl-β-D-glucopyranose (1, 1,4,6-tri-O-galloyl-β-D-glucopyranose (2, 1,2-di-O-galloyl-β-D-glucopyranose (3, 1,3-di-O-galloyl-β-D-glucopyranose (4, 1,2,3-tri-O-galloyl-α-D-glucopyranose (6 and methyl 3,4,6-tri-O-galloyl-α-D-glucopyranoside (10, were synthesized for the first time in the present study. In in vitro MTT assay, 1–12 inhibited human cancer K562, HL-60 and HeLa cells with inhibition rates ranging from 64.2% to 92.9% at 100 μg/mL, and their IC50 values were determined to be varied in 17.2–124.7 μM on the tested three human cancer cell lines. In addition, compounds 1–12 inhibited murine sarcoma S180 cells with inhibition rates ranging from 38.7% to 52.8% at 100 μg/mL in the in vitro MTT assay, and in vivo antitumor activity of 1 and 2 was also detected in murine sarcoma S180 tumor-bearing Kunming mice using taxol as positive control.

  11. Hypopituitarism Presenting as Adrenal Insufficiency and Hypothyroidism in a Patient with Wilson's Disease: a Case Report.

    Science.gov (United States)

    Lee, Hae Won; Kang, Jin Du; Yeo, Chang Woo; Yoon, Sung Woon; Lee, Kwang Jae; Choi, Mun Ki

    2016-08-01

    Wilson's disease typically presents symptoms associated with liver damage or neuropsychiatric disturbances, while endocrinologic abnormalities are rare. We report an unprecedented case of hypopituitarism in a patient with Wilson's disease. A 40-year-old woman presented with depression, general weakness and anorexia. Laboratory tests and imaging studies were compatible with liver cirrhosis due to Wilson's disease. Basal hormone levels and pituitary function tests indicated secondary hypothyroidism and adrenal insufficiency due to hypopituitarism. Brain MRI showed T2 hyperintense signals in both basal ganglia and midbrain but the pituitary imaging was normal. She is currently receiving chelation therapy along with thyroid hormone and steroid replacement. There may be a relationship between Wilson's disease and hypopituitarism. Copper deposition or secondary neuronal damage in the pituitary may be a possible explanation for this theory.

  12. Frontal presentation of Alzheimer's disease: A series of patients with biological evidence by CSF biomarkers

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    Leonardo Cruz de Souza

    Full Text Available ABSTRACT Besides its typical amnesic presentation, focal atypical presentations of Alzheimer's disease (AD have been described in neuropathological studies. These phenotypical variants of AD (so-called "atypical AD" do not follow the typical amnestic pattern and include non-amnestic focal cortical syndromes, such as posterior cortical atrophy and frontal variant AD. These variants exhibit characteristic histological lesions of Alzheimer pathology at post-mortem exam. By using physiopathological markers, such as cerebrospinal fluid markers, it is now possible to establish in vivo a biological diagnosis of AD in these focal cortical syndromes. We report a series of eight patients who were diagnosed with behavioural variant frontotemporal dementia based on their clinical, neuropsychological and neuroimaging findings, while CSF biomarkers showed an AD biological profile, thus supporting a diagnosis of frontal variant of AD.

  13. Variations in the Presentation of Aphasia in Patients with Closed Head Injuries

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    Dara Oliver Kavanagh

    2010-01-01

    Full Text Available Impairments of speech and language are important consequences of head injury as they compromise interaction between the patient and others. A large spectrum of communication deficits can occur. There are few reports in the literature of aphasia following closed head injury despite the common presentation of closed head injury. Herein we report two cases of closed head injuries with differing forms of aphasia. We discuss their management and rehabilitation and present a detailed literature review on the topic. In a busy acute surgical unit one can dismiss aphasia following head injury as behaviour related to intoxication. Early recognition with prolonged and intensive speech and language rehabilitation therapy yields a favourable outcome as highlighted in our experience. These may serve as a reference for clinicians faced with this unusual outcome.

  14. Variations in the presentation of aphasia in patients with closed head injuries.

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    Kavanagh, Dara Oliver

    2012-01-31

    Impairments of speech and language are important consequences of head injury as they compromise interaction between the patient and others. A large spectrum of communication deficits can occur. There are few reports in the literature of aphasia following closed head injury despite the common presentation of closed head injury. Herein we report two cases of closed head injuries with differing forms of aphasia. We discuss their management and rehabilitation and present a detailed literature review on the topic. In a busy acute surgical unit one can dismiss aphasia following head injury as behaviour related to intoxication. Early recognition with prolonged and intensive speech and language rehabilitation therapy yields a favourable outcome as highlighted in our experience. These may serve as a reference for clinicians faced with this unusual outcome.

  15. Extramedullary Plasmacytoma Diagnosed in an HIV-Positive Patient by an Unusual Clinical Presentation

    Science.gov (United States)

    de Camargo Moraes, Paulo; Thomaz, Luiz Alexandre; Montalli, Victor Angelo Martins; Junqueira, José Luiz Cintra; Ribeiro, Camila Maria Beder

    2016-01-01

    The aim of this paper is to describe a case report of EMP in an HIV-positive patient. A 44-year-old, dark-skinned HIV-infected woman was referred to the Oral Diseases Treatment Center with a swelling at palate and left gingival fornix in the maxilla. Biopsy was taken and the oral lesion was diagnosed as EMP with well-differentiated plasma cells and restriction of the lambda light-chain. Skeletal survey was performed and no radiograph alterations were observed, thus supporting the diagnosis of EMP. Patient was referred to treatment and after two months of chemo and radiotherapy, an expanding lesion was observed in L5/S1 patient's vertebrae. Biopsy of the spinal lesion was consistent with lymphoma with plasmocitary differentiation, supporting the diagnosis of multiple myeloma (MM). Regarding the medical history, the final diagnostic was an oral extramedullary plasmacytoma with rapid progression into multiple myeloma. It is crucial to emphasize the relevance of HIV infection as a risk factor for both aggressive clinical behavior and unusual clinical presentation of extramedullary plasmacytoma cases. PMID:27980867

  16. Predictors of In-hospital Mortality Among Patients Presenting with Variceal Gastrointestinal Bleeding

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    Amith S Kumar

    2015-01-01

    Full Text Available Background/Aim: The recent years have witnessed an increase in number of people harboring chronic liver diseases. Gastroesophageal variceal bleeding occurs in 30% of patients with cirrhosis, and accounts for 80%-90% of bleeding episodes. We aimed to assess the in-hospital mortality rate among subjects presenting with variceal gastrointestinal bleeding and (2 to investigate the predictors of mortality rate among subjects presenting with variceal gastrointestinal bleeding. Patients and Methods: This retrospective study was conducted from treatment records of 317 subjects who presented with variceal upper gastrointestinal bleeding to Government Medical College, Patiala, between June 1, 2010, and May 30, 2014. The data thus obtained was compiled using a preset proforma, and the details analyzed using SPSSv20. Results: Cirrhosis accounted for 308 (97.16% subjects with bleeding varices, with extrahepatic portal vein obstruction 9 (2.84% completing the tally. Sixty-three (19.87% subjects succumbed to death during hospital stay. Linear logistic regression revealed independent predictors for in-hospital mortality, including higher age (P = 0.000, Child-Pugh Class (P = 0.002, altered sensorium (P = 0.037, rebleeding within 24 h of admission (P = 0.000, low hemoglobin level (P = 0.023, and serum bilirubin (P = 0.002. Conclusion: Higher age, low hemoglobin, higher Child-Pugh Class, rebleeding within 24 h of admission, higher serum bilirubin, and lower systolic blood pressure are the independent predictors of in-hospital mortality among subjects presenting with variceal gastrointestinal bleeding.

  17. Utility of Chest Radiography in Emergency Department Patients Presenting with Syncope

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    Matthew L Wong

    2016-11-01

    Full Text Available Introduction Syncope has myriad etiologies, ranging from benign to immediately life threatening. This frequently leads to over testing. Chest radiographs (CXR are among these commonly performed tests despite their uncertain diagnostic yield. The objective is to study the distribution of normal and abnormal chest radiographs in patients presenting with syncope, stratified by those who did or did not have an adverse event at 30 days. Methods We performed a post-hoc analysis of a prospective cohort of consecutive patients presenting to an urban tertiary care academic medical center with a chief complaint of syncope from 2003–2006. The frequency and findings for each CXR were reviewed, as well as emergency department and hospital discharge diagnoses, and 30-day outcome. Results There were 575 total subjects, 39.7% were male, and the mean age was 57.2 (SD 24.6. Of the 575 subjects, 403 (70.1% had CXRs performed, and 116 (20.2% had an adverse event after their syncope. Of the 116 people who had an adverse event, 15 (12.9% had a positive CXR, 81 (69.8% had a normal CXR, and 20 (17.2% did not have a CXR as part of the initial evaluation. Among the 459 people who did not have an adverse event, 3 (0.7% had a positive CXR, 304 (66.2% had a normal CXR, and 152 (33.1% did not have a CXR performed. Fifteen of the 18 patients (83.4% with an abnormal CXR had an adverse event. Eighty-one of the 385 patients (21.0% with a normal CXR had an adverse event. Among those who had a CXR performed, an abnormal CXR was associated with increased odds of adverse event (OR: 18.77 (95% CI= [5.3–66.4]. Conclusion Syncope patients with abnormal CXRs are likely to experience an adverse event, though the majority of CXRs performed in the work up of syncope are normal.

  18. Stroke prevention by direct revascularization for patients with adult-onset moyamoya disease presenting with ischemia.

    Science.gov (United States)

    Kim, Tackeun; Oh, Chang Wan; Kwon, O-Ki; Hwang, Gyojun; Kim, Jeong Eun; Kang, Hyun-Seung; Cho, Won-Sang; Bang, Jae Seung

    2016-06-01

    OBJECT Moyamoya disease (MMD) is a progressive disease that can cause recurrent stroke. The authors undertook this retrospective case-control study with a large sample size in an attempt to assess the efficacy of direct or combined revascularization surgery for ischemia in adults with MMD. METHODS The authors investigated cases involving patients with moyamoya disease presenting with ischemia who visited Seoul National University Bundang Hospital and Seoul National University Hospital between 2000 and 2014. Among 441 eligible patients, 301 underwent revascularization surgery and 140 were treated conservatively. Variables evaluated included age at diagnosis, sex, surgical record, Suzuki stage, and occurrence of stroke. Patients were stratified into 2 groups based on whether or not they had undergone revascularization surgery. Actuarial 1-, 5-, and 10-year stroke rates were calculated using the life table method. Risk factor analysis for 5-year stroke occurrence was conducted with multivariate regression. RESULTS Of the 441 patients, 301 had been surgically treated (revascularization group) and 140 had not (control group). The mean follow-up durations were 45 and 77 months, respectively. The actuarial 10-year cumulative incidence rate for any kind of stroke was significantly lower in the revascularization group (9.4%) than in the control group (19.6%) (p = 0.041); the relative risk reduction (RRR) was also superior (52.0%) in the revascularization group, and the number needed to treat was 10. The 10-year rate of ischemic stroke was greater (13.3%) in the control group than in the revascularization group (3.9%) (p = 0.019). The RRR for ischemic stroke in the revascularization group was 70.7%, and the number needed to treat was 11. However, the actuarial 1- and 5-year rates of ischemic stroke did not significantly differently between the groups. Overall, revascularization surgery was shown to be an independent protective factor, as revealed by multivariate analysis

  19. The strong coupling regime of twelve flavors QCD

    NARCIS (Netherlands)

    Silva, Tiago Nunes da; Pallante, Elisabetta

    2012-01-01

    We summarize the results recently reported in Ref.[1] [A. Deuzeman, M.P. Lombardo, T. Nunes da Silva and E. Pallante,"The bulk transition of QCD with twelve flavors and the role of improvement"] for the SU(3) gauge theory with Nf=12 fundamental flavors, and we add some numerical evidence and theoret

  20. Human Evolution in Science Textbooks from Twelve Different Countries

    Science.gov (United States)

    Quessada, Marie-Pierre; Clement, Pierre; Oerke, Britta; Valente, Adriana

    2008-01-01

    What kinds of images of human beings illustrate human evolution in school textbooks? A comparison between the textbooks of eighteen different countries (twelve European countries and six non-European countries) was attempted. In six countries (Algeria, Malta, Morocco, Mozambique, Portugal, and Tunisia), we did not find any chapter on the topic of…

  1. Bibliography of Spanish Materials for Students, Grades Seven through Twelve.

    Science.gov (United States)

    California State Dept. of Education, Sacramento.

    This annotated bibliography of Spanish materials for students in grades seven through twelve is divided into the following categories: (1) Art, Drama, Music, and Poetry; (2) Books in Series; (3) Culture; (4) Dictionaries and Encyclopedias; (5) Literature; (6) Mathematics; (7) Physical Education, Health, and Recreation; (8) Reading and Language…

  2. A rare presentation of adult onset Still’s disease in an elderly patient

    Directory of Open Access Journals (Sweden)

    Mariya Apostolova

    2011-10-01

    Full Text Available Adult onset Still’s disease (AOSD is a rare inflammatory disorder of unknown etiology that usually affects young adults. Very few patients older than 70-year-old have been reported. Clinical features include quotidian fevers, arthralgias, arthritis, pharyngitis, lymphadenopathy and an evanescent rash. AOSD should be considered in the differential diagnosis of fever of unknown origin. Early diagnosis is often difficult since it is a diagnosis of exclusion and the presence of infectious, neoplastic and autoimmune conditions needs to be ruled out before the diagnosis is made. No specific laboratory tests are available to aid in the diagnosis of AOSD. As a result, a set of diagnostic criteria that define the clinical features of this condition, termed the Yamaguchi criteria, have been most commonly used to establish the diagnosis. We describe the case of a 72-year-old Caucasian male with past medical history significant for generalized anxiety disorder, depression, BPH, and hypertriglyceridemia, who presented to a tertiary institution complaining of profound generalized weakness and weight loss that started three weeks prior to presentation. Initial laboratory studies showed leukocytosis, elevated ESR, CRP, ferritin and liver dysfunction. Cultures, ANA and rheumatoid factor studies were negative. The patient underwent further extensive workup that excluded the presence of infectious, neoplastic and autoimmune disorders and was subsequently diagnosed with AOSD and new onset diabetes mellitus. For the management of AOSD he was started on prednisone with significant improvement in markers of inflammation, symptoms and level of function.

  3. [Novel possibilities for the rehabilitation of patients presenting with congenital external and middle ear malformations].

    Science.gov (United States)

    Mileshina, N A; Osipenkov, S S; Bakhshinian, V V; Tavartkiladze, G A

    2014-01-01

    The objective of the present study was to estimate the advantages of cochlear Baha BIA 400 abutments in the intraoperative and early postoperative periods. A total of 10 implantations of the systems with the use of hydroxyapatite bone cement were performed in 9 patients of different age. Stability of the implants and intensity of skin reactions were evaluated. The data obtained indicate that the use of cochlear Baha BIA 400 abutments significantly simplifies and shortens the surgical stage of rehabilitation producing a good cosmetic result. The use of the Osstell instrument made it possible to estimate stability of the implants intraoperatively and evaluate the effectiveness of osteointegration during the follow-up period. Analysis of the results of the study provided a basis on which to improve the quality and shorten duration of the rehabilitative treatment of the patients presenting with congenital external and middle ear malformations. Moreover, the data obtained can be used to develop practical recommendations for the further work in this area.

  4. Epigastric pain as presentation of an addisonian crisis in a patient with Schmidt syndrome.

    Science.gov (United States)

    Lelubre, Christophe; Lheureux, Philippe E R

    2008-02-01

    A 39-year-old woman presented with a 10-day history of epigastric pain accompanied by persistent fatigue and loss of appetite for 3 months. She had presented several weeks earlier with adhesive capsulitis, treated by local infiltration of corticosteroids. She was not taking any other medications. Results of heart, lung, and abdominal examinations were unremarkable, except for mild epigastric tenderness. Purple stretch marks were observed on examination of the skin. The only blood chemistry abnormalities were hyponatremia (125 mEq/L) and hyperkalemia (6.8 mEq/L). Based on the clinical and biologic picture, adrenal insufficiency was suspected. The patient was transferred to the intensive care unit and received hydrocortisone intravenously for 3 days. She was then given oral hydrocortisone and fludrocortisone. Biologic abnormalities reversed entirely; the final diagnosis was primary autoimmune adrenal insufficiency (Addison's disease) associated with autoimmune hypothyroidism (Schmidt syndrome). Adrenal insufficiency should be considered in patients with abdominal pain, especially when associated with electrolyte abnormalities.

  5. Pediatric Autoimmune Hepatitis in a Patient Who Presented With Erythema Nodosum: A Case Report

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    Zohreh Kavehmanesh

    2012-01-01

    Full Text Available Background: Autoimmune hepatitis (AIH is a form of chronic hepatitis with unclear causative factors and is characterized by immunological and auto-immunological manifestations. Several extrahepatic manifestations, such as other autoimmune disorders, are associated with AIH. AIH with dermatological conditions as the initial manifestation is rare. We report the case of AIH in which erythema nodosum (EN was the first manifestation.Case Presentation: An 8-year-old girl with several persistent dermatological lesions was referred to our hospital several months ago. Her skin had nodular, painful, dry, and erythematous lesions, predominantly on the extensor areas of both the legs, with some erythematous patches on her face. Physical examination revealed that she had hepatosplenomegaly as well. Skin biopsy indicated EN. The results of the laboratory tests showed increased levels of several liver enzymes. The patient's International Autoimmune Hepatitis Group (IAIHG score was a definite indicator of AIH. The results of liver biopsy indicated AIH. Other causes of EN and abnormal liver function were ruled out. The only obvious cause of skin lesions was chronic inflammation due to an autoimmune response. The patient was treated for AIH, and her skin lesions along with other signs and symptoms resolved.Conclusions: AIH can present with protean clinical manifestations, and is thus associated with the risk of delayed diagnosis. Dermatological manifestations, including EN, could indicate a serious disease, and further investigation might be required. AIH should be considered as the possible diagnosis in such cases.

  6. The Prevalence of Anti-Aquaporin 4 Antibody in Patients with Idiopathic Inflammatory Demyelinating Diseases Presented to a Tertiary Hospital in Malaysia: Presentation and Prognosis

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    S. Abdullah

    2017-01-01

    Full Text Available Background. There have been inconsistent reports on the prevalence and pathogenicity of anti-Aquaporin 4 (AQP4 in patients presented with idiopathic inflammatory demyelinating diseases (IIDDs. Objective. To estimate the prevalence of anti-AQP4 antibody in patients with IIDDs presented to University Malaya Medical Centre in terms of patients’ clinical and radiological presentations and prognoses. Methods. Retrospective data review of IIDDs patients presented from 2005 to 2015. Patients were classified into classical multiple sclerosis (CMS, opticospinal (OS presentation, optic neuritis (ON, transverse myelitis (TM, brainstem syndrome (BS, and tumefactive MS. Anti-Aquaporin 4 antibody was tested using the Indirect Immunofluorescence Test (IIFT cell-based assay. Statistical analysis was done using the SPSS version 20. Results. Anti-AQP4 antibody was detected in 53% of patients presented with IIDDs. CMS was more common in the seronegative group, 27/47 (57.45%; p<0.001. Conversely, OS involvement was more common in the seropositive group, 26/53 (49.06%; p<0.001. Longitudinally extensive spinal cord lesions (LESCLs on MRI were also more common in the seropositive group, 29/40 (72.50%; p=0.004. Only 2/40 (5.00% had MRI evidence of patchy or multiple short-segment spinal cord lesions in the AQP4-positive group (p=0.003. The relapse rate and Expanded Disability Status Scale (EDSS were also higher in the seropositive group (5.43 versus 3.17, p=0.005; 4.07 versus 2.51, p=0.006, resp.. Typical clinical presentations that defined NMO were also seen in the seronegative patients, but in a lower frequency. Conclusion. Our cohort of patients had a higher prevalence of seropositivity of anti-AQP4 antibody as compared to those in Western countries. This was also associated with a more typical presentation of opticospinal involvement with LESCLs on MRI, a higher rate of relapse, and EDSS.

  7. Atypical presentation of acute idiopathic megacolon in a 14-year-old patient

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    B. Barakat

    2012-12-01

    Full Text Available In clinical practice the term “megacolon” is used to indicate a marked dilatation of the cecum and the sigmoid colon (>12 and 6.5 cm, respectively (1. From a clinical standpoint, a megacolon can be classified as chronic or acute depending on its clinical presentation. Chronic megacolon typically refers to a congenital disorder in which the enteric nervous system (ENS supplying the colon does not develop properly, thereby leaving the distal segments of the viscus without myenteric and submucosal ganglia (i.e. Hirschsprung’s disease (2. Other cases of non-aganglionic chronic megacolon can be secondary to variety of conditions such as Chagas’ disease and neurodegenerative diseases (e.g. Parkinson’s and Alzheimer’s diseases, leading to or associated with ENS abnormalities (3. The acute form of megacolon, also referred to as Ogilvie’s syndrome, is characterized by a predominant involvement of the cecum and right colon usually affecting elderly patients undergoing surgery (e.g. orthopedic procedures or taking medications altering gut motility (e.g. opioids or antidepressants (4. Some forms of acute megacolon, however, can be idiopathic in origin since no underlying etiology can be identified. Patients with acute idiopathic megacolon usually have a longstanding history of constipation, often accompanied by laxative abuse, and their clinical presentation is characterized by abdominal distension and severe pain with radiological evidence of stool impacted in the colon and rectum (1, 4. The case herein reported represents an unusual form of acute idiopathic megacolon characterized by massive descending and sigmoid colon distension complicated with a volvulus in a 14-year-old boy with no Hirschsprung’s disease. In addition, just to increase the peculiarity of this case report, the patient had an unremarkable clinical record, and never suffered from chronic constipation in the past.

  8. Mass-gathering Medicine: Risks and Patient Presentations at a 2-Day Electronic Dance Music Event.

    Science.gov (United States)

    Lund, Adam; Turris, Sheila A

    2015-06-01

    Music festivals, including electronic dance music events (EDMEs), increasingly are common in Canada and internationally. Part of a US $4.5 billion industry annually, the target audience is youth and young adults aged 15-25 years. Little is known about the impact of these events on local emergency departments (EDs). Drawing on prospective data over a 2-day EDME, the authors of this study employed mixed methods to describe the case mix and prospectively compared patient presentation rate (PPR) and ambulance transfer rate (ATR) between a first aid (FA) only and a higher level of care (HLC) model. There were 20,301 ticketed attendees. Seventy patient encounters were recorded over two days. The average age was 19.1 years. Roughly 69% were female (n=48/70). Forty-six percent of those seen in the main medical area were under the age of 19 years (n=32/70). The average length of stay in the main medical area was 70.8 minutes. The overall PPR was 4.09 per 1,000 attendees. The ATR with FA only would have been 1.98; ATR with HLC model was 0.52. The presence of an on-site HLC team had a significant positive effect on avoiding ambulance transfers. Twenty-nine ambulance transfers and ED visits were avoided by the presence of an on-site HLC medical team. Reduction of impact to the public health care system was substantial. Electronic dance music events have predictable risks and patient presentations, and appropriate on-site health care resources may reduce significantly the impact on the prehospital and emergency health resources in the host community.

  9. Miliary brain metastasis presenting with calcification in a patient with lung cancer: a case report

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    Inomata Minehiko

    2012-09-01

    Full Text Available Abstract Introduction Miliary brain metastasis is an extremely rare form of brain metastasis which can present with atypical imaging findings. We report the case of a patient with miliary brain metastasis of lung cancer showing calcification in metastatic lesions. Case presentation A 68-year-old Japanese woman was diagnosed with lung adenocarcinoma. Brain computed tomography revealed multiple small calcified lesions in both cerebral hemispheres. Mutation of the epidermal growth factor receptor gene (exon 21, L858R in lung cancer cells was detected, and treatment with gefitinib was initiated. A partial response was observed; however, the patient was readmitted to our hospital because of regrowth of the primary lesion and complaints of nausea, headache, and difficulty walking. Brain magnetic resonance imaging revealed scattered tiny nodules enhanced by gadolinium. A diagnosis of leptomeningeal carcinomatosis was made on the basis of cerebrospinal fluid cytology. The patient’s general status worsened, and she died 356 days after the day of first medical examination. Upon autopsy, the brain was found to be edematous and swollen. Lung carcinoma cells were diffusely disseminated on the meningeal surface. Metastatic foci of small nodular form, accompanied by calcifications, were also found in the brain parenchyma. We diagnosed miliary metastasis of lung carcinoma. Conclusions To the best of our knowledge, this is the third report of calcified miliary brain metastasis confirmed by autopsy. We describe calcified lesions that increased in size during the clinical course of nine months. Brain computed tomography findings that reveal multiple small calcified lesions in patients with malignancy should raise suspicion of miliary brain metastasis.

  10. Clinical characteristics and outcome of patients with neuroblastoma presenting genomic amplification of loci other than MYCN.

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    Anne Guimier

    Full Text Available BACKGROUND: Somatically acquired genomic alterations with MYCN amplification (MNA are key features of neuroblastoma (NB, the most common extra-cranial malignant tumour of childhood. Little is known about the frequency, clinical characteristics and outcome of NBs harbouring genomic amplification(s distinct from MYCN. METHODS: Genomic profiles of 1100 NBs from French centres studied by array-CGH were re-examined specifically to identify regional amplifications. Patients were included if amplifications distinct from the MYCN locus were seen. A subset of NBs treated at Institut Curie and harbouring MNA as determined by array-CGH without other amplification was also studied. Clinical and histology data were retrospectively collected. RESULTS: In total, 56 patients were included and categorised into 3 groups. Group 1 (n = 8 presented regional amplification(s without MNA. Locus 12q13-14 was a recurrent amplified region (4/8 cases. This group was heterogeneous in terms of INSS stages, primary localisations and histology, with atypical clinical features. Group 2 (n = 26 had MNA as well as other regional amplifications. These patients shared clinical features of those of a group of NBs MYCN amplified (Group 3, n = 22. Overall survival for group 1 was better than that of groups 2 and 3 (5 year OS: 87.5%±11% vs 34.9%±7%, log-rank p<0.05. CONCLUSION: NBs harbouring regional amplification(s without MNA are rare and seem to show atypical features in clinical presentation and genomic profile. Further high resolution genetic explorations are justified in this heterogeneous group, especially when considering these alterations as predictive markers for targeted therapy.

  11. Levels of soluble adhesion molecules in patients with various clinical presentations of coronary atherosclerosis

    Institute of Scientific and Technical Information of China (English)

    LU Hui-he; SHENG Zheng-qiang; WANG Yi; ZHANG Li

    2010-01-01

    Background Adhesion molecules play an important role in the development and progression of coronary atherosclerosis. The aim of this study was to compare concentrations of soluble forms of adhesion molecules in patients with different clinical presentations of coronary artery disease (CAD).Methods One hundred and twenty-eight patients with CAD were divided into three groups; the first group was acute myocardial infarction group (AMI group, n=45), the second group was unstable angina pectoris group (UAP group, n=48),the third group was stable angina pectoris group (SAP group, n=35). We compared them with patients with normal coronary arteries (control group, n=31). The serum levels of vascular cell adhesion molecule (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), E-selectin and P-selectin were measured in all subjects.Results The serum level of VCAM-1 in the AMI group was significantly higher than in the UAP, SAP and control groups (P <0.01). The level in the UAP group was significantly higher than the SAP group and control group (P <0.01) and the level in the SAP group was significantly higher than in the control group (P <0.01). The serum ICAM-1 level was significantly elevated in the AMI, UAP and SAP groups as compared to the control group (P <0.01). The levels of serum E-selectin and P-selectin in the AMI and UAP groups were significantly higher than in the SAP and control groups (P<0.01).Conclusions Increased levels of VCAM-1 and ICAM-1, E-selectin and P-selectin, as markers of inflammation, showed the importance of inflammatory processes in the development of atherosclerosis and clinical expression of CAD. Soluble ICAM-1, VCAM-1, E-selectin and P-selectin concentrations are useful indicators of the presence of atherosclerosis and the severity of CAD clinical presentation.

  12. Sjögren's syndrome patients with ectopic germinal centers present with a distinct salivary proteome.

    Science.gov (United States)

    Delaleu, Nicolas; Mydel, Piotr; Brun, Johan G; Jonsson, Malin V; Alimonti, Andrea; Jonsson, Roland

    2016-06-01

    Clinical expression of SS shows considerable interpatient heterogeneity. Thus, the aim of this study was to assess whether individual salivary proteomic profiles provide a framework for identification of disease-phenotype-driven biomarker signatures. Using a 187-plex capture antibody-based assay, proteomic biomarker profiles from unstimulated whole saliva were generated from a SS-cohort representing six clinically distinct disease phenotypes. Discriminant function analyses identified the most powerful biomarker signatures for correct recapitulation of each patient's status with respect to hyposalivation and histopathological features of salivary gland inflammation. In addition, gene ontology-based network analyses allowed systematic interpretation of the molecular patterns underlying these specific disease features. Presentation of hyposalivation was associated with significant alteration in 22 out of 119 reliably detectable biomarkers. Thereof, a 4-plex signature allowed accurate prediction of salivary gland function for >80% of the cases. With respect to histopathological features, the most distinct profiles were identified in conjunction with ectopic germinal centres. Selected from the 13 analytes relevant here, pregnancy-associated plasma protein A, thrombospondin 1 and peptide YY would recapitulate the presence or absence of tertiary lymphoid organization for 93.8% of the patients. Whereas functional annotation of alterations associated with hyposalivation identified the IL1 system as a dominant pro-inflammatory component, changes observed in context with ectopic lymphoid organization revealed specific shifts in chemotactic profiles and altered regulation of apoptotic processes. Multivariate analyses of a patient's salivary proteome could reliably recapitulate specific aspects of SS disease. Accessible and repetitively collectable, such biomarker signatures harbour great potential for patient subclassification and subsequent follow-up. © The Author 2016

  13. Extracolonic findings (ECF) on CT colonography (CTC) in patients presenting with colorectal symptoms

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    Sarit Badiani, Sarit; Karandikar, Sharad [Dept. of General Surgery, Heart of England Foundation Trust, Birmingham (United Kingdom); Tomas-Hernandez, Silvia; Roy-Choudhury; Shuvro [Dept. of Radiology, Heart of England Foundation Trust, Birmingham (United Kingdom)], e-mail: shurvrorc@googlemail.com

    2013-10-15

    Background: Computed tomographic colonography (CTC) is now an established method for imaging the colon and rectum in the screening and symptomatic setting. Additional benefit of CTC is the ability to assess for extracolonic findings especially in patients presenting with colorectal symptoms. Purpose: To determine prevalence of extracolonic findings (ECF) in symptomatic patients undergoing CTC and determine accuracy of CTC for exclusion of significant abdominal disease and extracolonic malignancy (ECM). Material and Methods: A total of 1359 unenhanced prone and postcontrast supine CTC studies were performed between March 2002 and December 2007. ECF were retrospectively classified according to C-RADS criteria into E1 to E4 findings. For ECM, a gold standard of clinical and/or radiological follow-up supplemented with data from the regional cancer registry with a median follow-up of 42 months was created. Sensitivity and negative predictive values for ECM was calculated. Results: Following exclusions, 1177 CTCs were analyzed. Of 1423 extracolonic findings reported, 328/1423 (23%) E3 and 100/1423 (7%) E4 (including six eventual FP studies) findings were identified. Thirty-two ECMs were confirmed following further investigations. Seven further small ECMs were detected during the entire follow-up, of which two were potentially visible in retrospect (false-negative studies). Additional tests were generated from 55/1177 (4.7%) studies. Sensitivity and negative predictive value for ECM was 94.1% (95% CI 78.9 - 98.9%) and 99.8% (95% CI 99.3 - 99.9%), respectively. Conclusion: One in 37 patients were found to have an ECM. Two potentially detectable cancers were missed. Only a small proportion of patients underwent additional work-up.

  14. Survey of diabetes care in patients presenting with acute coronary syndromes in Canada.

    Science.gov (United States)

    O'Neill, Blair J; Mann, Ursula M; Gupta, Milan; Verma, Subodh; Leiter, Lawrence A

    2013-09-01

    Diabetes (DM) adversely affects prognosis in acute coronary syndromes (ACS). Guidelines promote optimal glycemic management. Cardiac care often occurs in subspecialty units where DM care might not be a primary focus. A questionnaire was circulated to 1183 cardiologists (CARDs), endocrinologists (ENDOs), and internists between February and May 2012 to determine current practices of DM management in patients presenting with ACS. The response rate was 14%. ENDOs differed in perception of DM frequency compared with CARDs and the availability of ENDO consultation within 24 hours and on routinely-ordered tests. Disparity also existed in who was believed to be primarily responsible for in-hospital DM care in ACS: ENDOs perceived they managed glycemia more often than CARDs believed they did. CARDs indicated they most often managed DM after discharge and ENDOs said this occurred much less. However, CARDs reported ENDOs were the best health care professional to follow patients after discharge. ENDOs had higher comfort initiating and titrating oral hypoglycemic agents or various insulin regimens. There was also no difference in these specialists' perceptions that optimizing glucose levels during the acute phase and in the long-term improves cardiovascular outcomes. Significant differences exist in the perception of the magnitude of the problem, acute and longer-term process of care, and comfort initiating new therapies. Nevertheless, all practitioners agree that optimal DM care affects short- and long-term outcomes of patients. Better systems of care are required to optimally manage ACS patients with DM during admission and after discharge from cardiology services.

  15. Ulcerative colitis in a multiracial Asian country: Racial differences and clinical presentation among Malaysian patients

    Institute of Scientific and Technical Information of China (English)

    Yan-Mei Tan; Khean-Lee Goh

    2005-01-01

    AIM: To determine the prevalence of ulcerative colitis (UC) in Malaysian patients and to establish the spectrum of the disease seen in Malaysian patients.METHODS: Data were obtained retrospectively from a review of the medical records of in- and out-patients with a diagnosis of UC at the University Hospital, Kuala Lumpur between 1985 and 1998.RESULTS: There were 45 confirmed cases of UC, of which 3 were foreigners, who were excluded from analysis.Thirty new cases of UC were diagnosed during the study period. Their mean age at presentation was 33.0±10.0 years.The highest prevalence of UC was 17.9/100 000 hospital admissions in the Indians, followed by 11.2/100 000 hospital admissions in the Chinese. The lowest prevalence was 3.7/100 000 hospital admissions in the Malays. The prevalence of UC was significantly higher in the Indians and the Chinese when compared with the Malays with an OR of 4.89 (CI = 2.02-12.24; χ2 = 15.45, P<0.001) and 3.06 (CI = 1.24-7.78; χ2 = 6.30; P= 0.012) respectively. The extent of colonic disease was similar in the Malay and Indian patients. In contrast, distal or left-sided colitis predominated in the Chinese with an OR of 8.17 (95%CI = 1.31-64.87;χ2 = 5.53, P = 0.02). Extraintestinal manifestations were uncommon (11.9%).CONCLUSION: UC is an uncommon disease in Malaysia,but racial differences exist. The Indians had the highest prevalence of UC with the Chinese demonstrating the least extensive disease.

  16. Peroxynitrite modified DNA presents better epitopes for anti-DNA autoantibodies in diabetes type 1 patients.

    Science.gov (United States)

    Tripathi, Prashant; Moinuddin; Dixit, Kiran; Mir, Abdul Rouf; Habib, Safia; Alam, Khursheed; Ali, Asif

    2014-07-01

    Peroxynitrite (ONOO(-)), formed by the reaction between nitric oxide (NO) and superoxide (O2(-)), has been implicated in the etiology of numerous disease processes. Peroxynitrite interacts with DNA via direct oxidative reactions or via indirect radical-mediated mechanism. It can inflict both oxidative and nitrosative damages on DNA bases, generating abasic sites, resulting in the single strand breaks. Plasmid pUC 18 isolated from Escherichiacoli was modified with peroxynitrite, generated by quenched flow process. Modifications incurred in plasmid DNA were characterized by ultraviolet and fluorescence spectroscopy, circular dichroism, HPLC and melting temperature studies. Binding characteristics and specificity of antibodies from diabetes patients were analyzed by direct binding and inhibition ELISA. Peroxynitrite modification of pUC 18 plasmid resulted in the formation of strand breaks and base modification. The major compound formed when peroxynitrite reacted with DNA was 8-nitroguanine, a specific marker for peroxynitrite induced DNA damage in inflamed tissues. The concentration of 8-nitroguanine was found to be 3.8 μM. Sera from diabetes type 1 patients from different age groups were studied for their binding to native and peroxynitrite modified plasmid. Direct binding and competitive-inhibition ELISA results showed higher recognition of peroxynitrite modified plasmid, as compared to the native form, by auto-antibodies present in diabetes patients. The preferential recognition of modified plasmid by diabetes autoantibodies was further reiterated by gel shift assay. Experimentally induced anti-peroxynitrite-modified plasmid IgG was used as a probe to detect nitrosative lesions in the DNA isolated from diabetes patients.

  17. Delayed hemolytic transfusion reaction presenting as a painful crisis in a patient with sickle cell anemia

    Directory of Open Access Journals (Sweden)

    Antonio Fabron Junior

    1999-01-01

    Full Text Available CONTEXT: Patients with sickle cell anemia (SCA are frequently transfused with red blood cells (RBC. Recently, we reported that the calculated risk of RBC alloimmunization per transfused unit in Brazilian patients with SCA is 1.15%. We describe a delayed hemolytic transfusion reaction (DHTR presenting as a painful crisis in a patient with SCA. CASE REPORT: A 35-year-old Brazilian female with homozygous SCA was admitted for a program of partial exchange transfusion prior to cholecystectomy. Her blood group was O RhD positive and no atypical RBC alloantibody was detected using the indirect antiglobulin technique. Pre-transfusional hemoglobin (Hb was 8.7 g/dL and isovolumic partial exchange transfusion was performed using 4 units of ABO compatible packed RBC. Five days after the last transfusion she developed generalized joint pain and fever of 39°C. Her Hb level dropped from 12.0 g/dL to 9.3 g/dL and the unconjugated bilirrubin level rose to 27 mmol/L. She was jaundiced and had hemoglobinuria. Hemoglobin electrophoresis showed 48.7% HbS, 46.6% HbA1, 2.7% HbA2, and 2.0% HbF. The patient’s extended RBC phenotype was CDe, K-k+, Kp(a-b+, Fy(a-b-, M+N+s+, Le(a+b-, Di(a-. An RBC alloantibody with specificity to the Rh system (anti-c, titer 1:16.384 was identified by the indirect antiglobulin test. The Rh phenotype of the RBC used in the last packed RBC transfusion was CcDEe. The patient was discharged, asymptomatic, 7 days after admission.

  18. O uso da toxina botulínica no tratamento da distonia laríngea (disfonia espasmódica: estudo preliminar com doze pacientes Use of botulinum toxin in the treatment of laryngeal dystonia (spasmodic dysphonia: preliminary study of twelve patients

    Directory of Open Access Journals (Sweden)

    Hélio A. G. Teive

    2001-03-01

    Full Text Available A distonia laríngea (disfonia espasmódica é distúrbio do movimento caracterizado por contrações involuntárias da musculatura laríngea envolvida no processo de vocalização. A utilização da toxina botulínica no tratamento da distonia laríngea trouxe consideráveis benefícios clínicos. Descrevemos os resultados preliminares do uso terapêutico da toxina botulínica no tratamento da distonia laríngea em 12 pacientes. Após investigação clínica, os pacientes foram submetidos a videolaringoestroboscopia para confirmação diagnóstica e as injeções de toxina botulínica foram realizadas através de punção da membrana cricotireóidea em direção ao músculo tireoaritenóideo, com uso de eletromiografia. A maioria dos pacientes submetidos ao tratamento com toxina botulínica apresentou melhora significativa da distonia laríngea (83% dos casos, com duração média do efeito de quatro meses, sem efeitos colaterais significativos.Laryngeal dystonia (spasmodic dysphonia is a movement disorder characterized by involuntary contractions of laryngeal muscles involved with vocalization. The introduction of botulinum toxin in the treatment of laryngeal dystonia had a major clinical impact due to the striking improvement of symptoms. We report the preliminary results of therapeutical use of botulinum toxin in the treatment of twelve patients with laryngeal dystonia. After an extensive clinical evaluation, the patients underwent a videostroboscopic exam for diagnostic confirmation. Botulinum toxin was injected in the cricothyreoid membrane, directed towards the thyreoaritenoid muscle, with the aid of eletromyography needles. Most of patients who underwent botulinum toxin injection had a significant improvement of their symptoms (83%, with effects lasting for four months in average and without important side effects.

  19. Improved meal presentation increases food intake and decreases readmission rate in hospitalized patients.

    Science.gov (United States)

    Navarro, Daniela Abigail; Boaz, Mona; Krause, Ilan; Elis, Avishay; Chernov, Karina; Giabra, Mursi; Levy, Miriam; Giboreau, Agnes; Kosak, Sigrid; Mouhieddine, Mohamed; Singer, Pierre

    2016-10-01

    Reduced food intake is a frequent problem at a hospital setting, being a cause and/or consequence of malnutrition. Food presentation can affect food intake and induce nutritional benefit. To investigate the effect of improved meal presentation supported by gastronomy expertise on the food intake in adults hospitalized in internal medicine departments. Controlled before and after study. Two hundred and six newly hospitalized patients in internal medicine departments were included and divided in two groups, a) control: receiving the standard lunch from the hospital and b) experimental: receiving a lunch improved in terms of presentation by the advices received by the Institut Paul Bocuse, Ecully, Lyon, France together with the hospital kitchen of the Beilinson Hospital, without change in the composition of the meal. The amount of food left at the participants' plates was estimated using the Digital Imaging Method, which consisted in photographing the plates immediately to previous tray collection by the researcher. In addition, the nutritionDay questionnaire was used to measure other variables concerned to their food intake during hospitalization. Charlson Comorbidity Index was calculated. There was no significant difference between the groups regarding demography or Charlson Comorbidity Index. Patients who received the meal with the improved presentation showed significantly higher food intake than those who received the standard meal, despite reported loss in appetite. Participants from the experimental group left on their plate less starch (0.19 ± 0.30 vs. 0.52 + 0.41) (p  0.05). Both of the groups were asked how hungry they were before the meal and no significance was shown. More participants from the experimental group reported their meal to be tasty in comparison to those in the control group (49.5% vs. 33.7% p < 0.005). Length of stay was not different but readmission rate decreased significantly in the study group (p < 0.02) from 31.2% to 13

  20. The curious case of a cardiac tamponade in the hypertensive patient presenting as abdominal fullness.

    Science.gov (United States)

    Li, William; Subedi, Rogin; Madhira, Bhaskara

    2017-01-19

    Cardiac tamponade is a medical emergency consisting of an accumulation of fluid in the pericardial space which is rapidly progressing and fatal. Because cardiac tamponade is ultimately a clinical diagnosis, mindful consideration for atypical presentations is essential for the reduction of mortality in the acute setting. Our patient was a 77year-old female admitted after presenting with general malaise, weakness, somnolence, altered mental status and urinary incontinence found to have CML (chronic myeloid leukemia) on confirmatory bone marrow biopsy after suspicions arose from a leukocytosis of 34,000 cells per mcL with 85% neutrophils and elevated blasts (8%). Initial vital signs revealed mild tachycardia, mild tachypnea and blood pressure elevated to 162/84mm Hg along with a temperature of 38.7°C and oxygen saturation of 96% on 2l by nasal cannula. She received the standard of care for a community acquired pneumonia and was started on treatment with decitabine as further work-up was unremarkable. An abdominal CT performed for abdominal fullness later displayed a large pericardial effusion. Repeat echocardiography exhibited right atrial diastolic collapse, inferior vena cava dilatation (IVC) without inspiratory collapse >50% and the large pericardial effusion consistent with tamponade. The blood pressure remained hypertensive until she suddenly went into cardiac arrest after being intubated for a pericardial window and expired. Our case highlights the need to keep cardiac tamponade as a differential in the hypertensive individual with abdominal complaints as atypical presentations can obscure diagnosis, delay treatment and increase mortality.

  1. Postoperative Conversion Disorder Presenting as Inspiratory Stridor and Hemiparesis in a Pediatric Patient

    Science.gov (United States)

    Nelson, Erik J.; Wu, Jennifer Y.

    2017-01-01

    Patient: Female, 13 Final Diagnosis: Postoperative conversion disorder Symptoms: Right-sided weakness and right-sided sensory loss • difficulty speaking Medication: — Clinical Procedure: EUS/EGD Specialty: Anesthesiology Objective: Rare co-existance of disease or pathology Background: Postoperative conversion disorder is rare and has been reported. The diagnosis is usually made after all major organic causes have been ruled out. Case Report: We describe a case of a 13-year-old female who presented in the post-anesthesia care unit with acute-onset inspiratory stridor and unresponsiveness to verbal or painful stimuli after receiving a general anesthetic for upper endoscopy. Later in the post-anesthesia care unit, she presented with acute-onset right hemiplegia and sensory loss. She was first evaluated for causes of her stridor and unresponsiveness. The evaluation revealed paradoxical vocal cord movement, and all laboratory test values were normal. For her hemiplegia and sensory loss, she was evaluated for stroke with head MRI and CT scans, which were normal. Conclusions: After extensive workup and consideration of multiple etiologies for her presenting signs and symptoms, the most likely diagnosis was conversion disorder. PMID:28093564

  2. Diagnostic significance of haematological testing in patients presenting at the Emergency Department

    Directory of Open Access Journals (Sweden)

    Giuseppe Lippi

    2012-03-01

    Full Text Available The use of simple and economic tests to rule out diseases of sufficient clinical severity is appealing in emergency department (ED, since it would be effective for contrasting ED overcrowding and decreasing healthcare costs. The aim of this study was to assess the diagnostic performance of simple and economic haematological testing in a large sample of adult patients presenting at the ED of the Academic Hospital of Parma during the year 2010 with the five most frequent acute pathologies (i.e., acute myocardial infarction, renal colic, pneumonia, trauma and pancreatitis. Both leukocyte count and hemoglobin showed a good diagnostic performance (Area Under the Curve [AUC] of 0.85 for leukocyte count and 0.76 for hemoglobin; both p < 0.01. Although the platelet count was significantly increased in all patients groups except pancreatitis, the diagnostic performance did not achieve statistical significance (AUC 0.53; p = 0.07. We also observed an increased RDW in all groups, except in those with trauma and the diagnostic performance was acceptable (AUC 0.705; p < 0.01. The mean platelet volume (MPV was consistently lower in all patients groups and also characterized by an efficient diagnostic performance (AUC 0.76; p < 0.01. This evidence led us to design an arbitrary formula, whereby MPV and hemoglobin were multiplied, and further divided by the leukocyte count, obtaining a remarkable AUC (0.91; p < 0.01. We conclude that simple, rapid and cheap hematological tests might provide relevant clinical information for decision making to busy emergency physicians, and the their combination into an arbitrary formula might further increase the specific diagnostic potential of each of them.

  3. Anal phyllodes tumor in a male patient: a unique case presentation and literature review.

    Science.gov (United States)

    Ho, Szu-pei; Tseng, Hui-hwa; King, T M; Chow, Philip-C

    2013-03-26

    Lesions of anogenital mammary-like glands are rare, and only 44 female cases have been reported. Herein, we describe a particularly rare case of phyllodes tumor of anogenital mammary-like glands in a 41-year-old male presenting anal bleeding. Papillectomy was performed. The excised tumor was circumscribed in shape, and after it was sliced into sections, it was noted that there were leaf-like slits on the surface of cut side. Under the microscope, the tumor was found to be biphasic, with a bland glandular epithelium and low-to-intermediate cellular stroma, which together created the leaf-like slits. Gynecomastoid hyperplasia was evident at the periphery. The epithelium showed immuno-activity for ER, PR(focal), AR, and GCDFP-15. The stromal cells showed positive staining for CD34 and vimentin. The morphology and immunophenotype were similar to benign phyllodes tumors of breast. To the best of our knowledge, this case report represents the first case of phyllodes tumor of anogenital mammary-like glands with gynecomastoid hyperplasia at the periphery in a male patient. To make a diagnosis, we had to differentiate this lesion from hidradenoma papilliferum of skin appendage, phyllodes tumor of ectopic prostatic tissue, and other tumors of anogenital mammary-like glands analogous to the breast tumor (e.g., fibroadenoma phyllodes, periductal stromal sarcoma, and spindle cell carcinoma). While gynecomastia of male breast is usually a result of hormone imbalance, our patient's tumor did not seem to be related to peripheral hormone status in the anogenital mammary-like glands. Nevertheless, because hormone imbalance has been strongly related to male breast cancer, hormone levels may need to be followed in male patients who have this rare malady. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1509145815899177.

  4. Tertiary lymphoid structures are confined to patients presenting with unifocal Langerhans Cell Histiocytosis.

    Science.gov (United States)

    Quispel, Willemijn T; Steenwijk, Eline C; van Unen, Vincent; Santos, Susy J; Koens, Lianne; Mebius, Reina; Egeler, R Maarten; van Halteren, Astrid G S

    2016-08-01

    Langerhans cell histiocytosis (LCH) is a neoplastic myeloid disorder with a thus far poorly understood immune component. Tertiary lymphoid structures (TLS) are lymph node-like entities which create an immune-promoting microenvironment at tumor sites. We analyzed the presence and clinical relevance of TLS in n = 104 H&E-stained, therapy-naive LCH lesions of non-lymphoid origin and applied immunohistochemistry to a smaller series. Lymphoid-follicular aggregates were detected in 34/104 (33%) lesions. In line with the lymphocyte recruitment capacity of MECA-79(+) high endothelial venules (HEVs), MECA-79(+)-expressing-LCH lesions (37/77, 48%) contained the most CD3(+) T-lymphocytes (p = 0.003). TLS were identified in 8/15 lesions and contained T-and B-lymphocytes, Follicular Dendritic Cells (FDC), HEVs and the chemokines CXCL13 and CCL21 representing key cellular components and TLS-inducing factors in conventional lymph nodes (LN). Lymphoid-follicular aggregates were most frequently detected in patients presenting with unifocal LCH (24/70, 34%) as compared to patients with poly-ostotic or multi-system LCH (7/30, 23%, p = 0.03). In addition, patients with lymphoid-follicular aggregates-containing lesions had the lowest risk to develop new LCH lesions (p = 0.04). The identification of various stages of TLS formation within LCH lesions may indicate a key role for the immune system in controlling aberrant histiocytes which arise in peripheral tissues.

  5. Anaesthetic management of patients with congenital heart disease presenting for non-cardiac surgery.

    Directory of Open Access Journals (Sweden)

    Mohindra R

    2002-01-01

    Full Text Available The incidence of congenital heart disease is about one percent of all live births in the United States. Treatment is being performed at a younger age and these children are showing improved survival. It is not unusual for children with congenital heart disease to present for non-cardiac surgery. Their management depends on their age, type of lesion, extent of corrective procedure, the presence of complications and other congenital anomalies. Each patient needs a detailed pre-operative evaluation to understand the abnormal anatomy and physiology, and related anaesthetic implications. No anaesthetic agent is an absolute contraindication, although drugs beneficial for one lesion may be detrimental for another. Regional anaesthesia has also been safely used in children with congenital heart disease. However the anaesthesiologist must have a detailed understanding of the pathophysiology of the lesion and the pharmacology of drugs being used to be able to provide safe anaesthesia for children with congenital heart disease.

  6. A rare presentation of subcutaneous granuloma annulare in an adult patient; A case report

    Directory of Open Access Journals (Sweden)

    Waleed Alajroush

    2016-07-01

    Full Text Available We are reporting a 33-year old woman with multiple skin-colored, firm, non-tender nodules of varying sizes (ranging between 1 and 1.5 cm, with limited mobility and normal overlying skin. They were distributed mainly on the palmer side of the fingers. History and laboratory examination indicated lack of systemic diseases such as diabetes, rheumatoid arthritis, and tuberculosis. Histopathologic examination confirmed the subcutaneous granuloma annulare (SGA diagnosis by showing a normal epidermis with palisading granulomas (histocytes and giant cells surrounding small areas of connective tissue degeneration (central necrobiosis and mucin accumulation in the reticular dermis and subcutaneous tissues. The patient responded well to two-session course of intra-lesional steroid injections. SGA should be considered by dermatologists in the differential diagnosis of subcutaneous nodules even without concomitant systemic disease and with rare presentation.

  7. Coincidental Finding of Beta Thalassaemia Minor in a Patient of Lacquer Thinner Poisoning Presenting as Methaemoglobinemia.

    Science.gov (United States)

    Agarwal, Charu; Mohanpuria, Anisha; Buxi, Gurdeep; Kumar, Vijay

    2016-11-01

    Lacquer thinner, commonly used for removing household paints, is known to contain various aromatic hydrocarbons and naphtha; if ingested, may cause methaemoglobinemia. We report a case of 13-year-old girl who presented with episodes of vomiting, abdominal pain and numbness of limbs. Peripheral blood smear showed few fragmented erythrocytes and 10-12 nucleated red blood cells /100 white blood cells. Reticulocyte count was 15% with presence of Heinz bodies. There was a history of accidental ingestion of lacquer paint thinner. Levels of methaemoglobin were very high along with raised HbA2 levels. An impression of haemolytic anaemia, due to lacquer thinner paint poisoning, with methaemoglobinemia was given. Incidentally High Performance Liquid Chromatography (HPLC) revealed increased HbA2 levels i.e., heterozygous inheritance of beta thalassaemia minor. Patient responded well to methylene blue. Blood transfusion was performed and symptomatic treatment was given.

  8. Combinations of Genetic Data Present in Bipolar Patients, but Absent in Control Persons

    DEFF Research Database (Denmark)

    Mellerup, E; Andreassen, OA; Bennike, B.

    2015-01-01

    The main objective of the study was to find combinations of genetic variants significantly associated with bipolar disorder. In a previous study of bipolar disorder, combinations of three single nucleotide polymorphism (SNP) genotypes taken from 803 SNPs were analyzed, and four clusters...... of combinations were found to be significantly associated with bipolar disorder. In the present study, combinations of four SNP genotypes taken from the same 803 SNPs were analyzed, and one cluster of combinations was found to be significantly associated with bipolar disorder. Combinations from the new cluster...... and from the four previous clusters were identified in the genomes of 209 of the 607 patients in the study whereas none of the 1355 control participants had any of these combinations in their genome....

  9. Atypical presentation of syphilis in an HTLV-I infected patient

    Directory of Open Access Journals (Sweden)

    Carnaúba Jr Dimas

    2003-01-01

    Full Text Available We report the case of a 44 year-old female, who presented a long-lasting, clinically atypical, secondary syphilis ("malignant syphilis" in the right foot, which started six months before medical evaluation. The patient had a serological diagnosis of HTLV-I infection and syphilis two years before the onset of the skin lesions, following a blood donation. As she believed she was allergic to penicillin, she initially received sulfamethoxazole + trimethoprim, without any improvement of the clinical picture. After failure of this first treatment regimen, she was given penicillin, which promoted complete healing of the lesion. We found evidence that infection by HTLV-I is capable of modifying the clinical course of secondary syphilis.

  10. Hyperhomocysteinemia Presenting with Complete Unilateral Intracranial and Extracranial Carotid Occlusion in a Young Patient.

    Science.gov (United States)

    Niazi, Farheen; Rahman, Abdul; Batool, Uzma

    2017-09-01

    Hyperhomocysteinemia has been associated with premature peripheral vascular, cerebrovascular, and coronary artery disease. It has been associated with vascular diseases including cerebrovascular disease, particularly in subjects with significant carotid stenosis. However, hyperhomocysteinemia causing unilateral complete occlusion of whole of internal carotid, common carotid, and external carotid has been rarely reported. We report a case of an adult patient aged 35-year with complete occlusion of right common carotid, internal carotid, both intracranial and extracranial part, presented with recurrent TIAs and stroke and was found to be having hyperhomocysteinemia as the cause of this complete occlusion and showed marked clinical recovery with appropriate treatment. Prompt identification and treatment of hyperhomocysteinemia, as a vascular risk factor especially in young, is of utmost importance especially when its treatment is cost-effective and can save major disability from stroke.

  11. A patient presenting with spinal cord compression who had two distinct follicular cell type thyroid carcinomas.

    Science.gov (United States)

    Koca, E; Sokmensuer, C; Yildiz, B O; Engin, H; Bozkurt, M F; Aras, T; Barista, I; Gurlek, A

    2004-06-01

    A 61-yr-old woman presented with complaints of weakness and pain in her legs. A magnetic resonance imaging showed a 3 x 5.6 x 7.8 cm mass lesion destructing the T1 and T2 vertebral bodies and compressing the spinal cord. The mass was excised surgically. It was follicular carcinoma metastasis of the cervicodorsal region. Then, she underwent a total thyroidectomy. Pathological examination showed two different types of carcinomas in two different focuses; follicular carcinoma in the left lobe and follicular variant papillary carcinoma in the isthmic lobe. After the operation she was given 100 mCi 131I. This is the first report of a patient who had both metastatic follicular carcinoma and follicular variant papillary carcinoma together.

  12. Atypical presentation of posterior reversible encephalopathy syndrome: Clinical and radiological characteristics in eclamptic patients

    Directory of Open Access Journals (Sweden)

    Aleksandra Aracki-Trenkić

    2016-08-01

    Full Text Available Posterior reversible encephalopathy syndrome (PRES is an obstetric emergency frequently occurring in a pregnant or puerperal woman, manifested with an acute headache, consciousness impairment, seizures, and visual deficits and is associated with white matter changes predominantly affecting the posterior parietal and occipital lobes of the brain. Apart from the above-described typical location of the changes, the most common atypical location involves the brain stem and basal ganglia. Since magnetic resonance imaging (MRI is more sensitive and specific imaging technique compared to computerized tomography, establishing the diagnosis and follow-up in patients with PRES is based mainly on MRI findings. It is particularly important not to exclude PRES as a possible diagnosis when we have the appropriate clinical presentation accompanied by the atypical radiological findings, since this clinical-radiological syndrome can often be manifested with an atypical MRI image.

  13. Paradoxical presentation of orthostatic headache associated with increased intracranial pressure in patients with cerebral venous thrombosis

    Directory of Open Access Journals (Sweden)

    Jung B Kim

    2013-01-01

    Full Text Available Headache is the most common symptom of cerebral venous thrombosis (CVT; however, the detailed underlying mechanisms and characteristics of headache in CVT have not been well described. Here, we report two cases of CVT whose primary and lasting presentation was orthostatic headache, suggestive of decreased intracranial pressure. Contrary to our expectations, the headaches were associated with elevated cerebrospinal fluid (CSF pressure. Magnetic resonance imaging and magnetic resonance venography showed characteristic voiding defects consistent with CVT. We suggest that orthostatic headache can be developed in a condition of decreased intracranial CSF volume in both intracranial hypotensive and intracranial hypertensive states. In these cases, orthostatic headache in CVT might be caused by decreased intracranial CSF volume that leads to the inferior displacement of the brain and traction on pain-sensitive intracranial vessels, despite increased CSF pressure on measurement. CVT should be considered in the differential diagnosis when a patient complains of orthostatic headache.

  14. Case report: Presentation of lacrimo-auriculodento- digital (LADD) syndrome in a young female patient.

    LENUS (Irish Health Repository)

    McKenna, G J

    2009-11-01

    BACKGROUND: Lacrimo-auriculo-dento-digital (LADD) syndrome (OMIM #149730) is an autosomal-dominant congenital disorder that can be caused by heterozygous mutations in the tyrosine kinase domains of the genes encoding fibroblast growth factor receptors 2 (FGFR2) and 3 (FGFR3), and has been found in association with a mutation in the FGF10 gene, which encodes an Fgfr ligand. Clinical signs vary, but the condition is characterised by involvement of the lacrimal and salivary systems, cup-shaped ears, hearing loss and dental abnormalities. Additional features may include involvement of the hands and feet with other body systems particularly the kidneys. CASE REPORT: Previous literature on the subject has been reviewed and this case is the first presentation of LADD syndrome in the Republic of Ireland, as a sporadic case in a 12-year-old girl who exhibited a range of dental and digital anomalies. TREATMENT: Her general medical practitioner managed her medical care whilst her oral care necessitated a multidisciplinary approach involving restorative and orthodontic elements. FOLLOW-UP: The initial restorative phase of treatment has successfully improved the appearance of the patient\\'s anterior teeth using direct resin composite build-ups.

  15. The cif Virulence Factor Gene Is Present in Isolates From Patients With Pseudomonas aeruginosa Keratitis.

    Science.gov (United States)

    Bahl, Christopher D; St Laurent, Jessica D; Karthikeyan, R Siva Ganesa; Priya, J Lakshmi; Prajna, Lalitha; Zegans, Michael E; Madden, Dean R

    2017-03-01

    To determine whether the cif gene is present in pathogenic Pseudomonas aeruginosa isolates from patients with bacterial keratitis at Aravind Eye Hospital, a referral eye care center in southern India, and from corresponding environmental isolates. Polymerase chain reaction amplification was performed on strains of P. aeruginosa isolated from ocular infections and environmental soil samples were collected from the area surrounding Aravind Eye Hospital. DNA sequencing of 16S ribosomal DNA amplicons was performed to verify strain identity. We determined that 45 of 48 patient isolates carry a genomic copy of cif. Analysis of a catalog of environmental strains previously isolated from the surrounding area revealed that only 4 of 10 P. aeruginosa strains and 1 of 14 strains of related species carry the cif gene. This is the first study to show that P. aeruginosa strains with ocular pathogenicity carry the cif gene and that the presence of this gene may be enriched over its prevalence in the environment. Taken together, these results suggest a potential role for Cif in acute bacterial keratitis.

  16. Clinico-radiological improvement in an immunocompetent patient presented with scedosporium apiospermum osteomyelitis.

    Science.gov (United States)

    Mohan, Rahul; Gopakumar, T S

    2016-01-01

    Scedosporium apiospermum is frequently found as a saprophyte in soil, sewage and contaminated water. Its manifestations in immunocompetent patients are usually localised and in immunodeficient patients, it causes invasive systemic diseases. We are reporting the case of a 40-year-old male, who presented with pain, oedema and multiple discharging sinuses over the lateral aspect of the left foot with history of thorn prick. On examination, there were multiple active sinuses with tenderness and local rise in temperature. Calcaneum on palpation showed a thickened and irregular surface with limitation of ankle and subtalar movements. Blood investigations showed a moderate rise in ESR and CRP. X-rays showed typical features of chronic osteomyelitis with sclerosis, cavities and irregular bone contour. CT report showed features of osteomyelitis involving calcaneum, talus, cuneiforms and navicular bone with periarticular soft tissue involvement and mild focal collection in the calcaneum. On repeated culture, it was found to be scedosporium apiospermum fungus. We managed the case with voriconazole therapy and it responded with excellent clinical and radiological improvement by 9 months.

  17. Disseminated tuberculosis after extracorporeal shock-wave lithotripsy in an AIDS patient presenting with urosepsis.

    Science.gov (United States)

    Tourchi, Ali; Ebadi, Maryam; Hosseinzadeh, Alireza; Shabaninia, Mahsa

    2014-03-01

    Haematogenous dissemination of undiagnosed urinary tuberculosis after performing extracorporeal shock-wave lithotripsy (ESWL) is extremely rare. Herein, we report a 41-year-old male who presented with urosepsis to the emergency room; catheterization was performed and retention resolved. He had a tattoo on his left arm and a five-year history of intravenous drug use. Blood tests indicated anaemia, leukocytosis, elevated CRP and ESR and mild hyponatraemia; haematuria, moderate bacteriuria and 2+ proteinuria on urinanalysis were observed. Chest X-ray revealed lesions suggestive of miliary tuberculosis, which was confirmed by chest CT scan. Brain CT and MRI suggested brain involvement in the setting of tuberculosis. On further investigations, HIV infection and hepatitis C seropositivity were detected and the patient remained in a coma for five days with a Glasgow Coma Scale of 6/15. Finally, the diagnosis of haematogenous dissemination of tuberculosis following lithotripsy was established. Anti-tuberculosis and anti-retroviral therapy were prescribed and monthly follow-up visits were scheduled. In conclusion, in a patient diagnosed with ureterolithiasis, a thorough history and physical examination, with specific attention to HIV and tuberculosis predisposing factors, should be carried out and preoperative screening tests considering the possibility of urinary tuberculosis are required. Finally, if urinary tuberculosis is detected, ESWL must be postponed until after appropriate treatment of tuberculosis.

  18. Review of Clinical Presentations in Thai Patients With Primary Amoebic Meningoencephalitis

    Science.gov (United States)

    Wiwanitkit, Viroj

    2004-01-01

    Context: Primary amoebic meningoencephalitis (PAM) is a very rare but deadly infection of the central nervous system. Since the disease was first identified in 1965, fewer than 200 cases have been observed worldwide. Objective: The author performed a literature review of the reports of PAM in Thailand in order to study the clinical summary of PAM among Thai patients. Design: This study was designed as a descriptive retrospective study. A literature review of the papers concerning PAM in Thailand was performed. Results: According to this study, there have been at least 12 reports of PAM in Thailand, of which 2 cases were nonlethal. The mean age was 15.2 ± 16.1 years with a male:female ratio of about 2:1. History of risk behaviors such as suffocation of surface water during swimming was demonstrated in 6 cases. Also, 2 interesting cases involved possible water contact according to the Thai tradition and culture. Concerning the patients' clinical features, fever, headache, impaired consciousness, and stiff neck were seen in all cases. However, some unusual presentations such as intermittent abdominal pain and convulsion were also seen in this series. Similar to worldwide findings, most cases occurred during the summer months. Most of the cases involved young males from rural provinces in various regions of Thailand. Concerning the laboratory investigation, the cerebrospinal fluid (CSF) profile presented the polymorphonuclear (PMN) pleomorphic with hypoglycorhachia pattern. Trophozoite could be identified in all but 2 cases in this series. Conclusion: PAM is sporadically reported in Thailand but remains a public health issue. The clinical diagnosis of PAM is usually difficult as many clinicians are unfamiliar with the disease. The prognosis outcome is usually grave although broad medications are prescribed. PMID:15208515

  19. Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers.

    Science.gov (United States)

    Trevena, Lyndal J; Zikmund-Fisher, Brian J; Edwards, Adrian; Gaissmaier, Wolfgang; Galesic, Mirta; Han, Paul K J; King, John; Lawson, Margaret L; Linder, Suzanne K; Lipkus, Isaac; Ozanne, Elissa; Peters, Ellen; Timmermans, Danielle; Woloshin, Steven

    2013-01-01

    Making evidence-based decisions often requires comparison of two or more options. Research-based evidence may exist which quantifies how likely the outcomes are for each option. Understanding these numeric estimates improves patients' risk perception and leads to better informed decision making. This paper summarises current "best practices" in communication of evidence-based numeric outcomes for developers of patient decision aids (PtDAs) and other health communication tools. An expert consensus group of fourteen researchers from North America, Europe, and Australasia identified eleven main issues in risk communication. Two experts for each issue wrote a "state of the art" summary of best evidence, drawing on the PtDA, health, psychological, and broader scientific literature. In addition, commonly used terms were defined and a set of guiding principles and key messages derived from the results. The eleven key components of risk communication were: 1) Presenting the chance an event will occur; 2) Presenting changes in numeric outcomes; 3) Outcome estimates for test and screening decisions; 4) Numeric estimates in context and with evaluative labels; 5) Conveying uncertainty; 6) Visual formats; 7) Tailoring estimates; 8) Formats for understanding outcomes over time; 9) Narrative methods for conveying the chance of an event; 10) Important skills for understanding numerical estimates; and 11) Interactive web-based formats. Guiding principles from the evidence summaries advise that risk communication formats should reflect the task required of the user, should always define a relevant reference class (i.e., denominator) over time, should aim to use a consistent format throughout documents, should avoid "1 in x" formats and variable denominators, consider the magnitude of numbers used and the possibility of format bias, and should take into account the numeracy and graph literacy of the audience. A substantial and rapidly expanding evidence base exists for risk

  20. Gastric lipoma presenting as a giant bulging mass in an oligosymptomatic patient: a case report

    Directory of Open Access Journals (Sweden)

    Neto Francisco Américo

    2012-09-01

    Full Text Available Abstract Introduction Lipomas of the gastrointestinal tract are a rare condition. Only 5% are of gastric origin, and this corresponds to 2% to 3% of all benign tumors of the stomach and less than 1% of all gastric neoplasms. It is our purpose to report an unusual presentation of a giant gastric lipoma in an oligosymptomatic patient and highlight the importance of discussing differential diagnosis in this situation. A review of the literature has shown that this is one of the largest gastric lipomas described. Case presentation We describe a rare case of a benign gastric tumor with uncommon features in a 63-year-old Caucasian woman. She was admitted with abdominal discomfort, nausea, and upper abdominal fullness after eating. The lesion was suspicious of malignancy because of its dimension and central contrast enhancement on computed tomography. Conventional upper digestive endoscopy revealed a large bulging mass in the gastric posterior wall and three ulcerated areas. In this procedure, a technical limitation due to the location of the mass in the submucosa prevented an adequate biopsy from being obtained. The fragments obtained from the ulcers revealed nothing but necrotic mucosa. Our patient underwent a subtotal gastrectomy and D1 lymphadenectomy with a Roux-en-Y reconstruction. Macroscopic findings revealed a 12 × 8 × 6cm mass with a volume of 576cm3, and the histological pattern demonstrated well-differentiated mature adipose tissue surrounded by a fibrous capsule, confirming the diagnosis of gastric submucosal lipoma. Conclusions Gastric lipoma is a rare benign disease that eventually simulates a malignant tumor.

  1. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study.

    Science.gov (United States)

    Stanley, Adrian J; Laine, Loren; Dalton, Harry R; Ngu, Jing H; Schultz, Michael; Abazi, Roseta; Zakko, Liam; Thornton, Susan; Wilkinson, Kelly; Khor, Cristopher J L; Murray, Iain A; Laursen, Stig B

    2017-01-04

     To compare the predictive accuracy and clinical utility of five risk scoring systems in the assessment of patients with upper gastrointestinal bleeding.  International multicentre prospective study.  Six large hospitals in Europe, North America, Asia, and Oceania.  3012 consecutive patients presenting over 12 months with upper gastrointestinal bleeding.  Comparison of pre-endoscopy scores (admission Rockall, AIMS65, and Glasgow Blatchford) and post-endoscopy scores (full Rockall and PNED) for their ability to predict predefined clinical endpoints: a composite endpoint (transfusion, endoscopic treatment, interventional radiology, surgery, or 30 day mortality), endoscopic treatment, 30 day mortality, rebleeding, and length of hospital stay. Optimum score thresholds to identify low risk and high risk patients were determined.  The Glasgow Blatchford score was best (area under the receiver operating characteristic curve (AUROC) 0.86) at predicting intervention or death compared with the full Rockall score (0.70), PNED score (0.69), admission Rockall score (0.66, and AIMS65 score (0.68) (all P<0.001). A Glasgow Blatchford score of ≤1 was the optimum threshold to predict survival without intervention (sensitivity 98.6%, specificity 34.6%). The Glasgow Blatchford score was better at predicting endoscopic treatment (AUROC 0.75) than the AIMS65 (0.62) and admission Rockall scores (0.61) (both P<0.001). A Glasgow Blatchford score of ≥7 was the optimum threshold to predict endoscopic treatment (sensitivity 80%, specificity 57%). The PNED (AUROC 0.77) and AIMS65 scores (0.77) were best at predicting mortality, with both superior to admission Rockall score (0.72) and Glasgow Blatchford score (0.64; P<0.001). Score thresholds of ≥4 for PNED, ≥2 for AIMS65, ≥4 for admission Rockall, and ≥5 for full Rockall were optimal at predicting death, with sensitivities of 65.8-78.6% and specificities of 65.0-65.3%. No score was helpful at predicting rebleeding or length

  2. Videofluoroscopy of the oral phase of swallowing in eight to twelve years old children with dental malocclusion.

    Science.gov (United States)

    Junqueira, Patricia; Costa, Milton Melciades

    2013-11-01

    The objective of this study was to describe the oral phase of swallowing in individuals with dental malocclusion and to generate data that would contribute to the rehabilitation of those patients. The study was based on the evaluation of the swallowing system through videofluoroscopy on thirty-four children of both genders, aged eight to twelve years old who present with Angle Class II and III dental malocclusions. Thirteen children of similar age and gender presenting normal dental occlusion formed the control group. The results indicated that the oral phase of swallowing is different between individuals with normal occlusion and malocclusion. Dental occlusion types Angle Class II and III did not present a swallowing pattern, independently of the amount of liquid ingested. The swallowing appeared effective in the oral phase of individuals with dental malocclusion, even though adaptations were identified. The outcome, in the absence of a single pattern and the efficiency of the adapted swallowing demonstrates, first a need for additional research investigating orofacial myofunctional treatment for patients with malocclusion and second how such analyses should focus on contributing positively to the rehabilitation of these patients.

  3. An unusual presentation of intraocular tuberculosis in a monocular patient: clinicopathological correlation.

    Science.gov (United States)

    Aggarwal, Kanika; Agarwal, Aniruddha; Sehgal, Shobha; Sharma, Suryaprakash; Singh, Nirbhai; Sharma, Kusum; Samanta, Ramanuj; Invernizzi, Alessandro; Sharma, Aman; Gupta, Vishali

    2016-12-01

    Lack of uniform diagnostic criteria often poses a challenge in the diagnosis and management of tubercular uveitis. The index case describes an unusual presentation of tubercular panuveitis initially misdiagnosed as sympathetic ophthalmia, where the appropriate diagnosis was made using various imaging and laboratory investigations. A 52-year-old Indian woman underwent multimodal imaging, extensive clinical and laboratory work-up, and analysis of microbiological and histopathological specimens. At presentation, her best-corrected visual acuity (BCVA) was 20/30 in OD and no perception of light in OS. Ocular examination revealed multiple grayish-yellow choroiditis lesions resembling Dalen-Fuch's nodules, vitritis, and disc edema. Diagnosis of sympathetic ophthalmia was made and patient treated with intravenous and oral corticosteroids and immunosuppressive therapy. After an initial favorable response, the lesions progressively increased with worsening of vitritis. Due to worsening of chorioretinal lesions which were atypical for sympathetic ophthalmia, further investigations were performed that revealed positive tuberculin skin test and contrast-enhanced computerized tomography chest showed calcified mediastinal lymph nodes. Enucleation of OS confirmed acid-fast bacilli on Ziehl-Neelsen staining, tubercular granulomas on histopathology, and positive polymerase chain reaction. Anti-tubercular therapy and oral steroids were started with good healing response. Tubercular uveitis may have protean clinical manifestations. Thorough clinical evaluation and molecular/histopathological evaluation helps in establishing the diagnosis and the institution of appropriate therapy.

  4. Cardiac arrhythmias in recently diagnosed hypertensive patients at first presentation: an electrocardiographic-based study.

    Science.gov (United States)

    Ejim, E C; Ike, S O; Anisiuba, B C; Essien, I O; Onwubere, B J; Ikeh, V O

    2012-01-01

    Various forms of cardiac arrhythmias have been documented in hypertensive subjects, and hypertension is an important risk factor for the development of atrial and ventricular arrhythmias and sudden death. Electrocardiography at rest easily documents significant arrhythmias in patients, and this study was carried out to determine the types and frequency of arrhythmias in hypertensive subjects at first presentation in the Hypertension Clinics of the University of Nigeria Teaching Hospital (UNTH) Enugu, Nigeria. The study was hospitalbased and retrospective in nature. The resting 12lead ECG reports of 346 consecutive hypertensive subjects seen at the Hypertension clinics of the UNTH Enugu over a 14 month period were retrieved from the case files and studied. Other information obtained from the case files included the age and gender of the subjects. The mean age of the subjects was 57.3 years. Ninety-five of the subjects had arrhythmias representing 27% of the study population, out of which fifty-five were males (57.9%) and forty were females (42.1%). However 26.9% of all the male subjects had arrhythmias while 28.2% of all the females had arrhythmias. Multiple ventricular ectopics, sinus tachycardia, sinus bradycardia and atrial fibrillation were the most prevalent arrhythmias. This study showed that a significant proportion of hypertensive subjects present initially with significant rhythm disturbances.

  5. Muscle hypertrophy as the presenting sign in a patient with a complete FHL1 deletion.

    Science.gov (United States)

    Willis, T A; Wood, C L; Hudson, J; Polvikoski, T; Barresi, R; Lochmüller, H; Bushby, K; Straub, V

    2016-08-01

    Four and a half LIM protein 1 (FHL1/SLIM1) has recently been identified as the causative gene mutated in four distinct diseases affecting skeletal muscle that have overlapping features, including reducing body myopathy, X-linked myopathy, X-linked dominant scapuloperoneal myopathy and Emery-Dreifuss muscular dystrophy. FHL1 localises to the sarcomere and the sarcolemma and is believed to participate in muscle growth and differentiation as well as in sarcomere assembly. We describe in this case report a boy with a deletion of the entire FHL1 gene who is now 15 years of age and presented with muscle hypertrophy, reduced subcutaneous fat, rigid spine and short stature. This case is the first, to our knowledge, with a complete loss of the FHL1 protein and MAP7D3 in combination. It supports the theory that dominant negative effects (accumulation of cytotoxic-mutated FHL1 protein) worsen the pathogenesis. It extends the phenotype of FHL1-related myopathies and should prompt future testing in undiagnosed patients who present with unexplained muscle hypertrophy, contractures and rigid spine, particularly if male. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  6. Wernicke encephalopathy Clinical presentation and MR images in two nonalcoholic patients

    Institute of Scientific and Technical Information of China (English)

    He Zhang; Jun Wu; Zhiping Hu; Bo Xiao; Guoliang Li

    2008-01-01

    The aim of the present study was to investigate the importance of and correlation between clinical presentations and magnetic resonance imaging (MRI) of two different cases of nonalcoholic Wernicke encephalopathy. Case 1: A 63-year-old man with a diagnosis of incomplete mechanical intestinal obstruction. His abdominal symptoms were improved by gastrointestinal decompression, but blurred vision, hypoacusis, dizziness, and unsteady gait were noted. His illness deteriorated to confusion on day seven. MRI showed hyperintense lesions in the medial thalami, tectum of the midbrain, and the periaqueduct region on T2- and diffusion-weighted images. Thiamine therapy was commenced immediately with good results. Case 2: A 22-year-old woman was admitted for sudden-onset confabulation and unsteady gait after hyperemesis gravidarum. She had no history of alcohol or any medication. Brain MRI was normal. The patient experienced relief after Vitamin B1 treatment. These results suggest that brain MRI can define characteristic abnormalities in Wernicke encephalopathy, and that diffusion-weighted imaging may improve the diagnosis sensitivity. In addition, the MRI images may be correlated to the clinical stage and severity of the disease. Nevertheless, the clinical features are essential for correct diagnosis.

  7. Indifference to pain syndrome in a twelve-year-old boy (case report

    Directory of Open Access Journals (Sweden)

    Baghdadi T

    2007-08-01

    Full Text Available Background: People vary greatly in their response to painful stimuli, from those with a low pain threshold to those with indifference to pain. However, insensitivity to pain is a rare disorder, characterized by the lack of usual subjective and objective responses to noxious stimuli. Patients who have congenital indifference to pain sustain painless injuries beginning in infancy, but have sensory responses that are otherwise normal on examination. Perception of passive movement, joint position, and vibration is normal in these patients, as are tactile thresholds and light touch perception. Case report: A twelve-year-old boy was admitted to the hospital for a painless deformity, degeneration in both knees and a neglected femoral neck fracture that was inappropriately painless. Further examination revealed normal sensory responses, perception of passive movement, joint position, vibration tactile thresholds and light touch perception. Spinal cord and brain MRI were normal as was the electromyography and nerve conduction velocity (EMG/NCV examination. There was no positive family history for this disorder. Conclusion: The deficits present in the different pain insensitivity syndromes provide insight into the complex anatomical and physiological nature of pain perception. Reports on pain asymbolia, in which pain is perceived but does not cause suffering, and related cortical conditions illustrate that there can be losses that independently involve either the sensory-discriminative component or the affective-motivational component of pain perception, thus highlighting their different anatomical localization. The paucity of experience with this entity and the resultant diagnostic problems, the severity of the associated disabling arthropathy and underscore the importance of this case report of indifference to pain.

  8. Anal phyllodes tumor in a male patient: a unique case presentation and literature review

    Science.gov (United States)

    2013-01-01

    Abstract Lesions of anogenital mammary-like glands are rare, and only 44 female cases have been reported. Herein, we describe a particularly rare case of phyllodes tumor of anogenital mammary-like glands in a 41-year-old male presenting anal bleeding. Papillectomy was performed. The excised tumor was circumscribed in shape, and after it was sliced into sections, it was noted that there were leaf-like slits on the surface of cut side. Under the microscope, the tumor was found to be biphasic, with a bland glandular epithelium and low-to-intermediate cellular stroma, which together created the leaf-like slits. Gynecomastoid hyperplasia was evident at the periphery. The epithelium showed immuno-activity for ER, PR(focal), AR, and GCDFP-15. The stromal cells showed positive staining for CD34 and vimentin. The morphology and immunophenotype were similar to benign phyllodes tumors of breast. To the best of our knowledge, this case report represents the first case of phyllodes tumor of anogenital mammary-like glands with gynecomastoid hyperplasia at the periphery in a male patient. To make a diagnosis, we had to differentiate this lesion from hidradenoma papilliferum of skin appendage, phyllodes tumor of ectopic prostatic tissue, and other tumors of anogenital mammary-like glands analogous to the breast tumor (e.g., fibroadenoma phyllodes, periductal stromal sarcoma, and spindle cell carcinoma). While gynecomastia of male breast is usually a result of hormone imbalance, our patient’s tumor did not seem to be related to peripheral hormone status in the anogenital mammary-like glands. Nevertheless, because hormone imbalance has been strongly related to male breast cancer, hormone levels may need to be followed in male patients who have this rare malady. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1509145815899177 PMID:23531415

  9. Aetiology, Clinical Presentation, and Outcome of Meningitis in Patients Coinfected with Human Immunodeficiency Virus and Tuberculosis

    OpenAIRE

    Smita Bhagwan; Kogieleum Naidoo

    2011-01-01

    We conducted a retrospective review of confirmed HIV-TB coinfected patients previously enrolled as part of the SAPiT study in Durban, South Africa. Patients with suspected meningitis were included in this case series. From 642 individuals, 14 episodes of meningitis in 10 patients were identified. For 8 patients, this episode of meningitis was the AIDS defining illness, with cryptococcus (9/14 episodes) and tuberculosis (3/14 episodes) as the commonest aetiological agents. The combination of h...

  10. The Haiti Breast Cancer Initiative: Initial Findings and Analysis of Barriers-to-Care Delaying Patient Presentation

    Directory of Open Access Journals (Sweden)

    Ketan Sharma

    2013-01-01

    Full Text Available Background. In Haiti, breast cancer patients present at such advanced stages that even modern therapies offer modest survival benefit. Identifying the personal, sociocultural, and economic barriers-to-care delaying patient presentation is crucial to controlling disease. Methods. Patients presenting to the Hôpital Bon Sauveur in Cange were prospectively accrued. Delay was defined as 12 weeks or longer from initial sign/symptom discovery to presentation, as durations greater than this cutoff correlate with reduced survival. A matched case-control analysis with multivariate logistic regression was used to identify factors predicting delay. Results. Of N=123 patients accrued, 90 (73% reported symptom-presentation duration and formed the basis of this study: 52 patients presented within 12 weeks of symptoms, while 38 patients waited longer than 12 weeks. On logistic regression, lower education status (OR = 5.6, P=0.03, failure to initially recognize mass as important (OR = 13.0, P<0.01, and fear of treatment cost (OR = 8.3, P=0.03 were shown to independently predict delayed patient presentation. Conclusion. To reduce stage at presentation, future interventions must educate patients on the recognition of initial breast cancer signs and symptoms and address cost concerns by providing care free of charge and/or advertising that existing care is already free.

  11. Patient characteristics upon initial presentation to chiropractic teaching clinics: A descriptive study conducted at one university.

    Science.gov (United States)

    Kaeser, Martha A; Hawk, Cheryl; Anderson, Michelle

    2014-10-01

    Objective : The purpose of this study was to compare demographics and chief complaints of the new patient population at our institution's fee-for-service clinics to the patient population of practicing chiropractors in the United States. We also compared the prevalence of obesity and hypertension to reference standards for the adult population. Methods : Patient data were obtained from the electronic health records. All records identified as new patients during October 2013 were included. Variables of interest were clinic site, patient demographics, blood pressure, body mass index (BMI), chief complaint, and ICD-9 codes. Descriptive statistics were computed and compared to reference standards from previous reports. Results : During October 2013, there were 224 new patients that entered the clinics. The average patient was a 31- to 50-year-old white male. Our clinic patients differed from those seen by US chiropractors in the distribution of all demographic variables. For adult patients, 31.4% were overweight, 29% were obese, and 8% stage 1 or 2 hypertension. Conclusion : New patients in the fee-for-service teaching clinics appear to be dissimilar to those of US practicing chiropractors in several important demographics, characteristics, and types of complaints. The new patients had lower levels of overweight, obesity, and hypertension compared to US reference standards.

  12. Amyotrophic lateral sclerosis-like presentation in a HIV-positive patient.

    Science.gov (United States)

    Anand, Kuljeet Singh; Wadhwa, Ankur; Garg, Jyoti; Mahajan, Rakesh Kumar

    2014-01-01

    There has been several reports of an MND like syndrome in HIV-1 infection, however the data is still sparse. Furthermore, HIV-associated amyotrophic lateral sclerosis (ALS) syndrome differs from the classical ALS in some key aspects.. A 44-year-old male presented with a history of insidious onset and gradually progressive asymmetric weakness of lower limbs. He also complained of thinning in both legs, the left leg more than the right since 1 year along with spontaneous twitching of muscles in both the thighs. On neurological examination, the assessment of higher mental functions was normal. There were no cranial nerve deficits. Motor power was grade 5/5 (Medical Research Council scale) in both the upper limbs and 4+ at hips and knees bilaterally, 5 at right ankle, and 4+ at left ankle. All the deep tendon reflexes were brisk with extensor planter responses. There were no cerebellar signs or sensory deficits. HIV-1 was reactive in enzyme-linked immunosorbent assay. Electrophysiological studies were conducted per the MND protocol.None of the nerves studied showed an abnormal drop in compound muscle action potential amplitude with proximal stimulation. There was evidence of diffuse spontaneous activity, which manifests as fibrillation and fasciculation potentials in most muscles tested . Overall there seems to be sufficient evidence to implicate HIV as a potential cause of an ALS-like disorder, but one must also consider the possibility of coincidental HIV infection in patients who have sporadic ALS.

  13. The kaleidoscopic presentation of the spondyloarthritis concept in a female patient.

    Science.gov (United States)

    De Langhe, Ellen; Lories, Rik; Maenaut, Kristin; De Vlam, Kurt

    2011-12-01

    Spondyloarthritis is a group of chronic joint diseases that share clinical, pathological and genetic features and is divided into distinct diagnostic entities, including ankylosing spondylitis, psoriatic arthritis, inflammatory bowel disease-associated spondyloarthritis, reactive arthritis, juvenile onset and undifferentiated spondyloarthritis. Since the spectrum of spondyloarthritides is wider than the sum of aforementioned disorders suggests, the term "Spondyloarthritis concept" might prove to be appropriate. Here, we present a case in which many features of the spondyloarthritis concept, but also unexpected osteitis in the skull and tibia, emerge during the disease course. A 45-year-old HLA-B27 positive woman with a family history of psoriasis, a former diagnosis of ankylosing spondylitis, reactive arthritis and fulminating acne, was referred to our department with a painful tibial swelling, symmetrical polyarthritis and severe headache. Conventional radiography and bone scintigraphy demonstrated large osteolytic lesions on the left parietal side of the skull and the right anterior tibia. She was treated with surgery and pamidronate. Etanercept treatment was initiated as the arthritis deteriorated and was replaced by infliximab when new onset Crohn's disease became apparent. This case is the illustration of spondyloarthritis as a disease concept, covering the entire spectrum, from ankylosing spondylitis, urogenital reactive arthritis and psoriatic arthritis to inflammatory bowel disease. Cases like this illustrate that the clinical classification of spondyloarthritis patients into distinct diagnostic entities is bypassing the value of the "concept" and provides support for the new classification criteria that were recently proposed.

  14. Delayed Presentation of a Cervical Spinal Epidural Abscess of Dental Origin after a Fall in an Elderly Patient.

    Science.gov (United States)

    Bodman, Alexa; Riordan, Margaret; Chin, Lawrence S

    2016-05-23

    Spinal epidural abscesses are an uncommon cause of spinal cord injury but, depending on the size and presence of neurological deficits, urgent neurosurgical intervention may be required. We present a unique case of a patient presenting with a spinal epidural collection several days after a fall. While a spinal epidural hematoma was suspected based on the patient's history and MRI findings, a spinal epidural abscess was found during surgery. The patient underwent laminectomy and instrumented fusion with successful treatment of her infection.

  15. Listening to "How the Patient Presents Herself": A Case Study of a Doctor-Patient Interaction in an Emergency Room

    Science.gov (United States)

    Delbene, Roxana

    2015-01-01

    This is a case-study based on a micro-ethnography analyzing a doctor-patient interaction in an emergency room (ER) in New York City. Drawing on the framework of narrative medicine (Charon, 2006), the study examines how a phenomenological approach to listening to the patient facilitated the patient's narrative orientation not only to relevant…

  16. Tratamiento nutricional de los enfermos con pancreatitis aguda: cuando el pasado es presente Nutritional management of patients with acute pancreatitis: when the past is present

    Directory of Open Access Journals (Sweden)

    A. García Almansa

    2008-05-01

    Full Text Available Los pacientes con pancreatitis aguda sufren con frecuencia un acusado deterioro de su estado nutricional. En algunos éste es ya anterior a su ingreso hospitalario, como ocurre en muchos casos de etiología alcohólica. En otras ocasiones la desnutrición se manifiesta posteriormente en el seno de una pancreatitis de larga evolución o complicada, que impide una correcta alimentación por un tiempo prolongado. A todo ello hay que sumar el hipercatabolismo proteico y el estrés que presentan estos enfermos. Es norma habitual en el tratamiento de la pancreatitis aguda mantener al enfermo en ayuno absoluto. En las pancreatitis leves este estado solo es necesario durante muy pocos días, iniciándose la realimentación por vía oral progresivamente, y no se requieren especiales cuidados nutricionales, salvo que presenten una desnutrición previa. Ahora bien, en los pacientes con pancreatitis moderada y/o grave en los que se prevé un ayuno prolongado por más de una semana, debemos siempre recurrir a un soporte nutricional artificial, que preserve el estado nutricional de estos enfermos, ya que no es suficiente la habitual reposición hidroelectrolítica. En este capítulo realizaremos una revisión actualizada del tratamiento nutricional en estas situaciones, intentando responder a diferentes preguntas entre las que se incluyen el tipo de soporte nutricional indicado, cuándo hay que instaurarlo y hasta qué momento.Patients with acute pancreatitis usually present nutritional status impairment. In alcoholic pancreatitis this impairment is usually presented before hospital admission. In patients with long-term complicated pancreatitis, malnutrition develops during the course of the disease. Besides, these patients present an increased stress and protein hypercatabolism. Treatment of acute pancreatitis usually maintains patients in a short period of starvation. In mild pancreatitis, starvation is needed for a few days, beginning progressively oral

  17. Prevalence Pattern of Risk Factors for Coronary Artery Disease among Patients Presenting for Coronary Artery Bypass Grafting in Oman

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    Rajeeva Rivikath Pieris

    2014-05-01

    Full Text Available Objectives: To identify the pattern of prevalence of risk factors in patients presenting for coronary artery bypass grafting at a single center in Oman. Methods: All patients who had coronary artery bypass grafting between March 2008 to March 2010 were included and data were obtained from history and laboratory investigations. The prevalence rates of eight conventional risk factors are presented as a retrospective single center observational study. Results: Out of 146 total patients, 107 (73.29% were male. The age ranged from 31 to 87 years old. The mean age was 58.18 ± 10.08 years (males = 56.81 ± 10.42, females = 61.95 ± 7.97. Hypertension was present in 119 patients (81.51%, 115 patients (78.77% had dyslipidemia, 107 patients (73.29% were male, 79 patients (54.11% had diabetes mellitus, 70 patients (47.95% were over the age of 60 years, 41 patients (28.08% gave a history of smoking, 31 patients (21.23% were obese, and 19 patients (13.01% gave a positive family history. Conclusions: The most common risk factor was hypertension, followed by dyslipidemia, male gender, diabetes mellitus, old age, smoking, obesity and positive family history; 87.7% had three or more risk factors. The females in this study were older than the males and had more risk factors at presentation. The most common combination of factors seen together was diabetes, hypertension, dyslipidemia and male gender.

  18. Differentiation of Acute Q Fever from Other Infections in Patients Presenting to Hospitals, the Netherlands 1

    OpenAIRE

    Keijmel, S.P.; Krijger, E.; Delsing, C.E.; Sprong, T; Nabuurs-Franssen, M.H.; Bleeker-Rovers, C.P.

    2015-01-01

    Differentiating acute Q fever from infections caused by other pathogens is essential. We conducted a retrospective case-control study to evaluate differences in clinical signs, symptoms, and outcomes for 82 patients with acute Q fever and 52 control patients who had pneumonia, fever and lower respiratory tract symptoms, or fever and hepatitis, but had negative serologic results for Q fever. Patients with acute Q fever were younger and had higher C-reactive protein levels but lower leukocyte c...

  19. Mutant GDF15 presents a poor prognostic outcome for patients with oral squamous cell carcinoma

    OpenAIRE

    Ma, Jie; Tang, Xiao; Sun, Wen-Wen; Ying LIU; Tan, Yi-ran; Ma, Hai-Long; Zhu, Dong-wang; Wang, Min; Wang, Li-Zhen; Li, Jiang; Tu, Yao-yao; Zhang, Chen-Ping; Zhang, Zhi-yuan; Zhong, Lai-ping

    2015-01-01

    Purpose To investigate the mutation status of growth differentiation factor 15 (GDF15) in patients with oral squamous cell carcinoma (OSCC), as well as the prognostic value of missense GDF15 mutations. Patients and methods Formalin-fixed paraffin-embedded biopsy samples from 46 OSCC patients were involved in this study. GDF15 and TP53 mutations were sequenced using the Ion Torrent Personal Genome Machine, GDF15 protein expression was detected using immunohistochemistry. Torrent Suite Software...

  20. [Hand hygiene--part of patient safety from Semmelweis to the present].

    Science.gov (United States)

    Anttila, Veli-Jukka

    2014-01-01

    Hand disinfection is one of the most important part of patient safety. By adequate hand disinfection healthcare workers can prevent about 40 per cent of healthcare-associated infections and about 50 per cent of patients' MRSA contaminations in hospitals. Adherence to hand disinfection has been observed in an average of 40 per cent of patient contacts. One of the risk factors leading to poor adherence is the "doctor" status of a healthcare worker. Introduction of an alcohol-based hand rub close to the patient is one of the most significant factors for improved hand hygiene.

  1. Autonomic Dysfunction Presenting as Postural Orthostatic Tachycardia Syndrome in Patients with Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Khalil Kanjwal, Beverly Karabin, Yousuf Kanjwal, Blair P Grubb

    2010-01-01

    Full Text Available Background: Autonomic dysfunction is common in patients suffering from multiple sclerosis (MS and orthostatic dizziness occurs in almost 50% of these patients. However, there have been no reports on postural orthostatic tachycardia syndrome (POTS in patients suffering from MS. Methods: The patients were included for analysis in this study if they had POTS with either a prior history of MS or having developed MS while being followed for POTS. Postural orthostatic tachycardia (POTS is defined as symptoms of orthostatic intolerance(>6months accompanied by a heart rate increase of at least 30 beats/min (or a rate that exceeds 120 beats/min that occurs in the first 10 minutes of upright posture or head up tilt test (HUTT occurring in the absence of other chronic debilitating disorders. We identified nine patients with POTS who were suffering from MS as well. Each of these patients had been referred from various other centers for second opinions. Results: The mean age at the time of diagnosis of POTS was 49±9 years and eight of the 9 patients were women. Five patients (55% had hyperlipidemia, 3 (33% migraine and 2 (22% patients had coronary artery disease and diabetes each. Fatigue and palpitations (on assuming upright posture were the most common finding in our patients (9/9. All patients also had orthostatic dizziness. Syncope was seen in 5/9(55% of patients. Four patients (44%, who did not have clear syncope, were having episodes of near syncope. The presence of POTS in our study population resulted in substantial limitation of daily activities. Following recognition and treatment of POTS, 6/9(66%, patients were able to resume daily activities of living. Their symptoms (especially fatigue and orthostatic intolerance improved. The frequency and severity of syncope also improved. Three (33% patients failed to show a good response to treatment. Conclusion: Patients suffering from MS may manifest autonomic dysfunction by developing POTS. Early

  2. Presenting a Spatial-Geometric EEG Feature to Classify BMD and Schizophrenic Patients

    Directory of Open Access Journals (Sweden)

    Fatemeh AliMardani

    2016-03-01

    Full Text Available Schizophrenia (SZ and bipolar mood disorder (BMD patients demonstrate some similar signs and symptoms; therefore, distinguishing those using qualitative criteria is not an easy task especially when these patients experience manic or hallucination phases. This study is aimed at classifying these patients by spatial analysis of their electroencephalogram (EEG signals. In this way, 22-channels EEG signals were recorded from 52 patients (26 patients with SZ and 26 patients with BMD. No stimulus has been used during the signal recording in order to investigate whether background EEGs of these patients in the idle state contain discriminative information or not. The EEG signals of all channels were segmented into stationary intervals called “frame” and the covariance matrix of each frame is separately represented in manifold space. Exploiting Riemannian metrics in the manifold space, the classification of sample covariance matrices is carried out by a simple nearest neighbor classifier. To evaluate our method, leave one patient out cross validation approach has been used. The achieved results imply that the difference in the spatial information between the patients along with control subjects is meaningful. Nevertheless, to enhance the diagnosis rate, a new algorithm is introduced in the manifold space to select those frames which are less deviated around the mean as the most probable noise free frames. The classification accuracy is highly improved up to 98.95% compared to the conventional methods. The achieved result is promising and the computational complexity is also suitable for real time processing.

  3. Limited Wegener's granulomatosis presenting as lung nodules in a patient with rheumatoid arthritis: a case report.

    Science.gov (United States)

    Pai, Sushma; Panda, Mukta

    2008-12-23

    Rheumatoid arthritis has varied pleuroparenchymal manifestations. Wegener's granulomatosis can develop in an established case of rheumatoid arthritis and this association although previously reported is very rare. A 60-year-old lady had been diagnosed with rheumatoid arthritis on the basis of her clinical symptoms and serological tests which were positive RA factor and anti-CCP antibodies. Her rheumatoid arthritis activity had been mild and well controlled with hydroxychloroquine and low dose prednisone. She presented with a productive cough and right-sided pleuritic chest pain. CT scan of the chest showed three lung nodules with increased uptake on PET CT scan, raising concerns for an inflammatory or malignant process. The differential diagnosis included rheumatoid nodules, infections or malignancy. A CT-guided needle biopsy of the largest nodule was undertaken which showed vasculitis typical of Wegener's granulomatosis. Stains and cultures of the biopsy specimen were negative for bacteria, fungi and acid fast bacilli. A panel of serological tests for vasculitis were checked and showed elevated titers of cANCA and anti-proteinase 3 antibodies. Urine analysis and CT scan of paranasal sinuses was normal. Since the upper respiratory tract and the kidneys were spared a diagnosis of limited Wegener's granulomatosis affecting only the lungs was made. Due to the toxicity of cyclophosphamide, her relatively mild disease sparing the kidneys and the underlying rheumatoid arthritis, weekly methotrexate was started and low dose prednisone was continued. She had marked symptomatic improvement and complete resolution of the nodules was documented on subsequent imaging. Wegener's granulomatosis developing in a patient with rheumatoid arthritis is very rare but should be considered as it warrants a different and possibly more aggressive treatment approach.

  4. Outcome of patients presenting with idiopathic facial nerve paralysis (Bell's palsy) in a tertiary centre--a five year experience.

    Science.gov (United States)

    Tang, I P; Lee, S C; Shashinder, S; Raman, R

    2009-06-01

    This is a retrospective study. The objective of this study is to review the factors influencing the outcome of treatment for the patients presented with idiopathic facial nerve paralysis. The demographic data, clinical presentation and management of 84 patients with idiopathic facial nerve paralysis (Bell's palsy) were collected from the medical record office, reviewed and analyzed from 2000 to 2005. Thirty-four (72.3%) out of 47 patients who were treated with oral prednisolone alone, fully recovered from Bell's palsy meanwhile 36 (97%) out of 37 patients who were treated with combination of oral prednisolone and acyclovir fully recovered. The difference was statistically significant. 42 (93.3%) out of 45 patients who presented within three days to our clinic, fully recovered while 28 (71.8%) out of 39 patients presented later then three days had full recovery from Bell's palsy. The difference was statistically significant. The outcome of full recovery is better with the patients treated with combined acyclovir and prednisolone compared with prednisolone alone. The patients who were treated after three days of clinical presentation, who were more than 50 years of age, who had concurrent chronic medical illness and facial nerve paralysis HB Grade IV to VI during initial presentation have reduced chance of full recovery of facial nerve paralysis.

  5. Differentiation of Acute Q Fever from Other Infections in Patients Presenting to Hospitals, the Netherlands(1)

    NARCIS (Netherlands)

    Keijmel, S.P.; Krijger, E.; Delsing, C.E.; Sprong, T.; Nabuurs-Franssen, M.H.; Bleeker-Rovers, C.P.

    2015-01-01

    Differentiating acute Q fever from infections caused by other pathogens is essential. We conducted a retrospective case-control study to evaluate differences in clinical signs, symptoms, and outcomes for 82 patients with acute Q fever and 52 control patients who had pneumonia, fever and lower

  6. Body attitudes in patients with eating disorders at presentation and completion of intensive outpatient day treatment.

    NARCIS (Netherlands)

    Exterkate, C.C.; Vriesendorp, P.F.; Jong, C.A.J. de

    2009-01-01

    Due to the importance of the distorted body experience in eating disorder diagnosis and treatment, we wanted to explore body attitudes of patients with eating disorders before and after 5 months of intensive specialized outpatient day treatment. We assessed 193 patients diagnosed with Anorexia

  7. A Case of Mixed Infections in a Patient Presenting with Acute Febrile Illness in the Tropics

    Directory of Open Access Journals (Sweden)

    L. S. Yong

    2013-01-01

    Full Text Available Concurrent infections with more than one etiological agent can result in an illness with overlapping symptoms, resulting in a situation where the diagnosis and management of such a patient could be challenging. We report a case of vivax malaria in a patient who was also serologically positive for leptospirosis and dengue.

  8. Differentiation of Acute Q Fever from Other Infections in Patients Presenting to Hospitals, the Netherlands(1)

    NARCIS (Netherlands)

    Keijmel, S.P.; Krijger, E.; Delsing, C.E.; Sprong, T.; Nabuurs-Franssen, M.H.; Bleeker-Rovers, C.P.

    2015-01-01

    Differentiating acute Q fever from infections caused by other pathogens is essential. We conducted a retrospective case-control study to evaluate differences in clinical signs, symptoms, and outcomes for 82 patients with acute Q fever and 52 control patients who had pneumonia, fever and lower respir

  9. Does age really matter? Recall of information presented to newly referred patients with cancer.

    NARCIS (Netherlands)

    Jansen, J.; Butow, P.N.; Weert, J.C.M. van; Dulmen, S. van; Devine, R.J.; Heeren, T.J.; Bensing, J.M.; Tattersall, M.H.N.

    2008-01-01

    Purpose: To examine age- and age-related differences in recall of information provided during oncology consultations. Patients and Methods: Two hundred sixty patients with cancer diagnosed with heterogeneous cancers, seeing a medical or radiation oncologist for the first time, participated in the st

  10. Does age really matter? Recall of information presented to newly referred patients with cancer

    NARCIS (Netherlands)

    Jansen, J.; Butow, P.N.; van Weert, J.C.M.; van Dulmen, S.; Devine, R.J.; Heeren, T.J.; Bensing, J.M.; Tattersall, M.H.N.

    2008-01-01

    Purpose To examine age- and age-related differences in recall of information provided during oncology consultations. Patients and Methods Two hundred sixty patients with cancer diagnosed with heterogeneous cancers, seeing a medical or radiation oncologist for the first time, participated in the stud

  11. Envelope specific T cell responses & cytokine profiles in chikungunya patients hospitalized with different clinical presentations

    Science.gov (United States)

    Tripathy, Anuradha S.; Tandale, Babasaheb V.; Balaji, Saravana S.; Hundekar, Supriya L.; Ramdasi, Ashwini Y.; Arankalle, Vidya A.

    2015-01-01

    Background & objectives: Since the 2006 massive outbreaks, chikungunya (CHIK) is a major public health concern in India. The aim of this study was to assess envelope specific immune responses in patients with chikungunya infection. Methods: This study included 46 hospitalized patients with chikungunya virus infection (encephalitis, n=22, other systemic involvement, OSI, n=12, classical, n=12) and six controls from Ahmedabad city, Gujarat, India. T cell responses and the levels of Th1, pro/ anti-inflammatory cytokines against the CHIK virus envelope antigens were assessed by lymphocyte proliferation assay and by cytometric bead array in flow cytometry, respectively. Results: Lymphoproliferative response was uniform among the patients. Comparisons of cytokines revealed significantly higher levels of interleukin (IL)-4 and IL-5 in encephalitis, OSI and classical patients versus controls. The levels of tumour necrosis factor (TNF)-α were higher in classical patients categories compared to the controls. Interferon (IFN)-γ levels were lower in encephalitis patients versus control. Interpretation & conclusions: Our findings showed recognition of T cell epitopes on the envelope region of chikungunya virus by all patient categories. Lower level of IFN-γ may be associated with the severity of disease in these patients. PMID:25900956

  12. Presentations and outcome analysis of 205 adult patients with Henoch-Schnlein purpura nephritis

    Institute of Scientific and Technical Information of China (English)

    宣萍

    2014-01-01

    Objective To analyze the clinical,pathological data and outcomes of the adult patients with HenochSchnlein purpura nephritis(HSPN).Methods The data of 205 HSPN patients who were diagnosed in Kidney Disease Center of the First Affiliated Hospital of Zhejiang University betwee Jan 2004 and May 2013 were collected and analyzed in different groups.Results The average

  13. Care of the patient after renal allograft failure: managing the present and planning for the future.

    Science.gov (United States)

    Fuquay, Richard; Teitelbaum, Isaac

    2012-01-01

    The number of patients with end-stage renal disease undergoing kidney transplantation - both cadaveric and living-donor - continues to rise. With long-term graft survival relatively fixed, this trend means that increasing numbers of patients are returning to dialysis after graft loss. Most will never be retransplanted, which introduces a host of clinical questions regarding optimal management of this unique patient population. In this paper, we explore data that informs astute care of the patient requiring dialysis after graft loss. We address new data about the increased clinical risk and the optimal dialysis modality in renal allograft loss, explore new approaches to immunosuppression and transfusion management, and examine the risks and benefits of allograft nephrectomy and timing thereof. While there are no randomized clinical trials in this field, rapidly evolving data will aid the clinician whose practice includes patients who have been transplanted and are returning to dialysis. Copyright © 2012 S. Karger AG, Basel.

  14. Acute Retinal Necrosis Presenting in Developmentally-delayed Patients with Neonatal Encephalitis: A Case Series and Literature Review.

    Science.gov (United States)

    Okafor, Kingsley; Lu, Jonathan; Thinda, Sumeer; Schwab, Ivan; Morse, Lawrence S; Park, Susanna S; Moshiri, Ala

    2016-05-18

    We report three cases of patients with developmental-delay from neonatal herpetic encephalitis and/or meningitis who presented years later with acute retinal necrosis due to herpes simplex virus. The diagnosis was delayed in all cases due to the patients' inability to verbalize their ocular complaints and cooperate with eye examinations. This case series documents the clinical course, pathophysiologic mechanism, and treatment of acute retinal necrosis in this patient population. Clinicians should understand the importance of prudent consideration of acute retinal necrosis in patients with a history of neonatal herpetic encephalitis and/or meningitis presenting with a red eye.

  15. The twelve theses: a call to a new reformation

    Directory of Open Access Journals (Sweden)

    John Shelby Spong

    2015-03-01

    Full Text Available With every discovery emerging from the world of science over the last 500 years concerning the origins of the universe and of life itself, the traditional explanations offered by the Christian Church appeared to be more and more dated and irrelevant.  Christian leaders, unable to embrace the knowledge revolution seemed to believe  that the only way to save Christianity was not to disturb the old patterns either by listening to, much less by entertaining the new knowledge. I tried to articulate this challenge in a book entitled: Why Christianity Must Change or Die, published in 1998.  In that book I examined in detail the issues that I was convinced Christianity must address. Shortly after that book was published I reduced its content to twelve theses, which I attached in Luther-like fashion to the great doors on the Chapel of Mansfield College at Oxford University in the United Kingdom. I then mailed copies of those Twelve Theses to every acknowledged Christian leader of the world. It was an attempt to call them into a debate on the real issues that I was certain the Christian Church now faced.  I framed my twelve theses in the boldest, most provocative language possible, designed primarily to elicit response and debate. I welcome responses from Christians everywhere.  I claim no expertise or certainty in developing answers, but I am quite confident that I do understand the problems we are facing as Christians who are seeking to relate to the 21st century.

  16. Ultrasound presentation of abdominal non-Hodgkin lymphomas in pediatric patients.

    Science.gov (United States)

    Brodzisz, Agnieszka; Woźniak, Magdalena Maria; Dudkiewicz, Ewa; Grabowski, Dominik; Stefaniak, Jolanta; Wieczorek, Andrzej Paweł; Kowalczyk, Jerzy

    2013-12-01

    Burkitt's lymphoma accounts for approximately 25% of lymphomas diagnosed in children of developmental age. The tumor is localized mainly in the intestine (usually in the ileocecal region), mesenteric lymph nodes and extraperitoneal space. The clinical symptoms are non-specific and include: abdominal pain, vomiting, gastrointestinal bleeding, and acute abdomen suggesting appendicitis or intestinal intussusception. On ultrasound examination, Burkitt's lymphoma may manifest itself in various ways, depending on the origin of the lesion. The aim of this paper was to review the ultrasound manifestation of abdominal Burkitt's lymphoma in children. The analysis included 15 pediatric patients with Burkitt's non-Hodgkin lymphoma in the abdominal cavity. The mean age of the patients was 9.5. Abdominal and gastrointestinal ultrasound examinations were conducted using a Siemens scanner with a convex transducer of 3.5-5 MHz and linear array transducer of L4 - 7.5 MHz. Ultrasound examinations conducted in the group of 15 patients revealed pathological masses localized in the gastric wall in 3 patients (20%), in the ileocecal region in 10 patients (67%) and a disseminated process in 2 patients (13%). In 12 patients with a diagnosed Burkitt's non-Hodgkin lymphoma in an extragastric localization, differences in the morphology of the lesions were observed. The clinical and ultrasound picture of abdominal Burkitt's lymphoma in children is variable. A careful ultrasound assessment of all abdominal organs conducted with the use of convex and linear probes increases the chances of establishing an adequate diagnosis.

  17. Intermittent Courses of Corticosteroids Also Present a Risk for Pneumocystis Pneumonia in Non-HIV Patients

    Science.gov (United States)

    Calero-Bernal, Maria L.; Martin-Garrido, Isabel; Donazar-Ezcurra, Mikel; Limper, Andrew H.

    2016-01-01

    Introduction. Pneumocystis pneumonia (PCP) is rising in the non-HIV population and associates with higher morbidity and mortality. The aggressive immunosuppressive regimens, as well as the lack of stablished guidelines for chemoprophylaxis, are likely contributors to this increased incidence. Herein, we have explored the underlying conditions, immunosuppressive therapies, and clinical outcomes of PCP in HIV-negative patients. Methods. Retrospective analysis of PCP in HIV-negative patients at Mayo Clinic from 2006–2010. The underlying condition, immunosuppressive therapies, coinfection, and clinical course were determined. PCP diagnosis required symptoms of pneumonia and identification of the organisms by visualization or by a real-time polymerase chain reaction. Results. A total of 128 cases of PCP were identified during the study period. Hematological malignancies were the predisposing condition for 50% of the patients. While 87% had received corticosteroids or other immunosuppressive therapies for >4 weeks prior to the diagnosis, only 7 were receiving PCP prophylaxis. Up to 43% of patients were not on daily steroids. Sixty-seven patients needed Intensive Care Unit (ICU) and 53 received mechanical ventilation. The mortality for those patients requiring ICU was 40%. Conclusions. PCP diagnosis in the HIV-negative population requires a high level of suspicion even if patients are not receiving daily corticosteroids. Mortality remains high despite adequate treatment. PMID:27721666

  18. Incidence and clinical presentation of portal vein thrombosis in cirrhotic patients

    Institute of Scientific and Technical Information of China (English)

    Yasir Furkan Cagin; Yahya Atayan; Mehmet Ali Erdogan; Firat Dagtekin; Cemil Colak

    2016-01-01

    BACKGROUND: Portal vein thrombosis (PVT) is due to many risk factors, but its pathogenesis is still not clearly understood. To identify the risk factors for PVT, we analyzed the clinical characteristics and complications associated with PVT in cir-rhotic patients. METHODS: We studied patients with liver cirrhosis who were admitted to our unit from April 2009 to December 2014. The patients were divided into the PVT and non-PVT groups, and were compared by variables including gender, age, the etiology of cirrhosis, stage of cirrhosis, complications, imaging, and treatment. RESULTS: PVT was found in 45 (9.8%) of 461 cirrhotic pa-tients admitted to our hospital. Most patients (45.9%) had hepatitis B virus (HBV)-related cirrhosis, with a similar dis-tribution of etiologies between the groups. However, there was no positive relationship between PVT and etiologies of cirrhosis. Most patients (71.5%) were in the stage of hepatic decompensation. No statistically signiifcant differences were found in complications including esophageal varices, ascites, and hepatic encephalopathy between the groups. However, there was a signiifcant positive correlation between hepatocel-lular carcinoma (HCC) and PVT (P CONCLUSIONS: The incidence of PVT was 9.8%, mainly in patients with HBV-related cirrhosis. The development of PVT was associated with the severity of liver disease and HCC.

  19. Outcomes of patients presenting to a dedicated rapid access lung cancer clinic.

    LENUS (Irish Health Repository)

    Dunican, E

    2012-02-01

    We examined the outcomes of the first 500 patients referred to a dedicated Rapid Access Lung Cancer Clinic. A total of 206 patients (41.2%) were diagnosed with a thoracic malignancy; 179 had primary lung cancer and 27 had secondary or other thoracic cancers. Pulmonary nodules requiring ongoing surveillance were found in a further 79 patients (15.8%). Of those patients found to have primary lung cancer, 24 (13.4%) had Small Cell and 145 (81%) had Non Small Cell Lung Cancer. In patients with Non small cell tumours, 26 (21.1%) were stage 1, 14 (11.4%) stage II, 37 (30.1%) stage III and 46 (37.4%) stage IV at diagnosis. For the 129 patients (72%) in whom the thoracic MDT recommended active treatment, primary therapy was surgical resection in 44 (24.6%), combined chemoradiation in 31 patients (17.3%), chemotherapy alone in 39 (21.8%) and radiation in 15 (8.4%).

  20. Definitive Primary Therapy in Patients Presenting With Oligometastatic Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Parikh, Ravi B. [Harvard Medical School, Boston, Massachusetts (United States); Cronin, Angel M. [Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Kozono, David E.; Oxnard, Geoffrey R.; Mak, Raymond H.; Jackman, David M. [Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Brigham and Women' s Hospital, Boston, Massachusetts (United States); Lo, Peter C. [Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Baldini, Elizabeth H.; Johnson, Bruce E. [Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Brigham and Women' s Hospital, Boston, Massachusetts (United States); Chen, Aileen B., E-mail: achen@lroc.harvard.edu [Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Brigham and Women' s Hospital, Boston, Massachusetts (United States)

    2014-07-15

    Purpose: Although palliative chemotherapy is the standard of care for patients with diagnoses of stage IV non-small cell lung cancer (NSCLC), patients with a small metastatic burden, “oligometastatic” disease, may benefit from more aggressive local therapy. Methods and Materials: We identified 186 patients (26% of stage IV patients) prospectively enrolled in our institutional database from 2002 to 2012 with oligometastatic disease, which we defined as 5 or fewer distant metastatic lesions at diagnosis. Univariate and multivariable Cox proportional hazards models were used to identify patient and disease factors associated with improved survival. Using propensity score methods, we investigated the effect of definitive local therapy to the primary tumor on overall survival. Results: Median age at diagnosis was 61 years of age; 51% of patients were female; 12% had squamous histology; and 33% had N0-1 disease. On multivariable analysis, Eastern Cooperate Oncology Group performance status ≥2 (hazard ratio [HR], 2.43), nodal status, N2-3 (HR, 2.16), squamous pathology, and metastases to multiple organs (HR, 2.11) were associated with a greater hazard of death (all P<.01). The number of metastatic lesions and radiologic size of the primary tumor were not significantly associated with overall survival. Definitive local therapy to the primary tumor was associated with prolonged survival (HR, 0.65, P=.043). Conclusions: Definitive local therapy to the primary tumor appears to be associated with improved survival in patients with oligometastatic NSCLC. Select patient and tumor characteristics, including good performance status, nonsquamous histology, and limited nodal disease, may predict for improved survival in these patients.

  1. Age impact in clinicopathologic presentation and the clinical evolution of prostate cancer in patients submitted to radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Alberto A. Antunes

    2006-02-01

    Full Text Available OBJECTIVE: To assess the influence of age in pathological findings and clinical evolution of prostate cancer in patients treated with radical prostatectomy. MATERIALS AND METHODS: Five hundred and fifty-six patients operated on between 1991 and 2000 were selected. Patients were divided into age groups of between 10 and 49 years, 50 to 59 years, 60 to 69 years and 70 to 83 years. RESULTS: Patients having less than 60 years of age presented clinical stage (p = 0.001, PSA (p = 0.013 and biopsy Gleason score (p = 0.013 more favorable than older patients. Age groups did not show any relationship between either postoperative Gleason score or pathological stage or risk of non-confined organ disease and involvement of seminal vesicles. After a mean follow-up of 58.3 months, 149 (27% patients presented recurrence. Patients aged between 40 and 59 years presented a disease-free survival rate significantly higher when compared to patients aged between 60 and 83 years (p = 0.022. However, when controlled with clinical stage, PSA, Gleason score and percentage of positive fragments, there was no relationship between age and biochemical recurrence risk (p = 0.426. CONCLUSIONS: Even though younger patients presented more favorable preoperative characteristics, postoperative pathological findings and biochemical recurrence rates did not differ between studied age groups.

  2. A patient presenting with metabolic acidosis despite severe vomiting--correct diagnosis by use of the physical-chemical approach.

    Science.gov (United States)

    Lindner, Gregor; Pfortmüller, Carmen; Exadaktylos, Aristomenis K

    2013-06-01

    We describe the case of a 28-year-old otherwise healthy woman who presents to our emergency department with nausea for 2 days and severe vomiting for 1 day. She has no history of travel, and her medical history is unremarkable. The physical examination shows a soft and nontender abdomen. Laboratory examinations reveal the presence of significant metabolic alkalosis despite the severe vomiting of the patient. Hypochloremic alkalosis would be expected to be present in this patient. We explain how to correctly identify the rare cause of metabolic acidosis present in this patient using the physicochemical approach (Stewarts approach) for the analysis of human acid-base disorders.

  3. Asthma in adult patients presenting with symptoms of acute bronchitis in general practice

    NARCIS (Netherlands)

    Thiadens, HA; Postma, DS; de Bock, GH; Huysman, DAN; van Houwelingen, HC; Springer, MP

    Objectives - To investigate the association between asthma and acute bronchitis in adults and to ascertain criteria to help general practitioners (GPs) differentiate between acute bronchitis and asthma. Design - Descriptive study. Setting - Primary health care centre in The Netherlands. Patients -

  4. Predictors of a Variceal Source among Patients Presenting with Upper Gastrointestinal Bleeding

    Directory of Open Access Journals (Sweden)

    Ahmad Alharbi

    2012-01-01

    Full Text Available BACKGROUND: Patients with upper gastrointestinal bleeding (UGIB require an early, tailored approach best guided by knowledge of the bleeding lesion, especially a variceal versus a nonvariceal source.

  5. Electrocardiographic Presentation, Cardiac Arrhythmias, and Their Management in β-Thalassemia Major Patients.

    Science.gov (United States)

    Russo, Vincenzo; Rago, Anna; Papa, Andrea Antonio; Nigro, Gerardo

    2016-07-01

    Beta-thalassemia major (β-TM) is a genetic hemoglobin disorder characterized by an absent synthesis of globin chains that are essential for hemoglobin formation, causing chronic hemolytic anemia. Clinical management of thalassemia major consists in regular long-life red blood cell transfusions and iron chelation therapy to remove iron introduced in excess with transfusions. Iron deposition in combination with inflammatory and immunogenic factors is involved in the pathophysiology of cardiac dysfunction in these patients. Heart failure and arrhythmias, caused by myocardial siderosis, are the most important life-limiting complications of iron overload in beta-thalassemia patients. Cardiac complications are responsible for 71% of global death in the beta-thalassemia major patients. The aim of this review was to describe the most frequent electrocardiographic abnormalities and arrhythmias observed in β-TM patients, analyzing their prognostic impact and current treatment strategies. © 2016 Wiley Periodicals, Inc.

  6. Management of infertility in a patient presenting with ovarian dysfunction and McCune-Albright syndrome

    NARCIS (Netherlands)

    J.S.E. Laven (Joop); S. Lumbroso; C. Sultan; B.C.J.M. Fauser (Bart)

    2004-01-01

    textabstractPersistent autonomous ovarian dysfunction in McCune-Albright syndrome (MAS) patients is associated with the development of multiple dominant follicles, premature luteinization, cyst formation, and anovulatory infertility. Due to the mosaic distribution of the mutation,

  7. The influence of diet on the evolution of symptoms presented in fibromyalgia patients

    Directory of Open Access Journals (Sweden)

    José Eduardo Martinez

    2015-06-01

    Full Text Available This research seeks to relate fibromyalgia and nutritional factors. Objective: to determine the influence of the food habits on the intensity of the symptoms of fibromyalgia patients. Methods: we interviewed 40 female patients, aged 15 to 59, in the clinic of the Hospital pain set of Sorocaba (CHS through about the fibromyalgia clinical picture and their eating habits. Results: the mean duration of symptoms of fibromyalgia among the interviewed patients was 6.75 years. The average impact of fibromyalgia on the quality of life was about 64 measured by the Fibromyalgia Impact Questionnaire. The only food that was related to symptom improvement by the patients was the banana (17.5%. The majority of respondents did not noticed relationship between such foods and modification of disease symptoms. Conclusion: there was not observed association between food intenak and fibromyalgia symptom severity.

  8. Systemic Sclerosis Patients Present Alterations in the Expression of Molecules Involved in B-Cell Regulation.

    Science.gov (United States)

    Soto, Lilian; Ferrier, Ashley; Aravena, Octavio; Fonseca, Elianet; Berendsen, Jorge; Biere, Andrea; Bueno, Daniel; Ramos, Verónica; Aguillón, Juan Carlos; Catalán, Diego

    2015-01-01

    The activation threshold of B cells is tightly regulated by an array of inhibitory and activator receptors in such a way that disturbances in their expression can lead to the appearance of autoimmunity. The aim of this study was to evaluate the expression of activating and inhibitory molecules involved in the modulation of B cell functions in transitional, naive, and memory B-cell subpopulations from systemic sclerosis patients. To achieve this, blood samples were drawn from 31 systemic sclerosis patients and 53 healthy individuals. Surface expression of CD86, MHC II, CD19, CD21, CD40, CD22, Siglec 10, CD35, and FcγRIIB was determined by flow cytometry. IL-10 production was evaluated by intracellular flow cytometry from isolated B cells. Soluble IL-6 and IL-10 levels were measured by ELISA from supernatants of stimulated B cells. Systemic sclerosis patients exhibit an increased frequency of transitional and naive B cells related to memory B cells compared with healthy controls. Transitional and naive B cells from patients express higher levels of CD86 and FcγRIIB than healthy donors. Also, B cells from patients show high expression of CD19 and CD40, whereas memory cells from systemic sclerosis patients show reduced expression of CD35. CD19 and CD35 expression levels associate with different autoantibody profiles. IL-10(+) B cells and secreted levels of IL-10 were markedly reduced in patients. In conclusion, systemic sclerosis patients show alterations in the expression of molecules involved in B-cell regulation. These abnormalities may be determinant in the B-cell hyperactivation observed in systemic sclerosis.

  9. Systemic sclerosis patients present alterations in the expression of molecules involved in B cell regulation

    Directory of Open Access Journals (Sweden)

    Lilian eSoto

    2015-09-01

    Full Text Available The activation threshold of B cells is tightly regulated by an array of inhibitory and activator receptors, in such a way that disturbances in their expression can lead to the appearance of autoimmunity. The aim of this study was to evaluate the expression of activating and inhibitory molecules involved in the modulation of B cell functions in transitional, naïve and memory B cell sub-populations from systemic sclerosis patients. To achieve this, blood samples were drawn from thirty one systemic sclerosis patients and fifty three healthy individuals. Surface expression of CD86, MHC II, CD19, CD21, CD40, CD22, Siglec 10, CD35, and FcgammaRIIB was determined by flow cytometry. IL-10 production was evaluated by intracellular flow cytometry from isolated B cells. Soluble IL-6 and IL-10 levels were measured by ELISA from supernatants of stimulated B cells. Systemic sclerosis patients exhibit an increased frequency of transitional and naïve B cells related to memory B cells, compared to healthy controls. Transitional and naïve B cells from patients express higher levels of CD86 and FcgammaRIIB than healthy donors. Also, B cells from patients show high expression of CD19 and CD40, while memory cells from systemic sclerosis patients show reduced expression of CD35. CD19 and CD35 expression levels associate to different autoantibody profiles. IL-10+ B cells and secreted levels of IL-10 were markedly reduced in patients. In conclusion, systemic sclerosis patients show alterations in the expression of molecules involved in B cell regulation. These abnormalities may be determinant in the B cell hyperactivation observed in systemic sclerosis.

  10. Glial nuclear aggregates of superoxide dismutase-1 are regularly present in patients with amyotrophic lateral sclerosis

    OpenAIRE

    2011-01-01

    The most common cause of amyotrophic lateral sclerosis (ALS) is mutations in superoxide dismutase-1 (SOD1). Since there is evidence for the involvement of non-neuronal cells in ALS, we searched for signs of SOD1 abnormalities focusing on glia. Spinal cords from nine ALS patients carrying SOD1 mutations, 51 patients with sporadic or familial ALS who lacked such mutations, and 46 controls were examined by immunohistochemistry. A set of anti-peptide antibodies with specificity for misfolded SOD1...

  11. Subclinical nephritic syndrome in children cohabiting with pediatric patients, Presenting acute nephritic syndrome

    OpenAIRE

    Guerrero-Tinoco Gustavo Adolfo; Julio-Barrios Emil

    2012-01-01

    Introduction: subclinical nephritic syndrome is the presence of hematuria, hypocomplementemiaand/or proteinuria without the presence of signs and/or symptoms.Objective: to determine the incidence of subclinical nephritic syndrome in childrenliving with pediatric patients diagnosed with acute nephritic syndrome.Methods: family visit to identify children living together in the two previous months, with pediatric patients hospitalized with acute nephritic syndrome, at Hospital InfantilNapoleon F...

  12. The Clinical Significance of Ependymal Enhancement at Presentation in Patients with Malignant Glioma

    Science.gov (United States)

    Kaidar-Person, Orit; Darawshe, Firas; Tzuk-Shina, Tzahala; Eran, Ayelet

    2015-01-01

    Introduction The current study evaluated the rate of ependymal enhancement and whether its presence influences survival of patients with malignant glioma (GBM). Methods A retrospective review of all patients who were treated in our institution from 2005 to 2011 was conducted. Data extracted from the medical records included age, date of diagnosis, co-morbidities, treatment regimen, and time of death. Magnetic resonance images (MRI) were evaluated for the presence of ependymal enhancement and its extent, and the correlation to survival was investigated. Results Between 2005 and 2011, 230 patients were treated for GBM. Eighty-nine patients were excluded from the study due to insufficient data, leaving 141 patients for analysis. Median age at diagnosis was 60 years. Sixty-seven (40.6%) patients had evidence of ependymal enhancement on MRI (group A), and 70 (42.4%) patients did not have evidence of enhancement. The assessment of ependymal enhancement was inconclusive due to mass effect and ventricular compression that precluded accurate assessment for 28 (17%) patients (group C). Median survival was 14 months for group A (range, 12–16 months), 15.9 months for group B (range, 14.28–17.65 months), and 11.7 months for group C (range, 6.47–16.92 months) (P>0.05). A multivariate analysis to predict survival indicated that male gender (P=0.039), hypertension (P=0.012), and biopsy only compared to complete gross tumor resection (P=0.001) were significant for poor survival. Conclusions Pretreatment ependymal enhancement on MRI was not found to be associated with poorer survival. These results might be due to better treatments options compared to prior reports. PMID:26886770

  13. The Clinical Significance of Ependymal Enhancement at Presentation in Patients with Malignant Glioma

    Directory of Open Access Journals (Sweden)

    Orit Kaidar-Person

    2015-10-01

    Full Text Available Introduction. The current study evaluated the rate of ependymal enhancement and whether its presence influences survival of patients with malignant glioma (GBM. Methods. A retrospective review of all patients who were treated in our institution from 2005 to 2011 was conducted. Data extracted from the medical records included age, date of diagnosis, co-morbidities, treatment regimen, and time of death. Magnetic resonance images (MRI were evaluated for the presence of ependymal enhancement and its extent, and the correlation to survival was investigated. Results. Between 2005 and 2011, 230 patients were treated for GBM. Eighty-nine patients were excluded from the study due to insufficient data, leaving 141 patients for analysis. Median age at diagnosis was 60 years. Sixty-seven (40.6% patients had evidence of ependymal enhancement on MRI (group A, and 70 (42.4% patients did not have evidence of enhancement. The assessment of ependymal enhancement was inconclusive due to mass effect and ventricular compression that precluded accurate assessment for 28 (17% patients (group C. Median survival was 14 months for group A (range, 12–16 months, 15.9 months for group B (range, 14.28–17.65 months, and 11.7 months for group C (range, 6.47–16.92 months (P>0.05. A multivariate analysis to predict survival indicated that male gender (P=0.039, hypertension (P=0.012, and biopsy only compared to complete gross tumor resection (P=0.001 were significant for poor survival. Conclusions. Pretreatment ependymal enhancement on MRI was not found to be associated with poorer survival. These results might be due to better treatments options compared to prior reports.

  14. Subclinical nephritic syndrome in children cohabiting with pediatric patients, Presenting acute nephritic syndrome

    OpenAIRE

    Guerrero-Tinoco Gustavo Adolfo; Julio-Barrios Emil

    2012-01-01

    Introduction: subclinical nephritic syndrome is the presence of hematuria, hypocomplementemiaand/or proteinuria without the presence of signs and/or symptoms.Objective: to determine the incidence of subclinical nephritic syndrome in childrenliving with pediatric patients diagnosed with acute nephritic syndrome.Methods: family visit to identify children living together in the two previous months, with pediatric patients hospitalized with acute nephritic syndrome, at Hospital InfantilNapoleon F...

  15. Misconceptions about breast lumps and delayed medical presentation in urban breast cancer patients

    Science.gov (United States)

    Rauscher, Garth H; Ferrans, Carol Estwing; Kaiser, Karen; Campbell, Richard; Calhoun, Elizabeth; Warnecke, Richard B.

    2013-01-01

    BACKGROUND Despite current recommendations for women to be screened for breast cancer with mammography every one to two years, less than half of all newly diagnosed breast cancers are initially detected through screening mammography. Prompt medical attention to a new breast symptom can result in earlier stage at diagnosis, yet many patients delay seeking medical care after becoming aware of a breast symptom. METHODS In a population-based study of breast cancer we examined factors potentially associated with patient delay in seeking health care for a breast symptom among 436 symptomatic urban breast cancer patients (146 White, 197 Black and 95 Hispanic). Race/ethnicity, socioeconomic status, health care access and utilization, and misconceptions about the meaning of breast lumps were the key independent variables. RESULTS Sixteen percent of patients reported delaying more than 3 months before seeking medical advice about breast symptoms. Misconceptions about breast lumps, and lacking a regular provider, health insurance and recent preventive care were all associated with prolonged patient delay (p<0.005 for all). Misconceptions were much more common among ethnic minorities and women of lower socioeconomic status. CONCLUSION Reducing patient delay and disparities in delay will require both educating women about the importance of getting breast lumps evaluated in a timely manner, and providing greater access to regular health care. PMID:20200436

  16. Levodopa Withdrawal Presenting as Fever in a Critically Ill Patient Receiving Concomitant Enteral Nutrition.

    Science.gov (United States)

    Whitman, Craig B; Ablordeppey, Enyo; Taylor, Beth

    2016-12-01

    Nutritional protein may decrease levodopa absorption and has resulted in withdrawal and neuroleptic malignant-like syndromes in critically ill patients. A 72-year-old male was admitted with shortness of breath. His medical history included Parkinson's disease for over 30 years for which he took carbidopa/levodopa 5 times daily. The patient's home medications were continued. On day 2, he was intubated and transferred to the intensive care unit (ICU). He was extubated the next day and reintubated on day 4. Enteral nutrition was initiated at 85 mL/h overnight. The patient's carbidopa/levodopa was administered to limit coadministration with nutrition. Throughout his ICU stay, the patient did not demonstrate changes in mental status. Despite resolution of his pneumonia, he developed fever after administration of one dose overlapping with nutrition, with defervescence throughout the rest of the day. On hospital day 10, that dose was empirically increased. After this dosing change, the patient failed to develop fever during the rest of his hospital stay. On day 16, the patient was discharged to a long-term care facility without any other complications. Our case highlights the interaction between levodopa and enteral nutrition and the potential of fever as the sole sign of withdrawal.

  17. Monitoring and optimising cognitive function in cancer patients: Present knowledge and future directions

    Directory of Open Access Journals (Sweden)

    S.B. Schagen

    2014-06-01

    Full Text Available The potentially detrimental effects of cancer and related treatments on cognitive functioning are emerging as a key focus of cancer survivorship research. Many patients with central nervous system (CNS or non-CNS tumours develop cognitive problems during the course of their disease that can result in diminished functional independence. We review the state of knowledge on the cognitive functioning of patients with primary and secondary brain tumours at diagnosis, during and after therapy, and discuss current initiatives to diminish cognitive decline in these patients. Similarly, attention is paid to the cognitive sequelae of cancer and cancer therapies in patients without CNS disease. Disease and treatment effects on cognition are discussed, as well as current insights into the neural substrates and the mechanisms underlying cognitive dysfunction in these patients. In addition, rehabilitation strategies for patients with non-CNS disease confronted with cognitive dysfunction are described. Special attention is given to knowledge gaps in the area of cancer and cognition, in CNS and non-CNS diseases. Finally, we point to the important role for cooperative groups to include cognitive endpoints in clinical trials in order to accelerate our understanding and treatment of cognitive dysfunction related to cancer and cancer therapies.

  18. AN ANALYSIS OF THE CLINICAL PRESENTATION , DIAGNOSIS , MANAGEMENT OPTIONS AND OUTCOME OF THE PATIENTS WITH GENITO - URINARY TUBERCULOSIS

    Directory of Open Access Journals (Sweden)

    Bhagavan

    2015-06-01

    Full Text Available AIMS AND OBJECTIVES: To analyze various clinical presentations and the treatment options in the management of the patients with genitourinary tuberculosis and to evaluate the role of urinary PCR in the detection of mycobacterium tuberculosis in patients with a clinical suspici on of genito urinary tuberculosis and to compare its sensitivity with urine for AFB smear, urine for myc. tuberculosis culture and bladder biopsy. MATERIALS AND METHODS: This is a retrospective and prospective study of patients with a diagnosis of genitour inary tuberculosis who underwent treatment in Gandhi General Hospital between January 2009 to December 2014. 62 patients with a diagnosis of genitourinary tuberculosis who underwent treatment were taken initially into the study. Five patients lost follow u p after initial visits. These patients were excluded from the study. The remaining 57 patients were managed. RESULTS: Irritative voiding symptoms (Frequency / Urgency / Dysuria were the most common symptoms. Gross hematuria seen in 22(38.5% patients and microscopic hematuria seen in 53% of patients. Urine for AFB attaining was positive in 16(31.3% patients, urine for MTb culture was positive in 21(41.1% patients and pus for MTb culture was positive in 4 of 7 cases. Urinary PCR to identify the mycobacter ial DNA was performed in 37 patients and was positive in 25(67.5% of 37 clinically suspected cases. The urinary PCR was falsely positive in 1(2.7% and falsely negative in 12(32.5% patients. Kidney was involved in 26(45.6% cases and ureter in 24(42.1%, and bladder in 28(49.1% cases. Overall surgical intervention was done in 36 patients. All patients received 4 to 8 weeks ATT before they were taken up for surgical intervention. In 24 patients who presented with ureteric strictures, 7 patients had nonfun ctioning kidneys and subsequently underwent nephroureterectomy, 8 patients had subnormal renal function in whom DJ stenting was done in 6 patients and PCN was done in 2

  19. Is radiography justified for the evaluation of patients presenting with cervical spine trauma?

    Energy Technology Data Exchange (ETDEWEB)

    Theocharopoulos, Nicholas; Chatzakis, Georgios; Damilakis, John [Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, Iraklion, 71003 Crete (Greece) and Department of Natural Sciences, Technological Education Institute of Crete, P.O. Box 140, Iraklion 71004 Crete (Greece); Department of Radiology, Faculty of Medicine, University of Crete, P.O. Box 2208, Iraklion, 71003 Crete (Greece); Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, Iraklion, 71003 Crete (Greece)

    2009-10-15

    Conventional radiography has been for decades the standard method of evaluation for cervical spine trauma patients. However, currently available helical multidetector CT scanners allow multiplanar reconstruction of images, leading to increased diagnostic accuracy. The purpose of this study was to determine the relative benefit/risk ratio between cervical spine CT and cervical spine radiography and between cervical spine CT and cervical spine radiography, followed by CT as an adjunct for positive findings. A decision analysis model for the determination of the optimum imaging technique was developed. The sensitivity and specificity of CT and radiography were obtained by dedicated meta-analysis. Lifetime attributable risk of mortal cancer from CT and radiography was calculated using updated organ-specific risk coefficients and organ-absorbed doses. Patient organ doses from radiography were calculated using Monte Carlo techniques, simulated exposures performed on an anthropomorphic phantom, and thermoluminescence dosimetry. A prospective patient study was performed regarding helical CT scans of the cervical spine. Patient doses were calculated based on the dose-length-product values and Monte Carlo-based CT dosimetry software program. Three groups of patient risk for cervical spine fracture were incorporated in the decision model on the basis of hypothetical trauma mechanism and clinical findings. Radiation effects were assessed separately for males and females for four age groups (20, 40, 60, and 80 yr old). Effective dose from radiography amounts to 0.050 mSv and from a typical CT scan to 3.8 mSv. The use of CT in a hypothetical cohort of 10{sup 6} patients prevents approximately 130 incidents of paralysis in the low risk group (a priori fracture probability of 0.5%), 500 in the moderate risk group (a priori fracture probability of 2%), and 5100 in the high risk group (a priori fracture probability of 20%). The expense of this CT-based prevention is 15-32 additional

  20. Twelve tips on teaching and learning humanism in medical education.

    Science.gov (United States)

    Cohen, Libby Gordon; Sherif, Youmna Ashraf

    2014-08-01

    The teaching of humanistic values is recognized as an essential component of medical education and continuing professional development of physicians. The application of humanistic values in medical care can benefit medical students, clinicians and patients. This article presents 12 tips on fostering humanistic values in medical education. The authors reviewed the literature and present 12 practical tips that are relevant to contemporary practices. The tips can be used in teaching and sustaining humanistic values in medical education. Humanistic values can be incorporated in formal preclinical environments, the transition into clinical settings, medical curricula and clinical clerkships. Additionally, steps can be taken so that medical educators and institutions promote and sustain humanistic values.

  1. Ultrasound presentation of abdominal non-Hodgkin lymphomas in pediatric patients

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    Agnieszka Brodzisz

    2013-12-01

    Full Text Available Introduction: Burkitt’s lymphoma accounts for approximately 25% of lymphomas diagnosed in children of developmental age. The tumor is localized mainly in the intestine (usually in the ileocecal region, mesenteric lymph nodes and extraperitoneal space. The clinical symptoms are non-specific and include: abdominal pain, vomiting, gastrointestinal bleeding, and acute abdomen suggesting appendicitis or intestinal intussusception. On ultrasound examination, Burkitt’s lymphoma may manifest itself in various ways, depending on the origin of the lesion. Aim: The aim of this paper was to review the ultrasound manifestation of abdominal Burkitt’s lymphoma in children. Material and methods: The analysis included 15 pediatric patients with Burkitt’s non-Hodgkin lymphoma in the abdominal cavity. The mean age of the patients was 9.5. Abdominal and gastrointestinal ultrasound examinations were conducted using a Siemens scanner with a convex transducer of 3.5–5 MHz and linear array transducer of L4 – 7.5 MHz. Results: Ultrasound examinations conducted in the group of 15 patients revealed pathological masses localized in the gastric wall in 3 patients (20%, in the ileocecal region in 10 patients (67% and a disseminated process in 2 patients (13%. In 12 patients with a diagnosed Burkitt’s non-Hodgkin lymphoma in an extragastric localization, differences in the morphology of the lesions were observed. Conclusions: The clinical and ultrasound picture of abdominal Burkitt’s lymphoma in children is variable. A careful ultrasound assessment of all abdominal organs conducted with the use of convex and linear probes increases the chances of establishing an adequate diagnosis.

  2. Undiagnosed tuberculosis in patients with HIV infection who present with severe anaemia at a district hospital

    Directory of Open Access Journals (Sweden)

    Mbulelo Mntonintshi

    2017-01-01

    Full Text Available Background: Tuberculosis (TB is a major cause of severe anaemia in patients with human immunodeficiency virus (HIV infection in South Africa. However, TB can be difficult to diagnose as it may be extra pulmonary and paucibacillary.Aim: The aim of this study was to investigate undiagnosed TB in patients with HIV infection and severe anaemia and to identify the optimal investigations for diagnosing TB.Setting: Mthatha General Hospital, a district hospital.Methods: The study was a case series.Results: Haemoglobin levels ranged from 3.6 g/dL to 7.9 g/dL, the mean CD4 count was 176 cells/μL and 80% of patients had a positive TB symptom screen. Forty-three (86% patients had either clinical or bacteriologically proven TB of whom 33 had pulmonary TB, 34 had extra pulmonary TB and 24 had both types. The diagnostic yield for TB was: chest X-ray (CXR 91%; ultrasound (US abdomen pericardium and lower chest 62%; sputum Xpert MTB/RIF 35%; TB blood culture 21% and TB urine culture 15%. Blood and urine cultures did not identify any additional cases over those identified by CXR and US. The laboratory turnaround times were as follows: sputum Xpert, 1.6 days; blood culture, 20 days and urine culture, 28 days. CXR and US were done within one day of initial patient assessment.Conclusions: The majority of HIV patients with severe anaemia had TB disease, and extra pulmonary TB was as prevalent as pulmonary TB. CXR, US and sputum Xpert were the optimum tests for rapid diagnosis of TB. South African national TB/HIV guidelines should incorporate these specific tests to diagnose TB in patients with HIV and severe anaemia.

  3. Abdominal Computed Tomography Utilization and 30‐day Revisitation in Emergency Department Patients Presenting With Abdominal Pain

    National Research Council Canada - National Science Library

    Patterson, Brian W; Venkatesh, Arjun K; AlKhawam, Lora; Pang, Peter S; Carpenter, Christopher R

    2015-01-01

    ...) visitation within 30 days of ED discharge for patients presenting with abdominal pain. A retrospective, observational study was conducted at a single, academic, urban ED with over 85,000 annual visits...

  4. Spontaneous recurrent hemarthrosis of the knee joint in elderly patients with osteoarthritis: an infrequent presentation of synovial lipoma arborescens.

    Science.gov (United States)

    Ji, Jong-Hun; Lee, Yeon-Soo; Shafi, Mohamed

    2010-10-01

    Synovial lipoma arborescens (SLA) is a rare, benign, fat-containing synovial proliferative lesion that is typically known to affect the knee joint in adults, although it has also been described in other joints. SLA usually presents as a painless swelling and recurrent joint effusion, and the laboratory test results, including aspirated synovial fluid, are usually normal. We present here two cases of SLA of the knee, which presented as spontaneous recurrent hemarthroses in elderly patients with osteoarthritis (OA) with bloody aspirated synovial fluid. Magnetic resonance imaging (MRI) and arthroscopic synovectomy suggested the diagnosis of SLA; the histopathologic examination confirmed the diagnosis. One year later, both patients remain symptom-free and report no new episodes of hemarthrosis. We postulate that SLA should be included in the differential diagnosis of patients with recurrent joint effusions with hemarthrosis in elderly patients with OA. The clinical presentation, MRI findings, and treatment of SLA are described, and the entity is briefly reviewed.

  5. Prevalence and Predictors of Adverse Events in Older Surgical Patients: Impact of the Present on Admission Indicator

    Science.gov (United States)

    Kim, Hongsoo; Capezuti, Elizabeth; Kovner, Christine; Zhao, Zhonglin; Boockvar, Kenneth

    2010-01-01

    Purpose of the Study: To examine the effects of the present on admission (POA) indicator on the prevalence of and factors associated with postsurgical adverse events in older patients. Design and Methods: This is a secondary data analysis of 82,898 surgical patients aged 65 years or older in 252 acute care hospitals in California in 2004. Four…

  6. A case of disseminated histoplasmosis diagnosed after oral presentation in an old HIV-negative patient in Sweden.

    Science.gov (United States)

    Mota de Almeida, Fernando J; Kivijärvi, Kristina; Roos, Göran; Nylander, Karin

    2015-09-01

    Histoplasmosis is an endemic disease in various regions such as North America and South-East Asia but remains rare in Europe. Disseminated histoplasmosis is unusual in HIV-negative patients. Here, we describe a case of disseminated histoplasmosis in an HIV-negative patient diagnosed after oral presentation.

  7. Application of Lean Six Sigma for patients presenting with ST-elevation myocardial infarction: the Hamilton Health Sciences experience.

    Science.gov (United States)

    Aldarrab, Ayad

    2006-01-01

    Most patients with symptomatic acute myocardial infarction (AMI), the leading cause of death in western industrialized nations, use the emergency department (ED) as their point of entry. Yet, one identified barrier to early recognition of patients with AMI is ED overcrowding. In this paper, the author presents a quality improvement model that applies Lean Six Sigma guidelines to the clinical setting.

  8. Significance of antineutrophil cytoplasmic antibody in adult patients with Henoch-Sch(o)nlein purpura presenting mainly with gastrointestinal symptoms

    Institute of Scientific and Technical Information of China (English)

    Yan Zhang; Yong-Kang Wu; Matthew A Ciorba; Qin Ouyang

    2008-01-01

    AIM: To test the clinical significance of antineutrophil cytoplasmic antibody (ANCA) in evaluation of adult Henoch-Schonlein purpura (HSP) patients presenting mainly with abdominal symptoms.METHODS: Twenty-eight consecutive HSP patients who presented predominantly with abdominal symptoms were enrolled in this study. Control subjects included 27 age-and sex-matched patients with peptic ulcer disease, colon cancer, acute gastroenteritis, irritable bowel syndrome and colonic polyps. ANCA was measured by indirect immunofluorescence (IIF) in all patients, and follow-up ELJSA was performed in patients with positive IIF tests.RESULTS: ANCA was detected in 9 HSP patients by IIF (2 were positive for c-ANCA and 7 were positive for p-ANCA). No ANCA was found in the control group. The sensitivity and specificity of a positive ANCA test (either c- or p-ANCA) were 32.1% and 100% respectively. Only one out of the 9 patients with positive ANCA by IIF had positive ANCA by ELISA and the antigen was myeloperoxidase (MPO). The patients positive for ANCA had higher HSP clinical scores, and were more likely to have renal function impairment. Patients with late purpura development were also associated with more severe clinical manifestations.CONCLUSION: A positive ANCA test is associated with more severe symptoms in HSP. After inflammatory bowel disease is excluded, a positive ANCA test provides a clue to the diagnosis of HSP presenting predominantly with abdominal symptoms.

  9. Clinical presentations and outcomes of patients with Ebola virus disease in Freetown, Sierra Leone.

    Science.gov (United States)

    Ji, Ying-Jie; Duan, Xue-Zhang; Gao, Xu-Dong; Li, Lei; Li, Chen; Ji, Dong; Li, Wen-Gang; Wang, Li-Fu; Meng, Yu-Hua; Yang, Xiao; Ling, Bin-Fang; Song, Xue-Ai; Gu, Mei-Lei; Jiang, Tao; Koroma, She-Ku M; Bangalie, James; Duan, Hui-Juan

    2016-11-03

    Clinical and laboratory data were collected and analysed from patients with Ebola virus disease (EVD) in Jui Government Hospital in Freetown, Sierra Leone, where patients with EVD were received and/or treated from October 1, 2014 to March 21, 2015 during the West Africa EVD outbreak. The study admitted 285 patients with confirmed EVD and followed them up till the endpoint (recovery or death). EVD was confirmed by quantitative RT-PCR assays detecting blood Ebola virus (EBOV). Among the 285 lab-confirmed EVD cases in Jui Government Hospital, 146 recovered and 139 died, with an overall survival rate of 51.23 %. Patients under the age of 6 years had a lower survival rate (37.50 %). Most non-survivors (79.86 %) died within 7 days after admission and the mean hospitalization time for non-survivors was 5.56 ± 6.11 days. More than half survivors (63.69 %) turned blood EBOV negative within 3 weeks after admission and the mean hospitalization time for survivors was 20.38 ± 7.58 days. High blood viral load (≥10(6) copies/ml) was found to be predictive of the non-survival outcome as indicated by the Receiver Operating Characteristic (ROC) curve analysis. The probability of patients' survival was less than 15 % when blood viral load was greater than 10(6) copies/ml. Multivariate analyses showed that blood viral load (P = 0.005), confusion (P = 0.010), abdominal pain (P = 0.003), conjunctivitis (P = 0.035), and vomiting (P = 0.004) were factors independently associated with the outcomes of EVD patients. Most death occurred within 1 week after admission, and patients at the age of 6 or younger had a lower survival rate. Most surviving patients turned blood EBOV negative within 1-4 weeks after admission. Factors such as high blood viral load, confusion, abdominal pain, vomiting and conjunctivitis were associated with poor prognosis for EVD patients.

  10. [The effectiveness of correction of the postural problems in the patients presenting with juvenile cerebral palsy].

    Science.gov (United States)

    Barbaeva, S N; Kulishova, T V

    2016-01-01

    We have studied stabilographic characteristics and their dynamics in the healthy children (n=30) and the patients suffering from juvenile cerebral palsy (JCP) in the form of spastic diplegia (n=99) after they had undergone the combined rehabilitation treatment with the use of various methods of electrical stimulation. The mean age of the children was 7.0±1.7 years. The patients with JCP included in the main group (n=45) received therapy with the application of electrical stimulation based on the AKorD apparatus while the patients with JCP comprising the group of comparison were treated with the use of the Mioritm 040 apparatus. Vertical stability of the schoolchildren was evaluated using the Stabilan-01-2 hardware system, once in the healthy children and twice (before and after the termination of rehabilitation) in the patients with JCP. A course of the rehabilitative treatment of the patients with JCP included in the main group resulted in a 24.6% and 15.8% reduction (pposture in comparison with the treatment based on the use of the Mioritm 040 apparatus.

  11. Overdiagnosing of femoroacetabular impingement: correlation between clinical presentation and computed tomography in symptomatic patients

    Directory of Open Access Journals (Sweden)

    Richard Prazeres Canella

    2016-04-01

    Full Text Available OBJECTIVE: To correlate the angles between the acetabulum and the proximal femur in symptomatic patients with femoroacetabular impingement (FAI, using computed tomography (CT. METHODS: We retrospectively evaluated 103 hips from 103 patients, using multislice CT to measure the acetabular age, acetabular version (in its supraequatorial portion and in its middle third, femoral neck version, cervical-diaphyseal and alpha angles and the acetabular depth. For the statistical analysis, we used the Pearson correlation coefficient. RESULTS: There were inverse correlations between the following angles: (1 acetabular coverage versus alpha angle (p = 0.019; (2 acetabular version (supraequatorial versus alpha angle (p = 0.049. For patients with femoral anteversion lower than 15 degrees: (1 acetabular version (supraequatorial versus alpha angle (p = 0.026; (2 acetabular version (middle third versus alpha angle (p = 0.02. For patients with acetabular version (supraequatorial lower than 10 degrees: (1 acetabular version (supraequatorial versus alpha angle (p = 0.004; (2 acetabular version (middle third versus alpha angle (p = 0.009. CONCLUSION: There was a statistically significant inverse correlation between the acetabular version and alpha angles (the smaller the acetabular anteversion angle was, the larger the alpha angle was in symptomatic patients, thus supporting the hypothesis that FAI occurs when cam and pincer findings due to acetabular retroversion are seen simultaneously, and that the latter alone does not cause FAI, which leads to overdiagnosis in these cases.

  12. A chronic hypercoagulable state in patients with beta-thalassaemia major is already present in childhood.

    Science.gov (United States)

    Eldor, A; Durst, R; Hy-Am, E; Goldfarb, A; Gillis, S; Rachmilewitz, E A; Abramov, A; MacLouf, J; Godefray, Y C; De Raucourt, E; Guillin, M C

    1999-12-01

    A higher than normal incidence of thromboembolic events has been observed in adult patients with beta-thalassaemia major (TM) and certain haemostatic anomalies found in these patients suggest the existence of a chronic hypercoagulable state. Thalassaemic red blood cells (RBC) were demonstrated to facilitate thrombin formation due to altered asymmetry of the membrane phospholipids with enhanced exposure of phosphatidylserine. Since RBC anomalies exist in thalassaemia from the first months of life, we studied markers of hypercoagulability and thrombophilia in 36 adult patients (range 19-38 years) and 26 children (range 2-18 years) with beta-TM. All the patients were in steady state and none had experienced clinical signs or symptoms of thrombosis. Highly elevated urinary levels of 11-dehydro-thromboxane B2 and significantly elevated plasma levels of thrombin-antithrombin III (TAT) complexes were observed to the same extent in TM children and adults. The levels of factor II were decreased while factors V, VII + X and plasminogen were within the normal range. The natural coagulation inhibitors, protein C (PC) and protein S (PS) were significantly decreased in all TM patients investigated, regardless of age, but the PS binding protein (C4bBP) and antithrombin III levels were normal. The frequency of other thrombophilic mutations was not increased. Thus, a chronic hypercoagulable state already exists in thalassaemia in childhood and may contribute to the cardiac and pulmonary anomalies and the thrombotic events which occur later.

  13. The light at the service of medicine: optical sensing beside the patient's bed (Conference Presentation)

    Science.gov (United States)

    Baldini, Francesco; Adinolfi, Barbara; Berneschi, Simone; Berrettoni, Chiara; Chiavaioli, Francesco; Giannetti, Ambra; Tombelli, Sara; Trono, Cosimo

    2017-02-01

    The last twenty years have seen the increasing demand by physicians of devices able to carry out fast and reliable measurements of chemical and biochemical parameters beside the patient's bed so as to allow the formulation of a rapid and reliable diagnosis and/or the choice of the most appropriate therapy, avoiding the need for analysis of centralized laboratories. These are the so-called Point of Care Testing (POCT) devices that are becoming essential for the analysis of many diseases, where a quick medical attention is crucial for the patient's life. Optical biosensors and chemosensors can definitely play a fundamental role in this area and the use of optical fibers as optical links can also lead to invasive continuous measurements within the human body. The determination of one single parameter is sometimes sufficient, but it is important to emphasize that it is often necessary to monitor a panel of biomarkers associated to the onset and/or to the development of a definite pathology and, in this context, the optical biochip can play an essential role in the development of POCT equipment. The activity developed at the Institute of Applied Physics in this field in strict collaboration with physicians is described with particular attention to the measurement of bile-containing refluxes in the gastroesophageal apparatus in non- hospitalized patients, to the detection of gastric carbon dioxide in intensive care patients, to the simultaneous measurement of sepsis biomarkers in serum samples and to the measurements of immuno-suppressants in transplanted patients.

  14. Microscopic colitis: A retrospective study of clinical presentation in 53 patients

    Institute of Scientific and Technical Information of China (English)

    Zsolt Barta; Gabriella Mekkel; István Csíp(o); László Tóth; Szabolcs Szakáll; Gábor G. Szabó; Gyula Bakó; Gyula Szegedi; Margit Zeher

    2005-01-01

    AIM: To evaluate the relationship between symptoms and microscopic colitis (MC) subtypes: to test whether collagenous colitis (CC) and/or lymphocytic colitis (LC)might be related to both constipation and diarrhea.METHODS: A cohort of patients with independently confirmed typical histopathological changes was investigated. Fifty-three patients with histologically proved MC (46 with CC, 7 with LC) were included. The existence of diarrhea or constipation and the co-existence of autoimmune diseases were also investigated and all data were retrospectively analyzed.RESULTS: Twenty-three (43.39%) of MC patients had chronic constipation (20 in CC, 3 in LC patients). Twentyfour(45.28%) of MC patients had autoimmune disease and the diagnosis of autoimmune disease was always prior to MC. Sjogren's syndrome was associated only with the constipation subgroup.CONCLUSION: The Janus face of MC resembles the subgroups of irritable bowel syndrome. The co-existence of autoimmune diseases and MC is confirmed in both the constipation and diarrhea subgroups.

  15. Reflux esophagitis and hiatal hernia as concomitant abnormality in patients presenting with active duodenal or gastric ulcer: cross-sectional endoscopic study in consecutive patients.

    Science.gov (United States)

    Loffeld, R J.L.F.; van der Putten, A B.M.M.

    2002-05-01

    BACKGROUND: Follow-up studies have shown that patients with ulcer disease are at risk of developing reflux esophagitis (RE) after successful eradication of Heliobacter pylori. It is still not clear whether this is induced by eradication of H. pylori or whether RE is already present at the time the ulcer is diagnosed. A cross-sectional study was done in consecutive patients suffering from active ulcer disease in order to assess coincidental RE. METHODS: Patients with an active duodenal or gastric ulcer were included in the study. Concomitant RE and the presence of hiatal hernia (HH) were scored. Biopsy specimens were taken for detection of H. pylori. RESULTS: In 375 patients (77%), an active duodenal ulcer was the only abnormality. In 43 patients (8.8%), duodenal ulcer and concomitant RE were present and 69 patients (14.2%) had a duodenal ulcer with concomitant HH. Patients with a duodenal ulcer were significantly younger than patients with concomitant RE or HH. From 374 patients (76.8%) with a duodenal ulcer, biopsy specimens were available for the detection of H. pylori. The majority of duodenal ulcer patients were H. pylori-positive. H. pylori was significantly more often present in patients with an active duodenal ulcer than it was in duodenal ulcer patients suffering from concomitant RE (P=0.04). In 218 patients (76%), a gastric ulcer was the only abnormality. Fifteen patients (5.2%) also had RE and 54 patients (18.8%) had a concomitant HH. There was no difference in H. pylori status in these three groups of patients. CONCLUSIONS: Given the low prevalence of concomitant RE, it is concluded that this condition is likely to occur in a large percentage of patients suffering from H. pylori-positive ulcer disease after successful eradication therapy.

  16. Hip fracture fixation in a patient with below-knee amputation presents a surgical dilemma: a case report

    OpenAIRE

    Rethnam Ulfin; Yesupalan Rajam; Shoaib Amer; Ratnam Thanga K

    2008-01-01

    Abstract Introduction Hip fracture fixation surgery in patients with below-knee amputations poses a challenging problem to the surgeon in terms of obtaining traction for reduction of the fracture. The absence of the foot and part of the leg in these patients makes positioning on the fracture table difficult. We highlight this difficult problem and suggest techniques to overcome it. Case presentation A 73-year-old man with bilateral below-knee amputations presented with a history of fall. Radi...

  17. Pseudomembranous colitis presenting as acute colonic obstruction without diarrhea in a patient with gastric Burkitt lymphoma

    Institute of Scientific and Technical Information of China (English)

    Kenichi Nomura; Shigeo Horiike; Takeshi Okanoue; Masafumi Taniwaki; Kohei Fukumoto; Daisuke Shimizu; Takashi Okuda; Naohisa Yoshida; Yuri Kamitsuji; Yosuke Matsumoto; Hideyuki Konishi; Yuji Ueda

    2005-01-01

    Pseudomembranous colitis (PMC) usually manifests asfever and diarrhea in hospitalized patients treated withsystemic antibiotics. We described a case of PMC withintestinal obstruction but without diarrhea. A 60-yearold man was hospitalized for chemotherapy for the treatment of Burkitt lymphoma of the stomach. The patient became febrile and complained of crampy abdominal pain during the post-chemotherapy nadir. Plain abdominal radiography showed some intestinal gas and niveau. Because stool cytotoxin assay for clostridium difficile was positive and colon fiberscopic examination showed a pseudomembrane at the left side of the colon,and a diagnosis of PMC was made. Treatment with intracolonic vancomycin administration by colonoscopy and nasoileus tube was successful. Physicians should take into account the possibility of bowel obstruction due to PMC occurring in patients undergoing chemotherapy and perform emergency colonoscopy examination of suspected cases.

  18. Spectrum of clinical presentations in familial hemophagocytic lymphohistiocytosis type 5 patients with mutations in STXBP2

    DEFF Research Database (Denmark)

    Meeths, Marie; Entesarian, Miriam; Al-Herz, Waleed

    2010-01-01

    in patients with mutations in STXBP2 encoding Munc18-2, recently associated with familial HLH type 5. The disease severity among 11 persons studied here was highly variable and, accordingly, age at diagnosis ranged from 2 months to 17 years. Remarkably, in addition to typical manifestations of familial HLH...... (FHL), the clinical findings included colitis, bleeding disorders, and hypogammaglobulinemia in approximately one-third of the patients. Laboratory analysis revealed impairment of NK-cell degranulation and cytotoxic capacity. Interleukin-2 stimulation of lymphocytes in vitro rescued the NK cell......-associated functional defects. In conclusion, familial HLH type 5 is associated with a spectrum of clinical symptoms, which may be a reflection of impaired expression and function of Munc18-2 also in cells other than cytotoxic lymphocytes. Mutations in STXBP2 should thus also be considered in patients with clinical...

  19. A dark past, a restrained present, and an apocalyptic future: time perspective, personality, and life satisfaction among anorexia nervosa patients.

    Science.gov (United States)

    Garcia, Danilo; Granjard, Alexandre; Lundblad, Suzanna; Archer, Trevor

    2017-01-01

    Despite reporting low levels of well-being, anorexia nervosa patients express temperament traits (e.g., extraversion and persistence) necessary for high levels of life satisfaction. Nevertheless, among individuals without eating disorders, a balanced organization of the flow of time, influences life satisfaction beyond temperamental dispositions. A balanced time perspective is defined as: high past positive, low past negative, high present hedonistic, low present fatalistic, and high future. We investigated differences in time perspective dimensions, personality traits, and life satisfaction between anorexia nervosa patients and matched controls. We also investigated if the personality traits and the outlook on time associated to positive levels of life satisfaction among controls also predicted anorexia patients' life satisfaction. Additionally, we investigated if time perspective dimensions predicted life satisfaction beyond personality traits among both patients and controls. A total of 88 anorexia nervosa patients from a clinic in the West of Sweden and 111 gender-age matched controls from a university in the West of Sweden participated in the Study. All participants responded to the Zimbardo Time Perspective Inventory, the Ten Item Personality Inventory, and the Temporal Satisfaction with Life Scale. A t-test showed that patients scored higher in the past negative, the present fatalistic, and the future dimensions, lower in the past positive and the present hedonistic dimensions, higher in conscientiousness, extraversion, and agreeableness, and lower in life satisfaction. Regression analyses showed that life satisfaction was predicted by openness to experience and emotional stability for controls and by emotional stability among patients. When time dimensions were entered in the regression, emotional stability and the past negative and past positive time dimensions predicted life satisfaction among controls, but only the past positive and present hedonistic

  20. [Somatosensorial disorders. Alterations in the quality of life in patients presenting with peripheral vestibular dysfunction].

    Science.gov (United States)

    Luchikhin, L A; Guseva, A L; Baush, Ia A

    2011-01-01

    The authors undertook the assessment of the available methods for the analysis of the sensations of patients suffering pathology of the vestibular analyzer. The fact that such conditions as dizziness and disequilibrium have great influence on the social status of a patient and his (her) position in society accounts for the use of functional stabilometry in the clinical practice along with the evaluation of quality of life. It is emphasized that the timely diagnosis of these disorders and elucidation of their primary causes are as important for the successful treatment of this pathology as the choice of an adequate course of medicamental and rehabilitative therapy.

  1. UNUSUAL CLINICAL PRESENTATION OF RELAPSE IN PATIENT WITH ACUTE LYMPHOBLASTIC LEUKEMIA.

    Directory of Open Access Journals (Sweden)

    Vanya Slavcheva

    2015-04-01

    Full Text Available Acute lymphoblastic leukemia is a disease, which is more common in children. We report a clinical case of a patient aged 25. Thirty-two months before his last admission in Hematology clinic, acute pre- B lymphoblastic leukemia had been diagnosed and treated till March 2012. In September 2013 after bone marrow aspiration, flow cytometric analysis, trepan biopsy and biopsy of the kidney had been carried out, the patient was diagnosed with first late relapse, involving bone marrow and kidney. A second remission was achieved using Berlin- Frankfurt– Munster chemotherapy [BFM] and allogenic stem cell transplantation was performed.

  2. Genomic imbalances in patients with a clinical presentation in the spectrum of Cornelia de Lange syndrome

    Science.gov (United States)

    2013-01-01

    Background Cornelia de Lange syndrome (CdLS) is a rare autosomal-dominant disorder characterised by facial dysmorphism, growth and psychomotor developmental delay and skeletal defects. To date, causative mutations in the NIPBL (cohesin regulator) and SMC1A (cohesin structural subunit) genes account for > 50% and 6% of cases, respectively. Methods We recruited 50 patients with a CdLS clinical diagnosis or with features that overlap with CdLS, who were negative for mutations at NIPBL and SMC1A at molecular screening. Chromosomal rearrangements accounting for the clinical diagnosis were screened for using array Comparative Genomic Hybridisation (aCGH). Results Four patients were shown to carry imbalances considered to be candidates for having pathogenic roles in their clinical phenotypes: patient 1 had a 4.2 Mb de novo deletion at chromosome 20q11.2-q12; patient 2 had a 4.8 Mb deletion at chromosome 1p36.23-36.22; patient 3 carried an unbalanced translocation, t(7;17), with a 14 Mb duplication of chromosome 17q24.2-25.3 and a 769 Kb deletion at chromosome 7p22.3; patient 4 had an 880 Kb duplication of chromosome 19p13.3, for which his mother, who had a mild phenotype, was also shown to be a mosaic. Conclusions Notwithstanding the variability in size and gene content of the rearrangements comprising the four different imbalances, they all map to regions containing genes encoding factors involved in cell cycle progression or genome stability. These functional similarities, also exhibited by the known CdLS genes, may explain the phenotypic overlap between the patients included in this study and CdLS. Our findings point to the complexity of the clinical diagnosis of CdLS and confirm the existence of phenocopies, caused by imbalances affecting multiple genomic regions, comprising 8% of patients included in this study, who did not have mutations at NIPBL and SMC1A. Our results suggests that analysis by aCGH should be recommended for CdLS spectrum cases with an

  3. Investigation and management of patients with pleuritic chest pain presenting to the accident and emergency department.

    OpenAIRE

    Jones, K.; Raghuram, A

    1999-01-01

    The assessment of a patient with pleuritic chest pain calls for a high degree of clinical acumen and a high degree of suspicion that the diagnosis might be pulmonary embolism. This area is one of the most difficult in A&E medicine (and indeed chest medicine). One error is to "think the best" when considering the diagnosis in such patients but experience soon teaches to "think PE" and diagnose less serious conditions only when pulmonary embolism has been excluded. A key consideration is the pr...

  4. Urinary tract infection complicated by urine retention presenting as pseudocyesis in a schizophrenic patient.

    Science.gov (United States)

    Yeh, Yi-Wei; Kuo, Shin-Chang; Chen, Chun-Yen

    2012-01-01

    Pseudocyesis is a rare condition wherein a nonpregnant woman shows signs and symptoms of pregnancy, such as abdominal enlargement, breast enlargement, pigmentation, cessation of menses, subjective sensation of fetal movement and labor pains at the expected delivery date. In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, it is classified as a somatoform disorder, characterized by a false belief of being pregnant that is associated with objective signs of pregnancy. We report the case of a middle-aged female schizophrenic patient who developed pseudocyesis secondary to a urinary tract infection complicated by acute urine retention. The patient accepted that she had pseudocyesis after the causative medical condition resolved.

  5. Case series: imaging features of intraductal papillomas in patients presenting as nipple discharge

    Directory of Open Access Journals (Sweden)

    Vedita Dhull

    2016-07-01

    Results: 7/25 patients had intraductal papilloma as proven by surgery/ FNA. Mass lesion was identified in all 7 cases on sonography and MRI while it was detected in only 3 cases on mammography. Dilated ducts were demonstated in all 7 cases on sonography, in 6 cases on CE- MRI and 5 cases on mammography respectively. Conclusions: Mammography has limited diagnostic accuracy in patients with unexplained nipple discharge and MRI should be considered the diagnostic technique of choice in this clinical setting, with relevant corresponding area focussed on sonography. [Int J Res Med Sci 2016; 4(7.000: 2878-2882

  6. [Sulpiride: study of 669 patient presenting with pain of psychological origin].

    Science.gov (United States)

    Ferreri, M; Florent, C; Gerard, D

    2000-01-01

    Among somatoform disorders, pain disorder (DSM IV) appears to be relatively common in general practice and to cause social, psychological, and functional impairment. A previous study conducted by Lemoine (1997) has shown that sulpiride is more effective than placebo in reducing intensity and frequency of pain in this disorder. The aim of our study was to assess safety and efficacy of sulpiride in a large sample of patients under natural conditions of use, in general practice. In a multicenter, open clinical trial, 669 patients (mean age: 47 years +/- 12; male: 245, female: 424) fulfilling the DSM IV criteria for pain disorder (of gastrointestinal localization), were included by 321 general practitioners (GP) and treated for 6 weeks with sulpiride 150 mg/d. Investigators' evaluations were planned at D14 and D42. Furthermore a diary was given to each patient for self evaluation and intercurrent events reporting. The pain was of psychological type in 93% of cases and caused social or working disabilities in 78% of patients. At inclusion the mean score of the Hamilton Anxiety Rating Scale was 18 +/- 8, and the mean score of the depression scale HARD (Humeur, Angoisse, Ralentissement, Danger) was 14.8 +/- 6.4. During the study 7.9% of the patients had at least one adverse event, and 3% of patients were withdrawn for adverse event. Safety assessed with a specific variable (grouping together adverse events' reporting and results of CGI item 3) was good for 88% of patients. The principal criterion of efficacy was the clinician's evaluation of the intensity and frequency of abdominal pain on a four-point scale from 0 (asymptomatic) to 3 (important/continuous) from D0 to D End a decrease in pain intensity (91% of patients) and in pain frequency (89%) was observed as well as in frequency and intensity of related gastroenterological symptoms such as disturbances of bowel movements (79% and 78%), bloated symptoms (88% and 83%), nausea/vomiting (90% and 90%). A similar

  7. Administration of Coagulation-Altering Therapy in the Patient Presenting for Oral Health and Maxillofacial Surgery.

    Science.gov (United States)

    Halaszynski, Thomas M

    2016-11-01

    Oral health care providers are concerned with how to manage patients prescribed coagulation-altering therapy during the perioperative/periprocedural period for dental and oral surgery interventions. Management and recommendation can be based on medication pharmacology and the clinical relevance of coagulation factor levels/deficiencies. Caution should be used with concurrent use of medications that affect other components of the clotting mechanisms; prompt diagnosis and any necessary intervention to optimize outcome is warranted. However, evidence-based data on management of anticoagulation therapy during oral and maxillofacial surgery/interventions is lacking. Therefore, clinical understanding and judgment are needed along with appropriate guidelines matching patient- and intervention-specific recommendations.

  8. Capillary lactate as a tool for the triage nurse among patients with SIRS at emergency department presentation: a preliminary report.

    Science.gov (United States)

    Manzon, Cyril; Barrot, Loïc; Besch, Guillaume; Barbot, Olivier; Desmettre, Thibaut; Capellier, Gilles; Piton, Gaël

    2015-01-01

    The triage nurse is involved in the early identification of the most severe patients at emergency department (ED) presentation. However, clinical criteria alone may be insufficient to identify them correctly. Measurement of capillary lactate concentration at ED presentation may help to discriminate these patients. The primary objective of this study was to identify the prognostic value of capillary lactate concentration measured by the triage nurse among patients presenting to the ED. This was a prospective observational study, performed in the ED of a university hospital. At ED presentation, capillary lactate measurement was performed by the triage nurse among patients presenting with a clinical criteria of systemic inflammatory response syndrome (SIRS). Clinical variables usually used to determine severity were collected at presentation. Twenty-eight-day mortality and MEDS score were recorded. One hundred seventy-six patients with clinical SIRS presented to the ED. Median age was 72 years, and 28-day mortality was 16%. Capillary lactate at ED presentation was significantly higher among 28-day non-survivors than among survivors (5.7 mmol.L(-1) [3.2 to 7.4] vs 2.9 mmol.L(-1) [1.9 to 5.2], p = 0.003). A score based on mottling and capillary lactate concentration >3.6 mmol.L(-1) was significantly associated with 28-day mortality (area under curve, AUC = 0.75), independently of the MEDS score (AUC = 0.79) for the prediction of 28-day mortality (AUC global model 0.87). A high capillary lactate concentration measured by the triage nurse among patients presenting to the ED with clinical SIRS is associated with a high risk of death. A score calculated by the triage nurse, based on mottling and capillary lactate concentration, appears to be useful for identifying the most severe patients.

  9. Improving Comparability Of Survey Results Through Ex-Post Harmonisation A Case Study With Twelve European National Travel Surveys

    DEFF Research Database (Denmark)

    Christensen, Linda; Hubert, Jean-Paul; Järvi, Tuuli

    that reflect behavioural differences rather than methodological ones, in the context of the COST Action SHANTI (Survey Harmonisation with New Technologies Improvement, TUD0804) an ex-post harmonisation approach was developed using microdata from twelve European NTS’s. The paper presents both concept and basic...

  10. Transmission of MRSA between companion animals and infected human patients presenting to outpatient medical care facilities.

    Science.gov (United States)

    Ferreira, Jorge Pinto; Anderson, Kevin L; Correa, Maria T; Lyman, Roberta; Ruffin, Felicia; Reller, L Barth; Fowler, Vance G

    2011-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen in both human and veterinary medicine. The importance of companion animals as reservoirs of human infections is currently unknown. The companion animals of 49 MRSA-infected outpatients (cases) were screened for MRSA carriage, and their bacterial isolates were compared with those of the infected patients using Pulsed-Field Gel Electrophoresis (PFGE). Rates of MRSA among the companion animals of MRSA-infected patients were compared to rates of MRSA among companion animals of pet guardians attending a "veterinary wellness clinic" (controls). MRSA was isolated from at least one companion animal in 4/49 (8.2%) households of MRSA-infected outpatients vs. none of the pets of the 50 uninfected human controls. Using PFGE, patient-pets MRSA isolates were identical for three pairs and discordant for one pair (suggested MRSA inter-specie transmission p-value = 0.1175). These results suggest that companion animals of MRSA-infected patients can be culture-positive for MRSA, representing a potential source of infection or re-infection for humans. Further studies are required to better understand the epidemiology of MRSA human-animal inter-specie transmission.

  11. Colonoscopic findings and management of patients with outbreak typhoid fever presenting with lower gastrointestinal bleeding.

    Science.gov (United States)

    Shaikhani, Mohammad A R; Husein, Hiwa A B; Karbuli, Taha A; Mohamed, Mohamed Abdulrahman

    2013-09-01

    Lower gastrointestinal bleeding (LGIB) along with intestinal perforation is a well-known complication of typhoid fever. Reports of colonoscopic appearance and intervention of typhoid perforation involve only few cases. This series reports the colonoscopic findings and the role of colonoscopic hemostatic interventions in controlling the bleeding ileocolonic lesions. During the typhoid fever outbreak in Sulaymaniyah City in Iraqi Kurdistan Region, we received 52 patients with LGIB manifesting as fresh bleeding per rectum or melena. We performed total colonoscopy with ileal intubation for all cases. The findings were recorded and endoscopic hemostatic intervention with adrenaline-saline injection and argon plasma coagulation was applied to actively bleeding lesion. These patients were young, 11-30 years of age, with female preponderance. Blood culture was positive in 50 %. Colonoscopic findings were mostly located in the ileocecal region, although other areas of the colon were involved in many cases. Twenty-four percent of the cases required endoscopic hemostatic intervention by adrenaline injection with argon plasma coagulation which was effective in all patients except one who died in spite of surgical intervention in addition of endoscopic hemostasis. Dual endoscopic hemostatic intervention can be a safe and effective management option for patients with LGIB due to typhoid fever.

  12. Prediction scores or gastroenterologists' Gut Feeling for triaging patients that present with acute upper gastrointestinal bleeding

    NARCIS (Netherlands)

    Groot, N.; Oijen, M.G. van; Kessels, K.; Hemmink, M.; Weusten, B.; Timmer, R.; Hazen, W.; Lelyveld, N. van; Vermeijden, J.R.; Curvers, W.; Baak, L.; Verburg, R.; Bosman, J.; Wijkerslooth, L. de; Rooij, J van; Venneman, N.; Pennings, M.C.P.; Hee, K. van; Scheffer, R.; Eijk, R. van; Meiland, R.; Siersema, P.; Bredenoord, A.

    2014-01-01

    INTRODUCTION: Several prediction scores for triaging patients with upper gastrointestinal (GI) bleeding have been developed, yet these scores have never been compared to the current gold standard, which is the clinical evaluation by a gastroenterologist. The aim of this study was to assess the added

  13. Marked variability in clinical presentation and outcome of patients with C1q immunodeficiency

    DEFF Research Database (Denmark)

    van Schaarenburg, Rosanne A; Schejbel, Lone; Truedsson, Lennart;

    2015-01-01

    be restored by allogeneic hematopoietic stem cell transplantation. Current literature lacks information on disease progression and quality of life of C1q deficient persons which is of major importance to guide clinicians taking care of patients with this rare disease. METHODS: We performed an international...

  14. Specific and generalized neuropsychological deficits: a comparison of patients with various first-episode psychosis presentations.

    LENUS (Irish Health Repository)

    Zanelli, Jolanta

    2010-01-01

    Overwhelming evidence suggests that compromised neuropsychological function is frequently observed in schizophrenia. Neurocognitive dysfunction has often been reported in other psychotic disorders, although there are inconsistencies in the literature. In the context of four distinct diagnostic groups, the authors compared neuropsychological performance among patients experiencing their first psychotic episode.

  15. Symptomatology, Clinical Presentation and Basic Work up in Patients with Suspected Pulmonary Embolism

    DEFF Research Database (Denmark)

    Madsen, Poul Henning; Hess, Søren

    2017-01-01

    referral to a relevant facility should be a part of the skills of all clinicians. Sudden onset dyspnea, chest pain, syncope and hemoptysis are essential symptoms of pulmonary embolism, and in most of these patients basic investigations like arterial blood gas analysis, electrocardiogram, chest x...

  16. A case of hyperprolactinemia in patient with metastatic breast cancer: clinical case presentation

    Directory of Open Access Journals (Sweden)

    L. K. Dzeranova

    2012-01-01

    Full Text Available The described clinical case illustrates the importance of careful medical care and follow-up for oncology patients which can prevent high degree of tumor dissemination in case of the disease progression and improve survival rate and quality of life.

  17. Congenital short bowel syndrome as the presenting symptom in male patients with FLNA mutations

    NARCIS (Netherlands)

    van der Werf, Christine S.; Sribudiani, Yunia; Verheij, Joke B. G. M.; Carroll, Matthew; O'Loughlin, Edward; Chen, Chien-Huan; Brooks, Alice S.; Liszewski, M. Kathryn; Atkinson, John P.; Hofstra, Robert M. W.

    2013-01-01

    Purpose: Autosomal recessive congenital short bowel syndrome is caused by mutations in CLMP. No mutations were found in the affected males of a family with presumed X-linked congenital short bowel syndrome or in an isolated male patient. Our aim was to identify the disease-causing mutation in these

  18. Blood coagulation profiling in patients using optical thromboelastography (OTEG) (Conference Presentation)

    Science.gov (United States)

    Tripathi, Markandey M.; Tshikudi, Diane M.; Hajjarian, Zeinab; Van Cott, Elizabeth M.; Nadkarni, Seemantini K.

    2016-02-01

    Impaired blood coagulation is often associated with increased postoperative mortality and morbidity in cardiovascular patients. The capability for blood coagulation profiling rapidly at the bedside will enable the timely detection of coagulation defects and open the opportunity for tailoring therapy to correct specific coagulation deficits Optical Thromboelastography (OTEG), is an optical approach to quantify blood coagulation status within minutes using a few drops of whole blood. The goal of the current study is to evaluate the diagnostic accuracy of OTEG for rapid coagulation profiling in patients. In OTEG, temporal laser speckle intensity fluctuations from a drop of clotting blood are measured using a CMOS camera. To quantify coagulation status, the speckle intensity autocorrelation function is measured, the mean square displacement of scattering particles is extracted, and viscoelastic modulus (G), during coagulation is measured via the generalized Stokes-Einstein relation. By quantifying time-resolved changes in G, the coagulation parameters, reaction time (R), clot progression time (K), clot progression rate (Angle), and maximum clot strength (MA) are derived. In this study, the above coagulation parameters were measured using OTEG in 269 patients and compared with standard mechanical Thromboelastography (TEG). Our results showed a strong correlation between OTEG and TEG measurements for all parameters: R-time (R=0.80, pblood coagulation status to potentially improve clinical capability for identifying impaired coagulation in cardiovascular patients at the point of care.

  19. Transmission of MRSA between companion animals and infected human patients presenting to outpatient medical care facilities.

    Directory of Open Access Journals (Sweden)

    Jorge Pinto Ferreira

    Full Text Available Methicillin-resistant Staphylococcus aureus (MRSA is a significant pathogen in both human and veterinary medicine. The importance of companion animals as reservoirs of human infections is currently unknown. The companion animals of 49 MRSA-infected outpatients (cases were screened for MRSA carriage, and their bacterial isolates were compared with those of the infected patients using Pulsed-Field Gel Electrophoresis (PFGE. Rates of MRSA among the companion animals of MRSA-infected patients were compared to rates of MRSA among companion animals of pet guardians attending a "veterinary wellness clinic" (controls. MRSA was isolated from at least one companion animal in 4/49 (8.2% households of MRSA-infected outpatients vs. none of the pets of the 50 uninfected human controls. Using PFGE, patient-pets MRSA isolates were identical for three pairs and discordant for one pair (suggested MRSA inter-specie transmission p-value = 0.1175. These results suggest that companion animals of MRSA-infected patients can be culture-positive for MRSA, representing a potential source of infection or re-infection for humans. Further studies are required to better understand the epidemiology of MRSA human-animal inter-specie transmission.

  20. Anticoagulation control in atrial fibrillation patients present to outpatient clinic of cardiology versus anticoagulant clinics

    Institute of Scientific and Technical Information of China (English)

    DU Xin; MA Chang-sheng; LIU Xiao-hui; DONG Jian-zeng; WANG Jun-nan; CHENG Xiao-jing

    2005-01-01

    @@ Nonvalvular atrial fibrillation (NVAF) is the most common sustained cardiac arrhythmia in clinical practice, which if untreated results in a doubling of cardiovascular morbidity and mortality. AF is an independent predictor of stroke, with an annual risk 5 to 6 times higher than patients in sinus rhythm.1 During recent years, several randomised clinical trials conducted by investigators around the world involving 13 843 participants with NVAF have demonstrated convincingly the value of warfarin therapies for stroke prevention in high risk patients.2-8 However, the dose response of warfarin is complex and its activity is easily altered by concurrent medications, food interactions, alcohol and illnesses. Adherence to medical advice and routine monitoring of the international normalized ratio (INR) is important, because low anticoagulant intensity predisposes the patients to thromboembolic complications and high intensity to haemorrhage. Studies suggested that anticoagulant clinics could improve the quality of anticoagulation control,9 and anticoagulant clinics are common in western countries. However, in China, most AF patients taking warfarin usually attend the outpatient clinic of cardiology, while the quality of anticoagulation control is never investigated. We therefore assessed anticoagulation control in the outpatient clinic of cardiology, and the quality of anticoagulation control since the establishment of anticoagulant clinics.

  1. Comparing the Neuropsychiatric Profile of Patients with Alzheimer Disease Who Present Spared versus Impaired Executive Functioning

    Directory of Open Access Journals (Sweden)

    Ezequiel Gleichgerrcht

    2011-01-01

    Conclusions. The presence of stereotypies could be associated with a dysexecutive profile in AD patients. These results shed light on the role of frontal circuitry in the expression of motor symptoms in AD and prompt for further research that will contribute to the differential diagnosis both of different subtypes of AD and other types of dementia.

  2. Off-hour presentation and outcomes in patients with acute ischemic stroke: a systematic review and meta-analysis.

    Science.gov (United States)

    Sorita, Atsushi; Ahmed, Adil; Starr, Stephanie R; Thompson, Kristine M; Reed, Darcy A; Dabrh, Abd Moain Abu; Prokop, Larry; Kent, David M; Shah, Nilay D; Murad, Mohammad Hassan; Ting, Henry H

    2014-04-01

    Studies have suggested that patients with acute ischemic stroke who present to the hospital during off-hours (weekends and nights) may or may not have worse clinical outcomes compared to patients who present during regular hours. We searched Medline In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Scopus through August 2013, and included any study that evaluated the association between time of patient presentation to a healthcare facility and mortality or modified Rankin Scale in acute ischemic stroke. Quality of studies was assessed with the Newcastle-Ottawa Scale. A random-effect meta-analysis model was applied. Heterogeneity was assessed using the Q statistic and I(2). A priori subgroup analyses were used to explain observed heterogeneity. A total of 21 cohort studies (23 cohorts) with fair quality enrolling 1,421,914 patients were included. Off-hour presentation for patients with acute ischemic stroke was associated with significantly higher short-term mortality (OR, 1.11, 95% CI 1.06-1.17). Presenting at accredited stroke centers (OR 1.04, 95% CI 0.98-1.11) and countries in North America (OR 1.05, 95% CI 1.01-1.09) were associated with smaller increase in mortality during off-hours. The results were not significantly different between adjusted (OR, 1.11, 95% CI 1.05-1.16) and unadjusted (OR, 1.13, 95% CI 0.95-1.35) outcomes. The proportion of patients with modified Rankin Scale at discharge ≥ 2-3 was higher in patients presenting during off-hours (OR, 1.14, 95% CI 1.06-1.22). The evidence suggests that patients with acute ischemic stroke presenting during off-hours have higher short-term mortality and greater disability at discharge. Copyright © 2014 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  3. Malignant peripheral nerve sheath tumor of the cervical vagus nerve in a neurofibromatosis type 1 patient - An unusual presentation

    Directory of Open Access Journals (Sweden)

    Ashok Gupta

    2010-07-01

    Full Text Available Malignant peripheral nerve sheath tumors (MPNST’S of the head and neck comprise 2% to 6% of head and neck sarcomas. These tumors may arise as sporadic variants or in patients with neurofibromatosis (NF. Development of these MPNST’s is one of the serious complications of neurofibromatosis type 1(NF1. To our knowledge there are only two reported cases of MPNST’s arising in the cervical vagal nerve, occurring in NF1 patients. We present here an NF1 patient who developed an MPNST of the cervical vagus nerve and presented only with a cervical swelling and hoarseness.

  4. Disseminated Coccidioidomycosis Presenting as Carcinomatosis Peritonei and Intestinal Coccidioidomycosis in a Patient with HIV

    Directory of Open Access Journals (Sweden)

    Umer Malik

    2017-03-01

    Full Text Available Coccidioidomycosis (CM is a fungal infection endemic in southwestern regions of the United States, northwestern regions of Mexico, and some areas of Brazil and Argentina. Clinical presentation varies depending on the extent of the infection and the immune status of the host. The most common presentation ranges from flu-like symptoms to self-limiting pneumonia. Extrapulmonary presentations are uncommon and may involve the meninges, skin, and bone. Gastrointestinal and peritoneal involvement is extremely rare. Here we report a case of disseminated CM presenting as carcinomatosis peritonei as an AIDS-defining illness in a young male.

  5. [Filarial infestation in patients emanating from endemic area. 14 cases series presentation].

    Science.gov (United States)

    Cuello, M Rivera; Cuadros, E Núñez; Claros, A Medina; Hortelano, M García; Fontelos, P Martín; Peña, M J Mellado

    2009-09-01

    The migration causes the emergence of new diseases in our environment. One of them is the filariosis which, due to the biologic cycle peculiarity, it's weird its appearance in pediatrics. This studio accomplishes a review of all the filariosis cases diagnosed the last years in an Unit specialized in Tropical Pediatrics Diseases. Retrospective analysis comprising 14 patients than were diagnosed with filariosis from 1995 to 2007 in the Pediatrics Unit of Carlos III Hospital (Madrid). They have been analyzed several variables to cope with clinic-epidemiological, therapeutics and evolutional characteristics. All patients in the study came from Equatorial Guinea, their ages were between 3 and 15 years old. The isolated species were: 6 cases with O. volvulus, 8 with M. perstans and 2 with Loa-loa. The pruritus was the main symptom in the 71% of the cases. The eosinophilia was detected in the 78% of the patients, and the Loa-loa was the specie with higher figures. The 85% of the patients showed co-parasitation, being the intestinal the most frequent. The diagnostics was established by epidermic biopsy, microfilaremia detection, direct visualization and serology. The utilized drugs were: Mebendazole for the cases with M. perstans and Ivermectin or Dietylcarbamazine for the rest of the species. One child showed mixed filariosis. The cure was successful in the 8 cases that could be followed up. We consider essential to execute a filariosis screening to every patient emanating from endemic area, especially to those with eosinophilia. The diagnostic in the childhood, even though it's difficult, it allows the prevention of the disease development, serious complications as blindness and break the parasite life cycle.

  6. Patients with "organically unexplained symptoms" presenting to a borreliosis clinic: clinical and psychobehavioral characteristics and quality of life.

    Science.gov (United States)

    Csallner, Gisela; Hofmann, Heidelore; Hausteiner-Wiehle, Constanze

    2013-01-01

    This study explores the prevalence of patients with "organically unexplained symptoms" presenting to a Lyme borreliosis clinic and describes their clinical and psychobehavioral characteristics as well as health-related quality of life. Study instruments consisted of a set of self-rating questionnaires and an organicity rating of presenting symptoms by an acknowledged expert. Participants included 125 patients presenting with symptoms attributed to borreliosis. Clinical and psychobehavioral characteristics as well as health-related quality of life for patients whose symptoms were rated as "organically unexplained" were compared with those of patients whose symptoms were rated as "organically explained." Symptoms of 37 (30%) patients were rated as "organically unexplained" (ORG-) and symptoms of 88 (70%) patients were rated as "organically explained" (ORG+). ORG- differed from ORG+ in various clinical and psychobehavioral characteristics and in health-related quality of life. For example, ORG- reported a higher number of symptoms, more illness consequences and negative emotional illness representations, and felt less reassured in the medical context, more dissatisfied with medical care, and more convinced of having a serious illness. Our results suggest that patients with "organically unexplained symptoms" inadequately attributed to Lyme borreliosis reveal many clinical and psychobehavioral characteristics that indicate significant somatic and mental distress. An early focus on all of the patients' mental and bodily symptoms, as well as on subjective illness perceptions and consequences allows for a more specific plan. Copyright © 2013 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  7. Clinical presentation, treatment, and long‑term outcomes in patients with takotsubo cardiomyopathy: experience of a single cardiology center

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    Grzegorz Opolski

    2010-06-01

    Full Text Available INTRODUCTION: Takotsubo cardiomyopathy (TTC is a rare transient cardiomyopathy mimicking acute coronary syndrome (ACS. OBJECTIVES: The aim of the study was to retrospectively analyze the clinical course, treatment strategies, and follow‑up of patients with TTC. PATIENTS AND METHODS: Among all patients hospitalized in the department between January 2005 and January 2010, we identified a group of patients who were fulfilling the modified Mayo Clinic criteria for the diagnosis of TTC. Clinical presentation, hospital course, and clinical outcomes were analyzed. RESULTS: A total of 31 patients with TTC were included into the study; women comprised 93.5% of the study population. The most common symptoms included chest pain and dyspnea caused by emotional or physical stress. Cardiogenic shock was present in 2 subjects and life‑threatening ventricular arrhythmias in 3 other patients. Twenty‑four patients had ST‑segment elevation on the electrocardiogram. A mean left ventricular ejection fraction was 42 ±8.6% during contractility abnormalities, and it increased to 58 ±7.9% during recovery. Troponin I was positive in 30 cases with a mean peak level of 2.7 ±5.1 ng/ml. Follow‑up data were available in 23 patients and a mean follow‑up was 955 ±502.8 days. We did not observe a recurrence of TTC. CONCLUSIONS: TTC is observed mainly in postmenopausal women. Clinical presentation of TTC is almost indistinguishable from ACS, but its course is milder and the outcomes are better.

  8. A rare presentation of a common entity: Chronic appendicitis in a patient with back pain

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    Ekene Onwuka

    2017-03-01

    Full Text Available Despite being one of the most common pediatric surgical diseases, some cases of appendicitis are far from straightforward to diagnose. We present here an interesting case of chronic, retrocecal appendicitis in a dancer who presented with isolated back pain.

  9. Antecedent presentation of aplastic anemia in a patient with diffuse large B cell lymphoma

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    Chien-Ting Chen

    2016-12-01

    Full Text Available Immunological manifestation occasionally develops concurrently with lymphoid neoplasms, including immune thrombocytopenia and autoimmune hemolytic anemia, but rarely reported acquired aplastic anemia (AA. Here we present a female case of diffuse large B cell lymphoma (DLBCL with antecedent presentation of AA. Recovery of AA was noted after complete response to lymphoma treatment. Literature regarding this issue was reviewed.

  10. Clinical and Genetic Characteristics of Mexican Patients with Juvenile Presentation of Niemann-Pick Type C Disease

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    Raul E. Piña-Aguilar

    2014-01-01

    Full Text Available Niemann-Pick type C disease (NPC is a rare lysosomal disease with a protean presentation, ranging from a fatal neonatal course with visceromegaly to an adult presentation with only neurological or psychiatric symptomatology. In this report we describe the genetic and clinical characteristics of 3 Mexican patients from different families with juvenile presentation of NPC. Clinical examination, imaging of central nervous and gastrointestinal system, and EEG were performed. Genetic studies include sequencing and deletion/duplication analysis of NPC1 and NPC2 genes. All patients presented with cognitive impairment, ataxia, and supranuclear vertical gaze palsy; one case had gelastic cataplexy. Also they developed epilepsy and cortical atrophy and two patients had thinning of corpus callosum. The 3 patients were compound heterozygotes for NPC1 sequence variants, including 5 missense and 1 nonsense mutations: p.P1007A and p.F1087L in Case 1; p.Q921P and p.G992R in Case 2; and p.R348* and p.V1165M in case 3. Mexican patients with juvenile NPC presented with a variable clinical phenotype and compound heterozygosity. This suggests a relative high frequency of mutation carriers as it is reported for European population. Consequently, clinicians should consider NPC as a diagnosis possibility in any adolescent or young adult patient with juvenile dementia and/or ataxia, even in absence of gelastic cataplexy and supranuclear vertical gaze palsy.

  11. Juvenile fibromyalgia in an adolescent patient with sickle cell disease presenting with chronic pain.

    Science.gov (United States)

    Ramprakash, Stalin; Fishman, Daniel

    2015-10-01

    Juvenile fibromyalgia in children with sickle cell disease has not been reported in the literature. We report an adolescent patient with sickle cell whose pain symptoms progressed from having recurrent acute sickle cell pain crisis episodes to a chronic pain syndrome over several years. He was eventually diagnosed with juvenile fibromyalgia based on the clinical history and myofascial tender points and his pain symptoms responded better to multidisciplinary strategies for chronic fibromyalgia pain. Chronic pain in sickle cell disease is an area of poor research, and in addition there is inconsistency in the definition of chronic pain in sickle cell disease. Central sensitisation to pain is shown to occur after recurrent painful stimuli in a genetically vulnerable individual. In a chronic pain condition such as fibromyalgia central sensitisation is thought to play a key role. Fibromyalgia should be considered as one of the main differential diagnosis in any sickle cell patient with chronic pain.

  12. Cognitive behavioral therapy for treatment of primary care patients presenting with psychological disorders

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    Brigitte Khoury

    2014-03-01

    Full Text Available Mental disorders affect a great number of people worldwide. Four out of the 10 leading causes of disability in the world are mental disorders. Because of the scarcity of specialists around the world and especially in developing countries, it is important for primary care physicians to provide services to patients with mental disorders. The most widely researched and used psychological approach in primary care is cognitive behavioral therapy. Due to its brief nature and the practical skills it teaches, it is convenient for use in primary care settings. The following paper reviews the literature on psychotherapy in primary care and provides some practical tips for primary care physicians to use when they are faced with patients having mental disorders.

  13. Secondary breast cancer in patients presenting with osteosarcoma: possible involvement of germline p53 mutations.

    Science.gov (United States)

    Russo, C L; McIntyre, J; Goorin, A M; Link, M P; Gebhardt, M C; Friend, S H

    1994-01-01

    Second malignancies following treatment for osteosarcoma are unusual. Breast cancer occurring in patients with osteosarcoma has been reported following therapeutic chest irradiation. We now report three cases of breast cancer occurring in young women who were successfully treated for osteosarcoma. These women had not received therapeutic chest irradiation and in two of the three women there was no family history of breast cancer. Peripheral blood was available for study from one case. Of import, this case demonstrated a germline mutation in exon 7 of the tumor suppressor gene, p53. The mutation was detected by constant denaturing gradient gel electrophoresis and confirmed by DNA sequencing. In this particular patient, inactivation of the p53 gene may be involved in the development of both the first and second malignancy.

  14. Bowel perforation by crumpled paper in a patient presenting with acute abdominal pain

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    Bakhshaeekia Alireza

    2009-01-01

    Full Text Available Many of the abdominal foreign bodies are due to accidental ingestion. Our objective in this case report is to emphasize the importance of the enquiry about the foreign body in the differential diagnosis of acute abdominal pain. According to our knowledge, this is the first report of bowel perforation caused by paper ingestion. A 14-year-old boy with abdominal pain underwent exploratory laparotomy and was found to have abdominal pus and ileal perforation. A crumpled paper was found at the site of perforation. Postoperative enquiry revealed that the patient had ingested 10 crumpled papers. We highlight that recording the history is an important aspect in the management of patients with acute abdominal pain and that foreign bodies should be included in its differential diagnosis.

  15. Clinical presentation, lipid peroxidation intensity, and features of nitric oxide production in patients with erysipelas

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    L. I. Ratnikova

    2011-01-01

    Full Text Available 65 patients with a diagnosis of erysipelas. Examination of the patients included an analysis of lipid peroxidation products (common polyene, diene conjugates, and conjugate ketodieny trieny, Schiff bases, antioxidant defense system (enzymatic activity of superoxide dismutase and nitric oxide metabolites (nitrates and nitrites. It was established that imbalance between excess activated lipid peroxidation and inadequate functioning of antioxidant defense system was remained during the entire period of the disease. The relationships between nitric oxide and lipid peroxidation were established. It was proved the advisability of developing and introducing new, improved schemes of pathogenetic therapy of erysipelas.

  16. Social Media and Oncology: The Past, Present, and Future of Electronic Communication Between Physician and Patient.

    Science.gov (United States)

    Lewis, Mark A; Dicker, Adam P

    2015-10-01

    The relationship between patient and physician is in flux with the advent of electronic media that are advancing and enhancing communication. We perform a retrospective, current, and forward-looking examination of the technologies by which information is exchanged within the healthcare community. The evolution from e-mail and listservs to blogs and the modern social networks is described, with emphasis on the advantages and pitfalls of each medium, especially in regard to maintaining the standards of privacy and professionalism to which doctors are held accountable. We support the use of contemporary platforms like Twitter and Facebook for physicians to establish themselves as trustworthy online sources of medical knowledge, and anticipate ongoing collaboration between researchers, patients, and their advocates in trial design and accrual. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. A patient with schizophrenia presenting with post-lobotomy catatonia treated with olanzapine: a case report.

    Science.gov (United States)

    Kumagai, Ryo; Kitazawa, Maiko; Ishibiki, Yoshiro; Narumi, Kenji; Ichimiya, Yosuke

    2017-05-01

    A 79-year-old Japanese woman with schizophrenia was hospitalized because of idiopathic duodenal stenosis. Three days after discontinuing ingestion, including the administration of psychotropic drugs, the patient demonstrated incoherent behaviour and strong general muscle tension, and was unable to engage in conversation. Computed tomography indicated bilateral regions of low density in the frontal lobes, subsequent to which she was diagnosed with post-lobotomy catatonia. Administration of olanzapine (10 mg/day) improved the patient's condition within a short period. Previous studies have demonstrated an association between the dysfunction of frontal circuits and catatonia; therefore, the observed catatonic episode might relate to the disconnection of nerve fibres in the prefrontal lobes induced by her lobotomy. Olanzapine was likely effective in treating catatonia because of its reported efficacy in improving frontal lobe function. © 2016 The Authors. Psychogeriatrics © 2016 Japanese Psychogeriatric Society.

  18. Presentation and management of docetaxel-related adverse effects in patients with breast cancer

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    Ho MY

    2014-05-01

    Full Text Available Maria Y Ho, John R MackeyDivision of Medical Oncology, Cross Cancer Institute, Edmonton, AB, CanadaAbstract: The taxane chemotherapeutic agent docetaxel has been utilized in the management of breast cancer in the adjuvant, neoadjuvant and metastatic setting. Although well tolerated by the majority of patients, docetaxel toxicity may limit the dose which can be administered. Adverse events include infusion reactions, febrile neutropenia, fatigue, fluid retention, pneumonitis, cutaneous and nail toxicity, epiphora and lacrimal duct stenosis, gastrointestinal complications, and neuropathies. In this review, we explore these complications and how they can be effectively managed to improve patient quality of life during and following docetaxel therapy.Keywords: toxicity, chemotherapy, adverse events

  19. Surgical therapy for portal hypertension in patients with cirrhosis in China: present situation and prospects

    Institute of Scientific and Technical Information of China (English)

    ZHOU Guang-wen; LI Hong-wei

    2009-01-01

    @@ Surgical therapy for portal hypertension (PHT) in patients with cirrhosis has long been controversial,and various operative approaches have been used to prevent or manage such lethal complications as gastroesophageal variceal hemorrhage. However, over a century various portazygos devascularization and shunt approaches have been developed or modified, but the therapeutic effects have not been satisfactory till 1963 when Starzl did the first liver transplantation in the world, which provides a new hope to the surgical treatment of PHT.

  20. ADAMTS13-binding IgG are present in patients with thrombotic thrombocytopenic purpura.

    Science.gov (United States)

    Tsai, Han-Mou; Raoufi, Mojgan; Zhou, Wenhua; Guinto, Enriqueta; Grafos, Nickolas; Ranzurmal, Safi; Greenfield, Robert S; Rand, Jacob H

    2006-05-01

    Functional assays are commonly used to measure the antibodies of ADAMTS13 found in patients of thrombotic thrombocytopenic purpura (TTP). In this study we used an enzyme-linked immunoassay to analyze the ADAMTS13-binding IgG levels in six groups of individuals: normal, random hospitalized patients, acute TTP, TTP after receiving plasma therapy, TTP in remission, and other types of thrombotic microangiopathy (TMA). The results showed that ADAMTS13-binding IgG levels were elevated in 100% of the acute TTP group, 75% of the TTP group after receiving plasma therapy, and 40% of the remission group. Overall, the ADAMTS13-binding IgG levels correlated with the inhibitory activity levels againstADAMTS13 (r = -0.69, P < 0.0001). The assay also detected elevated IgG binding levels in 5% - 15% of the normal, random, and other TMA control groups. Addition of purified ADAMTS13 protein to the plasma samples suppressed the IgG binding in each of the acute TTP patients, but in none of the non-TTP groups. Serial measurement in a patient that had two exacerbations of TTP within the first three weeks revealed that the ADAMTS13 activity levels remained <0.1 U/ml during this period, and the ADAMTS13-binding IgG remained elevated, suggesting that ADAMTS13 analysis may provide valuable insight to the disease status during the course of therapy. Analysis of ADAMTS13-binding IgG is helpful for the diagnosis and management of TTP.

  1. A Rare Cardiac Malformation in a Patient Presenting with Transient Ischemic Attack: Isolated Left Ventricular Diverticulum

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    Haldun Müderrisoğlu1

    2012-12-01

    Full Text Available Left ventricular diverticulum is a rare congenital malformation consisting of a localized protrusion of the endocardium and myocardium from the free wall of the left ventricle (LV. The prevalence of the disease is 0.26% in nonselected patients who underwent cardiac catheterization. It is believed that the etiology is an intrinsic abnormality developing during embryogenesis. It often does not cause any symptoms. We report a case of isolated left ventricular diverticulum with complaints of transient ischemic attack.

  2. Assessment of the frequency of sperm annulus defects in a large cohort of patients presenting asthenozoospermia

    OpenAIRE

    Dirami, Thassadite; Rode, Baptiste; Wolf, Jean-Philippe; Gacon, Gérard; Dulioust, Emmanuel; Touré, Aminata

    2015-01-01

    International audience; Background: The annulus is a ring-shaped structure located beneath the plasma membrane that connects the midpiece and the principal piece of mammalian sperm flagellum. It has been suggested that the annulus acts as a morphological organizer, guiding flagellum assembly during spermiogenesis, and as a diffusion barrier, confining proteins to distinct compartments of the flagellum in mature sperm. Previous studies on small cohorts of patients have attempted to correlate a...

  3. TRAITEMENT DE LA DOULEUR NEUROPATHIQUE CHEZ LES PATIENTS PRESENTANT DES NEUROPATHIES CENTRALES OU PERIPHERIQUES

    OpenAIRE

    OULHACI, Amina; BENMEZROUA, Asma

    2014-01-01

    INTRODUCTION : la douleur neuropathique est un motif tres frequent en consultation generale et specialisee. Selon les etudes internationales 7 a 8 % de la population generale presenterait des douleurs neuropathiques d’intensite moderee a severe. Actuellement, la prise en charge therapeutique de ce type de douleurs repose principalement sur les antiepileptiques, les antidepresseurs et les antalgiques opioïdes. PATIENTS ET METHODES : notre etude a permis d’etudier la prise en charge therapeu...

  4. Emergency Physicians' Perceptions and Decision-making Processes Regarding Patients Presenting with Palpitations.

    Science.gov (United States)

    Probst, Marc A; Kanzaria, Hemal K; Hoffman, Jerome R; Mower, William R; Moheimani, Roya S; Sun, Benjamin C; Quigley, Denise D

    2015-08-01

    Palpitations are a common emergency department (ED) complaint, yet relatively little research exists on this topic from an emergency care perspective. We sought to describe the perceptions and clinical decision-making processes of emergency physicians (EP) surrounding patients with palpitations. We conducted 21 semistructured interviews with a convenience sample of EPs. We recruited participants from academic and community practice settings from four regions of the United States. The transcribed interviews were analyzed using a combination of structural coding and grounded theory approaches with ATLAS.ti, a qualitative data analysis software program (version 7; Atlas.ti Scientific Software Development GmbH, Berlin, Germany). EPs perceive palpitations to be a common but generally benign chief complaint. EPs' clinical approach to palpitations, with regards to testing, treatment, and ED management, can be classified as relating to one or more of the following themes: (1) risk stratification, (2) diagnostic categorization, (3) algorithmic management, and (4) case-specific gestalt. With regard to disposition decisions, four main themes emerged: (1) presence of a serious diagnosis, (2) perceived need for further cardiac testing/monitoring, (3) presence of key associated symptoms, (4) request of other physician or patient desire. The interrater reliability exercise yielded a Fleiss' kappa measure of 0.69, indicating substantial agreement between coders. EPs perceive palpitations to be a common but generally benign chief complaint. EPs rely on one or more of four main clinical approaches to manage these patients. These findings could help guide future efforts at developing risk-stratification tools and clinical algorithms for patients with palpitations. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. [Management of delivery in patients with Marfan's syndrome presenting aortic dilatation].

    Science.gov (United States)

    Abecassis, P; Lecinq, A; Roger-Christoph, S; Mercier, F-J; Benhamou, D

    2004-09-01

    We report the anesthesic and obstetrical management of two pregnant patients with Marfan's syndrome. An important dilatation of the root of aorta was established at the beginning of the pregnancy. Based on a review of the literature and our experience, we searched for clues to identify the ideal term and the best mode of delivery, and which type of anesthesia may be the more appropriate in patients with aortic dilatation. No consensus can be found in the literature as far as anesthesia and obstetric management of these patients is concerned. Pregnancy must be continued as long as possible to ensure adequate fetal growth but fetal extraction should not be delayed if the diameter of the aorta enlarges too much. A diameter of 40 mm is probably the higher limit to accept for vaginal delivery. Beyond, cautious cesarean section would be advisable. In the absence of dural ectasia or a technical problem, neuraxial anesthesia is a good option. According to the severity of the aortic dilatation and its evolution, specific management, based on good cooperation between obstetricians and anesthesiologists, is the key of a successful and safe childbirth.

  6. Clinical and Radiological Presentation of Pulmonary Langerhans Cell Histiocytosis: A Case Series of 20 Patients

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    A. Fakharian

    2008-07-01

    Full Text Available Introduction & Objective: Pulmonary Langerhans Cell Histiocytosis (PLCH is an uncommon (5% ILD interstitial tissue disorder with significant importance. It occurs predominantly in adult smokers. The organs involved in LCH include skin, bone, pituitary gland, thyroid, lymph node, and lungs.Materials & Methods: In this descriptive study all patients admitted to the Masih Daneshvari Hospital in Tehran from 1996 to 2007 diagnosed with LCH (recognized by clinical features, laboratory investigations, radiological manifestations, BAL and biopsy were evaluated.Results: A total of 20 patients were studied; mean age was 27.8 yrs.; 40% were smokers; 80% had pulmonary involvement while in 20% other organs were affected. On spirometry, a mixed pattern (50% was the most common and on chest radiography (CXR 77% of lung cysts were visible. The most frequent finding on CT- scan was diffuse lung cysts (80%.Conclusion: It is notable that ground glass opacity and consolidation occur in the early stages of disease. Since most of the patients refer with features of advanced disease, it is essential for the physicians to consider the early signs during the diagnostic stage. Also bronchoscopy and bronchial lavage are recommended in selected cases.

  7. Brain MRI findings in patients with mucopolysaccharidosis types I and II and mild clinical presentation

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    Matheus, M.Gisele; Castillo, Mauricio; Smith, J. Keith [Department of Radiology, University of North Carolina School of Medicine, 27599-7510, Chapel Hill, NC (United States); Armao, Diane [Department of Pathology, University of North Carolina School of Medicine, Chapel Hill, NC (United States); Towle, Diane; Muenzer, Joseph [Department of Genetics and Metabolism, University of North Carolina School of Medicine, Chapel Hill, NC (United States)

    2004-08-01

    Our objective was to determine the brain magnetic resonance imaging (MRI) abnormalities in a selected group of patients with mucopolysaccharidosis (MPS) types I and II who had only mild clinical manifestations. We retrospectively assessed MRI brain studies in 18 patients with MPS (type I: 6 and type II: 12). We evaluated abnormal signal intensity in the white matter, widening of the cortical sulci, size of the supratentorial ventricles, dilatation of the perivascular spaces (PVS) and enlargement of the subarachnoid spaces. We observed a broad spectrum of findings, and despite severely abnormal MRI studies, no patients had mental retardation. We also observed that dilated PVS, previously believed to be caused by macroscopic deposition of the mucopolysaccharides, had an appearance similar to cerebrospinal fluid (CSF) in all MRI sequences performed, even in FLAIR and trace diffusion weighted images. Based on our results, we believe that with the exception of white matter abnormalities and brain atrophy, all other findings may be related to abnormal resorption of CSF, and there is no relationship between the imaging and clinical manifestations of the disease. (orig.)

  8. A dark past, a restrained present, and an apocalyptic future: time perspective, personality, and life satisfaction among anorexia nervosa patients

    Science.gov (United States)

    Granjard, Alexandre; Lundblad, Suzanna; Archer, Trevor

    2017-01-01

    Background Despite reporting low levels of well-being, anorexia nervosa patients express temperament traits (e.g., extraversion and persistence) necessary for high levels of life satisfaction. Nevertheless, among individuals without eating disorders, a balanced organization of the flow of time, influences life satisfaction beyond temperamental dispositions. A balanced time perspective is defined as: high past positive, low past negative, high present hedonistic, low present fatalistic, and high future. We investigated differences in time perspective dimensions, personality traits, and life satisfaction between anorexia nervosa patients and matched controls. We also investigated if the personality traits and the outlook on time associated to positive levels of life satisfaction among controls also predicted anorexia patients’ life satisfaction. Additionally, we investigated if time perspective dimensions predicted life satisfaction beyond personality traits among both patients and controls. Method A total of 88 anorexia nervosa patients from a clinic in the West of Sweden and 111 gender-age matched controls from a university in the West of Sweden participated in the Study. All participants responded to the Zimbardo Time Perspective Inventory, the Ten Item Personality Inventory, and the Temporal Satisfaction with Life Scale. Results A t-test showed that patients scored higher in the past negative, the present fatalistic, and the future dimensions, lower in the past positive and the present hedonistic dimensions, higher in conscientiousness, extraversion, and agreeableness, and lower in life satisfaction. Regression analyses showed that life satisfaction was predicted by openness to experience and emotional stability for controls and by emotional stability among patients. When time dimensions were entered in the regression, emotional stability and the past negative and past positive time dimensions predicted life satisfaction among controls, but only the past

  9. A dark past, a restrained present, and an apocalyptic future: time perspective, personality, and life satisfaction among anorexia nervosa patients

    Directory of Open Access Journals (Sweden)

    Danilo Garcia

    2017-09-01

    Full Text Available Background Despite reporting low levels of well-being, anorexia nervosa patients express temperament traits (e.g., extraversion and persistence necessary for high levels of life satisfaction. Nevertheless, among individuals without eating disorders, a balanced organization of the flow of time, influences life satisfaction beyond temperamental dispositions. A balanced time perspective is defined as: high past positive, low past negative, high present hedonistic, low present fatalistic, and high future. We investigated differences in time perspective dimensions, personality traits, and life satisfaction between anorexia nervosa patients and matched controls. We also investigated if the personality traits and the outlook on time associated to positive levels of life satisfaction among controls also predicted anorexia patients’ life satisfaction. Additionally, we investigated if time perspective dimensions predicted life satisfaction beyond personality traits among both patients and controls. Method A total of 88 anorexia nervosa patients from a clinic in the West of Sweden and 111 gender-age matched controls from a university in the West of Sweden participated in the Study. All participants responded to the Zimbardo Time Perspective Inventory, the Ten Item Personality Inventory, and the Temporal Satisfaction with Life Scale. Results A t-test showed that patients scored higher in the past negative, the present fatalistic, and the future dimensions, lower in the past positive and the present hedonistic dimensions, higher in conscientiousness, extraversion, and agreeableness, and lower in life satisfaction. Regression analyses showed that life satisfaction was predicted by openness to experience and emotional stability for controls and by emotional stability among patients. When time dimensions were entered in the regression, emotional stability and the past negative and past positive time dimensions predicted life satisfaction among controls, but

  10. Antibacterial activities of extracts from twelve Centaurea species from Turkey

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    Tekeli Yener

    2011-01-01

    Full Text Available Members of the genus Centaurea (Asteraceae have been used in traditional plant-based medicine. The methanol extracts of twelve Centaurea species, of which five are endemic to Turkey flora, were screened for antibacterial activity against four bacteria (Escherichia coli, Bacillus cereus, Salmonella enteritidis, Staphylococcus aureus. The antibacterial activity was evaluated by the microdilution method and the minimum inhibition concentrations (MIC of the extracts were determined. C. cariensis subsp. microlepis exhibited an antimicrobial effect on all tested microorganisms. The extracts from eight Centaurea species (C. balsamita, C. calolepis, C. cariensis subsp. maculiceps, C. cariensis subsp. microlepis, C. kotschyi var. kotschyi, C. solstitialis subsp. solstitialis, C. urvillei subsp. urvillei and C. virgata possessed antibacterial activity against several of the tested microorganisms.

  11. Twelve tips on how to compile a medical educator's portfolio.

    Science.gov (United States)

    Dalton, Claudia Lucy; Wilson, Anthony; Agius, Steven

    2017-09-17

    Medical education is an expanding area of specialist interest for medical professionals. Whilst most doctors will be familiar with the compilation of clinical portfolios for scrutiny of their clinical practice and provision of public accountability, teaching portfolios used specifically to gather and demonstrate medical education activity remain uncommon in many non-academic settings. For aspiring and early career medical educators in particular, their value should not be underestimated. Such a medical educator's portfolio (MEP) is a unique compendium of evidence that is invaluable for appraisal, revalidation, and promotion. It can stimulate and provide direction for professional development, and is a rich source for personal reflection and learning. We recommend that all new and aspiring medical educators prepare an MEP, and suggest twelve tips on how to skillfully compile one.

  12. Integrated cognitive behavioral therapy for patients with Substance Use Disorder and Comorbid ADHD : Two case presentations

    NARCIS (Netherlands)

    van Emmerik-van Oortmerssen, Katelijne; Vedel, Ellen; van den Brink, Wir; Schoevers, Robert A.

    2015-01-01

    Two cases of integrated cognitive behavioral therapy (ICBT) for substance use disorder (SUD) and Attention Deficit Hyperactivity Disorder (ADHD) are presented illustrating that ICBT is a promising new treatment option. (C) 2015 Elsevier Ltd. All rights reserved.

  13. Infective Endocarditis Presented as a Right Atrium Mass in a Patient with Ulcerative Colitis

    Directory of Open Access Journals (Sweden)

    Ali Asghar Moeinipour

    2015-01-01

    Full Text Available Involvement of the heart is infrequently seen in irritable bowel syndrome (IBD. We present a case of severe acute infective endocarditis diagnosed as ulcerative colitis in further workup.

  14. A case of adrenoleukodystrophy presenting with manic symptoms in a patient on steroids for Addison's disease.

    Science.gov (United States)

    Jyothi, K S; George, Cyriac; Shaji, K S

    2016-01-01

    Adrenoleukodystrophy (ALD) is an X-linked disorder with diverse clinical presentations. A 30-year-old male, previously diagnosed with Addison's disease, on steroid supplementation for 18 years, presented to us with manic symptoms for 4 years. He was found to have white matter hypodensities in computed tomography head and had white matter signal changes in magnetic resonance imaging, and therefore a diagnosis of ALD was made.

  15. A Rare Clinical Presentation of Giant Bilateral Labial Fibroepithelial Stromal Polyps in Patient with Psoriasis Disease

    Directory of Open Access Journals (Sweden)

    Ayse Filiz Avsar

    2016-01-01

    Full Text Available Fibroepithelial polyps (FEPs are rarely seen lesions of the lower female genital tract with polypoid proliferations of stroma. These tumors usually present in the vulvovaginal region of the reproductive aged women. In this presentation, we report a case of a psoriatic woman who developed unusual multiple polypoid lesions approximately 15 cm in size arising from both left and right labia minora and unique connection of FEPs with psoriasis disease.

  16. Airway plaque presenting after alteration of immunosuppression in a pediatric patient remote from heart transplantation.

    Science.gov (United States)

    Ryan, Thomas D; Absalon, Michael J; de Alarcon, Alessandro; Gupta, Anita; Peters, Anna L; Lorts, Angela; Danziger-Isakov, Lara A; Chin, Clifford

    2017-08-24

    Success after solid organ transplantation is dependent on the proper balance of immunosuppression to prevent rejection of the allograft while limiting the risk of developing infections and malignancy. We present a 9-year-old girl, remote from transplant, who presented with airway plaque after a change in immunosuppression to include the mTOR inhibitor sirolimus. Differential diagnosis included direct medication side effect, infection, and neoplasia. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  17. Profile of patients with idiopathic granulomatous mastitis presenting to a university teaching hospital in UAE: A case series

    Directory of Open Access Journals (Sweden)

    Manda Venkatramana

    2013-07-01

    Full Text Available Objective: To highlight the profile of five patients diagnosed as having idiopathic granulomatous mastitis by histopathological examination. Materials and Methods: This presentation is a case series of patients, diagnosed as idiopathic granulomatous mastitis by histopathological examination of excised specimens. The total number of cases included in the report was five females over a 4-year period from 2005 to 2009. Results: The mean age of the patients was 29.6 years and the duration of symptoms varied from 3 weeks to 4 months. All the patients presented with a palpable mass in the breast, and two patients had associated pain and one had a bloody nipple discharge. The average size of the excised mass was 3.8 × 3.1 cm. Four out of the five patients diagnosed to have breast abscess or segmental mastitis had taken a course of antibiotics. One patient had a persistent wound sinus which subsided with ATT and the rest of the patients had no post-operative complications. Conclusion: Idiopathic granulomatous mastitis is a relatively rare disease which mimics the common breast disorders in the reproductive age group including malignancy

  18. An Unusual Presentation of Liver Failure in a Patient with Primary Gastrointestinal Hodgkin's Lymphoma

    Directory of Open Access Journals (Sweden)

    Gabrielle B. Rocque

    2011-01-01

    Full Text Available Introduction. Hodgkin's lymphoma (HL presenting either with primary bowel involvement or with cholestasis is unusual. The combination of primary gastrointestinal HL presenting with cholestasis and ductopenia has not been previously described. Case Report. We present a case of primary gastrointestinal HL with evidence of liver involvement, but also with prominent ductopenia on liver biopsy and associated intrahepatic cholestasis. A 50-year-old man with a history of Crohn's disease presented with a bowel obstruction, for which he underwent a small bowel resection. Histology revealed HL. His course was complicated by