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Bilateral Involvement (bilateral + involvement)
Selected AbstractsClinical manifestations of chondromalacia patella in 260 Iranian patientsINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2005I. SALEHI Abstract Background and aim:, Chondromalacia patella, which is characterized by softening of the patellar cartilage, is the most common cause of anterior knee pain in young women. The aim of this study was to identify the clinical features of patients with chondromalacia patella in Iran. Methods:, All patients under 40 years, complaining of mechanical knee pain who were referred to Amir A'lam Rheumatology Unit, with positive shrug sign and normal knee X-rays during the period September 2000 to September 2002, were included in this study. After physical examination and knee radiography, patients with knee arthritis, knee osteoarthritis and knee periarthritis were excluded. Patients with the clinical diagnosis of chondromalacia patella were studied. The demographic data, clinical disease characteristics and disease course were recorded. Results:, There were 260 patients. They were predominantly female (F : M, 2.6 : 1), in the third decade of life and a mean age of 22.8 years at the onset of disease. Bilateral involvement was found in 92% of patients. The first manifestation was knee pain. The history of trauma or swelling of the knee occurred in about 20% of cases. The history of dislocation was 3%. Sitting with flexed knees, stairs, and the use of Turkish WCs aggravated the knee pain. About one-third had knee malalignment, mostly mild genu varus. Patella alta was seen in 1.6%. Q-angle more than 15° was seen in 90.8%. Mean Q-angle was 21.9°, mean patellar angle was 122.6°, and mean intercondylar angle was 141.5°. All patients had the shrug sign. About 90% had Rabot test and crepitation, 3.5% had knee effusion, and 1% had knee laxity. Lower limb discrepancy was seen in 6.2% and spinal deformity in 10%. Ninety-three percent of the patients were treated by conservative (medical) therapy. Conclusion:, So the classic case of chondromalacia patella is a woman in her third decade of life with mechanical knee pain and positive shrug test. [source] Systemic adverse events following botulinum toxin A therapy in children with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2010KRISHANT NAIDU Aim, We studied the incidence of incontinence and respiratory events in children with cerebral palsy who received injections of botulinum toxin A (BoNT-A). Method, We used multivariable logistic regression to investigate relationships between (BoNT-A) dose, Gross Motor Function Classification System (GMFCS) level, and the incidence of bladder or bowel incontinence, unplanned hospital admission, emergency department consultation or prescription of antibiotics for respiratory symptoms, and diagnosis of upper respiratory tract infection. Results, Of 1980 injection episodes in 1147 children (mean age 4y 7mo, SD 1y 10mo, range 9mo,23y), 488 (25%) were in children with unilateral involvement and 1492 (75%) in children with bilateral involvement. At the time of injection 440 (22.2%) of children were at GMFCS level I, 611 (30.9%) were at level II, 330 (16.7%) were at level III, 349 (17.6%) were at level IV, and 250 (12.6%) were at level V. The incidence of serious adverse events was low, with 19 episodes of incontinence (1% of injection episodes) and 25 unplanned hospital admissions due to respiratory symptoms (1.3%). Incontinence typically resolved spontaneously 1 to 6 weeks after injection. The incidence of adverse events was associated with GMFCS level and dose of BoNT-A. Interpretation, The incidence of serious adverse events was low but suggests systemic spread as well as a procedural effect. We recommend reviewing upper dose limits for children at all GMFCS levels, particularly those at levels IV and V with a history of aspiration and respiratory disease. In these children, alternatives to mask anaesthesia may be particularly important. [source] AAN-EFNS guidelines on trigeminal neuralgia managementEUROPEAN JOURNAL OF NEUROLOGY, Issue 10 2008G. Cruccu Several issues regarding diagnosis, pharmacological treatment, and surgical treatment of trigeminal neuralgia (TN) are still unsettled. The American Academy of Neurology and the European Federation of Neurological Societies launched a joint Task Force to prepare general guidelines for the management of this condition. After systematic review of the literature the Task Force came to a series of evidence-based recommendations. In patients with TN MRI may be considered to identify patients with structural causes. The presence of trigeminal sensory deficits, bilateral involvement, and abnormal trigeminal reflexes should be considered useful to disclose symptomatic TN, whereas younger age of onset, involvement of the first division, unresponsiveness to treatment and abnormal trigeminal evoked potentials are not useful in distinguishing symptomatic from classic TN. Carbamazepine (stronger evidence) or oxcarbazepine (better tolerability) should be offered as first-line treatment for pain control. For patients with TN refractory to medical therapy early surgical therapy may be considered. Gasserian ganglion percutaneous techniques, gamma knife and microvascular decompression may be considered. Microvascular decompression may be considered over other surgical techniques to provide the longest duration of pain freedom. The role of surgery versus pharmacotherapy in the management of TN in patients with multiple sclerosis remains uncertain. [source] Ischemic nephropathy in an elderly patientGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 2 2008Satoshi Hoshide Congestive heart failure often occurs in patients with bilateral renal artery stenosis. Recently, Jacobson and Breyer, and Jacobson introduced the term "ischemic nephropathy", which implies critical bilateral involvement or global ischemia. Ischemic nephropathy is not only a cause of hypertension but also an important cause of end-stage renal disease. However, the aging kidney often show that the renal artery does not demonstrate stenosis of the main trunks, but stenosis of an atherosclerotic branch. We present a case of multiple atherosclerotic peripheral renal arteries, which might have caused ischemic nephropathy in an elderly hypertensive patient with advanced atherosclerosis. [source] The incidence of high-grade prostatic intraepithelial neoplasia and atypical glands suspicious for carcinoma on first-time saturation needle biopsy, and the subsequent risk of cancerBJU INTERNATIONAL, Issue 4 2007Lynn Schoenfield OBJECTIVE To investigate the detection rate and extent of high-grade prostatic intraepithelial neoplasia (HGPIN) and atypical glands (AG) suspicious for prostate cancer, and the cancer risk in subsequent biopsies, diagnosed by a first 24-core saturation biopsy, as although the optimum extent of biopsy is controversial there is a trend to increase the number of cores taken, and apart from detecting prostate cancer, identifying HGPIN and AG is associated with a greater risk of finding cancer in subsequent biopsies, thus warranting a closer follow-up. PATIENTS AND METHODS The study included 100 men with consecutive first-time saturation biopsies; the indications for biopsy were an abnormal digital rectal examination and/or a serum prostate-specific antigen (PSA) level of >2.5 ng/mL. Each biopsy specimen was reviewed retrospectively by two pathologists to confirm the histological diagnosis. The number and percentage of cores positive for HGPIN, bilateral involvement and multifocality (HGPIN involving two or more cores) were recorded in each case. The presence of AG and cancer was also recorded. An extended (10,12 cores) repeat biopsy was available in 23 patients. RESULTS The median (range) age and PSA level of the patients was 63 (41,80) years and 4.9 (1.5,67.0) ng/mL, respectively. Of the 100 patients, 34% had normal findings (benign prostatic tissue, BPT), 39% had cancer, 26% had HGPIN and cancer, 22% had HGPIN alone, and 5% had AG. Repeat biopsies were available in nine of the 22 (41%) patients with HGPIN, four of five with AG, and 10 of the 34 (29%) with BPT. The median (range) interval between the first and second biopsy was 13 (4,36) months. Prostate cancer was detected at the second biopsy in a third of patients with isolated HGPIN on the first biopsy, and one of the four with AG. None of the patients with BPT had cancer on re-biopsy. The cancer detection rate was significantly greater in patients with multifocal than in those with unifocal HGPIN (80% vs none, P = 0.010). The median number of cores and percentage of tissue involved by HGPIN was 3.5 (2,5) and 1.0 (0.5,1.2)%, respectively, in patients with cancer detected in repeat biopsies, compared to 1.0 (1,3) and 0.2 (0.2,0.6)% in patients without cancer on repeat biopsy (P = 0.023 and 0.015, respectively). CONCLUSION Identifying multifocal HGPIN on first saturation biopsy is associated with an overall cancer detection rate of 80% on repeat 10,12-core biopsy. Although there were few patients, the detection of multifocal HGPIN warrants additional searches for concurrent invasive carcinoma by repeated biopsy. [source] 2215: Animal models of herpetic retinitisACTA OPHTHALMOLOGICA, Issue 2010M LABETOULLE The Herpes simplex virus (HSV) is characterized its ability to replicate in the nervous system, before inducing a latent infection with potential reactivation. Most frequent ocular complications of recurrent HSV infection are keratitis and conjunctivitis. Less frequently, the iris and the ciliary body may also be involved (anterior uveitis). The most severe HSV ocular infection is retinitis, a rare but potentially blinding disease, due to frequent bilateral involvement. Studies on human post-mortem tissues showed that HSV is widely distributed in the population, with a preferential location within the trigeminal ganglions (innervating the cornea), but also in the superior cervical ganglions (innervating the iris) or in brain/medullar tissues (innervating the retina). Animal models have been developed to understand the pathogenic processes that lead to this rare but devastating retinal disease. Since human is the only natural host of HSV, it is difficult to obtain a perfect animal model that perfectly mimics the disease. Several animal models, based on different inoculation procedures, are thus necessary to circumscribe the anatomical, cellular and molecular aspects that lead to retinal infection. Finally, HSV retinitis appears as a clinical condition that is highly constrained by the relationships between the strain of the virus and the immune response of the host. [source] Mantle Cell Lymphoma in the Ocular RegionACTA OPHTHALMOLOGICA, Issue 2008S HEEGAARD Purpose To characterize the clinicopathological features of mantle cell lymphoma (MCL) in the ocular region. Methods All lymphoid lesions were retrieved searching the Danish Ocular Lymphoma Database 1980-2007. Specimens were collected from Danish pathology departments and re-evaluated with a panel of monoclonal antibodies. For all patients with confirmed MCL the complete clinical files were collected and reviewed. Results Twenty-one patients with MCL were identified comprising nine percent (21/230) of all lymphomas in the ocular region. There were 18 male and three female patients with an age range from 60 to 90 years (median 75 years). Ocular region MCL as first presenting symptom included 67% of the patients. Of these, 71% had bilateral involvement and all had lymphoma in more than one site within the ocular region. The orbit (71%) and eyelids (64%) were the most commonly affected sites. At the time of diagnosis 93% of the patients were in Ann Arbor stage III/IV, with bone marrow involvement (79%) and B-symptoms (50%). Median overall survival (OS) was 30 months and the five-year OS rate was 21%. Patients receiving anti-CD20 (Rituximab)-containing chemotherapy had a significant better 5-year OS rate (80 %) (p < 0,027) than patients in treatment regimes without Rituximab (5-year OS rate, 29%). Conclusion MCL presenting in the ocular region has a male predominance and affects elderly patients. The orbit and eyelids were frequently involved. Patients with ocular region MCL as first presenting symptom had a high proportion of bilateral affection. Patients had advanced stage disease at diagnosis, multiple relapses and a low 5-year OS rate similar to systemic MCL. Treatment with Rituximab-containing chemotherapy improved survival significantly. [source] Isolated extraocular muscle involvement as the ophthalmic manifestation of leukaemiaCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 6 2009Hayyam Kiratli MD Abstract Background:, Clinical and imaging features of patients with orbital leukaemia primarily involving extraocular muscles were evaluated. Methods:, This retrospective case series includes patients with leukaemia whose only ophthalmic manifestation was extraocular muscle enlargement. Demographic data, clinical information on the systemic disease, prominent ocular signs and symptoms, computed tomography and magnetic resonance imaging characteristics, treatments applied and the outcomes were collected. Results:, Five patients were diagnosed as leukaemic infiltration of extraocular muscle between 1995 and 2008. The age at presentation ranged between 3 and 61 years. Acute myeloid leukaemia was the diagnosis in two patients, and chronic lymphocytic leukaemia, chronic myeloid leukaemia and biphenotypic acute leukaemia were found in one patient each, respectively. One patient had bilateral involvement. The lateral rectus muscle was affected in four patients and the superior rectus muscle in one case. Restricted ocular motility was the most common finding. In one patient who had no prior history of leukaemia, an incisional biopsy established the diagnosis. All patients received multi-agent chemotherapy. Four patients expired after a rapid decline of the systemic status within a mean period of 7 months. Conclusions:, Leukaemic infiltration of extraocular muscles is a rare and late manifestation of the advanced disease associated with relapse and there seems to be a predilection for the lateral rectus muscle. Systemic prognosis remains dismal despite intensive chemotherapy. [source] | ||||||||||