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Acute Stage (acute + stage)
Selected AbstractsWater Apparent Diffusion Coefficient and T2 Changes in the Acute Stage of Maple Syrup Urine Disease: Evidence of Intramyelinic and Vasogenic-Interstitial EdemaJOURNAL OF NEUROIMAGING, Issue 2 2003Andrea Righini MD ABSTRACT Background. The acute phase of the neonatal classical form of maple syrup urine disease (MSUD) is usually associated with generalized brain edema. Methods and Results. The authors present the case of a newborn infant in the acute stage of the classical form of MSUD in whom a remarkable decrease in the water apparent diffusion coefficient (ADC) in advanced myelinating white matter areas was associated with an increase in the T2 signal. This diffusion magnetic resonance imaging (MRI) pattern appears to be compatible with a rare kind of cytotoxic edema, the so-called intramyelinic edema. At the same time, an increase in the ADC was seen in unmyelinated areas together with an increase in the T2 signal, a sign of a coexistent vasogenic-interstitial edema. Conclusions. ADC measurements in MSUD provide more specific information than conventional MRI about the pathophysiology of white matter changes. [source] Calcaneal ultrasonometry in patients with Charcot osteoarthropathy and its relationship with densitometry in the lumbar spine and femoral neck and with markers of bone turnoverDIABETIC MEDICINE, Issue 6 2001A. Jirkovská Abstract Aims To assess calcaneal ultrasonometry in Charcot osteoarthropathy (CO) and to compare it with densitometry measured by dual energy X-ray absorptiometry (DEXA) and with bone remodelling markers. Patients and methods A group of 16 diabetic patients in the acute stage of CO with a mean age (± sd) of 51 ± 13 years was compared with 26 sex- and age-matched control subjects. Both calcaneal quantitative ultrasound (QUS) parameter stiffness and bone mineral density (BMD) measured in lumbar spine and femoral neck by DEXA were compared. Collagen type I cross-linked C-telopeptides (ICTP) were used for assessment of bone resorption. Results Patients with acute CO had significantly lower stiffness of the calcaneus in the Charcot and non-Charcot foot (both P < 0.001) and significantly lower femoral neck BMD (P < 0.05) in comparison with the control group. The T-score of stiffness was significantly lower in the Charcot foot compared with the non-Charcot foot (,3.00 ± 1.39 vs. ,2.36 ± 1.12; P < 0.01) and significantly lower than the mean T-score of BMD in the lumbar spine (,0.57 ± 1.28; P < 0.001) and femoral neck (,1.58 ± 1.24; P < 0.05). A significant difference in ICTP (8.49 ± 4.37 vs. 3.92 ± 2.55 ng/ml; P < 0.001) between patients with CO and the control group was found, and a significant correlation was demonstrated between ICTP and the T-score of stiffness (r = ,0.73; P < 0.01). Conclusion The lower calcaneal QUS parameter stiffness in the Charcot foot in comparison with the control group, with the non-Charcot foot and with BMD in the lumbar spine and femoral neck, and its association with increased bone resorption indicate that calcaneal ultrasonometry may be useful in diagnosing the acute stage of CO and in assessing the risk of foot fracture. Diabet. Med. 18, 495,500 (2001) [source] Serum VEGF levels in acute ischaemic strokes are correlated with long-term prognosisEUROPEAN JOURNAL OF NEUROLOGY, Issue 1 2010S.-C. Lee Background and purpose:, We investigated whether serum vascular endothelial growth factor (VEGF) levels in acute-stage ischaemic stroke patients with small vessel disease (SVD) or large vessel disease (LVD) are correlated with long-term prognoses, based on the difference in NIH Stroke Scale (NIHSS) scores between acute and chronic stages. Methods:, From March 2007 to May 2008, we evaluated patients who experienced an ischaemic stroke for the first time, defined as SVD (n = 89) or LVD (n = 91) using the TOAST classification. Serum samples were taken immediately after admission (within 24 h of stroke onset) to evaluate VEGF levels. After 3 months, follow-up NIHSS scores were collected for all patients. Results:, Serum VEGF levels in the acute stage (within 24 h of stroke onset) were higher in the LVD group than in the SVD group and were correlated with infarction volume. The increase in serum VEGF levels in the acute stage was proportional to an improved NIHSS score after 3 months. After adjustment for covariates, serum VEGF levels in the acute stage were still significantly correlated with the long-term prognosis of ischaemic stroke. Conclusion:, Serum VEGF levels are correlated with long-term prognoses in acute ischaemic stroke patients. [source] Evaluation of a German version of the Rivermead Mobility Index (RMI) in acute and chronic stroke patientsEUROPEAN JOURNAL OF NEUROLOGY, Issue 5 2000M. R. Schindl The English Rivermead Mobility Index (RMI) has been proposed as a simple, valid and reliable measure in stroke rehabilitation. A German version was established and validated in two centres. In centre A 46 acute (median: 3.0 days after onset) and in centre B 151 chronic (median: 88.0 days after onset) stroke patients participated. Interrater reliability of the German RMI was tested in 12 subjects in the acute stage of stroke and was found to be statistically significant (r = 0.98, P < 0.0001). In centre A, a statistically significant correlation was found between the German RMI and the 10-m walk time at baseline (r = 0.73, P < 0.0001) and after three weeks (r = 0.92, P < 0.0001). In centre B, the German RMI correlated significantly with the motor part of the Functional Independence Measure (motor-FIM) on admission (r = 0.78, P < 0.0001) and after three weeks (r = 0.79, P < 0.0001), respectively. The change of the RMI correlated significantly with the change in 10-m walk time in acute patients (r = 0.87, P < 0.0001) and with the change in motor-FIM in chronic patients (r = 0.54, P < 0.0001). A moderate ceiling-effect was detected in the chronic study population. The German RMI appears to be a reliable, valid and responsive measure for mobility disability in acute and chronic stroke patients. [source] Does contact dermatitis to fragrances influence the quality of life?FLAVOUR AND FRAGRANCE JOURNAL, Issue 4 2009A descriptive study measuring, comparing the quality of life, skin involvement in patients with contact dermatitis to fragrances Abstract The study of the impact of diseases on individuals' quality of life is an important and useful tool for clinicians, particularly for an efficient follow-up and for the good management of patients suffering from chronic diseases. Contact dermatitis is a common condition in dermatological patients. However, despite efficient screening, the understanding and acceptance of contact allergy remain difficult and avoidance of these allergens is not always possible. The aim of this study was to determine whether contact dermatitis to fragrances affects quality of life and to define whether there is a relationship between the severity of skin involvement and quality of life. To measure the quality of life, we chose the VQ-Dermato (VQ-d) questionnaire, the only valid and reliable questionnaire in French, to which we added 10 non-validated specific questions regarding fragrances. We included patients with pertinent positive patch test reactions to fragrances attending the contact clinic between 1 January 1998 and 30 September 2004. During this time, 2814 patients were patch tested and 310 had positive reactions to the fragrance mix 8% (FM) of the standard series. We recruited non-atopic individuals, exclusively allergic to fragrance mix, with patch test reactions scored ++ and +++; the only additional positive reactions accepted were to balsam of Peru and the patient's own perfumes; 52 patients met these criteria, but only 33 participated. To evaluate the severity of skin involvement, we used the severity scoring of atopic dermatitis (SCORAD index). The quality of life of individuals allergic to fragrances was mostly moderately affected. Patients were more affected psychologically during the first year after the diagnosis of fragrance allergy. Skin reaction during the acute stage of contact allergy to fragrances can be severe. No correlation between VQ-d and SCORAD could be established. It was concluded that there was no severe impact on quality of life because of fragrance contact allergy, but that psychological issues and depression may play an important role in determining the way skin disease affects people. Patch testing improves the quality of life. Lack of correlation between VQ-d and SCORAD demonstrates that an objective measure such as SCORAD may not fully capture the impact of the disease. These results cannot be generalized because of the low response rate and limited sample size. Copyright © 2009 John Wiley & Sons, Ltd. [source] Electroencephalographic Abnormalities in Aseptic Meningitis and Noninfectious Headache.HEADACHE, Issue 1 2001A Comparative Study Background.,The finding of abnormalities on electroencephalogram (EEG) during the course of aseptic meningitis is often considered to be indicative of parenchymal brain involvement, even in absence of clinical signs of encephalitis. Objective.,To investigate if patients with aseptic nonherpetic meningitis who have abnormal EEG recordings during the acute stage of the disease differ in clinical characteristics or cerebrospinal fluid findings from patients with aseptic meningitis and normal EEG recordings. Methods.,The EEG records of 82 patients with aseptic meningitis were reviewed. A comparative group consisted of 41 age-matched patients with severe headaches without evidence of meningeal inflammation. Results.,Significantly more patients with aseptic meningitis (28%) demonstrated abnormalities on EEG than controls (12%) (P = .048). Patients with aseptic meningitis and abnormal EEG findings (n = 23) did not differ in age, duration of symptoms, clinical course, cerebrospinal fluid cell count, or protein level from those with normal EEG findings (n = 59). However, all patients with aseptic meningitis who were confused (n = 5) also revealed EEG abnormalities (P<.00012). Patients with headache with normal EEG recordings did not differ from those with abnormal EEGs in age, sex, or duration of symptoms. Nevertheless, patients with common migraine (n = 9) showed abnormalities on EEG (P = .06) more frequently. Conclusions.,The finding of an abnormal EEG in patients with aseptic meningitis, clear mental state and absence of focal neurological signs should not be used as proof of encephalitis. Because pathological examination is usually not performed, it remains unclear if EEG abnormalities in patients with aseptic meningitis indicate a silent parenchymal inflammation, or reflect an infectious encephalopathy. [source] Effectiveness of Supportive Educative Learning programme on the level of strain experienced by caregivers of stroke patients in ThailandHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2010R. Oupra RN MSc MNS PhD Abstract In Thailand, the crude death rate from stroke is 10.9/100 000 population and increasing. Unlike Western countries where community rehabilitation programmes have been established to provide services following the acute stage of stroke recovery, there is no stroke rehabilitation team in the community in Thailand. Therefore, family caregivers are the primary source for ongoing care and support. While family members accompany patients during their hospitalisation, they receive little information about how to assist their relatives, and as a result feel inadequately trained, poorly informed and dissatisfied with the support that is available after discharge. Family caregivers report that they suffer both physically and psychologically and find themselves overwhelmed with strain, experiencing burden and exhaustion. This study aimed to develop and implement a nurse-led Supportive Educative Learning programme for family caregivers (SELF) of stroke survivors in Thailand and to evaluate the effect of the SELF programme on family caregiver's strain and quality of life. This was a non-randomised comparative study with concurrent controls, using a two-group pre-test and post-test design. A total of 140 stroke survivors and 140 family caregivers were recruited; 70 patients/caregiver pair in each group. Caregivers of patients admitted to the intervention hospital following an acute stroke received the intervention, while caregivers of patients admitted to the comparison hospital received the usual care provided at the hospital. The data were collected prior to discharge of the patients and after 3 months. The family caregivers in the intervention group had a significantly better quality of life than the comparison group (GHQ-28 at discharge t = 2.82, d.f. = 138, P = 0.006; and at 3 months t = 6.80, d.f. = 135, P < 0.001) and they also reported less strain (Caregiver Strain Index at discharge t = 6.73, d.f. = 138, P < 0.001; and at 3 months t = 7.67, d.f. = 135, P < 0.001). This research demonstrated that providing education and support to the family caregiver of stroke survivors can reduce caregiver strain and enhance their quality of life. [source] Cutaneous manifestations of chikungunya fever: observations made during a recent outbreak in south IndiaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 2 2008Arun C. Inamadar MD Background, Chikungunya fever is an Aedes mosquito-borne Arbo viral illness with significant morbidity. Methods, In a recent outbreak of the disease in south India, the dermatologic manifestations of 145 patients attending a tertiary care hospital were recorded. Results, All age groups were affected, including newborns. Some of the cutaneous features were observed during the acute stage of the illness, and others during convalescence or thereafter. Pigmentary changes were found to be the most common cutaneous finding (42%), followed by maculopapular eruption (33%) and intertriginous aphthous-like ulcers (21.37%). Lesions with significant morbidity were generalized vesiculobullous eruptions (2.75%), found only in infants, lymphedema, and intertriginous aphthous-like ulcers. Exacerbation of existing dermatoses, such as psoriasis, and unmasking of undiagnosed Hansen's disease were observed. A perivascular lymphocytic infiltrate was a consistent histopathologic finding in all types of skin lesions. All patients responded well to symptomatic, conservative treatment. Conclusions, The cutaneous findings hitherto not reported may be the result of the African genotype of the virus detected during this outbreak in India. [source] Health-related quality of life in persons with long-term pain after a strokeJOURNAL OF CLINICAL NURSING, Issue 4 2004Marita Widar MSc Background., No study has, to our knowledge, previously been published on health-related quality of life (HRQoL) in a group suffering from long-term pain after a stroke. Aim., The aim of the present study was to describe HRQoL in persons with long-term pain after a stroke, and to compare this with different types of pain conditions, age, gender and household status. Design., This study has a design combining qualitative and quantitative methods. Methods., Forty three participants suffering from long-term pain after a stroke were included. A qualitative interview was performed and then analysed by means of latent content analysis. In addition, two self-report questionnaires, SF-36 and the Hospital Anxiety and Depression Scale (HAD Scale), were used. Results., The qualitative data revealed that physical and cognitive functioning, economic security and good relationships, support and having the ability to be together with family and friends were important factors with regard to experienced HRQoL. No significant differences were found in SF-36 and the HAD Scale with regard to the different types of pain. The older age group had decreased physical functioning in SF-36. The men had more decreased vitality than the women. Conclusion., The results show, that the participants in this study have a lower HRQoL due to their long-term pain than those in previous studies on stroke survivors. It is evident that further research is needed with longitudinal studies and larger populations to gain more knowledge and thereby provide better supportive care. Relevance to clinical practice., Awareness and understanding of the patients' perceptions and transitions with regard to their life situation and suffering from long-term pain after a stroke is important in order to support a maintained or increased HRQoL. This is also important after the acute stage and rehabilitation, including quality of life of the relatives, especially to older and dependent persons. [source] Water Apparent Diffusion Coefficient and T2 Changes in the Acute Stage of Maple Syrup Urine Disease: Evidence of Intramyelinic and Vasogenic-Interstitial EdemaJOURNAL OF NEUROIMAGING, Issue 2 2003Andrea Righini MD ABSTRACT Background. The acute phase of the neonatal classical form of maple syrup urine disease (MSUD) is usually associated with generalized brain edema. Methods and Results. The authors present the case of a newborn infant in the acute stage of the classical form of MSUD in whom a remarkable decrease in the water apparent diffusion coefficient (ADC) in advanced myelinating white matter areas was associated with an increase in the T2 signal. This diffusion magnetic resonance imaging (MRI) pattern appears to be compatible with a rare kind of cytotoxic edema, the so-called intramyelinic edema. At the same time, an increase in the ADC was seen in unmyelinated areas together with an increase in the T2 signal, a sign of a coexistent vasogenic-interstitial edema. Conclusions. ADC measurements in MSUD provide more specific information than conventional MRI about the pathophysiology of white matter changes. [source] Heart Rate Variability and Sympathetic Skin Response in Male Patients Suffering From Acute Alcohol Withdrawal SyndromeALCOHOLISM, Issue 9 2006Karl-Jürgen Bär Background: Many symptoms of alcohol withdrawal (AW) such as tachycardia or elevated blood pressure might be explained by increased peripheral and central adrenergic activity. In contrast to many neurochemical studies of sympathetic activation during AW, only very few studies investigated autonomic balance using neurophysiological methods. Methods: We investigated heart rate variability (HRV) and sympathetic skin response (SSR) in male patients suffering from mild AW syndrome (n=20, no treatment required) and in patients with moderate to severe AW syndrome (n=20, clomethiazole treatment) in the acute stage. Sympathovagal influence was quantified using measures of time and frequency domain of HRV as well as modern nonlinear parameters (compression entropy). Furthermore, we obtained latencies and amplitudes of SSR to quantify isolated sympathetic influence. Measures were obtained during the climax of withdrawal symptomatology before treatment, 1 day after climax, and shortly before discharge from hospital. Alcohol withdrawal scores were obtained and correlated to autonomic measures. Results: Ambulatory blood pressure and AW scores revealed characteristic withdrawal symptoms in both patient groups. Apart from the nonlinear parameter compression entropy, Hc, measures of HRV revealed no sign of autonomic dysfunction in contrast to the significantly increased heart rates at the time of admission. Latencies and amplitudes of SSR did not indicate any increase of sympathetic activity. A negative correlation was found between Hc and mental withdrawal symptoms. Conclusions: We show here that classical measures for autonomic nervous system activity such as HRV and SSR are not suitable for describing the autonomic changes seen in acute AW, although a major role for the sympathetic nervous system has been proposed. This might be due to multiple dysregulation of metabolites in AWS or to subtle alcohol-induced damage to neuronal structures, issues that should be addressed in future studies. [source] Pulmonary oedema in Swedish hunting dogsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 5 2003A. Egenvall A syndrome of acute dyspnoea after hunting in 16 Swedish hunting dogs is characterised. Radiographic pulmonary infiltrates interpreted as pulmonary oedema were found in the acute stage. In 12 dogs, the infiltrates regressed after five to 14 days. Subendocardial necrosis and pulmonary oedema were found at postmortem examination in four other dogs with acute and recurrent dyspnoea after hunting, and myocardial fibrosis in a further three dogs with a history of recurrent dyspnoea after hunting; none of these pathological changes was seen in dogs which had no previous history of dyspnoea after hunting. A pathogenetic mechanism is proposed whereby high catecholamine levels, present during hunting due to the stress of excitement and exercise, cause acute cardiac and pulmonary lesions in some susceptible dogs, similar to neurogenic or postictal pulmonary oedema. [source] The scavenger receptor BI and its ligand, HDL: partners in crime against HCV neutralizing antibodiesJOURNAL OF VIRAL HEPATITIS, Issue 2007M. Dreux Summary., Better knowledge of the viral and host factors that determine HCV clearance vs. persistence at the acute stage of infection is needed in order to improve antiviral therapy and develop efficient vaccines. Spontaneous HCV clearance is associated with a strong, early and broad cellular immune response. Yet, several observations suggest that antibody-mediated neutralisation occurs during HCV infection in vivo and that polyclonal antibodies to HCV can be protective. The recent development of HCV infection assays has confirmed that sera from HCV-infected patients neutralise infection in vitro. Recent studies have demonstrated that Nt-antibodies, of narrow specificity, are induced during the early phase of infection and could play a role in controlling viral infection or clearance. Yet, high-titre, broadly cross-reacting Nt-antibodies are readily detected in chronically infected patients, suggesting that their effectiveness is limited in patients who do not resolve the disease. The factors that mitigate the impact of the Nt-antibody response need to be clarified. Here we review some essential features of the Nt-antibody responses to HCV. We then discuss an original mechanism that HCV may use in vivo to attenuate Nt-antibodies, which involves the hyper-variable region-1 of the HCV-E2 glycoprotein, high-density lipoprotein (HDL) and the physiologic activity of the scavenger receptor BI, a receptor shared by both HCV and HDL. [source] Comparison of the Healing Mechanisms of Myocardial Lesions Induced by Dry Radiofrequency and Microwave Epicardial AblationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2006ROSA HENRIQUES DE GOUVEIA Background: Histological assessment of the evolution of lesions induced on a pig's left atrium by microwave (MW) epicardial applications and comparison with dry radiofrequency (RF) lesions. Methods: MW (40 W, 40 seconds) and dry RF (80°C, 2 minutes) were epicardially applied on nine pigs' left atrium. Samples were procured following application (n = 2), at day 3 (n = 2), day 7 (n = 2), day 14 (n = 2), and at 1 month (n = 1). They were fixed in formalin, embedded in paraffin, sectioned (2 ,), stained with histochemical dyes, immunomarked, and histologically analyzed. Results: Histological features of acute stage MW lesion are interstitial hemorrhage, adipose, and muscular tissues' coagulation necrosis, thrombosis of myocardial interstitium small vessels at damaged and optically undamaged areas, epicardial coronary branches, and endocardial parietal thrombosis. Day 3,lymphohistiocytic infiltration (lysosyme+) highlights lesion limits. Day 7,lymphohistiocytic infiltration increases, multi-nucleated giant cells appear surrounding/fagocyting necrotic tissue. Neovessels and scarce myofibroblasts appear. Lesion edges are now better defined. Day 14,myofibroblastic proliferation (actin++, vimentin+) creates "young" scar tissue, as in "healing by second intention." Lesions are deeper and wider than appeared at acute stage. One month,dense fibrous tissue scar appears. Endothelial cells covering endocardium are morphologically intact. RF lesions are histologically identical to MW's, although no vessel thrombosis was identified at acute optically undamaged areas and cytomorphologic elements emerge at later stages in the healing process. Conclusions: (1) Microwave scars are deeper and wider than the lesions observed at the acute stage. (2) Evolution of microwave lesions is faster and induces broader scars than dry radiofrequency. (3) Scar formation (both energies) is "healing by second intention." (4) Endocardial thrombosis may occur despite morphologically intact endothelium. [source] Re-treatment regimens for acute stage of Kawasaki disease patients who failed to respond to initial intravenous immunoglobulin therapy: Analysis from the 17th nationwide surveyPEDIATRICS INTERNATIONAL, Issue 4 2007RITEI UEHARA Abstract Background: Current regimens for re-treatment of patients with Kawasaki disease who failed to respond to the initial intravenous immunoglobulin (IVIG) therapy are still uncertain. The purpose of this study is to reveal what regimens were used as the initial therapy and re-treatment for acute stage of Kawasaki disease in the current Japanese medical setting. Methods: The 17th nationwide survey on Kawasaki disease covered patients whose onset was in 2001 and 2002. In questionnaires sent to all hospitals with a bed capacity of 100 or more and a pediatric department, several questions related to therapeutic regimens for Kawasaki disease were posed. The authors observed the proportions of hospitals that had regimens for patients who failed to respond to the initial therapy. Results: Among those hospitals that responded to the survey, 1052 (64.1%) reported that at least one patient with Kawasaki disease visited the hospital. Among these 1052 hospitals, 73.3% had a regimen to administer 30,39 mg/kg per day of oral aspirin with initial IVIG. The proportion of hospitals that used 1 g/kg per day of IVIG for 2 days was the largest among the options for the initial treatment. For those patients who fail to respond to the initial therapy, 464 hospitals (44.1%) reported that their pediatricians would use additional IVIG only. The number of hospitals that planned to administer high-dose IVIG and ulinastatin was 185 (17.6%). The number of hospitals having regimens of additional IVIG and steroids was 54 (5.1%). Conclusions: The current status of the treatment for patients with Kawasaki disease not responding to the initial IVIG therapy in Japan was revealed. A randomized trial of a large sample is needed to ascertain the effectiveness of several options for re-treating Kawasaki disease. [source] Incidence of Kawasaki disease in Japan: the nationwide surveys of 1999,2002PEDIATRICS INTERNATIONAL, Issue 4 2006HIROSHI YANAGAWA Abstract Objective: The purpose of the present study was to describe the results of nationwide epidemiologic surveys of Kawasaki disease for the 4 year period 1999,2002. Methods: The design is a retrospective incidence survey. The patients reported in these two surveys are all new patients who were reported during the two study periods (1999,2000 and 2001,2002), although the data were collected retrospectively. A questionnaire was sent to all pediatric departments of hospitals with 100 beds or more throughout Japan, requesting data on patients with Kawasaki disease, such as sex, age, date of first hospital visit, recurrence, and cardiac lesions. Results: The total number of patients reported in the 4 year period 1999,2002 was 32 266 (18 604 male, 13 662 female), with an average annual incidence of 137.7 per 100 000 children younger than 5 years old. The male/female ratio was 1.30. The incidence peaked at 9,11 months of age, and the proportion of patients under 1 year of age was 26%. The monthly distribution had a high peak in January and a gradual increase in summer. Geographically, the high-incidence areas were limited to certain prefectures and moved from year to year. The cardiac lesions at acute stage and cardiac sequelae occurred more in children under 1 year and older than 4 years. Among the principal symptoms, fever persisting ,5 days occurred most commonly, followed by conjunctival congestion, changes in lips and oral cavity, polymorphous exanthema, and changes of extremities. Cervical lymphadenopathy occurred less. Conclusion: More than 32 000 patients with Kawasaki disease during the 4 year period 1999,2002 were reported to the nationwide incidence surveys. The number of patients is steadily increasing despite the decrease of children. The seasonal variation, geographical distribution, and age-specific distribution support the infection theory for the etiology of Kawasaki disease. [source] Familial cases of Henoch-Schönlein purpura in eight familiesPEDIATRICS INTERNATIONAL, Issue 6 2005Osamu Motoyama AbstractBackground:,Familial cases of Henoch-Schönlein purpura (HSP) have rarely been reported. Methods:,Familial cases of HSP were reviewed by medical records of 418 children with HSP. Results:,Two members developed HSP in eight families. HSP occurred in a mother and her daughter in one family and in siblings, including one pair of twin sisters, in seven other families. Four pairs of patients developed HSP at the same age. Three pairs presented HSP within 1 month of each other and the other pairs presented HSP between 9 months and 5 years. Seven patients had a history of allergic diseases. The clinical courses of 12 patients were reviewed. Upper respiratory tract infection preceded HSP in 10 patients, two of whom had elevated antistreptolysin-O titers. No pairs of patients in a family received the same drugs before the onset of HSP. Abdominal pain was noted in eight patients, arthralgia in six and nephritis in four. Severity of skin lesions, presence of abdominal pain and nephritis, and serum IgA levels at the acute stage varied among family members of HSP. Conclusions:,The incidence of HSP in family members of children with HSP seems to be high. Onset at the same age and onset of HSP within 1 month in siblings have not previously been reported. There were no characteristic or similar findings between two patients of the same family. No trigger or genetic factor causing HSP was identified. [source] Absence of hypercoagulability in acute Kawasaki diseasePEDIATRICS INTERNATIONAL, Issue 2 2005Ming-Tsan Lin AbstractBackground:,Kawasaki disease (KD) is a systemic vasculitis syndrome with the striking feature of cardiovascular involvement. Endothelial cell (EC) damage has been suggested to predispose individuals to the development of coronary vascular disorders. When EC are perturbed, prethrombotic complications ensue. The purpose of this study was to examine the clinical relevance of EC activation and hypercoagulability in the pathogenesis of KD and to determine if plasma levels of these markers are correlated with the development of coronary aneurysms. Methods:,EC function and coagulation status were assessed in 52 patients with acute KD, 20 febrile control subjects, and 20 healthy control subjects. Biological markers of EC and hypercoagulability were measured and included thrombomodulin, tissue factor, tissue factor pathway inhibitor, von Willebrand factor (vWF), coagulation factor VII (FVII), activated factor VII, prothrombin fragment 1 + 2 (F1 + 2), and D-dimer. Results:,Transient dilatation of coronary arteries was the most common complication (55.8%), and coronary aneurysm was noted in five patients (9.6%). Levels of vWF, FVII, F1 + 2 and D-dimer were higher in acute KD patients compared with healthy controls but not febrile controls. Markers of EC and hypercoagulability were not different between patients with cardiac complications and those without cardiac complications. Biological and immunological assays did not demonstrate the prethrombotic state in acute KD. Conclusions:,Our results suggest that hypercoagulability does not occur during the acute stage of KD. Markers of EC damage and hypercoagulability are not predictive of coronary aneurysms in KD. [source] Broad-band ultraviolet B phototherapy in zoster patients may reduce the incidence and severity of postherpetic neuralgiaPHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE, Issue 5 2006Mir Hadi Aziz Jalali Background: Postherpetic neuralgia (PHN) is one of the common complications of herpes zoster infection, particularly in the elderly. Current therapeutic measures are only partially effective in the affected patients. As inflammatory mediators released by different cells play an important role in the pathogenesis of this neuropathic pain and with regard to the immunomodulatory effects of ultraviolet B (UVB) spectrum, we presumed that UVB phototherapy might be effective in the prevention of PHN. Method: This study was performed in two phases. Phase I was a prospective open controlled trial. Twenty-five patients with severe pain in the first 7 days of zoster rash were divided into two groups: the prevention group (n=12) received oral acyclovir (800 mg five times a day for 10 days) plus broad-band UVB to the affected dermatomes, starting with 20 mJ/cm2 and gradually increasing the dose by 10 mJ/cm2 each session to a maximum dose of 100 mJ/cm2. Treatment sessions were repeated three times a week until pain relief or to a maximum of 15 sessions. The control group (n=13), who had disease characteristics similar to the prevention group, received only oral acyclovir with the same dose. All patients reported their severity of pain on a verbal rating scale (VRS, score 0,4) before treatment and at 1 and 3 months' follow-up. In phase II of the study, five patients with established PHN (more than 3 months after rash onset) received UVB with the above-mentioned protocol. Results: A total of 17 patients older than 40 (10 females, seven males; mean age, 65.5 years; range: 47,82 years) who had intractable pain due to zoster infection received UVB in two phases of the study. In patients who received phototherapy in the first 7 days of rash, 58.33% and 83.33% were completely pain free at 1-and 3-month follow-up, respectively. The corresponding figure in the control group was significantly lower (38.46% at 1 month and 53.85% at 3 months). The severity of pain was also lower in the phototherapy group than the control group (mean VRS 2.50 vs. 3.28 at 3 months). None of the patients who were treated more than 3 months after rash onset (established PHN) experienced significant (more than 50%) pain relief. Conclusion: UVB phototherapy in the acute stage of zoster rash might reduce the incidence and severity of PHN. Treatment after 3 months does not seem to have a significant beneficial effect. [source] Predicting motor recovery of the upper limb after stroke rehabilitation: value of a clinical examinationPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 1 2000Hilde Feys Abstract Background and Purpose Only a few studies have been conducted to predict motor recovery of the arm after stroke. The aims of this study were to identify which clinical variables, assessed at different points in time, were predictive of motor recovery, and to construct useful regression equations. Method One hundred consecutive stroke patients who had an obvious motor deficit of the upper limb were evaluated on entry to the study (two to five weeks post-stroke) and at two, six and 12 months after stroke. The Brunnström,Fugl-Meyer test was used as the outcome measure. Predictors included demographic data, overall disability, clinical neurological features, neuropsychological factors and secondary shoulder complications. Results In multiple regression analyses, motor performance was invariably retained as the predictive factor with the highest R-square. Other significant predictive variables were overall disability, muscle tone, proprioception and hemi-inattention. Between 53% and 89% of the total amount of variance was accounted for in all selected models. The accuracy of prediction from clinical measurement in the acute phase diminished as the time span of measurement of outcome increased. Similarly, assessment of the variables at two and six months, rather than in the acute stage, resulted in a considerable improvement in the percentage variance explained at 12 months. The highest accuracy was obtained when predictions were made step-by-step in time. Conclusions It is possible to predict motor recovery of the upper limb accurately through the use of a few clinical measures. Predictive equations are proposed, the use of which are practicable in both clinical practice and research. Copyright © 2000 Whurr Publishers Ltd. [source] Prediction of respiratory insufficiency in Guillain-Barré syndromeANNALS OF NEUROLOGY, Issue 6 2010Christa Walgaard MD Objective Respiratory insufficiency is a frequent and serious complication of the Guillain-Barré syndrome (GBS). We aimed to develop a simple but accurate model to predict the chance of respiratory insufficiency in the acute stage of the disease based on clinical characteristics available at hospital admission. Methods Mechanical ventilation (MV) in the first week of admission was used as an indicator of acute stage respiratory insufficiency. Prospectively collected data from a derivation cohort of 397 GBS patients were used to identify predictors of MV. A multivariate logistic regression model was validated in a separate cohort of 191 GBS patients. Model performance criteria comprised discrimination (area under receiver operating curve [AUC]) and calibration (graphically). A scoring system for clinical practice was constructed from the regression coefficients of the model in the combined cohorts. Results In the derivation cohort, 22% needed MV in the first week of admission. Days between onset of weakness and admission, Medical Research Council sum score, and presence of facial and/or bulbar weakness were the main predictors of MV. The prognostic model had a good discriminative ability (AUC, 0.84). In the validation cohort, 14% needed MV in the first week of admission, and both calibration and discriminative ability of the model were good (AUC, 0.82). The scoring system ranged from 0 to 7, with corresponding chances of respiratory insufficiency from 1 to 91%. Interpretation This model accurately predicts development of respiratory insufficiency within 1 week in patients with GBS, using clinical characteristics available at admission. After further validation, the model may assist in clinical decision making, for example, on patient transfer to an intensive care unit. ANN NEUROL 2010;67:781,787 [source] Intravenous immunoglobulin and salicylate differentially modulate pathogenic processes leading to vascular damage in a model of Kawasaki diseaseARTHRITIS & RHEUMATISM, Issue 7 2009Andrew C. Lau Objective Kawasaki disease (KD) is a multisystem vasculitis affecting children and is characterized by immune activation in the acute stage of disease. Systemic inflammation eventually subsides, although coronary arteritis persists, resulting in aneurysm formation. KD is the leading cause of acquired heart disease among children in North America. Accepted treatment guidelines include high-dose intravenous immunoglobulin (IVIG) and aspirin in the acute phase. Although this therapy is effective, the cellular and molecular mechanisms involved are not clear. The aim of this study was to examine the effect of IVIG and salicylate at each stage of disease development. Methods Using a murine model of KD, we established and validated several in vitro techniques to reflect 3 key steps involved in disease pathogenesis, as follows: thymidine incorporation to evaluate T cell activation, enzyme-linked immunosorbent assay to measure tumor necrosis factor , (TNF,) production, and real-time polymerase chain reaction to examine TNF,-mediated expression of matrix metalloproteinase 9 (MMP-9). Results At therapeutic concentrations, IVIG, but not salicylate, effectively reduced the immune response leading to TNF, expression. Unexpectedly, pharmacologic doses of salicylate were not able to inhibit TNF, production and in fact enhanced its production. Neither drug directly regulated MMP-9 expression but did so only indirectly via modulating TNF,. TNF, activity was a prerequisite for local expression of MMP-9 at the coronary artery. Conclusion Therapeutic concentrations of IVIG and salicylate differentially modulate the expression of TNF, and its downstream effects. Further dissection of the biologic effects of aspirin in acute KD is necessary for the rational design of therapy. [source] Morphological Correlates of Acute and Permanent Hearing Loss During Experimental Pneumococcal MeningitisBRAIN PATHOLOGY, Issue 2 2003Matthias Klein In patients with acute bacterial meningitis, hearing loss can be transient but is often permanent. The mechanisms underlying meningitis-associated hearing loss are not fully understood. Therefore, we investigated the morphological correlates of hearing loss in a rat model of pneumococcal meningitis. Transcutaneous intracisternal injection of Streptococcus pneumoniae resulted in a dose-dependent hearing loss (determined by auditory brainstem response audiometry), which was partially reversible during the acute stage. Nevertheless, a severe permanent hearing loss persisted until 2 weeks after infection. Suppurative labyrinthitis was accompanied by blood-labyrinth barrier disruption (determined by cochlear Evans blue extravasation), which correlated closely with hearing loss during the acute stage but not after recovery. Two weeks after infection, spiral ganglion neuronal density was markedly decreased and correlated with the severity of permanent hearing loss. Neuronal loss can be explained by the new finding of meningitis-associated spiral ganglion neuronal necrosis rather than apop-tosis (determined by morphology, TUNEL staining, and immunohistochemistry). [source] Skin manifestations in acute arsenic poisoning from the Wakayama curry-poisoning incidentBRITISH JOURNAL OF DERMATOLOGY, Issue 4 2003K. Uede Summary Background Four people died and 63 others became ill after eating arsenic-laced curry served at a community festival in Wakayama, Japan, on 25 July 1998. Although dermatological manifestations after the acute ingestion of arsenic have seldom been documented, they were observed in 56% of the victims in the Wakayama curry-poisoning incident. Objectives To characterize the skin manifestations due to acute arsenic poisoning. Methods Four of the 67 patients with arsenic poisoning died, and the remaining 63 patients served as subjects for this study. The dermatological findings were extracted from the medical charts at the institutions which admitted the victims, and from the results of a medical inquiry and examinations during a health screening 3 months after the incident. Results Dermatological findings were observed in 56% of the victims during the acute stage of poisoning. Facial oedema was observed in 13 patients, transient flushing erythema in five, conjunctival haemorrhage in 15, maculopapular eruptions in the intertriginous areas in eight, acral desquamation in 11, and herpesvirus infection in three. The histopathological findings of the maculopapular eruptions showed moderate to marked perivascular infiltration with endothelial swelling. Examination of 21 patients at 3 months after their exposure to arsenic revealed ungual changes including Mee's or Beau's lines in 17 cases, periungual pigmentation in nine, and acral desquamation in four cases. Conclusions Our observations indicate that skin lesions are common in patients with acute arsenic poisoning; these findings may provide information of diagnostic significance. [source] Multi-variate analysis predicts clinical outcome 30 days after middle cerebral artery infarctionACTA NEUROLOGICA SCANDINAVICA, Issue 1 2000M. Giroud Background and purpose, To evaluate the functional prognostic value of proton magnetic resonance spectroscopy performed within the 5 days of an infarction of the middle cerebral artery territory, compared with previously demonstrated prognostic factors. Methods, Proton magnetic resonance spectroscopy was performed on 77 consecutive non-comatosed patients during the acute stage of middle cerebral artery infarction. The functional status was determined for each patient via the Orgogozo score. Proton magnetic resonance spectroscopic data were acquired in the infarction and in contra-lateral normal tissue and the results were expressed as metabolite ratios. Correlations were evaluated between the Orgogozo score at day 1 and day 30, the age, the sex, the volume of the infarction, and the metabolic ratios. Results, In a monovariate analysis, the decrease of the NAA/choline ratio was correlated with a low Orgogozo score at days 1 and 30 (P<0.05) and with a large infarction (P<0.05). A stepwise analysis showed a significant relationship between the Orgogozo score at day 30 and the Orgogozo score at day 1, the sex, the volume of infarction, and the NAA/Cho ratio within the infarction. Conclusions, Our work demonstrates that a good clinical outcome at day 30 depends on a good initial clinical score at day 1, a small volume of infarction, a small decrease of NAA/Cho, and being of the female gender. [source] Allergic airway inflammation is exacerbated during acute influenza infection and correlates with increased allergen presentation and recruitment of allergen-specific T-helper type 2 cellsCLINICAL & EXPERIMENTAL ALLERGY, Issue 8 2004B. J. Marsland Summary Background Respiratory viral infections are a leading cause of the hospitalization of asthmatics, however, the cellular immunological interactions which underlie these two diseases remain elusive. Objective We sought to characterize the effect influenza viral infection has on allergic airway inflammation and to identify the cellular pathways involved. Methods We have used an ovalbumin (OVA) model of allergic airway inflammation, which involves sensitization of animals with OVA adsorbed in alum adjuvant followed by an intranasal challenge with OVA in phosphate-buffered saline. To study T cell recruitment into the lung, we adoptively transferred in vitro activated T cell receptor-transgenic T cells, which were subsequently identified by fluorescence-activated cell sorting (FACS) analysis. In addition, to study in vivo dendritic cell (DC) migration, we administered fluorescently labelled dextran and identified DCs that had phagocytosed it by FACS analysis. Results We found that different stages of influenza infection had contrasting effects upon the outcome of OVA-induced allergic airway inflammation. The allergic response against OVA was exacerbated during the acute stage of influenza infection; however, mice were protected against the development of airway eosinophilia at late time-points following infection. We investigated the mechanisms responsible for the virus-induced exacerbation and found that the response was partially independent of IL-4 and that there was increased delivery of inhaled allergens to the draining lymph node during the acute stage of the infection. In addition, virus-induced inflammation in the lung and draining lymph node resulted in the non-specific recruitment of circulating allergen-specific effector/memory cells. Conclusion In addition to virus-mediated damage to the lung and airways, influenza viral infection can also enhance unrelated local allergic responses. [source] Immunological profile of peripheral blood lymphocytes and monocytes/macrophages in Kawasaki diseaseCLINICAL & EXPERIMENTAL IMMUNOLOGY, Issue 3 2005T. Matsubara Summary Kawasaki disease (KD) is an acute illness of early childhood characterized by prolonged fever, diffuse mucosal inflammation, indurative oedema of the hands and feet, a polymorphous skin rash and nonsuppurative lymphadenopathy. The histopathological findings in KD comprise panvasculitis with endothelial necrosis, and the infiltration of mononuclear cells into small and medium-sized blood vessels. The levels of many proinflammatory cytokines, chemokines and adhesion molecules can be elevated in sera from children with KD at the acute stage. Although many immunological studies on KD involving peripheral blood have been reported, the data obtained remain controversial. This review focuses on the immune response of peripheral blood lymphocytes and monocytes/macrophages during acute KD. [source] Differential regulation of nitric oxide synthase isoforms in experimental acute Chagasic cardiomyopathyCLINICAL & EXPERIMENTAL IMMUNOLOGY, Issue 1 2000B. Chandrasekar We have previously demonstrated induction and high level expression of IL-1,, IL-6 and tumour necrosis factor-alpha in the myocardium during the acute stage of experimental Trypanosoma cruzi infection (Chagas' disease). The myocardial depressive effects of these cytokines are mediated in part by the induction of nitric oxide synthase (NOS), production of nitric oxide (NO) and formation of peroxynitrite. In this study we investigated the expression, activity and localization of NOS isoforms, and the levels of NO, malondialdehyde (a measure of oxidative stress), and peroxynitrite in rats at 1·5, 5, 10 and 15 days after infection with T. cruzi trypomastigotes. The myocardial inflammatory infiltrate and number of amastigote nests increased over the course of infection. A significant increase in tissue nitrate + nitrite levels, NOS2 mRNA, and NOS2 enzyme activity was observed at all time points in the infected compared with uninfected animals. The enzyme activity of constitutive NOS, tissue malondialdehyde levels, and NOS3 mRNA levels was only transiently increased after infection. The protein levels of the NOS isoforms paralleled their mRNA expression. While no positive nitrotyrosine immunoreactivity was detected in control myocardium, its levels increased in infected animals over time. Thus, by 1·5 days post-infection, when no parasite or immune cell infiltration could be detected, the myocardium expressed high levels of NOS and NO metabolites. Nevertheless, the early production of NO in the myocardium was not sufficient to clear the parasites. [source] Vitreous surgery for macular hole in patients with Vogt-Koyanagi-Harada diseaseCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 9 2008Izumi Kobayashi MD Abstract We describe two patients with Vogt-Koyanagi-Harada (VKH) disease, both in the convalescent stage, who presented with unilateral macular holes together with clinically significant epi-retinal membranes. Vitreo-retinal surgery was performed on the affected eyes and the surgical technique involved a standard three-port vitrectomy, peeling of the epi-retinal and internal limiting membrane (ILM). In both cases the retinae were tamponaded with air resulting in anatomical closure of the macular holes. The histology of the excised membrane was available in one case and this revealed multiple layers of presumed retinal pigment epithelial cells with cytoplasmic processes and intercellular junctions forming a basal lamina attached to the smooth surface of the ILM. Our findings demonstrate that macular holes can develop in patients with VKH but that the hole can be successfully closed with vitreo-retinal surgery. The convalescent stage tends to occur several weeks after the acute stage when the uveitic process has subsided and is characterized by choroidal depigmentation, producing a sunset glow appearance to the ocular fundus. Patients may also demonstrate varying degrees of cutaneous hypopigmentation, poliosis and/or alopecia. Macular holes have also been reported previously in patients during the convalescent stage of VKH and this communication describes the outcome of two patients who underwent vitreo-retinal surgery for this problem. [source] Increased laryngeal lavage lipid-laden macrophage index during acute bronchiolitisACTA PAEDIATRICA, Issue 7 2007Chang Keun Kim Abstract Aim: To investigate aspiration risks associated with bronchiolitis in infants using the lipid-laden macrophage index (LLMI) from laryngeal lavages. Methods: Laryngeal lavages from 29 infants with acute bronchiolitis caused by respiratory syncytial virus were evaluated (acute stage). Repeated studies were then performed at 3,4 weeks after the initial study (remission stage). Lavage cell counts and differentials were determined. The amount of lipid per single macrophage was evaluated and the LLMI was determined by evaluating 100 cells. In addition, 24-h pH monitoring (pHm) was performed in 16 patients. Results: The LLMIs in the acute stage were significantly higher than those in the remission stage (p < 0.05). The neutrophil percentage of the laryngeal lavage correlated significantly with the LLMI (r = 0.707, p < 0.0001) during the acute stage of bronchiolitis. When patients were divided into pHm-positive (n = 5) and pHm-negative (n = 11) subgroups, a significant decrease in LLMI between acute and remission stages was noted among the pHm-positive (p < 0.01) subgroup, but not in the pHm-negative subgroup. Conclusion: These findings suggest that there is a transient increased LLMI in patients with bronchiolitis, which could be caused by gastroesophageal reflux. [source] | |||||||||||||||||||||||||||||||