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Acute Presentation (acute + presentation)
Selected AbstractsInsights into the acute cerebral metabolic changes associated with childhood diabetesDIABETIC MEDICINE, Issue 5 2005F. J. Cameron Abstract Aims Type 1 diabetes is a prevalent chronic disease in childhood with the commonest single cause of death being cerebral oedema in the context of diabetic ketoacidosis (DKA). The nature of the alterations in cerebral metabolism that may result in vulnerability to neuronal injury remains unknown. The aim of this study was to analyse the magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) brain data from eight children with diabetes following acute presentation with hyperglycaemia with or without ketoacidosis, to determine the nature and timing of any alterations in cerebral structure and metabolism. Methods This study used MRI and MRS to investigate regional cerebral abnormalities in a small series of diabetic patients with and without DKA. Changes were compared with the clinical and biochemical features of the patients studied. Results Our small series of patients all demonstrated abnormal signal changes in the frontal region on fluid attenuated inversion recovery (FLAIR) MR imaging, suggestive of oedema, and spectroscopic abnormalities of increased taurine, myoinositol and glucose levels. The MR abnormalities varied in severity but did not correlate with any clinical or biochemical parameters. Conclusions These changes indicate that many diabetic children, particularly at presentation, may have alterations in cerebral metabolism with implications for the pathogenesis and treatment of the cerebral complications of DKA. In addition, our findings suggest that increased taurine may be one of the important differentiating factors in the response of the brain of diabetic children to DKA that may reflect an increase in their vulnerability to cerebral oedema compared with diabetic adults. [source] Features associated with treatment failure in type 1 autoimmune hepatitis and predictive value of the model of end-stage liver disease,,HEPATOLOGY, Issue 4 2007Aldo J. Montano-Loza Autoimmune hepatitis may fail to respond to corticosteroid therapy, but the frequency and bases for this outcome are uncertain. We aimed to determine the frequency and nature of treatment failure in patients with type 1 autoimmune hepatitis, define features associated with its occurrence, and assess if the model for end-stage liver disease can predict this outcome. Patients failing conventional corticosteroid regimens were compared to patients who responded to similar regimens. Fourteen of 214 patients (7%) failed corticosteroid treatment. Patients who failed therapy were younger (33 ± 3 years versus 48 ± 1 years, P = 0.0008), had higher serum levels of bilirubin at accession (4.1 ± 0.9 mg/dL versus 2.3 ± 0.2 mg/dL, P = 0.02), presented acutely more frequently (43% versus 14%, P = 0.01), and had a higher frequency of HLA (human leukocyte antigen) DRB1*03 (93% versus 53%, P = 0.004) than did patients who achieved remission. An alternative disease (fatty liver disease) emerged in only 1 patient who failed therapy (7%). Scores determined by the model of end-stage liver disease at presentation of patients who failed treatment were higher than those of who achieved remission (16 ± 1 versus 10 ± 0.3 points, P < 0.0001), and score greater than 12 points had greater sensitivity (97%) and specificity (68%) for treatment failure than did HLA DRB1*03 or other features. Conclusion: Onset at an early age, acute presentation, hyperbilirubinemia, and presence of HLA DRB1*03 characterize patients who fail corticosteroid treatment. The model for end-stage liver disease may be a useful instrument for identifying patients prone to this outcome. (HEPATOLOGY 2007.) [source] Systemic and topical corticosteroid treatment of oral lichen planus: a comparative study with long-term follow-upJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 6 2003M. Carbone Abstract Background:, Topical corticosteroids are the mainstay treatment for oral lichen planus (OLP), but some authors suggest that systemic corticosteroid therapy is the only way to control acute presentation of OLP. Methods:, Forty-nine patients with histologically proven atrophic,erosive OLP were divided into two groups matched for age and sex. The test group (26 patients) was treated systemically with prednisone (50 mg/day), and afterwards with clobetasol ointment in an adhesive medium plus antimicotics, whereas the control group (23 patients) was only treated topically with clobetasol plus antimycotics. Results:, Complete remission of signs was obtained in 68.2% of the test group and 69.6% of the control group, respectively (P = 0.94). Similar results were obtained for symptoms. Follow-up showed no significant differences between the two groups. One-third of the patients of the test group versus none in the control group experienced systemic side-effects (P = 0.003). Conclusions:, The most suitable corticosteroid therapy in the management of OLP is the topical therapy, which is easier and more cost-effective than the systemic therapy followed by topical therapy. [source] Intra-abdominal metastases from soft tissue sarcomaJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2004FRCS (Ed.), FRCS (Glas.), Kasim A. Behranwala MS Abstract Objective To define the clinical features and prognosis of patients with abdominal metastasis from primary soft tissue sarcoma (STS) at other sites. Methods All patients with abdominal metastasis from STS were identified from the Royal Marsden Hospital Sarcoma Unit prospective database from January 1990 to July 2001. Results Nineteen patients developed abdominal metastasis out of a cohort of 2127 patients (0.9%) evaluated during the study interval. The median age was 49 (19,71) years. The median time to abdominal metastasis from diagnosis of the primary was 27 (8,91) months. The presenting complaints were incomplete intestinal obstruction (n,=,5), abdominal pain (n,=,4), mass (n,=,2), gastrointestinal bleed (n,=,2), urinary obstruction (n,=,2), anorexia (n,=,1), and abdominal distension (n,=,1). Emergency laparotomy was done for perforative peritonitis (n,=,2), intussusception (n,=,2), and bleed in spleen (n,=,1). Two patients were asymptomatic. The common histologies were myxoid liposarcoma (n,=,6) and leiomyosarcoma (n,=,4). The median follow-up of survivors post metastasis was 12 months. Abdominal metastatectomy was performed in 16 patients, 3 of these patients had abdominal recurrences. The 1- and 2-year overall disease specific survival for the 19 patients was 66% (SE,=,11%) and 43% (SE,=,13%) with a median survival of 13 months (95% CI,=,11.8,14.7). Metastasectomy was associated with slight improved median post-metastasis survival (33 months vs. 8 months for unresected patients). Conclusions Although abdominal metastasis is rare, vigilance is warranted. Symptomatic patients should be examined and investigated thoroughly for metastases. Surgery is the treatment of choice for patients with an acute presentation; however, survival is dismal. J. Surg. Oncol. 2004;87:116,120. © 2004 Wiley-Liss, Inc. [source] | ||||||||||